By David Harasti - Published in Australiasia Scuba Diver 2005: Issue 1
"I thought I was invincible and then I got bent…."
As
most of my dive buddies and friends know I'm pretty blasé when it comes
to diving; stick regs in mouth, fall into water, take photo's for an hour or
so and then get out. It's all pretty simple really and I use this fancy thing
called a dive computer that tells me when I need to head to the surface before
all those nasty nitrogen bubbles cause decompression illness (DCI), more commonly
known as the 'bends'.
One could say I do a fair amount of diving and I would almost consider myself to be an 'experienced' diver. Each year I do about 150 or so dives to varying depths, some deep but the majority are shallow. I think I've clocked up over 900 dives, it's a bit hard to tell because there is thing called a logbook which you are apparently meant to use to remind you of where you were and on what day… I kind of regularly forget to fill it out.
I consider myself to be a pretty conservative diver, I stay within no decompression limits and I always perform a safety stop at 5 metres. I do however like long bottom times (90 minutes) on shallow dives (less than 10 metres), especially now that I have a drysuit and don't notice the cold. And now that I have a digital camera I don't have to get out after I've shot my 36 shots… I love digital ;-)
So everything was all going rosy until a trip in August 2004 to the southern Great Barrier Reef. Four days of fantastic diving on reefs and some wrecks and I made sure that all my dives were no decompression with minimum 5 minute safety stops. During the trip I noticed that I got some pins and needles in my hand on the 4th dive of the day. I didn't think much of it as I'd been holding my camera in my right hand for about 5 hours that day so I just assumed it was cramping up. And for some unknown reason my right shoulder was aching; I just assumed that it was sore from jerking up and down on the boat anchor whilst doing safety stops.
How wrong I was. After flying back to Nelson Bay (after waiting 30 hours before I boarded the plane) I noticed my shoulder was still sore. I went for a shallow 30 minute night dive a couple of days later to a maximum depth of 9 metres. The dive wasn't a problem, but 2 hours later my shoulder started to hurt, I had tingles up and down the right arm and I started to lose feeling in my fingers.
Not
having experienced being bent before I tried to ignore the symptoms took some
Nurofen and went to bed. When I woke up the next morning I had the same symptoms
however now my face felt like it was numb. This is when I knew there was a problem.
I was put in touch with the doctors at HMAS Penguin who said you need to get
down to Sydney ASAP - Sydney is about a 2 hour drive from Nelson Bay.
Fortunately I ended up scoring a lovely flight down to Sydney in the Westpac Rescue Helicopter down to Sydney. We landed at Penguin where I was assessed by the Hyperbaric doctor from the Submarine and Underwater Medicine Unit (SUMU) who concluded that I was suffering from DCI and needed recompression.
My initial treatment was 5 hours in the chamber; now I'm not the kind of person who likes to sit still so lying on my arse for 5 hours isn't the most exciting thing to do. To pass time I counted the rivets in the chamber… I think I got to about 90 or so. After 2-3 hours I found that feeling returned back to my face, hand, arm and most of my shoulder… it's amazing what recompression and some 100% O2 can do!
I had two more follow up treatments over the next two days; both of these were of 2 hours duration and are referred to as 'soaks'. By the end of the 3rd day I had good feeling back in my body and most of the pain in the shoulder had gone. I was told to stay out of the water for a month and have a medical check up before getting back in. It was like my football coach telling me "Mate, you performance isn't up to scratch so you're going to sit on the sidelines for a month to get your act together". So I got benched… and it was so frustrating!
One of the hardest things about dealing with the incident was that I felt embarrassed about being bent. In my small narrow-minded view the only people that got bent were the 'Muppet divers', deep tech divers or those that did something 'wrong' on the dive… well I didn't really think that I fitted into any of those categories. When I told people I was bent their first response is 'so what did you do wrong?' Well I admit it, I did do something wrong - I went underwater. You see the last time I checked I don't have gills, I'm not a fish and my body isn't designed to be blowing bubbles at 10 metres or so. If you get bent people immediately assume you must have done something wrong, this is one of the biggest misconceptions with DCS. I'm living proof that you can get bent with out doing something wrong.
After
a month I got back in the water, by this time I had gotten over my bend and
ended up blaming it on my dive computer. My computer wasn't all that conservative
so obviously it was wrong and it made me bent, which was my theory anyway. So
I binned my old computer and bought a brand new flash wiz bang state of the
art computer that has all the bells and whistles… I can't get bent now
with the super computer.
Wrong again. In November I got bent again - this was after I had done about 20 dives after my first bend. This time I was shore diving, maximum depth was about 10 metres, the majority of the dive was at about 5-8 metres and I had a bottom time of 80 mins. Whilst in the shallows I got the same pins and needles again in my hand… s##t. I scored another trip to HMAS Penguin (this time I drove down with a friend) and went through the same treatment process all over again. All my symptoms disappeared during the recompression process. One of the diving medics at SUMU congratulated me on joining their 'frequent diver club'… not something that I'm proud of!
Now I had a problem, I've just been bent in 10 metres of water and no one can explain why. The hyperbaric doctor recommended that I have a test on my heart to determine if I have a patent foramen ovale (PFO), more commonly known as a hole in the heart. PFO's have been known to increase the risk of DCI to divers so we needed to investigate on whether I had a PFO present or not.
I booked in to see a cardiologist who would perform a transthoracic ultrasound with micro bubbles, this is where they stick a ultrasound probe externally to you're chest and inject saline/blood solution into the arm to see if any micro bubbles pass through the chamber wall. If they pass through then you have a PFO. Well the test returned positive, according to the transthoracic examination I have a small PFO.
Hmmmmm, is this a good thing or a bad thing? I figured it must be good as I could now blame something for both bends and apparently a PFO can actually be repaired. I was put in touch with a cardiologist who performs PFO closures through a relatively non-intrusive procedure that involves implanting an Amplatzer device into the hole. The heart tissue grows around the device, seals the hole and 3 months later you can go diving again. A friend of mine who is a diving instructor had this operation and I had a good to chat to him about it and he helped allay any fears I had.
The cardiologist who was to perform the operation needed to see the size of the hole so he booked me in for a transoesophageal examination; this is where a ultrasound probe is put down the throat into the stomach where it sits behind the heart - this is apparently the best way to examine a PFO and determine the size of it. They gave me some awesome drugs that helped relax me, these drugs seriously put me into another world and then the probe was put down my throat… and it found that there is no PFO!!! Double s##t! Three surgeons examined the monitor and they found that there was no evidence of bubbles passing through the chamber wall - therefore I didn't have a PFO after all. I was told I had a perfectly operating healthy heart, this I guess could be taken as good news but I was very disappointed as I wanted a PFO as it could explain my bends. I guess I should be happy the heart works.
So
I'm now back to the drawing board, there is no explanation for why I got bent.
It's going to remain a mystery and I guess I'm going to be one of the 1000's
of other divers that have been bent with reason undetermined. It's exceptionally
frustrating and I know that I'll be nervous when I first get back in the drink.
So where to from here? Well I'm staying out of the water for a couple of months and when I do get back in I'm going to be doing it on high Nitrox mixes or on a rebreather. Actually, I've always wanted a rebreather, however the Minister of War and Finance (my lovely wife) has been strongly opposed to such a purchase. But she can't knock one back on health reasons can she…
Finally, a big thanks to the staff in SUMU at HMAS Penguin for providing excellent treatment and for putting up with me on two occasions. And I will now always donate to the Westpac Rescue Helicopter Service, you never know when you might need it. Thanks also to Steve, Dr Simon and the rest of my dive buddies who have provided some excellent advice over the past couple of months. And on a parting note, I have written this article because I just wanted to point out that getting bent can happen to anyone; it's not a crime, you don't have to do something wrong and finally it doesn't matter how experienced a diver you are… you are not invincible...