Posted by Elaine on August 14, 2004 at 10:43:19:
For everyone who doesn't know, I recently experienced decompression sickness. After about 1,500 dives, I guess that it was my turn. I found that I was pretty ignorant about it when it happened to me, so, I'm posting this in the hopes that others can learn something from my experience.
How I got Bent
On June 19, 2004, I went on a day long wreck diving trip off of our California Coast. For anyone oriented toward details, I did one 107 ft. 25 minute dive on the Palawan, followed by two 74 ft. dives on the Star of Scotland, the first for 41 minutes and the second for 31 minutes. My surface interval after the first dive was approx. 2 hours and 20 minutes; my surface interval after the second dive was approximately 1 hour and 8 minutes. I had very square dive profiles. I was using a conservative Suunto Cobra Computer.
What happened or what did I do wrong? On the second dive, I blew off one minute of my safety stop - no good reason, I just blew it off, and perhaps a building nitrogen level influenced this decision. On the third dive, while I was still at 74 feet, I had less than one minute of no decompression time left. I have used this computer on several hundred dives and know that if I ascend at my normal really slow rate, I often fall into the decompression mode on the way up, especially when I have cut my bottom time so closely to no decompression limits. Once again, I just didn't feel like hanging around for a long time on a safety stop. My nitrogen brain told me that if I just went up a little more quickly than I usually do, maybe I could stay out of deco. It worked. I did my 3 minute safety stop, and when the computer said that I was done I got out of the water. End of story. What was different for me was that, on this day, I dove less conservatively than I usually do, and, normally I know when I'm getting narced and head for shallow waters -- this time I just felt good -- no worries.
What It Was Like When I Got Bent
One of the major symptoms of "the bends" is DENIAL. The following is what happened to me and how I reacted to it. The symptoms that I experienced are all in caps. I have tried to relate, as best that I can, what was going on inside my head at the time as well - because it is a pretty good description of DENIAL. .
After the third dive, I took a shower and changed clothes. A short time later, I began having an INTENSE ITCH on the right upper side of my body and arm. I started clawing at my arm, and no amount of scratching would make the itch go away. Next I noticed that I was getting a WEIRD LOOKING RASH and skin pain. I had a close friend look at it and he noticed that it was rapidly spreading over all of the itchy areas. At this point, I and everyone with me began trying to figure out how I had gotten a jelly fish into my dry suit (and below three layers of clothing - OK, what's wrong with this picture?). This perhaps shows that it is possible for other people to share in the experience of DENIAL, so donut always think that you are there alone. The real story was that this was the "skin bends" and the rash may have been something called "cutis marmorata". It started out as small flat red areas, and later changed to looking a little bit like lace.
A short time later my arm on the affected side began to hurt. A mild ache turned into intense achy PAIN. It wasn’t really joint pain; it felt instead as if I had perhaps broken my arm bone. Maybe, in addition to the jelly fish in my dry suit, I had pulled my arm on the anchor chain. I experienced several episodes of LIGHT HEADEDNESS and a little DIZZYNESS like I might pass out. Fortunately, the world stayed out there, it was just a bit farther away than usual. I figured that this was from the pain or from whatever had caused the rash. Instead of saying anything, I decided that if I lay down for a few minutes, maybe this would pass - and it did.
Through all of this, my brain was trying to figure out what the cause might be. I must have thought up five or six possibilities. It did occur to me that one of the possibilities might be "the bends". I began to worry that if I had come up with that thought, maybe others would start thinking it too. I knew if treatment started for "the bends" an entire series of events would follow, and I really didn’t want that to happen. After all, I probably wasn’t bent. I did my best to not let others know exactly how badly I was feeling. As the arm pain got worse, my biggest concern became how to make it feel better, and, how to make it look like I wasn’t hurting. I didn’t want treatment for DCS if I wasn’t bent, that would be really embarrassing. If I could fix it myself, it would keep this whole thing, whatever it was, low key, and, I would deal with it when I got home. I had a Tylenol with codeine with me. I always brought it in case I dropped a tank on my toe or something. I took it and short time later began to feel better. (This was REALLY the wrong thing to do, if you ever even think that you might be bent, go for the oxygen and not the drugs). When we did get back to the dock, I was able to carry most of my stuff off of the boat, so, I figured that this whole thing must have been nothing major.
Getting Treatment on Dry Land
If you are "bent", but have successfully made it back home, getting appropriate treatment is harder than if you take care of it at the time that it happens. Also, the longer that you wait, the less effective treatment may be.
Over the next two days, my arm still hurt - but now it was more of a dull ache. I also still had the weird looking rash. At this point, friends tried to convince me that I was bent and that I needed to call "The Chamber". On Tuesday morning, three days after the fact, I finally decided maybe they were right and maybe I really did have some DCS. I finally picked up the phone to try and see what to do about it.
After talking to our Southern California DCS experts at USC, and many hours of work on their part, it was decided that I should go to a local University Medical Center that had a hyperbaric chamber. On Tuesday afternoon, I went to the ER and told them that I needed to be evaluated and maybe treated for DCS. This Medical Center is in the Inland Empire and they don’t often see diving related maladies. The ER doctor talked to me and looked at my weird looking rash. He thought that all of my symptoms were from some kind of marine life interaction or perhaps from diving in the Santa Monica Bay - yucky water there right? (This guy thought up more excuses than I ever could have ever come up with - I guess that is why he is a doctor). I tried to explain "dry suit", but, I don’t think that he understood. He just said that he did not think that I was bent. I was sent home with the instructions to call my regular doctor if I wasn’t better in 2 -3 days.
After again talking with our Southern California DCS experts it was decided that maybe I should go through my health plan and see if I had any better luck that way. I called Kaiser and they told me to come directly to the ER. Almost as soon as I got there I was flung into a bed, decked out with 100% oxygen, and had an IV sticking out of my arm. (Hey guys, this happened a couple of days ago, remember?). I had to wait through the night and part of the next morning for an opening to come up for the hyperbaric chamber back at the local University Medical Center. I spent several hours Wednesday in "The Chamber". When this entire ordeal was done, I had been something like 36 hours without sleep.
After I Did Time in "The Chamber"
Follow-up was confusing. I was told everything from stay out of the water for a few days, to stay out of the water for 6 - 8 weeks, to maybe I should never go back into the water again. It was scary. I chose to wait a month, and, well, maybe I should have listened to some strong advice and stayed out a little longer. After two weekends back in the water I noticed that my arm was still feeling a little strange when I dove and afterwards too. I went back for more evaluation and this time spent an entire night in the chamber - at least this time I was familiar with it and could sleep through most of it.
Things That Happened After I Was Bent That I Had Never Thought About Before
When I was "bitten" by my favorite sport, which is also, almost my favorite thing in life, I got pretty wigged out. Maybe I had a nitrogen bubble hit my brain, but, I was angry, irritable, cried a lot, over ate, drank more beer than usual, and, I still didn’t want to believe that any of this had happened to me. All I wanted to do was to get back into the water and to know that I could still dive. On the other hand, I was now very afraid of getting bent again. The first few dives after being bent were kind of like being dipped in fire to see if I still wouldn’t burn. To me, they were perhaps the most important dives of my life.
Another thing that happens is that friends all have different, often strong reactions to a scuba related injury. Some said "you’re never diving again, right?" Some blamed me for making the decisions that I did during the dives. Some felt sorry for me. Some were angry with me. Some were very supportive. Some were a combination of all of the above. My employer merely looked at me with a cold eye and said "we can’t afford to have anything happen to you" - thanks boss, always thinking of the bottom line. This experience impacted not only my life but their lives too. CAUTION: If you ever get "bent", on top of everything else, expect that friends and loved ones will act strangely. My friends generally tolerate my scuba activities, mostly because I always make it back safely. Some now voiced some very strong opinions, be prepared for this and expect it. This event will impact every important relationship in your life, probably much more than you can imagine.
What Happens Next
Who Knows! I have to be very careful and very conservative, at least for a while, perhaps forever. Will this be hard - yes. I’m supposed to dive like a little old lady, and, I really didn’t want old age to start now. I’m trying to think up things to do so that longer safety stops aren’t so boring, maybe I’ll try and learn to blow bubble rings.
That’s my report on getting "bent" and my belated trip to the chamber, times two even. .
Until next time, (which thankfully isn’t that far away now).
Elaine