Subaqua Sternal Rubs

Based on DAN data, I am now one of the top 90 divers in the world. Or better yet, bottom 90, because I was stupid enough to get Type II Decompression Illness with some neurological symptoms.

You all no doubt remember my foolish dive attempt last week. Well, after the dive, I started feeling very nauseous and vomited a couple of times over the side of the boat. Soon thereafter, I started feeling pain and numbness/tingling in my extremity joints. I had initially attributed this to hyperventilation and hypocapnia. However when the symptoms persisted over the next 24 hours, I began to suspect some sort of sub-clinical variant of decompression illness.

The next day after the dive I presented to the University Health Services Clinic for evaluation. After intake history and vitals by the nurse, I saw the doctor on call. He was in agreement that I had decompression illness, and his advice was to go home and rest, after taking acetaminophen and some fluids. He said the illness would resolve by itself, but when queried on how long it would take, he really didn't have an answer.

The worst part is that I believed him, despite my diving and medical training. See, the thing is, I have been in Emergency Medicine (both EMS and the ED) for too long, and I have a become slightly jaded with regards to medical emergencies. Basically, unless you 1) don't have a pulse, 2) aren't breathing, or 3) have a condition that will lead to point 1 or 2 within 10 minutes, I really don't consider it a true emergency. (When people call 911 repeatedly at 4 am for a condition that they've had for months and aren't dead yet, you'll get this way too.) As I wasn't having any difficulty breathing or any symptoms more serious that a little pain/numbness/tingling, I didn't consider my condition to be too dire, so I took the doctor's advice and went home.

The next day, I showed up to Pathology lab in the afternoon ready to present my slides for my group. However, I relayed my symptoms to my dive buddy, who happens to be in my group, and he seemed to take it more seriously than me, since he convinced me to get a second opinion. Evidently at that point my symptoms had progressed slightly, since my friends said I was walking like a drunk person (ataxic gait) and was slightly confused, again like I was drunk (I failed the mini-mental state exam). These symptoms were slightly more ominous as they indicated that the nitrogen bubbles were starting to affect my central nervous system (brain and spinal cord).

With the progression of the illness, I sought the opinion of a second doctor (one of the primary MD's in the University Clinic). He believed I needed hyperbaric oxygen therapy sooner rather than later. Unfortunately, Grenada does not have a hyperbaric chamber on the island, so within two hours the school had made all the arrangements, and I was on an air-ambulance to Barbados. Though completely unnecessary in my opinion, the school was kind enough to send a physician (one of our clinical tutors in Pathology) with me on the flight. The flight was very nice and short (only about an hour).

Once in Barbados, Customs and Immigration met the plane and cleared the doctor and I. Shortly thereafter, a Land Rover ambulance from the Barbados Defence Force (BDF) rolled on the tarmac. Since I could still walk, I climbed out of the air-ambulance and into the ground ambulance, seating myself on the bench seat. However, the BDF EMT wouldn't allow it, saying I had to be on the stretcher in the Trendelenburg position (feet raised). The EMT also put me on oxygen via non-re-breathing face mask for the first time since the accident happened. Now I have put oxygen masks on thousands of patients, but it was the first time I remember experiencing it. The plastic does make the oxygen taste funny.

Once I was on the stretcher, we took off for St. Ann's Fort, The Garrison, (the decompression chamber is on the BDF compound) with lights ablaze. I told the crew that I would prefer not to use the lights since it was associated with increased risk of accident, and I didn't feel my condition warranted it, but they stated the lights had to be on whenever a patient was in the back.

Upon arriving at the Fort, I was taken to the Medical Receiving Station (BDF Hospital) and had my intake history and vital signs recorded. Compared to my initial VS, I seem to have relaxed a bit (150/90, P100 vs. 100/70, P60). Since there was no staff available at the chamber the night I arrived, I was placed on oxygen via nasal cannula for sleeping, and my hyperbaric treatment was scheduled for 8 AM the next morning. The accommodations at the MRS were decent, but unfortunately they had no air-conditioning. There was a nice breeze, and with all my experience with no A/C in my dorm room, the temperature did not cause any sleeping problems (only the joint pain). However, I did end up with at least 25 new mosquito bites as a result of my open window. I was placed in the "isolation" room of the medical ward. Good thing about that is I got my own bathroom with shower, the only problem is that is were all the people with all the weird infections go, so I hope no microbes were still around…

After being woken up at 5 in the morning for vital signs and breakfast (I knew there was a reason I would never make it in the army), I met with the Hyperbaric Physician, who examined me and recommended two dives in the decompression chamber. The current chamber in Barbados is relatively new. (Pictures of old chamber) It is relatively large, with two interlocking compartments and space for 6-8 divers in comfortable chairs. I spent the next 5 hours in the chamber with another gentleman called a "tender" who was there in case something went wrong. It was pretty boring, but I brought in some of my medical textbooks, so I was able to get some studying done. (Pretty much the only way I was going to study Nutrition was to lock me in steel container with nothing else to do.) Unfortunately, I couldn't sleep, since every 20 minutes or so, I had to take an oxygen mask on and off.

The first treatment helped significantly, and was able to clear up the more worrisome symptoms of ataxia (unsteady walking) and decreased mental status (confusion). The joint pain/numbness/tingling also resolved, but unfortunately came back later that night. After the treatment was done, I spent the remainder of the day resting in the MRS and having some new food experiences. I ate Shepard's Pie for lunch (some sort of combination of ground beef and mashed potatoes), and lamb for dinner, both for the first time ever. The Shepard's Pie was good, but for some reason the flavor of the lamb was a little too strong for me, so I couldn't eat it. I eventually got hungry enough that I did manage to eat some sort of whitefish fillet.

The next morning I was woken up at 4:45 AM to check my stable vital signs and breakfast. At 7:30, it was time for my second chamber treatment. This time, I was in the chamber with another patient (who was there for wound issues after complications with compartment syndrome) and two tenders. The other patient had been in the chamber a few times before, so he knew to bring a DVD with him (they have a TV/speaker system set up). Unfortunately, I really didn't get into whatever Jamaican dance video it was. After the second treatment, I again felt better, with only minor occasional joint pain in the fingers. The doc said this would take months to go away, if at all…

So now I am done with my treatments, but I am still in Barbados. Since the insurance company didn't want to shell out thousands of dollars for a low-altitude charter flight back, I will have to wait until Monday so I can fly a commercial flight. Cost of that? $30-50, which is what the flight evacuation insurance cost. Well, they did cover the thousands of dollars for the initial air-ambulance. And my diving insurance with be covering the thousands of dollars for the hyperbaric treatment and accommodations, so that's all good… Though I did change my accommodations after I no longer needed medical treatment to the Hilton. I know, I know… It's a bit expensive, but the insurance should cover up to $2,500 in accommodation, so I am hoping that I won't have to pay for it. I really didn't mind the accommodations at the army barracks, but two things were getting to me: 5AM wake-up for no apparent reason, and the mosquitoes.

Well, now I have a few days to relax on "vacation." Unfortunately, I do have that Nutrition exam Monday, so I will have to keep studying, though I don't know what time the flight is going to be yet (the insurance company has to make arrangements), so I don't know if I will even make the exam…

Other than that, I'll update again when I am back on Grenada…

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