DCS treatment

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Thanks DDM and Akimbo for the the links. Lots of interesting info in the navy dive manual, some of which I will have a look at later as well.

Reading through the neurological assessment it is even more evident to me now that I had very limited assessment from the Fijian doctor. Based on the fact that he did not intend on giving me a table 6 treatment straight away and DAN had to tell him to do so, I did not have much confidence in his knowledge about how to treat diving injuries.

In the end, I have learned a lot (and still am learning) from this experience and am hopeful I will have a complete recovery. The next question is what to do differently in the future to prevent another incident.
 
… The next question is what to do differently in the future to prevent another incident.

All the prophylactic measures against DCS I am aware of boil down to diving conservatively. This can be done in several ways. Here are a few techniques, but most require manually tracking your OTUs and MOD.

1. Program your dive computer for the most conservative mode. Also set it for the highest exertion level. Some also allow telling it how old you are. You can lie about your age as long as you say you are older than you are.

2. Intentionally stay farther away from the “yellow” and “red” decompression zones that many computers display for decompression obligations.

3. You can dive with richer mixes of Nitrox than you tell your computer or the decompression table you select. For example you tell the computer you are diving air when you are actually using 32% Nitrox.

4. You can decompress or take safety stops on pure O2 but not take credit for it… basically don’t switch gases on your computer.

5. You can take longer or unscheduled safety stops than recommended. This is especially effective on pure O2.

6. You can make repetitive dives to 10-20' on pure O2 without telling your computer.

You might find these links interesting:

http://www.scubaboard.com/forums/diving-medicine/466912-o2-after-dive.html

http://www.scubaboard.com/forums/diving-medicine/402490-increasing-safety-margin.html

http://www.scubaboard.com/forums/ad...ns/438153-managing-oxygen-toxicity-risks.html
 
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Thanks for the advice Akimbo. In the time that I am healing I will definitely be doing some more reading and your links will be a good place to start.

I have already changed my computer to the most conservative personal adjustment. It is already quite conservative (Suunto) but this should add an additional margin.

I will probably consider option 3 as well. Normally I dive Nitrox and after getting bent while diving air for the first time in years I will definitely be sticking with Nitrox in the future. Unfortunately I will probably lose the advantage I often have of having my own guide as I am the only person diving Nitrox so have more bottom time than everyone else. I guess I am no longer going to be first in, last out of the water. :(

About 90% of my diving is done overseas so having an extra tank of O2 for deco/safety stops is probably not feasible a lot of the time.

I usually take nice, long safety stops... usually poking around taking photos. I will continue to do so.

The one obvious factor I will need to be mindful of is surface intervals. They were short and I am sure this contributed to my DCS. Both DAN and the dive doctor I saw here in NZ told me the same thing --- the minimum recommended surface interval is 2 hours. This is never (?) the case in my experience on a two-tank day trip. They both suggested that I skip the second dive in that case. I feel that is being too conservative and there are enough other changes that I can implement to reduce my chance of DCS happening again. Or perhaps I am wrong???
 
…About 90% of my diving is done overseas so having an extra tank of O2 for deco/safety stops is probably not feasible a lot of the time…

You might be surprised. A lot of places that provide Nitrox can provide pure oxygen if you arrange for it in advance. This concept mostly applies to boat diving since I don’t think packing an O2 bottle is justified in this case. You can hang it over the side for use even if you swim back to the boat after a safety stop. Then you essentially make a reped on pure O2 for as long as you want. Let your computer think you are still on air or Nitrox during the reped.

You probably want your own O2 clean regulator with SPG, stage-bottle rigging, and a hang-line though (great, more stuff to travel with).

…The one obvious factor I will need to be mindful of is surface intervals. They were short and I am sure this contributed to my DCS. Both DAN and the dive doctor I saw here in NZ told me the same thing --- the minimum recommended surface interval is 2 hours. This is never (?) the case in my experience on a two-tank day trip…

Agreed, 2 hour surface intervals are pretty rare. To make matters worse, there isn’t all that much quantitative data on repeds… yet. The world’s Navies (the source for most historic data) really didn’t do that many repeds deeper than about 40'. When they did, they would rotate through the entire dive team before a sailor’s turn was up again. I would guess that typical surface intervals deeper than 40' probably was 4-6 hours.

DAN is collecting a lot of data from recreational computers now, but I don’t believe it has been going on long enough to really affect computer algorithms on repeds much. Aside from repeds; age, physical conditioning, meandering dive profiles, and gender are variables that distances “typical” recreational Scuba divers farther from the data collected from Navies that influenced dive algorithms. I am not suggesting the gender is a negative or a positive… we just don’t know for conclusively.

By meandering profiles I mean that military working dive profiles are usually spend all at the max depth (a square profile) where recreational divers typically vary their depth a lot. This probably generally works in our favor but the effects on 1-4 repeds a day might surprise us one day. I think that most hyperbaric physiologists recommend that dives start near the maximum depth for the dive and gradually work shallower rather than the reverse.

In any case, thanks for sharing your story. I hope you have a full and rapid recovery. Please keep us updated.
 
You probably want your own O2 clean regulator with SPG, stage-bottle rigging, and a hang-line though (great, more stuff to travel with).

I'm already struggling to pack with all the camera gear I have acquired in the past 6 months. :D

In any case, thanks for sharing your story. I hope you have a full and rapid recovery. Please keep us updated.

Will do! Body is definitely still working to repair itself. Back at work this week and am exhausted by end of day (teaching). Arms are tired/weak but fingers not tingling anymore so I guess that is progress in the right direction. I'll be following up with dive doctor in a few weeks. I am supposed to be going on a 6 week diving trip in mid-December and I will need to make a decision as to whether that has to be cancelled or not. Fingers crossed I heal fully soon.

Thanks so much to everyone for the advice over the past few weeks. It has been very informative, reassuring when needed, and much appreciated. It's great to have such knowledgeable divers willing to share their experience and help others out.
 
I just wanted to give an update now that it's been 7 weeks since I got home. My arms are still tired/weak but not as bad as they were last week or last month. Slowly but surely my body is continuing to heal. I saw the doctor at the navy hyperbaric unit a week ago to check on my progress and to make a decision about whether I was fit to dive on my planned vacation for mid-December to the end of January. Unfortunately, as my body is still recovering (remaining inflammation) he advised against diving and recommended that I cancel the trip. Very disappointing, but I think a prudent decision right now.

DAN did pay for all 5 chamber treatments, but I still have to sort out the claim with my primary travel insurer. It took a few weeks for my energy to come back to the point that I could deal with anything more than just trying to get through each teaching day. Then it took awhile to chase up the invoice to pass on.

I will be spending my first summer in New Zealand since I moved here 5 years ago... enjoying the beach and sorting through all the insurance paperwork. Just one more week of school to go! :)
 
I just wanted to give an update now that it's been 7 weeks since I got home. My arms are still tired/weak but not as bad as they were last week or last month. Slowly but surely my body is continuing to heal. I saw the doctor at the navy hyperbaric unit a week ago to check on my progress and to make a decision about whether I was fit to dive on my planned vacation for mid-December to the end of January. Unfortunately, as my body is still recovering (remaining inflammation) he advised against diving and recommended that I cancel the trip. Very disappointing, but I think a prudent decision right now.

Thanks for the update, Kat.

Man, 7 wks? Whatever you got hit with it was obviously substantial.

I think the advice to pass on the diving at this stage is sage.

Enjoy the beach.

Cheers,

DocVikingo
 
The long delay to getting treatment was a problem. By the time I got to the chamber the nitrogen bubbles had done their damage. Diving in remote locations is risky. My outcome would probably have been worse if the hit had been more serious.

Lessons learned from this - it is really important to find out about a resort's emergency plan.. how long to get to a chamber and how much oxygen is available. In my case, the resort only had a couple hours of oxygen and didn't seem to have an emergency plan or at least not one that the staff present at the time were aware of.
 
Hi h20-kat
I am wondering how you have progressed since your last post?
I got DCI 3 weeks ago and my only choice to get to a chamber was by a 45 minute commercial flight. 24 hours after symptoms began I was treated but it seems I was not treated adequately and told to fly home the next day- I did not as I did not feel up to it but flew out 2 days after treatment. This seems to have caused a bit of damage. I finished my chamber treatments at home about 10 days ago and am still struggling- I am experiencing ridiculous fatigue and have difficulty processing information- numbness comes and goes but less intense than before. I am a teacher too and at the moment only lasting about 4 hours in the classroom. I really did not expect this to go on so long. Would really appreciate hearing that you are healed and back diving and any hints on how to assist my recovery.
 
So sorry to learn of this aquamarine1! Would you mind starting a new thread telling us about how you were hit or what occurred? If you don't want to, I'll understand but if you are willing, often the group and the diver (you) can learn a lot.
 

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