Unexpected Skin Bends--Why

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So, long story long...
My buddy got bent several times in the course of a year. All on pretty conservative dives (by our standards). The last dive was a 100’ cave dive for 2 hours with about 40 minutes of deco on CCR. The diver actually did 20 minutes more deco than I did at the same GF and the same PPO2

About an hour after surfacing, we’re eating dinner at the diner and my buddy says he doesn’t feel good. Seconds later, we caught his head from falling into his soup. We called DAN who said to take him to Orlando. They would call ahead to let the staff know that DCS was incoming.

We arrived at Orlando in less than an hour. We actually had my wife meet me with her Camaro as it was a bit faster than Avalanche. At any rate, my buddy was breathing O2 for an hour prior to arriving at the ER. Head spinning, Migraine, Loss of movement in the feet. We tell the ER staff that we have a DCS incidence. The tell us that DCS is pretty unlikely (bear in mind, this was his 4th or 5th hit in a year). They check him for Heart Attack, (It’s dcs), They check him for Stroke (its dcs). They check him for Vertigo (it’s dcs). By the way, since when does vertigo cause paralysis in your feet? LOL. We spent 2 hours with them trying to diagnose everything but DCS. They also wouldn’t give him any O2, so I pulled the AL40 from the car and he breathed that.

Finally, they came and said, “Okay, we think it’s DCS”. REALLY?!?!?! You fuggin think? “It’ll take 30 minutes for the DCS team to get here.” The team arrives and says, “So you guys did a bunch of diving today huh?” “No, just one dive”. “Oh then it’s highly unlikely that he has DCS, what was the dive?” I respond, “2 hours at 100’ on CCR”. “OH MY GOD, OH MY GOD, YOU CAN’T DO THAT, THAT’S NOT POSSIBLE, YOU’RE LUCKY YOU'RE BOTH ALIVE... I look over at my buddy and say, “You’re probably not going to live through this”. So, the guy has Daniel change into a gown and starts loading Daniel into a chamber. I say to Daniel, dude, did you remove your cell phone and Bluetooth headset. “No, should I?”. The doctor says, “oh yeah, thanks for reminding me”. I look over at Daniel and say, “Dude, you’re probably going to die”. For those of you not in the know, electronics in the chamber is a sure fire way of blowing up everyone.

So, Daniel gets loaded into the chamber. And the doctor says, “Okay, he’s doing a table 6, you should be able to pick him up in the morning.” I said, “Doc, he’s got bilateral paralysis in his feet, it’s type 2 dcs, it’s not going to be fixed by one chamber run”. He says, “Oh yeah, this will fix him right up”. I say, “Daniel, you’re probably not going to survive this”.

The next morning, I pick Daniel up at the end of his Table 6. I load him into my car and say, “Hey, where do you want to go for breakfast before I bring you back here?” He says, “What do you mean?” I told him he’s got about 90 minutes before he ends up back in the chamber. Thankfully, we were able to finish breakfast. He did 4 more table 6’s over the next 5 days before he came home. Hyperbaric Physicians are idiots.
 
32%. We set our computers to what gas we are actually diving. If we ever had an accident and had to go to a chamber it would be important for the chamber crew to know your real profile. Many divers set their computer to air while diving nitrox, but that really doesn't increase their safety as the air tables are already conservative.
Thanks for your quick response!
 
Was she also skin bend free for many years and dives before she was affected?
She had close to 500 dives before getting skin bends. She suffered for over a year, getting them often after making two dives. Once she began graphing her depth and time and increasing her safety stops to at least ten minutes they have not reoccurred.
 
My wife got skin bent on her first ocean dive, and hasn't had a problem since. I'm not sure that there is a real answer as to "why" because there are so many variables.
 
Guy-
There has been some mention in recent (this or last year) DAN articles about aging and gas transport. While there was nothing specific, there are apparently indications that as we age, the same way that skin may wrinkle, the spacing between out cells may change, and that small change in interstitial spacing may cause a difference in the way gasses can pass through. The bottom line was that as you age, you may need to get more conservative than the tables--because the tables are written for youngsters, and there's not enough information to say more.
So other than getting over any remaining sensitivity caused by the past incidents? Yeah, the only answer is to be more conservative. I'd say to use a safety factor of "2", the most that computer usually allow, and take whatever other steps you can. (Be hydrated, stay warm, etc.) And if you are using air, consider moving to nitrox--but still using the more conservative air tables. Another bump in your safety factor.

Superlyte-
I wouldn't knock all hyperbaric docs over that one. all doctors, all specialists, all hospitals, vary in quality. There are even some that think along your lines, saying that every patient should have a "patient advocate" to speak for the patient, whether that's a spouse or friend. Because as critical as medical care may be, the people at the hospital are just human, and they don't always know their business. Once you get into the medical equivalent of unicorns (DCS is *how* common?) there are reasons why they may foolishly be sticking to diagnostic scripts, and 12/14 hour shifts do tend to make forgetful idiots out of the best of them.
Even if it is a chamber--CALL DAN and get a liaison who really knows their business on the phone with the local medics.
 
At every chamber I’ve ever been to for my friends that got bent, NONE of them knew anything about the type of diving we did.... EVER. Looking at our profiles, they told us we were diving death sentences and while I had no symptoms, said that I should be in the chamber alongside my buddy. They had zero understanding of nitrox, trimix or decompression diving. I was a chamber operator in the GoM for a decade. The hyperbaric docs in hospitals are a bunch of idiots who know how to treat gangrene. They don’t know how to treat DCS other than “let’s run a table six, come pick up your buddy in 6 hours”. After they almost put him in the chamber with a cell phone in his pocket. FYI, Type II DCS with paralysis in both legs isn’t treated with a single Table 6.

Right. That's a bit of a blanket statement. I'm sorry that has been your experience, but I can name quite a few hyperbaric physicians who do not fit the description of "idiot" and have forgotten more about treating decompression sickness than most of us will ever know.

Best regards,
DDM
 
So, long story long...
My buddy got bent several times in the course of a year. All on pretty conservative dives (by our standards). The last dive was a 100’ cave dive for 2 hours with about 40 minutes of deco on CCR. The diver actually did 20 minutes more deco than I did at the same GF and the same PPO2

About an hour after surfacing, we’re eating dinner at the diner and my buddy says he doesn’t feel good. Seconds later, we caught his head from falling into his soup. We called DAN who said to take him to Orlando. They would call ahead to let the staff know that DCS was incoming.

We arrived at Orlando in less than an hour. We actually had my wife meet me with her Camaro as it was a bit faster than Avalanche. At any rate, my buddy was breathing O2 for an hour prior to arriving at the ER. Head spinning, Migraine, Loss of movement in the feet. We tell the ER staff that we have a DCS incidence. The tell us that DCS is pretty unlikely (bear in mind, this was his 4th or 5th hit in a year). They check him for Heart Attack, (It’s dcs), They check him for Stroke (its dcs). They check him for Vertigo (it’s dcs). By the way, since when does vertigo cause paralysis in your feet? LOL. We spent 2 hours with them trying to diagnose everything but DCS. They also wouldn’t give him any O2, so I pulled the AL40 from the car and he breathed that.

Finally, they came and said, “Okay, we think it’s DCS”. REALLY?!?!?! You fuggin think? “It’ll take 30 minutes for the DCS team to get here.” The team arrives and says, “So you guys did a bunch of diving today huh?” “No, just one dive”. “Oh then it’s highly unlikely that he has DCS, what was the dive?” I respond, “2 hours at 100’ on CCR”. “OH MY GOD, OH MY GOD, YOU CAN’T DO THAT, THAT’S NOT POSSIBLE, YOU’RE LUCKY YOU'RE BOTH ALIVE... I look over at my buddy and say, “You’re probably not going to live through this”. So, the guy has Daniel change into a gown and starts loading Daniel into a chamber. I say to Daniel, dude, did you remove your cell phone and Bluetooth headset. “No, should I?”. The doctor says, “oh yeah, thanks for reminding me”. I look over at Daniel and say, “Dude, you’re probably going to die”. For those of you not in the know, electronics in the chamber is a sure fire way of blowing up everyone.

So, Daniel gets loaded into the chamber. And the doctor says, “Okay, he’s doing a table 6, you should be able to pick him up in the morning.” I said, “Doc, he’s got bilateral paralysis in his feet, it’s type 2 dcs, it’s not going to be fixed by one chamber run”. He says, “Oh yeah, this will fix him right up”. I say, “Daniel, you’re probably not going to survive this”.

The next morning, I pick Daniel up at the end of his Table 6. I load him into my car and say, “Hey, where do you want to go for breakfast before I bring you back here?” He says, “What do you mean?” I told him he’s got about 90 minutes before he ends up back in the chamber. Thankfully, we were able to finish breakfast. He did 4 more table 6’s over the next 5 days before he came home. Hyperbaric Physicians are idiots.
Wow, that’s a crazy story... but why wouldn’t they listen to you? Doctor hubris?? Clearly you knew a lot about this stuff. Too me a good doctor should be like a good detective, gather intel and LISTEN!
 
Right. That's a bit of a blanket statement. I'm sorry that has been your experience, but I can name quite a few hyperbaric physicians who do not fit the description of "idiot" and have forgotten more about treating decompression sickness than most of us will ever know.

Best regards,
DDM
Glad to hear THAT!
 
Have you already discussed this with DAN?

Are you still diving Scubapro computers? The decompression algorithm tends to be middle of the road to conservative

I will call DAN to follow up (second opinion) after my doctor visit.

I am still diving Scubapro. I increased the conservatism from "0" (no alteration" to "1" (slightly more conservative). It can go to "5" I added the extra safety stop time on my own.

I am hoping DukeDiveMedicine (many of whom work with DAN) might give me some insight as well, especially as to how much time I should wait before diving again.
 

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