D.C.S. ::: Dive Cozumel Soon even though I got DeCompression Sickness

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North America » Mexico » Quintana Roo » Cozumel
October 15th 2009
Published: May 22nd 2011
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I came to Cozumel to DIVE. There is a ferry that runs every hour from Playa del Carmen to Cozumel, and its an air-conditioned, smooth, 45 minute ride to this island that marks the start of the Mesoamerican Barrier Reef. The dive shops are numerous, as are the dive sites, so I know I am in the right place! I walked a bit out of the main tourist zone and found the Dive Paradise shop, located next to a flaming orange building called the Hotel Barracuda. They have a multitude of diving packages, and the 9 dives/3 nights at the Barracuda was the one for me!

Those nine dives added more to my dive log than I could have ever expected! Each dive brought a litany of new creatures to the front of my mask. The first exciting encounter was with the Splendid Toadfish, endemic only to Cozumel. This blue and white speckled bottom dweller buries under coral shelves and has a white anntane beard that drags along the sand. I next was lucky enough to be the last diver remaining with the dive master when he spotted two seahorses with their tails wrapped tight on a slice of sea grass in about 12 feet of water! Another dive was a dream….leading us through coral towers over 90 feet tall and wide swim-through formations hiding every size of friendly fish. My final dive of the series was a shallow wreck dive at 60 feet. The wreck has an easy penetration through the top cabins, and it was magical to discover who was living around each corner! After a long hallway, we swam through a doorway and “stepped” onto the bow of the large ship at the bottom of the sea! We continued on to the coral, and did a bit of lionfish hunting. (The lionfish is a beautiful fish-- but it belongs in the Pacific and Indian Oceans - it’s an invasive species has no natural predators in the Caribbean and is highly toxic and aggressive towards our local fish populations.) While searching for an escaped target, I spotted a grouper and green moray eel team hunting! They were traveling together flawlessly, weaving between coral heads and other fish in perfect synchronicity. Then the eel shoved its head into a small crevasse and started thrashing the rest of its 6 foot green muscle of a body through the water as it fought whatever was inside! Meanwhile the grouper waited outside the entrance for any of the scraps or other escapees! Fascinating!!!!

I came up from this exhilarating dive with a huge grin and absolute awe of the underwater playground I had visited all week. As I started removing my gear, I said aloud to no one in particular that I had a slight headache. It wasn’t pressing, but as headaches are unusual for me, I definitely noticed. But it went away as quickly as it came and my buddy and I started reliving the highlights of our dive. A few minutes later I again said aloud to no one that my hand was tingling and had fallen asleep. This immediately alerted my buddy - she pointed out that I had just mentioned a headache and now I was complaining of tingling….two symptoms of decompression illness.

For you non-divers out there, let me explain decompression sickness, also known as DCS, or “the bends.” When diving, we expose our bodies to immense amounts of external pressure from the weight of the water, but we don’t FEEL the pressure because our tissues are pliable and negate the difference. Of course there are a few physiological effects that cannot be ignored, one the most important being the way our body processes the air we breath. As you know, air is 78% nitrogen and only 21% oxygen …Under this intense pressure, our body is not able to properly expunge the nitrogen inhaled and the gas becomes trapped as bubbles in the body tissues. (This is the reason for the mandatory “safety stop” at the end of a dive. At a minimum, every diver stops at a depth of 15ft for at least 3 minutes in order to allow the nitrogen to disperse naturally.) If a diver goes too deep for too long OR surfaces so quickly the bubbles cannot naturally dissipate, the diver will get DCS. DCS Type I is the most common of this illness (and the one referred to as “the bends“) and it occurs when the nitrogen bubbles are trapped in the joints of the individual. DCS Type II is a bit more serious as it is a neurological “hit” and the nitrogen bubbles are trapped in the spinal cord. And now back to my story ….

I alerted the dive master of my symptoms and he immediately took to action - he sat me down in the shade, gave me lots of water to drink, and hooked me up to the 100% oxygen tank. They made a call to the dive shop to arrange for a transfer to the local hospital with a decompression chamber and at this point I was like, whoa-whoa-whoa, don’t you think you’re overreacting a bit? I was within the no decompression limits of my personal dive computer, and the last dive was only to 60 feet with an extremely slow ascent (we took about 10 minutes to go from 60 to 15) and an extra five minute safety stop (because I will admit, at 60 feet I came within a minute of hitting the computer’s no decompression time limit.) The crew assured me that in the rare instances of DCS (only 1% of divers have been hit,) time is of the essence and it’s better to be safe than sorry.

The owner of the shop, Apple, was waiting at my hotel dock to take me to the island’s hyperbaric chamber and to see Dr. Pascual Piccolo. By this time, both of my symptoms had subsided, so I didn’t have much to report to the doctor …. I told him of my fleeting headache and tingling and gave him my dive profiles from the previous 3 days. I passed his series of balance and reflex exams, so he decided I could be dehydrated and hooked me up to an IV for 30 minutes. The hospital staff was kind and English-speaking, making me feel very comfortable in the sterile, air-conditioned room. While I was lying there, I felt the tingling in my hand a few more times, but chalked it up to the fact that the IV was inserted into the back of that same hand! (Now that’s some denial!) After my hydration, I assured the doc that I felt fine and he could release me to the wild. He complied but with strict instructions to be ultra sensitive to any abnormal feelings and to return at 8am for a follow-up exam the next morning.

Still feeling confident that this illness couldn’t happen to me, I walked the 20 minutes back to my hotel instead of taking a cab. As I was walking, the tingling intensified and turned into more of a pins and needles feeling. Now I’ve started to question what’s really going on, and decided to at least follow the doc’s advice of no alcohol, lots of water, and bed rest. As the night went on, the sensations in my hand continued to intensify (then diminish completely) and by the time it was morning, I was quite scared and looking forward to seeing the doctor.

When I walked in the small office at 8am, I was surprised to see my dive buddy Tiffany sitting there…as she was supposed to be on the boat doing her last day of diving! Apparently she had had a rapid ascent because of a snagged reel line the day before and had started to feel incredible pains in her shoulder and elbows in the middle of the night. She had come in very early this morning and was in scrubs waiting to enter the decompression chamber….I had a pretty good feeling I’d be joining her!

Doc was not surprised to hear my complaints, and apologized for letting my leave the afternoon before. He suspected a neurological hit, and after another series of eye coordination, balance, and strength tests, he diagnosed the DCS Type II and told me to gear up to ride with Tiffany! I was relieved to be going in the chamber with a friend, and also fascinated by the medical diagnosis and scientific process.

The hyperbaric chamber comes in all different sizes, but it’s function is the same. The chamber recreates the pressures experienced at a specific depth, and you remain under these pressures for a predetermined amount of time, allowing the body to naturally dissolve the intruding gas bubbles. The chamber in Cozumel was a cylinder about 7 feet long and 5 foot diameter. There were two cots mounted on each side of the cylinder with equipment for two patients at once. Tiffany and I climbed in and a hyperbaric chamber technician followed us. The tech stayed in the chamber with us during the entire 4 ½ hour treatment…..and I thought I used to have an odd job!

Most of the time in the chamber, I had to wear an on-demand oxygen mask that delivered 100% oxygen with every breath. The mask was a heavy duty black gas mask that was strapped to my head in two places and covered my entire mouth and nose with its smelly plastic weight. Every breath I took sounded like Darth Vader of the Deep! The pressure inside the chamber was slowly increased to the equivalent of a 60 foot depth (the entire time having to equalize by popping the ears, similar to when descending in a plane,) and there we sat for 4 hours. Lucky for us, this chamber had a projector showing our pre-selected movies on the inside curve of the cylinder! We had to wear the masks for 49 minutes on and 4 minutes off….that 4 minutes was so GLORIOUS!!! 😉 At no time did I feel claustrophobic or frightened to be in the chamber, but the weight and fit of the mask was almost unbearable. Those 4 minute breaks were way too short, and when the chamber started hissing and clunking -- signs that we were slowly being unpressurized and the end of the ride was near -- I was thankful!

The rules of treatment were clear -- after the chamber ride there was to be NO FUN. No caffeine, no sun, no alcohol, and no physical activity. It was Tiffany’s last night in town, so she asked, “Can I go on the sunset cruise we planned for tonight?” The doc opened his top drawer and pulled out a postcard sized piece of junk mail where he had written in Sharpie on one side “NO.” “What? But it’s my last night! How about just one glass of wine with dinner?” He held up the sign again with a knowing smirk. “NO.“ I saw him use this postcard at least a dozen times on half as many people …. Seems all of us divers were in denial!

The doc was heading our way, so he gave both of us a ride in his air-conditioned, tinted window, black SUV. I went straight to bed, as ordered, and watched Beverly Hills 90210 reruns and TNT movies while enjoying the techno tunes from the Oceanside pool below me. I drank gallons of Gatorade and water, and by dinnertime I was convinced I was healed and ready to grab some Turkish food from the hotel restaurant! Yeah! The hotel pool/restaurant! I couldn’t have found a better fit for my personality and recovery than this spot - not only was it clean, friendly, on the ocean, reasonably priced, and had a sunken plane you could snorkel right off the dock … BUT ALSO the poolside restaurant is run by a Turkish couple serving all your favorite Mediterranean dishes (cacik, falafal, hummus) and the place is packed each day with the cruise ships staff members enjoying their day off! I met so many people from around the world that were engaged in a smattering of activities on the boat: waitress, pool activity director, casino dealer, and even a break dancer!!
Anyways, the staff at the restaurant were ridiculously friendly, and knew me by name and itinerary, so they were surprised to see that I had stayed an extra day! As I was telling my story, a few other divers at the bar interrupted me and began to ask questions. Inevitably, the first question was always, “So, what did you do wrong?” (Nothing….it was a normal, routine dive!) Follow up question? “Oh, well how deep did you go?” (60 feet…a very shallow and common recreational diving depth.) “Oh!” And that’s when they got the it-could-happen-to-me? look.

Yes! It can happen to you!

At this point, I was feeling very comfortable about my healing progress….I had followed the strict doctor’s orders, and none of my symptoms had returned! I was enjoying sharing the experience with the divers, and discussing preventative measures (my biggest lesson learned::: drink MORE WATER!!!) and other diving safety issues. After a fantastic dinner of falafel, tabouleh, tzatziki, and warm pita bread, I went back to my room for more resting. But after about an hour, the stinging and pins and needles returned in my left hand. I was crushed! Nooooo! I chugged the water, willing it to go AWAY!

But it didn’t. I woke up at sunrise, and watched the divers get picked up from the end of our dock with jealous eyes. Oh, the amazing surprises that awaited them today!!…..And I‘m stuck in this stupid bed. (You can all guess that I’m not a very good rester.) I had another 8am appointment with the doctor, and I gave him a full report -- expecting him to send me home for more rest. But instead he threw a pair of scrubs at me and told me to get ready for another chamber ride. Only 3 hours and 15 minutes this time! (That’s only two movies, instead of three….much improved!) He said the chamber rides will continue until there is absolutely NO SIGNS of the tingling for over 24 hours. If not treated to completion, the condition will become chronic and remain with me for the rest of my life.

By now, Doc knew a little bit about my medical background, so he started teaching me the physiology and physics behind what was going on in my body and the chamber. He showed me a photograph in a dive medicine textbook showing me a cross section of the spinal cord ….imagine you grab a handful of raw spaghetti noodles and you look at it from the top…you are looking at all of the nerves running from the brain to the various parts of the body. Now imagine there is a black spot, or gas bubble, squeezed in between the tightly packed noodles (or nerves) and to make room for itself, it’s compressing the surrounding nerves….causing the nerve damage/tingling/pins and needles feeling in my hand. The doctor had to keep reminding me that it wasn’t my HAND that was injured….it was my NECK and SPINAL CORD! Oh no. I see a lot more resting in my future.

He gave me a lengthy scientific paper discussing all the aspects of DCS, from prevention to symptoms to treatments, and I was absolutely fascinated. Here I am in what should be a scary situation…in Mexico…by myself…but I’m floored - I’ve found a combination of my two passions! Diving and medicine! It’s brilliant! Buuuut, hold the excitement. I’ve got a few more days of treatment first.

That’s right, I ended up in the chamber for five mornings in a row, followed by five entire days of bed rest at the Hotel Barracuda. Of course, it wasn’t the worst place to be stuck. I had an ocean view from my bed and a few TV channels in English. The nightstand didn’t have a Bible, but an orange book of Buddha’s teachings that I found incredibly insightful and interesting! Across the street was a MEGA food store that had the most marvelous selections of fresh bakery every day, exotic imported salamis and cheeses, and produce we don’t see in Belize like red peppers and avocados!

And I made quite a few friends as they passed through the hotel, including some cool Canadians Jeff and David that were newly certified divers. We talked about diving, traveling, and food -- but also about the universe, ancient civilizations, and soul mates! Jeff and David rented a car one day and invited me to join them in a tour around the small island. Since it was my last day of treatment -- simply under observation for an 24 additional hours before being released back to Belize -- I packed my sunglasses, hat, and a few giant waters, and figured it’d be OK to join them! We stopped at numerous small rum shacks on the side of the road with nothing but beach and sea in both directions. I even found a T-shirt signed by a family from Peshtigo, WI inside one of them!
Finally, after an extra week in Cozumel, I was cleared to leave. Good friends by now, Doc invited me to join him and his wife and son at breakfast that morning before catching the ferry. His wife was a nurse in the states and we had a great conversation about the pathways to dive medicine. They were very encouraging and overall exceeded my expectations in every aspect! I felt lucky to have had them taking care of me all week, and I’m sure I will stop by and visit my old friends (including the chamber) next time I’m in town!

Now, I’m sure you are all wondering …. How much did all of that cost? Divers -- listen up!! There were two very valuable lessons I learned on that Cozumel trip and bout with DCS. #1. HYDRATE. Start hydrating the day before and continue throughout your dive series! Think of the extremes you are offering your body: sun, salt water, physical exercise, inhaling compressed air, pressure at depth, and most likely you are on vacation and had a few beers, rums, sodas, or coffees! And #2. DO NOT DIVE WITHOUT DAN INSURANCE! The DAN (Divers Alert Network) is an organization committed to researching and publishing everything about diving safety and medicine. I became a DAN member in May, and purchased the additional dive insurance -- total cost for one year was $75 USD. Then for $30 more I upgraded to a total trip travel insurance package, which means they would cover any expenses incurred if I should have ANY TYPE of accident outside my home country. So that was $100/year for basically medical, dive, and travel insurance! (And they publish a wonderful magazine quarterly that I read cover to cover and enthusiastically share with every other diver!)

The total of my five chamber rides, hospital fees, and Doc’s fees was $17,590USD. I paid $0. In addition, because I had the supplemental travel insurance, DAN reimbursed me for the 7 days additional hotel nights, all my food over those days, and paid for a flight home…which I took instead of a bus to continue protecting my neck injury. They sent me a check for over $700 within weeks of me submitting my receipts!! Why would you dive without this insurance???!?! (Especially since most of your health insurance policies at home specifically will NOT cover dive accident expenses!)

Additional photos below
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14th September 2011

I re-read this blog again today
I hope all the divers take your advice on hydrating and the DAN insurance!! and since the DAN magazine comes to me first before I forward it on,not even being a diver I read it cover to cover it's so interesting and the pics breathtaking!! am glad you are blogging again and there will be a new one soon, even tho you are WAY behind in this department!! and love the HI MOM on your sandy legs. miss you as usual and love you tons, MOM

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