Scuba diving decompression sickness 11 year ago

[kell490]

2011 I went diving and foolishly flew on a commercial airline too soon experienced Decompression sickness (Bends). The symptoms were tingling pins and needles my legs and arms as the flight got to about 10k feet. They took me back to the airport in Florida I was airlifted in a helicopter to a hospital I got treatments in a decompression chamber. I never lost consciousness I was able to walk doctor called it mild bend. I spent a week in Florida then flew back to Phoenix. Problem is I never got my records not sure they even have them any longer it's been long time. What do I have to do with the FAA. I don't even remember the doctors name. I was just about to get my class 3 next month waiting on a year of 6 plus hours a day of CPAP data for my Sleep Apnea SI.

I suspect the bends were a result at the time of untreated sleep apnea I did sleep 4-5 hours before the flight due to the breathing issues with OSA probably never off gassed the nitrogen enough.

 

[mandm]

Yikes, did they do an emergency landing for that?

 

[Tantalum]

..I might be missing something but based on https://www.aviationmedicine.com/wp...PPLICATION-FOR-AIRMAN-MEDICAL-CERTIFICATE.pdf why would this be any issue?

The form asks to disclose visits to doctors in the last 3 years.

Then there are a series of questions on there.. since you didn't pass out I am not sure if any would even apply to you?

Sample form you will be filling out on the medxpress site.. it seems question 18 is the one you are concerned with.. would you be answering 'yes' to any of these as a result of that event?

 

[kell490]

18x "Other illness" diagnosed in your entire life catch all I think I read somewhere medical records are only kept for 7 years have no clue how the FAA thinks can get records going back 11 years.

 

[Brad Z]

Curious...How soon after your dive did you get on a commercial flight?

 

[kell490]

Yikes, did they do an emergency landing for that?

I hit the button for the flight attendant who got me oxygen we were still climbing to cruise altitude when they told the flight crew they seemed to level off. It took about 30 minutes before they actually turned around my understanding was they had to get approval from some service they use for medical emergencies. The doctor on the phone talked to an NP was was helping me she just happend to be on the flight. Finely they turned around landed took awhile I was telling them to fly lower I think they understood but it was an airbus. I don't think they declared anything probably just asked ATC for vectors back to the airport I'm guessing. Who knows would have happend if just kept going maybe paralysis. We were staying in Keywest put off diving until the last day planning a 120' dive on the USN Vandenberg then a 30' reef dive. The DM said the water was so clear we were going to do 2 dives to 120 feet 2nd one be shorter obviously max loading nitrogen. Not really thinking much driving all the way from Keywest to FLL was 150 miles lot of it was slow. Took way longer then I thought our flight was at 5am the next morning. Lack of sleep, arguing with my wife on the way back, undiagnosed sleep apnea all things contributed.


Curious...How soon after your dive did you get on a commercial flight?

I was out of the water at 3pm 3-4 hours of sleep in an airport hotel next morning 5am take off.

Any activity where logs are kept has an element of danger and complexity to it can be unforgiving. When I was getting decompression treatment I met a woman who was a scuba instructor she got bent for no reason she had no idea why it was her 3rd time. Doctor said some people just don't off gas the nitrogen right and consider giving up scuba diving. I dove a few more times after that just to say I wasn't afraid but haven't since 2012.

 

[Half Fast]

Sounds like you were pushing it a bit. Were these non-decompression dives? Were you using a dive computer, and did it say you were safe to fly?

 

[kell490]

Sounds like you were pushing it a bit. Were these non-decompression dives? Were you using a dive computer, and did it say you were safe to fly?

I had a computer it was a group dive DM was managing the time I was only using the computer to tell me how fast to ascend it was a non-decompression dive. The computer said 24 hours to fly that was tossed in a checked bag and forgotten about. Looking back I made ton of mistakes I only had about 5 hours of open water diving before this. I was good at diving with buoyancy the DM was an instructor he stayed with me super comfortable under the water. The issue was when I planned the dive 3 days before I called the shop told them I was flying out they said it would be fine since it was 1 dive to 120 on the wreck, and 2nd shallow dive no longer thought about it being a problem. Looking back likely even that profile they would have gone much longer on the reef dive still loading lot of nitrogen who goes back to the boat with 1/2 the air left no one. Maybe someone younger in better shape would not have happend bends happen way more often then the diving community talks about. I met lot of people online who got bent for no reason most were on live aboard trips where your diving multiple days in a row.

 

[Salty]

Not sure your fitness makes it (the bends) better or worse.

 

[Rushie]

18(u) admission to hospital. We’re you admitted? Or just treated in the ER? I would think that makes the difference whether the incident needs to be reported. (?)

 

[bflynn]

First, what you suspect has no bearing on any medical condition, other than if you suspect you have an issue, you have a duty to get it checked. Second, this is very likely certifiable because the bends are typically transient, especially mild cases. There can be side effects in severe cases, but it sounds like that isn't you. Third, don't do that. You should know from certification classes not to fly within 24 hours and the amount of sleep has nothing to do with it. I know this was 11 years ago, today my dive computer tells me what altitude I can safely go to. Within 24 hours of no-decomp diving, it's always clear.

The MedExpress questionnaire asks (in 18 u) have you ever in your life been in the hospital. So this will be reported.

A medical would be easier with the records, so I encourage you to try to get them. The problem is there CAN be side effects from altitude induced decompression sickness. If you say you had it but you can't provide the doctor's report on outcome, there is a chance the FAA might assume you could be a worst case and make you disprove it.

 

[Rushie]

The MedExpress questionnaire asks (in 18 u) have you ever in your life been in the hospital. So this will be reported.

It says admission to hospital. I take that literally. Treat and release from the ER is not admission.

 

[Mahneuvers]

...who goes back to the boat with 1/2 the air left...

Me. During my last diving vacation the dive master said he's never seen anything like it joking that I must have gills. The upside for me was, for the rest of the week, the dive master would have me enter the water first and allowed me to be the last one back in the boat. I'd get in 10-15 minutes more diving on each dive compared to the others on the boat. I was in much better shape then than I am now. That, and I guess just being comfortable in the water, causes me to sip air.

I'm glad your event wasn't more serious.

 

[nauga]

It says admission to hospital. I take that literally. Treat and release from the ER is not admission.

Hyperbaric treatment for DCS is not typically outpatient nor is it 'treat and release' to the best of my knowledge. Whether or not a chamber profile constitutes admission remains to be seen in the thread. That dive profile makes me cringe more than just a little. Diving on air? If times/tables/computer usage and flight info are accurate sleep apnea in and of itself doesn't sound like a primary cause. OP was very lucky.

@kell490 if you don't mind answering, how long were the dives?

Nauga,
stopped

 

[kell490]

18(u) admission to hospital. We’re you admitted? Or just treated in the ER? I would think that makes the difference whether the incident needs to be reported. (?)

Not according to my short term disability insurance my employer uses they said even though I was kept overnight it was listed as outpatient observation they only pay if I was admitted. I had no more vacation time had to take no pay from my employer. That's why was thinking it would go under 18x.

First, what you suspect has no bearing on any medical condition, other than if you suspect you have an issue, you have a duty to get it checked. Second, this is very likely certifiable because the bends are typically transient, especially mild cases. There can be side effects in severe cases, but it sounds like that isn't you. Third, don't do that. You should know from certification classes not to fly within 24 hours and the amount of sleep has nothing to do with it. I know this was 11 years ago, today my dive computer tells me what altitude I can safely go to. Within 24 hours of no-decomp diving, it's always clear.

The MedExpress questionnaire asks (in 18 u) have you ever in your life been in the hospital. So this will be reported.

A medical would be easier with the records, so I encourage you to try to get them. The problem is there CAN be side effects from altitude induced decompression sickness. If you say you had it but you can't provide the doctor's report on outcome, there is a chance the FAA might assume you could be a worst case and make you disprove it.

The problem is with undiagnosed OSA stop breathing like I do once every 60 seconds could be the source of the problem sleeping like that for 5 hours might have contributed to it. I heard this forever from diving community who tell me I wasn't bent because they can't figure out why on a chart. Not everyone fits the chart the doctor at St Mary's in Florida he said he sees people all the time can't figure out why they were bent lot of dive instructors many who were only diving to 20-30 feet deep ascended normally yet still got bent. Not everyone handles nitrogen the same. Even dive doctor over on scubaboard suggested the same thing I spoke to him on the phone about it.

I called St Mary's in West Palm beach where I went left a message see if they still have the records. It took a year for mild tingling to go away completely since then I have been up to 12k skiing no issues.

 

[Lindberg]

First, what you suspect has no bearing on any medical condition, other than if you suspect you have an issue, you have a duty to get it checked.

From where do you conclude this duty exists?

 

[kell490]

Hyperbaric treatment for DCS is not typically outpatient nor is it 'treat and release' to the best of my knowledge. Whether or not a chamber profile constitutes admission remains to be seen in the thread. That dive profile makes me cringe more than just a little. Diving on air? If times/tables/computer usage and flight info are accurate sleep apnea in and of itself doesn't sound like a primary cause. OP was very lucky.

@kell490 if you don't mind answering, how long were the dives?

Nauga,
stopped

I don't remember exactly I do have a video of it using a gopro it has the computer screen times on it let me see if I can find it.

 

[Lindberg]

Not according to my short term disability insurance my employer uses they said even though I was kept overnight it was listed as outpatient observation they only pay if I was admitted. I had no more vacation time had to take no pay from my employer. That's why was thinking it would go under 18x.



The problem is with undiagnosed OSA stop breathing like I do once every 60 seconds could be the source of the problem sleeping like that for 5 hours might have contributed to it. I heard this forever from diving community who tell me I wasn't bent because they can't figure out why on a chart. Not everyone fits the chart the doctor at St Mary's in Florida he said he sees people all the time can't figure out why they were bent lot of dive instructors many who were only diving to 20-30 feet deep ascended normally yet still got bent. Not everyone handles nitrogen the same. Even dive doctor over on scubaboard suggested the same thing I spoke to him on the phone about it.

I called St Mary's in West Palm beach where I went left a message see if they still have the records. It took a year for mild tingling to go away completely since then I have been up to 12k skiing no issues.

I'm amazed anyone would call this an undeserved DCS hit. Per PADI tables, the NDL at 120' is 13 minutes. Then if you spent an hour on the boat between dives, you'd get 7-8 minutes NDL time for the second dive.

A safety stop is mandatory on any dive that deep. Hopefully you saved air for that.

Then 18 hours is considered the minimum time-to-fly after repetitive dives, even when you abide by the limits.

PADI may be on the more conservative side, but I'd say you earned this one. Which probably works in your favor since a truly undeserved hit could point to other medical problems.

 

[Rushie]

Not according to my short term disability insurance my employer uses they said even though I was kept overnight it was listed as outpatient observation they only pay if I was admitted. I had no more vacation time had to take no pay from my employer. That's why was thinking it would go under 18x.

That makes sense then, “other illness”. If the hospital has the records great, if not I’m not sure what the FAA would do with it, I would think the OSA is a bigger problem for you than this incident a decade ago.

 

[Half Fast]

Not sure your fitness makes it (the bends) better or worse.

Poor circulation or respiration can make the gas exchange slower. I also believe fatty tissues outgas slower. I messed with deco modeling back when I was cave diving and doing a lot of deco dives, but it’s been quite a while since I messed with it.

 

[Salty]

Poor circulation or respiration can make the gas exchange slower. I also believe fatty tissues outgas slower. I messed with deco modeling back when I was cave diving and doing a lot of deco dives, but it’s been quite a while since I messed with it.

Maybe. But maybe it also slows the uptake. I’m just saying stuff, not based on fact. But generally speaking tissue saturation models are little more than a wild guess with a large spoonful of conservative measure added for safety because it’s really hard to tell how any one persons body will react.

 

[Half Fast]

Maybe. But maybe it also slows the uptake. I’m just saying stuff, not based on fact. But generally speaking tissue saturation models are little more than a wild guess with a large spoonful of conservative measure added for safety because it’s really hard to tell how any one persons body will react.

All true. The faster tissues likely saturate at that depth and time, though, which is why slow ascents and safety stops are recommended.

Too complex, and too many variables, for any deco algorithm to be completely accurate. It’s necessary to be pretty conservative.

Some years ago Disney World couldn’t understand why divers at the Living Seas at EPCOT were getting bent at depths of 20’ or so. Turned out the divers were going to south Florida and diving deep wrecks on their days off. The constant diving, with no days off to outgas, eventually built up a severe decompression penalty.

 

[kell490]

Both dives best I can figure out was about 25 minutes we did have a 30 or 60 minute break in between I don't remember exactly. Looking at the video both dives were to about 103 feet deep. Here a picture of computer at the safety stop near the end of the 2nd dive see I had been down to 103 feet. I felt fine rest of the day if I had just stayed in Keywest one more day I would have been fine.

 

[Lindberg]

Both dives best I can figure out was about 25 minutes we did have a 30 or 60 minute break in between I don't remember exactly. Looking at the video both dives were to about 103 feet deep. Here a picture of computer at the safety stop near the end of the 2nd dive see I had been down to 103 feet. I felt fine rest of the day if I had just stayed in Keywest one more day I would have been fine.

Even if we round in your favor, you were beyond NDL times on both dives. You were lucky to not be bent on the boat. And then flying 14 hours later.... No wonder it was almost immediate. Perhaps you spent very little time at depth and most much more shallow. But these were dangerous "trust me" dives.

 

[Dana]

Is the bends considered an "illness" or an "injury"? Question 18 doesn't ask about injuries, only illnesses or hospital admissions.

 

[bflynn]

From where do you conclude this duty exists?

Morality + 61.53. Ok, technically you have a duty not to fly, but since I cannot imagine a pilot not wanting to fly, tha translates to a duty to find out what's wrong so you can fly.

 

[Lindberg]

Morality + 61.53. Ok, technically you have a duty not to fly, but since I cannot imagine a pilot not wanting to fly, tha translates to a duty to find out what's wrong so you can fly.

The requirements of 61.53 and the Medxpress form are limited to actual or constructive knowledge. When posters ask questions here, they probably assume the answers are based on regulations rather than morals, unless specified.

 

[bflynn]

The requirements of 61.53 and the Medxpress form are limited to actual or constructive knowledge. When posters ask questions here, they probably assume the answers are based on regulations rather than morals, unless specified.

So you claim the FAA would say "Well, he said he suspected he was having heart problem, but he didn't KNOW he was. Awww, give the guy a break." ???

 

[Sinistar]

I wouldn't have done that pair of dives.

The first one to 120ft, as long as it wasn't too long at max depth was okay. But that second dive basically being a repeat - 120ft and such a short surface interval really put you into a higher risk category. I can't remember the last time I pushed a 24hr no fly even though not required.

There are lots of others factors: are you overweight? a smoker? were you drinking a lot the night before? Dehydrated before the dives? Do you have COPD.

Also how many days of diving in a row before this final day? If you had nitrogen loading remaining from the previous day that really adds more fuel to the fire.

 

[kell490]

Even if we round in your favor, you were beyond NDL times on both dives. You were lucky to not be bent on the boat. And then flying 14 hours later.... No wonder it was almost immediate. Perhaps you spent very little time at depth and most much more shallow. But these were dangerous "trust me" dives.

I believe the computer is saying I could remain 9 hours and 13 minutes at 19 feet deep No Decompression Limit. It changes when deep it would say 13 minutes, 24 minutes gain time as I rise up to the surface. The DM only had us deep on the 2nd dive for short 5-6 minutes we spent more time on the upper deck around 40-60 feet. The wreck is big ship I'm sure anyone who ever dived in Keywest knows about it.

None of this matters now all in the past lessons learned.

 

[nauga]

Is the bends considered an "illness" or an "injury"? Question 18 doesn't ask about injuries, only illnesses or hospital admissions.

"The bends" is referred to as decompression sickness (DCS), which along with arterial gas embolisms comprise decompression illness (DCI).

Nauga,
who doesn't follow the magenta line and doesn't dive someone else's computer(well, one of those is true, anyway )

 

[GaryM]

Glad it ended ok for you, even if there might be some FAA hoops to jump through now. I'd think they'd only be minor hoops, but the FAA can move in mysterious ways.

One risk factor not mentioned is PFO (patent foramen ovale), a hole between the left and right atria (upper chambers) of the heart that didn't close normally at birth. When present, it allows some of the blood circulation to bypass the lungs, which reduces off-gassing. But few people know if they have it or not, even among the tech diving community.
I wonder if sleep apnea is really a risk factor? I'd not heard it mentioned when I was doing deep mixed-gas dives. Once the excess nitrogen in the blood makes it into the alveoli of the lungs, it's out the blood stream and can't cause the bends, even if it isn't cleared from air space within the lungs as efficiently as it might be due to the sleep apnea.

Undeserved (e.g. unexplained) DCS hits are a thing, but as others have noted, you were diving a very aggressive profile, especially if breathing air instead of nitrox, and if you only had 5 hours of open water diving, you were almost certainly on air. Which is fine, it just reduces allowable bottom time a bit. Time to fly values on many, if not most, recreational dive computers aren't calculated, they just count down 24 hours from when you surfaced. The 18 hour guidance one often hears is more appropriate after shallower dives, particularly if one isn't doing multi day diving.

On future dives, remember, you are diver in command. Dive your computer, don't rely on the divemaster's!

 

[Brad Z]

BTW- thank you for your frankness in sharing this story. Many of us fly and recreationally dive, so it is useful to read this case study.

 

[jbarrass]

Was DAN involved? Either through their insurance or their facilities? If so check with them, they keep good records.

 

[kell490]

Was DAN involved? Either through their insurance or their facilities? If so check with them, they keep good records.

No they were not involved because I didn't need their insurance being that I was diving in the US and my regular insurance paid for everything including the helicopter ride. Dan will only pay if your primary insurance won't pay so didn't make any sense to have it being in the US. It would have been reported if I got the bends while on the boat reporting it was the last thing on my mind at the time.

 

[bbchien]

No they were not involved because I didn't need their insurance being that I was diving in the US and my regular insurance paid for everything including the helicopter ride. Dan will only pay if your primary insurance won't pay so didn't make any sense to have it being in the US. It would have been reported if I got the bends while on the boat reporting it was the last thing on my mind at the time.

There is an insurance record.
You will need whatever records you can garner
Current Neurology evaluation and likely he'll require a Brain MRI (Neruologist is goigg to want to know).
ALL depends on the Neurologist. Get to a good one.

Glad you survived. Yeah, you should have waited one more day. I also dive and fly and am pretty religious about the wait period. Good for you that it wasn't crippling. I have one guy in my T-jet transition group who was a noncompliant sora guy, didn't shave clean, got bent in Tweetie pie and never flew again.

 

[kell490]

There is an insurance record.
You will need whatever records you can garner
Current Neurology evaluation and likely he'll require a Brain MRI (Neruologist is goigg to want to know).
ALL depends on the Neurologist. Get to a good one.

Glad you survived. Yeah, you should have waited one more day. I also dive and fly and am pretty religious about the wait period. Good for you that it wasn't crippling. I have one guy in my T-jet transition group who was a noncompliant sora guy, didn't shave clean, got bent in Tweetie pie and never flew again.

I did get a MRI from a Neurologist back in 2012 when I returned back to Phoenix no issues found I should be able to get those records would that be sufficient, or does this have to be done again 12 years later? I'm little surprised that they would want an brain MRI it's been long time since everything resolved.

I also have Unilateral Diaphragm Paralysis on the right side that happened before this event around 2008 X-Ray indicated it elevated and noted by a Radiologist which I have those records I never had any symptoms. PCP at that time said not to worry about it since I had it for awhile. Later in 2017-2018 I had a sniff test, and a Pulmonologist evaluated it gave me a pulmonary function test said I was 80% still with in the normal range not bad enough for diaphragm plication surgery.

I also have treated by CPAP Sleep Apnea severe OSA more then 20 months of 6 plus hours day using the CPAP.

Overall with the bend in 2011, Diaphragm issue, Sleep apnea is this going to turn into a big issue with the FAA?

 

[bbchien]

No, but it is going to be “thorough”, and will need to be updated....

 

[kell490]

No, but it is going to be “thorough”, and will need to be updated....

Does that mean the FAA will want testing done yearly for conditions I have no symptoms for like the Pulmonary function test, fluoroscopy x-ray for the diaphragm paralyses, and MRI and neurologist report for the bend 12 years ago?

Can't the AME just do a standard physical exam verify if there is any nerve damage ? I had planned on providing the sniff test for the diaphragm leave out the PFT it was from 2018 longer then 3 years. Still trying to get the insurance claims but not as easy as I thought old policy over 10 years ago UHC said might not be possible to get the records. The neurologist I saw in 2012 is no longer at the same location I don't remember her name the imaging place is also gone I suspect bought up by one of the larger companies in the area.

 

[Lindberg]

Does that mean the FAA will want testing done yearly for conditions I have no symptoms for like the Pulmonary function test, fluoroscopy x-ray for the diaphragm paralyses, and MRI and neurologist report for the bend 12 years ago?

Can't the AME just do a standard physical exam verify if there is any nerve damage ? I had planned on providing the sniff test for the diaphragm leave out the PFT it was from 2018 longer then 3 years. Still trying to get the insurance claims but not as easy as I thought old policy over 10 years ago UHC said might not be possible to get the records. The neurologist I saw in 2012 is no longer at the same location I don't remember her name the imaging place is also gone I suspect bought up by one of the larger companies in the area.

You'd be well advised to contact a "hard case" AME in your area and have a consult with your medical records.