DCS Hit, DAN, & Virginia Mason

[Domer Down]

I thought I would share my cautionary tale with all of you, with the hope that it might spare someone the experience that I had recently.

I had a wonderful night dive on the Lobster Shop wall last month to 109 fsw and started for the surface 4 minutes before the no decompression limit on my computer. The ascent never exceeded 30 fpm and my buddy and I did 6 minutes at the safety stop level of 15 fsw. We were out of the water at 10:45 PM, and after driving home and stowing my gear, I was in bed by midnight.

At 1:00 AM I could not sleep, and my belly started to itch. At 2:00 AM the itching was keeping me awake, so I got up to look at my bare chest in the bathroom mirror. When I flipped the light on, I literally said "Holy S***" as I stared at a bright red sunburn-like rash the size of a tea saucer, located just above my navel. Although I had never seen one before, I knew this was a DCS rash. My first thought was that if I ignored it, it would probably be gone by morning. My second thought was "don't be an idiot" and I grabbed my dive computer from the garage rack and wrote down my dive profile. At 2:15 AM I was on the phone with DAN speaking with one of their medical professionals.

I can't say enough about how great DAN was in that circumstance. After a complete briefing, I was advised to skip the local emergency room and drive directly to Virginia Mason Medical Center and their Hyperbaric Medicine unit. Then came the hardest part of the experience: waking up my wife to drive me in to Seattle, while explaining that I had done something to screw myself up.

I was diagnosed with Type 1 DCS, manifesting as the skin bends. I had no neurological or pain symptoms (other than the itch). This type of DCS is rare, and seems to happen more often to drysuit divers. I spent 4 1/2 hours in the chamber, "diving" to 60 feet for 1 1/2 hours, then 30 feet for the remainder. During that time, it was 20 minutes on pure oxygen followed by 5 minutes off in a repeating cycle.

Virginia Mason was fantastic, and well versed in dive injuries. Their chamber is one of the best in the world, and is the size of a small jetliner fuselage. I sat in a cushioned recliner during treatment, and was a hell of a lot more comfortable than my wife who was on an office chair in the waiting area.

After a complete review of contributing factors, here is what my doctor and I determined:

1. I dove within the tables, but into the "caution zone." I've been doing this sort of thing for over 30 years without problems, but I'm not 17 anymore (who really wants to admit that?). I was told to "dial it back a notch."
2. Before the dive that night, I had a rocky entry and a long surface swim. Because we thought we had a lost diver, I ended up doing that entry and swim twice (we found the guy). Although I did not feel exhausted, my body was probably fatigued from the extra work.
3. The water was cold. Add 10 fsw to your depth for cold water when calculating nitrogen loading.
4. I probably did not pay attention to proper hydration. Who wants to drink a pint of water before donning a drysuit?

I was cleared to dive again, without restrictions, three weeks later.

Those little things you are told to avoid DCS? And start to let slide when you've been diving a long time? They might just come to bite you in the butt (or at least a stomach rash) one day.

[ljjames]

with a pee valve installed in your drysuit, hydration problems become much less of an issue. the ability to hydrate and pee using a pee valve is a truly awesome thing

[pensacoladiver]

Domer,

Thanks for sharing your story. Kinda sucks to see the dark side of diving.... that you can do things within the boundaries and still get bent.

[Tom Nic]

Thanks for telling the story... MUCH APPRECIATED!

I've always said that we learn more from the things that went wrong and everybody still makes it back than from the ones that went off without a hitch.

I believe DiverBob had a case of the skin bends recently? Or perhaps it was a too tight dry suit?

Couple of questions:

-air or nitrox? (sorry if I missed this)

-Do you use your suit for buoyancy or your buoyancy control device? (I've heard of a tight dry suit squeeze being an irritant factor that ends up being a part of the reason bubbles come out of solution where they ought not.)

**Plus one for Geezer Gas! Interesting to me that you've been diving many years - especially to me as a new diver. Accepting the changes in our bodies over time is hard enough, but if you've been doing the same thing for many years it's harder to notice the differences.

Again, thank you so much for telling the story and for doing the right thing and calling DAN - big help and encouragement!

Best Regards,

Tom Nic

[Domer Down]

Thanks for telling the story... MUCH APPRECIATED!

I've always said that we learn more from the things that went wrong and everybody still makes it back than from the ones that went off without a hitch.

I believe DiverBob had a case of the skin bends recently? Or perhaps it was a too tight dry suit?

Couple of questions:

-air or nitrox? (sorry if I missed this)

-Do you use your suit for buoyancy or your buoyancy control device? (I've heard of a tight dry suit squeeze being an irritant factor that ends up being a part of the reason bubbles come out of solution where they ought not.)

**Plus one for Geezer Gas! Interesting to me that you've been diving many years - especially to me as a new diver. Accepting the changes in our bodies over time is hard enough, but if you've been doing the same thing for many years it's harder to notice the differences.

Again, thank you so much for telling the story and for doing the right thing and calling DAN - big help and encouragement!

Best Regards,

Tom Nic

1. I was diving air that night. I have since made the decision to dive nitrox far more often than I have been in the past.

2. I use my drysuit for buoyancy control. It's interesting that you brought up the point. I had a long discussion with the dive doctor about drysuit squeeze as a contributory factor to the skin bends. The rash showed up exactly where my Zeagle Tech BC straps cross my stomach. The Tech has no cummerbund, but I did have the straps tighter than usual that night because I didn't want my gear wobbling around while making the rocky entry. I now make sure my straps are a bit loose.

3. The dive doctor and I both started diving as teenagers in the 1970's. We agreed that we want to still be diving at 80. Thus the advice to dial it back. For over 30 years I've been following safe dive practices, and eventually it was not good enough to keep me from taking a mild hit.

Fortunately, this was a warning shot across my bow, so better hydration, more nitrox, and a bit more conservative on the computer should keep me going.

[sungurl]

Wow.....thank you for sharing this story with us.....always good to learn from others experiences so that we can minimize our own tales of woe...I'm just glad you are okay to go dive again. I must admit, hearing stories like this as a newbie is a bit scary, but I'm going to take it and tuck it away in my good to know book and be mindful of all the little things we do during our dives that add up....

[defied]

with a pee valve installed in your drysuit, hydration problems become much less of an issue. the ability to hydrate and pee using a pee valve is a truly awesome thing

Not sure I want to know how you hydrate using the pee valve.... shudder...

D(B)

[Tom Nic]

Fortunately, this was a warning shot across my bow, so better hydration, more nitrox, and a bit more conservative on the computer should keep me going.

There are a couple of shops in the Tacoma area that will sell you an "all you can eat" nitrox subscription. Since I usually do shallow dives (I seldom go below 90fsw and only occasionally hit triple digits - there has to be something I'm after more than seeing the digits on my computer) I'm usually using a higher percentage of Nitrox - 34 to 36% or whatever happends to be in the banks. Since I dive at least once a week it is very much worth it. Heck, who am I kidding, since I'm old and fat it is very much worth it! Geezer Gas is my friend.

If I end up getting "bit" as far as DCS goes it will probably be the hydration issue. I'm always doing at least one hour dives and no matter how much I go before I'm always doing the drysuit dance at the end of a dive.

Let's be honest, who hasn't put off drinking the extra bottle of water because they know they are about to do a dive and don't want to be suffering by the end of it?

The pee valve and it's attendant plumbing have always been a put off for me, but I think that the ability to hydrate like crazy is a huge plus in its favor. Gonna have to break down and do it.

[Nwbrewer]

The pee valve and it's attendant plumbing have always been a put off for me, but I think that the ability to hydrate like crazy is a huge plus in its favor. Gonna have to break down and do it.

There's always Depends....

[Tom Nic]

The pee valve and it's attendant plumbing have always been a put off for me, but I think that the ability to hydrate like crazy is a huge plus in its favor. Gonna have to break down and do it.

There's always Depends....

Which might push you even quicker toward a Pee Valve!

[Domer Down]

Wow.....thank you for sharing this story with us.....always good to learn from others experiences so that we can minimize our own tales of woe...I'm just glad you are okay to go dive again. I must admit, hearing stories like this as a newbie is a bit scary, but I'm going to take it and tuck it away in my good to know book and be mindful of all the little things we do during our dives that add up....

Actually, this story was not meant to scare anyone and should not scare anyone. One of the morals of the tale is that if you follow the dive tables and do a safe ascent and safety stop (especially on deep dives) you should be able to dive your entire career without a DCS hit. "Should" is no guarantee that it will not happen, and a very small percentage of divers will take a hit anyways. This will probably not be you (or any other individual diver), but if it is, the second moral is that you should not ignore the symptoms. If you call for help and get treatment right away, chances are excellent that you will be 100% once again. Right now, I'm no more prone than the next diver to have another DCS hit.

Oh, and I suppose there is a third moral: YOU DO NOT WANT TO PAY FOR A CHAMBER RIDE. I just received the bills for my treatment. Thank the stars for my DAN insurance. Get DAN (or comparable) dive insurance. Your regular health plan will not cover you for this. For less than $100 per year, you can be covered for dive accidents.

And following the thread, I as well may have to break down and get a pee valve installed on my drysuit. That, along with my bifocal diving mask, will end my hopes for anyone thinking that I'm a young stud anymore. Hopefully, I can be a healthy old stud.

[Tom Nic]

And following the thread, I as well may have to break down and get a pee valve installed on my drysuit. That, along with my bifocal diving mask, will end my hopes for anyone thinking that I'm a young stud anymore. Hopefully, I can be a healthy old stud.

[Norris]

I have DAN, the most expensive plan... and I am sure that you do, so can you tell us what the damage is for a visit like that?

[Sounder]

Hydration is critical and the p-valve makes it possible. While we were on the live aboard in the Channel Islands, we hydrated like crazy. We were doing 5-6 aggressive recreational profiles per day and hydration was critical... regularly you'd see someone standing off the back steps smiling while we were in-transit between sites.

I was a late-adopter on the p-valve, but it has totally changed my pre-dive process and I plumb for every dive now, even if it's just a quick trip around Cove 2. Instead of skipping that bottle of water or gatorade, I drink two of them. Then, right before I get in the water, I take another large series of gulps. It's wonderful to be able to pee - actually makes my dives more enjoyable and relaxed, and I feel better after the dive.

[CaptnJack]

I have DAN, the most expensive plan... and I am sure that you do, so can you tell us what the damage is for a visit like that?

My Table 6 extended ride was about $4K. This one sounds like shorter Table5. Your own + even the cheapest DAN insurance should easily cover the actual chamber ride. If you have Type2 hit with complications you are definitely going to need all the coverage you can get.

[Pinkpadigal]

My sister's 2 rides last year cost around $10k. DAN paid everything...no deductible. Everyone I have talked to that has DAN and has had to use it appreciates it. We are lucky to have it in our sport. Other "aggressive" sports out there do not have anything close to it.

[Domer Down]

My chamber ride was a single Table 5, and as I mentioned lasted 4 1/2 hours. The total cost was $3,910. My regular health insurance covered some of it (I disclosed to them when I signed up that I am a diver), and DAN picked up the rest. My out of pocket was the $100 emergency room co-pay because I showed up at 3:30 in the morning and regular check-in was closed.

I fully agree that as participants in an "adventure" sport that we are very lucky to have DAN insurance.

Did I mention that my ride included breakfast? I ordered off a menu, and chose a ham and cheese omlette with egg substitute, and a glass of orange juice. It was delivered through an air lock hot and tasty. It was better service than I've had on a commercial airline in 20 years.

[Nwbrewer]

Did I mention that my ride included breakfast? I ordered off a menu, and chose a ham and cheese omlette with egg substitue, and a glass of orange juice. It was delivered through an air lock hot and tasty. It was better service than I've had on a commercial airline in 20 years.

A little more expensive though....

[Ken G]

Just renewed my DAN insurance about 15 min ago. This post makes me feel like it was a smart move. Keep that DAN insurance current!

[Mattleycrue76]

Wow, Thanks for sharing your story. I put off getting DAN insurance for far to long and just signed up for it a few months ago. Reading something like this will remind me not to let it lapse.

[mz53480]

Tom,
Glad you're ok, and hope to go dive with you again soon.
MZ

[Domer Down]

Tom,
Glad you're ok, and hope to go dive with you again soon.
MZ

Thanks, Mike. I'm back in the water again and wanting to make up for lost time. We should hit the water together soon.

[Domer Down]

I saw another thread where DiverBob was asking what the skin bends look like, because he was not sure if this is what he had. I had refrained from sharing pictures, but perhaps it would be helpful.

Initially the rash was bright red and looked like a deep sunburn, and itched like crazy (3 hours after the dive). By 6 hours after the dive the redness had faded and I had a mottled rash remaining. Three days later and after treatment, when this picture was taken, the rash was still visible (the purple outline is from a marker used in the emergency room to outline the rash):

http://www.nwdiveclub.com/gallery/album.php?album_id=68

The rash was gone completely two days later.

OK, so now you can all pass along hilarious comments about how I somehow lost my six-pack abs over the course of 30 years of diving.

[pogiguy05]

I have got the full DAN insurance and it is auto renew which is about to happen soon. $105 if I recall but alot better than a bill from the chamber of bankruptcy.

About 1 month or so we were diving Day Island Wall and one of the guys had to do a 7 hour stay in the chamber. I heard that it cost like $1000 per hour.

[Dusty2]

I saw another thread where DiverBob was asking what the skin bends look like, because he was not sure if this is what he had. I had refrained from sharing pictures, but perhaps it would be helpful.

Initially the rash was bright red and looked like a deep sunburn, and itched like crazy (3 hours after the dive). By 6 hours after the dive the redness had faded and I had a mottled rash remaining. Three days later and after treatment, when this picture was taken, the rash was still visible (the purple outline is from a marker used in the emergency room to outline the rash):

http://www.nwdiveclub.com/gallery/album.php?album_id=68

The rash was gone completely two days later.

OK, so now you can all pass along hilarious comments about how I somehow lost my six-pack abs over the course of 30 years of diving.

Six pack abs??? From what I have seen of the club members they are as rare as moah moah sightings in Puget sound!