Undeserved Hit, Question for Dr. D

[Blackwood]

My girlfriend took an undeserved (type-II, I believe) hit this Sunday.

Catalina Island: three dives (max depths of 72, 73 and 49, with surface intervals of 1:50 and 1:30, respectively), slow ascents (less than 30fpm). Average depths in the 35, 40 and 25 foot range. Only foul was dehydration.

She underwent two chamber treatments at Long Beach Memorial (90 minutes each, the consisting of a 30 minute dive to 3ATA followed by 60 minutes at 2ATA, and the second at 2ATA for the entire 90 minutes).

Her symptoms (shoulder pain, tingling and numbness in the arm) are all but gone, but she occasionally gets bursts of pain in her left arm.

She's wondering if this is normal or whether she should seek a third treatment. The Hyperbaric Doctor quoted 1.5 rides as average, and said her symptoms should subside within a few weeks. Would you agree with that?




Additionally, he heard a very faint heart murmur that in her 24 years no other doctor has mentioned. He recommended a bubble tracking EKG to determine if she has a PFO. What are your thoughts about diving with PFO (assuming she has one)?



In the future, she plans to limit herself to 60FSW max (doctor’s recommendation) diving air tables on Nitrox, no more twice a day, observing conservative surface intervals. Do you have any input? Should she seek rec TriMix?



Thanks!

 

[Tristessa]

Sorry to hear about that, i hope everything works out ok. I think the appropriate course of action would be to relax. Take things slowly, do some follow up visits to the doctor and make sure everything is ok. I believe your rushing here. See of she is comfortable getting back into the water and then worry about how deep or how long or whatever. I had a good friend and a great diver who got bent with a rebreather, and it took him almost 6 months before he could complete a simple dive to about 50 feet, when he dove 150 before his accident. Usually after such accidents, as far as i know from experience, the problem is mental, rather than physiological. I hope everything works out for you guys.

 

[Blackwood]

Sorry to hear about that, i hope everything works out ok. I think the appropriate course of action would be to relax. Take things slowly, do some follow up visits to the doctor and make sure everything is ok. I believe your rushing here. See of she is comfortable getting back into the water and then worry about how deep or how long or whatever. I had a good friend and a great diver who got bent with a rebreather, and it took him almost 6 months before he could complete a simple dive to about 50 feet, when he dove 150 before his accident. Usually after such accidents, as far as i know from experience, the problem is mental, rather than physiological. I hope everything works out for you guys.

I'm not going to rush her. I told her to take all the time she needs.

She loves diving and wants to return to it, but she is (naturally) a bit hesitant now. Because she got an undeserved hit, the possibility exists that she is pre-disposed towards getting bent.

I say undeserved from a "didn't dive wrong" standpoint. She didn't exceed any limits (depth/time/rate). However, as I mentioned, she was dehydrated. Additionally, it was cold water and she was overweighted on the first dive.

She's going to do the recommended tests, etc., and take some time off. Save for the "is this normal" question (to which I imagine the most correct response would be something along the lines of this is DCS, we're talking about... there is no normal), I'm talking eventualities.



Thanks for your concern.

 

[mart1]

Dehydration is the biggie: keep hydrated at all times, use rehydration salts if you lose a lot of fluid (diving, warm weather)
Second point is exertion: you mention overweighted, which means harder work.
It is quite normal to have some remaining symptoms for some time, but check this one with DAN or the doctor treating her. Difficult to say anything without running a full set of tests.
PFO is present in over 30% of the population, so there are a lot of divers out there with PFO and no problems.
Most of the divers with an underserved hit never have one again.
Trimix is fine, recreational trimix is not so: helium being a much faster gas makes it more important to stick exactly to your schedule. Trimix divers know this and adhere to it, recreational trimix divers less so.
Hope this helps.

ciao, mart

 

[Snowbear]

Truly "undeserved" hits are rare. There's usually SOMETHING avoidable that caused the DCS. Depending on the dive (depth, duration, exertion (i.e. from overweighting, current, cold, hike to the car, whatever), etc....) and the dehydration level, a 30fpm ascent could be less conservative than you think.

If this was a truly undeserved hit, the followup PFO rule-out may be a good idea. I actually don't know if a PFO is one of the causes of a heart murmer or not... usually it's a leaky valve...

 

[miguel sanz]

i AGREE 100% WITH SNOWBEAR.
a PFO can cause a heart murmur, anyway I would look for it if I´ve had a hit and wanted to dive.

 

[vlada]

<snipped>
She's wondering if this is normal or whether she should seek a third treatment. The Hyperbaric Doctor quoted 1.5 rides as average, and said her symptoms should subside within a few weeks. Would you agree with that?

Additionally, he heard a very faint heart murmur that in her 24 years no other doctor has mentioned. He recommended a bubble tracking EKG to determine if she has a PFO. What are your thoughts about diving with PFO (assuming she has one)?

In the future, she plans to limit herself to 60FSW max (doctor&#8217;s recommendation) diving air tables on Nitrox, no more twice a day, observing conservative surface intervals. Do you have any input? Should she seek rec TriMix?

Thanks!

From personal experiences - if the tingling and numbness are gone, then what's left is likely just tissue damage - it'll heal eventually.

As for PFO and diving with it, it had been discussed on this and other board at length. Yes, some divers have it and are perfectly asympthomatic, however, this would not be her case since she already experienced undeserved Type 2 on a benign profile.

If she indeed has a PFO, and depending on what her doc would recommend at that time, then she'd have a decision to make as to how much risks she is willing to take on each dive. Diving with a known PFO and previous DCS history is always a lottery - you can do everything right, be extra conservative and still got bent pretty bad. It's her decision - does she really like diving that much to risk her health?

Lastly, keep in mind that bubble EKG can produce a false negative sometimes - meaning that it would not show a small PFO.

And good luck,

 

[Blackwood]

Trimix is fine, recreational trimix is not so: helium being a much faster gas makes it more important to stick exactly to your schedule. Trimix divers know this and adhere to it, recreational trimix divers less so.
Hope this helps.

I was trying to rule out deep diving, and thought there may be "rec trimix" courses that don't require deep dives.

 

[Blackwood]

As for PFO and diving with it, it had been discussed on this and other board at length. Yes, some divers have it and are perfectly asympthomatic, however, this would not be her case since she already experienced undeserved Type 2 on a benign profile.

hmm... I searched for it and didn't turn anything up.

Lastly, keep in mind that bubble EKG can produce a false negative sometimes - meaning that it would not show a small PFO.

And good luck,

Interesting. Thanks.

 

[Blackwood]

Truly "undeserved" hits are rare. There's usually SOMETHING avoidable that caused the DCS. Depending on the dive (depth, duration, exertion (i.e. from overweighting, current, cold, hike to the car, whatever), etc....) and the dehydration level, a 30fpm ascent could be less conservative than you think.

If this was a truly undeserved hit, the followup PFO rule-out may be a good idea. I actually don't know if a PFO is one of the causes of a heart murmer or not... usually it's a leaky valve...

That's what I'm thinking. It probably was "deserved" due to the dehydration. I generally see the term "undeserved" associated with dives that either don't exceed any rec limits or don't involve deco violations, so that's how I used it above.

The baro MD said that a PFO can cause a murmer. However, so can things such as stress and nervousness (both of which she was experiencing).