dcs question

[glennv]

Well , last week i rode with him to his divesites (dahab, Blue hole) and i must say the taxi rides where not very healthy for he lungs.
Beaten up old trucks smelling of heavy petrol fumes, CO and CO2 (although CO is odourless i had to assume there was lots of it present). Got me sick every time.
Interesting thought.......

 

[John A]

You are right that CO in odor-less, but if you are smelling the fumes from the car, you are getting a lot of CO. CO bonds twice as fast with the red blood cells as does O2. So, you start the dive with lots of CO in the blood stream blocking the O2, now add the increase CO2 build up and you can see a pattern here. His symptoms sounded very close to what my buddy experienced after a dive on a dive boat (both of us experienced divers and trimix cert.) rainy day so he stayed below with all the diesel fumes in the cockpit and I stayed on the deck in the rain. He could barely get out of bed the rest of the day, I felt fine.

 

[immerlustig]

john a:

interesting input. i just checked my log.

26th and 27th august, the first 2 days of symptoms, were done after a jeep ride.
1st sept, 40m, no symptoms, no jeep ride.
4th sept, 46m, no symptoms, jeep ride
6th sept, 48m, symptoms, jeep ride.

i couldn't really say wether the exhaust fumes are somewhat connected to all this. also, how should co cause these symptoms? there is about 2 hours between the 30min drive and the time of my last dive. so i would guess that whatever co causes should happen before my dives rather than after. even if i have lesser o2 transport because of co i'd think that the result should be a more demanding dive. but i don't have this impression. recoveries are easy. maybe you can answer that. anyhow, i think that this is worth thinking about.

eric:

my ascent rates are between 0.86 - 0.92m/s (i dive bi-fins only). how long a 'deco' stop would you think is useful/recommended?

sam:


the residual damage after an episode is actually what concerns me most. sounds also like yours was a more serious case than mine. sorry to hear that.
i visited the chamber yesterday and wasn't really surprised by the non-specific treatment and medication i got prescribed. the doc admitted of not having experience with freediver-dcs, did a simple skin sensory test, and sent me home with 'stay dry for another week, take b6/12 for 10 days, take rehydration salts'.
i take those vitamins (plus other supplements) for 3 months already on a daily basis, plus, being in egypt, i add rehydration powders to every bottle of water i drink. so somehow i still didn't get further.

however, has anyone any info regarding the recovery time of nerve tissue?

thanks again for all the suggestions and contributions.

regards

roland

 

[DeepThought]

Originally posted by immerlustig
however, has anyone any info regarding the recovery time of nerve tissue?

Yes, I heard of a case in which some guy where I used to scuba never recovered - lost control of his lower part of the body . I keep that as one of the exmaples on how dangerous DCS can be.

 

[immerlustig]

hi michael

maybe i should rephrase it : how long does damaged (not dead!) nerve tissue take to recover?

greets

r

 

[John A]

Your post has forced me to learn more about CO poisoning, and the more I read, the more it sounds like your problem. From my quick search I have found that CO bonds with the red blood cells 200 times faster then O2, also it can take up to 9 hours or more to “clean” your system of the CO, and the symptoms are very close to the symptoms of a DCS neurological hit.
So, you drive to the dive site in a jeep that is pumping out lots of CO and you are breathing it in, now you exert your self in such a manner where you are depleting your body of O2 and building up CO2, than you drive home in the same environment. Over a couple of days you are not giving you body (brain) the time to purge itself from the CO, you continue to build on it. Good news is that there is a simple blood test for CO, should you experience this again and conditions are the same (smelly jeep ride), may be a good idea to take the test. You may have a lower tolerance to CO than other people.
Medical treatment of sever CO poisoning is hyperbaric O2. I wonder how many cases of DCS are really CO poisoning? I really believe that CO is a much greater problem (especially on dive boat with enclose cabins/cockpits) than the industry realizes and is often mis-diagnosed as DCS.

 

[immerlustig]

hi john a

usually i have just 1 dive session a day meaning a 24 hour intervall between dives. also on most days i dive at the 'house reef' and don't take that ride with the jeep. so accumulation can't happen given there is more than 9 hours between rides.

on the other hand i can't really tell if my co-intake from the exhaust fumes is always the same. i try to find some info on co poisoning, though.

thanx

roland

 

[DeepThought]

I just remembered... another good "source" for CO in the blue hole was that awful disel opperated pumps they turned on sometimes while we were resting before/between dives. Usally the smoke came right in the sitting area.
I think they pumped sea water for the toilets or soemthing like that, which was clearly not as important as our well beings.

 

[efattah]

It takes more than 24 hours to get rid of carbon monoxide from your body.

I used to have a detector which was like a 'breathalizer' which could detect your blood CO level by exhaling into it.

I measured my level, 0ppm (in expired gas). Then, I went into the garage, and inhaled some car exhaust fumes right at the muffler. Just ONE breath.

Then, my CO level jumped to 24ppm, and after 24 hours I think it was still 2 or 3ppm.

I was on a boat once with a very dirty engine (blue exhaust). The CO detector went into alarm mode, as the CO in the air was more than 1000ppm. The CO in the air was so high, for so long, that the detector broke. It said in the manual that extreme concentrations of CO would 'break' the sensor, and it did.

I tried not to inhale the blue fumes. But, there was no escape. When we got into the water, I had the worst dive session of my life. My apneas would feel extremely strange----hypoxia without hypercapnia. Hypoxic contractions after 0'55" in static, without any CO2 buildup!


Eric Fattah
BC, Canada

 

[samdive]

be careful guys! don't forget CO in your bloodstream is not only going to affect your hypoxia but also become toxic in itself as you get deeper.

if you think you may have inhaled boat fumes on your breathe up.. don't dive until you feel completely clear (if at all). We were all freediving off a RIB a couple of weeks ago and you could see the fumes on people's breath - nasty stuff

and yes DCS can affect you for life. My symptoms are pretty minor but with me forever. Physio has helped a bit. I have a friend who had completely learn to walk again and still needs to use a stick - and she's only in her mid twenties. Nerves that die don't tend to regrow...

so yes, take it seriously, on scuba or freediving but particularly if you do both!

Sam

 

[John A]

As a preventative measure, when my buddies and I were doing a lot of tech diving, we would take ibuprofen (400 mg) prior to diving. The reasons were two fold, ibuprofen acts as a blood thinner so it hopefully would aid in moving any small bubbles in the blood stream into the lungs and not coagulating for filtering and second, it would reduce inflammation if you got a type 1 hit. We would also, on occasion, take 2 more (and lots of fluids, vip) when we got to the surface if the dive was overly strenuous, we just got lazy and blew off some deco or the deco was screwed up in some way. Big caveat, I am not a doctor, so don’t try this at home kids, this is what worked for me and my buddies and it may really screw you up! We also dove really high HE/low O2 mixes and did all of our deep stops, so our problems were always type 1. Don’t know if it would benefit free divers?

 

[Rik]

Well, aside from my ideas on using Ibuprofen on compressed air diving (not positive), I think it is quite crazy to use any blood thinner in freediving.

Just think what will happen if you get a squeeze during your dive, especially a lung squeeze.

With that said, just look up what the average diving check up book says about the use of anti-coagulants, and you will see that most of them won't let you dive anyway.

A friend of mine posted article on medical drugs on my site, and although it isn't speficially dealing with anti-coagulants, it might be intresting for some of the readers.

And for those who want to use blood-thinners afterall, I would recommend you to talk to your diving physican.

 

[JasonWelbourne]

I don't think Ibuprofen is a very strong blood thinner

 

[Rik]

Your right that Ibuprofen isn't a strong blood thinner, but the idea of using any blood thinner for freediving doesn't really appeal to me.

Just to tell people to be cautious with medicine like this and others.

 

[Adrian]

I think it's quite crazy to use any medication or drugs unless one is ill and under doctor's orders - and still then. The joy of competeing - even if it's against one's self is to know that you did it - not some drug that apart of extracting a possible toll on the body, will leave an empty place in the heart.

Adrian

 

[John A]

Just to clarify some points, my suggestion for the use of Ibuprofen is way below prescription strength. Second it was based on my use of the product for deep trimix diving which obviously has very little in common with free diving other than some of the depths associated with it. Third, I would find it hard to believe that anyone would consider ibuprofen as a performance enhancing drug. I never suggested that anyone should eat a handful of Coumadin and go diving!
The post was merely to suggest an over the counter product to “possibly” alleviate and/or avoid the onset of DSC by someone that has used it in the past for trimix diving.

 

[Rik]

I understand your point, and the thought behind it.

However, for both freedivers as tri-mix divers, I don't like the use of Ibuprofen, especially as prophylaxis, due of the major and side-effects. Just look closely to what it does. It is a painkiller, affecting your sensory capabilities of sensing pain. It is quite aggressive for the stomach, and has a full array of other side-effects you don’t really want to have during diving.

Like often, it is a combination of risks. What is the risk that you will have a problem during your dive, or after it, due to use of Ibuprofen (or any other NSAID)? What is the risk on getting DCS? And finally what is the favor of using the NSAID? I still would recommend consulting your diving physican, and I wouldn’t be surprised if the answer could change your mind.

I also believe that any medication, including the use of over-the-counter medication, require a well balanced decision when diving. Most of these medicines aren’t tested under hyperbaric circumstances, and I doubt that any medicine is tested for (deep) breath-hold diving.

If you don’t need medical drugs: Great! If you need them: Ask yourself if you would like to dive with them, or should dive with the reason why you need them. If you want to use medication: consult your diving physican.

Just my 0.2 cents,

Rik

 

[JasonWelbourne]

Ibuprofen is only a pain-killer as a side-effect. It reduces swelling, which is why it is considered an anti-inflammatory. It's pain killing effects are only effective against pain caused by swelling such as the throbbing pain associated with tooth extraction. It is VERY tough on the stomach, but eating with it usually nullifies that effect. Other than the very minor blood thinning effect, which would only become relevant if a person were to bleed, i can not postulate a mechanism by which ibuprofen could contribute to the demise of a human being under water.

But then again, with the exception of the purchase and use according to directions of OTC medications, I am not even certified to make decisions about my OWN health.

But then again, knowledge is power, and the american medical system is totally screwed up, and I support the idea of educating one's self much more than I support the idea of paying a doctor to summarize from text books that I can find at the local thrift store for $2 a piece.

 

[Rik]

Textbooks… Mine one is categorizing it as a painkiller, but then again, it is depending how you categorize it, or what for it was used in the first place.

You wondered how Ibuprofen could contribute a diving fatally. Well, I didn’t state that Ibuprofen does. Problems with medications like these are that they often aren’t the cause of an incident, but more a complication.

A general example would be that a diver misdiagnoses an arising pain after a dive. You don’t want to miss a DCS hit caused by medication that dulled the pain enough to make it feel harmless. Ibuprofen won’t be a substitute of oxygen and hyperbaric therapy.

Another example is that of aspirin. Aspirin is mainly used as a painkiller, but also has a well known blood thinning effect. It effect in combination with peoples own constitution is severe enough that some dentist won’t perform a tooth distraction due of the complications that can arise.

Now think of a freediver using aspirin as a painkiller and getting a severe enough contraction that causes a lung squeeze on a relative shallow depth. Combine that with a physician who knows nothing of hyperbaric medicine and isn’t informed about the aspirin use (The over-the-counter isn't a real medicine syndrome).

Impossible? Not quite, that’s the way how you get a classic case of a patient with complication after complication.

How less medicine you use and how healthier you are during your dives, how easier things are when you need to be treated by a physician.

Needing medication? Ask a well-informed physician or think if you really need to dive in your situation. (And write down your experiences for us )

Rik

 

[John A]

One issue that seems to be being misunderstood is that after every dive there is some bubbling (micro) the more extreem the dive and the use of HE can increase this micro bubbling. It is also well understood that these mico bubbles can and do join up to form bigger bubbles (problem time). Specifically as it relates to Deep trimix diving the use of ibuprofen is not really used as a "prophylaxis" but you are treating what is commenly known to be there.
Now forgetting the ibuprofen issue altogether, jumping to deep free diving the question is, is the deep free diver also experiancing the same mico bubbles? anybody out there know of any doppler testing?