Jean,
I include here some stuff collected on an inquiry in 2002 on the list
re a case of bends, some stuff on nitrogen rx since the etiology of
damage is too much blood nitrogen. Of course, nitrogen rx may have
nothing to do with this case, but thought it might be useful background.
Here's an interesting snippet from the below:
"..Nitrogen narcosis occurs in divers, when blood nitrogen levels
become raised. Various symptoms occur including hallucinations,
paranoia, impairment of mental function and inco-ordination. It has
been found that divers suffering from the 'bends' in warm water
experience euphoria and pleasant sensations, while those in cold, dark
water experience panic, fear, anxiety and paranoid delusions of danger.
Euphoria confounds reason to the extent that divers have been known to
remove diving gear in order to experience 'the freedom' of a fish. .."
Referenceworks searches (unsorted for spurious):
Embolism/embolus/thrombosis/clot [rem] euphoria/elated [rem] (thinking
[sen] difficult)/dullness: agar.8, am-c.8, 2bell-p.149, 2carc.196,
caust.8, chin-s.8, chlam-t., coca8, cortiso., croc.8, ferr.8, fl-ac.8,
gels.8, graph., hippoz.8, ign.8, iod.8, kali-i.8, lsd, meli.8, nat-m.8,
nux-m.8, nux-v.8, oena.36, 3Op.8, 3Phos.8, plb.36, ser-ang.188, spect.,
stann.8, sul-ac.8, sulph.8, tarent.36, thuj.8, thyr., 2visc.119
Of these, Am-c is a nitrogen compound, as ammonia is NH3.
Euphoria/elated [rem] (thinking [sen] difficult)/dullness: absin.188,
adam.222, agar.8, agath-a., agki-p., aids, am-c.5, androc.222, anh.149,
aran-ix.188, arg-s.205, 2asar.8, aur.8, bad.36, bamb-a.1184, bani-c.,
bell-p.85, benz-p., berb.8, betul., c-di-o.205, cann-i.8, 2carc.196,
caust.8, cench., cere-b.36, chin-m.85, chin-s.8, chir-f., chlam-t.,
chlor.8, chloram.149, choc.222, cob-n., coca8, coenz-a.232, coff.,
con.8, cortiso., croc.8, cur.8, cymbo-ci., dicha.149, dronab., ephe.85,
ery-a.8, falco-p., ferr.8, ferr-i.8, fl-ac.8, gels.8, germ., gink.227,
graph., haliae-lc.222, halo., hepar-s.232, hippoz.8, hydr-ac.36,
hydro-c., hydrocort.223, hydrog.222, ign.8, ignis194, iod.8, iodof.8,
irid.8, kali-i.8, kali-p.188, kola.1184, lac-del., lac-gl., lac-h.214,
lac-lox-a.204, lap-c-b., lap-mar-c.194, lsd, luna85, mag-m.8, mand.,
mang-p.232, mant-r., meli.8, merc-i-f.8, musca-d., myos-a.232, nat-m.8,
nat-pyru.232, nit-ac.8, nux-m.8, nux-v.8, oena.36, onop.188, 2op.36,
ox-ac.36, 3Ozone227, pancreas232, phos.8, 2pip-m.36, plat.36, plb.36,
plut-n., posit., psil., pyrid-hy.232, pyrog.56, querc-cyn., ratt-r.215,
ruby, salx-a., sant., scorp.223, senec.8, ser-ang.188, sol, spect.,
spong.8, stann.8, sul-ac.8, sulfa., sulph.8, supren.232, tarent.36,
tela, teucr.2, ther.8, thuj.8, thyr., til.36, trio.149, 2tung.252,
ubul., valer.2, visc.119
complete 2000
MIND; ELATED (25) : agki-p., bell-p., caust., chlor., coca, ephe.,
ery-a., falco-p., fl-ac., haliae-lc., hydrog., iodof., kali-p.,
lar-ar., mant-r., merc-i-f., nux-m., ox-ac., ozone, plat., senec.,
sul-ac., teucr., valer., visc.
MIND; EUPHORIA (30) : androc., ange-s., anh., aran-ix., asar., bani-c.,
chloram., cob-n., cortiso., cymbo-ci., dicha., falco-p., germ.,
haliae-lc., halo., hydr-ac., hydro-c., kola., kres., lac-lox-a.,
lap-c-b., lap-mar-c., mand., mant-r., ozone, palo., perh., thyr.,
til-c., tung.
Ozone is interesting in above rubrics, as it has "dreams of diving;
euphoria, and dullness.
A Curiosity: A Referenceworks search on diver and sea diving yields 2
remedies with DREAMS of diving, interestingly both "gas" remedies: CO2
(klein recent proving) and ozone (I think Schadde proving).
Namaste Jean,
Andy
==============================
Berkeley Digby, rfwrks, under am-c
NITROGEN, NITRATES & NITRATES
Nitrogen is found in the protein of all living things. It is the
sixth most abundant element. It makes up 78% of the atmospheric gases.
Nitrogen gas is composed of two nitrogen atoms which form a powerful
bond that is not easily broken. It is thus relatively inert, not
combining easily with other elements. It forms only a few compounds. It
combines with hydrogen to form ammonium, and oxygen to form nitrous
oxide (laughing gas). Combined with carbon, it forms highly explosive
compounds (nitro-glycerine, gunpowder, T.N.T. etc.)
In gaseous form it is found in the sun, in volcanic gases, in many
meteorites, in coal beds, and in some hot water springs. It is found
compounded in saltpetre, in rain, and as ammonium salts. Nitrogen is
fundamental to the creation of amino acids which form the basis of all
life forms. In the nitrogen cycle, plants build up their protein
structure from nitrogen absorbed from the earth and from the air, and
in turn become a supply of nitrogen for animals. Most fertilizers are
made with a base of nitrogen or phosphorus, both of which have a
tremendously stimulating effect on plant growth. Plants that have a
close association with nitrogen are the leguminous plants (pea family),
with their kidney shaped beans. These include such plants as alfalfa,
which is frequently used as a rotation crop to 'fix' nitrogen into the
soil, thus improving the quality of the soil for future crops.
In the human body, the kidneys are the organs that govern the
physiological nitrogen cycle, processing nitrogenous waste, and holding
onto nitrates or eliminating them via the bladder. The function of
nitrogen in human physiology remains a mystery, although biochemists
have proven that there is significant quantity of nitrogen in the
blood. Chinese medicine associates the kidneys with maintaining the
balance of yin and yang, storing of 'life force', and support of the
sexual organs and the hormonal system. This 2000 year old assertion is
borne out by relatively recent physiological knowledge of the kidneys
function in maintaining the electrolyte balance within the body fluids,
ie. the ratio of positive to negative ions or acidity to alkalinity.
They also preserve the balance of male (testosterone) and female
(oestrogen) hormones via the adrenal cortex. Excess acidity with
consequent arthritic or gouty tendencies or an imbalance of hormones
leading to hirsuitism in females, or femininism in males are directly
connected with the kidneys (sycotic phenomenon). Again from Chinese
medicine we learn that the emotions of the kidneys relate to fear,
survival, the fight or flight mechanism, and libido through the
adrenal/steroid axis.
In certain esoteric teachings the kidneys are seen as the organs
that governing activity of the 'astral body', otherwise called the
'emotional body', with the pancreas governs the physical body, the
liver governs the 'etheric body', the lungs the 'mental body', and the
heart harbours the 'soul'. The astral or emotional body, rooted in the
kidneys is that part of the psyche that registers pleasure and pain,
desire and aversion, euphoria and paranoia - and sensual pleasure. Like
all predominantly sycotic remedies, the nitrogens have their sphere of
influence in the 'astral/kidney' complex.
The nitrogen compound, ammonium (NH4) has been linked to the
creation of the earth's first life forms. In scientific experiments
with ammonia, amino acids have been created. Before the planet earth
developed an oxygen rich atmosphere, ammonium gases swirled around the
earth, and organisms were dependent on nitrogen for respiration. As
oxygen replaced nitrogen, these primitive life forms were forced to
dive deep into airless crevices to survive. They were the forebears of
the anaerobic bacteria that we know today - tetanus and clostridium
botulinum. These are some of the meanest bacteria in existence, causing
extreme suffering with dreadful pains, cramps and convulsions.
------
Nitrogen narcosis occurs in divers, when blood nitrogen levels
become raised. Various symptoms occur including hallucinations,
paranoia, impairment of mental function and inco-ordination. It has
been found that divers suffering from the 'bends' in warm water
experience euphoria and pleasant sensations, while those in cold, dark
water experience panic, fear, anxiety and paranoid delusions of danger.
Euphoria confounds reason to the extent that divers have been known to
remove diving gear in order to experience 'the freedom' of a fish.
------
Nitrous oxide - a gas which has been used as an anaesthetic,
induces a state of insensibility to pain, and loss of emotional
inhibition. There is euphoria and mild hysteria, with laughing and
sometimes crying. Thus it is called 'laughing gas'.
Amyl nitrate is a substance that has been traditionally used as a
palliative and preventive of angina pectoris. This gas blocks
inhibition or relaxes the smooth muscles, thus causing arterial
dilation with a rush of blood to the head and face. It has also been
used as a 'pleasure drug', taken to relax inhibitions, increase sexual
pleasure, and prolong erections.
Liquid nitrogen is used to burn the skin in the treatment of skin
cancer.
Here is a distillation of key concepts about the nitrogens, which
may be significant from a homoeopathic point of view:-
Polarity of enjoyment and pleasure seeking juxtaposed with
paranoia, distrust and survival. Fluctuations between euphoria and
fear. Closed and alone (Nitrogen doesn't combine easily with other
elements). May get close sexually and sensually, through sharing
pleasure but not too close to others, because of an underlying level of
distrust. Fear and survival. The theme of being embodied, physical,
sensual (nitrogen builds bodies - it is the basis of all living
proteins)
Nitrogens have an expansive and explosive tendency. Nitrogen is
the key explosive factor in TNT, Gunpowder and fertilizer bombs.
Ebulliations or blood, flushes of heat, explosiveness and
expansiveness, with a dislike of being contained, are found in the
nitrogen compounds, eg. Argentum Nit - hot flushes, and fear of closed
places, must sit near an exit. Nitrogenium has the same fears. Need for
space and freedom (as in nitrogen narcosis and Argentum Nit.) Euphoria,
relaxation and pleasure (nitrogen narcosis and amyl nitrate)
Uninhibited, sensual, sexual (see nitrous oxide and amyl nitrate)
Laughing and crying - hysteria (nitrous oxide) Fear, paranoia and
anxiety. Distrust and fight for survival (nitrogen narcosis)
Malicousness, defiance, and survival urge (nitrogen dependent anerobes)
Burning and excoriating (liquid nitrogen)
From a miasmatic point of view the nitrogens appear to be
predominantly sycotic and secondarily syphilitic and carcinogenic
(Nitric acid in particular). Sycosis is the miasm which belongs to the
water element with its focus on feelings, sensuality and fear; and its
disturbances of the kidney/bladder/hormonal system, and mucous
membranes of the body. The 'firey' ebulliations of blood and cardiac
affects of some of the nitrogens (Amyl Nitrate, Glonoine) and the
ulcerative destructiveness of Nitric Acid suggest the syphilitic miasm,
which belongs to the the fire element.
Important nitrogen based remedies are Nitric acid, Nitro Muriatic
Acid, Argentum Nit, Ammonium Carb, Ammonium Mur, Kali-nit; Calc-nit;
Nat-nit; Amyl Nitrate, Pic ac; Glonoine, Gunpowder. If their mental
syptoms are closely studied many of the above characteristics will be
found. The miasmatic bias of the nitrogens, considering sensuality,
sexuality, fear and distrust, is Sycosis.
Bends
The "morbific influence" seems to be the excessive load of inert
nitrogen in the form of large bubbles in bloodstream-causing mechanical
occlusions and pressure damage. So the injury seems to be more
mechanically than chemically mediated.
Decompression Sickness
The "bends" is a condition that is today
readily associated with SCUBA diving - the name having been used
originally to describe
the physical effects caused by the pain
suffered by workers returning from pressurised enclosures called
'caissons' during the
construction of bridges in the 19th century.
The modern term for the bends is decompression sickness or illness (DCS
or DCI).
Effects were also termed the "chokes",
"staggers" and "niggles" depending on the symptoms shown.
The British Hyperbaric Association have
produced a credit-card sized 'Diver Help Card', which gives a summary
of the main
symptoms along with first aid measures and
emergency contact information for the UK. It can be purchased for a
nominal fee
from the BHA. Divers who have undergone
treatment at the Hyperbaric Medicine Unit may also request one from
nursing staff.
Other agencies, such as the Divers Alert
Network (DAN), supply similar cards.
Signs and Symptoms
Nausea, weakness or fatigue.
Itching, rash or lumps.
Joint, muscle or abdominal pain.
Chest pain or coughing.
Visual disturbances.
Memory loss, lack of co-ordination or
vertigo.
Numbness, altered sensation or tingling.
Unconsciousness.
Any presenting symptoms should be assessed in
relation to the diver's specific circumstances. If in any doubt,
contact the
appropriate service - see the contact section.
First Aid
Initial treatment will depend on the severity
of presenting symptoms and casualty's history.
Safety first - do not place yourself at
risk of becoming another casualty.
Seek help - alert the emergency
services if required.
Lay the casualty down - keep them
comfortably cool and dry but beware of hypothermia.
Encourage fluid intake (aim for 1 litre
per hour) - if the casualty has a reduced conscious level or has
difficulty in swallowing then avoid giving oral fluids. If available,
intravenous fluid therapy is preferred.
Administer high concentration oxygen if
possible - never give Entonox.
Monitor for deterioration and record
observations.
If unconscious, place the casualty in
the recovery position and ensure airway is open.
Do not disassemble the casualty's
equipment - it may be requested for inspection later.
Do not assume
that the closest chamber is the best option - contact the appropriate
service first.
Classification
As stated by Boyle's Law, ascending towards
the surface results in a reduction in the pressure of the gases within
the body and an increase in volume. In the case of oxygen the
body quickly reabsorbs the extra volume as
the cells use it up. However, the body cannot use nitrogen so unless
enough time is allowed to enable it to be excreted through the lungs
any collection within the body's tissues can
increase in volume to the point where small bubbles are formed. These
bubbles can lead to the formation of emboli (singular: embolus)
that cause adverse physiological effects by
impeding blood flow, damaging tissues or exerting pressure on nerves.
Bends can be classified as either Type 1 or
Type 2. The different classification reflects both the effect and the
severity of the condition, although it is probably easier to initially
class
all divers with symptoms simply as having DCS
due to its progressive nature.
Type 1
The label 'Type 1' is used when the bubbles
affect the nerves in the body's joints and soft tissues resulting in
localised pain ("niggles") and stiffness. It is this effect that
originally led
to the condition being termed the "bends".
Symptoms may be mild or even undiagnosed. If left untreated it may
progress to 'Type 2' DCS, especially if further dives are undertaken.
A more serious type of "skin bend" is 'cutis
marmorata' resulting from the development of bubbles within
subcutaneous tissues. Symptoms include mottling of the skin and
discolouration. This can indicate the
development of more serious bend and should be treated as an emergency.
Type 2
'Type 2' decompression sickness results when
nitrogen bubbles emerge, or are transported to, the central nervous
system (CNS) - which consists of the brain and spinal cord.
Symptoms are similar to those caused by a
'stroke' and can include numbness, weakness, reduced mental function
and unconsciousness. More than half of those diagnosed will be
classified as Type 2.
Type 2 DCS can also affect the respiratory
system if an embolism occurs within the blood vessels supplying the
lungs (pulmonary vascular tree). Symptoms include coughing and
substernal pain. Although comparatively rare
the condition may deteriorate, therefore urgent treatment is required.
The "staggers" is an old fashioned term for a
'vestibular bend'. The vestibular area is a part of the inner ear
responsible for balance. Emboli can interfere with its function
resulting in
vertigo, dizziness, tinnitus, nausea and
nystagmus.
Arterial Gas Embolism
A particularly serious SCUBA diving related
problem is Arterial Gas Embolism (AGE). These emboli can form if a
rupture occurs between the gas filled spaces and the blood vessels in
the lungs.
The most likely reason for a diver to suffer
from an AGE is breath holding. If, for example, the diver had five
litres of air in their lungs at a depth of 20msw and ascended rapidly to
the surface without breathing out - the
volume in the lungs would equal eight litres at 10msw and 16 litres at
the surface. The tissues within the lungs are not able to contain such a
large volume of air and are therefore likely
to rupture leading to gas emboli entering the blood vessels.
The gas emboli only have a short distance to
travel from the lungs through the heart to the brain, where serious
damage can occur. The affected diver will probably lose
consciousness suddenly or may have seizures
or profound weakness. This is a life threatening condition that
requires urgent hyperbaric treatment and intensive care support. Brain
injury is not limited to the immediate area
around the emboli because damage spreads to surrounding tissue due to
swelling.
Treatment
Even in the absence of obvious symptoms,
certain things may suggest the possibility of decompression sickness.
These include ascent rate (i.e. faster than normal), depth of dive,
length of dive, length of time since last
dive, number of repeated dives, dive profile (i.e. the dive depth
represented along a time base) and predisposing factors.
The definitive treatment for any form of DCS
is recompression in a hyperbaric chamber in order to reduce the size of
(or completely dissolve) any existing bubbles. In addition, 100%
oxygen should be given in order to speed the
excretion of nitrogen molecules from the body. Symptoms may persist due
to existing tissue damage and the accumulation of blood
cells, etc, around the points where bubbles
were situated.
At the Hyperbaric Medicine Unit in Aberdeen
the most common therapy for bends is based on the U.S. Navy Table 6
profile. In
this treatment the patient is compressed to
nearly three times normal atmospheric pressure, which equates to a
depth of 18msw.
If the patient's condition is not improved
near the completion of a table 6 treatment, the depth may be increased
to 30msw -
necessitating a change to a TT30 table
utilising a helium / oxygen breathing mix called Heliox (HeO2).
Predisposing Factors
The risk of developing decompression sickness
depends on many factors, most of which are not yet clearly understood.
Some
of these are discussed below - click on a
link or scroll down the page.
PFO
Flying
Exercise
Smoking
Alcohol
Obesity
Dive profile
Temperature
Breathing gas
Age & gender
Patent Foramen Ovale (PFO)
One of the most significant predisposing risk
factors in DCS is a physical abnormality of the heart called Patent
Foramen Ovale
(PFO) - a small opening between the upper two
chambers of the heart (atria). Every unborn baby has a Foramen Ovale
that
allows blood already oxygenated by the
mother's lungs to by-pass the baby's respiratory system. The opening
usually seals up
following birth. If it remains open (patent)
then it can cause a 'short circuit' of blood flow allowing bubbles to
pass directly from
the venous circulation to the brain through
the heart, bypassing the filtering effect of the respiratory system.
The diagram on the
right shows normal blood flow around the
heart (black arrows) and the route of blood and bubbles through a PFO
(green arrow).
Click on the diagram for a larger view.
PFO is present in about 25% of the general
population and does not normally cause health problems. However, it
affects up to
80% of those diagnosed with Type 2 DCS. The
reason for this may be due to the fact that divers often perform the
Valsalva
manoeuvre to equalise inner ear pressure.
This involves increasing the pressure within the chest, which leads to
an increase in
pressure difference between the two atria and
a greater chance of abnormal blood flow. Although PFO increases the
risk of
decompression sickness, individuals with PFO
do not necessarily develop symptoms.
A more severe form of this abnormality is
Atrial Septal Defect (ASD), which is likely to have already been
diagnosed since the
signs and symptoms are more obvious - usually
from an early age. The symptoms include heart murmur, cyanosis and
faintness.
Because most people with PFO show no obvious
signs, diagnosis is usually only attempted following an incidence of
DCS. The
test to confirm PFO uses an echocardiograph
machine to indicate the presence of blood flow between the two atria of
the heart.
A cardiologist, following referral by a
specialist in hyperbaric medicine, normally carries out testing.
[Back to factors] [Back to top]
Flying after SCUBA Diving
As discussed in the principles section,
surface atmospheric pressure is a result of the air above us. Because
there are fewer molecules of gas at higher altitude, there is less
pressure and therefore a lower partial
pressure of each gas in the air - which means there is less oxygen
available. This hypobaric effect is the opposite of hyperbaric pressure.
This concept is familiar to most people since
aircraft flying at high altitudes must have pressurised cabins to
support life. All commercial passengers are reminded that in the event
of
sudden cabin de-compression oxygen masks will
drop down from above. However, in normal operation, the cabin
'altitude' can be as high as 7,500 - 8,000 feet.
Although reducing the available amount of
oxygen to the body can lead to hypoxic conditions, most healthy people
will not
experience symptoms during a normal
commercial flight. The main risk to divers from flying is not the
reduction in oxygen partial
pressure, but the reduction in atmospheric
pressure itself.
As can be seen on the graph to the right, as
pressure decreases with increasing altitude, the volume of a gas will
increase.
Although the degree of change in a hypobaric
atmosphere is less pronounced than in a hyperbaric atmosphere,
pre-existing
nitrogen bubbles in the body will grow larger
and may exacerbate or even cause DCS. Larger gas spaces, such as
pneumothoraces, will also grow.
The length of time required between a dive
and flying depends on many factors, e.g. depth, duration and number of
dives,
therefore it is impossible to give a
definitive pre-flying time period. However, it is recommended that
following SCUBA diving an
individual should wait 12 to 24 hours before
flying (depending on the type of dive). Before flying, it is worth
considering several
points:
Everyone undergoing de-compression from
a hyperbaric air atmosphere will accumulate nitrogen that will tend to
form
bubbles.
The more time the body has to excrete
nitrogen, the less likely bends are.
Commercial aircraft cabins are only
pressurised to about 0.8ata (7,500 feet).
Failure of cabin pressure at altitude
may result in severe DCS in those already carrying excess nitrogen.
Medical resources for the treatment of
DCS are limited on passenger aircraft.
[Back to
factors] [Back to top]
Exercise
Fit, healthy individuals are less likely to
suffer from most medical conditions than unfit ones but there are
possible risks involved with strenuous physical exercise.
Studies have shown that strenuous exercise
causes the formation in the body of tiny gas bubbles called
'micronuclei'. It takes several hours for these bubbles to disperse and
although no link has been proved between the
existence of micronuclei and the bends, it is recommended that
strenuous exercise be avoided for four hours prior to SCUBA diving and
six hours after.
Conversely, moderate exercise is known to
improve blood circulation in muscle tissue and increases
cardiopulmonary function therefore may help to increase the rate of
nitrogen
excretion from the body.
Physical exercise is most beneficial when
done in moderation as part of a healthy lifestyle. Avoiding strenuous
exercise may be difficult to avoid but seems to be a worthwhile
precaution.
[Back to
factors] [Back to top]
Smoking
Considering the importance of effective
respiratory function, the effects of smoking can have a considerable
impact when SCUBA diving.
Cigarette smoke contains carbon monoxide
(CO), which is a poison. The amount of CO in a smoker's body can be as
high as 10%, compared to less than 2% for a non-smoker. This
increased level of CO reduces the ability of
the red blood cells to carry oxygen.
Longer-term problems include chronic
obstructive pulmonary disease (COPD) which leads to reduced oxygen
availability and an increase in carbon dioxide (CO2) retention in the
body.
This has been implicated as a factor in CNS
oxygen toxicity. Smokers are also generally less healthy and are more
prone to develop circulatory problems. Refer to the CO poisoning
section for further details on the effects of
carbon monoxide.
[Back to
factors] [Back to top]
Alcohol
The effects of alcohol on co-ordination,
consciousness and mental reasoning are well documented and have obvious
implications in the ability of a diver to carry out the tasks
necessary for a safe dive. This reduction in
ability also applies to a 'hangover'.
Alcohol will increase the chances of
developing nitrogen narcosis due to the depressant effect on the
central nervous system. As with any CNS condition, intoxication
following a dive
will potentially mask some of the symptoms.
Alcohol is also a powerful diuretic that will
increase urine output and promote dehydration - one of the risk factors
in DCS.
[Back to
factors] [Back to top]
Obesity
An increase in adipose (fat) tissue leads to
an increase in nitrogen loading in the body, since nitrogen is five
times more soluble in fat tissue than muscle. Because fat can also
absorb more gas than muscle, it will take
longer for the body to excrete it. This means that there is a greater
risk of decompression sickness.
Obesity also increases the body's oxygen
requirements, leading to a likely reduction in physical ability. The
long-term implications of obesity are well known. Conditions related to
obesity such as diabetes and coronary artery
disease are themselves risk factors.
[Back to
factors] [Back to top]
Dive Profile
Following each dive the body retains some of
the inert gas dissolved in the tissues. The correct use of dive tables
usually allows enough of the gas to be excreted via the lungs to
avoid the formation of bubbles large enough
to cause physiological problems. Repeated dives will increase the risk
of DCS if adequate time is not allowed to offload the dissolved gas.
For the same reason, the depth and duration
of the dive will influence the amount of absorbed gas.
[Back to
factors] [Back to top]
Temperature
SCUBA diving in warm water will generally
result in higher nitrogen loading than in cold water. This is due
mostly to the effects of vasodilatation.
A relatively rare complication of cold-water
exposure is pulmonary oedema (fluid in the lungs) caused by peripheral
vasoconstriction resulting in increased intrathoracic pressure.
The general effects of cold on the body are
discussed further in the hypothermia section.
[Back to
factors] [Back to top]
Breathing gas
Certain alternatives to standard air can be
used for SCUBA diving. The unique properties of each gas, and mixture,
should be considered to determine a safe dive profile.
[Back to
factors] [Back to top]
Age and Gender
There are conflicting studies showing the
existence, or lack, of a relationship between a diver's age / gender
and the incidence of decompression sickness although a study by the
Armstrong Laboratory concluded that there is
a three-fold increase in high altitude DCS in men over 42 years old
compared to those aged 18-21. The reason for any increased risk in
dive related DCS might be due to the
distribution and amount of fat in the diver's body.
[Back to
factors] [Back to top]
References
Schwerzmann M, Seiler C
Recreational scuba diving, patent foramen
ovale and their associated risks.
Swiss Med Wkly (Switzerland), Jun 30 2001,
131(25-26) p365-74
Leffler CT
Effect of ambient temperature on the risk of
decompression sickness in surface decompression divers.
Aviat Space Environ Med (United States), May
2001, 72(5) p477-83
Wilmshurst P, Bryson P
Relationship between the clinical features of
neurological decompression illness and its causes.
Clin Sci (Lond) (England), Jul 2000, 99(1)
p65-75
Bove AA
Medical aspects of sport diving.
Med Sci Sports Exerc (United States), May
1996, 28(5) p591-5
Wilmshurst P, Nightingale S
Relationship between migraine and cardiac and
pulmonary right-to-left shunts.
Clin Sci (Lond) (England), Feb 2001, 100(2)
p215-20
Newton HB
Neurologic complications of scuba diving.
Am Fam Physician (United States), Jun 1 2001,
63(11) p2211-8
Schwerzmann M, Seiler C, Lipp E, et al.
Relation between directly detected patent
foramen ovale and ischemic brain lesions in sport divers.
Ann Intern Med (United States), Jan 2 2001,
134(1) p21-4
Buttinelli C, Beccia M, Argentino C
Stroke in a scuba diver with patent foramen
ovale.
Eur J Neurol (England), Jan 2002, 9(1) p89-91
Kohshi K, Katoh T, Abe H, et al.
Neurological accidents caused by repetitive
breath-hold dives: two case reports.
J Neurol Sci (Netherlands), Sep 1 2000,
178(1) p66-9
Page updated
19-Jul-2002
© Stuart Walker
Information provided is from a
review by the site's author of the available literature and is approved
by the unit's medical consultants.
However, no responsibility can be
accepted b
SPECIFIC TO CASE WHICH HAD "tingling and pricking" sensations after
bends injury:
However, interestingly, a rubric
one might use for "pins and needles" sensation which is reported as
sx-not sure if internal or external; but rubric for internal has NITRIC
ACID in bold, so one wonder if chemical effects are involved in this
case? This is just speculation of course, but perhaps worthy of
thought.
GENERALITIES; TINGLING, prickling; internal (K1392, SRII-519, G1148):
abrot., acon., ail., arum-t.Knt, aur., bar-s.Knt, cann-s., dios., lach.,
NIT-AC., osm., ph-ac., phos., plat., ran-b., sabad., sang., sec.,
seneg., verb., viol-o.
Might have to just use symptoms and let them lead to the remedy and have
etiology be important only if you can somehow make a connection with one
of the modes of injury that seem to be possible in bends, and thus could
lead to sequelae. Something, chemical or mechanical from the
experience aggravated his constitution. How and why may or may not
become apparent.
A Curiosity: A Referenceworks search on diver and sea diving yields 2
remedies with DREAMS of diving, interestingly both "gas" remedies: CO2
(klein recent proving) and ozone (I think Schadde proving).
BENDS INJURIES IN GENL
Other pressure and gas related injuries are also possible, according to
a quick skim of the sources below. Rubrics and remedies that have
mechanical injuries, like Bellis-p or the like. The trauma is coming
from inside-out instead of the usual impact from the outside. Blood
vessel injuries should be repertorizable, I know Hamamaelis is one in
that category. Bursting sensation rubrics. Hemorrhages,
ruptures,thromboses. Nerve injuries also. Blood thickens-did not search
much but might be covered in some rubric or remedy.
EMBOLISM
(REFERENCWORKS F, UNSORTED)
Embolism: abcixi., altepl., aml-n., anthr.8, arg-n., ars.117, aur-ar.,
bar-m., both-l.187, calc., 2calc-ar.8, capeci., caps., carbn-o.1101,
carc., chen-a., clozap., coenz-q., conch.36, croc.223, crot-c.,
crot-h., diph.156, ery-m., estrad., ferr., fum-ac., glyc-g., hippoz.,
kali-br.8, kali-chl., kali-i., 3Kali-m.8, lach.155, lat-h., leupro.,
lim-b-c.204, meli., naja, nux-v., op.8, phos.1101, retepl., samb.,
sec., spect., streptok., sulph., sumatr., tamoxi., thea., tinzap.,
visc., warfar.
(Complete 2000)
GENERALITIES; EMBOLISM: kali-m.(Clarke)-might look in clarke to see if
any more info
More rubrics most probably not applicable to your case but maybe bends
sequelae in general:
GENERALITIES; SNAPPING, bloodvessels: chin-s.AlnE
GENERALITIES; SORE, bloodvessels: ham.Ptk, puls.Ptk
GENERALITIES; CARIES, necrosis; bones; mechanical injuries, after:
merc.Hah
GENERALITIES; BLOODVESSELS, complaints of; prickling, sticking in:
ham.Bog, merc.Bng
GENERALITIES; THROMBOSIS (K1407, SRII-635, G1160): acetan.Crk, am-c.Knr,
am-caust.BlkM, apisKnr, arn.Brk, ars.Her, both-l.Schm, calc-ar.Knr,
carb-v.Bng, card-m.Ptk, cortico.Stph, fl-ac.Ptk, ham.Ptk, kali-chl.Bog,
kres.Jul, lach.Brk, mag-f.Jul, nat-s.Her, prot.Pat, sec.Crk, vip.Bog
CHEST; THROMBOSIS; artery, pulmonary: queb.Brk
CHEST; THROMBOSIS; coronary: acon.125, am-caust.BlkM, apisKnr,
bell-p.Jul, chlorpr.Jul, hed.Stph
GENERALITIES; INJURIES, blows, falls and bruises; general; rupture of;
bloodvessel (SRII-327): mill.Knr
GENERALITIES; INJURIES, blows, falls and bruises; general; nerves, of,
with great pain (K1369, SRII-330, G1129): all-c.Brk, arn.Brk,
bell-p.Schm, calen.Brk, cur.Knr, glon.Bog, Hyper., led.Bng, mag-p.Knr,
meny.Knr, ph-ac.Ptk, phos., tarent.Knr, ther.Knr, xan.
GENERALITIES; INJURIES, blows, falls and bruises; ailments from:
am-m.Far, arn.Brk, calc-f.Nsh, carb-v.Brk, cic.Brk, con.Brk, glon.Brk,
ham.Brk, hyper.Brk, ign.Crk, led.Brk, nat-s.Brk, stront-c.Brk, thal.250
GENERALITIES; BLOOD; deterioration; general: tab.AlnE
Hope this is helpful. Maybe you will come upon a remedy which has
"ailments from deep sea diving" and can publish the case if cured.
regards, andy
appendices
Some internet "bends" basic info sources:
______________________________________________________________________
http://www.hyperchamber.com/thebends/
from
http://www.mindef.gov.sg/navy/medical/divemed.htm
Medical Hazards of Diving -- Decompression Illness and Other Diving
Accidents
While diving is generally a safe activity when the proper precautions
are taken, it nonetheless carries with it a unique set of potential
health hazards
which can lead to significant morbidity and even fatality in extreme
instances.
Decompression Sickness
Infamously referred to as 'the bends', this not uncommon condition is
perhaps the best known of the so-called diving illnesses, though it is
far from well understood. It
derives its popular eponym from the fact that a common manifestation is
joint pain, which may be excruciating. The basic pathology is thought to
be due to the presence of
nitrogen microbubbles in the blood and tissues of divers who have
ascended too quickly for their bodies to dispose of the dissolved inert
gas load. Although mild forms of
this disease present only as joint aches or nonspecific skin rashes,
more severe forms of the disease may result in significant neurological,
cardiovascular, respiratory and
other systemic derangement. Symptoms range from numbness, paralysis and
breathlessness to heart failure and coma.
Appropriate management involves prompt institution of first aid measures
such as administration of 100% oxygen and fluids, followed by definitive
treatment in a
decompression facility. A study conducted by Singapore's Naval
Hyperbaric Centre revealed that of the cases of decompression illness it
has treated over the past 7 years,
barely one-quarter of these divers received any attempt at proper diving
first aid, and almost 60% only underwent decompression therapy after
more than 24 hours from the
start of their symptoms.
Long-term sequela6 involving the nervous and skeletal systems have been
reported in cases of decompression illness that have been inadequately
managed. Paralysis
and other sensory deficits may persist, and neuropyschological
dysfunction, leading to cognitive and possibly even emotional
disturbances, may last for months, resulting in
functional incapacitation of the victim for prolonged periods. This is
all the more tragic when one considers that many of these patients are
young men and women in the
prime of their lives. Dysbaric osteonecrosis, which refers to death of
bone associated with exposure to pressure, is the other feared long-term
complication -- in severe
cases joint destruction is a prominent feature and this may be
debilitating. This condition may only manifest itself after many years
of diving, and is particularly common in
those who dive very frequently (e.g. commercial divers), and in those
who do not follow proper decompression procedures (e.g. unsafe,
poorly-trained divers).
Barotrauma
Physical laws dictate that the@ volume of a given gas changes
significantly with appreciable changes in the ambient pressure. The
human body has many gas-filled
cavities, and changes in the surrounding pressure as the diver ascends
or descends result in corresponding changes in these gas volumes. This
can potentially lead to
considerable tissue damage if the magnitude of these changes are drastic
enough, and this phenomenon is known as barotrauma.
The body compartment most at risk is the chest cavity. If the diver
ascends too quickly or traps air in his chest during ascent (e.g.
breath-holding in the setting of panic or an
asthmatic attack), the volume of air in his lungs may increase too
rapidly and burst portions of the lung, resulting in abnormal air
collections that can cause respiratory
embarrassment and possibly leading to death. Air from the burst lung may
escape into the tissues surrounding the heart and hinder its normal
contractions, or it may also
escape into the blood and ultimately end up in the vessels of the brain,
causing a catastrophic stroke-like syndrome called CAGE (see below).
The air compartments of the ears and sinuses can also be affected,
though the consequences in these cases are virtually never fatal.
However, ear involvement can result in
deafness, vertigo and disorders in balance and position sense, and such
injuries may be temporary or permanent.
Cerebral Arterial Gas Embolism (CAGE)
Cerebral arterial gas embolism (CAGE) is perhaps the most feared diving
accident as the presentation is catastrophic and the prognosis grim. As
mentioned earlier, this
occurs when free air enters the bloodstream and is carried to the brain
where the air bubbles subsequently occlude critical blood vessels,
leading to severe neurological
deficits. This may occur in the setting of pulmonary barotrauma as
described above, or, less commonly, in patients with preexisting heart
defects which allow mixing of the
body's two complementary circulation's.
Prompt treatment is necessary if the patient is to have a decent chance
of survival. Fluids and 1 00% oxygen must be liberally given, and the
patient must be delivered to a
decompression facility as soon as possible.
Conclusion
The conditions described above can generally be avoided by any healthy,
well-trained aquanaut diving with proper, well-maintained equipment with
which he is familiar. In
the event that such accidents do occur, the dive supervisor and/ or dive
buddy should be familiar with the appropriate measures to be taken to
ensure a favourable outcome.
Written by:
Dr Chia Shi-Lu
Head, Diving Medicine Branch, NMHC
19 July 1998
[Back to Safe Diving Page]
from
http://www.hbotoday.com/treatment/clini ... roved/app-
decompression.shtml
DECOMPRESSION SICKNESS
Hyperbaric oxygen (HBO2) treatment should begin
during the acute episode. Recompression is indicated for the
following clinical manifestations:
Profound Fatigue
Neurological Dysfunction
Joint Pain
Skin Eruptions
Several treatments may be necessary to reduce
bubble size and clear symptoms.
RATIONALE: The disease arises from the generation
of nitrogen bubbles in the vascular system and tissues in
volumes sufficient to interfere with the function
of an organ or cause alterations in sensation. The cause of gas bubble
formation is the rapid decompression during
ascent from diving, flying or a hyperbaric or hypobaric chamber when the
speed of decompression exceeds the ability of the
gas saturated tissues to vent the gases by simple diffusion.
Secondary effects of the nitrogen bubble at the
blood bubble interface can include activation of the complement system,
lymphophobic effects and increased blood
viscosity. Prompt treatment is important to reduce bubble size and
repetitive
treatments may be necessary for patients with
residual defects following the initial recompression. Treatment should
be undertaken even in patients suffering a delay
(greater than six hours) from either the onset of symptoms to
diagnosis, or in the transport to a treatment
facility, because there are some who will show favorable response
despite
the late use of recompression therapy.
Source: Hyperbaric Oxygen Therapy: A Committee
Report. Undersea and Hyperbaric Medical Society. 1996 Revision.
D Rona
Glenda,
I had the bends while working as a professional diver (while in
college). For me the joint pain was very sudden in onset within 24
hours
of a dive and perhaps due to pre-existing tendencies, I wound up with a
minor event causing major damage to the structure of one knee (torn
ligaments, something ruptured, at that age, who was taking notes?). The
joint problems progressed and that lovely 'pins and needles' stuff
lasted
for years. Almost 20 years later knee surgery repaired some of the
physical damage, but left far more pain. Standard medical prognosis was
for me to have both knees replaced within a few years and then move on
to
the hips. That's when I began serious study of naturopathy and
homeopathy. Of course naturopathy does look to cause in determining
treatment options, but as far as homeopathy, other than recognizing that
there was a 'traumatic event', the case taking revolves around the
standard cast of characters: location, sensation, modality, etc etc
etc.. The fact that the bends brought on these symptoms is really not
part of the equation.
Best wishes in your research. I will be very interested to watch the
replys of the others on this list.
Donna Rona
Glenda Wilks wrote:
ÿ Hello,
Hi Glenda,
Pins & Needles represents Neurological Decompression Sickness which
would be indicative of Spinal Cord involvement during the DCS episode
IF the joint pains are bilateral then most likely this is from the
above noted Spinal Cord involvement... if NOT bilateral pains then it
is considered Type 1 (simple) DCS...
How many times was the patient treated via recompression chamber? if at
all?
Something would be needed to stimulate nervous tissue that has been
damaged in this case... Consider treating this as a "Spinal Cord
Injury" in the reportization as foremost in the physical aspect...
I look forward to others feed-back with the above *new* info supplied
as to suggestions on reporitization. Thank you!
More questions? Let me know... I can learn from this too as we are
Professional Scuba Divers (see my website below for credentials).
Respectfully yours,
Patti Mount, President IANTD World Headquarters
Patti@iantd.com http://www.iantd.com
Shogun's Webpage
http://www.iantd.com/Shogun/Puppy.html
Ariel's Webpage & Pedigree
http://www.iantd.com/Ariel/Ariel.htm
GENERALITIES; PAIN; general; joints (SRII-408)
GENERALITIES; TINGLING, prickling; internal (K1392, SRII-519, G1148)
GENERALITIES; ICE; sensation of; ice needle
GENERALITIES; IRONS, wires, needles, as from hot
GENERALITIES; PAIN; stitching; needles, like; cold, like, internal
(K1386, SRII-458, G1143)
GENERALITIES; PAIN; stitching; needles, like; fine
GENERALITIES; PAIN; stitching; needles, like; hot (SRII-459)
GENERALITIES; PAIN; stitching; needles, like; hot; internal
GENERALITIES; PAIN; stitching; needles, like; hot; muscles (K1387,
G1144)
GENERALITIES; TINGLING, prickling; needles, as from, external
GENERALITIES; PAIN; general; joints (SRII-408)
GENERALITIES; PAIN; stitching; needles, like; fine
GENERALITIES; TINGLING, prickling; internal (K1392, SRII-519, G1148)
EXTREMITY PAIN; STITCHING; needles, as from
MIND; SADNESS, despondency, depression, melancholy (K75, SRI-864, G60)
GENERALITIES; INJURIES, blows, falls and bruises; general; rupture of;
bloodvessel (SRII-327): mill.Knr
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