Iain's Experience of Decompression Illness

Post date: Apr 5, 2011 1:29:21 PM

Myself and another club member, Keith, booked a British Sub Aqua Club ( http://www.bsac.com/ ) mixed gas course at the National Diving Activity Centre ( www.ndac.co.uk ) in Chepstow.

The venue is an old granite quarry. The water level is approximately 150 feet below the ground level and battered old minibuses are used to take equipment from the car park down a long ramp to near the waters edge. Then trolleys are used to take kit to the ends of the floating pontoons from which the diving takes place.

It is a very picturesque place with long granite slab cliffs and is a real sun trap in the summer. Adjacent to the car park is a shop, filling station, toilets and changing rooms and a burger van. In fact burger van really does not do it justice as they serve all sorts of food but the curry, rice and chips is the main reason I travel here from Northampton. They are just completing the installation of some chicken coops so that divers have some budget accommodation when they visit which will keep the cost of trips down.

We stayed at a bed and breakfast called Parkfield7 ( http://www.parkfield7.co.uk ) located in St Arvans a few miles away. The rooms were warm, clean and large. We received a fantastic welcome and the full Irish breakfast was definitely in my top five breakfasts of all time. As a connoisseur of the full English/Irish/Scottish I can say I have sampled quite a few. The pub over the road is less than a McMahon reel away and

does good food. Its busy enough to have a friendly atmosphere but not so busy there isn’t room to spread yourselves out over a large table with all your dive planning tools preparing for the next day.

We arrived the Thursday evening. I had been up since 05.45am that morning and had driven to London and back. Keith drove to Chepstow and did all driving. On arrival we walked to the pub over the road and I had two pints of lager.

I got to bed about 12.30am and woke up at 7.00am. Had a cooked breakfast, two cups of tea, two cups of coffee and orange juice. Went to NDAC and met the course instructors, Phil and Stewart and the other students on the course.

We spent a lot of time outside and I felt cold most of the time. We carried our kit to the bus and at other end carried it to trolleys and wheeled it down to the pontoon. Due to the type of course we were doing we carried more kit than I usually would. Also the dive site meant there was more carrying than I am used to when boat diving. We were encouraged to help each other to carry equipment and treat this as team diving. Although we did this there were several occasions when other people were occupied and it was quicker to just lift equipment oneself.

We did some theory in the canteen on the first day as it was not very busy. This was warm and comfortable. Then we conducted a 68 minute dive to a maximum depth of 6.3 metres. My drysuit leaked and I felt wet and cold. I cannot say I was colder than I have been during other dives though. I have a pee valve and was connected to a catheter but did not need to urinate during the dive. My main concern about the course was

shutdowns. I managed to do these without any problem and my buoyancy was very good too. I was not in the least concerned about setting off my dsmb as I have done this numerous times. I was using a different reel and when I released it the line caught and I was dumping air whilst trying to free the reel. I managed to sort it out but had risen three metres although we were only in six metres of water.

We carried our kit back up to the bus and back to our cars. We sorted kit and had some theory lessons. Some of time was spent in the canteen but the rest was outside. I spent the day drinking tea, coffee, coke and water but still felt dehydrated. We ate food in the afternoon and finished about 5.30pm then went to the pub to finish the lesson. I had a pint of lager then back to the B&B, sorted kit then went to the pub and had food and one pint of lager. I got to bed about 12.30pm. Soon after going to bed I woke with a slight tingling in the fingers of my right hand. I thought I had been laying on my arm and turned over and went back to sleep. With hindsight I was possibly aware that these symptoms were not from laying on my arm but I was very drowsy and fell asleep again within a couple of minutes. I only remembered this when there were symptoms the next day.

I woke at 4.30am and read the course book. We had another delicious cooked breakfast, tea, coffee and orange juice. I drank water in the car on way to NDAC but still felt dehydrated. We sat outside planning the days dive. I felt very cold and drank tea to try to warm up. We carried equipment to the bus and dive site and conducted a 59 minute dive to a maximum of 48.8m.

Keith and I had very carefully applied masking tape to our slates so that we could write the dive plan on top of it. Usually I do this in advance in my garage using scissors or some shears. I am generally quite anal about it and it has to be perfect. On this occasion we did it in my B&B bedroom ripping the tape by hand. The jagged edges overlapped. During the dive I realised to my dismay that although the tape sticks very well to the slate it does not stick well to itself when wet. I had no plan and saw with some amusement and alarm, neither did Keith as part of his plan floated off into the distance. Fortunately our rather better prepared instructor Phil had a slate and a VR3 on each arm. One with his gas mixes and one with ours. We followed his lead and conducted a virtually identical profile.

Keith and I did all decompression stops. We had back gas 20/30 breathed from the surface to the bottom and then back to 24 metres, then breathed 40% Nitrox to 10m then 70% Nitrox. I felt no ill effects on the surface although again my leaking drysuit meant I was very cold. Again I was connected to my pee valve but did not urinate during the dive.

We returned to the car park and sorted gear. There was more theory which was completed in the pub. I had one pint of lager then back to the B&B and then to the pub. Again I had one pint of lager and some food, got to bed about 11.30pm and woke at 6.40am. Another delicious cooked breakfast, tea, coffee and orange juice. This day I did not feel dehydrated.

At NDAC we planned the days dive outside again. The night before I had reapplied the masking tape very carefully. This day I wrote the plan twice just in case as well as my “just deeper / longer”, “loss of deco’ gas” and “bail out” plans. We dived for 61 minutes to 57.1 metres. The water level was low so when we reached the platform we were not quite at the 60 metres we had planned for so in fact the dive was slightly shallower. We stuck to the plan and surfaced after doing all stops. My buddy, two instructors and one other student did the same profile. Following the dive we sat down and breathed our 70% Nitrox mix for ten minutes before any other activity.

I had felt nervous before the dive as I was worried about sticking to the plan, doing shut downs and other skills. The day before had been a bit of a disaster and I knew I would not pass the course if this dive was not a lot more successful. During this dive I urinated twice and needed to again as we were transporting kit back up to the bus. I held off the last time though as I couldn’t bring myself to walk up and down the pontoon with pee running down the outside of my drysuit leg.

Back to the car park, more theory then an open book exam with some discussion between students and instructors. During the exam I could feel tingling in the fingers of my right hand. Then the hand itself became uncomfortable. It was tingling, almost throbbing, irritating but not quite painful. At the back of my mind I knew it was unlike anything I had felt from straining a muscle or spraining a joint. I felt I was less experienced than other divers present, wanted to pass the course and was embarrassed to say I was feeling anything. If I said anything I thought we would all have to stop the exam and I did not want to cause a problem for the other divers and instructors on the course. I tried to persuade myself it would go away.

We finished the course and left to drive home. After about an hour my hand got increasingly more painful and became uncomfortable and now my right arm was also hurting, my hand was swollen and I had a red rash on the back of my hand. I was still reluctant to say anything as I wanted to get home to see my wife and I knew she was cooking spaghetti bolognaise.

I told my buddy who was driving. He got a 70% Nitrox cylinder out of the back of the van and I breathed that whilst we continued. I looked up numbers for chambers on Google with my phone, called a number and spoke to someone who advised going to nearest A&E and also put Rugby hyperbaric chamber on standby.

We arrived at Worchester Accident and Emergency and after 20 minutes of arriving was able to lie down, was given O2 and put on a saline solution. After fifteen minutes the symptoms diminished to just a tingling in the fingers on my right hand.

We left the hospital after about an hour and a half and drove to Rugby. Soon after leaving the Nitrox ran out and the pain became worse. We arrived at the chamber and after an examination by the Doctor I went into chamber for treatment. During the 5.5 hour treatment the pain came and went. At its worst it was excruciating and almost unbearable with a severely throbbing middle finger on my right hand. The fingers either side of it were throbbing also and there was severe pain just above my right elbow. This lasted for 15 minutes then dissipated to a dull throbbing and tingling to the middle right finger only. It kept coming and going, sometimes worse than others.

At 4.30am the treatment finished and I stayed at a nurses’ home about 200m away. I found it difficult to sleep. The pain would wake me up then subside and I would go to sleep. I slept on and off between 5am and 8am. I then returned to the chamber at 08.30am for a further 1.5 hour treatment.

The pain was still there but bearable and the Doctor advised me to take 400mg of ibuprofen three times a day with food.

My drysuit has never leaked before but must have a small hole as it leaked on every dive. It was wet when removed and I felt wet and cold in the water. I should have not dived after the first dive but had paid to do course and paid for B&B and did not want to let my buddy down. I am not exactly skinny and do not usually feel the cold particularly. I must be getting soft in my middle age as I felt cold for most of the three days. My suit has now gone off for repair.

I felt dehydrated on the first two days. I did drink quite a bit of water but as I was so cold I drunk lots of tea, coffee and coke. I also drank alcohol each evening, but not in large amounts. I had four units of alcohol each evening maximum.

I was nervous prior to and during last dive. I was worried I would not be able to do shutdowns and that we would not stick exactly to the plan and would fail the course. Although nervous I did not consciously feel any narcosis.

When the symptoms were apparent I should have told the instructors immediately. Several members of our club have done this course and they are all more experienced than me. I did wonder if I was experienced enough to do this course. I was embarrassed that I would fail the course and that the instructors and students had done the same profile and were fine. Although I knew what I was feeling was not a strain or pulled muscle I tried to persuade myself it would go away. This of course is the classic denial which often accompanies decompression illness.

I am overweight and felt physically tired from carrying all the kit to and from the dive site. I need to lose weight and gain fitness. The doctor at the chamber was less concerned about cold and dehydration. He thought that this usually accompanies longer, deeper diving and that the other divers I was with were almost certainly cold and dehydrated too. What he thought was more of a concern was my weight and he informed me that “trunk fat as good absorber of nitrogen.” A polite way of telling me to eat fewer pies.

I did not get enough sleep. I was excited about the course and the trip. I was also nervous of failing and worried about my job as well. I went to bed late as I was reading the course material and woke up early thinking about the course, dives and work.

The dives were planned using V planner and Pro plan. The instructors checked the profiles and everyone dived the same profiles.

The Doctor at Rugby hyperbaric chamber thought the pain in my hand and arm was caused by a bubble in my neck causing tissue around it to become inflamed and press on a nerve which runs from my neck to my fingers. He thought that after a couple of days the inflammation would subside and the pain would go.

Ten days later I still have pain in my middle finger and tingling in the fingers either side of it. The sensation on my finger tips feels different. Almost as if I have burnt the tips. At the chamber doctors advice I visited my GP who prescribed a stronger pain killer. I am now taking paracetamol, ibuprofen and codeine. I will return to my GP in two weeks if the pain has not gone away.

The chamber doctor thought that the chances of me having a patent foramen ovule are unlikely, due to my previous diving experience. It is possible I will never have an incidence of DCI again and there is no reason to test for it unless I do. He advised me he will be happy after four weeks for me to dive as usual with no restrictions.

All of us learn about DCI during our first diving course. We are told that denial is a major factor. I have thought about it and know that if it had been my buddy and he had told me he had symptoms at any time it would not have been an issue and dealing with the DCI would have taken precedence over the diving or course.

There were a few factors which may have contributed such as the cold a leaking suit and dehydration. In the longer term losing weight and increasing my fitness levels will benefit my diving and general health. What I have learnt the most though is to say something immediately. Even if I am unsure that the symptoms might be caused by DCI it is sensible to have a doctor determine this.

I would thoroughly recommend the BSAC mixed gas courses. Phil and Stewart are incredibly knowledgeable and I learnt a huge amount. Much of what I learnt will be used on shallower dives using air and Nitrox and there has been plenty of kit fettling since I got home.

My buddy, Keith, was also great and kept calm and looked after me. He even held off from smoking in the van whilst I was breathing Nitrox.

Worchester A&E were also very good although it did take a long time for them to process me. They also would not let us take a bottle of oxygen or lend us a blue flashing light for our trip to Rugby. Perhaps understandable, although both Keith and I were very disappointed.

The guys at Rugby chamber were brilliant. They really do know their stuff and couldn’t have looked after me better.

I did have my wife’s spaghetti bolognaise the next evening when I got home. My wife is slightly disappointed it is only my finger that has been constantly throbbing ever since.