Case of the Bends

[Team Sergeant]

I've got a surgeon asking me if and when an individual can safely return to diving after a nasty case of the Bends? Is there a standard time period for this?

TS

[x SF med]

Jefe-
I saw one site that says 6 weeks after last hyperbaric Tx - this is from a guy who got the bends in Australia.

link: http://photo.net/travel/diving/decompression-illness

Here's a cut:
Dr. Griffiths says that I can SCUBA dive again in six weeks.



Ok - who's the local Dive Medic? find one of the guys with Shark in his name (not you RL, you are a real shark) and has the bubble button.

[Ambush Master]

Here's a start:

http://www.scubadiving.com/article3449

And more:

http://www.londondivingchamber.co.uk...?id=dci&page=9

[Peregrino]

Originally Posted by Team Sergeant

I've got a surgeon asking me if and when an individual can safely return to diving after a nasty case of the Bends? Is there a standard time period for this?

TS

TS - Depends on what a "nasty case of the bends" is. Type II/III DCS frequently causes permanent damage, e.g. lingering neurological deficits (as serious as stroke-like symptoms). If the PT completed a full course of treatment with complete resolution of symptoms then a physical appropriate to the intended level of diving activity (recreational, technical, or commercial/military - along the lines of a Class "A" flight physical) administered by a physician trained in hyperbaric medicine (check with DAN for referrals) will clear them to return to diving. This is a case where your surgeon needs to "pass the buck" to a specialist. The potential liability issues aren't worth doing a favor for a friend. That's my professional advice FWIW. Peregrino

[Surgicalcric]

What Peregrino said, not that he needs me as Polly Parrot.

I have never heard of a standard time frame. We were taught (civilian Rescue Divers) it was dependent on the degree of DCS. It was always one of the Pulmonologists at GMH that cleared any of us to return to duties. Pulmonary Functions Test, Neuro, and EKG were always included.

Crip

[Warrior-Mentor]

DAN (Divers Alert Network) associated with Duke University would be the organization to consult.

Here's link from their site:

http://www.diversalertnetwork.org/me....asp?faqid=137

[Peregrino]

TS - FWIW, here's another data point for your surgeon: Undeserved DCS hits are rare. They're like plane crashes. Competent investigation usually reveals operator error. In diving it's most often carelessness (lack of SA/ATD) and or high risk behaviors (extra deep/extra long) coupled with about 17 known (? unknown) predisposing factors. Carelessness and HRBs are character traits. The chances of the PT repeating the behavior that caused their DCS hit are good. (I've seen it happen - fatally.) Given the litigious nature of our society if the PT manages to kill themselves in a subsequent accident, the family will play the legal lottery. Ambulance chasers will be all over them offering their services. From that point Dr.s understand the risks. It's better to let a specialist risk their malpractice insurance. Peregrino

[Z731]

The answer> when cleared by the appropriate medical authority. These are usually the Group level flight surgeons with the associated dive credentials. They are not dive qualified but are qualified to give the "victim" his certificate of release. Most Group Level Surgeons can let him get back in the water.

BOTTOM LINE: Without the Group Surgeon signing off on it the guy isn't legally getting back in the water.

Z

[The Reaper]

Originally Posted by Z731

The answer> when cleared by the appropriate medical authority. These are usually the Group level flight surgeons with the associated dive credentials. They are not dive qualified but are qualified to give the "victim" his certificate of release. Most Group Level Surgeons can let him get back in the water.

BOTTOM LINE: Without the Group Surgeon signing off on it the guy isn't legally getting back in the water.

Z

Z:

I think he is referring to a non-military civilian patient.

TR

[Team Sergeant]

Thanks for the responses. The physician just wanted to point the patient in the right direction. The DAN link will work just fine.
IMO the patient himself needs to be the responsible one in this situation and make an informed decision on his own. (The patient asked the question after returning from decompression sickness and treatment 2 weeks ago.)

TS

[mugwump]

Originally Posted by Peregrino

TS - FWIW, here's another data point for your surgeon: Undeserved DCS hits are rare. They're like plane crashes. Competent investigation usually reveals operator error. In diving it's most often carelessness (lack of SA/ATD) and or high risk behaviors (extra deep/extra long) coupled with about 17 known (? unknown) predisposing factors. Carelessness and HRBs are character traits.

<snip>

One man's high risk behavior is another man's "fun dive".

I've always thought of DCS as a statistical certainty if you dive long enough. I know that you know this, but most sport divers don't realize that tables and dive computers are designed to leave you un-bent "most of the time." A lot of people think that if their little dial doesn't turn red they can continually push the limits of their computer.

I believe many sport divers approach clinical DCS and don't realize it. I've heard many people complain about extreme fatigue after the second or third tropical dive of a day. I always logged "extreme fatigue" as borderline DCS and I took that into account when planning similar dives (i.e., added "conservative" weighting factors into my plans).

[Peregrino]

Originally Posted by mugwump

One man's high risk behavior is another man's "fun dive".

I've always thought of DCS as a statistical certainty if you dive long enough. I know that you know this, but most sport divers don't realize that tables and dive computers are designed to leave you un-bent "most of the time." A lot of people think that if their little dial doesn't turn red they can continually push the limits of their computer.

I believe many sport divers approach clinical DCS and don't realize it. I've heard many people complain about extreme fatigue after the second or third tropical dive of a day. I always logged "extreme fatigue" as borderline DCS and I took that into account when planning similar dives (i.e., added "conservative" weighting factors into my plans).

MW - I agree completely - with all of your statements. I also believe in risk analysis, mitigation, and individual responsibility. Otherwise I wouldn't be doing mixed-gas technical dives. I certainly wouldn't be teaching it. DAN and DEMA both collect statistics (sometimes at cross purposes) and the trends (# of divers/# of dives/# of incidents-accidents) show decreasing incidents of DCS. The trend is usually attributed to improved training, better equipment, and more restrictive dive profiles imposed as part of a graduated series of certifications.

The primary risk factors for DCS are well known and recreational divers ignore them at their own peril. (Commercial and military divers have different standards and laws/regulations they are required to follow that take into account the increased risks.) There's a big difference between borderline DCS and "a nasty case of the bends". Current speculation is that divers get "bent" every time they dive - the issue is whether it's clinical or not. True undeserved "clinical" hits are rare, especially with the conservative algorithms in today's dive computers. Most of the time clinical DCS can be attributed to divers engaged in behaviour/activities well outside recommended limits for their chosen aspect of the sport (even "techies" have guidelines ).

FWIW - Peregrino

ETA: MW - Didn't mean to put on the lecture hat but left the tone as it is because you and I aren't the only ones reading this. Spent too many years teaching "inverse ratio of testosterone to common sense" types prone to high risk behaviors not to reinforce the points.