The Danger of Decompression illness?

‘Umm Anke, can I ask you something? How big is the danger of decompression sickness?’ Look, that’s a question that we get often as guides on the Safari boats. We’ve all learned that decompression sickness is lurking and my experience tells me it can always happen. Strangely enough, we don’t expect that at all and even if we notice something weird in our bodies, the penny of decompression sickness does not drop quickly. This is also the case with Paul, who boarded with me in the Maldives.

A young spotted eagle ray

With its 26 atolls and located on the equator somewhere far below India, the Maldives is a popular diving destination. In the distant past, these atolls were volcanic islands that rose from the sea. And once the volcano went dormant, life began to grow, including a reef surrounding the island. Over time, the volcanic mountains disappeared under water, but their reefs are still there. In the meantime, some reefs have collected sand and trees grow on them and this is how the 1200+ islands of the Maldives have arisen. And because the Maldives is in the middle of the ocean, with only very deep water around it, it has collected a huge amount of large underwater life. And that week we were going to dive the central atolls of the Maldives.

We had departed from Male and had become acquainted with the well-known current in the Northt Male Atoll and seen our first mantas. They say that mantas are the most intelligent fish and even after 100 encounters, a dive with a manta remains downright magical. After the North Male Atoll we visited Rasdhoo where we saw large schools of gray reef sharks, some eagle rays and mobula rays, what a great start to this trip. In the meantime we descended into the Ari Atoll and it is known for its many manta cleaning stations and the whale sharks in the south. Tomorrow we go in search of the whale shark and that was the topic of conversation during dinner. Everyone was really looking forward to tomorrow, yet someone was missing. Where is Paul? His friend and cabin-mate Steve said that Paul had gotten a bit seasick and that he was sitting on the deck. Hmmm let’s have a look I think and I walked outside. ‘Hey Paul, how are you? Everything good?’ Paul said he was a bit seasick, but now that he was outside he felt better. He was going to take a tablet, nothing more to worry about, he assured me. I asked him if he had any other symptoms besides the nausea, but he said nothing was wrong. Paul is a very experienced diver, has made many trips and dives in many waters and had a lot of knowledge about diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent. How are you? Everything good?’ Paul said he was a bit seasick, but now that he was outside he felt better. He was going to take a tablet, nothing more to worry about, he assured me. I asked him if he had any other symptoms besides the nausea, but he said nothing was wrong. Paul is a very experienced diver, has made many trips and dives in many waters and had a lot of knowledge about diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent.

Reef manta

How are you? Everything good?’ Paul said he was a bit seasick, but now that he was outside he felt better. He was going to take a tablet, nothing more to worry about, he assured me. I asked him if he had any other symptoms besides the nausea, but he said nothing was wrong. Paul is a very experienced diver, has made many trips and dives in many waters and had a lot of knowledge about diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent. nothing else to worry about, he assured me. I asked him if he had any other symptoms besides the nausea, but he said nothing was wrong. Paul is a very experienced diver, has made many trips and dives in many waters and had a lot of knowledge about diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent. nothing else to worry about, he assured me. I asked him if he had any other symptoms besides the nausea, but he said nothing was wrong. Paul is a very experienced diver, has made many trips and dives in many waters and had a lot of knowledge about diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent. made many trips and dived in many waters and had a lot of knowledge of diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent. made many trips and dived in many waters and had a lot of knowledge of diving. He is one of those divers who does everything deliberately, follows procedures and knows what he is doing. And while knowledge gives power, in this it also blinded, because it gave him a confidence in himself that he had simply missed the apparent.

Deco boy…

Later that evening, I was sitting on the sundeck chatting about the fantastic manta dives we’d been doing when Paul tapped me on the shoulder. “Um, Anke … I have a rash that I’m a bit concerned about, maybe it’s a skin bend.” and with those magical words I got up to speak to Paul separately. He told me he had some rash on his stomach after the first dive yesterday. He had noticed it while taking a shower, but thought it was an allergic reaction to his new neoprene vest. So he put some moisturizer on it and the stain got less and less over time. After the second dive, the spot came back and even when it did after the third dive, Paul was still not alarmed. And so he had been diving happily today too. On our first dive today we visited a manta cleaning station and it was fantastic. Visibility was great, the current very strong, but with the ease of our reef hooks we could view all the mantas in peace, although it took some work before you found a good spot. After that dive Paul suffered from a stiff left arm, but blamed it on the current because he had worked so hard with his reef hook. He also noticed a mottled red spot on the back of his left arm, but that didn’t make him think, at least until now. And so Paul had made all of today’s dives and thoroughly enjoyed them. Still, he and Steve had looked again on the internet and now thought the result could be a skin bend and he pushed up his sleeve. Oops, that was undeniably a skin bend, decompression sickness in the skin and he had been diving with that all day? Nauseous now and also yesterday a recurring result? BIG OOPS!!! And so I took Paul to his room, where I gave him oxygen. In addition, I gave him 2 liters of water with rehydration salts to drink. And instructed him to do 20 mins with and 10 mins without oxygen and to drink as much as possible and then just relax. I would come back every 10-15 minutes to see how things are going and from then on the whole circus started spinning. Inform the captain, the other guides and the fleet manager. Looking for a telephone contact with a specialized doctor and report it to the insurance company and in the meantime check with Paul every 10 minutes and keep a log of everything that happened. Time flew by and Paul felt worse and worse, his stomach was playing tricks on him and throwing up had become a continuous affair. The dive doctor in Male agreed with me that it was probably deco illness and recommended that Paul be taken to a deco room as soon as possible. Now Male is far away from us and so we looked for a deco center in the Ari Atoll, which was still open at this hour. Luckily we found one in the north of the atoll, but that was at least another 10 hours of sailing and Paul was deteriorating. In addition, when we go north again, we have a problem in the trip, which is that we may miss the opportunity to show our guests the whale shark and so we decided that a speedboat was the best solution for both Paul and our other guests. First we called the insurance and they said that Paul was not insured because he was on a cruise (WHAT?!?). After I asked what they think a cruise is, she suggested a ship sailing more than 12 miles offshore. I assured them that the Maldives has no mainland, only islands and that we are within 12 miles of civilization at all times. She wouldn’t confirm that she wanted to cover the costs so I informed Paul. He agreed with me that treatment is more important than insurance and he would look into that further later. First we went to a specialist and so we reported to the deco center, so that they are on standby, and then called the water taxi. Paul would get two rides, one to the center of the atoll and number two to the center, because sailing at night can be dangerous and only very experienced captains want to do that. The problem was not so much the $1300 in costs, but that 600 of them had to be paid in cash and Paul didn’t have that much in his pocket. Fortunately, the captain and crew jumped in, who put the dollars on the table from their saved tips. Pfff… another problem solved. Now came the hard part for Paul, getting into a speedboat while he is so sick. We gave him blankets, water with rehydration salt, oxygen, the necessary paperwork and one of our guides. And so Paul disembarked just after midnight, while the rest of our guests, unsuspectingly, enjoyed their night’s rest. Fortunately, the captain and crew jumped in, who put the dollars on the table from their saved tips. Pfff… another problem solved. Now came the hard part for Paul, getting into a speedboat while he is so sick. We gave him blankets, water with rehydration salt, oxygen, the necessary paperwork and one of our guides. And so Paul disembarked just after midnight, while the rest of our guests, unsuspectingly, enjoyed their night’s rest. Fortunately, the captain and crew jumped in, who put the dollars on the table from their saved tips. Pfff… another problem solved. Now came the hard part for Paul, getting into a speedboat while he is so sick. We gave him blankets, water with rehydration salt, oxygen, the necessary paperwork and one of our guides. And so Paul left the ship just after midnight, while the rest of our guests, unsuspectingly, enjoyed their night’s rest.

OLYMPUS DIGITAL CAMERA

The next day, during the early morning briefing, I informed all our guests. The first reaction was of course shock and fear and that day some of my guests showed some spots on their bodies asking if that was also deco disease. So the fear was certainly there and there is nothing wrong with that, as long as you don’t get stuck in it. Realizing that it can happen to anyone and the only thing you can do to avoid getting decompression sickness is not to dive and of course that is not an option. In the end Paul had 3 sessions in the room and after 2 days he was back on board. When he arrived just before dinner, we were all waiting for him to give him a warm welcome. Paul had experienced a lot and his adventure was discussed extensively. According to the specialist, Paul would make a full recovery, although he was not allowed to dive for 6 months. Of course he was sorry that he had to miss so many beautiful dives, but his health was much more important. In addition, he said that he had come to the Maldives to see the manta and that he had done so. Such a guy who can put things into perspective and appreciates what he has. In any case, we were very happy that Paul was back safe and sound. And they couldn’t resist playing a joke with Paul. So during dessert we crowned him bubblemaker of the year with a pink shirt where everyone had written something sweet or funny. In the end, Paul also got the insurance company to cover the costs after all, good news since that misstep had already presented a bill of about 20,000 dollars. Certainly no joke when you consider that you get that stress on top of the decompression sickness. But all’s well that ends well.

Later that evening when Paul showed me the bill from the deco center, I saw that the invoice number went in ascending order and by year. It is now the end of December and Paul was number 8 that year. Hmmm that not only explains the high costs, but also gives an idea about the answer to the question; what is the risk of decompression sickness? It’s unlikely to happen to anyone, but it can happen to anyone, including you, no matter how unlikely it may seem at times.

Love life… Blow bubbles… Anke