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Lung squeeze - what now???

Thread Status: Hello , There was no answer in this thread for more than 60 days.
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donmoore

donmoore

New Member
Aug 19, 2002
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A couple thoughts:
If the trachea is more inflexible and the cause of most lung squeeze, then why does increasing the depth gradually cause it to adapt? In practice it seems a well-proven technique. I just wonder why?

If the trachea is the cause of lung squeeze then maybe it is most affected when a person is descending because the air wants to go up which puts the greatest pressure, or lack of negative pressure, in the bottom of the lungs (the highest point). But the more flexible the rib cage, the more the lungs will be able to compress and put more air volume in the trachea. Maybe this is the adaptation to pressure that prevents squeeze?
don
 
laminar

laminar

Well-Known Member
Aug 13, 2001
1,129
206
168
Hi Don,
A few points:
1. You suppose that increasing depth causes the trachea to adapt. It may just adapt because of an increased number of dives, not specifically because they are deeper.
2. Trachea squeeze and lung squeeze are two different things. A trachea squeeze could cause bleeding, which could interfere with lung function as the blood coats the alveoli and prevents surfactant from working properly for gas exchange. But you could have both types of squeeze at the same time.
I don't think we can look at the lungs and trachea as a simple "shaft and balloon" type of model. Both trachea and lung compress and collapse no doubt to different degrees depending on a number of variables including hydration, blood flow, tissue elasticity, air volume, blood shunt, body temperature, blood viscosity, cardiac output, etc, etc...
But the more flexible the rib cage, the more the lungs will be able to compress and put more air volume in the trachea. Maybe this is the adaptation to pressure that prevents squeeze?
I don't see how this would actually work. If I am inverted at 0m on a full breath, I can assume that both lungs and trachea are at full capacity of air volume. At 10m, TLC is 50% less. If your idea of air seeking the surface holds true, then the air would always move into the bottom of the lungs, as far away from the trachea as possible (in the simple shaft and balloon model). The only way to avoid a complete collapse of the trachea at X depth (where their is not enough air to fill the balloon and the shaft at the same time) is for the lungs to always compress to the point where a minimum pressure is maintained in the trachea. Perhaps this is why plasma eventually seeps into the lungs to prevent them from collapsing further. I am not clear as to whether or not thoracic filling refers primarily to the lungs AND trachea as the mechanism to avoid squeeze. There might be plasma filling in the trachea as well. However, there has also been speculation that at around 200m the trachea would collapse on itself, meaning an unpleasant death for whomsoever goes to that depth.
Interesting ideas.
I still believe that through rapid descents and packing, freedivers create negative pressure situations in the LUNGS which results in pulmonary barotrauma.
Pete
 
D

DrLindholm

New Member
May 31, 2004
14
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Im probably guilty of starting the idea of tracheal squeeze, I showed some pictures at a presentations in 2002 and 2003. The study we did on glossopharyngeal breathing (the "medical" word for lungpacking and reversed packing) is accepted for publication in European Journal of Applied Physiology but I dont know the date.

I would like to stress that the idea of a tracheal origin for many of the "small" bleedings from a breath-hold dive is a theory since it is very hard to prove the exact origin of a bleeding in a diver, after a breath or two blood may have moved around in the lungs even if the origin is the trachea.

Peter Lindholm
 
P

pat fish

staying in the blue zone
Feb 19, 2004
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I found some very good ideas in this thread from a phyiological point of view. Thank you very much laminar. I experienced two milder lung squeezes in the last two years of freediving. And both of them were accompanied by dyspnea/having of short-of-breath symptoms. Wouldn't that implicate that capillaries in the lung tissue ruptured and lead into a disbalance at the surface of alveoli at least as well as capillaries in the trachea (I guess it will remain a mystery until the first endoscopic prove in a chamber or so). Besides of that, I regard the respiratory system as an open-communicating system without any traps in general. Even the smaller bronchioli can still get squeezed when their diameter gets filled by plasma because that plasma is still not in a closed compartement, thus allowing even the smaller bronchioli to compress further to a point where capillaries could rupture there. Any thoughts?
 
samdive

samdive

Mermaid, Musician and Marketer
Nov 12, 2002
3,221
278
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I got a big lung squeeze on my comp dive in Cyprus in 2003. I had a cold anyway and hadn't got past 12m on my warm up - but rather stupidly just decided to storm it down to 35m on my comp dive and deal with the consequences later... lots of orangey froth coughed up and short of breath for several days... really screwed up my static the next day!

anyhow the mixed news is that about a month later I had a bad DCS problem through scuba and as a result of that had loads of x rays and lung function tests done (I had a theory that the lung damage had caused the DCS). Six weeks after the dodgy dive, the doctors could not see anything on the x ray or in the lung function tests to show any damage... so it does not look like this kind of thing is that long lasting.....

however it feels so nasty it can't be good for you so I don't recommend it!

Sam
 
DeepThought

DeepThought

Freediving Sloth
Sep 8, 2002
2,334
410
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I wanted to thank you Laminar for enhancing my undertanding of such cases, Can't give you karma anymore but I rated this thread *****. :)
 
cebaztian

cebaztian

Well-Known Member
Oct 3, 2003
827
177
133
Well doctor Peter Lindholm as customary to scientists your input is no fun at all, since you stay repsonsible and dont try to join us in our speculations ;-)

The key questions seems to be; where does the blood come from?
One place, many places?

Could it be that the ultimate limiting factor for depth is the trachea area.

Peter, you put me in the magnet x-ray and we could see the trachea fold into itself - how far do you think that could be pushed?

Sebastian
Sweden

DISCLAIMER - Please do not use x-ray cameras without proper skilled assistance :)
 
cebaztian

cebaztian

Well-Known Member
Oct 3, 2003
827
177
133
1) packing....it is safe to assume that it will have some effect on blood shift you as you descend.
2)...It is "set up" in the first 20m

Very interesting - and seems to be a lot of sense in it.
And this tells us that packing and frenzel/fattah is truly dangerous if you learn it too "early" in your "career".

Slow seems to be the way to go.

And what if you do SLOOOOOOW negative dives. 1 minute down to 6 meters. That would take away most of the negative effects that Laminar mentions.

Sebastian
Sweden

DISCLAIMER - Too much time spent on internet may harm your eyes and your social life;-)
 
P

pat fish

staying in the blue zone
Feb 19, 2004
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good proposal. But I guess the idea of the combination of higher ambient pressure (centralisation) and pressure in the lower respiratory system is still missing then. You can gradually and slowly build up that lowered pressure in your lungs but without the effect of the pressure of the surrounding water on your peripheral system. I tried many inverted-packed dives in a fun dive week in January this year. My approach was to take time and descend on the reef within 1 minute to max. 10m. But for me the real benefits I found were the increased tolerance to that irritating feeling on the epiglottis. Maybe this would have a conditioning effect to the trachea as well. But as a preparation and prevention for deep inhale dives I'd consider FRC-dives to be superior, because of the pressure resulting in a better centralisation.
One thing I didn't find in the ideas of Pete is the hydration and nutrition aspect. I suppose that beeing overhydrated would favor ruptures of capillaries in pulmonary and/or tracheal tissues as well.
 
cebaztian

cebaztian

Well-Known Member
Oct 3, 2003
827
177
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Excercises in pressure and simulated deep dives are not only there to adapt physicly - for me it is also to mentally get used to the feelings that breatholding and pressure produces. Most of a deep successful dive is actually due to right mental attitude, I would say.

Therefore I am puzzled when reading SAN SAN write the following.

SanSan said:
2 weeks ago for the first time I did -30m and it felt realy good and with no signs of lung squize what so ever and after reading Cebaztiens post I thought great I'll be at 40m by the end of my next trip to the Sea.

I claimed going from 50-65 in a week. Which was followed by posts implying how irresponsible this was. Since it could be dangerous and people could follow.

San san obviously was inspired and without knowing anything about my general health, my my preparations during the previous weeks, my diet, my methods of warming up, my technique, my suit, my method of diving (VWT,FIM,NLT,CWT,CNF), the quality of water e t c. (All these things that what makes a good dive) - He drew conclusions about his own possibilities.

San san talked about moving his PB from 30 to 40. Nothing in my post reveals where my PB is. Also I would say that moving from 30-40 is a bigger challenge than 50 to 60.

Freediving is so complex and mysterious, and we all react so differently to the challenges. One of the most important abilities is to listen and know yourself.

Sebastian
Sweden

PS. Sorry for this preaching type of contrubution but I get disturbed when freediving is judged on moral grounds. And that we should conform to what is the right way of diving. I usually find this kind of debates on scuba sites where a common topic is to between the lines compete in who is the most responsible diver.
 
SanSan

SanSan

New Member
Apr 22, 2005
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Cebaztian, I would probably try to go for 40 eaven if I wouldn't read Ur post. When I did my 30m it was on the end of my diving session so I didn't take another try. Thank god. And also my friend caught up a little blood while diving to 30m so I was also a little afraid of going deeper.
When doing my 30m I had plenty of air and power left so after I forgot a bit about my fiends blood and reading Ur post I decided to go for 40m next time, because U gave me the feeling that caughing up a little blood isn't a big deal. I'm certan I can reach at least 40m but i'll go rather slow now. I'm regulary practicing in the pool but I don't have much experience whith deepth as im a bit far from the Sea :(.
I'm glad this post turned out this way...
 
cebaztian

cebaztian

Well-Known Member
Oct 3, 2003
827
177
133
Yes - this site has taught us a lot. I have learnt so many things that has taken me deeper from just reading on internet.
So San San how do you equalize? How long did the 30 meter dive take?
40 meter means another 20 meters (down and up). How long will that take? And you might just pass your "RV limit"?

Sebastian
Sweden
 
SanSan

SanSan

New Member
Apr 22, 2005
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About my equalising... its the stranges thing to me. A lot of friends ask me that but I allways have to answer: I don't know, I just don't... I learned about equalising when I was 18 and did my scuba curse. But I dove long before that to 10m+ without knowing that U have to compenste but I never experienced any pain so I newer asked. U can imagine the look on my face on the curse when the teacer started to talking about injures of the inner ear and the eardrum... I don't know how I do it I just do it. Maybe it has something to do with my synuses surgery as a kid? I don't know.

My dive to 30m took about 1:20 as I did a short static on the bottom. I wasn't looking at my wathc and it was the only time. I was just to happy :). If I look at my times in the pool I'd say I'd make 40m in about 1:20-1:30.

I'm sure I would pass my "RV limit" at 40m...
 
immerlustig

immerlustig

BlueSkunk
Aug 17, 2002
597
90
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Hi guys,

I am not aware of any sport where bleeding is being accepted as a natural part of progression.

Here in my neighborhood I often meet freedivers on a vacation (1-2 weeks usually), most coming from countries with little access to deep water. The majority of them feel the urge to set a new pb within the time of their vacation and the majority of them is also spitting blood.

If I wanted to improve my downhill skiing I would probably need to spend more than 2 weeks a year on the slopes. Why should freediving be different?

SanSan, spending time doing shallower dives just figuring out how you equalise and what you do generally (technique, relaxation, etc) will be time well spent. Awareness can be practised. There are many factors that can change your susceptibility to squeeze from one day to another and also from one dive to the next. If you are not aware what you are doing and what is happening you might just increase your depth but you will not improve. you needlessly risk injury.

Sure, it is everyones own decision, but take it easy and take your time, I would suggest. There is more than depth that makes a good freediver.

Be safe, man

roland
 
laminar

laminar

Well-Known Member
Aug 13, 2001
1,129
206
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Frenzel/Fattah - a dangerous technique?

The inexperienced or inattentive freediver who learns the Fenzel/Fattah will be able to equalize far deeper than their oxygen limit and will be tempted to go much deeper than is safe. I believe this is very common, especially among those who have no knowledge of the dangers of lung barotrauma or have yet to experience it. For example, a diver who is at 30m and running out of air to equalize will be focused on improving his equalizing. Equalizing is the primary limiting factor. When he suddenly discovers that he can easily jump 10 metres with this new equalizing technique and air doesn't seem to be an issue, then it is likely he will go even further at the risk of squeeze.

On the other hand, using the Frenzel/Fattah single mouthfill technique properly means that during the sub-residual volume phase there is no tension in the diaphragm at all, assuming, of course, the chest and everything inside it is adapted to those pressures. Since the air required for all the remaining equalizations below, say, 30m, is held in the mouth and cheeks, there is no reason to involve the diaphragm at all. I think for someone adapted to diving deep, Frenzel/Fattah is far safer than Valsalva and regular Frenzel (air drawn into mouth from diaphragm for each equalization). BTV would be safe too for those lucky enough to have it work really deep as long as diaphragm movements were not required to move the air into the eustachian tubes.

I agree with you 100% immerlustig!


Pete
 
Wishbone

Wishbone

Paragraph aquanaut
Jan 13, 2002
364
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Hey guys,

As a used-to-be competitive spearfisher, I know some of the stuff you guys are talking about, without getting into the top performance details, but here's a story you may find interesting.
As a son of a spearfisher, I started freediving and hunting recreationally when I was ten. My first comp. was when I was 26, so I was quite experienced at this point. In 2002 I did the whole season of spearfishing competitions here - about 10 - stretched from may to september. Since most of you don't know what a spearfishing competition is here, it's kind of like that - you're dropped in the water for 6 hours and then you're picked up with whatever fish you were able to take. The usual depths are between 8-15m., but sometimes we go deeper.
During the first comp. day of the Nationals (last start for the season), we had really bad weather and I personally didn't feel very well. Nevertheless I did the whole day without any success only to find myself feeling even worse and vomiting from my buoy in the water. After that day I was convinced that I better drop this comp. But on the next day we had fine weather, calm water and everything seemed ok. So I did another 6 hours of almost perfect diving pushing myself to the comfort limit, but not beyond. I scored some fish that kicked me up the ranks so I ended up way infront of my teammates. I felt really tired but happy. The only thing I didn't know was that it's going to be my last real dive.
One week later I suffered a 100% haemo pneumothorax (total lung collapse with heavy internal bleeding), which was filed as spontaneous, even though the ER guys claimed they see such severe cases only after major car crashes. I was literally dead when they did their surgery. After that 50% of the docs were conviced that it's a result of complications from a barotrauma I suffered without even knowing. The other half refused it and called it a genetic issue since they couldn't, just as me, believe that after more than 20 years of diving it would suddenly pop up (or collapse down actually). Well... I did the tests for conectivity tissues disorders and the CT scans and they all came out negative... As a result, I am more and more convinced that a barotrauma complication may be the reall issue. It took me more than 6 months to recover enough so I can go to work and I am completely unable to do any sport besides competitive Monopoly probably. The doctors confirmed once again a month ago that due to the heavy adhesions and the lost of ellasticity in the lung any diving is a big NO for me. Of course I cannot just stop and I already do some very mild snorkeling trying not to go below the 3rd meter... And since I feel a bit better with every year passing, I may return some day to the recreational spearfishing at shallow depths. :wave

But the actual reason I am sharing this with you guys is that whenever I read somebody's question whether he should seek medical help after spitting blood, I get the cold shower feeling. I was convinced the hard way that the human body is quite fragile and even though we learned to do some patching and stitching it's not 100% repairable. I admire all the pros for doing what they feel they have to, but shit happens - no matter how well trained, and how many techniques we've theoretically developed and tested into practice. And when there's an obvious smell of the shit going to happen (like bood in the saliva, wheezing breatheng, any kind of pain or abnormal feeling, whatever) the easiest thing is to go and see a doctor. Otherwise we push our luck too darn far.

Sorry if I bored you with the don't-end-up-like-me stuff... :)

Cheers,

Ivan
 
M

motek777

New Member
Sep 12, 2004
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Ivan, let your case be a warning scream to all irresponsible freedivers.
I've seen a doctor about a week ago. She told me that my life is not in danger - anymore. I should have inhaled oxigen the first week after the incident, when i felt weak and had breathing difficulties. Many times i sensed that "vision nerrowing" feeling what normally comes right before a blackout. Now i still feel little discomfort in my chest, but every day less and less. The doc told me not to lift heavy weight and should stay away from apnea for a month or so.
I'm definately going to be much careful in the future.
 
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laminar

laminar

Well-Known Member
Aug 13, 2001
1,129
206
168
Wishbone,

Wow! Sorry that you had such a horrible experience. Were there any theories on how your lung collapse was precipitated by a barotrauma? Frightening story.

Thanks for sharing that. I hope that over the years you'll see some sort of recovery.

Best wishes,

Pete
 
Wishbone

Wishbone

Paragraph aquanaut
Jan 13, 2002
364
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Thanks guys...
Unfortunately no... They cannot find any real explaination on how exactly it did happen, other than the fact that the freediving is the only thing I did to count as a risk factor.
They only speculated: somehow the tissue of the lung was hurt. Maybe lung squeeze, eh? :) Even though I haven't noticed any blood (not that I checked though). That same place got punctured later forming a one-way valve allowing the air to stay trapped in the pleural space. Each breath then packed more and more air there causing what they call a tension pneumothorax. The air presses the lung not allowing it to fill with air to the point when it's squeezed completely. During the process some larger vessel bursted causing the bleeding.

Later I read an article here called The fear of the ascend or something like that, describing the danger of such thing happening to freedivers. I think the article met a lot of negative comments by the readers of Deeper Blue, cause the author later excused himself that this stuff is only theoretical and if it happens it's very rare. Yeah - like I haven't heard that 1:10000 stuff before... :)

Anyways, thanks for the comments and just be careful. :)
 
G

gianpaoloc

Well-Known Member
Nov 13, 2004
29
5
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This is one of the most interesting threads I read. Thanks to all the contributors for sharing their experiences/speculations.

After reading (most notably Laminar reports and speculations) I have a question: what about variable weight dives? Apparently they disattend all the suggestions made to avoid lung squeezes. They are very fast and bring us very deep (often much more deeper than our pb) quickly. People (e.g., Pipin) went as deep as 170 meters in less than 3 minutes and as far as I know they did not experience any injury. How was it possible. Perhaps the "head up position" helps. Any experience from you? Any idea.

I am personally interested since this summer I plan to use a sled to help adapting my body to deep, in order to further improve my performance in CW.

Bye
G.
 
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