Return to Diving

I am planning to return to diving after a mild case of cutaneous decompression sickness (DCS), or "skin bends." If I dive using nitrox, will that be enough to prevent recurrence of DCS?

Conservative diving is strongly recommended to avoid a repeat DCS incident. Cutaneous DCS has about a 20 percent chance of having a neurological component. The next event could be similar to this one or be significantly more severe. Diving conservatively, however, involves more than simply switching to nitrox. Consider the following recommendations:
  • Dive with nitrox, but set your computer to "air" or "21 percent." Clearly note the maximum operating depth (MOD) for the mix you're actually breathing, and never exceed that depth. Use a partial pressure of oxygen (PPO2) setting of 1.4 or lower to avoid oxygen toxicity. If you reset your computer to a nitrox setting, then your potential bottom time will be calculated as longer and defeat the purpose of minimizing gas loading. Nitrox is only safer if you shorten bottom times.
  • Spend an extended period at less than 30 feet, and add long safety stops to allow offgassing prior to surfacing. Extra stop time in shallow water is an effective way to reduce decompression stress and the likelihood of bubble formation.
  • Select the most conservative setting on your computer to limit bottom time.
  • Use a slow ascent rate of 20 to 30 feet per minute.
  • Extend your surface interval, especially after long, deep and repetitive dives.
  • Avoid exercise and load lifting in post dive hours, and do not engage in intense physical training for 24 hours after diving; perform only low-intensity exercise within that period.
  • While diving, minimize your exercise intensity, and avoid overheating during the deepest parts of the dive.
  • Take warm showers, enjoy the pool after diving, but avoid hot showers and hot tubs.

Being conservative is a trade-off. Divers want to maximize their bottom time to get the most out of every dive, but that maximum bottom time is also maximum inert gas (nitrogen) loading. Remain well rested and hydrated, and dive with a partner who has similar goals and follows similar practices. Adding small safety margins to each step can help provide a comfortable security cushion. Dive computers are powerful tools, but sound knowledge of diving physiology, good physical conditioning and adherence to thoughtful practices offer the best protection for divers. Every diver is unique, with varying susceptibility to decompression stress. Ultimately, only you can determine how much risk you want to take.
— Frances Smith, EMT-P, DMT

© Alert Diver — Q2 Spring 2018


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