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Victoria Brown

We have had the pleasure at London Diving Chamber to have recently been treating Derek Green: a keen diver with a tale from the deep, every bubble blowers nightmare.

It was 2007 when Derek experienced his first episode of decompression illness whilst he was basking in the magical waters of Bali, and yes you read it right; Derek is not a one hit wonder.

It was clear morning when Derek and his two best dive buddies, a sweet experienced couple from Australia, cruised out towards Tulamben dive site. They observed the beautiful coastline and chatted whilst intermittently spitting in their masks and completing their safety checks. At the chosen site they completed two dreamy dives that had given them a whole host of delicious reef life and a world of underwater happiness under their weight belts. Then as they bobbed on the surface awaiting the boat to come and fish them out of the warm blue lagoon Derek protested that he had a headache, and not a nice one at that. He initially dismissed it as the return of migraines he used to experience when he was a small boy. He described to me the feeling of absolute dread that he felt which was made worse by a creeping chest pain, which detracted from the acute tingles occurring in his legs. The boat arrived and picked up the trio, Derek remained calm and continued to play down his symptoms to himself. Back on shore the group changed transport and were taken by truck back to the hotel. Unfortunately for Derek the route took in a small mountain and the rising altitude aggravated the bubbles inside his blood stream, worsening his condition. Derek retired to his hotel room alone, no doubt trying to brave it out but inadvertently putting himself at further risk. These are all common mistakes made by many but hopefully this article reduces that number.

After some hard persuasion amidst a blur of confusion, pain and worry he found himself being potted at midnight in the local hyperbaric chamber. In true international medical care style it was only after the money had been paid. At this stage Derek was vomiting, incontinent, unable to walk and being prodded and tested from every which way. He remained in the chamber overnight and came out feeling almost brand new except of course he spent the next two weeks recovering hidden away in his Bali hotel room.

The only test that wasn't conducted was a bubble test, something he found vaguely amusing at the time. A simple colour flow Doppler echocardiogram (a sterile salt solution is shaken until tiny bubbles form and then is injected into a vein) can detect the presence of bubbles in the flow of blood between the right atrium and left atrium in your heart. A positive test will indicate the patient has patent foramen ovale (PFO), essentially a hole in the heart.

The lucky escape faded into the past but Derek never lost his lust for diving. However he found out in 2013 that he in fact did have a PFO, regrettably something which was not tested in Bali. One in six people in the UK have a PFO and to be frank most people are unaware until they go diving and then you may really know about it, like Derek. The doctor referred him to have the PFO closed and when he was fit and ready he travelled with his club, Stevenage BSAC, to dive off Dover. This site is infamous for its rushing waters where aquanauts explore shipwrecks in search of gold.

Of course Derek, like all of us had a niggle: he had just arrived back from Everest Base camp not too long before he fell a little weary and dehydrated from the journey, the last thing he needed was a troublesome dive. The conditions were running and the visibility was poor. He and his buddy lost contact with each other at 39m on the seabed in the darkness. Diver Derek ascended at a rate of 8m per minute, and skipped the safety stop, not really worrying about it as he had not racked up any precious decompression minutes that needed to be observed. His primary driver was to reunite with his buddy upon the surface to ensure his partner's safety perhaps forgoing his own.

At sea level the dive took a turn for the worse as Derek felt the familiar tremble in his legs and he worried that his bent nightmare from six years ago was about to be re-lived. Concerned that he had been breathing in a stressful manor he suspected a lung injury amongst every other panicked thought he could muster but in times of total angst Derek did all he could to keep a cool head. His central concern was allayed when he laid eyes on his missing buddy who was waving to him from the boat. After about five minutes on the surface he had developed weakness, numbness and paralysis in his lower limbs causing him to collapse on the deck. This time Derek experiences a new symptom: a visual aura accompanying frontal sinus pain. He was put straight on the oxygen the skipper hammered full blast back to the shore to get the diver in trouble over to Ashford hospital. Two hours and a lot of oxygen later his symptoms had resolved and he headed home.

The next day when Derek awoke his symptoms had returned with a vengeance. He went to the local hospital with his unsteady gait.

A diagnosis of a suspected pneumothorax was given by the doctors and he was sent to x-ray to get a look inside his lungs. Poor Derek lay in a bed for 6 hours in a bad way. They transferred him to the local hospital for spinal tests, probably because he couldn't walk and when training at medical school there is not even in a paragraph on diving and decompression illness so it is no wonder this obvious cause is missed after diving incidents. Finally Derek took his life into his own hands and called the LDC 24 hour advice line and he came straight in. Dr Oli saw Derek and after a thorough consultation he was potted. On a Table 62 he initially went in for nearly six hours experiencing numbness, paralysis, incontinence and imbalance. All these symptoms were overriding the numbness and tingling that he was feeling in his legs and arms. As soon as he descended to depth in the chamber he found to his heavenly relief (a whole other heaven to paradise he experienced in his Bali days) the symptoms immediately subsided. As the initial treatment progressed he had a varying progression of symptoms and return of them which is usual. As bubbles compress and work their way out they can aggravate cells inside the body which can make other parts of the body tingle, or feel pain. This is normal and ironically the path to recovery. His follow up treatments were seven rounds of two hour treatments at depth.

I met Derek when he had happily just passed his return to dive medical. He was still experiencing numbness along the left leg, however he no longer was toppling off his feet or in need of a nappy.

Dr Oli has prescribed a 20m depth limit fro all future dives, plenty of water to maintain hydration and a great level of care when ascending. Derek has not been put off by his incredible ordeal.

It was such a pleasure to talk with Derek, he has a passion for diving I can relate to.

Derek we salute you, see you next edition.

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