Bends Explained: How to Plan a Safe Dive

Ideas about bends have changed from the concept that a bubble formed in the nervous system or the joint by cavitation-negative pressure. Rapid ascent or joint motion caused the culprit to appear and pressure would make the bubble go away. Now we are treating tissue damage with oxygen. But, we are still using pressure and oxygen to increase the partial pressure of oxygen in the affected tissue. The treatment of choice is the 5 hour long U.S. Navy Treatment Table 6 which washes out the nitrogen in the tissue and washes in the oxygen. Careful understanding of how my patients got bent and how they responded should make any diver more cautious regarding repetitive diving and a multi-day series of dives. Pressure at the deepest part of the dive washes in the nitrogen over time. Fatty tissue, that includes the central nervous system and peripheral nerves, absorbs more nitrogen than watery tissues such as muscle. Shaping-up to dive includes weight loss, abstinence during the duration of the series of dives, and improving lung function.

Physical conditioning such as walking 20 or more minutes a day for several weeks before diving is as important as paying for the trip.

Dive accidents sometimes do not have a treatable solution. Most "accidents" resolve after one recompression breahing oxygen under pressure. Many patients were treated multiple times, and some did not get complete relief of thir symptoms and/or neurological fndings. Immediate thrapy traditionally is in-water recompression which has its drawbacks. It is difficult to administer and hypothermia, fatige, and drwning are risks. Surface-On-Deck oxygen breathing from a facemask or immediate recompression in a chamber are always effective treatments. Transport to a facility has logistical problems and the destination chamber may not be functional when it i needed. The book is about the chamber that I personally operated and staffed. I was continually available except for a few meetings, shopping trips for supplies, and family obligations. The volume of bent divers that I treated, not all are included, speaks for itself.

I attended Bronx Science HS and Columbia College in NYC before attending the University of Louisville School of Medicine. After a Straight Surgical Internship and a year of Neurological Surgery at NY's Mt. Sinai Hospital under Dr. Leonard I. Malis, I served in the USNR and was a Lt. Commander, I was a Fellow at the Cleveland Clinic in Neurology, Neurosurgery and Internal MEdicine. I also completed a year of Internal Medicine residency at Brookdale Medical Center and less than a year of a Nephrology Fellowship at St. Lukes Hospital both in NYC. Andre Galerne appointed me a consultant at the North American Hyperbaric Center.I treated SCUBA diving accidents and a variety of medical conditions in the Iglu which was 20 feet tall with a wet pot in the lower half. It is 10 feet diameter and I have been an inside tender with as many as nine patients at once. The Diver's Alert Network referred most if not all of the patients that I treated for Bends.My intention is to pay tribute to Andre by continuing to serve the diving community with my outlook on diving accidents. As most divers I have had brushes with bends myself. A little insight may help divers recognize bends early and perhaps avoid more serious episodes. For example, if on the third day diving on air to 80-100 fsw one starts vomiting after breakfast it might be a good idea not to dive that day. I relocated to Kissimmee to enjoy a more relaxed retirement and raise Lilian in a country environment. However Poinciana where I live has grown into a city-same zip code. I enjoy movies, outdoor swimming, and my wife's cooking. Her specialty is oatmeal cookies.