"Early" contractions & lung squeeze

[Renard palmé]

Hi all,

I have been here on DB since a little while now though I did not post any message yet.
I would like to share with you the experience I am going through as I do not really know how I should handle things now. Maybe some of you have encountered the same problem and have managed to solve it.
Sorry in advance for the lenght of this message, but I would like to describe things precisely. Hope you will have the patience to read !

I have been freediving for 3 years now, and I am mainly a "pool freediver". I train once to twice a week (dynamics). My personnal bests are 100m DYN bi-fins & mono in a 25m pool and 5' STA. I also train once to twice a month in a pool tank (20m max depth).

6 months ago, I took a week vacation to practice CWT. Before this week, I did not practice too much at depth though I reached 26m and 29m at two or three occasions.

During this training week, I improved gradually from 25m to 36m. My progression was stopped by difficulties to compensate beginning from 33m (mainly due to a lack of relaxation). I realized I needed some time to digest my new sensations, relaxation during free fall, etc... I always surfaced very clear. O2 was not my limitating factor. During this week I also practiced some breathing exercices in order to improve my preparation before immersion.

Begining from the 2nd day of training, I started to feel some kind of lung irritation (in the upper part) which I kept all the week (with intensity growing). I did not feel real difficulty to breath though but I tried not to push to much on full inhale (especially during breath-ups) as I could feel a burning effect if so.
This bad feeling did not stop me from improving my depth during the week.

Things began to hurt my mind the day after my last training day when I noticed some blood in my spit. It was not a huge amount, but still it was there and I immediatly thought about some kind of lung squeeze. I also made the correlation with my "lung irritation"...
What surprised me is that I started to feel this "irritation" on my 2nd day when I only performed some dives to 25m max which I already made by the past without any problem. Also, it was not a depth I had in mind when talking about lung squeezes (I thought I would be more likely to encounter this kind of risk at depth where my lung reach the VR).
Also, it came back to my mind that when surfacing from 1 or 2 dives in the beginning of the week, I had some caughing (but I don't know if my spit contained some blood at that time as I did not imagine any kind of accident at that time and did not pay attention to it).

Back home, I did not urge myself to see a doctor as I breathed normally. Only this irritation sensation was still there. I slowed my earger to go back to training and took some rest. The feeling took at least 6 weeks to smooth, and I decided then that it was stupid not to see a physician ; it would at least help to explain (maybe) what the situation really was.

The physician I saw made also the hypothesis of a lung squeeze though he made the necessay analysis to check it was not a lung desease or so. I saw a generalist physician, a lung specialist, and a cardio physician specialist in diving physiology. I have gone through lung radiography, lung scanner, analysis of electrocardiogram under effort + heart echography !

Conclusions from the lung specialist : no trace of lung injury (though I still could have gone through a squeeze : as I made the exam 1.5 months after the incident, blood had time to evacuate)
My heart have been described as in very good shape : very good physical condition, no anomaly.
Conclusion of the cardio physician was that it might not have been a lung squeeze as generally symptoms are more severe (heavy dyspnea, noticeable caughing, etc...). His hypothesis was that I probably had some kind of bronchitis worsened by breathing exercices (air was a bit dusty as well) and repeated breath-ups, and that all this coupled with several immersion + compensation difficulties probably created severe irritation which have lead to some traces of blood in my spit : maybe some capillaries have been damaged this way.

I accepted this explanation which was compatible with what I felt.

Last week-end, I went diving in a lake with friends to practice again some CWT. There was no depth objective and I decided to take it smoothly. I made a few dives to 5 and 10m to warm myself and then we headed for a 20m bottom. I made 3 dives at this depth and started to feel again a (small) "irritation" in the upper part of the lungs. This time I paid clear attention to my breathing and eventual caughing, but nothing. I Could breath clear, no trace of mucus feeling in the lungs. So I was convinced the irriation explanation was correct and thought that it could be explained by immersion (chest compression) + maybe chest contractions (as I felt I had several ones under water).

We then decided to go on a 30m bottom to extend eventually our depth. I deciced to prepare myself with a free immersion dive to 10m with 1 min static at the bottom. I made a 3-4 min breath-up prior to it and made the dive which lasted 1'50". I came up feeling very good. Of course still the same feeling in the upper lungs. However I paid greater attention to my contractions during the dive and noticed I had a big one already at 5m (after only 10 or 15sec dive) followed by smaller ones. It had some kind of destabilizing effect on the psychological side but I noticed that once I managed to accept this first big contraction (which is going through all the chest, not only the diaphragm), then the following ones were softer and I could accept them and then relax to do my static in good condition.
I made a second dive with the same protocol. Same feelings, though I felt the contraction was even more destabilizing (probably as I paid greater attention to it than I am used to).

I then made the conclusion that my "irritation" was probably due to these contraction.

I then headed for a CWT 30m dive after a 3/4 minute breath-up. This time I had a big contraction at around 12m followed by softer ones ; it was very noticeable. I evacuated it mentally, relaxed myself and entered in free fall for the last 10m ; I was feeling very good. During ascent, I noticed again some contractions in the chest. I surfaced very clear and happy from my feelings at the bottom.


I stopped there my progression and went back home realizing that I really needed to understand why these "early" contractions which might be one of the main causes of this irritation feeling in my chest.
But it became even more clear (and frightening) the day after, at wake up : once again some traces of blood in my spit...! Very little (2mm² spots or so), but still it showed that there have been some capilaries broken. So now, I feel it really is a "mild" lung squeeze as I don't think it could be done by the irritation itself which was softer and made in one day only compared to the fist time.

I feel somehow that it is the consequence of the ambiant pressure on the chest on one side, and the probable big negative pressure inside the chest created by the contractions + I suppose a complex hemodynamic context.


Now I don't really know what to do. I don't really understand I could encounter this problem so easily whereas I am in apparent very good physical condition. Depth were relatively shallow, I cannot see significant additionnal risk factors that could help the incident to happen (i.e. very cold water => unusual vasoconstriction, heavy stress, ...).
As you can imagine, I feel very frustrated...

Are there some of you who had the same kind of experience ?
And also, are there also some of you feeling early contractions like this ; I assume they are not caused by CO2 at this time of the dive...

Thanks in advance for your feedback !

 

[trux]

Salut Renard, and welcome to DB!

I do not know the answers to your questions - there are far too many factors and possibilities that play a role. It could be also trachea squeeze. It is certainly recommendable to visit a pulmonologist immediately if it happens to you again (not that I'd wish it to you). You could at least localize the problem better.

Anyway, in case you did not see yet the following threads, I highly recommend reading through them. Especially this one contains a lot of info. Although the case of Ol Dirty Diver may not match with yours, there are many tips and a lot of information in the thread, so it is definitely good reading.

http://forums.deeperblue.net/safety/69802-immersion-pulmonary-edema-lung-squeeze-help.html

Being in excellent physical condition won't protect you from lung squeeze. As you see on the example of Ol Dirty Diver and other triathlonists, higher susceptibility to lung edema is not exceptional among excellent athletes. I believe I even saw a study explaining it, but do not remember where exactly (perhaps it is refereed to in the above mentioned thread).

It would be interesting to know whether you pack before your dives - paradoxically, packing is suspected to be related with many cases of lung or trachea squeeze. The barotrauma can even happen directly during the immersion, when the already overfilled lungs are compressed during the duck dive. Another possibility is at surfacing (if you do not slightly exhale a few meters below the surface) - the air in lungs expands to the original volume and pressure (minus a very small difference of around 2-5%) but since the lung volume may be considerably reduced due to blood shift, it may result in a dangerous level of pressure build-up. Read more about it here:

http://forums.deeperblue.net/safety/66867-new-theory-about-risk-freediving-dcs-airtrapping.html

As for the early contractions: at depth, contractions usually come sooner, due to quicker blood pH change (CO2 cannot easily diffuse to lungs in depth, due to the partial pressure build-up, hence it remains in blood and tissue). However, I do not think that it could trigger them as soon as just at 5m after just 10-15s. I did not hear yet about such case, but perhaps others did, and will shed some light on it.

Anyway, I do not think that a contraction at 5m could cause any harm. Even if you packed extremely, or dived on FRC, at 5m the lung volume is reduced to 75%, so there is plenty of room both ways for the contractions, so I do not really believe it could cause neither hyperbaric nor hypobaric injury at that depth.

Strong involuntary (hypercapnic) or voluntary (i.e. Valsalva, or mouth filling) contraction at depth may indeed cause hemoptysis: Hemoptysis Provoked by Voluntary Diaphragmatic Contractions in Breath-Hold Divers -- Kiyan et al. 120 (6): 2098 -- Chest

Well, I wish you that you find the culprit and manage to avoid another squeeze, but it would probably safest progressing extremely slow in your depth training. Instead of trying to add meters, train rather technique and relaxation in depth you are well comfortable with, and only add a meter at a time when you stay within the last maximal depth for at least a few days.

Some more documents about lung squeeze may be found here: squeeze @ APNEA.cz

 

[hteas]

Renard,
What you felt may be a cough rather than a contraction. If there is irritation, from whatever source (such as allergies, minor cold, lung damage from previous dives, etc,), you may get an urge to cough, which is rather difficult during a breathhold, adn feels similar to a contraction.
You may need to stay shallow for a longer interval before going deep again, then increase your depth over a greater time.

Howard

 

[cdavis]

Hi Renard, welcome to DB and yes, there is at least one other diver out there with very similar symptoms, me. Same lack of extreme "squeeze" symptoms, same long recovery period, very similar feeling in the chest although mine feels like the tale end of a bad chest cold, same getting cumulatively worse. I never saw any blood, but otherwise you sound just like me. Mine was brought on by overenthusiastic exhale diving, see the thread, "Exhale diving for the average diver" I had the same impression that a tense diaphragm, straining to equalize, tense chest, etc, was contributing to the problem.

I think there is something out there that is not well understood and hasn't been described, that we both experienced, something between a classic squeeze and pulmonary edema. Maybe somebody else with similar symptoms will chime in.

I beat mine by very very very (blaaa) slowly extending the amount of exhale in a pool and doing almost all exhale diving at very slowly increasing depths. Went too fast a lot, but when I finally slowed down enough, I'm pretty sure I was seeing physiological changes in my lung tissue that adapted it to increasing depth and pressure. I'm now doing reverse pack exhales in a 4 m pool with a ridiculous number of reverse pacs and laying on the bottom a while with no symptoms whatever. Pretty sure you can beat your problem with the same approach.

On your contractions, I am not much help. There is a class of early contractions that comes from overexciting the stretch receptors in your diaphram. Causes sometimes hugh contractions, chest heaving and other weird symptoms. I hit these the first time I went below 70 ft, very disconcerting. As far as I know, these only show up as you approach or exceed RV, so should not be related to yours, but who knows.

Good luck and keep us posted.

Connor

 

[jome]

Renard,
What you felt may be a cough rather than a contraction. If there is irritation, from whatever source (such as allergies, minor cold, lung damage from previous dives, etc,), you may get an urge to cough, which is rather difficult during a breathhold, adn feels similar to a contraction.
You may need to stay shallow for a longer interval before going deep again, then increase your depth over a greater time.

Howard

My thoughts exactly, but I'd like to add that a "cough" contraction is usually much more violent than a co2 one - and thus I believe much more harmful. It doesn't need more than the feeling of pressure on the throat to get a cough reflex and if you're not used to the sensation, it is hard or impossible to control.

Lung squeeze is not very well understood currently. Or rather, I think there are several types of squeezes. Some people seem to be more "rigid" in the trachea and bronchi. That's more or less speculation, but makes sense that then they would be more suspectible to little barotraumas too. To some extent I believe you can make them more flexible (and the whole breathing apparatus, rib cage etc) with specific and regular training.

If you go for deep dives every 6 months it's not surprising that there'd be problems. But doing repetitive sub maximal dives several times a week throughout the year (in the pool e-dives), doing exhale stretches every morning etc. To keep the cartilage and connecting tissues moving and flexible.

People have also structural differences for example the c-shaped cartilages in the trachea may be more "closed" on some persons and others completely open. For example in the study Peter Lindholm did on negative packing some of the 5 divers showed the trachea clearly "collapsing" (=flexible, which is good) and others not. Is this due to training or born traits? (you can see the abstract here Studies on inspiratory and expiratory glossopharyn...[Eur J Appl Physiol. 2005] - PubMed Result)

It's hard to say though, might be that none of this helps to your case specificly. But to me it would make sense that with regular and specific training you could improve it, but it's important to keep very conservative.

As an example, I used to get a "runners knee" basically every time I ran over 5 km. But I kept doing it over and over again, because I felt 5 km is such a sissy distance I must run more to improve. So I kept going...5, 6, 7km Until finally I'd have my knee in so much pain I could barely walk and then I'd take 6 months or so break. Needless to say I wasn't improving much. But then one winter month it hit me that I should just run more regularily but always quit before I had any pain sensations from the knee. So I did this, 3-5 times per week, at first just real slow, 2-3 km. Then over the course of one year, gradually increasing the distance. If there was no pain, I'd add maybe one km and so on. So the moral of the story is, I haven't had any pain in my knee for years, on any surface (I used not to be able to run on asphalt at all), and any distance I've done so far (over 40 currently). But I've also never had a complete break from running more than one month and even after a short break I take it easy for a couple of times.

Not saying this is directly applicable to diving or your case spesificly, but as a general idea I think a lot of people keep hitting their head in the wall, unwilling to take a step back to go forward because it's hard not to when your limits are not in apnea for example and you know you could go twice the depth without this one problem. Be it the knee keeping you from doing a marathon when your other physiological parameters are well in there, or a lung squeeze keeping you from going deep when you have an excellent pool condition, perfect gear and technique and good dive site close to you But sometimes, that's exactly what it takes.

 

[Renard palmé]

Bonjour & thank you all for your replies !

I will go through the thread link given by Trux in details. Ol Dirty Diver case is not exactly the same but advices certainly still apply the same way.
Working on my chest flexibility as well as putting a step back, and going little steps by little steps should be the good starting point.

To answer Trux's question, I do not pack, so I rejected hypotheses related to overpressure coming from air expansion. I feel it rather comes form this contraction issue causing direct injury or big negative intra thoracic pressure.

I did not think about the "cough" hypothesis but it can be a good track. I would say that it really looks like a cough but I don't feel it coming from the throat. However the power is nearly the same. My feeling is that it is more a "chest spasm" rather than a contraction. I really feel that my rib cage muscles need to contract to contain the spasm. It is rather "disturbing" on the mental side, much more than CO2 contraction which I am used to deal with to a certain point when doing 25m or 50m hypercapnic pool series.
Usually this spasm/contraction lasts 1 to 2 seconds (I feel it quite long), the same kind of feeling in the chest than when you sneeze nose and mouth closed but without the pressure feeling in the throat and upper airways.
The strange thing compared to other cases I read is that I don't feel fluid or mucus in my lungs nor rales when breathing during the dive session. I only feel irritation (at the end of inhale). I only see some traces of blood the day after in the morning after wake up when I manage to spit some mucus which might have been formed during the night. Maybe this blood is coming from a trauma rather than alveoli rupture.
The others days after the indident, I feel I have to evacuate something from my lungs but it is very sporadic.

Do you know about a description of a trachea squeeze somewhere ? I would be interested to compare it to my feeling & symptoms. I am not quite sure how it may feel. In my case, if I breath in the lower part of my lungs, I will not really feel the pain (except overall irritation). But if I perform a full inhale and breathhold, then I will feel it very clear (irritation feeling increasing) and it will remain very sensitive for many minutes after. The thing is that it is located in the upper lungs or upper bronch but I do not feel pain in the trachea itself (or at its base depending of how long we consider the trachea).

Maybe that at immersion, the water pressure on my upper chest creates a cough or spasm reflex causing high intrathoracic pressure causing a barotrauma somewhere in the upper bronch and lower trachea.
humm, investigation is moving forward

 

[Renard palmé]

Hi Renard, welcome to DB and yes, there is at least one other diver out there with very similar symptoms, me. Same lack of extreme "squeeze" symptoms, same long recovery period, very similar feeling in the chest although mine feels like the tale end of a bad chest cold, same getting cumulatively worse. I never saw any blood, but otherwise you sound just like me. Mine was brought on by overenthusiastic exhale diving, see the thread, "Exhale diving for the average diver" I had the same impression that a tense diaphragm, straining to equalize, tense chest, etc, was contributing to the problem.

I think there is something out there that is not well understood and hasn't been described, that we both experienced, something between a classic squeeze and pulmonary edema. Maybe somebody else with similar symptoms will chime in.

I beat mine by very very very (blaaa) slowly extending the amount of exhale in a pool and doing almost all exhale diving at very slowly increasing depths. Went too fast a lot, but when I finally slowed down enough, I'm pretty sure I was seeing physiological changes in my lung tissue that adapted it to increasing depth and pressure. I'm now doing reverse pack exhales in a 4 m pool with a ridiculous number of reverse pacs and laying on the bottom a while with no symptoms whatever. Pretty sure you can beat your problem with the same approach.

On your contractions, I am not much help. There is a class of early contractions that comes from overexciting the stretch receptors in your diaphram. Causes sometimes hugh contractions, chest heaving and other weird symptoms. I hit these the first time I went below 70 ft, very disconcerting. As far as I know, these only show up as you approach or exceed RV, so should not be related to yours, but who knows.

Good luck and keep us posted.

Connor

It is very good to know that you have been able to overcome your problem or at least push the limits this way !!
Reverse pack exhale at 4m.... humm... alreay big pressure there. Would be curious to know how much you have you been able to extend your depth on full inhale (from the time you had your problems and now)

 

[Renard palmé]

Not saying this is directly applicable to diving or your case spesificly, but as a general idea I think a lot of people keep hitting their head in the wall, unwilling to take a step back to go forward because it's hard not to when your limits are not in apnea for example and you know you could go twice the depth without this one problem. Be it the knee keeping you from doing a marathon when your other physiological parameters are well in there, or a lung squeeze keeping you from going deep when you have an excellent pool condition, perfect gear and technique and good dive site close to you But sometimes, that's exactly what it takes.

Thanks for your example and advice. I feel your are right and I think it is certainly very rewarding to overcome oneself difficulties this way, keeping courage, patience and confidence. Sometimes things are not as simple as we would like them to be. Maybe that is where challenge is.

 

[Jouskari]

Just to add my own experiences to this thread:

I´ve had the same sympthoms as Renard twice.

The last dive was a "Easy" CNF dive to 30 m. Had one bigger and then small contractions during the descent and at a few points I had to suck up a litte air to equalize. At the turn everything was fine (though I bumped my head in the plate) as on the surface, but 10 min after the dive I had a slight feeling of irritation or warmth in the "center" of my chest. I recognized this feeling from my last CNF 30 m dive from one year ago and spat in my hand. There we´re clear traces of blod in the saliva and based on the sensation I´d say that it´s from the trachea or bronchi.

I think Jome has a good view on this. I´d just be really interested to know what triggers contractions already after 5 m of depth as I can go 50 m DNF in 5 m deep pool without? (and I´m not packing or hyperventilating)

My own theory for the moment is that my squeezes is probably due to insufficient flex of rib cage and trachea / bronchi. This again I figure could be due to my background in icehockey and taekwondo as they really put stress on the rib cage. It´s also possible that I also by birth just have thinner "walls" in the tarchea and therefore more prone to have bloodvessels ruputure at low pressure.

 

[jome]

Just to add my own experiences to this thread:

The last dive was a "Easy" CNF dive to 30 m. Had one bigger and then small contractions during the descent and at a few points I had to suck up a litte air to equalize.

This is what catches my attention. You wouldn't normally expect to have any kind of contractions or the need to "suck air" on a dive to 30m. I think there is still very much hope for you if you're able to eliminate these and I believe a lot of it comes down to technique and experience. Ie concentrate on how to get to 25 without any of these movements for a while. It is possible After that 30m is "just a few more meters". There's a few tricks I can show you guys over the weekend...See you there!