Cave Diving, Cave Exploration and Cave Mapping in Yucatan, Mexico
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Getting Bent, How could this happen?

Mhhh…I wish I could entitle this one: “How Not to Get Bent” but unfortunately, that is not what this article is about. I did get bent and this article is just one way for me to analyze what happened and try to find some clues on what I can do different next time.

Most of my personal deep diving experience comes from mixed gas diving in the Egyptian Red Sea. The workload before the dive was minimal since we used a boat to reach the dive site. I usually sat down at the end of the platform with all my stage tanks at arms length. The dive itself was mostly cruising a long a reef wall or wreck at depth, sometimes for pleasure and sometimes for collecting data. Most of the dives were easy swimming since elevating your breathing at depth using Open Circuit Scuba is not really something you want to do. Occasionally, heavy currents made it difficult to hold precise deco stops or forced me to hang on a shot line like a flag in a heavy wind.  Profiles were square shaped sometimes with a single bottom depth and ascent, sometimes a multilevel dive going from deck to deck of a shipwreck for example. Bottom times where typically limited by gas volume and my RMV. Since my resources were very limited in Egypt (80cf tanks only) and I had decided to never make a dive with less then 10min bottom time my depth was automatically limited to about 120m (400ft).

At first I used GAP and later Z-Planner for my custom cut tables.  When I look back on those dives them seem somewhat aggressive, not by choice but by lack of experience and knowledge.  However, I can’t really recall a single time when I felt different after a dive then at the beginning of the dive. Usually, I felt even better because I had spent some time breathing O2.

Doing deep cave dives with extended bottom times requiring long horizontal distances turned out to be way different from doing them in the ocean. These circumstances often force us to do things which can have a very negative impact on our decompression, such as:

  1. Strenuous work before the dive, which includes getting to the site, setting up etc
  2. Strenuous work during the dive, meaning traveling with bigger amounts of equipment long horizontal distances as fast/efficient as possible.
  3. Possible ups and downs as our profile is dictated by the cave which can lead to bounce dives and therefore a higher risk of DCS.
  4. Extended bottom times leading to hours of in water decompression.
  5. Strenuous work post dive, which includes getting all your gear back together and leaving the dive site.

As I reported in the article Three More Trips to The Pit, I believe that our three days at The Pit and my inability to listen to myself, contributed to my accident. Our analysis of the execution of the dive didn’t reveal any of the standard causes, there was no: rapid ascent, dehydration, violation of decompression profile, or ceiling violations.   From an execution perspective, the dive went very smoothly and according plan until the first symptom manifested itself.

Therefore, I have to look for other possibilities to understand the possible cause (if there is such a thing) for my accident or at least identify the contributing factors. Looking at the three days, I believe that I have found a pattern that gradually resulted in me lying in a recompression chamber.  The pattern was driven by the 5 aforementioned points as well as by ego and commercial interests.

Our objectives for the first day were to install a system for evacuating an unconscious diver and execute a dive to Wakulla Room.  During the dive I would fine tune new equipment and bailout at depth to check RMV under realistic circumstances. It took us more time, effort, concentration, work, etc. to install the system then anticipated, therefore we called the dive. For some unexplainable reason, I felt that I lost an opportunity and was behind schedule.  I felt slightly defeated when I left The Pit.

Three days later, we returned with the goal of perfecting the system and executing the first dive of the project. AGAIN, it took way more time, effort, etc. then planned to rig the lift system, however this time I didn’t call the dive. Why? I even thought about it.

I usually tell my students during their training that if they think about calling a dive, the dive is already called and they simply have to inform their team. I didn’t call the dive because I wanted to dive, because of all the effort I had put in, because I had already “lost” one day there, because other people were there to support my dive, because I wanted to know if everything works so I could make further plans, because I have to get this done, because I need to know if my configuration is better, because, because, because a thousand different reasons of which not one has any value compared to the outcome.

Looking back it is all so obvious and clear.  However, it wasn’t back then, I thought I would be just fine. My Ego needed adjustment and it got it!

We entered the water super late; this threw my focus off target, instead of relaxing and visualizing the dive, I focused on the late start.  I did my bailout exercise and finished my dive running a VPM B algorithm which I padded by about 20 minutes divided on the last stops to account for the pre-dive work as well as the workload and higher breathing rate during my fast exit. When I surfaced felt a slight pain in my left shoulder and the right ankle which I explained by the pre-dive work (lowering the tanks with my left arm), heavy kicking on the way out swimming at 60ft a minute in full gear with bailout tanks and the probability of a very minor Type 1 DCS hit. The pain disappeared in less then 10 minutes and I had no other symptoms.

Usually at the end of the dive we rest and eat on the platform, close to the water, for at least 2 hours to give our bodies time to recover before climbing up and evacuating the gear.  However, this time we omitted the rest period because it was getting dark which would have made the drive out more difficult and increased the risk to the vehicles. So, I climbed up and helped the support diver hoist the equipment out as fast as possible.

On the way back to Playa del Carmen, I got a phone call from Alain who happily announced that he had taken the next day off to support us. “Great!” I thought.  Since we had agreed to only dive there with support, every member of our support team is a working dive instructor with very limited time, and with the high season coming in fast, I feared it would be impossible to get enough people together. Maybe that is the reason I felt so pressured to dive.

Back in Playa, we went to Protec to blend for the next day and after a lot of work I finally arrived home at 22:00h. When I cut tables for the following day, I decide to go with the more conservative VPM B/E algorithm.  I took this step to add conservatism in consideration of the pain, all the work and two days of back to back deep diving.  The change to VPM B/E gave me 40 minutes more decompression then the previous dive, Pit Revisited, which had the same profile and longer bottom time.  I considered this more then an ample amount of decompression time.

The next morning, we got out of Playa a little late.  And as Hans was setting up his gear he had an equipment failure and called his dive.  I started my dive alone and felt great.  I found the alternate line into Jills Chamber and was super excited.  The dive was going really smoothly until I experienced a strong pain in my left shoulder on the 12m (40ft) stop while moving my arms. (The hyperbaric physician stated later that excess motion could have triggered bubble formation). Within minutes, the pain pretty much disappeared and so I went through the rest of my decompression padding my stops further due to the unexplained pain.

As I ascended through the last 3m (9ft) the pain in my left shoulder returned and I got a new pain in my both my ankles, the pain was significant. As I contemplated what to do I stayed on O2 breathing from the loop.  After 10-15 minutes, I hauled myself up on the platform doffed my gear and started breathing Open Circuit O2.  I stayed on the O2 until I decided that it wasn’t changing any of my symptoms.  Once off the O2 I started to feel better and better and after 30minutes I was free of pain or any other sign or symptom of DCS.  At this point, I was a bit confused and I scanned my body rigorously for any remote signs. We left the jungle and I felt great! First, my dive was awesome.  Second, I thought I had very closely escaped a chamber ride…Boy was I wrong.

After dropping people and gear I came home and since it was late I ate something and went to bed, still without pain or any other symptom.   The next day I woke up with sore muscles in my left shoulder. Nothing unusual after challenging day in the jungle, however, given the episode I was worried and cautious. As the day passed the pain didn’t change but I had no other symptoms which drove me mad. Here is what I thought,

“If I go to the chamber and tell them the kind of diving I did, they will put me in no matter what and I will not be allowed to dive for at least 6 weeks. Given that diving is my only income and that in the past 6 years the longest brake I took was about 3 weeks that thought was unbearable. It did not help that my work calendar was filled with bookings.”

So, I decided to breathe oxygen to see if that would make any difference, which it didn’t.  Next, a friend came over, who is working a hyperbaric chamber operator, to give me a neurological exam, which came out totally ok. However, I was still very unsure what to do. After some talking, I decided to go to the chamber and see the physician. He gave me the same exam which came out clean, again.  However, as anticipated he sent me to the chamber for a table 6 treatment.

My shoulder pain didn’t change during the treatment, however my right ankle started to hurt on decent and then stopped. Five hours later I exited the chamber in the same condition I entered, except I was more tired and my lungs were burned. The next day I returned with the same issues and so I went back in for a table 5 treatment which I exited unchanged again.  After 5 treatments and no changes they switched the plan to table 9 and I did two more treatments to a total of 7. The last two days I had some relief in the shoulder in the evenings but the pain pretty much came and went and alternated between my ankle and the shoulder.

It was a very difficult time with a lot of emotional episodes. Blaming God and the world for what happened to me and questioning what went wrong over and over again with endless discussions and the opinions of every diver that crossed my path. (Some of which where helpful).

After that my treatment was suspended due to the fact that it seemed not to change anything. I was prescribed anti-inflammatory medication for two weeks and another doctor visit in two weeks. After 5 Days on medication the pain started to fade and now it is sometimes on, sometimes off, sometimes strong, sometimes week. But generally it seems to fade.

I asked the question, “When can I return to diving?” And no one knows. Five different doctors give me 6 different answers ranging from 5 days after pain dissolved up to 3 months. It continues to be a difficult time, I have many questions and there is nobody there to answers them.

Summing up, I think my accident (if you can call it that way) was an accumulation of many things. I believe that the mix of hard work, repetitive long deep dives,  pre-existing injuries caused by the dive the day before and all the other stuff contributed to situation I find myself right now.  Do I regret it? Yes, of course. Will I stop this kind of diving? Of course not! But I definitely learned a lesson or 7.

Safe Diving,
Patrick

I want to thank DAN and the local chamber for doing an excellent job, Hans, Alain, Matt, Steve, Nando, Etienne, Alex, Santiago, Maura, Victor, Allie, and many more for their moral support. I also want to apologize to my family and my girlfriend for putting them through this.

9 comments

1 Ross { 12.31.08 at 9:25 am }

Hi Patrick, I am glad to read that you are getting better. Your report is detailed and I think you have nailed the culprits.

I think it would probably be helpful to speak to a hyperbaric physician that is primarily involved with commercial operations and ask what the standard protocols are in such cases and how soon divers are allowed to return to work.

Well, enough of this. Milena and I wish you a Happy New Year and a speedy, complete recovery. Hope to meet again in ’09.

Ross.

2 sonny { 01.01.09 at 3:38 pm }

Hey Patrick and Hans,

Happy new year. We know you would be ok… dive safe

sonny & hannah

3 Patrick { 01.04.09 at 7:18 pm }

Hey Ross,

Nice to hear from you. I am recovered and back at work. Happy year to and Milena too, come back soon, you are missing out!!!!

cheers,
Patrick

4 Patrick { 01.05.09 at 6:56 pm }

Hey Sonny,

happy to know you are doing fine. Happy new year to you, hannah and rambo…

hope to see you soon back here!!!!

cheers
Patrick

5 Ross { 01.05.09 at 8:58 pm }

Can’t wait man, can’t wait!

6 John Katerenchuk { 01.23.09 at 8:54 am }

Patrick

Just go around to reading you account. It’s been kind of hectic here.

One thing that I thought about that you might want to consider. My suggestion comes to mind because a dive buddy of mine had a very similar issue when we surfaced from a deep cave dive. Because of his background and hyperbaric knowledge he decided to immediately do an in water recompression. I supported him by keeping watch and ensuring gas supply. The result was quite good in that upon surfacing from the in water recompression his pain was gone.

I bring this alternative up as I know Hans and you have very detailed and well thought out protocols. You may want to consider adding this method as an option to your protocol list.

John

7 Mark Chase { 01.23.09 at 11:43 am }

Hi Patrick

Sorey to read this M8, but If I understood Hans coment corectly your back in the water again. Thats great news.

Its a strange one. A frend went in the pot for sholder pain and came out with the same pain. They told him it wasn’t a bend if recompresion and 02 didnt help?? So he took Ibroprofen to manage it and a week or so later the pain went away.

I had thaught this would have been the case with your discription so I was surprised about the multiple treatments.

I am loving reading about the dives thanks for all your reports. Team Chaos (Me Howard and Janos) will be out to Protec in March 14th to the 20th so pop round one evening for a bear on us.

ATB

Mark

8 Patrick { 01.26.09 at 10:07 pm }

Hey John,

Thanks for your post. As I wrote in one of the articles in water recompression or simply dropping back down till the pain stops and then slowly working my way up went of course through my mind but given the CNS load, my body temperature and the 4h run time I decided against it. I just spoke though to one of the responsables today and got the green for the habitat…and soon I have some time of work 😉

cheers
Patrick

9 Patrick { 01.26.09 at 10:16 pm }

Hey Mark,

good to hear from you, even better to know that I will see you soon…
well my story is actually quite complicated. After the treatments I took anti inflamatory meds for a month and still the pain was the same but my stomach was f**** after that the hyperbaric doctor sent me to an orthopäd.

My shoulder he immediatly diagnosed with a trapped ligament and the ankle afetr an xray with capsolitis.
Then he ordered bloodtests and my rheumatocides or smth like that are double the normal value which indicates that I have rheumatic artritis and after yet another blood test they found that I had a slight salmonella poisoning which, and now it gets interesting, can cause artritis…I wouldnt have believed him if I would not have seen the same on wikipedia…

All in all a long, painful and strange story…but it gave me a new perspective on my diving, my carreer and generally my life.

I am back in the water and working hard since mid december and the pain in the shoulder and ancle comes and goes but I really kinda got used to it already. Sometimes I am even days without pain…

Well then, c u and team chaos soon,

Patrick
P.S.: I will be back at the Pit soon too 😉