Hi sheik,
Sorry for the late reply, I just got back from Sabah doing dive medical check-ups for our Bomba diving team.

With regards to your question, we had a case early this year, (actually he presented to us late last year, but his treatment continued until february this year...), 40+yr old man, commercial diver, brought in unconscious to Hospital Lumut. He did a provocative repetitive dive using a single tank, 3 dives in total, with short SI, 45-50 metres each dive. Also had a small pneumothorax...Diagnosis : Acute Neurological Decompression Illness. He had both elements of DCS and Arterial Gas Embolism based on the history given by the dive supervisor. I mean too long a dive, too deep, and PLUS, he ran out of air during his last dive, which made him shot straight up to the surface...

He completed about 30 sessions of hyperbaric oxygen therapy (HBOT), of which 5 sessions lasted about 5 hours...In the end, he was left paraplegic from the waist down, had minimal muscle power of his legs, but was able to control his micturation and bowel habits.

Although that was one of the severe cases we have had since the inception of this department, the worst cases have got to be those involving underwater loggers AKA divers in Temenggor dams and Banding dams. They were usually brought in unconscious, one had both-sided chest-wall pneumothoraces, but AMAZINGLY, after less than 20 sessions of treatment, they recovered well enough to even resume diving again!!! What amazes me even more is that the equipment they used, were not even meant for diving!! They had an air compressor with a garden hose attached to it, and modified the 2nd stage regulator to attach it to the hose, and Whalla!! You have yourself a Surface-supplied breathing apparatus!!

BUT PLEASE, DON'T TRY THIS WHEN YOU GO DIVING!!

Like all diving buffs, I always like to remind myself, as well as you guys, to dive according to your dive table...Don't depend too much on your DC. I never do!! Dive tables were formulated after years of research on the human body's capabilities to absorb inert gas...so to be safe, memorize your dive table, or if you can't, then bring it along during any of your dive excursions...

Yo bro,

Kalo tak salah I lah kan, about RM10 per session for our clinical hyperbaric cases, which is about 2h15m duration...tapi kalo diving recompression treatment I guess slightly higher kot...kitorang kat department tak brape tau sangat hal2 bayaran nie, but I'll check it up for u, okay!

Thanks doc!  

sheik,

good thing to hear that you nak muhasabah diri...our ppl nowadays depend too much on electronics, but they dont take into account the dives that we make, whether it's a conservative or provocative dive.

One more thing, for HollowMan...
Regarding the cost of treatment per session, it's RM40.00 per session of diving emergencies treatment...

An alternative view from me: It is okay to rely on your DC only, without looking up your dive tables AND be just as safe.

How? 1. Know how your DC behaves in comparison with established No-D tables. 2. And then put in a reasonable safety margin.

Some DC's are quite conservative - short bottom times, fun-killer. Some give loooong bottom times - nice, but risky. It all depends on which algorithm is used. You'll need to know whether your DC is relatively conservative or liberal. This will determine how you use it:

Next, put in a reasonable safety margin. How?
1. Try not to extend your bottom time right to the DC's No-D limits - the DC's No-D limits are usually very liberal compared to tables, because many DC's take into account your multi-level profiles - so while you gain extra bottom time with a DC, you actually lose an extra safety margin against developing decompression sickness. (There is no such thing as a free lunch). So depending on your DC, you may want to put in a safety margin of say 15 - 25% of the bottom time and leave bottom before you hit your No-D limits.
2. Do a safety stop. The mathematicians and physicists amongst us will tell us how much this will reduce bubble formation. But, I still see many divers confuse a Safety Stop with a Deco Stop. Bad, bad, bad.
3. Vary your safety margin with your other risk factors: Multiple dives, Multi-day dives, dehydration, cold water, strenuous dives, old age, poor physical conditioning, obesity. If you have any of these, increase your safety margin some more.

Lumut often see sick divers who says "But... my DC tells me that I'm still within my limits". (The poor diver dived the computer to its No-D limits for 4 days in a row, 3 dives a day. He was also tired, dehydrated and had several strenuous dives - which the computer can't factor in).

A thought: When you switch on your Dive Computer, don't switch off your brains.

And then we get some sick divers who says "But... if I dive according to the DC's recommendations, then I should NOT get Decompression Sickness".

A thought: If you want a guarantee, buy a TV.

I love my dive computers - they are wonderful tools, better than fiddling with tables. But being user-friendly, they sometimes allow divers to completely avoid thinking. To illustrate, I have actually seen a diver hang his dive computer 5 metres below surface for a "required deco stop" while he is having a ciggy on the boat. Hmmm...

Tell me what you guys think.

one day, i dream, that they will make a divecomp that allows you to enter variables such as age, height, weight, amount of water/alcohol/calories intake... and then append it together with dive table algorithm..  :

one day...

Doc,
I got into an incident maybe 5-6 yrs back. Still dont know what actually happened but after some self research cudv been some kind of embolism. Heres wat happened:

It was a 5 day liveaboard to Tenggol. Been driving long hours the nite b4, not much sleep coz damn excited, very light breakfast the next day, dehydrated, smoking my lungs out while waiting for the damn transfer boat which was hours late. Finally reached tenggol in afternoon and immediately geared up for first dive (all rental stuff that time), no DC, maybe less than 20 logged dives that time. Wreck dive..max depth 30-31m. Bottom time bout 40mins. Did safety stop but surface swim was pretty strenous and cramped up before getting a lift on the chaser boat.

Upon gearing off on boat had piercing pain in my chest everytime i took a breath. So painful to breathe. Toes on 1 foot starting getting numb and the numbness eventually went up to my thighs over the next hour or so. So basically lost total control of my right leg thigh down. Felt like there was nothing there. Anyway had meal and drank gallons and gallons of water.

Story cut short - after all confusion not knowing wat else to do, just continued to drink water and eventually the numbness slowly went away and breathing was back to normal. Whole incident lasted round 2 hrs++. Went on for next dive without any problems. it was only after i got back and did some reading i found out i got hit, noting all the symptoms and events leading to it.

So what do you think Doc?

Diveghost

yup...anyway it was a multilevel dive. no way i'd stay at 30m for the entire 40mins. bengkok badan braderrr!!!...

On a more serious note, however, how can we vary our own safety margin with our other risk factors: Multiple dives, Multi-day dives, dehydration, cold water, strenuous dives, old age, poor physical conditioning and obesity.  :-/

Deepblu,
No hard and fast rules here. You'll need to just increase your safety margin with increasing numbers of risk factors. (Decompression theory is not an exact science yet).

A thought: If you are driving in the highway during a poor visibility, heavy downpour (a risk factor), to avoid an accident, you as a sensible person will drive at less than the 110km/h speed limit (similar to No-D limit). But the question is how slow? There are no straight answers here. I think it'll depend on your type of car, brakes, tires, how lucky you feel, time of the day, winding or straight road, your alertness etc (all risk factors). Your chosen speed might be 20 km/h or 90 km/h. Not an exact science.

I usually do 80% of my DC's No-D limit on my first dive. I'll then reduce it by 5% for each successive repetitive dive, another 5% if I do successive-day dives. But these numbers won't allow me to dive 3 times a day for 5 days in a row - I'll have very little bottom time time left! That is fine by me though - I enjoy a break after 2-3 days diving. If I go for a break of a day or more, I'll  reset. But then again, I'm old at 38. As for age, I have heard a good diving doctor mentioning something like taking 1 minutes off your No-D limit for every year after 30. Again, although this is good advice, it is purely arbitrary, and not exact.

So my advice would be: Know the risk factors for DCS, ask yourself if you have many (or none) of the risk factors, and adjust your dive profile as you see fit.

And don't forget to have fun down there.

Hey Cadecaus...u can say that again. Ever since that happened i've been monitoring my body after every single dive till now. Take galons of water b4 and after dives hence pee in wetsuit quite a bit haha. I am extremely lucky thank god for that. phew!..