One Dive Too Many on The Zenobia

[AmRus]

On the morning of September 19th, 2007, I joined the Dive-In’s Limassol, Cyprus-based Center, for a trip to Larnaca to dive the Zenobia, a wreck located at 25 ~ 42 meters. Our planned two dives were for 30+ meters and 25+ meters. Our group of nine experienced divers and divemasters were part of a large boat outing with divers from other companies.

Although my Suunto D9 registered no alarms during the dives, about 10 minutes following exit (climbing up the ladder with tank) onto the dive boat after the second dive, I began to experience the onset of the symptoms of decompression illness (DCI). This presented itself in sudden fatigue, intermittent but uncontrollable coughing sessions, dizziness and then a near total decrease in vision. Dive-In’s divemasters, David Mitchell and Yvette M - Bezuidenhous, though active with other divers in our group, were monitoring my increasing difficulties and, at the onset of decrease in vision, I was easily able to notify them that I was indeed in difficulty.

I was given oxygen, which immediately solved my vision problem, and the boat returned to shore where, with a portable oxygen canister in hand, I was escorted to a vehicle for transport to the nearest dive center. A dive-specialist doctor had already been called by Dive-In and I met him at the local dive center. After his evaluation, I was diagnosed with possible DCI, transported to Limassol and processed into the Dive-In hyperbaric chamber. During this processing (final evaluation by the same doctor, who had traveled to Limassol as well), it was determined that I was indeed suffering from a significant episode of DCI. The time from reporting the problem to entry into the chamber was about 2 1/2 hours (as I recall).

Throughout the 6 1/2 hour treatment in the chamber, I sweated profusely, resulting in my becoming clinically ‘acutely dehydrated’, despite the efforts of the attendant, Dmitry Dzhapunov, and the company’s managing director, Clive Martin, both of whom stayed in the chamber with me due to my difficulties. I was unable to sit upright without becoming dizzy and nauseous (toward the end I vomited much of the water I had taken in). At one point, according to Clive, I blacked out and went into convulsions - he thought they had lost me. Indeed, Clive got 'bent' from the exertion in helping me and was subsequently rewarded with his own stay in the chamber.

The doctor and staff were waiting upon my exit from the chamber, as well as an ambulance. With my blood pressure only about 60/30, I looked like a Smurf - the same color as my blue hospital scrubs. The doctor ordered my urgent transport to a local private clinic, where it was determined that my kidneys were not functioning. I was placed on a saline IV (a total of 5 liters were eventually replaced into my system) and carefully monitored. I was in the Intensive Care Unit for five days.

At the recommendation of the initial dive doctor (a noted cardiologist in his own right), I was subsequently transported to the Nicosia General Hospital where I was admitted for monitoring by kidney, heart and lung specialists. After three days, I was released with the opinions that I had completely recovered from my incident, but with a requirement to see a dive-specialist doctor for a complete checkup before diving again.

My recovery was in large part due to the immediate first aid treatment by Dive-In’s divemasters, subsequent professional evaluation and directions by the attending doctor, professional attention by the Dive-In hyperbaric specialists and follow-up care by the clinic and hospital doctors and staff. In every step of this process, I was most fortunate to be surrounded (sometimes literally) by caring, experienced professionals.
_______-

Dive Profiles (from Suunto D9)

I.
Air: Nitrox 30%
Dive Time: 34min. total
Water Temp: 27 C
Max Depth: 30.4 M

Surface Interval: 2H 05M

II.
Air: Nitrox 30%
Dive Time: 37min. total
Water Temp: 27 C
Max Depth: 27.5 M
____________-


What went wrong?

In my opinion this was an incident of diver error. I failed to properly monitor my own physical condition and undertook not one, but two challenging deep dives (the second dive involved entering the wreck). I noticed that my oxygen intake during both dives was significantly increased over my norm, but failed to realize the ramifications.

I am a ‘holiday’ diver. Although I have dived for over 5 years and have a Rescue Diver certification, I am at best a 52 year old hobby diver who dives twice a year while on holiday. I am also somewhat overweight. I failed to take these conditions into account and went on a dive beyond my capacity. Had I stopped at the first dive, I would not have experienced the DCI incident which led to my dehydration and subsequent problems. For the record, the doctor does not think that these subsequent problems were caused by the DCI, but may have been triggered by it.

I have read in this Forum that we must dive within our limitations. I was within my training parameters (having dived the Zen several times over the past few summers) and was not aware at the time that I may have been diving outside my physical limitations. The dive felt completely normal to me: no surprises, no anxiety. I had no idea I had a problem until the symptoms appeared. This fact continues to bother me.

I have continued diving, under a more conservative dive profile (P1). I take my general state of health into account before a diving holiday and at least a month before a trip increase my ongoing aerobic exercise program. I have had no further problems, including last summer's week-long live-aboard (Hurgada on the M/V Gelen - great trip! - sponsored by Dive-In) where we explored several wrecks, including entries into the Thistlegorm at 30 meters.

By the way, and not incidentally: The DAN people were absolutely fantastic and I didn't suffer even a 'financial inconvenience'. I would never dive without their insurance policy being up to date.

P.S. For those who are strong of stomach, I have attached a picture of mine, taken just before my entry into the chamber.

__________-

This is my first post on ScubaBoard and I hope others will find this story of some value in their future diving activities.

[jkaterenchuk]

I would suggest you consult with a doctor and look into the possibility of a PFO. I am not a doctor but your dive profiles and DCS problems would not be what I would consider normal or expected.

John

[alijtaylor]

Welcome to Scubaboard AmRus. Quite a starting story! I am glad you have got back into diving albeit more conservatively.

Alison

[pdelannoy]

I am curious about your profile. How long were you at your maximum depth? Also, did you make a stop at 1/2 your maximum depth on the ascent and were safety stops performed at 15 feet?

Because your profile does not seem like it should have been problematic. I have dived profiles like these and the DCI hit worries me.

PD

[DandyDon]

Wow! Thanks for sharing...!

I have had no further problems, including last summer's week-long live-aboard (Hurgada on the M/V Gelen - great trip! - sponsored by Dive-In) where we explored several wrecks, including entries into the Thistlegorm at 30 meters.

Glad you still can dive, and still want to. Two points I try to keep in mind...
> Work at hydration on dive trips, never waiting until I am thirsty; and
> The Hidden Safety Stop: Lazy floating on the surface for at least a minute after surfacing, following by a no-stress ladder climb that usually means passing my pony bottle up first. On a small boat, I pass my BC & Reg up next before climbing.

[AmRus]

Hi PD,

To answer your questions, I have attached an Excel spread sheet taken from my dive log. In case you are unable to access the file (or want to), in summary: I was at approximately 25+ meters for 9 minutes of the 37 minute dive. During this time, I was at max. depth of 27.5 meters for 2 minutes. I had a 4 minute stop at 16 ~ 17 meters and a 3 minute stop at 5 meters.

The Dive Manager software also reports that tissue saturation was never more than 80% and No Deco Time was never less than 10 minutes.

Although you will see that my tank pressure dropped below 50 bar during the end period of the dive. We were grouped at this point and there was no current; I felt no anxiety and was well aware of my tank pressure. During the 5 meter stop, the DM offered the use of the safety tank we had cached at 5 meters, but I saw no need to use it.
_________-

Thank you very much for your interest. I agree with you that it was a troubling incident, especially since there was no apparent safety violation during the dive according to the computer data. Perhaps, as the chamber specialist pointed out, "Sometimes these things happen. That's why it's called 'sickness' rather than an 'accident'."

It's why I made the post: to get the opinions and suggestions of more experienced divers on the Forum (Thanks DandyDon!) and to point out that one can suffer a DCS incident without anything exciting having occurred during the dive (at least in my case, it did).

[AmRus]

Thanks DandyDon. I was also advised after the dive about dehydration as a possible contributing factor. For the last summer's diving in the Red Sea (first time back in the water ), I brought along a canister of Gatorade powder and made sure I kept that... ah... flowing through my system - after the dive (it's my wetsuit).

Usually at the end of the dive, I hang back and allow others to re-board the boat - I just like being in the water. As I recall, for some reason I was one of the first out that time. I will certainly take your advice about the hidden safety stop from now on.

[DandyDon]

Originally Posted by AmRus

Thanks DandyDon. I was also advised after the dive about dehydration as a possible contributing factor. For the last summer's diving in the Red Sea (first time back in the water ), I brought along a canister of Gatorade powder and made sure I kept that... ah... flowing through my system - after the dive (it's my wetsuit).

Usually at the end of the dive, I hang back and allow others to re-board the boat - I just like being in the water. As I recall, for some reason I was one of the first out that time. I will certainly take your advice about the hidden safety stop from now on.

Dehydration is a all too common problem in hits, and Dr. Deco told me about the Hidden Safety Stop once. He is off line until July 7, but if you'd like an explanation for the renown expert, you can post on his forum here.

[pdelannoy]

Thanks for the profile. Just goes to show you that DCI is not that well understood. We all need to be extra careful.

PD

[Crowley]

AmRus - my best answer to this is "it happens".

Last April I had to personally tank a fellow instructor with a very similar dive profile to yours. His was actually slightly shallower (28 and 26 metres). His computer showed no rapid ascents or anything else to suggest he had done anything to predispose himself to DCS. He had not been drinking heavily the night before - just a couple of beers after work the night before; was well hydrated and had eaten properly etc. etc. - he was in his late 20s and otherwise fit.

The PFO (Patent Foramen Ovale or "hole in the heart") is actually rather common but is worth getting checked - although that could be said for all divers - it occurs in 1 in 3 people if memory serves.

Sometimes, however, it just happens, and nobody knows why.

Keep it safe,

C.