Delayed DCS

[Larry Hadley]

Hi Folks, I’m new to YD and would like to share with you all my experiences following a DCS I suffered recently. I’d like as many divers as possible to learn from this and would be pleased if you could forward it to any other interested parties.
As I wrote this several questions were raised, which I have included within the text. Some have been answered, others not, either way I look forward to any responses. I don’t promise to reply to them all, nor necessarily agree with them, but I hope that like this document, they might help to educate other divers and possibly even some medics.

PROFILE OF DCI FOLLOWING DIVE ON UB55 OUT OF DOVER JULY 2nd 2005 13:24 > 13:51

Weather conditions:-
Dry, 25oC, overcast.
Sea conditions:-
Slight swell, choppy.
Personal conditions:-
PADI Rescue Diver with 90 dives logged in various conditions of sea, fresh, temperate and tropical waters. In the weeks leading up to this event I had made a number of dives in the 25m to 32m range in similar sea states, so I feel I was prepared for this dive. I am a teetotaller so no hangover present. Well fed and watered during morning prior to first dive of day. As a retired professional seafarer the sea conditions were not affecting me. I was looking forward to the dive and was in no way unduly nervous, despite this being only my second dive out of Dover, and the deepest to date. Due to other commitments I had no intention of joining the second dive scheduled for late afternoon.
Question, what are the implications when making a second dive if DCI symptoms do not present immediately?
Dive Plan:-
Buddied with two other experienced divers, the plan was to follow shot line down to wreck and to return to the line to be ready to ascend immediately when the first of us ran out of No Deco Time, or reached 80 bar, cylinder pressure. We were all using air, and I had a 15 litre main tank plus a 3 litre reserve, each at 230 bar. I was using a Suunto Vytec dive computer with integrated cylinder pressure, with the personal setting at P0.
Dive Profile:-
We had no difficulty surface swimming to the buoy and I was not breathless prior to descending, as can often be the case in choppy seas. Descent time 2.5 minutes to 30m and a further 1.5 minutes to 33m. Visibility a good 6m, so no problems maintaining buddy contact. Depth then varied between 33.2m and 29.3m until 17 minutes elapsed time, at which point we started the ascent back up the shot line. My cylinder content was 99bar, and I had just reached the limit of no decompression time. Computer was then showing a minimum ascent time of 6 minutes with a ceiling at 3m. We ascended at 4m per minute until 16m at which point computer was showing no ascent time, no ceiling, and 20 minutes no deco time available. Ascent continued at similar pace to 6m where we started the safety stop. The computer had not shown any mandatory stops, and no slow alarms. There were 2 other divers on the shot line just above us, and with three of us in a group, in a fair swell, it made staying level quite difficult. However I completed the stop between 6.1m and 4.9m, and then continued to ascend at about 3m per minute. Total dive time was 27:50 minutes. Total ascent time was 11 minutes.
Air consumed 220-54= 166 bar. Surface air consumption, 25.82SLM. Average depth 22.8m.
Question, does being an air guzzler mean I take on more N2 than others, and should I consider using P1 or P2 personal settings?
Post Dive:-
Spent the afternoon at my daughter’s BBQ but only ate a small snack, and had dinner at a friend’s house, returning home at about midnight.
Sunday:-
Woke up feeling mildly bilious, but this soon cleared. Developed an all-over but mild headache about 14:00. Headache deteriorated during afternoon and I started feeling nauseous, but not enough to stop me eating. Headache so bad I went to bed about 20:30. At this time the possibility of a diving incident had not occurred to me.
Monday:-
Violently awakened at 02:00 by something similar to an adrenaline rush. Head pounding and feeling as if it was being pumped up. Eased sufficiently for more sleep by about 04:30. Re-awoke 06:30 (alarm) still feeling as if my head was being pumped up. Headache still all over, but less severe. After breakfast started to notice slight tingling in right arm (which is not unusual) and waves of dizziness. Still suffering from nausea and headache. 09:00 Rang DAN info line for advice. Told to ring emergency line. Did this and duty doctor felt I was probably not experiencing DCI due to late onset of symptoms. He asked me to see either my GP or local A&E unit, and ask for a full neurological check up. He advised that whoever I saw could ring him for further input. Rang GP who agreed to see me at 10:30. She conducted a neurological test but was unable to check the back of my eyes due to theft of ophthalmoscope the day before. She tried three times to ring DAN but was unable to get through to the duty doctor. Neuro tests were OK, but blood pressure up at 140/100.
Question, is the high blood pressure a symptom or a possible cause of DCI?
GP was not at all happy with my condition and arranged for ambulance transfer to A&E. On arrival I was sent through to the waiting area and was not seen until 16:00 by triage nurse, and then waited a further 2 hours before going through to Clinical Decision Unit. By this time I was starting to feel very confused and suffering from muscle fatigue. I was also very thirsty and realised I had drunk nothing since 08:00. Examined by doctor at 19:00. Repeat of neuro tests of this morning but not informed of results. I asked her about examining my eyes and she was very reluctant, but begrudgingly agreed to go and see if she could find an ophthalmoscope.
Question, what will this test show?
This was eventually done and she reported that nothing was wrong. My wife, Alex, had joined me by now and tried to persuade the doctor that I was definitely not my usual self. I tried to talk to the doctor about the possibility of DCI but she was adamant, despite my protestations, that 33m was too shallow to cause a DCI and even if I did have an air bubble I need not worry as it would soon dissipate.
Question, how can we educate medical staff not to make false statements about illnesses which they have little knowledge of? Should medical staff be encouraged to seek advice from both patient and experts when confronted with a possible, albeit remotely, DCI?
The doctor then prescribed a huge dose of mixed analgesia and told me if the headache did not go, then I would be sent for a scan in the morning. She was obviously aware of my dissatisfaction and called a consultant to see me. I have never been treated by a more pompous, ill-informed prat in my life. When questioned by him about my condition, if he received the wrong answer he then reworded the question in an attempt to elicit an alternative reply!
He also dismissed the DCI scenario due to shallowness of dive and time scale to awareness of symptoms. As I said before, I was very confused by now, and inclined to believe it was not dive related, but I still wanted them to bear it in mind if nothing else showed up. The doctor who had prescribed the analgesia had said she would return within an hour or two to re-assess the situation, but I didn’t see her again. I was given an ECG and a chest X-ray. The radiographer questioned the chest X-ray because my card said I had a headache. I told her about all the other symptoms and she said none of them were recorded! At this point I was considering contacting a diving friend and GP for a sympathetic friendly ear, but decided against that as I felt it was intruding in his private life, and I did not want him to feel obliged. At about 22:00 I decided to try and sleep, and Alex went home. During the night I was woken for more analgesia and moved to a side room on a medical ward with minimal observation.
Tuesday:-
More doses of analgesia given. (Total of 12 paracetamol prescribed in twenty hours despite my questioning it.) Alex came back in and told me she had contacted my diving friend GP, and obtained number for Diving Diseases Research Council in Plymouth. She had rung them and been told if scan results came back negative then I should contact them with a view to re-compression. Same consultant from last night came to see me at about midday, along with another junior doctor. He asked me if I wanted a scan! What’s all that about, I thought he was the medic? Told a scan would be in about 3 or 4 days if I stayed in hospital and in months if I went home. I raised the DCI subject again and received another torrent of verbal abuse from this buffoon. The junior doctor also asked why I thought it might be DCI as I only had a headache. I then confirmed for the record that my symptoms included non relenting all over headache, albeit not very painful, a feeling that my head was being inflated like a balloon, dizziness and loss of balance, severe confusion, muscle fatigue, tingling sensation all down right arm and hand, and a blood pressure maxing at 148/105! I then told the consultant what DDRC had said to which his response was, “If they want to know the result of any scans done they would have to write to him requesting such, and when he had written to me and received my written permission he would forward them on”!!!!!! What an arse. (Incidentally I make no apologies for any libellous remarks made about the medical staff at the hospital. If any one reading this is a friend of theirs and upset by my remarks then that’s tough, and if any of the aforementioned staff read this and wish to take legal action against me then bring it on. I’m more than happy to send a copy of this to the BMA).
Question, could we organise a club night with a hyperbaric trained doctor to give a lecture and invite some local medical staff along? Is there a website that doctors use to glean information about unknown conditions?
Alex then rang DDRC again and was told to ring the Institute of Naval Medicine in Portsmouth. They requested that we got the ward doctor to ring them in order to discuss my case. Fortunately he was responsive to this and within an hour they had been in touch with London Hyperbaric Medicine and my destiny was determined. To make things easier Alex drove me to Whipps Cross University Hospital, and we arrived there at about 18:00.
Question, should I have gone by ambulance with O2 therapy? If I had been in receipt of DCI treatment in the ambulance taking me to A&E would I have been seen any earlier?
After a check up by the unit doctor I was told I would need three treatments because of the delay in starting. The first session was 2.25 hours with almost constant O2 starting at 18m (equivalent pressure) and reducing to 9m for a while before a very slow decompression to the surface. My symptoms improved within the first hour, and by the end I was feeling fantastic! This improvement confirmed it was due to a diving incident and the doctor confirmed I would need two further sessions over the next two days. I was admitted to the over 50 men’s medical ward (groan) for overnight observation.
Wednesday:-
Second session of 2.25 hours at 15m with minimal decompression time at end of session. Constant O2 with about 5 minute break at half time.
Thursday (7th July):-
Third session as yesterday. Check up prior to discharge and released into London’s chaos. Glad we went up by car! No diving for at least a month.
Wednesday (27th July):-
Review with duty doctor at Whipps Cross
August:-
Fit to dive medical required!

Moral
Always carry a card with you having details on it of professional dive medical telephone numbers.

From advice received and from research it is apparent that as a recipient of an undeserved neurological DCS, I have a 75% chance of having a PFO, (hole in the heart). Consequently it is my intention not to dive until this has been checked out.

I hope by writing this to provide as broad an insight as possible into the developments I experienced. It is certainly not my intention to worry any inexperienced divers. Any feedback and contributions are more than welcome.

[ChrisP]

Originally Posted by Larry Hadley

Hi Folks, I’m new to YD and would like to share with you all my experiences following a DCS I suffered recently. I’d like as many divers as possible to learn from this and would be pleased if you could forward it to any other interested parties.

Welcome to YD Larry.
What a first post!
There is lots to think about and of course we have chatted about this since your hit. You will find YD full of a wealth of useful advice and opinions.
I will leave others to comment on your report but suffice to say that it is frankly remarkable that you can be told by any medic that a 33m dive is too shallow to cause DCI
The moral of your story has to be to seek a hyperbaric opinion if you develop symptoms after a dive. You are not the first person to use one of the emergency numbers from your hospital bed!
Take care

[abucksdiver]

From this post (and not intended as a criticism at all), I wonder about the wisdom/benefit of using DAN as the first contact to an incident in the UK?

It sounds as if the RN Duty Doctor or DDRC would be a better starting point...

Regards
Andrew

[BentDiver]

Larry,
Welcome to YD. A top post.
Hopefully the intransigence and dogmatism displayed by the docs who were ‘looking after you’ isn’t widespread.

Dom.

[gansell]

Crikey, that's quite a first post. Many medical staff do not have the experience of DCS (it's probably a 20 minute lecture in a 5 year course). Seeing as there are lots of things that can cause similar symptoms, confusion, headache, etc, they have to take all possible causes into account, especially with such a late onset. However, they should be willing to consult with a specialist, and not jeapodise your health by their arrogance. If you feel that they were doing this then consult with the BMA.

I am not a Dr, but here is my take on your questions FWIW.


Question, what are the implications when making a second dive if DCI symptoms do not present immediately?

Any second dive is going to increase your N2 load, thereby creating more trouble later on. It could also crush any non symptomatic bubbles back down to a size where they can enter the arterial circulation. However, if you are asymptomatic then you would not be concerned by the above, and probably do the dive.

Question, does being an air guzzler mean I take on more N2 than others, and should I consider using P1 or P2 personal settings?

I don't see how, it just means that you are shifting more N2 through your lungs/minute, not that any more is being absorbed. I would always consider using using the P1 and P2 settings for any factor such as weight (above a BMI of 25), dehydration (is your pee clear or yellow), age (over say 30ish), fitness level (can you run 100yards or 26 miles), etc.

Question, is the high blood pressure a symptom or a possible cause of DCI?
Pass.

Question, what will this test show?
Possible damage to retinal capillaries caused by bubbles, maybe?

Question, could we organise a club night with a hyperbaric trained doctor to give a lecture and invite some local medical staff along? Is there a website that doctors use to glean information about unknown conditions?

Yes you could, but would the come? Several sites are/can used, such as Medline, as well as medical text books, but again do Drs use them? You can lead a horse to water and all that.

Question, should I have gone by ambulance with O2 therapy? If I had been in receipt of DCI treatment in the ambulance taking me to A&E would I have been seen any earlier?

Probably not, and you would have been charged for the ambulance ride, as it was not an emergency. You would have triaged in just the same way when you arrived the hospital, and as you wern't dying would still have had to sit in the waiting room. If you were lucky they may have let you suck on therO2 for a bit longer though.

I think it may have been more benificial to have called DDRC or Navy when first suspected of a bend, you may have got treated faster.

[greekbird]

Originally Posted by Larry Hadley

<snip>
From advice received and from research it is apparent that as a recipient of an undeserved neurological DCS, I have a 75% chance of having a PFO, (hole in the heart). Consequently it is my intention not to dive until this has been checked out.

I hope by writing this to provide as broad an insight as possible into the developments I experienced. It is certainly not my intention to worry any inexperienced divers. Any feedback and contributions are more than welcome.

...man! what t**rs at the hospital?!
anyway, that aside, did you exert your self after the dive,eg climming up the ladder or similar? Two friends of mine, both diagnosed with PFO after undesrved bends, one exerted herself after the dive climming a ladder fully kitted, the other had a bit of a brown stuff hitting twirly thing during the dive, which he solved (NO rapid ascents or anything of the sort, just a stressfull few minutes) but his hearrt rate went up quite a bit which cause the bubble to shunt...
anything of the sort happend to you during or after the dive?
Hope it all goes well from now on for you

[Helen F H]

Originally Posted by gansell

Crikey, that's quite a first post. Many medical staff do not have the experience of DCS (it's probably a 20 minute lecture in a 5 year course).

I have a good friend who is studying medicine at a Scottish University, she is a diver - we did our training together, infact, it was her who got me into diving in the first place . She phoned a while ago to tell me she had just done her afternoon lecture on diving medicine. A section of this was a recording of listening to a recording of the comms where a commie diver got hypoxia, being hauled up and resuscitated.

[The Purist]

Originally Posted by abucksdiver

From this post (and not intended as a criticism at all), I wonder about the wisdom/benefit of using DAN as the first contact to an incident in the UK?

It sounds as if the RN Duty Doctor or DDRC would be a better starting point...

Regards
Andrew

My thoughts exactly - DAN are great for overseas cover, but for diving incidents in the UK the numbers you need are:

Duty Diving Officer - 07831 151523 (usual 1st point of contact)

In the SW, DDRC - 01752 209999

In Scotland, Aberdeen RI - 01224 681818

[SoggyFox]

thanks for the post.

think i would of got close to going mental in the hospital, but glad to hear its getting sorted.

[Sam]

the Aberdeen number has actually changed. The 01224 681 818 number will only be valid for another 2 months.


The new number is 0845 406 6008. Phil from the Millport chamber posted the new number on the Scottish Diver website.