The difficulty in determining DCS – Anatomy of a Dive Accident

[Pebbles Photo]

Dan just gave me a link to a PERFECT example of how to dolphin kick.... his friend Ron Smith...see first with no tank... then with scuba According to Dan, who used the Dol-Fins alot with Ron, you can kick almost the same way with good stiff freedive fins as you can with the Dol-fin. this technique IS how Dan Volker keeps up with Suex Scooter divers on hour long dives....the freedive fin dol-fin kick as Ron demonstrates, does not work dan's legs much at scooter speeds, it is the whole body oscillation that powers the kick, and it uses much less blood oxygen. Obviously Dan suggested to me as to what to say here since he is not allowed by scubaboard to say it himself :-(

 

[dmaziuk]

But you can see how much less @REVAN's butt moves with the tank vs. without. That's the modification -- if your back bends that way to begin with. Mine never really did so I always sucked at fly. Still I hit the back of my head on the 1st stage if I mount the tank its "proper" position where I can reach the valve without opening the belt buckle and pushing the tank up.

 

[Bob DBF]

Now I wonder if I should discuss this with an MD? Couldn't hurt I suppose.

As another old guy, I’d say yes. I had a similar issue, sounds like anyway, seems some nerve bundles had trouble moving properly and sometimes really caught my attention. A doctor visit, a few trips to a physical therapist, and some home exercises and I’ve been good for years now.

At least for that.

 

[barbaroonie]

Then on the one hour dive, Sandra and I dive with the GUE flat horizontal dive trim…a superman position. This causes a serious hyper extension of the neck if you want to see where you are going. And lifting her heavy camera up to the boat crew on getting back aboard is also a big stress on the cervical area.

The 3rd potential stressor would be the hydrostatic pressure that will occur in rapid descending as we do, where the spine gets compress temporarily by the pressure as we descend. Normally no big deal, but now things were already bad.

As she began presenting in the lower cabin with pain between the shoulder blades, then tingling and numbness in the stomach and then down into the legs, these are all easily connected to the underlying issues of her spinal nerves getting “bumped” by the canal, given the inflammations, pressures, etc. When we laid her flat on her back, to give her the oxygen, it was the flat horizontal positional change, removing pressure from the spine that caused the symptoms to disappear, it was NOT the Oxygen!

Going forward, Sandra has had an entirely new bike fitting by one of the best in South Florida, and now the handlebars are close to the same height as the seat, she is not reaching nearly as much, and the rides are very comfortable…no sore neck after riding. She might not even bike ride on days before diving. She will no longer try to look “GUE-pretty” during a dive….if she is near a muddy bottom, she will do GUE trim as needed. The rest of the time she will consider this to be ill advised and bad for her neck.

I get to lift the heavy camera and heavy gear for her, even more so than before. Now she has a perfect excuse

We now know an amazing Diving Medicine Doctor we would recommend to all of our friends should they ever need one, and had this not happened, Sandra would not have known she had neck issues that needed to be dealt immediately. Without this episode, they could have gotten to be so bad that she may have needed surgery. If you ever get a dive medicine scare, you can reach Dr. Grobman at 954-659-5930...it is a number to keep with your DAN card and other emergency material.

We now have a program where she should be able to get her cervical spine health to be equivalent to an average 40 year old or better. Who would have ever thought figuring out how you got DCS could go like this?

Very glad you figured out the source and remedy for Sandra's injury. I also had a suspected DCS hit in French Polynesia recently after a relatively short, 65' dive on the second dive of the day. About 45 mins out of the water my right foot felt weirdly unstable, just a bit tingly and my gait was definitely off. They whisked me back to the dive center and on O2, and then by ambulance onward to a clinic for further neuro evaluation. After 4+ hrs on O2 it still was not resolved until the next morning, though no hyperbaric recommendation. Unfortunately they told me no diving for 10 days, so the rest of my long-dreamed of dives in Fakarava had to be cancelled. I've been diving 25 years and am a very conservative diver.

I was fascinated by your connection to the cervical spine - I too have had some stenosis in my neck and never would have connected them. My two dive buddies were MDs, though, and said that even a light hit to a nerve could result in the type of presentation I had. I may have to consult with your hyperbaric MD before I head off to the Solomons in May. Glad it all worked out!

 

[Pebbles Photo]

Very glad you figured out the source and remedy for Sandra's injury. I also had a suspected DCS hit in French Polynesia recently after a relatively short, 65' dive on the second dive of the day. About 45 mins out of the water my right foot felt weirdly unstable, just a bit tingly and my gait was definitely off. They whisked me back to the dive center and on O2, and then by ambulance onward to a clinic for further neuro evaluation. After 4+ hrs on O2 it still was not resolved until the next morning, though no hyperbaric recommendation. Unfortunately they told me no diving for 10 days, so the rest of my long-dreamed of dives in Fakarava had to be cancelled. I've been diving 25 years and am a very conservative diver.

I was fascinated by your connection to the cervical spine - I too have had some stenosis in my neck and never would have connected them. My two dive buddies were MDs, though, and said that even a light hit to a nerve could result in the type of presentation I had. I may have to consult with your hyperbaric MD before I head off to the Solomons in May. Glad it all worked out!

Dr Grobman is an amazing diving medicine doc, and he enjoys diving himself as one of his great loves..this plus his other specialty in sports medicine makes him uniquely qualified for doing the detective work that needs to be done...to avoid doing what other docs would just call an "Undeserved Hit". Dan and I will never believe in Undeserved Hits.. Fortunately, that led us to this medical detective that saw clearly it was not DCS. Best of Luck with your next trip!

 

[markmud]

Hi Pebbles,

I agree with you and Dan:

Dan and I will never believe in Undeserved Hits..

If you are diving and you get hit, you deserved it. A diver may be able to mitigate the trigger mechanisms that set it off, but there is a reason for every hit. Modern science may not know what that reason is, but a reason exists nonetheless.

My wife complains of neck pain and similar issues that you reported with your incident (not to your extreme). She adjusts her tank on her BC so she can be slightly heads up. In this attitude she has no issues. When in the perfect horizontal position, she has issues because her neck is bent so far backwards.

She felt pain after diving so she quit doing the thing that caused her pain. The techies that we sometimes dive with be damned.

@uncfnp post: The difficulty in determining DCS – Anatomy of a Dive Accident

Uncfnp has a picture that shows my wife's preferred attitude while diving in the post linked above.

congrats,
markm

 

[Pebbles Photo]

Hi Pebbles,

I agree with you and Dan:


If you are diving and you get hit, you deserved it. A diver may be able to mitigate the trigger mechanisms that set it off, but there is a reason for every hit. Modern science may not know what that reason is, but a reason exists nonetheless.

My wife complains of neck pain and similar issues that you reported with your incident (not to your extreme). She adjusts her tank on her BC so she can be slightly heads up. In this attitude she has no issues. When in the perfect horizontal position, she has issues because her neck is bent so far backwards.

She felt pain after diving so she quit doing the thing that caused her pain. The techies that we sometimes dive with be damned.

@uncfnp post: The difficulty in determining DCS – Anatomy of a Dive Accident

Uncfnp has a picture that shows my wife's preferred attitude while diving in the post linked above.

congrats,
markm

My husband (Dan Volker) had a discussion with Jarrod Jablonski, head of GUE about this, and will be including this in an article I will post in the very near future. The short version though, is that JJ does not want GUE people or anyone else to think that when diving 10 feet off the bottom in a no or low current ocean environment, that they need to be flat horizontal or worrying much about "Perfect Trim"....Trim to JJ is something you use when it is beneficial, and not when it isn't ... How about that!!!! ????

 

[Lorenzoid]

My husband (Dan Volker) had a discussion with Jarrod Jablonski, head of GUE about this, and will be including this in an article I will post in the very near future. The short version though, is that JJ does not want GUE people or anyone else to think that when diving 10 feet off the bottom in a no or low current ocean environment, that they need to be flat horizontal or worrying much about "Perfect Trim"....Trim to JJ is something you use when it is beneficial, and not when it isn't ... How about that!!!! ????

A famous post revealing JJ's attitude toward "perfect trim":
My day with Jarrod, or how I was right all along . . .

 

[Pebbles Photo]

A famous post revealing JJ's attitude toward "perfect trim":
My day with Jarrod, or how I was right all along . . .

Our next article will ALSO have some quotes from George Irvine about his feelings on the unfortunate trend toward "always" diving with perfect trim...something neither he nor Jarrod ever endorsed. When George used to dive with Dan all the time in the past, his primary kicking was flutter kick, and his trim was perfect when it needed to be. The rest of the time it wasn't. He and Dan both are saying that DIR was NEVER about swimming in perfect trim at all times, and it was would not have included a disposition for cruising along a palm Beach reef, with 2 to 5 "tadpoles" slowly frog kicking in perfect horizontal trim, trying to be as tech-pretty as they can be. This was never an aim for DIR. it was never JJ's aim either. In any event, this is a perception that is really easy to fix!

 

[dmaziuk]

... science may not know what that reason is, but a reason exists nonetheless.

Of course they know: you dived. Remember, M-values are derived statistically from bent divers and exploded goats, and they only claim "acceptably low risk" of clinical DCS. "Acceptably low" does not mean "impossible", it only means "unlikely".