Any experienced divers on here? Trying to do some “troubleshooting” for one of my athletes who ended up passing out and DNF at Coz today.
I know you are not supposed to fly/scuba very close together, he flew Wednesday, Scuba’ed on Thurs (60ft, 2 bottles x 45min), and passed out at the race today. He said he felt very weak, wobbly and couldn’t really function. How bad does flying one day and scuba diving the next screw with your ability to race? Just from what he’s explained, it sounds like he has DCS.
You got to get that guy to a hospital to be evaluated.
For my own curiosity – at 60ft, did he consume 2 bottles in 45 minutes, or did he did he do 1 1/2 hrs and 2 bottles? what ascent protocol did he follow?
Diving after flying is fine (you shouldn’t fly for 24 hours after diving though). It’s very possible he might just be dehydrated, it’s easy to forget to take in enough water while you’re out diving. I doubt it’s DCS… there would be other symptoms within a day or two of the dive (joint pain, itchy skin, headaches)… if he felt fine until the race, it’s probably something else. It never hurts to get checked out at the hospital though.
If he dives regularly he might have insurance through DAN (Divers Alert Network, I have it). Give them a call, they have very knowledgeable people to help with things like this.
You got to get that guy to a hospital to be evaluated.
For my own curiosity – at 60ft, did he consume 2 bottles in 45 minutes, or did he did he do 1 1/2 hrs and 2 bottles? what ascent protocol did he follow?
I hope your friend feels better soon.
I told him to go to the local doc at the resort tonight. From the sounds of it he did 2 dives of 45 minutes @ 60 feet. I don’t know what ascent protocol he followed, and I don’t know how much time between dives. I don’t think he’s dived in quite awhile before this past week. Hopefully the group he dove with would make sure to not let him ascend to quickly, but I don’t know…
He has weakness in the legs, joint and abdominal pain, headache, fatigue, loss of balance, dizziness, vertigo.
He had a horrible bike and ended up passing out on the run - and he was well prepared to go sub-10 (9:30ish).
I’m no diver but I am an AF Pilot and have experience in aerospace phys. The symptoms you described sound very much like decompression sickness. The resort doc might not be familiar. He should go to a proper hospital ASAP.
2 dives 45 minutes in length with 45 minutes between. He took 3 minutes to come up from 60 feet. It’s been awhile for me, but I think it’s a minute for 30 feet, so that should be fine there shrug
It is really hard to believe that anyone planning to do an IM would go diving 2 days before a maximum effort event. I have over 1500 dives and am an instructor and it is hard to believe that anyone can take a dive class and not know that exercise increases the chance of bubble formation. A flight, dives, and an IM. It is amazing that people this stupid survive. This is nothing to screw around with, I have friends with permanent neurological damage from stuff like this.
There is a chamber downtown in Coz. I would bet he doesn’t have DAN dive insurance either, right? I’d get evaluated, well if I wanted to live. Won’t be cheap. Definitely don’t want to fly if he has had symptoms.
edit: btw, resort doc may well not know anything. It is MX, not US. Chamber is the place to go.
There is a condition known as exercise induced decompression sickness. It’s pretty well documented that no matter how careful you are scuba diving you’ll still have some nitrogen bubbles in your blood. It can be dangerous just going for an easy run after diving let alone a full triathlon. Hard to say what’s going on with your friend. If he does have the bends he’d better get checked out before flying as that can cause real problems. Good luck and keep us posted.
It is really hard to believe that anyone planning to do an IM would go diving 2 days before a maximum effort event. I have over 1500 dives and am an instructor and it is hard to believe that anyone can take a dive class and not know that exercise increases the chance of bubble formation. A flight, dives, and an IM. It is amazing that people this stupid survive. This is nothing to screw around with, I have friends with permanent neurological damage from stuff like this.
There is a chamber downtown in Coz. I would bet he doesn’t have DAN dive insurance either, right? I’d get evaluated, well if I wanted to live. Won’t be cheap. Definitely don’t want to fly if he has had symptoms.
edit: btw, resort doc may well not know anything. It is MX, not US. Chamber is the place to go.
Tell him to get to the chamber downtown. They are VERY good at distinguishing real versus false DCS (I speak from personal experience for that particular chamber). Even taking 3 minutes to ascend is a bit fast if he didn’t do a deco stop.
And yes, exercise induced decompression sickness is taught in even OW courses, but they also say to have a 24 hour window after diving before exercising. Presumably that was calculated based on “normal” exercise expectations (a jog, a tennis game, etc), NOT an Ironman for which different standards would apply.
Your friend’s decision may not have been particularly bright, but it is understandable - Coz is an incredible place to dive and I think the temptation would have been overwhelming to me, too.
I would be emphatic in telling your athlete to be seen by a a medical expert who understands diving as others have suggested. This sounds like it could be a potentially bad situation if he just gets on his flight in a day or two.
While it was pretty stupid to dive a few days before an ironman, the bigger point is his safety right now.
I’m a certified diver since 1976, former assistant instructor and well over a thousand dives from tropical reef watching to deep cold water wrecks.
I won’t get into the physiology, you can google it, but you’re not supposed to exercise after diving. Wait a minimum of 24 hrs before flying after a dive. You’ll generally be affected more by deeper dives than shallow (60 ft is relatively shallow). DCS is a possibility, but it could be other factors. Diving is surprisingly strenuous so he could just be over exhausted. If he is still having problems get medical attention ASAP.
Diving after flying is a known risk factor for DCS, due mainly to hydration issues. Exercise after diving is generally not a good idea. Add them all up, and it may be a problem.
Diving on Thursday, racing on Sunday, I don’t necessarily see a problem with that from a DCS standpoint, nearly 72 hours. I wouldn’t do it from a racing standpoint, but whatever. Also, if there were no symptoms between Thursday and Sunday when they arose, I would question whether it’s DCS, but I’d be interested to know if he went to the clinic in town, as noted they are world class and would know more than anyone here.
Diving after flying - generally OK if you hydrate
Flying after diving - not for 18-24 hours, depending on profiles, although DAN is now recommending shorter no fly times
Exercise before diving - recent studies show exercise 24 hours befor diving may help reduce bubbles
Exercise after diving - no way
Many many people have gotten “undeserved” hits from doing shallow and/or short dives. It’s not always a science, and there may be other issues, such as ascent rates, or even a patent foramen ovale which contribute to DCS
ETA - speaking of stupid, a friend on anotehr boat had a girl doing IM Coz. On the surface interval on Sunday, she got out of the boat and actually swam a half mile or so…
Yeah, more details/info would be great. Hope your friend is ok? We’re going to Taupo for IMNZ in March and want to do some diving afterwards… so any datapoints help.
It did end up being DCS, I still don’t have all the specifics, but he did tell a few other people I train something about nitrogen bubbles. I have not had a chance to meet with him since he’s been back, and he’s beating himself up quite a bit still. I’m hopefully going to see him later this week, and will update once I’ve talked to him.
I would like to hear the outcome on this because I am considering signing up for cozumel and I always go diving when I am there. Plan would be to do the race and dive the week after
I also would love to hear more about the outcome of this situation.
I’m an avid diver and also raced IM Coz this year. Honestly while many people are harping on the athlete in question for his decision to dive almost 3 full days before an IM, I would have thought very little of it, especially if you told me they were relatively shallow (65 ft) dives. I actually dove on Tuesday and went for a 6 mile run later that day and raced on Sunday, however, my dives were in the cenotes (shallow dives with very controlled ascents and relatively low nitrogen loading). This didn’t seem like a bad idea to me at all, and I had no adverse effects from it.
I’m curious to hear more about the diagnosis and treatment (did he undergo a chamber treatment?).
While the situation is horribly unfortunate for your athlete, it is a great opportunity for the rest of us to learn, as DCS is not nearly as Black and White and easy to model as we would like it to be.
I honestly don’t think diving thursday and racing sunday is contraindicated. There may have been additional issues, and probably were, dehydration after flying, humid climate, diving dehydrates you more, etc. I would also find it very odd if he had absolutely no symptoms Friday and Sat and then suddenly had them Sunday. DCS sets in much faster. From a Navy table, only 2% of cases between 24 and 48 hours:
Onset of DCS symptoms
Time to onset
Percentage of cases within 1 hour 42%
within 3 hours 60%
within 8 hours 83%
within 24 hours 98%
within 48 hours 100%
You got to get that guy to a hospital to be evaluated.
For my own curiosity – at 60ft, did he consume 2 bottles in 45 minutes, or did he did he do 1 1/2 hrs and 2 bottles? what ascent protocol did he follow?
I hope your friend feels better soon.
x2
The dive profile will tell everything. If he did 2 dives of 45 minutes @60 feet then he has strict guidelines to follow as a repetetive dive. His body has residual nitrogen that it needs to get rid of before the second dive. The other thing is the time between the dives.
For example the Navy Rev 6 manual
a 60/45 dive the person comes up and they are a “H” diver. Following the repet table if they had a surface interval of 4hrs between dives and then he goes back to 60 feet then he already has :24 minutes against him. Makes the second dive of 45 minutes. You must add the two times and 45+24= :69 minutes. at 60’ :69 minutes is off of the prescribed chart and the diver is at increased risk of DCS.
Diving before flying is ok in this case cause they dove the next day. Flying after diving for those who mentioned is ok at 24 hrs. You can even shorten those times if you know how to read the manual but a good rule of thimb is 24 hrs.
DCS can onset in any length of time, it is nitrogen that is in the blood stream trying to get out. Usually the time of onset as well as the symptoms help the diagnosis. In any case, yup the guy needs to go into the tube and start recompression. The athlete mentioned being weak and not functioning, he may have felt those symptoms and just thought he was a little tired from the dive so my guess is he knew he was a little off and just didn’t recognize it as a symptom.