Dear tubaloo:
As mentioned on several occasions in these FORUMS, there are two major contributors to decompression sickness. The first is supersaturation of inert gas in the tissues of the body and the other is the concentration of tissue micronuclei.
Because John Scot Haldane developed his tables, and decompression method with the avoidance of gas bubbles in mind, the presence of tissue nuclei has been virtually neglected. In recent decades, the nuclei have been somewhat acknowledged, but the ability to change the concentration has not been thought possible. Thus, table design has concentrated only on gas loading.
From our NASA studies, we have noted the effect of muscle activity on gas bubble formation during decompression. It is very profound. Divers must recall that off gassing is occurring while you are on the boat. Decompression is not over when you reach the surface.
While many speak about various factors in DCS risk, nothing plays a role as much as gas loading and tissue nuclei concentration. Gas loads are governed by time and pressure exposure. They are also controlled by activity levels upon surfacing (e.g., do not go to sleep during the surface interval). To control tissue nuclei, strenuous activity with upper and lower extremities is to be avoided. Do not lift scuba tanks any more than is necessary, climb ladders, run, and other such strenuous activities.
Naturally a PFO can play a very negative role if bubbles are formed during the decompression. This is especially true if Valsalva-like maneuvers are performed. In addition, we have obesity in divers with considerable adipose tissue (= fat) in the abdomen.
Dr Deco