DCS or not?

[Shadow]

I became very sick after two dives in July 2002. Although I am fine now, I still wonder what happened. Here are the facts:

Dive #1: Wreck dive, Columbia - 300 ft destroyer, 51 degree water, age 39, slim & fit, depth 98 ft, 26 minutes. At the deck of the destroyer (about 75 feet), we were heading for an ascent line. The current picked up a lot, and I over exerted myself trying to swim against it. Went through about 800 psi in a few minutes of huffing and puffing. Down to 400 psi and still at 75 feet, I decided that I couldn't get to the line, and that I would have to do a free ascent. That didn't go so well, and I ended up in an uncontrolled ascent, surfacing way too quickly. At the surface, I had to swim through wind and wave to the boat, and heaved myself aboard (more exertion). I felt extremely nauseous. It was all I could do not to throw up, and it wasn't due to any kind of sea sickness. I was concerned, and did not go on the next dive an hour later.

Dive #2: Same day, about 8 hours later, 55 degree water, max. depth 76 feet but mainly around 55 feet, 16 minutes. I got caught in an upwards current, which took me straight to the surface in seconds.

Next day: Felt okay til about noon, when I started vomitting. Thought it was flu, hadn't eaten anything suspicious. Laid down. Became increasingly weaker, more tired, body aches and pains. By about 11 pm, I could barely move, extreme dizziness, weakness, entire body hurt. When I tried to get up for the bathroom, and found I couldn't stand without help, and had shortness of breath, I arranged for an ambulance. I was evacuated from the island I was on (Quadra), and taken to the nearest emergency room (Campbell River Hospital). I was unable to exert myself at all, I was panting because I was out of breath just from trying to sit in a chair, any movement was excrutiating. Very dizzy, weak, and nauseous. The emergency oxygen revived me quite quickly. But once in the ambulance, I was given less oxygen, and didn't feel as good.

At the hospital, the emergency room doctor phoned the hyperbaric unit in Vancouver. Told them my dive profile, but no mention of over exertion or uncontrolled ascents. The dive doctor told the emerg doctor that it wasn't DCI because I wasn't deep enough for long enough. He felt it was fibromyalgia acting up, and recommended continued oxygen and a saline drip. I was too weak to advocate for myself, but I did point out that shortness of breath, vomitting, and dizziness were not symptoms of fibromyalgia (FM). Also, having had FM for over 10 years, I knew what it felt like, and I definitely was not having a flare up. The oxygen given to me in the hospital was so weak, I think there was more air flow in the room. I suffered through the night, and then wobbled out in the morning. I slowly recuperated over the next couple of days, and haven't had any lasting effects. During the slow night in emerg, the emerg doctor did some reading, and he told me that people with soft tissue disorders were more likely to experience acidosis. He wasn't sure of the diagnosis.

Sorry for the long preamble, questions:

1. Could it have been DCS?

2. What is the appropriate flow rate of oxygen when treating DCS? Are the oxygenation readings from a person's blood relevant in treating DCS?

Thanks.

 

[humanFish]

Plenty of people have gotten bent diving more conservatively than the profile you illustrated...even with doing safety stops.
I'm no doctor but it seems plausible. I'm wondering though that your symptoms subsided without any chamber rides.

Your symptoms certainly seem to indicate DCS, but again, I am not a doctor. Did you ever call DAN about this? Seems to me that a chamber ride was in order, especially given the nature of your ascents and your symptoms.

In any event, I'm glad you are around to tell the tale.

 

[matts1w]

I am assuming your were diving on air?

Using the RDP the first dive could have been planned to 110 feet considering cold water AND current. No deco time at 110 ft is sixteen minutes. According to your profile you were ten minutes over. Even if planned at 100 feet no deco time would have been exceeded the twenty minute limit by six minutes. All dives to 100 feet or more one should do a safety stop.

The RDP says you needed a safety stop of at least fifteen minutes if possible AND to be out of the water for 24 hours and monitor yourself for signs of DCS.

Adding a second dive eight hours later and another rapid ascent could not have helped.

That is pretty scary. I am glad you are ok. DCS? Makes me wonder. Be careful when you plan as, at least to me, that profile is really puhsing yourself.

Cheers.

 

[Dr Deco]

Hello Shadow:

DCS?

That does not exactly sound like a trivial dive considering the depth. There certainly is a potential problem from the exertion. This will increase the blood flow to tissues (heart rate, vasodilatation, and muscle pump mechanism). These are all known to increase gas loading while submerged. Since the activity stops when on the surface, the dissolved loads are much greater than allowed for by dive tables.

Additionally, the muscular activity will increase the size and number of tissue micronuclei (never proved but strongly suspected).

I would guess that a chamber exposure would have been the conservative thing to do at the hospital. People have been pressurized for much less. This looks like a case of numerous small gas bubbles being formed by the muscles. They eventually led to pulmonary gas exchange problems and probably eventually arterialized. (Did you ever have any patches of the skin that reddened?)

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology is September 10 – 11, 2005 :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Shadow]

I phoned DAN first, as I was a member and had travel insurance. They advised me to seek medical assistance.

I was diving on regular air. During the wreck dive, we probably took two minutes to descend to 75 feet (the deck), swam along the deck for about 10 minutes, dropped down to the bottom of the hull, looked for octopus, etc. for about 8 minutes, then back up to 75 feet, swam around the deck for a couple more minutes, then started for the ascent line, when I ran into trouble. I could not believe how fast I went through my air because of the current. In retrospect, I could have done things differently, like pull myself along the railing or some part of the ship. My buddy was ahead of me. He had enough air to have shared with me on the ascent line (although I didn't know that at that moment). Being stronger, he wasn't as winded by swimming against the current as I was. I admit that I was a bit freaked out when I looked at my gauge, which only 2 minutes before had over 1100 psi, now showed only 400, and still at 75 feet. I started my ascent too quickly, without dumping enough air out of my suit, and ended up on the surface within seconds. Lucky I didn't have an embolism.

 

[Shadow]

Thanks, Dr. Deco. No, I never had any red skin patches.

The nearest chamber was at a naval base (Nanoose Bay). I think they will treat civilians in an emergency - perhaps had I been unconscious that may have been considered severe enough to warrant intruding upon the military. The "expert" at the chamber in Vancouver put an end to any possible chamber treatment when he said that it couldn't be DCI. The emerg doc felt he had to defer to the expert, and didn't want to step on any toes. But the "expert" didn't have all the facts, he didn't ask enough questions about my dives, and he didn't see me personally.

About the oxygen administered. DAN recommends 100% oxygen. I received ordinary air (21% I guess). What changes is the flow rate. The flow rate was reduced in the ambulance and then further reduced in the emerg ward (to the point of doing nothing). Apparently, blood oxygenation readings are used to determine the flow rate for oxygen administration. If a person has DCS, is his/her blood oxygenation level really any different from normal? Is this a valid measure to use for treating DCS?

 

[Dr Deco]

Hello shadow:

Oxygen is administered in cases of DCS because it increases the gradient for elimination of tissue nitrogen. It does not add to the gas load because it is metabolized quickly.

What was probably measured was the arterial oxygen saturation with an oximeter probe on the finger. Someone with DCS will generally not have a reduction of oxygen saturation unless there is a serious disruption of blood/gas exchange in the lung capillaries.

An oximeter is an indicator of oxygen in the red blood cells, but what is needed is a complete removal of nitrogen from the arterial blood to aid in nitrogen elimination.

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology is September 10 – 11, 2005 :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Bubblejoy]

Does anyone know any good links to info on DCS from helium (Trimix) on the web? Thanks.
Philip

 

[ScubaSixString]

I became very sick after two dives in July 2002. Although I am fine now, I still wonder what happened. Here are the facts:

Dive #1: Wreck dive, Columbia - 300 ft destroyer, 51 degree water, age 39, slim & fit, depth 98 ft, 26 minutes. At the deck of the destroyer (about 75 feet), we were heading for an ascent line. The current picked up a lot, and I over exerted myself trying to swim against it. Went through about 800 psi in a few minutes of huffing and puffing. Down to 400 psi and still at 75 feet, I decided that I couldn't get to the line, and that I would have to do a free ascent. That didn't go so well, and I ended up in an uncontrolled ascent, surfacing way too quickly. At the surface, I had to swim through wind and wave to the boat, and heaved myself aboard (more exertion). I felt extremely nauseous. It was all I could do not to throw up, and it wasn't due to any kind of sea sickness. I was concerned, and did not go on the next dive an hour later.

Dive #2: Same day, about 8 hours later, 55 degree water, max. depth 76 feet but mainly around 55 feet, 16 minutes. I got caught in an upwards current, which took me straight to the surface in seconds.

Next day: Felt okay til about noon, when I started vomitting. Thought it was flu, hadn't eaten anything suspicious. Laid down. Became increasingly weaker, more tired, body aches and pains. By about 11 pm, I could barely move, extreme dizziness, weakness, entire body hurt. When I tried to get up for the bathroom, and found I couldn't stand without help, and had shortness of breath, I arranged for an ambulance. I was evacuated from the island I was on (Quadra), and taken to the nearest emergency room (Campbell River Hospital). I was unable to exert myself at all, I was panting because I was out of breath just from trying to sit in a chair, any movement was excrutiating. Very dizzy, weak, and nauseous. The emergency oxygen revived me quite quickly. But once in the ambulance, I was given less oxygen, and didn't feel as good.

At the hospital, the emergency room doctor phoned the hyperbaric unit in Vancouver. Told them my dive profile, but no mention of over exertion or uncontrolled ascents. The dive doctor told the emerg doctor that it wasn't DCI because I wasn't deep enough for long enough. He felt it was fibromyalgia acting up, and recommended continued oxygen and a saline drip. I was too weak to advocate for myself, but I did point out that shortness of breath, vomitting, and dizziness were not symptoms of fibromyalgia (FM). Also, having had FM for over 10 years, I knew what it felt like, and I definitely was not having a flare up. The oxygen given to me in the hospital was so weak, I think there was more air flow in the room. I suffered through the night, and then wobbled out in the morning. I slowly recuperated over the next couple of days, and haven't had any lasting effects. During the slow night in emerg, the emerg doctor did some reading, and he told me that people with soft tissue disorders were more likely to experience acidosis. He wasn't sure of the diagnosis.

Sorry for the long preamble, questions:

1. Could it have been DCS?

2. What is the appropriate flow rate of oxygen when treating DCS? Are the oxygenation readings from a person's blood relevant in treating DCS?

Thanks.

Lets see...

Agressive dive profiles. Inability to stand, vomiting, dizziness, etc within 24 hours.

I'm no doctor, but is sounds like a DCS hit to me.

 

[Saturation]

I concur with Dr. Deco and others. What is described should be considered DCI until proven otherwise because other possible diagnosis, such as fibromyalgia, are not associated with severe organic injury or even death, DCI is.

It would be prudent to start 100% 02 to see if changes in symptoms occur during cases of DCI. While some recovery can occur in other types of neurologic disease, its not as dramatic as it is in diving related injuries. This would clue the physician in charge that the findings are more associated with DCI that other issues.

DCS and Helium issues can easily be located using google.com.

http://en.wikipedia.org/wiki/Decompression_sickness#Helium

Swimming out to meet a ship, symbolic as it seems, is a problematic idea in modern days. Few ships are sailing vessels these days, and swimming out to meet a ship could lead to a fatal encounter with prop wash. The limited energies and swimming efficiency of a human that can, with olympic skills, reach 5 knots for but minutes, pales by most ships that exceed and sustain 20 knots without strain for days on end.