Puzzlement
Registered
I'm a little reluctant to post this, as I'm not really specifically looking for either avoiding-DCS advice or second-guessing of my medical treatment since I am now being advised by a hyperbaric specialist, but this is the kind of story I'd be interested in reading if I was a diver who'd never had DCS, so I'll post and see how it goes. At the end there's some discussion of how to be a table diver in a computer world, I'd be interested in thoughts.
I was the person who posted this: http://www.scubaboard.com/forums/ba...21547-bad-sunday-night-pain-after-diving.html
Summary: I did two dives six weeks ago approaching the limits of a Suunto Gecko computer (but not hitting or exceeding them) and exceeding the tables (at least if read as a square profile, and since I don't have my exact profile there's no other way to read the tables). I had some shoulder pain but no other symptoms. I called DAN who called the Sydney civilian hyperbaric chamber who in turn advised me to go to my local emergency room and come in in the morning if the situation warranted. The emergency room discharged me in the morning. After a day all pain was gone and after a week residual weakness and such was gone.
I went diving again on Saturday, again exceeding the tables but not pushing the Gecko so hard. (the lowest time remaining I saw was 18 minutes.) At 3am I woke with shoulder pain, milder than six weeks ago but in exactly the same location. Since nothing in the intervening period had done this I called DAN again in the morning at 9am and they rang the hyperbaric unit at Prince of Wales in Sydney so that they and the emergency room knew to expect me. I arrived and was examined by triage for breathing difficulties (none) before receiving high flow oxygen.
After about 45 minutes the hyperbaric specialist came in (he'd been at a footy game, I think he must have missed the whole thing). He was a good doctor in terms of bedside manner and not talking down to patients, I was pleased. (He is not a diver himself, although he said all his colleagues are, as he cannot clear his ears.) He didn't find any evidence of any neurological problems whatsoever. He explained that it is impossible to positively identify pain as DCS but that since it had happened twice soon after diving, there were no obvious causes and that exceeding the tables was the definitive risk factor he was assuming that it was DCS.
He did not seem concerned about the previous episode even though it was untreated. He explained that with pain that was resolving so quickly, and the six week break from diving between, I had come near to good practice anyway: he would normally be OK with not recompressing someone whose pain was clearly already resolving by the time they were examined. However, as this was the second occurence in a row, even though it was also resolving he leaned towards recompressing.
I had my first treatment yesterday for 4.5 hours. Because of the assumed previous hit they used Table 62 rather than 61. The only surprises were having to wear the most uncomfortable mask in the universe, and the heat as the chamber is brought up to pressure. Today is my second treatment, which will be with the "regulars". (I had no idea chambers had other medical uses, but the regulars are being treated for non-healing infected wounds.)
After recompression completes I am confined to < 300m altitude for a fortnight and must not exercise heavily for the same time period. I will be evaluated to start diving again in four weeks. The doctor thinks that he will probably agree to allowing me to continue diving at that time (they usually do unless the hit is within the tables and therefore unexplained) but that I must now dive strictly to the DCIEM tables. He does not recommend looking for a PFO, because apparently if they find one the combination of a PFO and a DCS hit means that they would recommend never diving again. Therefore they only suggest looking for PFOs if someone gets a hit within the DCIEM tables.
One thing I am curious about is for other people who dive tables: how well have you managed to work with dive guides?
I generally dive on organised trips simply because I don't own a car and so DIY shore diving is very expensive and difficult. (So are most Sydney clubs, as the protocol is to pick your tanks up from the dive shops some kilometres from the ocean and so on: I need taxis to do this.) On sites we know my husband (who, you can probably infer, is evidently not as vulnerable to DCS) and I dive without a guide but many dive operations in Australia insist on guides if you have not dived the site before. In my experience most dive guides expect to work to a plan where they monitor the group's air and computer time. I will now have to go to the guide and explain that due to a previous DCS hit I strictly dive tables and must stick to a pre-planned maximum depth and (if I do multilevel) ascend at pre-determined times etc. In addition, I will almost certainly be That Diver, the one who needs to come up first, meaning I will need to avoid operations where That Diver must end the dive for the whole group, as That Diver tends to be unpopular (I suspect especially so when it turns out That Diver has plenty of air left). I suspect a tempting alternative will be to throw us into the group of newly trained divers whose air consumption is not yet up to scratch, but that won't really do since they won't be as strict about holding to a pre-planned depth.
I was the person who posted this: http://www.scubaboard.com/forums/ba...21547-bad-sunday-night-pain-after-diving.html
Summary: I did two dives six weeks ago approaching the limits of a Suunto Gecko computer (but not hitting or exceeding them) and exceeding the tables (at least if read as a square profile, and since I don't have my exact profile there's no other way to read the tables). I had some shoulder pain but no other symptoms. I called DAN who called the Sydney civilian hyperbaric chamber who in turn advised me to go to my local emergency room and come in in the morning if the situation warranted. The emergency room discharged me in the morning. After a day all pain was gone and after a week residual weakness and such was gone.
I went diving again on Saturday, again exceeding the tables but not pushing the Gecko so hard. (the lowest time remaining I saw was 18 minutes.) At 3am I woke with shoulder pain, milder than six weeks ago but in exactly the same location. Since nothing in the intervening period had done this I called DAN again in the morning at 9am and they rang the hyperbaric unit at Prince of Wales in Sydney so that they and the emergency room knew to expect me. I arrived and was examined by triage for breathing difficulties (none) before receiving high flow oxygen.
After about 45 minutes the hyperbaric specialist came in (he'd been at a footy game, I think he must have missed the whole thing). He was a good doctor in terms of bedside manner and not talking down to patients, I was pleased. (He is not a diver himself, although he said all his colleagues are, as he cannot clear his ears.) He didn't find any evidence of any neurological problems whatsoever. He explained that it is impossible to positively identify pain as DCS but that since it had happened twice soon after diving, there were no obvious causes and that exceeding the tables was the definitive risk factor he was assuming that it was DCS.
He did not seem concerned about the previous episode even though it was untreated. He explained that with pain that was resolving so quickly, and the six week break from diving between, I had come near to good practice anyway: he would normally be OK with not recompressing someone whose pain was clearly already resolving by the time they were examined. However, as this was the second occurence in a row, even though it was also resolving he leaned towards recompressing.
I had my first treatment yesterday for 4.5 hours. Because of the assumed previous hit they used Table 62 rather than 61. The only surprises were having to wear the most uncomfortable mask in the universe, and the heat as the chamber is brought up to pressure. Today is my second treatment, which will be with the "regulars". (I had no idea chambers had other medical uses, but the regulars are being treated for non-healing infected wounds.)
After recompression completes I am confined to < 300m altitude for a fortnight and must not exercise heavily for the same time period. I will be evaluated to start diving again in four weeks. The doctor thinks that he will probably agree to allowing me to continue diving at that time (they usually do unless the hit is within the tables and therefore unexplained) but that I must now dive strictly to the DCIEM tables. He does not recommend looking for a PFO, because apparently if they find one the combination of a PFO and a DCS hit means that they would recommend never diving again. Therefore they only suggest looking for PFOs if someone gets a hit within the DCIEM tables.
One thing I am curious about is for other people who dive tables: how well have you managed to work with dive guides?
I generally dive on organised trips simply because I don't own a car and so DIY shore diving is very expensive and difficult. (So are most Sydney clubs, as the protocol is to pick your tanks up from the dive shops some kilometres from the ocean and so on: I need taxis to do this.) On sites we know my husband (who, you can probably infer, is evidently not as vulnerable to DCS) and I dive without a guide but many dive operations in Australia insist on guides if you have not dived the site before. In my experience most dive guides expect to work to a plan where they monitor the group's air and computer time. I will now have to go to the guide and explain that due to a previous DCS hit I strictly dive tables and must stick to a pre-planned maximum depth and (if I do multilevel) ascend at pre-determined times etc. In addition, I will almost certainly be That Diver, the one who needs to come up first, meaning I will need to avoid operations where That Diver must end the dive for the whole group, as That Diver tends to be unpopular (I suspect especially so when it turns out That Diver has plenty of air left). I suspect a tempting alternative will be to throw us into the group of newly trained divers whose air consumption is not yet up to scratch, but that won't really do since they won't be as strict about holding to a pre-planned depth.
Good luck and you do seem fortunate that the docs allowed you to keep diving!
