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Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 5:57 pm
by sarinae
Hi All,

My daughter Jolie and I are down in Mexico doing some underwater volunteer work on coral reef assessment and water quality assessment. It has been an amazing time until Sunday. I'd like to hear from all of you knowledgeable people, and maybe we can all learn from her DCI experience. Here's some relevant details:

Sunday--Flew in to Mexico
Monday--dove shallow reef x 2 (48 and 45 ft max)
Tuesday--dove shallow reef x 2 (38 and 45 ft max)
Wednesday--dove shallow reef x 2 (28 and 37 ft max)
Thursday--dove Taj Mahal cenote x2 (50 and 46 ft max)
Friday--dove shallow reef x 2 (46 and 40 ft max)
Saturday -- dove a shipwreck and then a shallow reef (89 and 37 ft max)
Sunday--lionfish hunt x2 (88 and 94 ft with a 58 minute surface interval, both dives 29 minutes)

We came up from the second dive and she complained of right shoulder pain. At first I poo-pood it and told her it was nothing to worry about, but then she said, "No, Mom, it is getting worse, I think it might be DCS." We had her lie down and gave her emergency oxygen. Fortunately, we weren't far away from port, so we threw her in the car and drove 10 blocks to the nearest hyperbaric chamber, oxygen continued until the tank ran out, about 5 minutes after we arrived at the hospital.

Since it was Sunday, the doctor was called in. He examined her and she showed no neurological symptoms, only the muscle pain in the right shoulder which was causing right arm weakness and tingling. He said that it was likely a bubble in the muscle tissue and said that she needed a Table 6 ride in the chamber. The team was called in to run the hyperbaric chamber, which took about an hour or so more.

Total ride time was 4hrs 45 minutes, nothing too exciting. The pain immediately subsided upon descent, but they made her do the full ride anyway. The doctor said to be sure, but I think they figured DAN was paying so they might as well milk it a little.

BTW, DAN will pay the entire $6485 bill, thank goodness. I didn't have to submit any payment at all. Keep paying that DAN insurance folks!

So, here is the dive log from my Oceanic computer. I don't have a cable that will take the data off of her Oceanic Veo 100NX, anyone have one I can borrow when we get home? I'd really like to see the specific data to this dive on her computer. We were close the entire dive, so this is a fair representation of what we were doing (right or wrong).

Please be kind, but I would appreciate your input on why she got a deco hit on this one. The worst part is that there was an irresponsible diver with us that day who had gone cenote diving in the morning. He was then far away from the group, not responsible to any buddy, and totally in his own world. On this very dive that she got DCS he exceeded his NDL significantly and had a deco obligation which he ignored. On top of that, he also ignored his safety stop (we did 5 minutes!). On TOP of THAT he didn't know how to use his computer and it turns out that it was set to NITROX. How much of a dumbass do you have to be at this point? One lucky SOB, is all I can say. His max depth was 106 ft. Oh, and did I mention that he has a PADI DM cert? Oh, I must have forgotten that little cherry on this Sunday sundae.

Thanks everyone for your insight! I would appreciate what you all have to offer. See the picture attached for the dive profile.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 7:06 pm
by fmerkel
You'll get far more objective analysis I'm sure, but in the end you'll have to chalk it up to bad luck. Seen very similar things happen to a few friends. The first reaction is - "WHAT? I didn't deserve that!" But there it is, and there you are.
Remember, the tables are an 'average', they make no allowances for outliers, which do happen.
Computer algorithms are actually all over the place in terms of safety. Some are simply more aggressive. Some become more conservative with multiple dives.

2 pieces of info that might be relevant:
Which computer - exact model and brand.
Sounds like you were not using NITROX? Makes a big difference on multiple dive days.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 7:25 pm
by sarinae
Yeah, I was pretty much just figuring it was bad luck mostly.

I am using an Oceanic Pro Plus 2, which does have a more generous algorithm. Jolie was using the Veo, which is slightly more conservative. Nitrox on these two deep dive days might have been a good idea, but I don't think anyone realized our dive was going to be quite as deep as it was the second day, and we have done things like that before with no issues at all. The group organizing the hunt said that they will insist on using Nitrox next time. Estimated depth was anticipated to be around 60-70 in that area.

We had plenty of rest, water, and were not doing anything crazy. No smoking, no alcohol, no drugs. Really, we're not much fun outside the diving!

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 7:54 pm
by diverden
I would agree. Probably just bad luck. No problem tho, sounds like treatment was 100% success and paid for. I am old and I have dived much more aggressively than this for serval years. So you showed the basic dive log over the days but after which dive did the symptoms start? You said "second dive" which I'm assuming was the second dive of the last day. People are different, there's always the risk.

There are a number of things that could give you minor symptoms which I've had (very mild): ascent rate to the safety stop, length of safety stop, any extra?, rate of ascent from last stop to surface, immediately working after surfacing, like climbing up the boat ladder. Once the dive is over you're still offgassing pretty good so anything to limit blood flow like work or just sitting funny could allow some bigger bubbles which could cause some minor symptoms.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 7:57 pm
by Desert Diver
We use nitrox almost every dive. I don't see any disadvantage of staying away from the no deco limits. It adds some cost but not so much in the whole scheme of a vacation. Hope everything goes alright now!

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 8:00 pm
by sarinae
Thanks, Diverden, I appreciate the insight. I don't know how you avoid climbing the ladder to get on the boat, lol! I am a big fan of not swimming back from the dive site, as a rule, especially if I want to avoid strenuous exertion. I think you're right though, sometimes it can be something very similar.

My understanding from my limited learning about decompression is that the muscular tissue compartments are among the fastest to off-gas, so I am surprised that her DCI was in a muscle tissue, not in something else. Maybe that was just the symptom? It was definitely not in the joint. Also, her position definitely changed the pain location.

We had her lie down for about 10 minutes as we got her to shore, during that time the bubble traveled inward toward her chest. She was upright for about 5 minutes as we drove to the clinic, and they kept her upright. During that time, the pain traveled upward toward her shoulder. It was very interesting to hear her report where her pain was every few minutes and how it was moving.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Fri Jul 31, 2015 9:49 pm
by BillZ
For an air dive the profile look slightly aggressive but not outrageous. I would have done my ascent a bit different but have done this exact same profile hundreds of times without issue.

Every time we breathe compressed gas underwater we run the risk of getting bent, it's just part of the sport. We do things to mitigate the risk such as diving nitrox, slowing our ascent profiles, etc. but there is always a chance of getting a hit.

If you want to understand more about decompression and the history and theory behind it Deco for Divers is a great read. Spatman has a copy he's trying to sell


Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 01, 2015 11:16 am
by diverden
Forgot to mention that people do bubble differently and supposedly some decent percentage of the population has a PFO. I talked to my doctor and because I was getting into tec diving and instruction, they did an ultrasonic bubble study and determined I was PFO free.
I'm not a doctor but hopefully it was just a fluke. If it were me, I would still dive (unless it was forbidden), dive nitrox on all dives, stay conservative, and slow the ascent rate especially the last 20 ft. Come up from the safety stop slower too, and do a 0ft stop for a couple minutes before climbing or contorting to get out of gear if possible.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 01, 2015 12:05 pm
by fmerkel
Did the O2 on the way there do any good? A guy I know did a pretty aggressive profile, came up OK, packed, and was driving home when he got a pretty bad hit while driving with weakness and some paralysis. Symptoms arrived after some time, probably an hour+ after the dive. O2 did a huge amount of good but he still required a decompression.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 01, 2015 1:52 pm
by Tangfish
15 minutes spent ascending from depth at 94'? I'd say you did nothing wrong and this is just bad luck, as the others said.

I've done many profiles more aggressive than this on air and been fine. The one thing I'd point out, if I were to nitpick and try to point out anything that could've been done differently, is that right at the depth where one would typically do a deep stop (around 47') there is a fairly steep ascent.

I always try to do the deep stop, there is some good thinking behind doing it, even if it's for a minute at half your max depth.

Sorry to hear that this happened to your daughter and I'm glad she turned out ok and without any neurological damage or a huge medical bill. As you say, that DAN insurance is worth every penny and we all should have it.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 01, 2015 3:59 pm
by Jeff Pack
Plugging the dive into multideco with straight air, you accumulated some deco using a worst case of 15m @90ft, but burnt it off.

I'd call it an undeserved hit. Unfortunately it happens

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 01, 2015 8:24 pm
by CaptnJack
You were getting progressively deeper as the week went on which is typical. The only thing which sticks out to me as "uh oh" is the 58 min SI on Sunday. Even though the 88ft dive was "only" 29 mins stacking it with a 94ft dive after only 58 min SI seems aggressive to me. Maybe not per the actual tables but on air it would have bent me too.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Mon Aug 03, 2015 10:58 am
by selkie
Way back in the day when I ran a chamber we always ran the full treatment table. The only modification we would do was maybe run a longer table if the med tech said to. The fact they ran the whole table is standard procedure. Some other factors to think about are rest and hydration. I would also agree with the suggestions of using Nitrox to increase the safety factor.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Mon Aug 03, 2015 11:15 am
by CaptnJack
A treatment table is a protocol. Although there are shorter and longer protocols, Table 4 is one of the shorter ones and 6 and 6A are longer, once started they can't shorten it. They can lengthen a Table 4 to a Table 6 or 6A however. They don't "bring you up" just because your symptoms resolved at depth. You need to eliminate the gas in the tissues and re-perfuse the injured tissues with O2 to help them heal.

Agree on using nitrox to increase the safety factor (assuming you don't dive right up to its NDL)
But personally I really think the 58min SI is part of Sunday's problem, stretching that out to 90 to 120 mins would also have be helpful. It might not have been 100% helpful but may have turned clinical (requiring treatment DCS) into subclinical "I'm kinda sore but getting better on aspirin" issues.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Tue Aug 04, 2015 1:44 pm
by ljjames
+ 1 for what Richard said... especially at the end of a nice long week of diving, where hydration, tired, etc may have also played a role.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Tue Aug 04, 2015 2:43 pm
by johndo88
Don't be concerned that they treated your daughter through a complete Table 6 profile even thought the symptom were releived. The diver that Fritz mentioned experienced complete paralysis of one arm and both legs. 100% O2 via an adult non-re-breather mask at 10 liters/min (lpm) was applied within 15 minutes of the onset of symptoms and 10 minutes after that, ALL symptoms had completely disappeared. The diver went to Virginia Mason and into the chamber on Table 6. That only makes sense to me. Maybe the O2 at the surface alleviated the problem, but to find out for sure, they would have had to take the diver off O2 then wait and see if the symptoms returned. I would not want that kind of experimentation done on anyone I know. :)

I do NOT think the medical team in Mexico was milking DAN for more money, not at all. It appears to me that your daughter got the same treatment in Mexico that she would have received here in Seattle. IMO, that says something impressive about the medical team in Mexico.

I too would like to know how the O2 was applied before getting to the hospital, nasal cannula at low flow (e.g., 2-4 lpm) on on a non-re-breather mask at high flow (e.g., 10-15lpm).

Very happy that your daughter recovered.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Tue Aug 04, 2015 2:56 pm
by CaptnJack
+1 on the non-milking lol

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Wed Aug 05, 2015 8:26 am
by Marc
Diving that many days in a row plays a role. I take a break in the middle of a dive trip to reduce the stress on my body.

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Tue Aug 11, 2015 6:01 pm
by Tom Nic
This has been said, so not piling on, but anytime I'm diving multiple days in a row I'm going to be on Nitrox. Even if I'm not diving very aggressive profiles my body is just happier. I can feel the difference, and every time folks say it's just psychological I answer, "Well, it's my psyche, so off I go!" :)

Age, weight, hydration, physical fitness can all be factors as well.

Sounds like you got just the treatment needed, both in the boat and in the chamber - a win in that regard.

Glad things turned out OK!

Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 15, 2015 8:58 am
by sarinae
The craptastic internet the last week or so in Mexico prevented me from logging in to see all of these awesome and great suggestions. I am taking away some great experience and insight, thank you all.

We're going to get her EANx cert'd as soon as we can and I think the next dive vacation, I agree, it is worth trying Nitrox for most of the days (especially on those deeper days). It can be tricky to arrange this ahead of time, especially in a location like that, but if we dive Nitrox with our computers set on air, that might add a significant margin of safety (as long as we keep those MODs in mind, of course).

Thanks, Jeff, for plugging it into the multideco program, I don't have one since I don't do Tech diving. I appreciate that tidbit about a half depth stop for a minute or so. If I was aware of that suggestion, I had forgotten about it, so that is really a great idea. I think we'll start incorporating that for all of our dives as an extra safety measure. When we practice responsible diving it becomes second nature, and my goal is that safety is just part of every dive without even thinking about it. To be honest, we do a lot of shore diving, and it is much easier to manage those stops when you have something to look at and a frame of reference. Those mid-water stops can be challenging when you're just surrounded by a lot of people and blue water. I have found that deploying the SMB can help offer some reference, but it becomes a bit more challenging to deploy one at 85 ft than at 30ft, more to go wrong as it rapidly ascends. Jolie had only deployed hers a few times so we asked her not to do it at depth on these dives because of that safety concern as she is still working out some of the kinks of how to hold everything, avoid entanglement, etc. Again, deploying at the bottom is easier because you can drop the reel and pick it up, deploying at mid-water is much trickier.

Captnjack and Johndo88--thanks for that reassurance regarding the hyperbaric. I wasn't feeling guilty about it, really, I would rather err on the side of conservative treatment than try to push it. I appreciate knowing that others don't feel that their DAN insurance costs were wasted, since we all pay into this and, in some way, we all share the burden of costs for these things in the necessary higher premiums if it is over used.

The great thing about my peeps here, you are all such a wealth of knowledge. I appreciate each and every one of you! Every visit to the site I learn something, and more importantly, I gain an appreciation for how much I have yet to learn also. I hope that others can take away something from this experience too.


Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sat Aug 15, 2015 5:35 pm
by Desert Diver
I appreciate you sharing the experience and think it can be a learning experience for most of us.


Re: Hyperbaric trip experience/getting bent call for insight

Posted: Sun Aug 16, 2015 9:14 pm
by ljjames
Working as team for SMB deployment is a big plus, not sure if you already do that but it's totally an approved method of getting an SMB safely to the surface. I worry sometimes that the educational system has reinforced a mentality that the only way to perform these skills is by oneself, or that people watch tech divers from afar and see them whipping out an SMB and sending it up single-handed. I got news for ya, we got docked in our T1 class for NOT helping each other. Yes, being able to do it alone is a bonus in case you are separated, but the reality is, if you are team diving, use your team to be as efficient as possible.