Decompression Accident in North Sulawesi

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I'm not very frequent to the board, so I'm late to the conversation. I can confirm first hand the wisdom of the responses. Freewillow and Divergirl1972's experiences I have seen before. I have witnessed cutis marmorata five times. One was treated with a convenient chamber ride. The other 3 resolved with O2. One time, the diver returned to diving the following day. My wife chose to play it safe and not dive after her events. First, skin bends isn't a discrete event, as in yes and no. It can vary in severity and accompanying symptoms, ergo I would consider the question of return to diving in any general terms. Both times I saw divers return to diving (without incident), the event was mild and had no other symptoms.

It's all about risk acceptance. I have evolved into a very risk averse diver. I've seen the results of a severe type II hit. I haven't been on a dive that is worth it. Having said that, I once had a conversation with the chamber doc at a local Dallas hospital. His personal view was that he would never clear anyone to dive that has had a DCS event. His view is that a person who takes a hit is at greater risk of a second hit, therefore should never dive again. A bit extreme.

Be safe.
 
I was on oxygen for about an hour at the resort before leaving for the hospital. Because they refused to believe that I had the skin bends, they would not provide me with treatment for it. I did ask for oxygen, but they just kept stating that I was having an allergic reaction and would not give it to me. I even explained that I had seen the skin bends before on someone else and I was 100% sure this was it.

I did try/offer to connect DAN with the ER doctors in Dumaguete, but they (ER) simply did not want to hear it! They would just basically ignore me. It was pretty ridiculous, actually, given that diving is a big tourism draw down there. I would have thought they would be much more knowledgeable and/or open-minded about this type of thing, but… That’s why I just got ticked off and left.

The doc at the recompression chamber in Cebu diagnosed it as Type I (though, yes, there was some overlap in type II symptoms at the initial onset), so that was the story and I was sticking to it. I did two modified 6A treatments on 100% oxygen while I was there and there were absolutely no residual symptoms after my treatment.

Our rules were basically common sense: Drink LOTS of water throughout the day, no dives deeper than 60 - 65 feet, all dives on 32% nitrox, 3 dives per day max with a minimum of 2 hr surface intervals, 5 – 6 minute safety stops, excruciatingly slow ascents from those safety stops, no hot showers for at least an hour or two after diving (unfortunately, we had some hot water issues in our room so that wasn’t a problem! lol), and I made sure there was 36 hours from my last dive until our flight out.

Sounds like a solid game plan to minimize risk. You may want to throw in thermal protection during the dive. Steve Lewis did some outstanding research a few years back on efficiency of off-gassing, with the hypothesis that being warm during the end of the dive contributed to more efficient off gassing. This is contrary to a lot of profiles, whereby we enter the water warm and toasty, and are freezing by the end of the dive. Just something to consider.
 
Sounds like a solid game plan to minimize risk. You may want to throw in thermal protection during the dive. Steve Lewis did some outstanding research a few years back on efficiency of off-gassing, with the hypothesis that being warm during the end of the dive contributed to more efficient off gassing. This is contrary to a lot of profiles, whereby we enter the water warm and toasty, and are freezing by the end of the dive. Just something to consider.

Great point and I couldn't agree more. I usually have the thickest thermal protection of any other diver on the trips we go on. Even in locations where others are wearing skins or just a hooded vest and board shorts (Maldives, Raja Ampat, etc...), I'm wearing my full 5mm and skin (or sometimes even a hooded vest thrown in). Not because I choose to specifically for DCS prevention purposes, but just because I get cold quickly when diving repetitively and it makes me miserable.
 
Great point and I couldn't agree more. I usually have the thickest thermal protection of any other diver on the trips we go on. Even in locations where others are wearing skins or just a hooded vest and board shorts (Maldives, Raja Ampat, etc...), I'm wearing my full 5mm and skin (or sometimes even a hooded vest thrown in). Not because I choose to specifically for DCS prevention purposes, but just because I get cold quickly when diving repetitively and it makes me miserable.

Same. 5mm in Indonesia even in Lembeh, Komodo, and Raja...People think I’m crazy but TBH I have never been hot or cold on a dive. Very comfortable. This is a good reason why now!
 
Same as you: 5/4/3 mm wetsuit, with hood and was perfectly OK in 28/29° C water :popcorn:
 
Dear fellow divers, especially the older ones.
grimace.gif


I just came back from a visit to the hyperbaric service of Dr Peter Germonpré @ the military Hospital in Brussels, Belgium.

I will try to summarize, with his permission, the 80 minute long discussion we had. The discussion was open and very friendly. Peter is a diver and shares our passion. He has been numereous times in the Asian Gold Triangle and 3 times in Lembeh.

I will not come back on the issue of "deserved" versus "undeserved" hit, for Dr Germonpré, this is a futile question.

From the description of my symptoms - he was not on the spot for the acute phase - I most likely suffered from a neurological/skin DCS. He is pretty sure that a PFO is present. This should be confirmed or not in a few weeks.

These are his recommandations for myself, whether I have a PFO or not.

- Nitrox dives
- use a dive computor set on air, being aware of the MOD. This should not be an issue considering future profiles.
- Stay in the "security" curve ( even more, start to go up 5 minutes away from the NDL).
- Safety stop of 5 minutes between 3 and 6 meters
- Successive dives are allowed PROVIDED that they do not bring me too fast close to the NDL.
- No Physical exercice within 2 hours following the dives. It can produce a large number of micro-bubles that can go through the PFO or any pulmonary shunt.

We also discussed some points that were raised in this and a french forum. I only relate what I understood from him. So there are no warranty on the accuracy of the information :daydream:



My dive profile, staying at a certain level ( around 18 meters), followed by a VERY SLOW ascent, is not a great idea, especially for multiple dives. It is much better to do square profiles or a two-levels dive, e.g. 20/25 meters, then half depths and then immediately to the safety stop.

He is not convinced that the photograph's apneae are a major risk factor. He is a photographer himself
bravo.gif



He is not in favor of Nitrox dives, using a Nitrox setting even put on a +1 or +2 conservatism. For this the divers have to realise that a dive computor does not know how a particular body behaves. They should therefore dive with wider margins than the computor indicates, especialy if risk factors are present. Moreover for dives with mandatory deco stops, the computor gives only ways and techniques in order to minimise a risk that is way bigger than dives within the NDL.

Interval of 60 minutes between two dives is the norm in a lot of countries. This is sad but difficult sometimes to avoid. It is acceptable but 60 minutes is an absolute minimum.

2 or 3 dives per day is OK, as long as succesive dives do not put the diver too close to the Deco line AND to rest without diving for 24 hours every 4/5 days. The goal, surprisingly, is more to give a chance to the dive computor to "reset" rather to enable the diver to recover. After several days of multi dives, a lot of computors are quite a bit lost, he explained.


He admits that to make a safety stop with enriched nitrox over 70% 02 could be a plus, but not essential for the recommended profiles. Moreover, he believes that when one undertakes to make a risky sport, like diving, even if the risk is quite low but unpredictable, one has to be attentive to first aid care. This means that when a small suspicion of DCS is present, the priority is to get oxygen and ample hydration before seeking advise and diagnosis from a competent doctor on the spot or distant advise from on a help line ( DAN or others).

This sumarises my meeting with a great person, volunteer to DAN Europe . I hope that I was able to reproduce his opinion on the matter.

Hoping that it can help fellow "elderly divers" like myself .

.
 
Dear fellow divers, especially the older ones.
grimace.gif


I just came back from a visit to the hyperbaric service of Dr Peter Germonpré @ the military Hospital in Brussels, Belgium.

I will try to summarize, with his permission, the 80 minute long discussion we had. The discussion was open and very friendly. Peter is a diver and shares our passion. He has been numereous times in the Asian Gold Triangle and 3 times in Lembeh.

I will not come back on the issue of "deserved" versus "undeserved" hit, for Dr Germonpré, this is a futile question.

From the description of my symptoms - he was not on the spot for the acute phase - I most likely suffered from a neurological/skin DCS. He is pretty sure that a PFO is present. This should be confirmed or not in a few weeks.

These are his recommandations for myself, whether I have a PFO or not.

- Nitrox dives
- use a dive computor set on air, being aware of the MOD. This should not be an issue considering future profiles.
- Stay in the "security" curve ( even more, start to go up 5 minutes away from the NDL).
- Safety stop of 5 minutes between 3 and 6 meters
- Successive dives are allowed PROVIDED that they do not bring me too fast close to the NDL.
- No Physical exercice within 2 hours following the dives. It can produce a large number of micro-bubles that can go through the PFO or any pulmonary shunt.

We also discussed some points that were raised in this and a french forum. I only relate what I understood from him. So there are no warranty on the accuracy of the information :daydream:



My dive profile, staying at a certain level ( around 18 meters), followed by a VERY SLOW ascent, is not a great idea, especially for multiple dives. It is much better to do square profiles or a two-levels dive, e.g. 20/25 meters, then half depths and then immediately to the safety stop.

He is not convinced that the photograph's apneae are a major risk factor. He is a photographer himself
bravo.gif



He is not in favor of Nitrox dives, using a Nitrox setting even put on a +1 or +2 conservatism. For this the divers have to realise that a dive computor does not know how a particular body behaves. They should therefore dive with wider margins than the computor indicates, especialy if risk factors are present. Moreover for dives with mandatory deco stops, the computor gives only ways and techniques in order to minimise a risk that is way bigger than dives within the NDL.

Interval of 60 minutes between two dives is the norm in a lot of countries. This is sad but difficult sometimes to avoid. It is acceptable but 60 minutes is an absolute minimum.

2 or 3 dives per day is OK, as long as succesive dives do not put the diver too close to the Deco line AND to rest without diving for 24 hours every 4/5 days. The goal, surprisingly, is more to give a chance to the dive computor to "reset" rather to enable the diver to recover. After several days of multi dives, a lot of computors are quite a bit lost, he explained.


He admits that to make a safety stop with enriched nitrox over 70% 02 could be a plus, but not essential for the recommended profiles. Moreover, he believes that when one undertakes to make a risky sport, like diving, even if the risk is quite low but unpredictable, one has to be attentive to first aid care. This means that when a small suspicion of DCS is present, the priority is to get oxygen and ample hydration before seeking advise and diagnosis from a competent doctor on the spot or distant advise from on a help line ( DAN or others).

This sumarises my meeting with a great person, volunteer to DAN Europe . I hope that I was able to reproduce his opinion on the matter.

Hoping that it can help fellow "elderly divers" like myself .

.
Thanks for this.
 
https://www.shearwater.com/products/swift/

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