Recurring issue - nausea, headaches & throwing up during dives

[Tiny-Bubbles]

I hope that some day soon I'm a wealth of information that can share like you all are. Thank you.

DandyDon - I've taken a half a sudafed before diving once when I was just finishing up with a cold, but I don't normally take these things. I think that I should though as I'm reading more and more that my sinuses aren't actually "normal". I thought everyone pretty much felt stuffed up all the time : ) Would you mind telling me the brand name of a pseudoephedrine? ... I'm not sure what that is. And I'm assuming an antihistamine is an allergy pill ... I do have Allegra (5mg desloratadine) which I was planning on taking while I'm away ... hoping it would help with diving and not keeping my roommate awake with snoring : ) Also, I believe that what I perceived as a need to "unnaturally exhale" may have been from shallow breathing ... air thirsty I heard it called. And I'm certified with PADI ... should I still register for DAN?

Peter_C - can you tell me what PFO is?

freewillie & lulubelle - I don't have a history of migraines, but I know the pain can be so excrutiating that it can cause nausea and lack of ability to concentrate. I think my level of pain is similar to a migraine, but I don't think it's actually a migraine.

TSandM - yes, I do think I have a bit of vertigo or some sort of visual/motion sensitivity as I feel "thrown off" by the slightest movements sometimes if there's no visual cue ... when the floor moves slightly as an elevator arrives or walking down the ramp to an airplane ... both make me feel a bit wobbly. And god forbid that I'm watching a roller coaster or flying scene in a movie that's shot from the passenger's perspective! I'm assuming that I'll get used to this as I dive more, and I've learned to focus on my gauges or do long slow blinks. And I don't think I'll attempt any more drift dives as it's just too much.

ianr33 - thanks for the tip of focusing on a specific particle. I'll try to remember that if I find myself in messy water again.

Thank you again all. You've really made a difference in how I'm feeling about my dives this coming week. I'm going to be sure to tell my friends who just got their OW certification about this forum.

 

[Jax]

Hi, Tiny! Glad you're still following all this.

Patent foramen ovale - MayoClinic.com

Patent Foramen Ovale

The first is from the Mayo Clinci, the second from Scubadoc.com. Hope that answers your PFO question. It's not that common, but is a consideration.

 

[Tiny-Bubbles]

Actually ... I do have one really great tip that I can pass on. If any of you hear of a woman compaining about being "top floaty" or whatever you may call it ... having trouble staying horizontal due to being larger chested ... I've found an easy fix without worrying about weights in pockets, etc. I set up my belt with a bit more of the weight towards the front, and when I get down in the water and there's a bit more give on the belt, I push it up a bit higher towards my ribs and tighten it. And voila!! ... I'm completely neutral and horizontal without even the tiniest bit of effort. This had plagued me for my first 20 dives or so and it was embarrassing, as I was akward and moving about way to much. This small change has massively improved my diving experience. Hopefully, someone else can use this tip too. : )

 

[DandyDon]

DandyDon - I've taken a half a sudafed before diving once when I was just finishing up with a cold, but I don't normally take these things. I think that I should though as I'm reading more and more that my sinuses aren't actually "normal". I thought everyone pretty much felt stuffed up all the time : ) Would you mind telling me the brand name of a pseudoephedrine? ... I'm not sure what that is. And I'm assuming an antihistamine is an allergy pill ... I do have Allegra (5mg desloratadine) which I was planning on taking while I'm away ... hoping it would help with diving and not keeping my roommate awake with snoring : ) Also, I believe that what I perceived as a need to "unnaturally exhale" may have been from shallow breathing ... air thirsty I heard it called.

Ok many people who take decongestants and antihistamines don't really know what they are. They either try the OTC meds advertised or suggested by friends, or rely on doctor's suggestions without reading. A simple statement that works for me is that decongestants help break up congestion and antihistamines help prevent the problem. Wikipedia articles linked for more info and of course there are many other sites with deeper discussion. After several decades of taking both, my opinion is anyone taking a decongestant for sinuses should be taking antihistamines but keep in mind that laymen like me are allowed to post our opinions here, so be careful what you believe.

Are you sure about Allergra being desloratadine? Maybe it is there? Allegra is just a name, a brand, and various meds can be packaged under the label. It really helps to become knowledgeable about such and be specific about what you are using. Allegra is a brand of fexofenadine here - both antihistamines, but different. It sounds like your a candidate for daily antihistamine use, and finding the best one for you often means trying many until you find one that seems to help more.

For decongestant, pseudoephedrine is without equal in my lay opinion. Sudafed took its name from the drug but now use it on other meds that are not at all the same. It has a colorful history as drug makers use it to make illegal products and it is now sold from behind the counter here, altho still without prescription in most states. The sudafed you took before may or may not have been the same thing, but it's quite popular among divers in helping keep ears open. There is actually a lot more info on a thread I started: http://www.scubaboard.com/forums/sc...ying-sudafed-her-instructor-told-her-get.html AllegraD is a combination by that company that includes both that decongestant and fexofenadine antihistamine.

I gave you a lot of links there. Hope they are helpful and you find the right approach for you, but yeah - I'd suggest both based on your described symptoms, daily - subject to your doctor's opinions. Pseudoephedrine continuously become more difficult to find because the retailers don't like the hassles, so I keep the maximum allowed on hand in case of a new shortage. I once ordered some online from a Canadian company, but found better prices at a chain with a store not far away.

And I'm certified with PADI ... should I still register for DAN?

YES! Omg yes. I don't think your medical insurance covers you when you leave the country so you may want to consider trip insurance that does, but that's another discussion. We try to manage Scuba safely, but accidents happen with harsh results possible - and you want the best on your side. You also want a free medical flight if needed to better facilities, which is included in DAN membership - and you want any expensive emergency and long term treatments needed to be guaranteed and paid, which DAN Dive Insurance provides with that extra option. See DAN | insurance: dive but do not get the cheapest plan - at least the middle if not the top one.

You can join and insure both online and print out temporary info to carry until your card and packet arrives. Do keep the phone numbers handy and call them collect if needed about any dive medical problem. I've called them several times, after hours and weekends included - just to make sure I was doing the right thing about me or a friend.

Peter_C - can you tell me what PFO is?

It's a fairly common condition as linked in a post above. 25-30% of divers have it and there are ongoing studies about whether it causes DCS or not, should be treated or not, etc. The suggestion is bantered around here as much as aspirin for headaches.

 

[Tiny-Bubbles]

Wow! Thank DandyDon! And you're right ... it's Aerius that I have for allergies. And I'm going to run out right now to a drug store to get some non-drowsy pseudoephedrine. It will make the flight a bit better too I'm sure. One of my girlfriends has a bit of a headcold, so I'll get her to take one too.
And I'll look into the Dan insurance. It's a good idea, especially since I'm not problem free unfortunately.
Thanks again ... I hope to be blowing bubbles within the next 36 hours!

 

[lulubelle]

Don't let the PFO thing scare you Tiny! 30% of people walking around out there have them to some degree. And certainly 30% of divers aren't getting bent. They ARE seen more frequently in divers with unexplained DCS hits. They ARE associated with migraines in SOME people, but lots of other things are associated with migraine. And I vaguely recall seeing one study which showed that after closing PFOs in divers who had them and also had an unexplained hit, some who were migraineurs reported improvement in their migraines.

I had to have an echo for non diving reasons. I am a migraineur and had problems with headaches when I first started diving here in NC. So while I was having the echo, the cardiologist did a bubble test which was negative. Good enough for me, although the standard for ruling out PFO is probably a Transesophageal echo which I declined. If I had to guess, any PFO which was small enough to be negative on a standard bubble test is probably too small to put me at risk.

If I were you, I'd probably try to find a dive medicine doc, ideally with a background in Neurology, perhaps ENT, and go see them. And I'd probably put my bet on CO2 retention in the meantime and see if paying more attention to your breathing changes things.

Actually ... I do have one really great tip that I can pass on. If any of you hear of a woman compaining about being "top floaty" or whatever you may call it ... having trouble staying horizontal due to being larger chested ... I've found an easy fix without worrying about weights in pockets, etc. I set up my belt with a bit more of the weight towards the front, and when I get down in the water and there's a bit more give on the belt, I push it up a bit higher towards my ribs and tighten it. And voila!! ... I'm completely neutral and horizontal without even the tiniest bit of effort. This had plagued me for my first 20 dives or so and it was embarrassing, as I was akward and moving about way to much. This small change has massively improved my diving experience. Hopefully, someone else can use this tip too. : )

I feel your pain! I had some trouble with trim when I was new and found steel tanks to work much better. I have integrated weights so there is no moving them up my torso. I do OK with AL tanks now and will do even better when the surgeon takes a crack at me soon!

 

[TSandM]

Just to insert a little educated medical opinion here . . . not all congestion is allergic, and antihistamines do nothing for other problems but make you sleepy. Pseudoephedrine, although a pretty effective decongestant, can raise blood pressure, potentiate abnormal heart rhythms, and raise anxiety levels. I do not think anyone should take medication on a regular basis for anything which has not been well investigated by the appropriate sort of physician -- in other words, if your sinuses are full all the time, see an ENT doc. It may well be that you have polyps or something else which is preventing them from draining normally. Diagnose the problem, and accept chronic medication as a last resort.

With regards to vertigo, though . . . I think I probably have as much experience and information about diving vertigo as anyone, anywhere, because it has plagued me from the very beginning. Vertigo can be a result of having your two ears equalize at different rates on ascent, and if it only occurs on ascent, that may well be it (especially given your congestion history). But if you get it at other times, it can be that you are like me, and excessively dependent on your visual input for your orientation. For the first several years that I dived, I would periodically simply misinterpret what I was seeing (and I still have problems with things that OUGHT to be oriented one way, and aren't, like uplines that are slanted). I'd get disoriented, think I was diving on my side or head down or something, and then there would be this perceptual "kchunk!" as I suddenly realized I was wrong. It was unnerving and uncomfortable, and the worst cases of it involved becoming completely disoriented in three dimensions, when out of view of anything to use as a reference.

At the beginning, I learned to accept the disorientation, and just said, "It doesn't matter if I'm doing somersaults, as long as I am doing them at 15 feet." That didn't fly when I got into more involved diving. There, I had to learn perceptual cues that weren't visual. Things like feeling the tracks of my exhaled bubbles moving evenly up both side of my face, and paying attention to the distribution of gas in my dry suit. Things like feeling whether my gear was lifting off my back or heavy, and also visual cues like whether the particles in the water were streaming past me going down (meaning I was going up) or up (meaning I was going down) or sideways (meaning I'd gotten badly off kilter). I also learned not to do any violent moving of my head underwater, which means my buddies simply have to stay where I can see them. I can look for them when we're on whatever structure we're diving, but once we're in midwater, they stay where they are supposed to be or they are on their own.

I have met only a very few people who have as much difficulty with this as I do, and I've never met one who got motion sick at the same time, but it could certainly happen. I hope some of these ideas help you on your next dive.

 

[DandyDon]

See - TSandM is a respected physcian as well as accomplished diver, and I was out of bounds on my antihistamine ideas. :silly: Got to be careful what to believe, do your reading, work with your own doctor, etc.

Wow! Thank DandyDon! And you're right ... it's Aerius that I have for allergies. And I'm going to run out right now to a drug store to get some non-drowsy pseudoephedrine. It will make the flight a bit better too I'm sure. One of my girlfriends has a bit of a headcold, so I'll get her to take one too.
And I'll look into the Dan insurance. It's a good idea, especially since I'm not problem free unfortunately.
Thanks again ... I hope to be blowing bubbles within the next 36 hours!

Hehe, yes all pseudoephedrine is non-drowsy, and I hope you don't have a problem with it. Some of us find it very helpful, but it does come with cautions, which TSandM referenced.

DAN diver insurance is something I think virtually all of us agree on, and don't be shy about asking them for help if needed. Hope everything works out, you have DEET insect repellent patched, don't drink the water or use it in your neti pot, and have a great dive trip. ilot:

 

[divin'dog]

I tend to feel a bit nauseous, then get a terrible headache which is quickly followed by tunnel vision and a difficult time concentrating (I think because of how much pain I'm in). I believe this is similar to a migraine. The headache becomes excrutiatingly painfu,...

Not too much I can add to what everyone has already said... Breathe fully! Call DAN... If anyone has seen it all, they would.

My only tip, which may or may not make any difference for your problem, is to take your time when jumping in. You're probably already stressed thinking about what's going to happen. A lot of divers rush to jump in and want to descend right away then carry that through the dive. Seems like it's rush to get ready, rush to jump in, rush to be first on the bottom, rush to see the shark, etc... When you're in the water floating on the surface and getting ready to descend, just before you empty your BC, take 3 deep breaths! 3 nice slow deep breaths to relax and slow yourself down (tell your buddy what you're going to do). Breaths can be on your regulator or just taking in the sea air. Then deflate and descend... and have a nice dive! If you have to do a "hot" entry (deflated bc) just take your breaths just before the person jumps in ahead of you. If you're calm and relaxed before descent, hopefully you'll carry that through the dive and maybe it will make a difference.

 

[freewillie]

I wanted to wait until back in the office to check my DAN Sports Diving Medical book on my desk.

There is an association between PFO (patent formen ovale) and migraine headaches. From what I can determine a large PFO can mimic migraine. I would recommend that you follow up with your primary care MD and inquire about getting a echocardiogram with bubble study.

Briefly, a patent foramen ovale is a hole in the upper chambers of the heart between the right and left atrium. Normally after birth the high pressure left atrium pushes a flap against the wall closing off the lower pressure right side. Normally the tissues seal over making the closure permanent. In a small percentage of patients it does not fully close and becomes a potential opening if the right side heart pressures increase. The most common way this happens is what is called a valsalva when you take a deep breath, hold it, the tighten up your stomach muscles while holding the deep breath. Think of sitting on the toilet straining with bowel movement.

I wouldn't worry about a patent PFO for average people. If you wish to continue diving then a echo with bubble test will exclude the PFO.

In my book, headache with tunnel vision and associated nausea is classic migraine. I did a quick online search and scuba diving is actually a listed precipitating factor. While common triptan medications (Imitrex for example) may be effective I'm not sure I would recommend them for diving. There is no recommendation that migraines will prevent you from diving unless the headaches are severe and are associated with vertigo. I would also recommend terminating the dive immediately and no diving for rest of the day. Also recommended not to dive within 24 hours of a migraine attack.

Hope that helps.