Ken Kurtis
Contributor
This actually happened two weeks ago on our Sea of Cortez trip. I have talked to Audrey (the woman affected) about posting this here and she has given her assent. (This is excerpted from my full trip report. It's written from my perspective so any reference to "I" or "me" is, well, me.) But I think there are a lot of lessons to be learned from Audrey's experience and we share it in that spirit.
- Ken
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As I got back on the Don Jose, thats when my second exciting moment of the trip started.
Joel came up to me as I was taking my gear off and said, You need to come over her. Audrey may be having a problem. Uh-oh.
Audrey was standing along the starboard side of the boat and had a concerned/pained look on her face. Whats going on? I asked. My whole right side is really tender and even painful to the touch, she replied. My first thought was skin bends, a relatively mild form of decompression sickness, but DCS nonetheless.
I asked to see her side because sometimes with skin bends theres a rash present. While I didnt see a rash I did see what looked like bruised or mottled skin in the affected area. Audrey said the pain started about 10-15 minutes after she surfaced but had stayed on her right side. She didnt have any tingling or numbness, no joint pain, no other muscle pains, and no other apparent neurological problems.
But she did exhibit what we sometimes jokingly refer to as the #1 symptom of the bends: Denial. I cant be bent, she said a number of times throughout the day, Im a good diver. And my computer wasnt in deco.
Good divers can get bent. Bad divers get bent. And both good and bad divers sometimes do things that should get them bent (rapid ascent, pushing computer limits, blowing off safety stops, etc.) but they dont get bent.
And just because you computers not bent doesnt mean that you cant be bent (or vice-versa). Dont lose sight of the fact that computers are simply mathematical models that may or may not pertain to your particular body physiology. And you might take five different computers on the same dive and come up with five different decompression profiles so which is the correct one?
Getting the bends isnt a crime or a sin. Its something that needs to be dealt with to prevent it from getting worse and REALLY becoming problem. And when we tell you, whether its a local trip or a foreign trip, that if after a dive youre feeling SOMETHING UNUSUAL FOR YOU . . . then you need to let us know. In Audreys case, she did the exact right thing once she realized there was a problem.
We put Audurey on oxygen and I ordered the boat to pull anchor and head back towards La Paz. Skin bends sometimes resolves with oxygen alone but I needed to get close enough to La Paz to get within cell phone range so we could contact the D.A.N. emergency line and get some advice and perspective on what was going on. And if need be, there was a chamber in La Paz (as well as one in Cabo) so that if Audrey did need to be treated, we could get her in as quickly as possibly. (Unlike in the U.S., you cant count on a helicopter to come get you so the usual course of action is to head back to port.)
The short version is that we kept Audrey on oxygen, her symptoms resolved, D.A.N. agreed with our skin bends suspicion, and no chamber treatment was required. It was recommended that she stay out of the water for at least 48 hours (which meant no more diving on the trip) and that shed be OK to fly after that but we should watch for any recurrence of symptoms during the flight.
As she and I have discussed this further post-trip, a big factor in all of this seems to be dehydration. Even though Audreys computer (Oceanic Proplus2) showed that she shouldnt have been bent, it doesnt know how well hydrated she was. In Audreys case, she was fairly severely dehydrated. (We actually had her medically evaluated for that, and treated with IVs, once we got back to La Paz.) Thats probably what pushed her over the edge because when youre dehydrated, your blood loses some volume is simply not able to off-gas as much as the computer model is predicting.
Its easy to tell what your hydration level is. It may sound gross to some, but just keep an eye on the color of your urine. Copious & clear are the hallmarks. Ideally, you should be drinking enough fluids (preferably water but if not water preferably non-caffeinated drinks) so that youre peeing a lot and its relatively clear. If your urine starts to get dark, then you need to drink more water.
In fact, its not a bad idea - even on local dives or single dives - to drink a glass of water a few minutes prior to the start of the dive. And drink some water after youre done with the dive as well. Theres nothing wrong with drinking too much water. Youll just pee or even sweat it out anyhow. But dont drink enough water, and you could find yourself in a predicament similar to Audreys. And Im sure shed be the first to tell you that she wouldnt wish that on anyone.
The other thing that may have factored in is that Audrey tends to dive what would probably be considered aggressive profiles. In other words, she likes to get as much time as her computer will allow. In fact, she had switched from a Cobra to the Proplus because she felt the Cobra wasnt giving her enough time underwater. But, as I said previously, computer are based on mathematical models that may or may not fit your particular body physiology. And the bottom line is that ANY time you spend more time in the water, you accumulate more excess nitrogen, and may be increasing the chances of a unpredicted bends hit. So you need to decide what your comfort level is and where you want to draw the line.
The other thing I noticed when looking at Audreys profiles is that while she was doing safety stops after each dive, she was generally only doing 3-minutes and no more. Personally, especially on trips where I know were far off shore, I tend to do 5-10 minute safety stops. Id much rather spend a few extra minutes in the water on a safety stop than a few extra hours in a chamber wishing Id done a longer safety stop. I cant say with 100% certainty that a longer safety stop would have helped Audrey avoid this problem, but it certainly wouldnt have hurt or made the situation worse.
The bends is the ultimate pass/fail test. Youre either not bent, or youre bent. And if youre not bent, we dont really know by how much (10 seconds??? 10 minutes???) and the only time you know if you passed or failed the bends test is when you fail and by then, its too late to avoid it. All the more reason to build as much caution into your diving as you possibly can.
And complicating all of this (and just FYI, Audreys given me permission to discuss all these problems in this public setting) is that shes on blood pressure medication and she may not have been taking it as regularly as she should have. But the medication is also a diuretic, which further exacerbates the dehydration issue.
And to further complicate things, the doctor in La Paz pointed out that her dosage was based on living in Colorado at 5,000 feet, not at being in La Paz at sea level. In the same way that (hopefully) youve heard before that medications can wear off more quickly than normal when youre diving, the same principle holds true for dosage levels. They may be different when you have big altitude changes as well as you should check with your doctor to see if diving over the course of a week will have any effect on your dosage levels and whether or not they should be adjusted.
So many lessons coming out of one dive . . .
- Ken
-----------------------------------------------------------------------------------------------------------------------------------
As I got back on the Don Jose, thats when my second exciting moment of the trip started.
Joel came up to me as I was taking my gear off and said, You need to come over her. Audrey may be having a problem. Uh-oh.
Audrey was standing along the starboard side of the boat and had a concerned/pained look on her face. Whats going on? I asked. My whole right side is really tender and even painful to the touch, she replied. My first thought was skin bends, a relatively mild form of decompression sickness, but DCS nonetheless.
I asked to see her side because sometimes with skin bends theres a rash present. While I didnt see a rash I did see what looked like bruised or mottled skin in the affected area. Audrey said the pain started about 10-15 minutes after she surfaced but had stayed on her right side. She didnt have any tingling or numbness, no joint pain, no other muscle pains, and no other apparent neurological problems.
But she did exhibit what we sometimes jokingly refer to as the #1 symptom of the bends: Denial. I cant be bent, she said a number of times throughout the day, Im a good diver. And my computer wasnt in deco.
Good divers can get bent. Bad divers get bent. And both good and bad divers sometimes do things that should get them bent (rapid ascent, pushing computer limits, blowing off safety stops, etc.) but they dont get bent.
And just because you computers not bent doesnt mean that you cant be bent (or vice-versa). Dont lose sight of the fact that computers are simply mathematical models that may or may not pertain to your particular body physiology. And you might take five different computers on the same dive and come up with five different decompression profiles so which is the correct one?
Getting the bends isnt a crime or a sin. Its something that needs to be dealt with to prevent it from getting worse and REALLY becoming problem. And when we tell you, whether its a local trip or a foreign trip, that if after a dive youre feeling SOMETHING UNUSUAL FOR YOU . . . then you need to let us know. In Audreys case, she did the exact right thing once she realized there was a problem.
We put Audurey on oxygen and I ordered the boat to pull anchor and head back towards La Paz. Skin bends sometimes resolves with oxygen alone but I needed to get close enough to La Paz to get within cell phone range so we could contact the D.A.N. emergency line and get some advice and perspective on what was going on. And if need be, there was a chamber in La Paz (as well as one in Cabo) so that if Audrey did need to be treated, we could get her in as quickly as possibly. (Unlike in the U.S., you cant count on a helicopter to come get you so the usual course of action is to head back to port.)
The short version is that we kept Audrey on oxygen, her symptoms resolved, D.A.N. agreed with our skin bends suspicion, and no chamber treatment was required. It was recommended that she stay out of the water for at least 48 hours (which meant no more diving on the trip) and that shed be OK to fly after that but we should watch for any recurrence of symptoms during the flight.
As she and I have discussed this further post-trip, a big factor in all of this seems to be dehydration. Even though Audreys computer (Oceanic Proplus2) showed that she shouldnt have been bent, it doesnt know how well hydrated she was. In Audreys case, she was fairly severely dehydrated. (We actually had her medically evaluated for that, and treated with IVs, once we got back to La Paz.) Thats probably what pushed her over the edge because when youre dehydrated, your blood loses some volume is simply not able to off-gas as much as the computer model is predicting.
Its easy to tell what your hydration level is. It may sound gross to some, but just keep an eye on the color of your urine. Copious & clear are the hallmarks. Ideally, you should be drinking enough fluids (preferably water but if not water preferably non-caffeinated drinks) so that youre peeing a lot and its relatively clear. If your urine starts to get dark, then you need to drink more water.
In fact, its not a bad idea - even on local dives or single dives - to drink a glass of water a few minutes prior to the start of the dive. And drink some water after youre done with the dive as well. Theres nothing wrong with drinking too much water. Youll just pee or even sweat it out anyhow. But dont drink enough water, and you could find yourself in a predicament similar to Audreys. And Im sure shed be the first to tell you that she wouldnt wish that on anyone.
The other thing that may have factored in is that Audrey tends to dive what would probably be considered aggressive profiles. In other words, she likes to get as much time as her computer will allow. In fact, she had switched from a Cobra to the Proplus because she felt the Cobra wasnt giving her enough time underwater. But, as I said previously, computer are based on mathematical models that may or may not fit your particular body physiology. And the bottom line is that ANY time you spend more time in the water, you accumulate more excess nitrogen, and may be increasing the chances of a unpredicted bends hit. So you need to decide what your comfort level is and where you want to draw the line.
The other thing I noticed when looking at Audreys profiles is that while she was doing safety stops after each dive, she was generally only doing 3-minutes and no more. Personally, especially on trips where I know were far off shore, I tend to do 5-10 minute safety stops. Id much rather spend a few extra minutes in the water on a safety stop than a few extra hours in a chamber wishing Id done a longer safety stop. I cant say with 100% certainty that a longer safety stop would have helped Audrey avoid this problem, but it certainly wouldnt have hurt or made the situation worse.
The bends is the ultimate pass/fail test. Youre either not bent, or youre bent. And if youre not bent, we dont really know by how much (10 seconds??? 10 minutes???) and the only time you know if you passed or failed the bends test is when you fail and by then, its too late to avoid it. All the more reason to build as much caution into your diving as you possibly can.
And complicating all of this (and just FYI, Audreys given me permission to discuss all these problems in this public setting) is that shes on blood pressure medication and she may not have been taking it as regularly as she should have. But the medication is also a diuretic, which further exacerbates the dehydration issue.
And to further complicate things, the doctor in La Paz pointed out that her dosage was based on living in Colorado at 5,000 feet, not at being in La Paz at sea level. In the same way that (hopefully) youve heard before that medications can wear off more quickly than normal when youre diving, the same principle holds true for dosage levels. They may be different when you have big altitude changes as well as you should check with your doctor to see if diving over the course of a week will have any effect on your dosage levels and whether or not they should be adjusted.
So many lessons coming out of one dive . . .
