advise on a bend and diving after a bend

jaymos2004

hi all i would like some advise and opions on the following please guys.

the story.

I did a dive to a max depth of 37m and bottom time of 75 mins and a total dive time of 112 mins. i did all my stops fine, including any deep stops that my VR3 and vision electronics told me to do. when i reached te surface i felt ok just abit tierd, when the rib came to pick me up i struggled to get my kit off,( i normally have no problems at all). after being on the rib for a few mins i felt some pain in my lower back but didt think to much of it. after a few more mins the pain traveled to my upper back my arms and my back side. we new something was badley wrong by this time and i was on o2 within seconds and we where heading back to shore. a freind toke me to the hospital and we were there within an hour of it happening.

after them doing an ecg and lots of tests on me they put me in the pot for 5 hours, starting from 60ft on 100% o2. the blood tests show that i had really high red blood cells almost double what they should be, and this is all they could really find wrong with me. they kept me in for a couple of days cos they were conserned about my RBC. luckerly the RBC level soon came down and they let me out with just a 2 week supply of asprin to take and some more blood test in a couple of weeks. they also told me not to dive for 4 weeks witch ive done.

These are the few of the things that i think might helped cos the bend.
1. i spent around 20 mins at the end of the dive working i.e hammering on a large lump of brass.
2. i did a dive the day before with a very simaler dive profile.
3. i had a few beers the night before but i didnt dive till 4pm the next day 16 hours after my last beer.(still wrong i know)
4. maybe i didnt drink as much as i normally do.
5.the long bottom time.

So guys what like to know is has anyone had something like happen, or got any ideas why my RBC were so high, or anything else witch might have caursed it. also ive got a trip next witch id like to go on (next week will be my 4 weeks up). how long have any of you waited before diving after a bend.

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chunter

That is very similar to what happened to a buddy of mine. I would get checked for a PFO.

Aloha,
Charlie

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schford

I popped this into thedive medicine forum as I think more likely to be spotted by some of the medical experts hope you dont mind.

Stuart

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dteubner

The 'what caused my bend?' threads, and there are many, don't usually come to any sensible conclusion. The precipitants of DCI (apart from hyperbaric exposure) are quite poorly understood - even when looking at a population of divers. Yes a PFO will increase the risk of some sorts of DCI. Dehydration probably does too. Exercise at depth, cold etc might also increase the risk. Exercising prior to diving is probably protective. In spite of this, it is absolutely not possible to ascribe causality to anything in an individual case.

DCI causes fluid to be lost from the blood into the tissues which causes the RBC count to rise. No real mystery here.

Different people have different advice about returning to diving post DCI. There is no good evidence base to support different practices. FWIW we say no diving until a 6 week review after which a return is OK as long as there are no residual symptoms. Other places are much less conservative. What did the guys who treated you say?

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jaymos2004

to be honest they didnt say to much, apart from have a 4 week break, and also see what my next blood results say,( which im shore will be fine). this is why ive for some advice for you guys.

wedivebc

Did they say why you should wait 4 weeks? Is there a higher chance of re-occurance in that period? I have had 2 incedents of the same thing in the last year. Dehydration played a factor in both cases but I am looking at a PFO test in the near future. My concern is if a PFO test is positive, how will it affect me and do I want to get it treated.

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JS1scuba

I am going to assume you were on a set point of 1.3 and using air as a diluent. 75 minutes is a bit long for that depth. On OC it was typical to see bends cases after 30 minutes using the base decompression, and was almost predictable after 50 minute dives.

Once these exposures exceed 30 minutes the typical Buhlman decompression schedules seem to fall apart. A quality bubble model would have started your decompression at about 18 msw and would have run a total of 126 minutes.

A model such as Hamilton's DCAP would have taken it out to 137 minutes.

The pounding on the brass did not help much as your muscles were blowing through any oxygen they were getting. Whenever you have a high stress dive or a "working" dive you have to pad those tables and computers heavily. Flying the computer on its straight #s will only give you best case decompression.

Skin blotches like you show are classic neurological decompression sickness. Though in the past they were considered just "skin bends" more examination and fine point neurological examinations prior to treatment and post treatment have shown that these types of bends cases are spinal.

Staying out of the water for a month is probably a good idea. Then get another neuro exam and clearence. There is nothing down there now that cant wait a month.

Good luck and get well.

Cheers

JDS

PS -- i ran an HBO facility in NY for 3 years in the 1990s. I've seen hundreds of cases of DCI over the years.

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Hanssing

Hi Joel,

Could yo eleborate a bit on that?
The case in point with lower backpain and rapid progression of syptoms, seems to support this.
But are you saying that the pictures do not show skinbends, or that skinbends is heavily correlated with neuro-bends?

Any pointers to reference-documents would be appreciated.

Nicolai

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CharlieT

You've identified 3 things which would have all worked against you.

Working on spidge, a few beers and maybe a little less water intake than good.

Any alcohol should be countered with a substantial increase in water intake. Deydration is such a common cause of DCS/DCI.

As Joel has said, I'd pad out what your Vision and VR3 demand if I was hammering away at brass.

Hope you get better

Charlie

Simon Mitchell

Hello,

The photos show classical cutaneous (skin) decompression sickness. I know what Joel is trying to say, but I think he has overcalled it a bit. It is well recognised that some forms of cutaneous DCS (especially the so-called cutis marmorata variant) are often portents of more serious disease such as spinal DCS. But it is stretching it to imply that the association is almost invariable. I have seen many cases of cutaneous DCS with no neurological involvement and this is well recognised in the literature. However, one implication of Joels comments that I agree with is that someone presenting with rash like the one shown deserves to be looked at carefully even if there are no other obvious problems.

Warm regards,

Simon M