By: Alan Levy, PADI OWSI

IF YOU FELL LIKE YOU MIGHT BE EXPERIENCE ANY SYMPTOMS OF DCS - DCI or "The Bends" please CONTACT your EMERGENCY MEDICAL SYSTEMS (in the USA 911) for EMERGENCY TREATMENT then CALL THE DIVERS ALERT NETWORK (DAN) at 1-919-684-8111 or 1-919-684-4 DAN (collect).
 

Introduction

 I wanted to share my experience, not to scare anyone but just to give you all a good example of the what can happen even though you did everything right and "By the Book" and still end up bent. I did two dives on this past Friday (May 24th, 2002) as part of my PADI MSDT training, and came up bent. Although I didn't really realize it until Saturday morning, I called DAN they said I should be seen by a diving doctor in Chicago, to which I did and I had a nice four hour stay in a recompression chamber. (And two subsequent stays - more later), I am fine, so don't worry about me. What I want to stress is I did everything by the book, it was an ultra-conservative supervised dive by a PADI Course Director and yet I came ended up with decompression sickness. Now for the facts:

The Event

Information:

As my final dive for my Deep Instructor specialty, myself and the Course Director did two dives on Friday. All my equipment was functioning fine (including my dive computer - but we will get to that later).  There was no new equipment introduced on these dives.  All my equipment was serviced regularly and in full working order. The dive profiles are as follows:

The Dives:

Dive 1 on EAN 35% to 80 Feet maximum depth for a total bottom time of 40 minutes, the average depth was 37 feet and the water temperature was 54 degrees. I personally verified the EAN percentage on both of my cylinders and calibrated the oxygen sensor myself before checking both cylinders. I was wearing a dry-suit and both full head and hands exposure protection. As part of dive two of the Deep Instructor program I was required to do a simulated decompression stop, so instead of the usual three minute safety stop we did a 12 minute simulated decompression stop at between 14-17 feet. We came up switched tanks and proceeded after a 30 minute surface interval to do a fun dive so I could get some additional practice navigating using "The NAV Finder". I felt fine so we proceeded on to dive two.

Dive 2 on EAN 35% to a maximum depth of 45 feet for a total bottom time of 56 minutes, the average depth was 23 feet and the average temperature was 46 degrees. The dive was fun, as we messed around following fishes and I practiced navigation.

We came up, talked at the dive site for about an hour logged our dives talked about the next time we were to meet and said our goodbyes. My dive profile on my computer said I had ample dive time left. At that time I felt fine, no joint or muscle pain and the only thing was out of place was that I felt kind of "foggy" on the brain. I did not mention this to anyone as I have had a similar feeling before after doing cold water dives. And it usually clears up by the time I get home. I drove home, eat dinner with my wife and went to bed.

DCS/DCI:

When I woke up the next morning, I stretched as usual, and my left arm and left leg felt "strange", they was a bit of a grind as I moved them. My first thought was that it could be DCS, but I dismissed it after a minute or two because of my conservative dive profiles, so I just decided to see if it went away after a bit and went back to bed for about another hour. After awaking for the second time, the same symptoms were present, I wanted to confirm my first thoughts, and my dive computer was still in my car, so I went downstairs and pulled it along with my log-book out of my car. I went over the two dives minute by minute (a nice feature of the Suunto Vyper), and came to the same conclusion I had done nothing wrong. But the weirdness in my left joints still nagged at me so did that little voice in the back of my head. I picked up the phone and called DAN, I asked to speak to the on-call diving doctor. The operator informed me that because it was the weekend, they would need to call the on call person and call me back if it was an emergency. I told the operator that it wasn't really a diving emergency and that I would wait till Tuesday.

That Little-Voice:

That little voice was getting a bit louder now, and I remember those words that they told us in my IDC, that you can do everything right "by the book", and still end up bent. I also remember when they said we as  instructors are bound to the same laws of physics as other divers but that we are better equipped to deal with most dive situations because of our increased knowledge. My wife by this time had woken up and came in to our den, and asked me what was wrong. I told her my suspicions, and what I was going to do about them (this was a bit of a scare for her, since she doesn’t dive and has had no dive training). For the second time that morning I called DAN, and told them I would like to have the on-call diving doctor paged. They told me to hold-on; the next voice I heard was the doctor who asked me what my problem was. I told him what my symptoms were and my dive profile was and he said he would suggest me getting checked-out by a diving doctor here in Chicago that day. We briefly talked as he fished around for this phone numbers of the chambers in my area he mentioned to me something weird, that he had treated two divers just the day before in North Carolina who too had dived on EAN and experienced symptoms with very conservative dive profiles. He then proceeded to give me the phone number of the chamber at Swedish Covenant Hospital, as well as his personal pager of the chamber doctor. He said that if I had any other questions to call DAN back 24 hours a day. I thanked him and proceed to call the numbers he had given to me.

The Chamber

MD Call:

I got a call back within 5 minutes and told my story for the second time that day to the chamber doctor Dr. Zenetti. He said that I should meet with him at roughly four, and most likely undergo a treatment for DCS. I asked him whether he thought I had DCS? He said that if after the treatment I felt the same as I did before I went into the chamber I didn't have DCS but if I felt better then yes indeed I did take a hit. With that knowledge I started to make preparations for my stay, he said it would be anywhere between 2 and 4 hours depending upon his evaluation. About an hour later I got a call by a different diving doctor, Dr. Matt Hickey who said he also worked at the chamber and said that if I wanted to come in sooner he could meet me at noon. He also said that I should bring two movies since they have a VCR and I can watch them while I undergo treatment.

Examination:

I met Dr. Hickey at noon and he told me what would happen, he to was surprised that I was experiencing symptoms after such a conservative dive profile. He told me a bit about himself that he was a Navy diver himself and that the Navy paid for him to attend medical school and that his specialty was diving related injuries. As we were getting ready for my chamber ride he told me that he was seeing more and more people coming in for treatment who had been diving on EAN. Most of the folks he has seen had flown to soon after diving. With those facts in had I was confident that I had made the right choice to come in for my exam. After a very thorough exam he found out that I had a bit of strength loss in my left leg as compared to my right leg. He said that because of the joint pain and my foggy head (slight neurological problem - Type II DCS) he would recommend that I be treated on a Navy recompression table 6. I asked about payment for all of this he asked what insurance I had I told him a PPO and DAN insurance. He said that DAN would pick up anything my own insurance company wouldn't pay for and I shouldn't see a bill at all. I had a whole lot of time to think while I was in the camber, and the one thought that I had was, paying my DAN membership this past year was the best $75.00 I had ever spent!

The Ride:

My ride involved me being brought down to 60 feet and then to 30 feet. At each level I breathed 100% Oxygen for 20 minutes at a time then took an air break then breathed 100% again. Dr. Matt as he asked me to call him said I should bring my dive computer along for the ride to see how accurate it was.  Dr. Matt had to bring his three year old with him, and before I went in she gave me a container of fruit chews for me to snack on. He said that she had seen 2-3 other go through the procedure and she liked to help out making people better too. This was the nicest thing, and totally took the edge off of any apprehension I was feeling. As we went down we compared my dive computer to what he was setting the depth to, and my dive computer was completely on the money- foot for foot.  Again I thought that there was nothing I could have done differently in planning or executing my dive.  Roughly four hours and two movies later the procedure was over. The procedure was 100% (no joke) painless - I want to stress this over again 100% painless! He asked me how I felt, I told him that the joint pain was gone along with the fog in my head.

After:

I asked Dr. Matt what my chances for full recovery and for me to dive again. He said that since I was treated within 24 hours of the event and that I DID NOT FLY after I dove that I should recover fine. Also that the one treatment would most likely be the only one I would need. He stressed how nice it was to treat someone who was "fresh" and that the sooner people get treated the better their overall chances for a full and complete recovery are. He said as to my future diving, I should take at least a week off from any diving or pool teaching. I said really diving again with only 7 - 10 days. He said my symptoms were mild and were treated in time and that since I was healthy and young enough that I fall within the Navy guidelines for return to diving after DCS. He warned that if I experience any symptoms I should come back for another treatment. I thanked him again for his time and for coming in on the weekend, he said it was no problem.

What did I learn:

1. You can do everything right - by the book and still get a hit of DCS.

 2. Trust that inner voice; it knows when something is wrong.

 3. If something is wrong, get it looked at and if there is something wrong get it treated ASAP - with DCS time is our enemy.

 4. DCS is a scary thing but the camber ride isn't - I lost part of a day saw two good movies and got to sit on my back for four hours.

 5.. If you think you might have DCS, get it looked at BEFORE you step foot on any airplane, if you fly it will only make treatment harder and the time we don't dive longer.

Prologue

One Week after:

The following Thursday after my treatment I woke up with a bit of a headache, and a bit of muscle pain.  I contracted Dr. Zenetti and he suggested that I came in for another treatment.  Two more movies and four hours later I completed another treatment on Table 6 and all symptoms subsided.   Dr. Zenetti  suggested that based on my return of symptoms I not return to diving for at least 4 weeks.  Since I had taken a leave of absence from the dive store I work with part time, I told him that this would be no problem.

Two Weeks After:

Everything was fine for roughly another week and then the headache returned.  Dr. Zenetti. said another treatment would be prudent.  This was the one the gave the DCS/DCI the knock-out blow, two weeks have passed with no return of symptoms.  Hopefully this will be the last time I ever have to visit a recompression chambers, except to give a tour to my Dive Master candidates.

Links:

• Divers Alert Network (DAN) - http://www.diversalertnetwork.org/

The Event

The Chamber

After Thoughts

Prologue

Web Links