Most people treated by the Diving Diseases Research Centre in Plymouth got bent diving within the tables. If like me, you thought most bends come about because people have 'broken the rules' or 'done something daft' then prepare yourself for a shock.
Ann Kruyer recounts her experience
"My bend appeared to come out of the blue. A bit like being hit by a bus when you're standing in the middle of a field, it's just not expected.
"This is how mine felt; forty minutes after surfacing from the Kowloon Bridge, Baltimore, Ireland. I developed terrible pains in my chest, I remember being bent double in agony. Partial blindness followed, as did confusion and extreme distress. I had to be helped off the boat, very unwell, but oblivious of what was happening to me.
"At the time it didn't occur to me that this was a bend. It didn't occur to those around me either, so instead of rushing me to the nearest chamber, I was tucked up in bed to 'sleep it off'."
Believing that she was suffering from the worse migraine of her life, Ann continued to dive.
"For the remainder of the week I did further dives, with symptoms after about half of them, including a rash across my stomach, swollen breasts and the beginning of pitching when I walked. My brain was already swollen and damaged; I didn't have the insight to know I had to stop and get help."
It wasn't me, I never done it
Research by Margueritte St Leger at DDRC shows that women are actually more likely than men to self-diagnose and come in for treatment. "Denial is a real problem. No-one wants to believe they've got a bend and often it's only when the symptoms are too serious to ignore that people will come in for treatment." Unfortunately delaying treatment of a bend will harm your chances of making a full recovery. So why is it so common for divers to deny their symptoms?
Tom Mount, head of IANTD, believes that we need to change our entire attitude to the illness 'We need to take the blame factor out of dealing with bends... a DCI hit should be viewed as a sports injury' If people feel that they will be condemned as 'bad divers' for suffering a bend, it does nothing to encourage people to speak up when they feel unwell after a dive
But even the most 'in your face' symptoms can be ignored. Adina was on a dive weekend in Portland when she began to experience serious pain and numbness down one side of her body "I was literally dragging my leg as I walked. My boyfriend was moaning at me for holding everybody up!" Nobody she was diving with questioned whether these symptoms might be a bend. "I really felt like I was being a pain. Ignoring it and getting on with the diving just seemed the best thing to do."
After the weekend she went to hospital. "At first they wanted to send me away with a painkiller, but I was in agony and was beginning to think I may have a bend so I insisted on being seen. They decided I had DCI and refered me to a recompression chamber." Adina turned out not to have a bend but was suffering from a slipped disk.
It seems almost comical. Like the battling knight in Monty Python and the Holy Grail, hopping around his severed leg repeating 'No, I'm fine! Its just a flesh wound' A very English attitude. That's why the whole thing is so scary: when it comes to admitting we have a problem, or identifying an injury in someone else we are crap. Its simply not polite to point out that someone is dragging their leg and question them about their diving. Its terribly embarrassing to own up to the fact that we cannot lift our arm properly, or that we suspect our murderous headache might need more than an aspirin to sort it out.
Ignore it - it'll go away
It all seems so simple in the textbook. A diver surfaces. They collapse, bent so we break out the oxygen and call the helicopter. They get taken to the chamber and recompressed. They walk out smiling. Sorted.
But what if it isn't that clear cut? What if we don't realise that someone is bending before our very eyes? Perhaps they look a bit ill but they're not making a commotion or demanding oxygen. So we resort to the traditional British strategy of : ignore it and it'll go away. I never realised that people with serious type 2 bends can continue to walk around, drive cars, and... go diving. But that's exactly what Ann did.
'After a week back in London, during which time I saw my GP and was made to feel I was wasting her time, I went on another dive holiday with my club to Cornwall.
40 minutes to an hour after surfacing from a perfectly normal dive on the Runnel Stone, it began. It started with a sharp stabbing pain in my left shoulder. Next came the very sudden loss of vision followed by shivering and feeling very cold.
I went to an experienced diver who was sitting near me and told her what was going on, she said; "let's get Ann on Oxygen" I felt a wave of relief that help was on its way, only to have that hope dashed when the Dive Marshall over-ruled her.
My symptoms got much worse. I started to get stabbing pains in the small of my back, then the terrible itching started. I got up and staggered over to a very experienced diver that I trusted. He asked if I had a rash and I told him I didn't know as I couldn't see. The DM suggested that I had a heat rash. I felt like a pest."
A reluctance to 'break out the oxygen' will have serious consequences for a bending diver, so it seems crazy not to administer oxygen if there is any doubt. Ian Fuller, who teaches all the BSAC and PADI rescue and first aid courses at Old Harbour Dive School agrees. "It is always preferable to assume the worst and administer oxygen. If you're wrong, it does no harm. If the person does have DCI you'll be promoting their recovery."
Life however, is not always this simple. Bob Cole of the SAA who has recently completed a book about decompression illness told me the following chilling tale. "A group of divers were out on a hardboat and they'd brought along their own oxygen kit. One of their divers surfaced after missing some stops, but the skipper refused to let them administer oxygen while aboard. He believed that he would be held liable for anything that happened if treatment took place on board his boat. They had to wait to disembark before the diver could be treated."
Fear of formality
No-one ever told me that I may have to scream, beg and fight to get DCI symptoms recognised and be administerd with oxygen. After all, why would anyone refuse? Unfortunately some of the procedures put in place by BSAC to protect divers, seem to present a barrier in the minds of some club members.
Whenever oxygen is administered, the DDRC should be contacted for advice. An incident report form should be sent to BSAC. For many people this feels like owning up to the authorities for some misdemeanor. Someone has done something wrong, the diving practices of the branch could be called into question. And, heaven forbid, we might end up looking stupid.
Natasha Abels faced a barrage of criticism when she sustained a bend on her record breaking 180m trimix dive in autumn 1999. "I have experienced the bends 3 times and each time has been different. I always train and plan for my dives, make sure I'm well hydrated and do more than the required stops. But if you dive enough, then decompression sickness is bound to catch up with you at some point.
"I was quite horrified at some of the attitudes I came across. People reacted in a very judgemental way, as if I was some silly girl who didn't know what she was doing. When I was in hospital, the doctor was hastily reading up about DCI and it was apparent that I was far more informed about my symptoms than he was.
"Yes I was pushing the limits, but no-one turns round to a mountaineer with a broken ankle and goes 'well that was a bit stupid wasn't it?' For some reason diving has a more moralistic attitude. Its not only unhelpful, its actually quite harmful to the sport."
Getting the treatment
Two weeks after returning from Cornwall, and still very ill, Ann faxed her symptoms to DDRC, was refered to Dr King, a DCI specialist and rushed to the recompression chamber. "It was such a relief to have my illness recognised. But then I was faced with the chamber... I'm claustrophobic and the treatment was not pleasant. Twice I had to be drugged up to get into the chamber, another time they practically had to peel my fingers from the edge of the chamber door. Other times I'd sit there for the duration with tears running down my face."
The myth that you will walk out of the chamber fixed up were quickly dispelled. Recompression often has to take place over a number of days and some people leave feeling as rough as when they arrived
"Because of the delay in treatment some of my injuries are likely to be permanent, they could include staggering, slurred speech, problems with short term memory, lack of energy. In short its very similar to having suffered a stroke."
Ann is still angry about what happened "I feel very let down by people who should have been looking out for me. Unfortunately the attitude is 'well why didn't you ask for oxygen or call an ambulance yourself?' Unless it happens to you, it's impossible to understand how powerless and ill you feel. Expecting someone with brain damage to think rationally, diagnose themselves, and fight for the correct treatment is just laughable."
If in doubt, get in touch
If you're a UK based diver, make good use of the resources available to us. The staff at DDRC are friendly and expert, and the treatment is first class. You can always phone them for advice on about any diving related medical issue. They aren't interested in judging you, they're interested in treating you and helping you recover. Being stuck in the pot is no fun at all, but it's far preferable to going untreated. As Ann will testify, fast diagnosis and treatment are your best bet.
Diving Diseases Research Centre Tel: 01752 261910 www.ddrc.org
Photo: Mark Brill
Scary bend Stuff
You have to dive deep to get a bend
Bends have happened to people diving in less than 6m of water
You must have dived outside the tables or ignored your dive computer
Ignoring the guidelines will mean you are more likely to get bent, but most people in the UK who were treated for DCI were following the guidelines
Long dives cause bends
The most provocative thing you can do is a series of quick dives
Women are more likely to get bent than men because they have more bodyfat
You've obviously not met many UK dive blokes! DDRC research suggests that women are statistically less likely to get bent. Reports of DCI incidents from PADI (US) confirm that women suffer less DCI hits.
Women do less adventurous diving that's why they don't get bent
Margueritte's research shows that women are doing the same adventurous dives as men but with less aggressive profiles.
Natasha Abels at a deco stop during her 180m dive
"If you do get decompression sickness, take it seriously - even mild pain in a joint could be the indication of something more dangerous. Its always worth getting it checked out, and if you're diving abroad, get yourself insured."
Bent to bits?
let's not go there!
The only way to make 100% sure that you don't get a bend is to stop diving. Too drastic! Here are the next best suggestions
Give yourself the best possible opportunity to off-gas - take it slow. Even if it means going into deco or doing extra deco. Far better to hang around than to leg it off to the surface and get into a problem.
No, not an excuse to get on the beer. Drinking lots of water will make sure you are properly hydrated. This gives your blood a better opportunity to hold gases in solution. Being dehydrated puts you at a disadvantage and at more risk of getting bent.
Underwater: Reducing the amount of nitrogen in your breathing mixture by adding more oxygen means theres less nitrogen for your body to absorb -
Nitrox Rox! Different nitrox mixes have different depth limits and you need to take a qualification to use it.
On the surface: Breathing oxygen or a rich oxygen mix on the surface will help to flush out the nitrogen you've absorbed - the surface is your last decompression stop!
When you get cold, your circulation shuts itself down a bit and concentrates on your vital organs. So all that gas being released in the shut down bits can't get transported away effectively.
Relax and take it easy
Don't do lots of work on the dive, and avoid exerting yourself afterwards. So stop wrestling with that porthole and don't try hoiking yourself up a ladder in full kit. You're not being a wimp, you're just looking after yourself.
Once a day is extra safe
Research by Dr Valerie Flook on bubble formation shows that divers produce tiny bubbles in their bloodstream after every dive. You can have bubbles, but no symptoms of DCI.
But once bubbles are present, the body is much less efficient at off-gassing. Repeat dives carry a greatly increased risk of a bend.
If you want to give yourself a bigger safety margin, follow the lead of many technical divers and restrict yourself to one dive a day.