Hospital of St John & St Elizabeth WHATISBOBO

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I have recently returned from a diving expedition to Roatan. On the morning of Friday 2nd March I got decompression sickness.

I was on a 30/14 profile but my max depth was 25m, my buddy had a dive computer and the ascent was fine, with a 3 minute saftey stop at 5 metres. I surfaced, and after a few minutes on the boat my elbow started to tingle, after about 10 mins I started to feel lightheaded and when I got of the boat I felt very dizzy. I was then put on oxygen (about 40 mins after surface time) and taken to see a dive doctor, I was put on oxygen again for another 30 mins. I then had an hour break in which I felt 99%, apart from a slight soreness in the elbow.

I was put in a recompression chamber for 2.15 hrs and felt fine afterwards. Then during Saturday afternoon I started to feel lightheaded again and slightly spaced out, this feeling has stayed with me ever since, in the following week I saw the doctor twice and she told me that it was just as a result of the treatment and it would pass, I haven't dived since and I still feel the same.

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Sorry but I think you need assessment quickly. The situation here is that a 2 hour plus recompression is not really adequate if you have been diagnosed as having a bend. The fact that you had these symptoms before treatment and then again after means that you need retreatment.

At our chamber we use a standard Royal Navy Table 62 for the first treatment. This is a minimum of 4 ½ hours and is accepted as the minimum needed for the first recompression. A table this short and with no further treatments when your symptoms returned is what we call a "partially treated bend".

You need to see a dive doctor for assessment and then start all over again if your symptoms warrant it.

[He was seen immediately and had the proper treatment at Capital Hyperbarics. He has now recovered]

The lesson here is that in various chambers over the world you well may come across different treatment tables, however if you are ever in doubt about what you have had then please e-mail us and we can advise you on what to do next. If you are going into the pot then you may as well go in properly. As if you don't then you will have to on your return to the UK anyway. And I'll tell you from experience it can be a bit boring the second time around.

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I had a Type 1 bend in Scapa Flow in April and was treated with a table 6 recompression. I have since see my diving doctor, who gave me a check up and a HSE Certificate (Recreational Divemaster) without any restrictions on my diving i.e. Depth limits etc.

I plan to go to Scapa again next April, what are the chances that I will get bent again? (I will be doing similar repetitive dives - 2 dives a day for 6 days). Should I do more deco or reduce my bottom time. I plan much slower ascents now (no more then 6-8m/min.) Do I have to dive with Nitrox on Air tables?

I might be answering my own question here...but if the doctor has given me the all clear with no restrictions, what am I worring about?

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I think a Type 1 that needed only 1 treatment in the chamber is fairly minor on the bends ladder. Is there a chance you could get bend again? Well there is a chance of a hit every time you dive. However I would say that Scapa with it's depths, bottom times needed and coldness can be more of a risk than say the good old Dredger in Portland with its 10metre max and lovely warmth!

So, to be really safe just use Nitrox and set your computer for air. Keep well hydrated, and if your deco stops are a bit chilly then increase the time by a few minutes to compensate for cold veins constricting and not letting the blood back so easily, which can decrease off gassing.

Or, what about waiting for Hollywood to make the movie of Scapa. They'll say it was them that won it, shoot it with full size re-creation in Palau, and stick it in 10 feet of water. Historically inaccurate as ever but a safer dive!

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This is probably a silly question but I will ask it anyway.

I was doing my rescue dive exam day off Sharm in September. I did the required search pattern exercise at 12m (approximately 10-12 minutes) about an hour and a half later I carried out a rescue scenario on an unresponsive diver found at 10m. For reasons I will not go into here I had to descend and ascend three times during this exercise (again I was only under for approximately 12-15 minutes). Later that afternoon I took part in a dive during which the instructors illustrated some novice diver mistakes/antics and during which I was responsible for leading the dive. This dive was very tiring even though it was short. The dive was only 23 minutes, maximum depth 20 metres (but we were only at 20 metres for two minutes and most of the dive was at 17-12 metres).

About half an hour after my dive I began to feel exhausted and faint. I attempted to rehydrate and immediately felt better. An hour or so after returning to the shore I felt extremely dizzy but again, sitting indoors and drinking water helped considerably. The dive instructors (and I) thought I just had heat exhaustion or sunstroke.

The following morning I woke feeling pretty ropey and I had tingling fingers and a dull pain in my elbow. I reported this to the dive operation and went to Sharm. I was treated with O2 and after a positive result was put in the chamber for 2 hours. I was asked to return twice to check that none of my symptoms had reoccured and I received no further treatment because I was fine.

My dive profile was judged to have been safe, however, the 47 degree heat and dehydration were deemed to have contributed to what was described to me as a mild bend.

I am due to book in for a dive medical soon and want to start my DM course in Thailand in April. I have noticed that my elbow (the one which was painful in Sharm) is painful if I press on it. It is a different kind of uncomfortable feeling than I think I remember from Sharm but I just wondered if that is something I should be concerned about.

Sorry for the length of this query.

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I've been in 45 degrees, and its hot. 47 has to be the hottest time ever out there. That and all those up and down shenanigans will easily equal a bend. You got better with the treatment. But now the pain is back. Well in my experience, if you press something hard enough it will hurt later. It doesn't mean the bend is back. But in these cases always see a dive doc just to make sure.

N.B. I saw this lady and all was fine. Tennis elbow, not an undertreated case of DCI. Better to make sure though.

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I am just back from 2 weeks diving in St Lucia. Great first week with 8 dives over 4 days but was not well the 2nd week. I moved resorts for week 2 and went on one of those day trips around the island but felt completely worn out by the next day. However, the following day I felt fine to dive so did 2 dives (both about 14m for 40-45 mins). Later that day I felt extremely tired and my neck, shoulders, arms and under my ribcage ached and had some slight tingling in my fingers. So the next morning I spoke to the dive instructor and he immediately put me on oxygen for 1 hour and phoned the DAN. They suggested I go for a check up. The doctor carried out various tests with blood pressure, pulse, temperature, reflexes, breathing and feeling/sensations all ok. He did not think I had DCS (I have to say that Tommy at Frogs Diving, and the hospital staff were fantastic).

So some background.

(1) 3 years ago I had a micro-discectomy on L4/L5. Since the operation I have learnt to dive (just reached my 50th dive) and have had fit to dive medicals etc. One consequence of the back problem is constant pins and needles in my right foot. To help combat this I was taking gabapentin working up from 100mg once a day in June 2006 to 500mg 3 times a day. One side effect of this is tiredness. This was the first time diving whilst on medication. I had seen the specialist just before I went away and he said that there should be no problem diving (his wife dives) but that I should try a different drug because of the tiredness. This meant reducing the dosage over the course of my holiday and my last dose was the day after my sight-seeing trip and before my final 2 dives. I have not started the new drug yet.

(2) I was not feeling 100% before I went away - the doctor thought that my symptoms could be viral.

(3) The doctor also thought that it could be dehydration - from cold London to hot and sticky St Lucia, long day trip, 8 dives in week 1 etc. I had been drinking plenty of water but perhaps not replenishing salts. Very little alcohol was drunk! He prescribed some of those rehydration sachets and told me to rest for the remainder of the holiday.

The tingling soon went but all the aches and tiredness still continue even though I've been back in the UK 4 days. I am wondering whether you have any thoughts on what this could all mean. Perhaps a visit to my GP is called for?

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Hmm, a complex mesh of interwoven symptoms, overlaid with curve balls and red herrings, all making a big slice from the Pie of Confusion and Doubt. Here are some thoughts. The gabapentin decreases the tingling but makes you tired. So by stopping it you’d think your tingling would increase but you would feel less tired. After the diving, and since your return, you still feel tired but the tingling has gone too. And your previous tingling was in your foot, not your hand. Dehydration can predispose to a bend as you have less fluids to take away all that nitrogen.

Yes, viral illnesses can make you tired and mimic any symptoms, but they usually run for 7-10 days, and you have these problems after a 2 weeks holiday and 4 days back. Should you see your GP for something that could be dive related? Probably not. They wouldn’t have a clue and would tell you to come back in a week, so you can catch something off someone else in the waiting room.

Here’s my advice. And remember the mantra. If it wasn’t there before diving, and it is there now, always assume it’s a bend until proved otherwise. So best you see the doc at your local chamber for full assessment for DCI, as that can only be treated by recompression. If it’s not a bend then post viral, change of meds, holiday fatigue, or still just plain miserable that we were so bad in Germany, will get better. Well maybe not the last one.

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We have just returned from a trip to Tobago. We did a night dive with two inexperienced Germans on their third dive of the day. Having lost his fin, his torch, and after a bit of a panic ran out of air, His buddy gave him his alternate, but they were taken in a down current to 33m. (from 15m) The dive guide and another diver went down and brought them to the surface ASAP due to lack of air reserves. The two Germans were given oxygen at the center, but declined treatment at the decompression chamber, due in part to the dive Doc not being able to find the key. Two days later one told me he had pins and needles and the other had had bleeding from his ears.

What happens if you do not get treatment after a bend? Does it sort its self out if you leave it long enough? Or are you asking for problems next time you dive?

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I love this. They turned down treatment on account of the doc losing the key to the chamber room. Yeah right. It sounds like someone persuaded them not to get un-bent because of the hassle of going to the locksmith. Ear bleed bloke was OK, but Herr Tingle did need treatment. The consequences of diving again, still symptomatic of DCS, are worsening the problem. Not clever.

On occasions it can just improve in time, but nitrogen bubbles are curious things. If they were totally asymptomatic, without treatment 4 weeks later, they could dive, maybe, but best to see a dive doc for a check up before risking it. In my experience though, on close questioning, there are always some symptoms left, and late treatment can be warranted if they were to dive again.

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I have recently undergone treatment for a bend for the second time this year. As for the first one, I have been advised not to dive for 6 weeks then that I should be OK. The doctor has said he is not worried about a PFO or other susceptibility, but I would like to clarify.

The first one occurred while using a new drysuit that had a shoulder instead of cuff dump (and which was also adjustable and inadvertently closed). I had dived to about 24m, basically sat on the bottom as it was a deep spec training dive and other group members having problems descending meant we couldn't proceed and didn't give me much time at the level to play with my buoyancy. When it came time to ascend, my buddy actually ascended faster than me, though mine was also out of control and only just within the 18m/min limit - part of the problem was that my buddy's faster ascent stopped me from realising my own situation. I brought it under control 1m from the surface, started to go back down to 5m for a safety stop then changed my mind at about 3m and came up. It wasn't especially severe, and I safely drove home from Chepstow to Poole, but felt ill that evening and next morning had a pain in my elbow. My buddies with faster ascents had no problems.

The second one occurred on a shallow dive, with a maximum depth at 9m and most of the dive at 5-7m (after going to 9m and coming up I don't believe I returned, but there was quite a bit of going over rocks and stuff) for about 50min. At the end of my ascent I dropped my SMB reel, which I went in again for believing that, while not ideal, that just to 5m and brief it should be OK, as the dive was within no-stop limits by a long way. I was shocked when the doctor described it as a "Guaranteed" bend, and this statement has provoked the same surprise from a number of very experienced divers and even instructors, who reinforced my original view that, while not recommended, such dives are very common particularly with regard to tying off anchors and stuff. My symptoms in this case occurred straight away and included itching skin and a general unwellness/lack of mental alertness. Stupidly I denied this for 24 hours and was treated the following day.

Should I be concerned about a PFO/is it worth testing for peace of mind, or was my profile on the second dive just more dangerous than I had realised?

Aside from that I am a reasonably young (24) and healthy non-smoker. On another note, I have been referred for a 6 week follow up consultation with an independant doctor in Ringwood (I think he's involved in some sort of survey). Problem is I am moving to Essex in 3 weeks and they have told me that there is no one I can be referred to in London instead. Surely that's not right?

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The last bit first. Utter b*******. Of course there are doctors in London who can assess you post treatment and pre-return to diving. There’s about 5 or 6 including myself. Whoever told you that at the chamber you were treated at should hang their head in shame.

Now, was it a guaranteed bend? Well itching, and feeling dull and drowsy are bends symptoms. You did get this straight after a dive, and I assume you got better in the pot. So it must have been. There are other causes of itching and dullness but it would be freaky if say you suddenly got eczema and Alzeimers straight after a dive. A coincidence to end them all. So we gotta say it was a hit. Now that’s 2 for you, and the last one after a shallow dive with a tiny bounce.

If it were me I would be hammering on the door of the cardiologist already. I think you have to exclude PFO for peace of mind and for the future, as you seem to be more than the once a year on holidays sort of diver. So see a dive doc and get referred for an echocardiogram to look for this hole.

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I've got a feeling that I never sent my last message. Sorry if I did. My question was that I had DCS Type 2 three weeks ago (bubble in the brain). I had 5 hours in the chamber and have fully recovered. Are there any rules to do with consuming alcohol after having DCS. I had 5 pints on Saturday and have a bit of a sore shoulder now. I did wake up laying in a strange position (on my shoulder) and it is getting better and isn't sore when standing but I'm a bit paranoid after the whole DCS incident.

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Only 5 pints. That’s an aperitif mate, in the diving world. But be calm, there are no rules about drinking alcohol after a full recovery from a bend. You are allowed to. The only rule is about drinking the 5 before you dive. A tad foolhardy that would be.

As for the other problem. You are 3 weeks away from full DCS recovery. Sleep funny on your shoulder. Wake with pain there. Mmmmm, I’ll go with it being bed trauma rather than a recurrence.

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I have been experiencing balance, coordination problems, and tremors since my last dive. My last dive was a long time ago, 6 weeks in fact, but to explain: I had an uncontrolled rapid ascent, bottom depth 21 metres, lost control around 14 metres. I emptied my BCD, breathed out, but came up so fast my mask was ripped off my head. The dive operation in Malaysia said I was fine and to stop complaining. That night I had itchy skin. Told me not to worry. I flew after 20 hours from the dive. Next day staggering and pain in my arms. Went to hospital in Korea, where I live. Told me not to worry, not dive related. Now I have neurological problems that I've never had before. Could it be related to the rapid ascent? What to do?

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This may seem like one of those no-brainers but I wanted to point out the sort of advice that is sometimes dished out by those “in the know” when overseas. I’d like to say I made this question up but unfortunately it is genuine, unadulterated, and all too representative of the overseas cases we are seeing at LDC. I hardly need point out the salient features that would have me hollering down the phone but this poor diver has illustrated perfectly the dangers of leaving decompression illness untreated. We have naturally urged her not to dive again until she’s been seen by a competent dive doc, but the salutary lesson is never be fobbed off by a dive school eager to absolve themselves of any blame.

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Hi, I spoke to someone on the London Diving Chamber 24 hour advice line who recommended I send you a quick email regarding some tingling I'm having in my left arm. I was doing my PADI Open Water course in the swimming pool yesterday and was at a depth of around three metres when I had to make an emergency ascent as I panicked during mask removal. I'm unsure if I held my breath as I ascended as I was panicking, but felt no lung pain or other symptoms on surfacing. On returning to three metres shortly afterwards I had lots of tingling and numbness in the bottom of both hands, but I have had this before when distressed (not diving related) and so disregarded it. This subsided shortly afterwards.

I was in the pool for a number of hours during the day, but this was at various depths (max three metres) and I was in and out of the pool during that time. The symptoms I'm having now are a slight intermittent tingling up my left arm, some minor loss of dexterity on this arm also, and very occasional mild dizziness. I'm a little concerned that I may have held my breath on my three metre ascent, and am worried that I may have done myself some damage because of this.

I'm also aware that I am tired due to the diving, and do not usually do the kind of physical exertion that scuba entails. It is very possible that I may have just strained my arm putting all the gear on. I just wanted to get your opinion before I disregard the symptoms and assume they will get better.

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This is the $6 million question. The problem that gets all us dive docs hotted up at the bar after a good old conference. Where DAN may disagree with the Aussies. Can you get a bend from a pool dive? A three metre pool is only at 1.3 atmospheres. Not usually enough to bring on a DCI. However, we have seen cases where, with plenty of other extraneous factors, things can go wrong: long bottom times; cold pools; multiple bounce diving; breath-holding ascents; and… the dreaded PFO (that little hole that can let microbubbles across the atria, straight into the arterial circulation).

So, I never say never. If the symptoms you have are different from the ones you get when distressed then it’s worth a check up with your local dive doc.

Yes, we have recompressed pool divers in the past, who have gotten better. And yes, we have figured out that some post pool diving problems are due to mental state rather than nitrogen. But either way we will be polite when we tell you our opinion.

HJE & WHATISBOBO