Safe to Fly?
Phil’s trip to the islands had been perfect. It was a work trip, but he’d managed to squeeze in two days of diving. On the plane, he got out his laptop and began editing his images. He wanted to post them to Facebook as soon as he got home. While sorting photographs, Phil noticed his neck and shoulders were stiff. He made a promise to spend a little more time in the pool swimming laps — there was no reason that carrying gear should make him this sore.
After the drink service Phil felt really tired. He attempted to get some sleep, leaning his seat back to stretch out, but he couldn’t get comfortable. He was suffering from decompression illness (DCI) but didn’t recognize the symptoms.
Phil had been diving for seven years, working dives in around his work schedule. He averaged about 20 dives a year but considered himself an avid diver, taking classes and attending dive-club meetings as often as he could.
Though he got his open-water certification after he graduated from college, Phil finally was making enough money to afford more dive trips. He’d always been in good health, but a football injury in high school had fractured three vertebrae in his lower back. Swimming was his preferred form of exercise now.
Phil’s company sent him to Hawaii for a series of meetings, and he got an unexpected bonus when his business concluded two days sooner than expected. Phil did exactly what any diver would do: He booked two days of diving. Phil was glad he’d brought along his housed camera; for Phil, the diving wouldn’t have been nearly as much fun without it.
Phil made four dives on his first day: After two morning boat dives, he took the afternoon off and then made two more dives that evening. He was back at the dock 12 hours later and completed two more dives, beginning with a dive to 80 feet for 25 minutes. While the boat moved to the second location, Phil relaxed in the sun, allowing himself the chance to off-gas nitrogen. Following a 1.5-hour surface interval, Phil made a final dive to 60 feet for 35 minutes.
Phil felt fine the rest of the day; he relaxed by the pool and caught up on e-mails. That evening, he had a couple of alcoholic drinks with his dinner to celebrate a successful trip, and went to bed tired but happy.
The next morning Phil woke up feeling run-down. He felt some soreness and stiffness in his shoulders and elbows. He rationalized that it was caused by the effects of the trip and two days of diving.
Nearly 30 hours after his final dive, Phil boarded a plane for the flight home. After his first flight he was still feeling a bit fatigued, but wrote it off to the tough travel. He made his connection and spent another couple of hours in an airplane. When he landed, he drove to his mountain home at approximately 5,000 feet above sea level.
For the next four days, Phil felt tired and fatigued. He thought he’d caught a cold on his flight. After dealing with the aches, pains and exhaustion for most of the week, Phil made an appointment to see his doctor. By now, six days had passed since his symptoms began.
At the doctor, Phil complained of shoulder, elbow and wrist pain on one side. He also noted that he felt fatigued, and there was a dull pain in the muscles of his back and upper chest. He also told his doctor about tingling and numbness in the right hand and forearm. During the examination, the doctor found that Phil had some difficulty concentrating and his short-term memory was impaired.
Fortunately for Phil, his doctor was also a DAN referral physician, and had recently refreshed his knowledge of diving medicine at a diving and hyperbaric medicine course. The doctor diagnosed DCI and referred Phil to the local chamber.
Phil was treated at the hyperbaric chamber with a U.S. Navy Treatment Table 6. That initial treatment resolved all his symptoms, with the exception of some remaining mild fatigue and muscle soreness. He received a second hyperbaric treatment the following day with complete resolution of all of his symptoms.
This case illustrates the point that mild symptoms of DCI can easily be confused with other injuries and illnesses. Symptoms of DCI usually begin within six hours after surfacing from a recreational scuba dive. While flying 18 to 24 hours after a dive is usually safe, occasionally symptoms can be precipitated even after a longer interval.
In Phil’s case, some symptoms were present before his first flight. The reduced cabin pressure on the airplane — most commercial airliners pressurize the cabin to between 5,500 and 8,000 feet — increased the pressure differential in Phil’s body, causing more nitrogen to come out of his system, creating bubbles and triggering additional symptoms of DCI.
Phil was fortunate his symptoms were fully resolved. A long delay from symptom onset to treatment with the exposures to altitude — both during the flights and at his home — could have made his symptoms more difficult to treat.
Phil has returned to diving with no additional problems, although he now dives more conservatively, allowing more time between dives and before flying. He has also continued his diving education to better understand the conditions that cause decompression illness.
LESSONS FOR LIFE
1 Dive conservatively and avoid exceeding the limits of the tables or your dive computer.
2 Allow plenty of time between dives and before flying home. Don’t push these limits either.
3 Learn the symptoms of decompression illness.
4 Every diver is different. Pay attention to your body and the symptoms, especially symptoms that appear shortly after a dive.
5 Don’t be afraid or embarrassed to tell other divers in your group or dive leaders about your symptoms. If you aren’t sure about what you are experiencing, call Divers Alert Network at 800-446-2671.
Eric Douglas co-authored the book Scuba Diving Safety, and has written a series of dive adventure novels and short stories. Check out his website at booksbyeric.com.