DCS berättelse på engelska...
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Decompression Sickness - A Personal Account
(I suffered DCS while on a dive trip to PNG in June 2002. My good fellow diver friend Karl Lung has asked me to write this article in hope that I will benefit other divers. Karl - thanks for this suggestion, and here's my recount.)
Having been diving since 1985, and having always been a strict follower of safe diving practices (i.e. deepest dive first, gradually shallowing dive profile, slow accent, safety stops at 9m and 6m etc., lots of regular exercise except during diving periods, intake of water, never dive to the limit, etc.), I must admit that my latest (and hopefully only) brush with DCS was totally unexpected yet unavoidable (except for me to stop diving once and for all). What has happened has everything to do with my physiology and nothing to do with my diving practice.
About 3 years ago I have developed a stiff neck as a result of frequent traveling (sleeping while seated during flights). My neck and upper back sinced them would become sore but this has always been alleviated by stretching exercises and proper resting. Hence when after traveling for more than 16 hours from HK to arrive PNG, my lower neck and upper back muscles feeling stiff was not particularly alarming.
My first dive, on the same day of our arrival at the boat, was to 27m for 37 minutes. It was uneventful and relaxing. This late afternoon dive was quite enjoyable. After I came up, I noted that my stiffness has gotten a little worse. It has extended up to my left shoulder but only very slightly. Nothing that can't be fixed by a good night's sleep, I figured.
Dives 2, 3 and 4 were done on Day Two. Profiles were 31m for 35 mins, 29m for 46 mins and 14 m for 74 mins, with surface intervals well above 2 hours. The ache disappeared after Dive 2, came back after Dive 3, and worsened after Dive 4. I began to lose appetite and felt a little nauseatic (which I attributed to seasickness). The ironic thing was that once I got submerged, the ache/pain went away, and the stiffness was gone. By this time, I noticed that my neck's flexibility has gone, and there were restricted movements if I looked to my right.
Felt better the next morning and hence proceeded with Dives 5 and 6, 35m for 40 mins and 30m for 50 mins respectively, taking care to do extended (10 mins) of safety stops at 6m and drinking more water before and after the dives. My ache, however, was now a pain. The source of pain was emanating from a point slightly to the left of the spinal cord (c5/6), and it extended all the way, like a wire, to the left shoulder and all the way to my lower forearm. At the same time, I have started experiencing a loss in skin sensation, along certain patches of the arm and lower forearm.
That evening, I've completely lost my appetite and the nausea became worst. Went to bed at 9pm, but woke up at 3.15am with intense pain. I'd rank the pain at 9.5 on a scale of 1-10. Somebody might as well cut off the arm to alleviate the pain, which felt as if the ‘wire' inside the arm was trying to explode and break out. By this time, the loss in sensation has widened, and the entire inside of the left arm could not feel anything. The arm and neck muscles also started twitching involuntarily.
Fortunately, two persons in our group are medical doctors. Maurice provided strong painkillers and ice treatment on my back, while Dr. Chan informed me that it's likely DCS. I started breathing pure oxygen but it only served to hold (rather than abate) the pain. By noon time, all fingers started to feel a continuous tingling sensation. The pain seemed to have lessened if I sat up, but always came back with excruciating intensity once I laid down. I have not been able to sleep for 2 days already as a result.
Later in the afternoon, I have decided to call in DAN. Our boat was turned back and had to travel for more than 6 hours to the nearest port, Kavieng, PNG. DAN and the diving doctor were in constant communication with the boat, keeping track of my condition. During this time, I was constantly on pure oxygen.
Early next morning, at 7am, I boarded an ambulance for the Kavieng airport. DAN has arranged a Beech 1900D aircraft, with two flight crew, a diving doctor and nurse, to pick me up. Due to the possibility that my condition was not purely DCS but can be DCS complicated by a pre-existing back problem, DAN has decided not to treat me at Port Moresby (the nearest hyperbaric chamber), but to fly me direct to Townsville General Hospital, where there is a chamber and other facilities. Our craft flew at close to sea level, and was also pressurized to ground level pressure (i.e. 1 ATM).
Upon arrival at TGH, the pain has intensified. I have now lost control of my muscular movement. E.g. I could not precisely control my left arm's movements and thus could not hold a glass to my mouth to drink (I kept missing my mouth!). Dr. David Griffiths, head of the hyperbaric chamber, immediately diagnosed my case as Type II neurological DCS. He based his diagnosis on the fact that:
1. I was having difficulty doing simple subtraction arithmetic (100 minus 7, all the way down to 0)
2. I was feeling much better when underwater, ie. the pain literally went away when I dove but came back when I resurfaced
3. I was unable to balance myself for more than 8 seconds with eyes closed and arms to my chest
4. My arm's and hand's strength has deteriorated immensely.
That afternoon, approximately 2 days after my last dive and an hour after seeing Dr. Griffiths, I was given a recompression treatment to Navy 6 (RN62), which lasted 6 hours. Dr. Griffiths stayed with me till 1am, and all the while, was observing any progress I might have. About 4 hours after the treatment began, my lost sensation started to come back. I felt warmth in my arm, and a little strength was coming back. My balancing duration was now 40 seconds.
I was hospitalized that evening, and next morning at 10am, underwent another 2 hours of treatment. I was met by another doctor at the hyperbaric medicine unit as well. Days 3, 4 and 5 were similar…each day I had 2 hours of treatment each day and interviewed by a different doctor. All doctors (all from the hyperbaric medicine unit) drew the same conclusions and treatment plans.
After treatment 5, my balancing duration was more than 1 minute, and all strengths came back. My arm's skin sensation came back as well.
I continued to return to the hyperbaric medicine unit for consultation, for another 5 days. Each time, Dr. Griffiths closely monitored any deterioration/improvement, and he concluded that what could be done through recompression, has already been done. He's happy with my progress and advised me of the following:
1. Altitude - avoid tall buildings, hills and mountains greater than 200 meters for 1 week
2. Exercise - avoid heavy strenuous activities for minimum 2 weeks
3. Alcohol - max 2 standard drinks daily for at least 2 weeks
4. Flying - avoid for minimum 3 weeks in commercial pressurized aircraft, one week acceptable if oxygen is constantly provided during flight, at a flow of 4 liters per minute.
5. Diving - avoid for minimum 6 weeks. At onset, dive only to 10m and see what happens. Then if okay, gradually increase depth.
Prior to my discharge, I also had an MRI and x-ray performed.
The final conclusion was that with age, my physiology has made me more prone to DCS. My stiff neck, which affected my disc at c5/6, was the starting point of bubble accumulation. The
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 DCS berättelse på engelska...
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Anders Bengtsson | 2002-07-09 23:29 |
  SVAR: DCS berättelse på engelska... | Björn Van Der Hert | 2002-07-10 08:16 |
| Ledproblem | Per Stenebo | 2002-07-11 08:28 |
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