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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
 

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<font color='#008080'>Hi Chris,

Glad to hear your bent was mostely resolved by the treatment. Hope you will get the all clear again soon.

I just got back recently from a week in Norway - 2 dives per day, cold water 6 degrees at the bottom, great viz, no currents. Generally first dive a bounce to somewhere between 45 and 30m max, with second dive in 35 - 25m range, all mostly V shaped profiles as most of the wrecks lay on a slope. Always four hours surface intervalls. One of my friends on the trip got bent on day four with tingling in his arms and legs. He didn't dive again that trip as he was generally feeling unwell/achy, but not majorly so.. anyway, decompression treatment was delayed for a variety of reasons until symptoms still persisted after 48 hr and a doctor was consulted and my friend was decompressed. Symptoms have now mainly, but not completely, been resolved following three further trips down the pot.  

I'm only mentioning this incident here to illustrate that you do not need to do four dives per day to get bent even if all dives are within no-stop times and you did not violate your computer.

Diving is a lottery - I believe the more you dive the more likely you are to get bent. Some hit the jakpot earlier and more often than others. :devil:

BSAC advocates you do no more then two dives per day with decent intervalls. Three dives in warm water. I have seen people do 4-5 dives per day in Truk starting at 50m getting progressively shallower to 20m during the day, with repeats on five consecutive days and they did not get bent.. but although all dives were no-stop all divers were encourged to do a fixed series of stops at 15, 12, 9 and 6m. I have seen divers do 4-5 dives per day over a week in the Barrier reef with 5 minute safety stops and nobody got bent, but again the dive marshalls there insisted that everybody do at least 5min stops at five metres. I have also seen people do a single shallow long dive followed by a normal ascent and get bent.. there are no rules or guarantees - only guidelines.

For one think about shallow sawtooth dives -  are they really OK? Think a bit about what actually happens.. you get the largest expansion of gas within your body in the last 10 m to the surface, hence by doing saw tooth dives in that range you are growing the largest bubbles each time you ascent a bit and then recompress them on descent, then grow them a bit more and recompress them not quite so much etc.. the end result, as I see it, are bigger bubbles.. if you then don't do a safety stop for 3-5 minutes between 6 - 4m to my mind you are more likely to get bent. The new Suunto Vyper for example, recognise this as agressive behaviour and will hit you with extra stops.

I did a dive in Capernwray with a buddy once who was trying out a new twinset after an absence from diving for several months.. he was up and down as a jo-jo, max depth  15m.. his Vyper hit him with 9 minutes of stops at the end of that dive, whilst mine was clear i.e. only asked for the three minute safety stops it always wants. As a rule I now always do 3-5 minutes of safety stops after any no-stop dive. The more dives per day I do the more time I built in at 6m.. this is usually easier in the Red Sea than in the UK, but well worth doing..

I must also say that I only dive on Nitrox now, and especially so when doing several dives per day.

AFAIK PADI advocates that all nostop dives should be ended with a 5 minute safety stop. The dive guides on your boat in Marsa Alam should have at least mentioned that, especially if the plan is for four dives per day.

So, after all that rumbling I would add to your lessons learnt:
- do a minimum of five minutes safety stops following any nostop dive. Stay longer on those stops the more dives you do in quick succession.
- avoid sawtooth dives, especially on shallow dives. If such profiles are unavoidable, then make sure your ascents are as slow as poss between descents and add extra stops at the end.
- use nitrox whilst diving on an air computer.

Keep safe

Anke
 

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<font color='#000F22'>Paul,

Sorry to read of your misfortune mate. It's always been a pleasure diving with and and I hope we can get a dip or two after you've been cleared.

I'm not gonna comment other than saying I've done exactly the same kind of diving in the past including this year in both the Philippines and Bali not to mention completing dives to 40m in the UK and bouncing shortly afterwards to get the shot!! Foolish boy! but so far not bent. Lucky probably.

The only thing I can recommend is do more stops that your computer says, alway include deep stops, ascend slower than 10m/min, use nitrox or as you've seen me  - sling a bottle of 02 for every last dive of the day regardless of deco or not.

Just my opinion and I hope that this is the last bend of the year from these boards or anywhere else.
 

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Sorry to hear about your bend Paul,

Probably a number of different factors and I have also done similar diving in the past and got away with it.

The one thing I would say about multi dives over multiple days is we have to take everything into consideration.  I have done 6 consecutive days diving all with 3 and sometimes 4 dives a day but usually whilst on a liveaboard in the red sea.  It is much easier to avoid exercise and rest between dives, keeping rehydrated should also not be as much of a problem (as long as you can keep the fluids in).

I do try to be a bit more conservative now and usually switch to Nitrox after the first dive of the day.  I also do multiple stops on deep dives and always stay at 5m for at least 10 minutes and my reasons for being more conservative is thanks to people like yourself who are willing to share their stories.

Hope you recover fully.

Daz
 

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[b said:
Quote[/b] (PaulC @ July 19 2003,12:41)]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). Paul
According to at least one Swedish hyperbaric medicine specialist, the odds are in fact even worse - MUCH worse. He say there is documentation showing that 1 in every 600 dives ends up in the pot!!
Glad you are recovering well, Paul. Dive safely everyone else.
 

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[b said:
Quote[/b] (aquaholic @ July 19 2003,13:19)]you did not violate your computer.
How do you violate a computer? I can't get my little fella in the holes for the pressure sensor, or inbetween the buttons or anything.  


I think I need to get out more. Or maybe I'm not designed for that sort of thing.
 

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Thanks for those thoughts people. If they let me back in the watter in Aug I'll just take it easy for a while...meanwhile I'm going to practice violating my 'puter  


Best,

P
 

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Paul
The main thing is pal youre on the road to recovery. Reading youre report I could all to easily see how you were tempted to bang in the extra dives etc.
Having said that 4 dives in a day is pushing it with the profiles, that's a personal opinion of course despite what the dive computer says. We ALL learn from each others experiences.

Look forward to diving with ya soon
Tony
 

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Sorrry to hear about your bend Paul, here's hoping it's your first and last. If you're not already nitrox certified this would be a good excuse to treat yourself to a course, increased safety and all that.
Cheers
Steve
 

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I've got the EANx cert, Steve - no nitrox on the boat sadly. I shall however be using it as much as possible, at least to start with, when I get back in the water...I see the doc. on 15th August so fingers crossed!

Tony, I agree with your thinking...4 dives probably just too much for me. You'd have been tempted too though...I'll never forget the hammerhead cruising past me about 5m away...
 

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Hi Paul,
           I've just ran across this. Glad you're Ok and hopefully the Doc clears you FTD.
 All I can say is take it easy and for your 1st few dives back in be aware of what your body is telling you.

Peter
 

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Paul - having recently recovered from a bend, I can only re-iterate what PK says - it will improve and a few introductory dives will have you back on full form before long. Did a 45 min dive at 30m a couple of weeks ago (2nd deco dive since bend) and no issues. See you in Tynemouth!
 

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Hey Paul

Glad to hear you're ok mate, but I've never seen you be able to walk in a straight line at the best of times


You're a good careful diver Paul and it's unfortunate that this has happened to you but I know you'll take the experience on board and learn from it, thanks for sharing it with us, helps to keep us mindful of the fact that we all face the hazard and it's good to hear other's stories... nice one mate, hope to see you soon.

Regards
Dave
 

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Hey Paul,

Glad you made it back to us safely - albeit a little worse for ware. Slowly-slowly-divey-safey  


Take it easy mate.
 

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Good news (to those who didn't see me at Tynemouth) - fit and well and back in the water. Thanks for all your thoughts.

Paul
 
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