i tried to fly out today and i ended up being bent

[Blastman4444]

OP, I think you were desperately unlucky.

OK, I am being unfair: I am hoping you were desperately unlucky. I am a self-confessed envelope pusher on the flying-after diving thing, but I would have thought that profile sounded perfectly safe on anyone's scale to me.

Lots of helpful suggestions put forward so far as to aggravating factors - I find myself wondering if there might not have been more than one aggravating factor working in tandem.

But whatever way you dice it, to get a full on hit 22 hours later sounds pretty darned unlucky.

All I can say is we talk about it a lot getting DCS but once you have it it's really scary to feel your limbs go numb it isn't fun. I would suggest not pushing you luck if it happens and you don't have oxygen near by it could be really bad I was able to get oxygen quickly which does help a lot I sucked about 3 bottles dry all the way to the hospital.

How do you know you do not have a PFO? Ascending to 8000 feet above sea level is like changing depth by 9 feet of sea water. Or at least sort of since you are saturated for 1 atmosphere before you start and are usually not saturated a depth during a dive. In any case the ascent to altitude should drive at most something like a third of a liter of nitrogen out of solution which should not be enough to bend a typical person. There is some way that you are atypical.

I didn't have those kind of symptoms which are caused by PFO DCS I spoke to DAN about PFO they also agreed with the doctors that the problem was I exited the water on the 2nd dip to 100 feet at 11 am I flew the next day at 7:20 not long enough. DAN said PFO is still not really understood and they are no convenced PFO even has an effect on DCS.

 

[DandyDon]

I hope the airline did not charge you additional landing fees, O2 used on board, or for changing your tickets. ilot: Hell, they charge for anything can these days but they'd rather have you on the ground than a worse emergency in the air.

DAN's guidelines for flying after diving have not changed since 2002...

The following guidelines are the consensus of attendees at the 2002 Flying After Diving Workshop. They apply to air dives followed by flights at cabin altitudes of 2,000 to 8,000 feet (610 to 2,438 meters) for divers who do not have symptoms of decompression sickness (DCS). The recommended preflight surface intervals do not guarantee avoidance of DCS. Longer surface intervals will reduce DCS risk further.

For a single no-decompression dive, a minimum preflight surface interval of 12 hours is suggested.

For multiple dives per day or multiple days of diving, a minimum preflight surface interval of 18 hours is suggested.

For dives requiring decompression stops, there is little evidence on which to base a recommendation and a preflight surface interval substantially longer than 18 hours appears prudent.

Like others, I wonder how chilled you got, if you did any strenuous activities, etc. but sometimes it just happens and we don't really know why. One of the most unexplained hits I've heard of spent weeks in ICU for no apparent reason.

When it's your body suffering and at risk tho, I am sure that it's quite real. Best wishes...!!

 

[Mr Carcharodon]

DAN said PFO is still not really understood and they are no convenced PFO even has an effect on DCS.

Well I do not understand that. One of the ways of diagnosing a PFO is using ultrasound to detect injected bubbles. If more bubbles in arterial circulation is not a risk factor for DCS I am not sure what is.

For what it worth I am writing from a hotel room at 5500 feet that I flew to today after doing 3 dives yesterday. Clearly not everyone gets bent by doing what you did. So that begs the question why.

 

[vladimir]

I didn't have those kind of symptoms which are caused by PFO DCS I spoke to DAN about PFO they also agreed with the doctors that the problem was I exited the water on the 2nd dip to 100 feet at 11 am I flew the next day at 7:20 not long enough. DAN said PFO is still not really understood and they are no convenced PFO even has an effect on DCS.

If we believe that Kell understood DAN correctly, then we have to either:

a) stop proclaiming the person who answers the phone at DAN to be the ultimate authority on all things DCS (a good idea in any case, IMO), or

b) conclude that something truly magical happens between the 20th and the 24th hours after a dive is concluded, which makes the difference between a serious neurological hit and a symptom-free decompression.

 

[DandyDon]

Well I do not understand that.

Yep, the discussion is ongoing. see Alert Diver | PFO and Decompression Illness in Recreational Divers

 

[GLENFWB]

I took a DCS hit in the Galapagos Islands at the end of 5 days of diving. There were 15 people in our group, and I dove some of the more conservative profiles. I was the only one in our group that took the hit. My body did not handle the nitrogen as well as others for some reason. Glad you are feeling better. I took four chamber rides before it was all said and done.

 

[Bubbletrubble]

I'm not sure I buy the PFO explanation.

Typically, when is venous bubbling in the post-dive period the greatest?
Is it 5 minutes after surfacing, 30 minutes, 1 hour, 3 hours, 12 hours, or 24 hours?
Based on published data, I'd venture a guess that venous emboli peak at some point between 30 minutes and 2 hours post-dive.
Taking this into consideration...and then superimposing the change in ambient pressure from sea level to whatever the cabin pressure was at 10,000 ft....I'm not sure if there would be enough of a bubble burden 20 hours later to elicit spinal cord DCS even in the presence of a PFO.
I'd argue that if the patient had a PFO (and PFO is a true risk factor for DCS), he would have experienced the hit shortly after the conclusion of his last dive...not almost a day later.

After a 20 hr post-dive interval, this asymptomatic individual boarded a commercial flight whereupon he experienced numbness/tingling in all of his extremities once the plane reached an altitude of 10,000 ft. Assuming that cabin pressure was kept within a range equivalent to 2000 - 8000 ft. in altitude and taking his dive profiles and pre-flight interval into consideration, this would place him on the "exceptionally prone" end of the DCS spectrum.

Rather than jump to a DCS diagnosis, I would be very careful in ruling out other causes of the patient's symptoms.
I would ask whether the patient was on any prescription/OTC/homeopathic medications.
I would ask whether the patient had a history of circulation, diabetes, or heart disease issues.
I would ask whether the patient has a history of chronic back pain or acute trauma to the vertebrae.
I would also have to consider anxiety/panic attack in the differential.

If I could rule out all of those other potential causes...and presumptive treatment for DCS (rides in the hyperbaric chamber + breathing O2) resulted in resolution of the patient's symptoms, then I would settle on a diagnosis of DCS and just say that, for whatever reason, the diver was very unfortunate to experience the hit.

 

[AfterDark]

Might also consider using O2 on your SS and /or part of your SI in the future.

 

[Rick Murchison]

A couple of folks have nibbled at the problem, but no one's really honed in on it. The reported dive profile DOES violate the NOAA flying after diving (FAD) table, which calls for at least 24 hours before ascending to 10,000 ft in an unpressurized aircraft for any nitrogen loading above repetitive group "H" on the Navy tables - the mishap diver was certainly beyond that, based on the reported dive profile.
The 12-18 hour guidance is strictly for commercial aircraft, whose cabin altitudes these days run around 4500'. (the guidance assumes less than 8000'). That extra 2000 feet of cabin altitude throws the 18hr guidance out and the diver is now on the NOAA FAD table guidance... which calls for a minimum 24 hour SI, and, as this incident has just proven, is apparently pretty good guidance.

I have seen folks say before that, if you get bent from flying after diving, you were bent before you got on the plane . . . and I suspect that was true here.

I suspect that too, but the fact that the diver was outside the NOAA FAD table as well sorta points to the efficacy of that table, eh? I should also mention that people have, in fact, gotten bent in unpressurized airplanes without ever having been diving in their lives, so it is possible to get bent in an airplane without being bent first. (That's why we'd pre-oxygenate before flying high altitude test flights)
Rick

 

[iztok]

A couple of folks have nibbled at the problem, but no one's really honed in on it. The reported dive profile DOES violate the NOAA flying after diving (FAD) table, which calls for at least 24 hours before ascending to 10,000 ft in an unpressurized aircraft for any nitrogen loading above repetitive group "H" on the Navy tables - the mishap diver was certainly beyond that, based on the reported dive profile.
The 12-18 hour guidance is strictly for commercial aircraft, whose cabin altitudes these days run around 4500'. (the guidance assumes less than 8000'). That extra 2000 feet of cabin altitude throws the 18hr guidance out and the diver is now on the NOAA FAD table guidance... which calls for a minimum 24 hour SI, and, as this incident has just proven, is apparently pretty good guidance.

As of now commercial airlines are pressurized for the altitude of maximun 8000 ft. A380 is the lowest at 5000ft (at 43k ft cruising altitude). I don't know where you got your 4500 ft but it is far from it. And pressure is gradually lowered to that altitude during the ascent. I don't know where you get the 10k ft limitation as this certainly wasn't the case with OP.