OP
Got bent, preferred IWR to my local chamber
- Thread starter AbyssDiver1983
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OP
AbyssDiver1983
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Interesting question. Yes, my shoulder strap was tighter than usual. I dive a halcyon infinity BC so I adjust before every dive and I must’ve pulled the right side too hard. We considered it as a risk factor especially since the exertion at depth was with the right arm.
Interesting question. Yes, my shoulder strap was tighter than usual. I dive a halcyon infinity BC so I adjust before every dive and I must’ve pulled the right side too hard. We considered it as a risk factor especially since the exertion at depth was with the right arm.
OP
AbyssDiver1983
Registered
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First thanks for posting... I truly believe that all incidents and accidents posted help all divers!
I'm not a medical professional, in fact I don't know anything about this stuff, but I've witnessed my share of DCS incidents during my technical diving.
I once attended a diver on a small island in the Sulu sea having DCS symptoms. We called Dan Europe and put him on O2 and fluids. The nearest chamber required a helicopter ride that was not so easy to organise (even for DAN), so IWR was also discussed. In the end we didn't do because we didn't have a full face mask and the symptoms started to ease sufficiently not to warrant such a drastic treatment. So I think I understand where you are coming from (no immediate help available, having to chose the lesser of 2 bad options, etc).
Some comments from me on your ordeal.
- "you analised the dive on the Teric and nothing seemed wrong so you didn't act!": Most of the DCS incidents I've witnessed were not blow ups or significant deviations from the planned ascend profile. But still they got hit! So when in pain post dive, or any neurological symptoms, always hit the O2.
- Psychologically don't ignore pain: If there is pain or other symptoms and you've done a dive, the first reaction should always be to view this as possible DCS. Too many people don't want to admit to themselves that they have DCS, because of various reasons (feeling they've done something wrong, don't want to stress out buddies, don't want to create a fuss, don't like the change this will make to any plans you have, etc).
- Evaluating the case: O2 will also help evaluating if it's a probable hit or you just smacked your shoulder against something. If the pain diminishes while you are on O2 but returns when you take an air break it's a hit.
- If you have DAN insurance always call them. Options from dive medicine professionals are always going to be better than the opinions from your dive buddies. Yes in many cases they will be over cautious but that's what you want in situations like these.
- If you are far away from a chamber or it is suspect, maybe it's a good idea to dive more conservatively (no deco) or at least make sure you have the equipment and procedures in place for a potential IWR. This is by the way in my opinion only a viable option if the water temperature is high enough, having to deal with undercooling issues while at the same time trying to treat DCS is a recipy for disaster.
- I know enough divers who've gotten type 1 hits (pain in joints) and decided not to take HBOT, but just keep using O2 and some anti inflamatory medication. However also here you might side on the caution side, you don't know what such damages will do to your body later in live (bone necrosis, etc).
Anyway, glad that you are ok. You had to take quite a lot of tough decisions in a short period of time!
I'm not a medical professional, in fact I don't know anything about this stuff, but I've witnessed my share of DCS incidents during my technical diving.
I once attended a diver on a small island in the Sulu sea having DCS symptoms. We called Dan Europe and put him on O2 and fluids. The nearest chamber required a helicopter ride that was not so easy to organise (even for DAN), so IWR was also discussed. In the end we didn't do because we didn't have a full face mask and the symptoms started to ease sufficiently not to warrant such a drastic treatment. So I think I understand where you are coming from (no immediate help available, having to chose the lesser of 2 bad options, etc).
Some comments from me on your ordeal.
- "you analised the dive on the Teric and nothing seemed wrong so you didn't act!": Most of the DCS incidents I've witnessed were not blow ups or significant deviations from the planned ascend profile. But still they got hit! So when in pain post dive, or any neurological symptoms, always hit the O2.
- Psychologically don't ignore pain: If there is pain or other symptoms and you've done a dive, the first reaction should always be to view this as possible DCS. Too many people don't want to admit to themselves that they have DCS, because of various reasons (feeling they've done something wrong, don't want to stress out buddies, don't want to create a fuss, don't like the change this will make to any plans you have, etc).
- Evaluating the case: O2 will also help evaluating if it's a probable hit or you just smacked your shoulder against something. If the pain diminishes while you are on O2 but returns when you take an air break it's a hit.
- If you have DAN insurance always call them. Options from dive medicine professionals are always going to be better than the opinions from your dive buddies. Yes in many cases they will be over cautious but that's what you want in situations like these.
- If you are far away from a chamber or it is suspect, maybe it's a good idea to dive more conservatively (no deco) or at least make sure you have the equipment and procedures in place for a potential IWR. This is by the way in my opinion only a viable option if the water temperature is high enough, having to deal with undercooling issues while at the same time trying to treat DCS is a recipy for disaster.
- I know enough divers who've gotten type 1 hits (pain in joints) and decided not to take HBOT, but just keep using O2 and some anti inflamatory medication. However also here you might side on the caution side, you don't know what such damages will do to your body later in live (bone necrosis, etc).
Anyway, glad that you are ok. You had to take quite a lot of tough decisions in a short period of time!
The problem with DCS is whilst we know things that will cause it, the evil is that it can happen for no apparent reason.
I have one friend who I did my tech courses with in cold water down to 60m deco on mixed gases using the same algorithm, all good. We went to Chuuk Lagoon and did two simple deco dives to 35m, no stress and warm water but the only thing being we did deco on air as on the first day no mixes were available, he got badly bent. You would think if he was going to get bent then it would happen in Melbourne in the cold dirty water. he got home and found he had a PFO, now why it didn't show earlier? Well the only thing we can put it down to is that every other dive we deco on mixed gas, at Chuuk, on air, but why this caused it is a mystery.
Had similar issues with my wife diving, did many dives in Melbourne cold water with decos on mixed gas, did dives in Bruni warm water and got bent, dived at Vanuatu and same. Found she has a tiny PFO unfixable. Now she must always dive with mixed gas deco and also do extra on pure O2 to prevent it. If she does a non deco dive with no O2 at the end its 50/50 she will get bent, with O2 for 3 min at the end of the dive she is fine, but only does one deep dive a day and over a week takes a break.
For us, rule 1 is always, if you at all suspect someone might be bent get them on O2. Its cheap and doesn't hurt, if they aren't bent no big deal, if they are you are helping them. It might be the only medical support in the area, and the sooner you get them on it the better. A good test is to do a 5m dive on O2, and if the pain diminishes, you are probably bent, if it makes no difference at all in 10-15 min it might be something else.
I have one friend who I did my tech courses with in cold water down to 60m deco on mixed gases using the same algorithm, all good. We went to Chuuk Lagoon and did two simple deco dives to 35m, no stress and warm water but the only thing being we did deco on air as on the first day no mixes were available, he got badly bent. You would think if he was going to get bent then it would happen in Melbourne in the cold dirty water. he got home and found he had a PFO, now why it didn't show earlier? Well the only thing we can put it down to is that every other dive we deco on mixed gas, at Chuuk, on air, but why this caused it is a mystery.
Had similar issues with my wife diving, did many dives in Melbourne cold water with decos on mixed gas, did dives in Bruni warm water and got bent, dived at Vanuatu and same. Found she has a tiny PFO unfixable. Now she must always dive with mixed gas deco and also do extra on pure O2 to prevent it. If she does a non deco dive with no O2 at the end its 50/50 she will get bent, with O2 for 3 min at the end of the dive she is fine, but only does one deep dive a day and over a week takes a break.
For us, rule 1 is always, if you at all suspect someone might be bent get them on O2. Its cheap and doesn't hurt, if they aren't bent no big deal, if they are you are helping them. It might be the only medical support in the area, and the sooner you get them on it the better. A good test is to do a 5m dive on O2, and if the pain diminishes, you are probably bent, if it makes no difference at all in 10-15 min it might be something else.
They would use a special plane with increased cabin pressure AFAIK.
I am curious if you meant to use the MRI to check if there was any damage from DCS or from something else? AFAIK, no x-ray, CT Scan or MRI can show anything related to DCS, isn't this true?
OP
AbyssDiver1983
Registered
Very true, when in doubt hit the O2.. biggest lesson learned.
Another habit I’m going to pick up is not switching gas in my computer. I used to dive more aggressive depth and duration profiles with my old Uwatec and it was a single gas Nitrix computer. My margins of safety were way bigger and I always had half my 12l stage full upon surfacing. I’m not telling my computer about my deco mix anymore, some things it’s better not knowing.
OP
AbyssDiver1983
Registered
Seems your wife got bent more than once. Sorry to hear that, but it shows true passion for the sport that she’s still diving technical. Respect. Did she do HBOT every time or did she opt for other types of treatment?
OTF
Coney Island Whitefish Biologist
Thank you for sharing. Sad to hear the chamber in your country is so... questionable.
I agree with all the posters recommending that in future suspected DCS hits you and everyone else should act fast without shame, get on O2, call DAN. Even if you're not a member DAN will advise you!! Acting fast matters. It sounds like your symptoms worsened to a pretty serious point quite a while after you suspected DCS. It could have become even worse than it did.
I don't really have much to say about your use of IWR. I'll leave that to others. Did you use a full face mask? It sounds like it was successful and may have been the most reasonable option considering your chamber situation. Sooner rather than later would have made it more effective. That's a scary high CNS % to reach.
As for incident analysis: It might be interesting to post the dive profile if you can. What GFs were you running? Do you suspect a PFO? Did you verify the mix in the tanks? Was there anything else unusual about the dive or events preceding the dive (exhaustion, dehydration, repeat dives etc.)? Or maybe there was no obvious explanation, unfortunately there are still so many unanswered questions in the physiology of diving.
I agree with all the posters recommending that in future suspected DCS hits you and everyone else should act fast without shame, get on O2, call DAN. Even if you're not a member DAN will advise you!! Acting fast matters. It sounds like your symptoms worsened to a pretty serious point quite a while after you suspected DCS. It could have become even worse than it did.
I don't really have much to say about your use of IWR. I'll leave that to others. Did you use a full face mask? It sounds like it was successful and may have been the most reasonable option considering your chamber situation. Sooner rather than later would have made it more effective. That's a scary high CNS % to reach.
As for incident analysis: It might be interesting to post the dive profile if you can. What GFs were you running? Do you suspect a PFO? Did you verify the mix in the tanks? Was there anything else unusual about the dive or events preceding the dive (exhaustion, dehydration, repeat dives etc.)? Or maybe there was no obvious explanation, unfortunately there are still so many unanswered questions in the physiology of diving.
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