Michael McFadyen's Scuba Diving - Severe Dizziness
Thursday 2 September 2004|
In the afternoon of 2 September 2004, I left Sydney for Cairns with 11 other members of the St George Scuba Club and at 12:10 am the next morning flew onto Guam where we arrived at about 4.30 am. We had to wait another four hours for the connecting flight to Chuuk. I did not get much sleep, either on the flight or at the airport, but got maybe a couple of hours on the plane.
Friday 3 September 2004
We arrived in Chuuk to a warm day and were met by the owner of the Truk Stop Hotel, Bill, and his dive organiser, Warren. We settled into our rooms bought some supplies and after lunch, headed out for the first dive of the trip.
That day I dived the Heian Maru, maximum depth 30.7 metres, time in water 61 minutes, with one minute decompression indicated on my Aladin Air-Z computer (which cleared before I came up to five metres). I did five a minute safety stop.
Saturday 4 September 2004
The next day the first dive was the Gosei Maru, maximum depth 35.8 metres, time in water 66 minutes, with no decompression indicated on my Aladin Air-Z computer. I spent 35 minutes shallower than 10 metres and 12 minutes at five metres. After a surface interval of 90 minutes, the second dive was the Fujikawa Maru, maximum depth 33.0 metres, time in water 57 minutes, with six minutes decompression indicated on my Aladin Air-Z computer which dropped to four by the time I got to three metres. Once the computer cleared, I spent 12 minutes at three to five metres.
It should be noted that this day I felt a bit sick in the stomach, with a bloated stomach and I had not been to the toilet since the day before (I think). After the dives I had a sore upper stomach which I felt was because of the bloated stomach and the fact that my wetsuit was extremely tight (it was very old).
Sunday 5 September 2004
I still had not been to the toilet since Friday.
The next day the first dive was the Nippo Maru, maximum depth 43.1 metres, time in water 60 minutes (27 minutes on wreck, average depth about 36 metres), with decompression of four minutes at six metres and 15 minutes at three metres. I spent an additional 13 minutes at three to five metres. This day was extremely hot, with no wind. After a surface interval of 120 minutes, the second dive was the Kiyosumi Maru, maximum depth 28.0 metres, time in water 55 minutes, with two minutes decompression indicated on my Aladin Air-Z computer which dropped to nil by the time I got to five metres. I spent 20 minutes shallower than 10 metres, with 14 minutes at five metres.
After the dive, it was very hot and I started to feel very faint and funny. I was very hot and even though I had been drinking lots of water, I was burning up. I had been peeing heaps, more than I thought I should considering how hot it was and how much I was drinking. I was now a bit dizzy and we had run out of water on the boat.
By the time we arrived at the wharf (about 3.30 pm) I was in a bit of trouble. I could not walk due to the dizziness and threw up as I attempted to get off the boat. In the end, I had to be almost carried off the boat and was placed on the gear trolley and wheeled back to the hotel. Again, I had to be carried up the stairs as I could not stand.
Once on the bed, I was not too bad as long as I kept my eyes closed. The only thing was that I was still very hot and even the application of cold towels to my head did not cool me down. I drank a little water but I was not getting better. Around this time my girlfriend Kelly and another friend Louise commented that back on the boat I looked like I had a rash on my stomach and on the backs of my thighs. However, the thigh rash seemed to have disappeared by then and it may have been simply caused by the heat.
At this time I thought that I must have heat stroke, because of how I felt. However, the longer the time went on that I did not recover led me to suspect that this was not correct. At about 7.30 pm it was decided to put me on oxygen and after I had been on this for some time, I had no improvement (in my view) whatsoever. About 8.15 pm it was decided that I should go to the hospital as it was obvious I was not going to get better quickly. I threw up again as I was put into the mini-bus.
At this stage, I should point out that back in 1998 when in Santo, I had a similar experience of dizziness (see separate article on this incident). This cleared almost totally with a few hours and was later confirmed to have been a rupture of the round window between the inner and middle ears. The difference this time was that I did not have an ear that felt full of liquid, I had no hearing loss, no ringing in my ear and it was not getting better.
I was admitted to the hospital at 8.30 pm where I was examined by Doctor A. Galindey. His comments were that I was "conscious, coherent, co-operative, [I cannot read the next bits], not in acute distress". My vital signs were taken: - blood pressure 110/70 (normal for me), heartbeat of 88 (a lot higher than normal for me) and respiratory rate of 16. By this time the rashes on the backs of my thighs were gone but there was still a rash on my stomach. My stomach was tender to touch. A neurologic examination showed that I was oriented to three spheres and was dizzy. I had well co-ordinated but weak muscle response. Other things were also normal. The only problem was when I sat up for one of the tests I threw up again. I also had some soreness on the upper arms but this was I am sure related to the very tight wetsuit that I had been using for over 20 years and which had shrunk (and I had grown).
After this I was put on a saline drip and given one litre every two hours which was repeated when the first one was empty.
A more senior doctor was sent for and Dr Herlip Nowell arrived. After a while he decided the he would contact DAN for advice. After speaking to DAN, I was sent to the new Hyperbaric Chamber which is down near the Blue Lagoon Resort. I arrived there at about 11 pm and threw up as I left the ambulance.
At 11:55 pm the treatment started. I was taken to a depth of 18 metres. Normally you would expect some immediate improvement in condition but I was still as dizzy as when I first entered the chamber. I was kept at 18 metres for 45 minutes. All the time in the chamber I was breathing 100% oxygen for 20 minutes with a 5 minute rest followed by oxygen again. The next stop was 9 metres. The treatment was supposed to be a 25 minute stop at 9 metres but it was decided to extend the treatment by two lots of 20 minutes. The total time in the chamber was three hours. I left it just after 3 am. This was an extended Standard Table Five.
The treatment in the chamber was provided by Larry Bruton under the direction of DAN specialist, Dr Chin-Thang Lee in Malaysia. At the end of this treatment I felt no better than when I entered the chamber.
We went back to the hotel and I immediately slept for about six or so hours.
Monday 6 September 2004
I felt a little better when I awoke, but I was still unable to walk.
Dr Nowell came to the hotel in the morning and examined me. Dr Lee decided that I needed another treatment and so I underwent a Standard Table Six which lasts for almost five hours. This was 80 minutes at 18 metres and the remainder at 9 metres (less ascent times). I entered the chamber at 3.55 pm and left at 8.46 pm.
Once again, I had no great improvement in my condition, although I was a little better, probably because almost five hours had passed since I entered the chamber.
I did not feel like eating so I went to bed when we got back to the hotel. I had a very good night's sleep.
Tuesday 7 September 2004
I felt even better when I got up this morning. I could now walk unaided, although I was still a little wobbly. I could stand still with my eyes open and not be sick.
That morning I passed my first water since Sunday afternoon, even though I had been drinking water all the time when in the chamber and back at the hotel. Later that morning I went to the hospital and saw Dr Nowell again. He did some tests and I seemed normal, although I could not walk a straight line. After Dr Nowell spoke to Dr Lee, Dr Lee decided that I needed another treatment.
I again needed to be assisted to the car although I could walk basically unaided. I still had to lie down in the car with my eyes closed to avoid being sick. At 11.10 am I entered the chamber for a Standard Table Six and this time spent a total of four hours and twenty minutes at depth, including 95 minutes at 18 metres and three hours at 9 metres. Again, I felt no improvement as a result of the treatment.
That night I ate my first food for about 56 hours and even had a couple of beers. I could walk without assistance and only needed to steady myself occasionally against the wall.
Wednesday 8 September 2004
In the morning I felt really well. I considered was that I was 98% okay at this time, the only problem being that I felt a bit dizzy when being driven in a car. I even went for a walk up the road with Kelly.
Despite how well I felt, Dr Lee decided that I should undergo another treatment. I entered the chamber at 3.05 pm and did another Standard Table Five treatment. After the treatment I felt almost 100%. I feel - again- that this small improvement was because of the time that had passed rather than the treatment.
Thursday 9 September 2004
The next morning I felt 100%.
What was the Cause?
Was I bent? Who knows? Inner ear decompresssion sickness (DCS) has symptoms similar to what I suffered. However, ear trauma can also give you the same symptoms but as mentioned above, you should have a loss of hearing, ringing in your ear and a feeling of fullness in your ear. I did not have any of this.
Dr Lee's comments in an email to Mr Bruton dated 13 September 2004 are "the history of ruptured round window is a [sic] inner ear Barotrauma - that may account for his dizziness". Dr Lee advised me not to dive for a month.
On returning to Australia I contacted Dr Simon Mitchell in New Zealand. Dr Mitchell is a noted expert in diving medicine. His view was that it was possibly Inner Ear DCS and that it may have been caused by a patent foramen ovale (PFO). This is where the link between the right and left sides of the heart (which is present when you are a foetus but which should close permanently before birth) is partially or fully open. This permits a portion of your nitogen enriched blood to bypass the lungs during ascent meaning that the correct amount of nitogen is not removed from your blood before surfacing. His suggestion was that I not dive for about two months and if it occurred again, to get tested for PFO.
All I can say is that I do not think that any improvement in how I felt came from the treatments, rather that I got better as time went on. It should be noted that all medical books on diving illnesses state that it is extremely rare to have inner ear DCS when breathing air. Nearly all such cases are when people are using helium mixes.
Another possibility may be "Tullio phenomenon". This is where very loud sounds cause damage to the ear (tympanic membranes - the ear drum). Three weeks before this incident, I did a dive at Swansea Bridge on the Central Coast of New South Wales. During this dive, a pile driving machine was hammering wooden piles into the seafloor during repairs to the bridge. This was very loud and uncomfortable. Perhaps it damaged my ear a bit and it did not show up till later. In Diving and Subaquatic Medicine on page 388 (see references below), a case is given where a person suffered this (albeit in a decompression chamber). This person was far more sensitive to noise in the damaged ear. When I went snorkelling a few days after I stopped being dizzy, the water lapping at my head was annoyingly loud, something that I had not really thought about until I read about this case.
I have since spoken to two non-diving friends who have related to me incidents where they became so dizzy they could not walk and were vomiting. In both cases they did not recover for a couple of days (it took me two to three days). In both these cases, they had an ear infection. Personally, I think that perhaps my problem was caused by a combination of illness (ear infection, stomach bug) and the extreme heat of the day. However, I will never know for sure.
Another possibility is that it was vestibular neuronitis which is probably caused by a virus. It may occur as a single, isolated attack of vertigo lasting several days, although many people have additional attacks of milder vertigo for several weeks thereafter. The first attack of vertigo is usually the most severe. The attack, which is accompanied by nausea and vomiting, lasts for 7 to 10 days. This corresponds with what happened to me.
As can be imagined, this incident was the end of my diving for the holiday. I did five dives and missed 17!
I did not dive for six weeks, two weeks more than recommended by Dr Lee and two less than Dr Mitchell suggested. My first dive back was on 16 October 2004. This dive was to 28 metres but I did a short bottom time and longer than normal safety stop. My next dive was a very shallow dive the next day and it was to be another two weeks before my next dive. Since then I have done 14 dives (till 25 November 2004), including a couple of decompression dives and one dive to over 42 metres with considerable decompression. I have had no problems, although I must admit to being a bit nervous on the first few dives.
Thanks to my partner Kelly Jandik (now my wife), longtime dive buddy Eddy Labour and his partner Louise Crowell who spent considerable time waiting for me at the chamber as well as Phil Rose, Bruce Graham and others who attended to me before and at the hospital.
Deeper into Diving by John Lippmann
Diving and Subaquatic Medicine (3rd Edition) by Carl Edmonds, Christopher Lowry and John Pennefather