Dcs

[Alastair]

Sunday dawns and I’m off on Wey Chieftain to dive the Mystery wreck with Andy Kerslake. It’s a really nice sailing ship which has yet to be identified and when I last dived it in July it became one of my favourite wrecks. We’ve had a 24 hours surface interval since our last dive. The dive has an average depth 54m for 30 minutes on the bottom. Our bottom mix is 18/45 and we use 50% and 100% for deco. I’d actually do the same profile back in July with exactly the same bottom time, gas and deco schedule albeit with slightly longer deep stops in that case. We surfaced at 14.07 and I’m back on the boat by 14.15.

Shortly after surfacing maybe 15 minutes I noticed my chest felt tight and constricted. It was a little uncomfortable when I breathed all the way in. I mentioned it to Clare and Andy and figured the 20 minutes on 02 at the end of the deco hadn’t agreed with me. Around 30 minutes after the dive I felt nausea and a bit dizzy – normal pattern for travel sickness which I often suffer from. It continued to be really bad so I called Fraser over and asked him to help get me out of my drysuit. He helped out and I managed to change. I figured being hot with my suit still on was the cause. The odd thing was it didn’t abate at all. As we neared harbour I again asked Fraser for help and got him to pack away all my gear as I just couldn’t do it. It’s really been a weekend of motion sickness. Andy missed a dive on Saturday for the first time in 5 years due to it and Bob sat out the diving on Sunday! I've never known Bob miss a dive so it gives you an idea to the sea conditions.

We reached the harbour and I was very relieved. What was odd was I still felt lousy. I got off the boat to go to the loo and when walking back noticed some visual disturbances. I relayed this to a couple of people on the boat I was quite concerned with what was going on. We moved some kit off the boat and I got hit by a massive wave of dizziness and sat down in Clare’s truck. About 20 minutes had now passed since we reached the shore and Clare at this point called the Royal Navy doc. The main reason was actually due to the lung constriction I was still feeling. Everyone me included was sure the rest of the symptoms was just down to motion sickness (quite true as it turned out). Clare spoke to them and I also spoke to the Doctor. They decided they’d like to talk to the chamber in Poole. Clare asked if I wanted to go and I actually said since sitting down I was feeling a lot better. I really didn’t think it was worth going. While we wait for a call from Poole Clare sticks me on 02 and Fraser gets me to start drinking water as a precaution.

We pack up and decide Fraser can drive me as it’s on his way home – we are still thinking it’s not DCS and that I’ve got pulmonary o2 reaction. While waiting for the call back we travel to Portland to pick up Fraser’s car. Poole phone up as we near Portland and want me to come in. As we are travelling in the car I feel much worse – really bad motion sickness. This convinces me it’s all just travel sickness so once we get there I come off the o2 and I wander off to the loo where I promptly starting vomiting violently. At this point I finally admit to myself that something is actually wrong. The drive to Poole is lousy with lots of traffic. I end up having to get Fraser to pull over so I can violently vomit again.

I finally reach the chamber at about 17.50 where I’m met by the Doctor. I discuss the dive in some detail talking through the deco profiles and gases. I then go through some tests; these include ears, eyes, balance, testing reflexes etc. I try and walk across the room with my eyes shut and fail badly. Needless to say the outcome is unfortunately not good. The reflex test (tap joints with mallet) which is a non-subjective test indicates my nervous system is not happy at all and it tells them I definitely have DCS. Add in the vomiting, dizziness and lack of balance and it looks like a vestibular bend. The balance problem caused by this was resulting in the motion sickness. They want to get me in the chamber immediately so I have time to go to the loo, change into the clothes they issue and briefly sort out what’s happening with Fraser. It’s subsequently arranged that I’ll stay in a B&B just up the road from the chamber and I’ll have to get a train back to Weymouth in the morning.

I climb into the 2 person chamber about 18.20 to start a very long treatment. The chamber is big enough for you to sit up but essentially you end up lying down. The schedule followed was a Comex 30 schedule. I was given diazepam to help deal with the effects of pulmonary o2 toxicity. This is pretty much a guaranteed outcome of the large amount of oxygen exposure I’m about to get.



This starts on Heliox 50/50 at a depth of 30m and later moves over to pure oxygen at 18m. In the chamber with me is Spencer who would for the most part be breathing the ambient air in the chamber. The initial descent is easy I just kept clearing my ears. The chamber heats up rapidly as the air compresses but not horribly so. Once at 30m I’m onto the Bibs mask on I start breathing the heliox. The bibs mask is a bit uncomfortable – it’s a bit like the mask you see pilots wearing in films. It’s a demand valve that seals on your face but it dug into the bridge of my nose which I didn’t even notice at the beginning but certainly did several hours later. Spencer takes a lot of time to explain everything to me and answers all my questions ranging from ones about the treatment to how I go the loo!

At the first air break I’m asked how I’m feeling and I have to say it was feeling better. The dizziness and nausea had pretty much gone. By the second air break I feel almost normal. By the third I feel great and realise quite how bad I’d been – bit of a sobering moment. Throughout Spencer and myself are reading books and chatting when we can to pass the time. The chamber has two mechanisms to allow items to be exchanged with the outside world. I get a lot of drinks passed through the small lock-out chamber and I’m drinking tea or water at every air break. The switch onto o2 at 18m seems to have come round pretty quickly and it’s about then we sort out what we are having for dinner. Spencer offers Chinese which I turn down due to an allergy, when I explain it makes me hurl he sensibly decides that would not be good in such a small space.

Pizza arrives and it is very welcome albeit I’ve only got a 5 minute air-break to eat it in so I stuff my face and manage a thank you once the mask is back on. I worked out that the last food I’d had was a bowl of cornflakes at 8am so it’s no surprise I’m hungry. Time continues to pass and I’m getting steadily through the book I took in. The chamber gets quite a few flushes of the ambient air to keep the temperature down but it’s a small space so it heats up quite quickly.

We are now over half way through but with several more cycles to go I’m finding the bibs mask really painful with it digging into my nose and more importantly my lungs are struggling to generate enough force to operate the demand valve. At the air break I’m coughing like crazy and very uncomfortable. I go through another 40mins of pain but Spencer gets ready to swap me over to a hood. This makes life easier as my chest doesn’t have to work as hard.

I try and doze off now and end up drifting in and out of sleep. Spencer later tells me that at this point I was up to 25 respirations per minute and was only taking very shallow breaths. Trouble is there isn’t much they can do - you just have to buckle down and keep going. The air breaks come and go and time passes very slowly. I keep hydrating at every opportunity as it’s the one thing that can help my lungs cope better. At one point I burp into the hood and have to live with the smell of pizza for 20 minutes before the air break – it makes me think of Andy Kerslake’s tale of a garlic taste in his rebreather loop staying with him for far too long! We reach the final section with just the ascent to go and I’m very relieved.

I exit the chamber at about 1.30am to see the Doctor again. We run through the tests and she’s very pleased that I seem to have had full resolution. She explains that vestibular bends are often very difficult to treat and take several sessions. I ask about susceptibility to it re-occurring and she tells me this is what they classify as an undeserved bend – i.e. no obvious cause. I was well hydrated, had a good 8 hours sleep, did a solid ascent with no missed stops, no alcohol in the last fortnight, non-smoker, good level of fitness and a sensible deco profile. There are no definite answers as to why vestibular bends occur. I could do exactly the same dive again and have absolutely no problems as indeed I’d done it once before. I get a standard ban on diving and flying for several weeks and we talk about avoiding deep mix dives for a spell. One of the comments is that her view is that nitrogen bubbles exist in the body after diving for anything up to 4 months. People who dive throughout the year can then end up with a fairly innocuous dive triggering a DCS incident with no obvious cause but these residual nitrogen bubbles then are there to play a role.

Overall I’m left in a rather odd state of mind. I feel grateful for the chamber staff and the fact that I got a full resolution. I can’t fault their care an attention but I don’t know why it happened. The difficulty with vestibular bends is that they simply don’t know what mechanism can sometimes result in such a bend. Definitely a few lessons to learn for everyone on the boat – DCS can present in odd ways. The travel sickness was quite real but down to the loss of balance rather than just being in a rough sea. What we should have done is the 5 minute neurological exam. This would have identified the balance problem at the time and given us a better steer. I’d also say that once the chamber wants to see you must just assume DCS and keep going on the o2 and water.

A couple of twinges have made me nervous and at the back of my mind I do wonder if I’ll suffer any long term effects. I actually rang the chamber on Wednesday just to have a chat. I got to speak to the Doctor who treated me who put my mind at rest somewhat. I’d had an incident of momentary dizziness which she said could happen over the next few days but that she was 100% happy I’d had full resolution so these were just normal effects of my system recovering. My lungs have taken a couple of days to recover for the pulmonary toxicity but now feel ok.

I’m not planning to give up deep mix diving however I do need to square it away in my head. One of my main decisions now was whether to post this or not. I’d like to think there is no problem with reporting DCS as it’s something everyone can learn from. I’ve filled in a BSAC incident report and I hope that it proves interesting reading.

Cheers
Al

[JohnKendall]

Dude,

I'm sorry to hear about that. I'm kinda glad I didn't manage to get down at the weekend if both Bob and Andy sat out dives due to motion sickness.

Hope you are feeling better now. How long do you need to stay out of the water?

All the Best
J

[Adrian Kelland]

A good write up Al.

I don't use 100% O2 so don't know how a problem would feel, or how likely an O2 problem would be compared to DCI. It seems to me that this and the motion sickness that you get, and the fact that others suffered from sickness too, helped with a bit of denial? Even though the sickness was indeed just that.

I think that is probably one of the hardest routes to the final correct diagnosis I have read. So much masking by other problems. Thanks for putting it up.

Adrian

[Clare Gledhill]

Quote: (Originally Posted by Adrian Kelland)

I don't use 100% O2 so don't know how a problem would feel, or how likely an O2 problem would be compared to DCI. It seems to me that this and the motion sickness that you get, and the fact that others suffered from sickness too, helped with a bit of denial? Even though the sickness was indeed just that.

I think that is probably one of the hardest routes to the final correct diagnosis I have read. So much masking by other problems. Thanks for putting it up.

From a buddy's perspective it is frightening how, in hindsight, we missed so many symptoms. It's why I encouraged Al to post.

The sickness we had all had that weekend (mine came on in the middle of the night so was not related to sea sickness at all ) made you feel a bit light headed as well.

When I called the RN Doc for Al - I was quite convinced that there was nothing wrong with him as far as DCS goes although I was a little concerned that he may have reacted to the O2. I was just going through the motions really, encouraged by Bob who, rightly, pointed out that calling in any possible symptoms after a deep dive is always a good idea.

As Al said - we should have done a neuro exam. But I'm not convinced that we would have done even if it occured to us as no-one suspected that he may have DCS.

Hopefully, should this happen to anyone else having read Al's report, a small seed of doubt will now exist and more appropriate action can be taken.

[Adrian Kelland]

Quote: (Originally Posted by Clare Gledhill)

...

As Al said - we should have done a neuro exam. But I'm not convinced that we would have done even if it occured to us as no-one suspected that he may have DCS.

...

Easy to say in hindsight, but I would have gone through the motions of a test. DCI would have been higher (No1) on my list of suspects than an O2 issue.

Thankfully(?) the only case I have seen was very obvious. Pain and paralysis within minutes of being on board. Never been sure about my own suspect case.

You got there without too much delay, which is the important thing.


Adrian

[Fiona]

Quote: (Originally Posted by Clare Gledhill)

From a buddy's perspective it is frightening how, in hindsight, we missed so many symptoms. It's why I encouraged Al to post.

Clare I went through exactly the same last year when SteveS had his vestibular bend, I hadn't even heard of it before. I can't tell you how long I felt very guilty for, even now I have no idea why it happened to him on our dive.

Thanks for posting Al, we need to read about these instances so we get to know all the symptoms and recognise them as soon as possible.

[Lou]

As Fiona said, that is a very, very similar tale to what we had with Steve's vestibular bend last year.

There was alot of resistance to the idea of a bend from most of the experienced divers on the boat, I guess because it doesn't present with the pain of a normal bend, and because dizziness can be caused by some many things.

I did feel that it may have been a bend, but in the face of so much more experience than I had in such things I didn't push the case as hard as I should have, although we did get Steve onto O2 and sat down with water to get down his neck at least. I didn't feel confident enought o suggest the neuro test, and I doubt if we could have got Steve to comply with it anyway, to be honest.

All these things still bother me, and, like Fiona, I felt guilty about not picking it up and being firmer earlier.

Al's excellent write-up will, I sincerely hope, push this back into a few minds, and maybe trigger the alarm bells earlier in others.

Al - all the very best with your recovery. Take it easy, and don't rush back. It is all there later!

Lou

[Divingniknaks]

Woh,

Firstly I'm glad you got a full resolution and secondly much kudos for posting.

Seems to have been a "lousy" weekend all round, shame.

All the best and as Lou says don't push it, the sea'll be there a while longer.

All the best.

.

[Janos]

Quote: (Originally Posted by Lou)

I did feel that it may have been a bend, but in the face of so much more experience than I had in such things I didn't push the case as hard as I should have, although we did get Steve onto O2 and sat down with water to get down his neck at least. I didn't feel confident enought o suggest the neuro test, and I doubt if we could have got Steve to comply with it anyway, to be honest.

I find it very hard to start going down the whole neuro-diagnosis part, as you do find resistance and people (including the first-aider) aren't willing to admit that the diver might be suffering from a real bend.

The approach I've taken in the past, is to jokingly say that non-compliance is denial, which is a symptom of a bend, and so if they continue to disagree then they'll be on the chopper pronto! My other course of action is to say that "The book" says I have to do a neuro-exam and if anyone found out that I didn't they'd take away my diving badges.

Janos

[iainmsmith]

Quote: (Originally Posted by Alastair)

Shortly after surfacing maybe 15 minutes I noticed my chest felt tight and constricted. It was a little uncomfortable when I breathed all the way in. I mentioned it to Clare and Andy and figured the 20 minutes on 02 at the end of the deco hadn’t agreed with me.

Al,

Sorry to hear about your bend. Thanks for writing it up, especially as it leads me to a couple of questions (for my own education):

Reading through your post, the thing that jumped out at me was the above - a suspicion of a pulmonary reaction to 20min on O2. (I assume that you mean some form of pulmonary oxtox?)

I stress that I have not got any signficant number of dives using O2 for deco (still in single figures), but is this not a tiny exposure to be concerned about pulmonary oxtox? (Medically, "The history doesn't fit...") Is there some other form of "pulmonary reaction" to oxygen that comes on after comparatively minor exposures? If so, how common is it?

Iain