BentBent onon DenialDenial A salutary tale of adventure, injury, recovery and enlightenment. This is a true story. All names have been changed for confidentially reasons. This story begins with a journey. It was a long weekend holiday and the dive club had arranged an interstate trip to dive the wreck of a Navy destroyer which had been purposefully sunk for diving some years before. Our main character … let’s call him Bob, was a very experienced diver with some 700 dives to his name, including technical courses for decompression procedures and Nitrox usage. While most of the group were travelling by car on the Friday night, Bob’s work commitments meant that he had to fly with some friends taking his gear. So, after working yet another 14 hour Dean Chamberlain Photo day, Bob was picked up by some friends and arrived at he plan was to do two dives per The divers were a little surprised their accommodation at Tday on a wreck that is situated in when after surfacing from the first dive some 28 metres of water. As Bob (for a total dive time of 45 minutes) about midnight. and his friends had technical diving they were informed that they had qualifications, they planned to dive the stayed down too long as the operator wreck on twin cylinders to maximise usually only allowed for a dive time their underwater time, using 80% of about 20 minutes with a surface Nitrox to accelerate decompression. interval of only one hour! However, at the last minute they Nevertheless, they waited the hour out decided to forgo the Nitrox as most and completed a second dive of about BY DR ANDREW FOCK people were just diving on single the same duration. Bob and his buddies cylinders. were all using dive computers and at no time were there any breaches of ascent rates or decompression ceiling. Alert Diver Asia-Pacific 18 About 20 minutes after surfacing, consented to come along and continue FACTS: Bob noticed an itch on his left arm. diving. He thought he would see if the • All symptoms occurring after This fairly rapidly progressed to a dull pain went with depth and then would diving should be considered ache of increasing intensity. use the Nitrox 80% mix to treat DCI until proven otherwise. himself if he thought he was bent. The sun was shining as the boat • Oxygen should be given headed back to the marina, and Bob irrespective of whether the kept quiet about the pain. “It was FACTS: victim asked for it or not! probably something else, not • In-water recompression is a • On shore diving medical decompression illness (DCI) and will difficult and exacting Under- expertise should be sought if get better. How could I get bent on taking and is not to be taken there is any doubt about the such a tame dive?”. lightly. diagnosis. A night out on the town and a few • Diving with existing beers dulled but failed to resolve the decompression illness can turn a Bob was in agony driving over the pain but he decided to sleep on it. minor injury in to a major one low hills on the way back to the “Maybe it would be gone by the such as full blown neurological accommodation. At this point he was morning”. decompression illness. sure he had decompression illness but • Delaying treatment for minor his friends kept reassuring him. “You FACTS: decompression illness has been know what they will say if you call the 50% of DCS symptoms will shown to make successful chamber. Have a few glasses of red. begin within one hour of treatment more difficult. It always works for me!” surfacing and 90% within 6 hours. • Decompression illness may After emptying the 80% Nitrox and Slow onset of symptoms is often cause subtle neurological with no relief of the pain, Bob finally associated with shallower dives changes impairing the victim’s called the local hyperbaric facility some or only marginal omission of ability to make rational 26 hours after the onset of his decompression. While symptoms decisions. symptoms. may resolve spontaneously without treatment, equally they Bob did the next dive. The pain FACTS: may worsen or stay the same. seemed better at 28msw (possibly partly • In excess of 75% of divers due to narcosis but also from the presenting with symptoms of Bob was awoken in the early hours temporary compression of the decompression illness have of the morning by the pain which had bubbles at depth?) and he stayed at dived within the tables / now grown worse. He took a couple 6msw breathing the 80%Nitrox for computers. of Panadol (paracetamol) tablets but about 10 minutes. However, on • 30% of divers wait more than was unable to get back to sleep. In the surfacing the pain was still there and 12 hours before presenting for morning he was unable to lift up the over the next half hour actually got treatment. kettle or pour juice with his left arm worse. • Denial is probably the single due to a combination of pain and At this point some sanity returned biggest factor in delayed weakness. “!@$# I must be bent!” he and Bob decided to sit the next dive presentation. thought. “This can’t be happening to out. He told a member of the crew me!”. He went and discussed it with that he had pain in his arm and was his friends. “You can’t be bent you Bob was examined by one of the not going to dive. But after a brief Diving Doctors and diagnosed as were diving with us and we’re not discussion on whether any bent”. “You’re just paranoid!”. having Type 1 Decompression decompression had been missed, he Sickness. He was treated with a Royal “You’ve paid for today’s diving so was assured that he could not be ‘bent’ why don’t you just see if it gets better”. Navy table 62 recompression profile and no oxygen was offered. (US Navy Table 6). However, because Bob was confused. He had the pain, of his late presentation and the failure but felt guilty at inconveniencing his of his symptoms to resolve, this was friends and disrupting their diving. He extended to a 7 hour treatment! At the didn’t want to be seen to be a end of his treatment, exhausted, he fell hypochondriac or weak so he asleep, the pain dulled but still present. Continued on Page 23 ... 19 ... Continued from Page 19 The next morning he awoke with the pain completely resolved. A further FACTS: treatment was done that morning (2 • If you dive enough, there is a hours duration) and he was released strong possibility that one day to go home with a return to diving in you will get decompression four to six weeks after review by a illness. hyperbaric doctor. • Getting “bent” should be LESSONS: Bob has returned to diving and has viewed like any other sporting There should be no guilt or shame had no further symptoms. injury…..if you get injured you about getting decompression illness. don’t keep playing, you get help The only “stuff up” is not admitting so that you can continue to that you have a problem and getting it enjoy the sport in the future. About the Author appropriately treated. Dr. Andrew Fock is an • Rapid acceptance and treatment are the cornerstone Early treatment with 100% oxygen anaesthetist and consultant may avoid a trip to the hyperbaric in diving and hyperbaric to achieving a speedy and complete recovery. chamber and should be actively medicine at the Alfred encouraged by friends and staff. Hospital in Melbourne. He is • Having an episode of decompression illness will a keen technical diver and usually not stop you from rebreather user and has a further diving. special interest in • Having a permanent injury decompression algorithms. from not having it treated may! Andrew has recently joined the Board of Directors of DAN AP. 23.