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G'day all and I'm afraid it's another bends story. However the suggested mechanism is worthy of note so read on, if you have a moment or 2.
I was out in the Red Sea in the first week of July (Marsa Alam - well worth it and full trip report may follow. In brief, I'd say get there and swim with the hammerheads before every other bugger does. And it's cheap at the mo' as well). The package was 3 days shore diving (2 dives/day) followed by 4 night/3 day liveaboard.
The shore diving passed off uneventfully in medical terms and was very much the sort of profiles you'd expect, morning dive of 22m followed by pm dive to 18 or so (exception being an am RIB trip to Elphinstone dropping off to 30-35m).
I felt fit as a butcher's dog getting on the boat and although the diving was then planned as 4 dives/day with 2 drop offs in the am of day 1 and 2 there was nothing untoward about that. On day 1 I was rather surprised to emerge from a 35m dive to be told not to bother taking my suit off because we were about to do the same thing again; but although it looks a bit funny in the log the fact was that after spiking to 35m we spent the rest of the 60 min dive slowly and evenly ascending to 5/6m and spending 15 min there. So not particularly abusive. The other 2 dives were 16/10m.
Day 2 one drop off dive in the am (I decided not to repeat the 'double whammy' of the previous day, although others did, because I thought it was a bit aggressive - wimp!). 3 more dives on that day to 19/10/15m (slight lack of 'deepest dive first' there but nothing radical I wouldn't have thought).
Day 3 and the first dive max 20m, ascending over 20 min to 10/12m where the profile was a bit saw-toothed owing to exploring coral gullies. However that was only in the range 10 - 14m or so and certainly nothing outrageous. Still felt fine after the dive.
It was in hindsight the next dive that 'dunnit': a stiff swim at 18m against the current for 15min followed by a number of swim throughs at 9 - 12m. Apart from the swim being tiring there was nothing actually on the dive that rang alarm bells or made me think there was anything wrong with the profile. However when I got on the boat I felt almightily knackered, and told my buddy at that point I was thinking of not diving again that day. I then had 3 hours kip on deck after which I felt a bit better so did the third dive, a wreck in 16m (foolish boy! I hear you cry. Yes, I should have stuck to my initial thoughts, but I thought I was just knackered and certainly didn't think there was anything particularly wrong with me). In hindsight I recall that I had some numbness in my right hand when I woke up, but I was fairly sure at the time that this is because I had slept on it - and because it disappeared very quickly, and my later problems were more left sided that may indeed be so.
After dive 3 (which had a bit of a combat exit into a RIB upwind of a nasty looking reef (not ideal I know, but these things happen) I felt really shagged and had no hesitation in calling dive 4. However I was not alone; a lot of people on the boat were tired at the end of a week's diving. I would say I felt quite unwell but the only symptoms were lack of appetite and excessive fatigue, which I put down to end of week-itis/Pharoah's revenge/a bit of dehydration (very hot, and although I was consciously trying to take in fluids it's not always easy).
I slept through until the next morning when I felt tired but better. It was at least 24 hours between the last dive and my flight (more like 29 in fact) and I felt no reason not to fly or seek any medical advice.
The next day I was back at work and feeling tired and a little dazed - but again this is what happens when you get home at 3am and have to be at your desk the next day, no?
It was in the early hours of the next day - so 60 hours or so after the last dive - that I woke up with significant discomfort in both forearms which was connected with wrist/elbow disclomfort. After a good half hour wondering what the heck was up (duh!) and discovering first hand why they call it the bends (yes, you really do end up bending/wrapping your arms around you to see if you can make it go away - which you can't) reality kicked in and I got on the phone to the thoroughly pleasant (if a little bleary) duty doctor at Whipp's Cross.
The result need not be stated at length because you've guessed it already - what really took me aback though was when I was given co-ordination tests at the chamber my balance was shot to **** and I couldn't walk heel to toe without falling over (and no, I hadn't been on the pop. Indeed one of the most bizarre symptoms I had was a complete lack of interest in drinking alcohol - which I'm glad to say miraculously resolved after my first 2 treatments!). I'd noticed at work the day before that my typing was hopeless but as mentioned above there were other factors which I could blame for that. Diagnosis: DCI with spinal/cerebral involvement (argh!). Treatment: Table 6 followed by table 5x2. Result: significant improvement but with a little 'nagging' in the L/H arm which is expected to resolve (indeed is resolving) spontaneously. Prognosis: I get a check up in a month after which they may let me back in the water/air if I'm good.
We had a good look at my computer. There was nothing of real note in any of the dives I'd done. At no time had I offended my computer or even gone into deco. It showed one or 2 'slow' warnings but it does that if I raise my arm suddenly - I certainly hadn't had any 'fast ascents' and indeed the whole trip was notable for dives ending with significant periods above 10 and 6 m before surfacing. Of all 11 boat dives there was to my memory only 1 (a short 14m night dive) in which I did not do a 5m/3min stop. There was however a certain amount of medical tooth-sucking at my 11 dives in the last 72 hours of my trip. The docs were clearly of the view that that was too much, and they said that they saw a number of DCI cases following repetitive dives on multiple days which cast some slight doubt on the wisdom of such diving.
One thing the docs did think is that PFO wasn't the problem here: they thought the nature of my symptoms and the way they had progressed (in particular the late showing of any actual pain/discomfort) argued against it. However we're going to revisit the question at my 'follow up' session.
So lessons learned/questions arising?
Lessons: keep hydrated (this was probably a pre-disposing factor, although I was trying...). Perhaps, be more conservative about calling a dive if you don't feel quite right. Consider whether excessive fatigue of itself may be a symptom of DCI. Dive less?
Questions: in reality, who hasn't done a dive when they felt less than 100%, a bit tired, etc? When should you call a dive because you feel tired? When is fatigue 'excessive'? Surely we don't want to be inundating chambers with telephone calls telling them we feel knackered? Is 4 dives a day too aggressive? Has anyone been on a liveaboard when they didn't offer 4 dives a day? Has anyone ever been warned by a liveaboard operator that there are risks attendant on doing 4 dives a day?
In the event, I may just have got 'hit' - one of the docs said to me that 1 in 3000 properly planned and executed dives ends in a bend (scary statistic if that's right). Looking back I can say that there was nothing particular about my profiles or dives that I could point to and say 'fool, PaulC, that was it!' However I don't see myself doing 4 dive days again: 2 is probably better, or perhaps 3 if it's not sustained over a long period (just guessing here, perhaps 3 dives/day for 2 - 3 days would be fine but beyond that, consider going slow?) Having said that, I'm well aware that there are people who perfectly happily fill their boots with 4/5 dives per day for a week or longer and don't have a problem, so my thoughts are about my diving and I'm not claiming to make recommendations for other people.
I'd be interested in any comments, suggestions, flames, character assassinations etc etc.
Dive safe all and see you in the watter in August! (I hope!)
Paul
G'day all and I'm afraid it's another bends story. However the suggested mechanism is worthy of note so read on, if you have a moment or 2.
I was out in the Red Sea in the first week of July (Marsa Alam - well worth it and full trip report may follow. In brief, I'd say get there and swim with the hammerheads before every other bugger does. And it's cheap at the mo' as well). The package was 3 days shore diving (2 dives/day) followed by 4 night/3 day liveaboard.
The shore diving passed off uneventfully in medical terms and was very much the sort of profiles you'd expect, morning dive of 22m followed by pm dive to 18 or so (exception being an am RIB trip to Elphinstone dropping off to 30-35m).
I felt fit as a butcher's dog getting on the boat and although the diving was then planned as 4 dives/day with 2 drop offs in the am of day 1 and 2 there was nothing untoward about that. On day 1 I was rather surprised to emerge from a 35m dive to be told not to bother taking my suit off because we were about to do the same thing again; but although it looks a bit funny in the log the fact was that after spiking to 35m we spent the rest of the 60 min dive slowly and evenly ascending to 5/6m and spending 15 min there. So not particularly abusive. The other 2 dives were 16/10m.
Day 2 one drop off dive in the am (I decided not to repeat the 'double whammy' of the previous day, although others did, because I thought it was a bit aggressive - wimp!). 3 more dives on that day to 19/10/15m (slight lack of 'deepest dive first' there but nothing radical I wouldn't have thought).
Day 3 and the first dive max 20m, ascending over 20 min to 10/12m where the profile was a bit saw-toothed owing to exploring coral gullies. However that was only in the range 10 - 14m or so and certainly nothing outrageous. Still felt fine after the dive.
It was in hindsight the next dive that 'dunnit': a stiff swim at 18m against the current for 15min followed by a number of swim throughs at 9 - 12m. Apart from the swim being tiring there was nothing actually on the dive that rang alarm bells or made me think there was anything wrong with the profile. However when I got on the boat I felt almightily knackered, and told my buddy at that point I was thinking of not diving again that day. I then had 3 hours kip on deck after which I felt a bit better so did the third dive, a wreck in 16m (foolish boy! I hear you cry. Yes, I should have stuck to my initial thoughts, but I thought I was just knackered and certainly didn't think there was anything particularly wrong with me). In hindsight I recall that I had some numbness in my right hand when I woke up, but I was fairly sure at the time that this is because I had slept on it - and because it disappeared very quickly, and my later problems were more left sided that may indeed be so.
After dive 3 (which had a bit of a combat exit into a RIB upwind of a nasty looking reef (not ideal I know, but these things happen) I felt really shagged and had no hesitation in calling dive 4. However I was not alone; a lot of people on the boat were tired at the end of a week's diving. I would say I felt quite unwell but the only symptoms were lack of appetite and excessive fatigue, which I put down to end of week-itis/Pharoah's revenge/a bit of dehydration (very hot, and although I was consciously trying to take in fluids it's not always easy).
I slept through until the next morning when I felt tired but better. It was at least 24 hours between the last dive and my flight (more like 29 in fact) and I felt no reason not to fly or seek any medical advice.
The next day I was back at work and feeling tired and a little dazed - but again this is what happens when you get home at 3am and have to be at your desk the next day, no?
It was in the early hours of the next day - so 60 hours or so after the last dive - that I woke up with significant discomfort in both forearms which was connected with wrist/elbow disclomfort. After a good half hour wondering what the heck was up (duh!) and discovering first hand why they call it the bends (yes, you really do end up bending/wrapping your arms around you to see if you can make it go away - which you can't) reality kicked in and I got on the phone to the thoroughly pleasant (if a little bleary) duty doctor at Whipp's Cross.
The result need not be stated at length because you've guessed it already - what really took me aback though was when I was given co-ordination tests at the chamber my balance was shot to **** and I couldn't walk heel to toe without falling over (and no, I hadn't been on the pop. Indeed one of the most bizarre symptoms I had was a complete lack of interest in drinking alcohol - which I'm glad to say miraculously resolved after my first 2 treatments!). I'd noticed at work the day before that my typing was hopeless but as mentioned above there were other factors which I could blame for that. Diagnosis: DCI with spinal/cerebral involvement (argh!). Treatment: Table 6 followed by table 5x2. Result: significant improvement but with a little 'nagging' in the L/H arm which is expected to resolve (indeed is resolving) spontaneously. Prognosis: I get a check up in a month after which they may let me back in the water/air if I'm good.
We had a good look at my computer. There was nothing of real note in any of the dives I'd done. At no time had I offended my computer or even gone into deco. It showed one or 2 'slow' warnings but it does that if I raise my arm suddenly - I certainly hadn't had any 'fast ascents' and indeed the whole trip was notable for dives ending with significant periods above 10 and 6 m before surfacing. Of all 11 boat dives there was to my memory only 1 (a short 14m night dive) in which I did not do a 5m/3min stop. There was however a certain amount of medical tooth-sucking at my 11 dives in the last 72 hours of my trip. The docs were clearly of the view that that was too much, and they said that they saw a number of DCI cases following repetitive dives on multiple days which cast some slight doubt on the wisdom of such diving.
One thing the docs did think is that PFO wasn't the problem here: they thought the nature of my symptoms and the way they had progressed (in particular the late showing of any actual pain/discomfort) argued against it. However we're going to revisit the question at my 'follow up' session.
So lessons learned/questions arising?
Lessons: keep hydrated (this was probably a pre-disposing factor, although I was trying...). Perhaps, be more conservative about calling a dive if you don't feel quite right. Consider whether excessive fatigue of itself may be a symptom of DCI. Dive less?
Questions: in reality, who hasn't done a dive when they felt less than 100%, a bit tired, etc? When should you call a dive because you feel tired? When is fatigue 'excessive'? Surely we don't want to be inundating chambers with telephone calls telling them we feel knackered? Is 4 dives a day too aggressive? Has anyone been on a liveaboard when they didn't offer 4 dives a day? Has anyone ever been warned by a liveaboard operator that there are risks attendant on doing 4 dives a day?
In the event, I may just have got 'hit' - one of the docs said to me that 1 in 3000 properly planned and executed dives ends in a bend (scary statistic if that's right). Looking back I can say that there was nothing particular about my profiles or dives that I could point to and say 'fool, PaulC, that was it!' However I don't see myself doing 4 dive days again: 2 is probably better, or perhaps 3 if it's not sustained over a long period (just guessing here, perhaps 3 dives/day for 2 - 3 days would be fine but beyond that, consider going slow?) Having said that, I'm well aware that there are people who perfectly happily fill their boots with 4/5 dives per day for a week or longer and don't have a problem, so my thoughts are about my diving and I'm not claiming to make recommendations for other people.
I'd be interested in any comments, suggestions, flames, character assassinations etc etc.
Dive safe all and see you in the watter in August! (I hope!)
Paul
