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Diver learns
the downs—
and ups—of
‘the bends’
Experience didn't protect this veteran
from many a diver's worst nightmare --
nitrogen bubbles in the bloodstream
leading to decompression sickness,
or 'the bends'Isles' only chamber took roundabout trip
Editor's note: Our Kauai correspondent, shown below,
an experienced diver, relates his experience with the bendsBy Anthony Sommer
Star-BulletinLIHUE -- I went scuba diving and I got bent.
Kind of embarrassing, for a seasoned diver. And, just a bit worrisome when I lost all feeling in my legs, was paralyzed from the waist down, and wasn't sure whether I was going to stay that way.
I was first certified in 1963. I've taught diving, worked as a dive guide, been a volunteer researcher on marine life studies all over the world, and since the mid-1980s I've been an avid World War II wreck diver: Truk, Bikini, Vanuatu, Palau, Kwajalein, Papua New Guinea, Guadalcanal, Tulagi.
In all that time, in all those hundreds of dives, I never got bent.
The good news -- beside the fact that I did get the feeling back in my legs -- was that I had a chance to see what a professional team of folks we have here in Hawaii to deal with getting the bends.During my six-hour stay at the University of Hawaii's Hyperbaric Treatment Center, I found out you actually do talk like Donald Duck when breathing a pressurized helium-air mixture.
I also learned you can eat a cheeseburger and fries while in a recompression chamber. But don't ask for a soda because it won't fizz at seven atmospheres. Neither will your blood, which is the whole point of being there.
No one can figure out exactly why I got bent on a routine dive when my dive computer, and more importantly all my experience, told me everything was perfectly safe. The best educated guess is that an asthma medication I'm taking may have altered the way my blood deals with compressed air, making me more likely to get bent.
Nitrogen overload
The bends officially is called decompression sickness, or DCS. When a diver goes underwater and breathes compressed air, the oxygen he breathes is used by the body but the blood becomes saturated with unused nitrogen, which makes up about 78 percent of the air we breathe.If a diver with nitrogen-saturated blood ascends without making decompression stops to allow the nitrogen to come out of solution and be exhaled, the gas can form bubbles in the bloodstream. The bubbles tend to become lodged in joints, causing a victim to double over in pain, or "get bent."
The bends isn't just for rookie divers who don't know what they're doing or experienced divers who do something astoundingly stupid. A veteran diver can get bent on a carefully planned dive doing everything right. It just surprises you a bit more when it happens that way.
So it was for me, on a recent two-tank dive trip from a tour boat to clear, relatively shallow water off Poipu on Kauai's south shore. My 22-year-old son, also an experienced diver, was my buddy on this bright, sunny Saturday morning. It was supposed to be a walk (or swim) in the park, "a three-hour tour" as they say on "Gilligan's Island."
We went to Sheraton Caverns and had loads of curious green sea turtles swimming nonchalantly around us.
We moved over to a nearby buoy for the second dive. Awesome. Three dolphins, which almost never come anywhere near scuba divers, cruised leisurely by and checked us out. Even the dive guides, who are in the water there every day, had never seen dolphins underwater. We were all really stoked.
Tingling, then numbness
Our maximum depth was 80 feet and the dive computer wasn't anywhere near going into a decompression mode. I went back to the boat, did a normal five-minute safety stop at 15 feet, climbed aboard, babbled about the dolphin and stowed my dive gear.About 10 minutes into the ride back to Port Allen, my lower back became very sore.
Then my feet and legs started tingling and I started to lose sensation in them. It was becoming increasingly difficult to move them.
It was obvious to me I had taken what divers call a "spinal hit" -- nitrogen bubbles in my spinal column were interfering with the nerves. I asked the crew to have an ambulance waiting at Port Allen.
The crew immediately put me on oxygen and I would be breathing oxygen for the next 14 hours. Breathing oxygen, preferably 100 percent oxygen, is the single best thing a diver can do to vent off excess nitrogen as quickly as possible.
An ambulance and fire truck waited at the dock. They took me to Kauai Veterans Memorial Hospital in Waimea, where I was X-rayed, electro-cardiogrammed and blood-tested.
Then I stared at the emergency room ceiling for a couple of hours. One of the drawbacks of living on Kauai is that the air ambulance has to come from Oahu. During the wait, slowly, gradually, feeling returned to my legs. After about three hours I could wiggle my toes, move my feet and bend my knees, and I knew the damage was not permanent.
Finally, another ambulance rushed me out to the Pacific Missile Range Facility, where the Navy crash crew helped load me aboard the air ambulance. We zoomed well under the clouds to Honolulu International, the better not to aggravate my condition. Then one more ambulance ride to Kuakini Hospital, sucking oxygen the whole way.
By then I was able to walk from the ambulance into the hospital. Didn't matter. I was still going into the chamber.
A 'real rush'
The recompression chamber is much larger than I would have imagined, perhaps twice the size of a standard condo kitchen. There's a door at one end and two side hatches into air locks that can be pressurized and depressurized so others can come and go during the six hours without affecting the pressure in the main treatment chamber.It's bright, but not particularly cheery inside. The decor is early submarine crossed with ambulance interior. While the patient, in this case me, is recovering inside, supervising doctors and medical technicians outside can watch on closed-circuit TV or peer in the portholes. There's a mattress on the floor and several chairs. I chose a chair.
Attendants, who are on call and only do this part time, each spend two hours in the chamber.
"Ever been narked?" asked the first attendant, a Navy diver who plans to go to medical school when his tour is complete. He was referring to nitrogen narcosis, a feeling of euphoria a diver gets from nitrogen breathed at high pressure on deep dives. I told him I had, quite often.
"Well, this is a real rush," he said, handing me a towel. Increase the pressure of a gas in a fixed container like a scuba tank or the propane bottle on your barbecue and it gets hot. Same thing in a recompression chamber. The towel was to wipe away the sweat.
A loud, hollow, high-pitched hissing sound signals our descent down to the pressure equivalent of being 220 feet underwater.
This "deep spike" is designed to force any remaining nitrogen bubbles back into my blood stream. Happily, I rarely have problems clearing my ears. My watch has a depth gauge, so I could see the numbers build.
At "220 feet," the chamber is filled with an air mixture in which helium, an inert gas that doesn't combine with anything else, replaces much of the nitrogen so the blood isn't becoming even more nitrogen-saturated.
Nothing to do but wait
While sounding like Donald Duck, I was acting more like Goofy. Instead of feeling anxious, which I expected, the narcotic effect from the high pressure was very pleasant. I was handed a bunch of forms to fill out: Name, address, telephone number, all the usual stuff. I couldn't do it without scribbling all over the page."We're traveling," a voice on the loudspeaker announced. It was a non-duck voice so I concluded it was coming from outside the chamber. I would hear that phrase many times over the next six hours, every time we "ascended."
Once we got back up to 60 feet and the danger of permanent paralysis was past, the novelty wore off. The cheeseburger gratefully eaten, the whole thing became much like sitting in a doctor's waiting room.
Like any doctor's office, the chamber is an elephant's graveyard for ancient People magazines. I read all about Bruce and Demi's happy marriage and how Pete Sampras was mourning the death of his coach. Pop culture deja vu.
My attendants took my vitals and adjusted all the things there are to adjust inside the chamber. After the Navy diver, I got a marine biology graduate student. We talked about marine biology and marine biologists in Hawaii.
The final attendant was a Honolulu firefighter who was truly fascinating because what he does on the department is the stuff of living fossils: he's a tillerman.
Shoeless and far from home
The tillerman is the guy who steers the rear half of those long, articulated ladder trucks that you hardly see anymore because fire departments aren't buying them anymore. When the driver turns left, the tillerman turns right. Best of all, every little boy he drives past waves at him.Finally, at 1:30 a.m. on a Sunday they were done with me and one of the staff gave me a ride to a hotel. For the first time it dawned on me that I was 100 miles from home in the middle of the night in a strange city and the sum total of my belongings consisted of a damp bathing suit, a damper T-shirt and a wallet. (Helpful hint if you ever send a friend or relative off on an air ambulance: toss in a pair of shoes.)
Staying the night and getting home to Kauai the next day provided the final lesson of my priceless adventure: Divers Alert Network insurance paid for the air ambulance and the chamber, but for everything else, there is indeed Mastercard.
Isles’ only decompression
chamber took roundabout
trip to KuakiniThe chamber's director says the
By Anthony Sommer
hyperbaric treatment helps divers
and nondivers alike
Star-BulletinI am grateful to Dr. Robert Overlock, medical director of the University of Hawaii's Hyperbaric Treatment Center, for making me feel better.
He wasn't there during my recent six-hour stay at the Oahu facility, though he was in touch by phone from his home on Kauai.
It was what he said when I talked to him a week later that I appreciated.
"Don't beat yourself up about it," he said. "I know people just like you who have been diving for decades without any problems and then get the bends for no apparent reason on a dive that wasn't the least bit challenging.
"Everyone is different and even the same person reacts differently at different times in their life. I've studied hundreds of cases looking for trends and the one thing I've learned is that there is no profile of an at-risk diver."
A diver since 1952, Overlock lives in Waimea on Kauai's west side and commutes to Kuakini Hospital on Oahu three or four days a week.
He served as medical director for the recompression chamber on Kauai, where he was in private practice, from 1979 until it was closed in 1994 because it wasn't getting much use.
In some of the Kauai chamber's final years it had zero patients. The Big Island also used to have a chamber, which is now also closed because there weren't enough patients to support it.
UH's chamber at Kuakini Hospital is the only one remaining in the state and it sort of ended up there by default, Overlock said.
For half a century the primary recompression chamber in Hawaii was the Navy chamber at Pearl Harbor, built in 1932 for submarine escape training. It was closed in 1983 when the Navy decided to scrap the training program.
"The Navy doctors actually were glad to treat civilians. Navy divers very rarely get injured so they were able to get lots of valuable experience treating commercial and recreational divers," Overlock said.
When the Navy got out of the chamber business, the state picked up some surplus hyperbaric chambers from the federally-funded "Man in the Sea" research project that was just ending in Hawaii.
Initially, the chamber belonged to the Department of Business and Economic Development and Tourism, apparently under the theory that the people who used it were either commercial divers or tourists. When that proved to be an unhappy marriage, it was shifted to the state Health Department.
"The Health Department didn't know what to do with it, either," Overlock said. "They aren't in the business of actually treating patients."
So it was moved again, this time to the UH School of Medicine, which doesn't have a university hospital and doesn't have any patients, either. Today it has a sort of stepchild status as a tenant at Kuakini Hospital.
The type of divers treated has changed since 1983, but the numbers have remained steady at 40 to 60 a year.
"In the early years we were getting a lot of commercial divers. They were still diving for black coral then, and fishermen would dive to set their nets. A lot of them showed up on our doorstep unconscious in the back of a pickup truck," Overlock said. "Today it's almost all recreational divers. But for reasons I can't explain the number we treat every year has remained very steady."
Most hyperbaric chambers take the patients "down" to a pressure equivalent of 60 feet below sea level, then begin a long slow "ascent."
Hawaii's chamber precedes that program with a rapid, short "spike" down to 220 feet, using the high pressure to quickly force any nitrogen bubbles back into the patient's bloodstream.
"It's a technique we adopted in the early years to deal with those commercial divers who came in with a long delay between the onset of symptoms and the beginning of treatment. It worked well, so we keep using it," Overlock said.
The center also treats 30 to 60 nondiver patients every week.
"Most are cancer patients who have undergone radiation treatment that has changed their tissues to the point they can't withstand a treatment surgery," Overlock said.
"We've found that with hyperbaric oxygen treatment before the surgery they stand a 100 percent better chance for a good outcome."
