A Thousand Ways To Die

(continued from previous post)

So, the obvious question is, "What happened?"

To put it simply, I drowned from the inside out.

The DAN medical team pegged my condition as Immersion Pulmonary Edema (IPE), also known as Swimming Induced Pulmonary Edema (SIPE), is an accumulation of fluid in the lungs while diving. Unlike drowning, IPE does not involve the aspiration of water through the mouth. Instead, a spike in pulmonary artery blood pressure causes blood and serum to leak into the alviolar spaces. DAN has a really good summary of the symptoms. The reason for the spike, particularly in otherwise healthy individuals, is unclear. However, testing at the Duke University Hyperbaric facility under Dr. Richard Moon, is starting to tease out the details and causes.

On January 10th, 2011, I traveled to Duke for testing with Dr. Moon's team. As a diver, this was like going to the mothership. The facility and its team left me awestruck. Meeting the great folks who work and study there was a real treat. The experiments I participated in tested the theory that there are some individuals who have higher pulmonary artery pressure spikes in response to immersion in cold water. They didn't tell me how cold but it was PLENTY cold!

I had to lie face down in a metal rescue litter while they lowered me into the water! The last thing Dr. Moon said before I went
under was, "Try not to gasp too much. It messes up our numbers!" The chamber tech, Eric, gave me a smile that said, "Gasp away my friend!" After lying still in the litter for a few (endless) minutes, I hopped out and the pool was reconfigured for underwater cycling. Then it was back under wearing a full face mask for 12 minutes of moderate pedaling while the medical team took blood samples, pressures and other measurements through various catheters and ports.

(this is not me but it is the same aparatus)

I have never been so cold in my life! After an hour or so of rewarming and a dose of Viagra (apparently it wasn't designed to give old guys "performance" - that was just a happy side effect), we did the whole thing again. Strangely, the water was a lot less shocking the second time.

(I know! It sounds like fun, right? Seriously though, if you think you've experienced this you should email Dr. Moon the Duke center and get into the testing program so they can help identify and treat these issues. So far, they've only had two divers agree who had experienced IPE.)

The assessment is that I am one of the lucky 1% or so of divers prone to this condition. To return to diving I must:

  1. lose some weight and get my bp down
  2. get recertified with my dry suit and start diving a dry for anything less than tropical dives
  3. avoid over hydration prior to a dive
  4. consider taking anti-hypertensive medicine prior to diving (Although, if you try this be sure you're working with a doctor familiar with dive medicine. In animal studies, Viagra appears to increase susceptibility to Oxygen toxicity - unless you want to posthumously help nail down the data for humans, I'd be more than a little careful with the magic blue pills!)

Every incident has a cause. The bottom line is that a gap in my fitness level, combined with unfortunate genetics, caused this one. Like many of us, I've picked up some pounds over the years and this has raised my blood pressure slightly. Not a big deal on land. But a huge deal underwater. I have to shed the weight and get my BP back to 120 / 70 or better or pick another hobby.

Here's my big takeaway. I have a resting pulse in the 40s and can ride, run and swim for hours at a stretch. In many ways I'm a pretty fit guy. But, diving takes me into an environment in which I am decidedly unfit. It's cold, dense and hypoxic. Any weakness in my constitution, when combined with circumstances and genetics, can generate any of a thousand ways to die. While advances in equipment and training have made diving safer than ever, I need to bring my A game every time.

You do too.

Here are more pics.

A very long 3 minutes or so.

Eric hooking me up for some dry land testing.

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Farback said...

Thanks very much for your candor and honesty. As a diver in my 50's I am working on my fitness level to dive safely. Years ago I had an incident on a dive boat where I had my young son along for the trip. I was more worried about scaring him than my own problem, which turned out to be a ruptured eardrum from a fast ascent to rescue my dive buddy from a situation. Your post was very informative, and I appreciate you sharing these details.


Unknown said...

Thanks for all this. It would be very difficult to determine if one happens to fall into that 1% mark. If I had started diving sooner in life, I may have thought about tackling deeper depths, places where a dry suit was the norm. However, I will definitely remain a satisfied recreational diver for hopefully a long time. However, losing a few pounds would also help me.

Laurens said...

what a great article..I needed to read that! This got me in the gym!

Farzanegan said...

I've been on both Diver Down (love them!) and the Duke chamber as a test subject. I even did one of Dr. Moon's tests for your condition. Glad you're okay and that you're inspired to make life changes.

MediaGuru said...

I don't know what it is with guys over 40 that precludes staying in shape. Laziness ?? As soon as I started reading your article, I thought to myself..."this guy is probably overweight,outta shape and has either HBP or is a DIABETIC or both. At 50, I am in better shape than I was at 35. I am a Rescue Diver working on my Dive Master. It's interesting that the dive industry espouses fitness as a major component but ...I see way too many divers...just waiting for a heart attack or similar incidence to happen. If ya want to live longer and enjoy your diving more...don't make excuses and assume your in shape because your stamina out of the water is good. Take good hard close look in the mirror...unless your looking at one with skinny glasses you will know. If that does not work get your fat ass to a Gym and have them do a Fitness Analysis so you know what your LBM (Lean Body Mass) to BF (Body Fat) Ratio is for your age. Then get in to the Good Category. Forget about BMI, its often wrong,is outdated and does not take into account lean muscle.

Phil said...

It's good advice but remember this, when this accident happened, I was within 5 lbs of my college race weight, I ran a sub 40 minute 10k, was swimming a mile in well under 30 minutes and had come 4th in my age group in a regional triathlon (the day before). I was less fit than college but by every measure I was the fittest guy on the boat. What doomed me was genetics. What saved me was training.