DVT problem (a true story)

*Dorota & Wojtek* · December 13th, 2007, 09:30 PM

Hey Falks,

Sorry for the long'ish post - but I believe it is worth knowing and being aware of....

My DVT (Deep Vein Thrombosis)

In the last several years I have done over two thousand dives. I did not have any health issue or dive accident. I was accomplishing new plans, new more ambitious dives and ideas for the future. Here follows a description of 13 days of my life, when I have learnt that a small hole in a pavement can decide upon if I will ever dive again…

Day 1
I have done two dives on shallow depths (max 15m) with total dive time of 140 minutes. More then half of the time I have spent on depths less then 6 meters. On the evening the same day I have twisted my ankle (I just fell with my leg in some small hole in the ground) – the ankle got swollen, so I have put some ice over it and contacted a doctor. After visiting the doctor a suspicion of broken bones comes to light – we are planning to make an x-ray next day.

Day2
Hospital – X-ray shows no bone damage, so it is classical ankle sprain. I got a cast for 14 days and we will see what will happen next with the ankle.

Day 3, 4 & 5
Except me being angry with the ankle and having a slight fever – all seams ok.

Day 6
..but also a part of the night from 5th to 6th day: I have a pain in my lower left chest side, and it get more painful with every hour. The fever is about 38-39oC. I call a doctor, who after coming and checking me suspects a spleen inflammation. He sends me to blood testing and ultrasound of stomach/abdomen area. I am advised to eat paracetamol (it will hurt I hear from the doctor) and we shell meet in 3-4 days (it was Friday) for checking.

Evening/night: the only position I can stand the pain is while sitting. The pain is not allowing me to sleep, I have problems breathing and moving. Except intramuscularly painkiller injections I am breathing almost 60% nitrox (I just got one at home).

Day 7
The pain is practically in whole left upper body part. My breath is very shallow – every try to get more deep breaths is too much pain. The pulse is over 120, the fever rises up to 39,8oC. I decide to go to hospital. I can not sit – I am 180 cm high, but now I can only hunch from pain to 160cm. It has to look odd – all people seeing me are just moving away. I can only speak with very weak voice, I ask for additional consultation with a doctor immediately after the test. Happily the personnel at the hospital spotted me quite fast and offered a separate room and immediate doctor attention. I am lucky – I meet a diving pulmonologist. The talk is short – X-ray of my chest at once. The results – the ultrasound looks fine, there is a slight inflammation but at the X-ray they can not see much – my diaphragm is raised very high so they can not see anything specific. We decide to make computer tomography of the chest. First free date is in two days and the results in next two days… The doctor offers agents for treatment for clotting in the blood vessels, antibiotic and strong painkillers. We shell have phone contact.

Day8
I feel a bit better – I can breath more deeply, after taking the painkillers I can fall to sleep for 40-60 minutes. I have a fever around 39oC. I sweat so heavily that thou I drink liters of fluids I start to dehydrate.

Day 9
Slight improvement. I can not sleep more then an hour. I will have the tomography in the evening. The technician at the hospital is complaining that I can not raise my arm high enough, so they make the test as they have put me (I can lay down for several minutes). The technician asks me to wait because he has to consult a doctor. After few minutes I see the doctor and after few more minutes I am transported to hospital with immediate life threatening condition.

The hospital
I try to listen to all opinions that I hear from doctors – they are different, but one point is common: I have clotting in my left lung, clotting in the down lung artery, bleeding into alveoli, fluid in pleura, threat of hart attack and arteries clotting. Next examination, everything is hurting me. I met a “specialist” – I have asked for strong painkiller, and the Ketonal works best with me, and the “specialist” says that Tramal would be better (thou I have indicated that I do not tolerate this medicament very well – last time I had hallucinations after it). As result I spent all night in pain, until finally someone notices that, so I get what I asked for before.

Day 10
I feel better. After another ultrasound I get first good news – the risk of hart attack and more serious clotting is getting smaller. From a patient with high risk factor I turn into a one with a low risk factor… Doctors and students come in groups to wonder – they say I have quite fast regeneration rate… They do not care that I am almost dying …J … they just consider why I get better so fast.

Day 11
Better and better. The breathing is not that difficult any more. They inject me all the stuff for anti-clotting and antibiotic and give me many more colorful pills….

Day 12
I seams that with a little time I will be as new, but… it only seams like that. They control the blood, urine, ultrasounds and all the other “important” things. I keep fighting for more painkillers…. Day like everyday then J

Day 13
I had a serious talk with an important doctor – everybody call him “boss” here. He brings me back to the ground – my condition is very serious still. Thou he is impressed with my regeneration potential = the lack of unequivocal answer about my health is a result of the fact that I am getting better too fast. From tomorrow they will reduce by half the anti-clotting agents. I ask when I will be healthy. He answers: “with you organism – I would say – they are big chances that soon… I would say…”.

…. Now
After few weeks from leaving the hospital I feel much better. After the DVT I feel only little pain in the left down part of my chest – the effect of regenerating lung tissue.
After several talks/consultations and visits – I got permission to return to diving – the lung is not showing any changes. The problem is still the ankle… but it also gets better. For six months after leaving the hospital I will take anty-clotting injections.

What happened?
The issue was trivial. After having the cast put on my leg I should had been given an anti-clotting injections. It is painless, subcutaneous injection , that would spare me from all the “attractions”.

Yes, yes… a simple ankle sprain was a reason for verifying my life plans. Paradoxically, the two thousands dives I done, did not hurt me…only a small hole in a pavement…

Wojtek A. Filip

GLOC · December 13th, 2007, 09:53 PM

OMG!!

The little things in life are sometimes the ones which can suprise us.

Get well soon and I hope that if anything like that happens to me, the doctors spend a little more time looking at causes rather than symptoms.

Regards

Marijn · December 13th, 2007, 10:35 PM

WOW, sound like quite an ordeal!

Best of luck man!
All the best with getting back to your old self.

LCF · December 14th, 2007, 08:26 AM

Wojtek, you are lucky to be alive. I cannot believe that, on day 6, you were not immediately diagnosed with a pulmonary embolus. If I were to miss that with the presentation you describe, I would be hung out to dry in a malpractice suit.

It is not necessary, however, to start every patient with an ankle sprain on anticoagulation. The incidence of DVT in patients splinted for sprains is very low. However, once you developed symptoms, your diagnosis should be been made MUCH more expeditiously.

*Brian Allen* · December 14th, 2007, 09:36 AM

What a shocking story, am glad you're ok.

*Dorota & Wojtek* · December 14th, 2007, 01:02 PM

Thanks for your best all the wishes

Some more adds - the doctors stated that I did not have any conditions that could have put into the raised risk of DVT - I train often, I am a non-smoker, no-alkohol, so that could have helped/prevented one. But it did not. Two of the doctor I spoke with indicated timidly that the dives I have done before that incident could have some influance. There was a suspicion that the presance of inert gas could have made me more prone to DVT "at some level" (as thay said). One of them even said that diving can make the risk factor higher.

Do you know guys any other opinions about dving, the coagulability of blood and DVT? Maybe there are some papers/work/research done on it. Would be good to read more....

MonkSeal · December 14th, 2007, 01:27 PM

Quote: (Originally Posted by Dorota & Wojtek)

Do you know guys any other opinions about dving, the coagulability of blood and DVT? Maybe there are some papers/work/research done on it. Would be good to read more...

I read an article about DVT in one of the recent DAN's "Alert Diver". But if I remember correctly the main focus was on DVT developing in people often flying over-seas.

Best wishes for fast recovery.

Dawn · December 14th, 2007, 02:58 PM

Hi Wojtek,

I am happy you are here with us to tell your story. Hopefully you are feeling a little better as each day goes by.

Yes, there are studies showing a state of hypercoagulation in diving; however, most of the papers out there are focused on symptomatic decompression illness. There are also a handful which have been done on saturation diving.

Of the papers I have seen on coagulation in diving, the most applicable (measuring changes in coagulation markers and platelet count in asymptomic dives) to your situation/question would be:

Hematologic changes after daily asymptomatic dives
Diercks, KJ
Eisman, PT
Undersea Biomed Res. 1977 Dec;4(4):325-31.
http://archive.rubicon-foundation.org/2776

The effect of air and nitrox divings on platelet activation tested by flow cytometry
Baj Z, et al
Aviat Space Environ Medicine 2000 Sep;71(9):925-8.
PMID: 11001346

The Baj group is working out of Poland with the Military Medical Academy, btw.

Best wishes and take care,
Dawn

amascuba · December 14th, 2007, 03:43 PM

Thanks for sharing! I hope that you get better soon!

***Fiona*** · December 15th, 2007, 01:08 PM

Sounds like you have had a very bad time.

Please accept this as a genuine question is putting a cast on the ankle and I am assuming you mean a plaster cast a usual course of action for a sprain.

December 13th, 2007, 09:30 PM	#1 (permalink)
Dorota & Wojtek(Offline) GUE Instructors Join Date: May 2006 Location: Hurghada, Red Sea, Egypt Posts: 30	DVT problem (a true story) Hey Falks, Sorry for the long'ish post - but I believe it is worth knowing and being aware of.... My DVT (Deep Vein Thrombosis) In the last several years I have done over two thousand dives. I did not have any health issue or dive accident. I was accomplishing new plans, new more ambitious dives and ideas for the future. Here follows a description of 13 days of my life, when I have learnt that a small hole in a pavement can decide upon if I will ever dive again… Day 1 I have done two dives on shallow depths (max 15m) with total dive time of 140 minutes. More then half of the time I have spent on depths less then 6 meters. On the evening the same day I have twisted my ankle (I just fell with my leg in some small hole in the ground) – the ankle got swollen, so I have put some ice over it and contacted a doctor. After visiting the doctor a suspicion of broken bones comes to light – we are planning to make an x-ray next day. Day2 Hospital – X-ray shows no bone damage, so it is classical ankle sprain. I got a cast for 14 days and we will see what will happen next with the ankle. Day 3, 4 & 5 Except me being angry with the ankle and having a slight fever – all seams ok. Day 6 ..but also a part of the night from 5th to 6th day: I have a pain in my lower left chest side, and it get more painful with every hour. The fever is about 38-39oC. I call a doctor, who after coming and checking me suspects a spleen inflammation. He sends me to blood testing and ultrasound of stomach/abdomen area. I am advised to eat paracetamol (it will hurt I hear from the doctor) and we shell meet in 3-4 days (it was Friday) for checking. Evening/night: the only position I can stand the pain is while sitting. The pain is not allowing me to sleep, I have problems breathing and moving. Except intramuscularly painkiller injections I am breathing almost 60% nitrox (I just got one at home). Day 7 The pain is practically in whole left upper body part. My breath is very shallow – every try to get more deep breaths is too much pain. The pulse is over 120, the fever rises up to 39,8oC. I decide to go to hospital. I can not sit – I am 180 cm high, but now I can only hunch from pain to 160cm. It has to look odd – all people seeing me are just moving away. I can only speak with very weak voice, I ask for additional consultation with a doctor immediately after the test. Happily the personnel at the hospital spotted me quite fast and offered a separate room and immediate doctor attention. I am lucky – I meet a diving pulmonologist. The talk is short – X-ray of my chest at once. The results – the ultrasound looks fine, there is a slight inflammation but at the X-ray they can not see much – my diaphragm is raised very high so they can not see anything specific. We decide to make computer tomography of the chest. First free date is in two days and the results in next two days… The doctor offers agents for treatment for clotting in the blood vessels, antibiotic and strong painkillers. We shell have phone contact. Day8 I feel a bit better – I can breath more deeply, after taking the painkillers I can fall to sleep for 40-60 minutes. I have a fever around 39oC. I sweat so heavily that thou I drink liters of fluids I start to dehydrate. Day 9 Slight improvement. I can not sleep more then an hour. I will have the tomography in the evening. The technician at the hospital is complaining that I can not raise my arm high enough, so they make the test as they have put me (I can lay down for several minutes). The technician asks me to wait because he has to consult a doctor. After few minutes I see the doctor and after few more minutes I am transported to hospital with immediate life threatening condition. The hospital I try to listen to all opinions that I hear from doctors – they are different, but one point is common: I have clotting in my left lung, clotting in the down lung artery, bleeding into alveoli, fluid in pleura, threat of hart attack and arteries clotting. Next examination, everything is hurting me. I met a “specialist” – I have asked for strong painkiller, and the Ketonal works best with me, and the “specialist” says that Tramal would be better (thou I have indicated that I do not tolerate this medicament very well – last time I had hallucinations after it). As result I spent all night in pain, until finally someone notices that, so I get what I asked for before. Day 10 I feel better. After another ultrasound I get first good news – the risk of hart attack and more serious clotting is getting smaller. From a patient with high risk factor I turn into a one with a low risk factor… Doctors and students come in groups to wonder – they say I have quite fast regeneration rate… They do not care that I am almost dying …J … they just consider why I get better so fast. Day 11 Better and better. The breathing is not that difficult any more. They inject me all the stuff for anti-clotting and antibiotic and give me many more colorful pills…. Day 12 I seams that with a little time I will be as new, but… it only seams like that. They control the blood, urine, ultrasounds and all the other “important” things. I keep fighting for more painkillers…. Day like everyday then J Day 13 I had a serious talk with an important doctor – everybody call him “boss” here. He brings me back to the ground – my condition is very serious still. Thou he is impressed with my regeneration potential = the lack of unequivocal answer about my health is a result of the fact that I am getting better too fast. From tomorrow they will reduce by half the anti-clotting agents. I ask when I will be healthy. He answers: “with you organism – I would say – they are big chances that soon… I would say…”. …. Now After few weeks from leaving the hospital I feel much better. After the DVT I feel only little pain in the left down part of my chest – the effect of regenerating lung tissue. After several talks/consultations and visits – I got permission to return to diving – the lung is not showing any changes. The problem is still the ankle… but it also gets better. For six months after leaving the hospital I will take anty-clotting injections. What happened? The issue was trivial. After having the cast put on my leg I should had been given an anti-clotting injections. It is painless, subcutaneous injection , that would spare me from all the “attractions”. Yes, yes… a simple ankle sprain was a reason for verifying my life plans. Paradoxically, the two thousands dives I done, did not hurt me…only a small hole in a pavement… Wojtek A. Filip

December 13th, 2007, 09:53 PM	#2 (permalink)
GLOC(Offline) Moderator Join Date: Nov 2005 Location: Fleet, Hants Posts: 1,994	OMG!! The little things in life are sometimes the ones which can suprise us. Get well soon and I hope that if anything like that happens to me, the doctors spend a little more time looking at causes rather than symptoms. Regards __________________ Gareth Images of Life Photography DIR Team Foxturd Travels Underwater and Further Afar If you don't have the time to do something right, where are you going to find the time to fix it? - Stephen King

December 13th, 2007, 10:35 PM	#3 (permalink)
Marijn(Offline) Smurf #1 Join Date: Aug 2007 Location: Papendrecht, The Netherlands Posts: 385	WOW, sound like quite an ordeal! Best of luck man! All the best with getting back to your old self. __________________ Its a fact that the humans can't go without water for more than 3 days

December 14th, 2007, 08:26 AM	#4 (permalink)
LCF(Offline) New Member Join Date: Dec 2005 Location: Seattle Posts: 623	Wojtek, you are lucky to be alive. I cannot believe that, on day 6, you were not immediately diagnosed with a pulmonary embolus. If I were to miss that with the presentation you describe, I would be hung out to dry in a malpractice suit. It is not necessary, however, to start every patient with an ankle sprain on anticoagulation. The incidence of DVT in patients splinted for sprains is very low. However, once you developed symptoms, your diagnosis should be been made MUCH more expeditiously. __________________ check out www.divematrix.com "So, it's a good thing to always do the drills the same way . . . but in real life you need to act the right way, whatever that happens to be." LauNar

December 14th, 2007, 09:36 AM	#5 (permalink)
Brian Allen(Offline) GUE Instructor Join Date: Nov 2005 Location: London & Plymouth Posts: 594	What a shocking story, am glad you're ok. __________________ ...dive planning again ... GUE fundamentals and Halcyon Equipment Online www.ocean-explorers.co.uk

December 14th, 2007, 01:02 PM	#6 (permalink)
Dorota & Wojtek(Offline) GUE Instructors Join Date: May 2006 Location: Hurghada, Red Sea, Egypt Posts: 30	Thanks for your best all the wishes Some more adds - the doctors stated that I did not have any conditions that could have put into the raised risk of DVT - I train often, I am a non-smoker, no-alkohol, so that could have helped/prevented one. But it did not. Two of the doctor I spoke with indicated timidly that the dives I have done before that incident could have some influance. There was a suspicion that the presance of inert gas could have made me more prone to DVT "at some level" (as thay said). One of them even said that diving can make the risk factor higher. Do you know guys any other opinions about dving, the coagulability of blood and DVT? Maybe there are some papers/work/research done on it. Would be good to read more....

December 14th, 2007, 01:27 PM	#7 (permalink)
MonkSeal(Offline) Old Member Join Date: Feb 2006 Location: Zagreb, Croatia Posts: 479	Quote: (Originally Posted by Dorota & Wojtek) Do you know guys any other opinions about dving, the coagulability of blood and DVT? Maybe there are some papers/work/research done on it. Would be good to read more... I read an article about DVT in one of the recent DAN's "Alert Diver". But if I remember correctly the main focus was on DVT developing in people often flying over-seas. Best wishes for fast recovery.

December 14th, 2007, 02:58 PM	#8 (permalink)
Dawn(Offline) New Member Join Date: Dec 2005 Location: North Carolina Posts: 153	Hi Wojtek, I am happy you are here with us to tell your story. Hopefully you are feeling a little better as each day goes by. Yes, there are studies showing a state of hypercoagulation in diving; however, most of the papers out there are focused on symptomatic decompression illness. There are also a handful which have been done on saturation diving. Of the papers I have seen on coagulation in diving, the most applicable (measuring changes in coagulation markers and platelet count in asymptomic dives) to your situation/question would be: Hematologic changes after daily asymptomatic dives Diercks, KJ Eisman, PT Undersea Biomed Res. 1977 Dec;4(4):325-31. http://archive.rubicon-foundation.org/2776 The effect of air and nitrox divings on platelet activation tested by flow cytometry Baj Z, et al Aviat Space Environ Medicine 2000 Sep;71(9):925-8. PMID: 11001346 The Baj group is working out of Poland with the Military Medical Academy, btw. Best wishes and take care, Dawn

December 14th, 2007, 03:43 PM	#9 (permalink)
amascuba(Offline) New Member Join Date: May 2006 Location: West Texas Posts: 129	Thanks for sharing! I hope that you get better soon!

December 15th, 2007, 01:08 PM	#10 (permalink)
*Fiona*(Offline) Moderator Join Date: Sep 2006 Location: Up North Posts: 1,212	Sounds like you have had a very bad time. Please accept this as a genuine question is putting a cast on the ankle and I am assuming you mean a plaster cast a usual course of action for a sprain. __________________ Fiona Resistance was Futile Move Along YD GUE Member