Recurring issue - nausea, headaches & throwing up during dives

[TSandM]

Headache with tunnel vision and associated nausea is also classic CO2 retention . . . this may be migraine, and maybe something about the diving environment is a precipitating factor. PFOs are somewhat associated with migraine, and certainly if you begin to have symptoms on land as well, a PFO study might be indicated.

Evaluation for a PFO can be an echocardiogram with bubble test -- unfortunately, transthoracic echo (where the probe is put on the outside of the chest) does not have a good accuracy rate for picking up smaller lesions. The gold standard is an esophageal echo, which is a major procedure. A third alternative is a transcranial Dopper, which is noninvasive. The shortcoming of that test is that it will be positive in the presence of significant intrapulmonary shunting, as well as a PFO. But if it is negative, that's pretty good information.

 

[lulubelle]

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.


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.

The medication thing is a bit more complicated than just whether or not it "helps". Is the person sick and trying to compensate? Bad idea. Does the drug vasoconstrict and possibly interfere with offgassing? (That's why migraine meds are not recommended when diving or for a period of time after diving). Is there any theoretical CNS toxicity? I couldn't find the DAN article on pseudoephedrine and diving with enriched air, but if I recall correctly, it was not recommended.

To TS and M's point, take the medication thing very seriously. Personally, I time myself out of diving much more conservatively than my physician's do based on my wellness and what medications I am taking at present. I don't want to be an accident report.

 

[DandyDon]

I did encourage her to review the cautions. Not many years ago we just said "take 2 sudafed and dive," when sudafed really was sudafed. A lot of divers still use it, but it's getting difficult to discuss it along with cautions, as well as find it. Of course her sinus problems need to be examined by a physician, and there is a new balloon procedure, but she's packing for Roatan.

 

[lulubelle]

I did encourage her to review the cautions. Not many years ago we just said "take 2 sudafed and dive," when sudafed really was sudafed. A lot of divers still use it, but it's getting difficult to discuss it along with cautions, as well as find it. Of course her sinus problems need to be examined by a physician, and there is a new balloon procedure, but she's packing for Roatan.

Doubt sinus issues are the issue here. I felt the need to comment as self medicating in the context of diving can be dangerous. Stuff we take on land and perceive to be very benign may be different underwater.

Real pseudoephedrine is still the same and still OTC is most states, you have to ask for it as it is behind the pharmacy counter, show ID and sign for it, and so on. To ensure that you aren't taking it back to your meth lab.

The crap that is on the shelf is not pseudoephedrine but may carry the brand name Sudafed too.

 

[Tiny-Bubbles]

Hey everyone! I'm back safe and sound, and my diving was amazing! Thank you all sooo much for all of your wonderful advice and support.
Because this was my first time back after my really bad episode 2 years ago, I paid much more attention to what I'm doing and how it makes me feel. I did use pseudoephedrine before a couple of my dives but only because I was feeling "a bit" congested. I had no ill effects. However, I will definitely take everyone's advice and seek a medical explanation as to why I'm always so stuffed ... there isn't any sense just living with it if it can be resolved. Does anyone know how I can find a dive medicine doctor who may specialize in ENT or neuro?
I've always been in the habit of being one of the first in the water so that I can get myself as calm as possible before we descend. I like to get used to breathing through the regulator again before each dive while floating face down at the top. And I always take my time descending ... so I think I've got myself well prepped for being as calm as possible before the dive.
I believe that I must be a bit of a lazy breather. I focused on my breathing, paying particular attention to my exhaling. And I ended each dive without the slight headache that I have had for most of my 30 dives prior. And it's made me mindful that my body would probably enjoy better breathing habits while I'm on land too. So, a great big thank you!
I also think that I'm probably just very sensitive to my visual cues which can quickly make me nauseous. I definitely noticed that I get dizzy if I look out too far ... like the open side of a wall whether I can see the bottom or not. I also don't like to look up if we're too far down. Dizzy may be too strong of a word ... but it's a weird sensation in my eyes. And I get a bit quezy if there's too much moving in the water, but I don't know if it's necessarily moving with me or opposite me or both that does it. Anyhow, I've taken the advice to try to focus on just one thing and it helps. My friends confirmed for me that I feel things they don't ... like I can feel like I'm moving if I stare at the water coming up on the beach, and I feel like I'm still being pushed by waves when I'm standing or sitting still long after I'm out of the water ... in fact, this feeling took 2 days to go away when I was back home.
To test this new theory, I got brave and decided to make my last dive a drift dive. So, without any meds at all, I dove Melissa's Wall which is a slow drift dive at varying depths of up to 100 ft. At times my eyes went a bit wonky but I just focused on something and ensured that I continued to breathe fully. It was one of my favourite dives ever! And I wouldn't have even tried it if I hadn't of gotten my confidence back.
Thank you again!

 

[wedivebc]

Forgive me if this has been covered (I'm not a good speed reader) but I agree with the above replies that indicate CO2 and my experience with it was very similar to yours.

Many new divers have a feeling of distrust when breathing off scuba and maybe subconsciously don't fully exhale out of fear of not receiving their next breath. As a result their lungs never fully expel built up CO2 and that is sometimes what causes the problem. I found by completely exhaling each breath I not only delayed the amount of time before I required my next breath which made my air supply last longer but I stopped getting headaches when diving.

 

[DandyDon]

Glad you had a good trip Tiny. Good luck on your follow up medical explorations and future diving. Stay in touch...!!

 

[clpkab]

. Does anyone know how I can find a dive medicine doctor who may specialize in ENT or neuro?

Contact DAN (Divers Alert Network) - they should be able to identify doctors.

(I contacted them when I was looking for a dive-savy ENT regarding an issue I had with my ear after a dive.)

 

[Tiny-Bubbles]

Thanks clpkab ... I'll try that.

 

[TSandM]

Tiny-bubbles, I empathize with your descriptions of what you feel. I have the same feelings of moving in the surf, and I get "landsick" easily after time spent on a boat. (Which is funny, because I don't get SEAsick at all.) I had terrible problems through the first couple of years of my diving career with midwater vertigo, and it took a LONG time to learn coping techniques -- the problem is not gone now, but it is far rarer, and I know some things I can do to deal with it when it happens.

Do you have problems with your balance on land? I was always the klutzy kid, and I can't walk a balance beam to save my soul. I always wondered if that has something to do with the issues I've had underwater.