By Joel Dovenbarger, BSN
Vice President, DAN Medical Services
The Diver:
This 49-year-old diver has been certified for 18 years. He has made 140 dives, eight in the past four months. This is his second dive trip of the year to his favorite location. In good health and a non-smoker, he takes decongestant medication for his sinuses to help with clearing during descent. The diver, well versed in the signs and symptoms of decompression illness, works as a medical professional; he has worked in a hyperbaric chamber as a tender in dive injury cases.
The Dives:
On the first day, he completed two multilevel dives to maximum depths of 80 feet / 25 meters and 60 feet / 18 meters. He normally dives without the benefit of a wetsuit because the water temperature is so comfortable.
That evening after dinner, the diver developed abdominal discomfort. Over the next two days, this developed into gastroenteritis, and he was not able to eat solid food. During this time the diver supplemented his caloric intake with two to three beers a day. After staying out of the water for two days, he decided to try another day of scuba.
Because the water had been a little chilly during his last day of diving, the diver decided to use a shortie wetsuit. On the way out to the dive site, although feeling physically well, the diver had an increased thirst, drinking four plastic cups of water.
He suited up for the first dive, which was to be no deeper than 70 feet / 22 meters for 30 minutes, according to the divemaster. Because this was his first day of diving after he had been sick, the diver decided to be conservative and to go no deeper than 60 feet / 18 meters. He had forgotten to add extra weight on his weight belt to compensate for the shortie, however, so he had to work a little harder than usual to descend and during the dive.
The added buoyancy also made it difficult to maintain the 15-foot / 4.5-meter safety stop after his 25-minute dive. After climbing the ladder and removing his fins, he developed leg cramps in both calves. During the surface interval he had fluids and snacked.
Because the water seemed warmer after his break, the diver decided to forego his wetsuit on the second dive. The dive was scheduled for no deeper than 60 feet, but the diver decided to go no deeper than 50 feet / 15 meters for no longer than 30 minutes. The second dive was uncomplicated and, outside the normal amount of fatigue after a dive, the diver noted that he felt fine.
The Complications:
During the remainder of the afternoon, the diver drank water, but he switched to beer later. He had a beer and a margarita with dinner. Somewhat fatigued after eating, he went to bed at 11 p.m. At about 1:30 a.m., he was awakened by pain in his left shoulder and left wrist. On a scale of 0-10, he ranked it about an 8.
This was approximately 12 hours after he had left the water on his final dive. When he moved the joints of his arm, he noted that the pain did not change. It did not seem to lessen after the diver had been awake for approximately 30 minutes; he said that it was unlike any pain he had experienced before. To help relieve the discomfort, he took four ibuprofen tablets with a glass of water. After about 40 minutes, the pain decreased, and he was able to go back to sleep.
The Treatment:
When the diver awoke the next morning, his pain had greatly decreased; he felt much better. After breakfast and a morning meeting that lasted three hours, the diver went to the local recompression facility for evaluation.
After a brief neurological exam, the diver was treated in the local chamber. During the third oxygen cycle of his treatment the remaining pain in the left shoulder and wrist completely resolved. After waiting three additional days to fly home, the diver returned to the United States without complication or return of symptoms.
The Discussion:
Decompression illness can happen to anyone, especially when someone disregards the best defense we have against DCI — common sense. Looking back on the week’s vacation, the diver was more than a little embarrassed to see that he had paid so little attention to what his body had been telling him: i.e., don’t dive with the signs he had been experiencing.
This diver may have considered a few different choices: more water and less alcohol to add in offgassing nitrogen; waiting an additional day to go diving to continue the body’s recovery period; or reducing exposure by limiting dive time to reduce the risk of gas bubbles and DCI and create a better outcome.
Fortunately, as in most DCI cases, there was no residual pain. This diver will be able to enjoy diving again: a wiser, older diver perhaps, but a little less bold.
