The Bends Down Under
My Decompression Sickness Experience
The Bends Down Under
Australia has been on my travel list for over two decades and I could not wait to set foot on this continent and start exploring.
But little did I know that I was in for even more adventure than I’d asked for when the unexpected happened and I got the bends down under.
Wait, you got the bends?!
Yep. I got the bends.
“How?” you ask.
Well let me tell you…
While planning for my trip to Australia, the snowball effect took over. I found myself not only adding Queensland to my destination list, but also booking a full blown PADI Open Water Scuba certification course with a 3 day and 2 night liveaboard out on the outer Great Barrier Reef.
Go big or go home, right?
PADI coursework and exams complete, I hopped on a plane in late October and 20 hours later (but two calendar days–the International Date Line is so strange) I found myself on the other side of the world!
From Sydney, it was a quick two and a half hour flight up to Cairns, a popular northern Queensland city for accessing the Great Barrier Reef full of unique tropical trees.
It was here where I had one day of scuba class in the pool (during which my biggest issue was getting my ears to equalize) before setting out on the liveaboard the next morning.
I could talk about these dives for hours, but for the sake of brevity, I’m going to stick to the high level experience and factors that may have contributed to getting the bends as well as things I was feeling that may have been symptoms.
If you’re interested in reading more about what to expect during the PADI Open Water Certification dives or just in general for scuba diving on the Great Barrier Reef, you can check out PADI Open Water Scuba Certification on the Great Barrier Reef.
Dive 1 (October 26, 2022 | 11:14)
I felt both excited and nervous to experience diving in the open water for the first time, especially in those last few minutes before we got into the water.
On the descent, I had problems equalizing my ears. More than anyone else in the group.
Per what we learned in the course, I stopped and ascended a few feet on several occasions. Cycling through the three methods they taught for equalizing, I was eventually able to get down to a depth of 32ft (9.8m).
The ocean surface had been very choppy and jarring so once we were under water, I started to feel more calm.
I was surprised to see how quickly I was using air, however, the instructors said this is normal for first time divers.
- Time in: 11:14
- Time out: 12:07
- Max depth: 9.8m (32ft)
- Bottom time: 29min
- Tank pressure: 190 > 90 bar
After the dive, I laid down in the cabin and fell asleep hard. I had taken a Dramamine when the boat first set off as a preventative for seasickness which is known to make me very drowsy.
I felt really groggy when they came to wake me up, but not unusual for when I have taken Dramamine.
Dive 2 (October 26, 2022 | 14:19)
We geared up and took giant strides back into the water for our second dive. More familiar with what to expect, I was feeling less nervous than I had on the first dive.
Equalizing went better on this descent, but I noticed on the boat in between dives that my ears felt like they needed to pop and wouldn’t. I had a hard time hearing with them in this state, but the instructors said this was normal.
- Surface Interval: 2h 12min
- Time in: 14:19
- Time out: 15:04
- Max depth: 10.5m (34ft)
- Bottom Time: 27min
- Tank pressure: 200 > 110 bar
I felt very tired in the evening after this dive and could hardly keep my eyes open at 7:45pm. I suspected this was from the Dramamine because you’re supposed to take it every 12 hours for sea sickness so I’d just had a second dose. Regardless, since I wasn’t feeling seasick I made the decision to cut down to a half dose because I felt like I was missing out on the liveaboard community experience!
Dive 3 (October 27, 2022 | 07:25)
I was a little nervous about my ears equalizing again. They still felt “unpopped” and I was having trouble hearing on the boat, but keeping them in this state seemed to make it easier to equalize on the dives.
Once in the water, we practiced simulated emergency ascents which made me feel a little stressed. However, I was the first one to go so I was able to calm my heart rate and breathing before we descended for the remainder of the dive.
I started feeling much more comfortable on this dive.
- Surface Interval: 16h 21min
- Time in: 7:25am
- Time out: 8:28am
- Max depth: 11.2m (37ft)
- Bottom Time: 30m
- Tank Pressure: 200 > 100 bar
Dive 4 (October 27, 2022 | 11:32)
It was time for a fun dive exploring as we were done testing skills.
The trend of feeling more comfortable each dive continued and I was starting to get the hang of how my breath impacted buoyancy.
This dive completed the certification and I passed!
- Surface Interval: 2h 32min
- Time in: 11:00
- Time out: 11:32
- Max depth: 14.5m (48ft)
- Bottom Time: 32min
- Tank Pressure: 200 > 90 bar
Dive 5 (October 27, 2022 | 15:10)
Nerves went up a bit as we got ready for this first unguided dive.
I was a little anxious to be responsible for navigation (what if we lost the boat?!) but did not experience any other noticeable stress or concerns on this dive.
- Surface Interval: 3h 38min
- Time in: 15:10
- Time out: 15:51
- Max depth: 13.4m (44ft)
- Bottom Time: 37 min
- Tank Pressure: 200 > 100 bar
first unguided dive after completing the PADI open water certification!
Dive 6 (October 27, 2022 | 19:27)
We were back with a guide as we experienced our first night dive.
I was a little anxious for potential shark encounters but felt very calm once I hit the water. We moved so slowly on this dive it ended up being more peaceful than stressful.
- Surface Interval: 3h 36min
- Time in: 19:27
- Time out: 20:00
- Max depth: 10.1m (33ft)
- Bottom Time: 31min
- Tank Pressure: 200 > 110 bar
Dive 7 (October 28, 2022 | 06:21)
This was our second unguided dive and we were given a max depth of 18m.
At one point, my dive buddy indicated we were too deep. I checked my dive computer and I was at 18.1m so I gave a few quick kicks upwards to ascend. My dive computer beeped at me for going too fast but I was already slowing because I’d reached an appropriate depth. This event was maybe 1-2 seconds of exertion.*
I must have dropped a couple more meters while I was checking my depth, because my max depth was 20.4m (67ft) at the end of the dive. Oops! It was a good learning lesson to make sure you’re frequently checking your depth. It’s hard to tell if you’re going up or down and the changes seem to happen so fast. The depth change shockingly didn’t trigger my ears to start hurting either.
We continued to explore and after a few minutes spotted a sea turtle! We watched this turtle for a several minutes and then swam up over the reef which pushed us up pretty shallow (about 3m) without a safety stop* but we weren’t done with the dive yet so we went back down a little and followed along the reef again and explored some of the more shallow stuff by the boat, did a safety stop, then ascended.
*Note: I have talked through this scenario with other diver friends and the doctors and they do not feel that this minor event should have caused decompression sickness. Also, my dive buddy who was right next to me for this whole dive and experienced the same depth and ascent did not get DCS.
- Surface Interval: 10h 21min
- Time in: 6:21
- Time out: 6:57
- Max depth: 20.4m (67ft)
- Bottom Time: 31min
- Tank Pressure: 200 > 80 bar
Dive 8 (October 28, 2022 | 08:59)
This was a fun easy dive with no stressful events or noticeable issues.
You can be certain I was checking my depth gauge every minute.
- Surface Interval: 2h 2min
- Time in: 8:59
- Time out: 9:35
- Max depth: 16.5m (54ft)
- Bottom Time: 30min
- Tank Pressure: 200 > 70 bar
Dive 9 (October 28, 2022 | 10:50)
We kept this dive shallow and it was a blast. We saw so much and I was feeling very comfortable!
- Surface Interval: 1h 51min
- Time in: 10:50
- Time out: 11:34
- Max depth: 10.2m (33ft)
- Bottom Time: 37min
- Tank Pressure: 200 > 100 bar
the beautiful Great Barrier Reef
final dive of the liveaboard
Heading Back to Shore
On the boat ride back to shore, I took a nap on the sun deck and when I woke up, I tried to stand and my left knee totally gave out.* It put my butt right back on the ground.
It felt like from my knee down had fallen asleep. So strange! I made note and hoped it was just from napping weird on the hard deck surface and not a sign of decompression sickness.
Arriving On Shore
When we stepped off the boat, I had to double checked I’d actually gotten off of it because it felt like everything was swaying still. I didn’t realize how much my body and eyes were accounting for that motion while we were out on the boat.
As we gathered the rest of our luggage and waited for our bus to the hostel, I noticed I had a mild headache so I started guzzling water thinking I was probably dehydrated.
The scuba crew met for dinner that night and I was still feeling out of sorts when I joined. Everything was swaying like the rocking motion of the boat.
I joined in with the crew and had dinner and a glass of wine. This was my first alcoholic beverage since arriving in Australia–I did not drink any alcohol during the diving trip since I’d read that it can make you more susceptible to DCS.
After I’d finished, I called it an early night and went to bed, hoping this would clear by morning. I’d looked up how long it typically takes for the swaying feeling to wear off and the internet said anywhere from a few hours to a few weeks!
The Morning After (October 29, 2022)
The next morning I wok up and still felt like the world was swaying back and forth. The mild headache was there and I felt exhausted.
I decided to go get some breakfast and do a little walking around to see if that helped but as the afternoon came, the symptoms weren’t getting any better.
I walked over towards the hospital and sat in the park area outside, debating whether to go get checked out. Did I really have a case of decompression sickness?
As I was sitting there, I noticed a slight tingling sensation in my left leg from the knee down–the same leg that’d given out on me the day before when trying to stand.
That was what put me over the edge. I decided I better be safe than sorry. I figured I’d probably go get looked at, they’d tell me I’m fine and they I’d be out exploring again in a couple hours. Or so I’d hoped.
Cairns Hospital (October 29, 2022)
They checked me out at Cairns hospital and after reviewing my symptoms with the doctor and doing some tests he didn’t think it was DCS, however, he wanted to run my case by their dive specialist.
My relief was short lived because the dive specialist confirmed that all the strangeness I’d been feeling–dizzy, weakness/tingling from my left knee down, mild headache on and off, fatigue–was a mild case of decompression sickness.
He said you can follow good dive principles and still get it, especially on your first experience with scuba and when doing multiple dives.
They started me on oxygen and IV fluids in Cairns right away and told me I’d be staying there in the hospital overnight so they could monitor me.
Since I’m not an Australian citizen, I had to organize my own transportation down to Townsville, the nearest town with a hyperbaric chamber, the next day to start treatments.
The worst part of this night was going through it alone. I was scared and anxious, traveling by myself, and it was currently 2am back home so I had no one to talk to. So I did a lot of praying.
I did some research on buses on my phone and found one that would get me to Townsville in 6 hours. It brought some relief to have one thing lined up.
I took a short oxygen and IV break to pack up my things from the hostel. I’d deal with canceling my other Cairns tours and flight later.
I did my best to settle in, mentally prepare for my 6 hour bus ride the next morning, and wait it out until it was a reasonable time to call my parents. My mom of course answered in a total panic knowing it was an odd hour in Australia but she took the news very well.
The Trek to Townsville (October 30, 2022)
I made it through the night and took an Uber to the bus station in the morning.
I was very anxious for how long I would be away from medical care as I made my way south. The sensation in my knee had gotten a little worse and was feeling more tingly.
The couple times that had triggered the more significant weakness in my knee were after napping and sitting on hard ground so I was a bit worried about sitting on the barely padded bus seat for the next 6.5 hours.
I said some prayers that God would get me through it and that my symptoms wouldn’t worsen before I got there. Knowing how serious the side effects of decompression sickness could be continued to bring on anxiety, but God helped me to keep it in check.
My leg seemed to do better if I kept it stretched out on the seat next to me so I did that as much as possible.
I wish I would have gotten looked at sooner in Cairns so I could have made it down to Townsville that evening but the symptoms I had were easy to explain away as sea legs and other things. In the end, I’m just grateful that God gave me enough symptoms that I couldn’t rule out DCS and I actually went and got checked. I don’t want to think about what would have happened if I’d hopped on my flight to Sydney on Monday in that condition.
Townsville Hospital (October 30, 2022)
After checking into the Townsville Emergency Department, I filled out some paperwork and then Dr. Roehr checked my reflexes and balance.
He proceeded to explain how the hyperbaric treatment process works, saying I’d do multiple “dives,” the first of which would be today and would go for 5-6 hours.
I’d stay in the hospital overnight and have another 2 hour dive tomorrow. What came as the biggest shock was that once I finished all my treatments, the three week no-fly clock would start. Three weeks! I was supposed to be on a plane out of Sydney in one week. I did my best to trust God’s plan and mentally prepare for another 33 hours of bus or train rides back to Sydney since flying was clearly not an option.
Hyperbaric Treatments (October 30, 2022)
Hyperbaric chambers are no joke and come with a lot of risk.
Before getting into the chamber, they had me shower to make sure there wasn’t anything on my body that would add to the already high fire risk in the chamber. They also gave me scrubs to wear and a locker to put my stuff in as you’re not allowed to bring anything in.
There was also a risk of collapsed lung, seizure from oxygen toxicity, vision changes, and a list of other things I didn’t want to think about.
During treatment I was instructed to:
- Avoid strenuous activities
- Avoid elevations greater than 200m
- Avoid alcohol
- Avoid caffeine
- Drink plenty of fluids
The chamber itself was pretty spacious. Roughly 12’ x 24’ and it had submarine looking windows.
There was a chair for me to sit in that had a leg rest but did not recline and another of the same chairs for the nurse that was in there with me.
I was fortunate that they had a TV rigged up in there, however, it was hard to hear with the TV in its special pressure resistant casing and a big helmet of forcefully flowing oxygen on my head.
Dive 1 (October 30, 2022)
The dive started with a “descent” and pressurized the chamber was pressurized to the equivalent of an 18m depth. I had to equalize my ears a lot. Even more than diving in water.
It was helpful that I could drink water to make swallowing easier (I didn’t have to try and pool up some saliva to ease swallowing like during actual scuba diving).
My left ear gave me the most trouble but neither totally equalized so I couldn’t hear very well.
Once we were down to 18m, they put on a clear astronaut looking helmet hood thing. It was attached to a plastic ring that was suspended around my neck with a blue tube-shaped rubber piece that fit tightly around the ring at one end and tightly around my neck at the other. This filled in the whole ring space so with the hood on, my head was in a concealed space.
Not the most comfortable to wear but the concealed space allows them to pump oxygen only into the hood which helps reduce the fire risk over having free flowing oxygen in the entire chamber.
They had me keep the hood on for 20 minutes, then I got a five minute break. I repeated this five times. They normally do 3 times but they added extensions because I had some new locations flare up with symptoms.
During the first 20 minutes, I felt pretty much the same. Then during the second 20 minutes, I started to feel worse.
They warned me this could happen. It’s common and it’s a good sign that it’s working and the bubbles are freeing themselves from wherever they were trapped.
I started to feel it more in my leg and then in my hip joints. First the left and then the right. My lower back also got a bit worse.
As the last few sessions went on, it got better again.
After those stretches at a 18m depth, we did a 30 minute ascent up to 9m.
It felt like it got a lot harder to breathe as we ascended. I think I was actually getting congested. They said it can happen from the pure, dry oxygen. They cranked the oxygen up for me and that helped a little bit.
After the ascent to 9m, I got a 15 minute break and they brought my dinner in through a little hatch. It was roasted lamb with a sauce, mashed potatoes, mashed pumpkin, broccoli, and apple juice. Pretty extravagant for a hospital meal.
Next I had a long one hour stretch at 9m. Then another 15 minute break.
At this point I bet you’re wondering about the bathroom. Ahead of the breaks, I could let them know if I needed the bathroom. The entryway into the chamber had a toilet with a curtain around it and a sink. If I needed it, they’d seal it and bring it to a matching pressure. Then during the breaks they’d open the door in between and let me use it.
I’d also get to take the neck ring off when I went to the bathroom since it was connected to the oxygen and exhaust tubes. That was a nice break.
To finish the session off, I had one more hour long session at 9m immediately followed by a 30 minute ascent back to sea level.
I got really sleepy during this part. I think part of it was due to my eyeballs getting so dry from the oxygen hood. It was really difficult to rest my head with that big hood on though.
I did my best to sleep but woke up due to a wave of nausea and learned we’d started the ascent to 0m.
Dr. Roehr checked out my ears after and confirmed I did end up with some bruising in the left one but he said that would heal.
I felt pretty terrible as I changed back into my own clothes and made my way up to the sleeping area. I went straight to bed and didn’t wake up for about 9 hours.
Dive 2ish (October 31, 2022)
My next dive was scheduled for 11:30 am the following day. This one was a group dive and the other patients in there with me were all seniors with various ailments like wounds to heal.
Before the session started, the director of the Hyperbaric unit met with me and answered some of my questions.
He said their 3 week no fly rule is because they had a woman fly sooner than that and she had some small bubbles in her spine that enlarged in flight and she was paralyzed by the time the plane landed. Definitely not a risk I was willing to take.
Luckily I’d been in contact with my manager and work and Family Medical Leave was able to cover the extra two weeks off for me–what a relief!
Another interesting thing the director said was that I don’t have any of the risk factors that can make you more prone to DCS. But he said that 25% of the population has a small, asymptomatic hole between the left and right sides of their heart (called Patent Foramen Ovale, or PCO) that can allow bubbles through and make them more prone to DCS.
I find it crazy that I didn’t hear a single mention of PCO during my PADI course. Neither during the online portion, nor the in-person portion. Australia even has a rigorous Dive Medical form and this wasn’t mentioned anywhere. I also went in for a physical specifically to see if my doctor had any concerns about me diving and this doctor who was a scuba diver herself didn’t mention it. Seems like a big gap to me!
Anyways, I digress. Back to the chamber. The six of us were all loaded up in our chairs and they started the descent but I could not get my right ear to equalize at all! We only made it to 3m before they had to stop.
The nurse took a look at my ears and the right one was a “grade 3.” She said she could see blood behind the membrane.
They depressurized and I got super light headed on the way back up because my ears were now all out of whack.
They pulled me out and then sent the rest of the group “down” without me. They took some pictures of my ears and the director said he was happy with my current state and that he’d be okay if I didn’t dive again.
Normally they like to keep going until symptoms are gone or you plateau on improving but they didn’t want to risk damaging my ears.
I was still a bit congested from last night’s dive so they think that’s why my ears didn’t equalize. They gave me some decongestant spray and told me to come back the next day but they weren’t sure if I’d dive or not.
I was feeling better. My left leg felt better. More like growing pains in my shin rather than joint stuff in my knee and tingling. My lower back still felt a bit of pressure but it would come and go. I still felt a little dizzy, like things swaying like on the boat.
They checked me out of the hospital and told me to come back at 7:45am tomorrow.
Dive 2 (November 1, 2022)
My ears were looking better so they wanted to try diving me again. The nasal spray they gave me to clear the inner ear congestion must have helped.
They also gave me this silly balloon you blow up with your nose and it helps your ears pop. So I learned a new skill. I can blow up a balloon with my nose.
I didn’t have much of an issue on the way down—the nose balloon really helped!
We went down to 14m and did a couple shorter sessions there before ascending.
During the ascent my ears started to hurt a bit. They checked them after and said they looked a little bruised but it should clear up.
They sent me on my way, said to keep using the spray and to check back in tomorrow morning.
getting ready for the descent. this is a good shot of the neck hoop and hood setup. my hood is on the floor but the woman next to me has hers on her lap.
here's a full shot of the inside of the chamber when setup for a group dive. for individual dives, they remove the extra chairs.
Feeling good and having a day ahead of me, I decided to explore Townsville. I spent several hours walking around at a leisurely pace, stopping here and there to get food or take pictures. It felt really nice to be outside exploring and not cooped up in a hospital.
That evening at the hostel, quite suddenly I got a wave of the tingles. It was my left and right leg, right arm, and neck. More locations and stronger and more consistent than any of the tingles I’ve felt before. It made me immediately panic which did not help. I think the anxiety was making it hard for me to breathe. It felt like someone had a rope around my neck.
I went up to the room to lie down, but I could not calm down. I was so scared that this was a bad sign and I might become paralyzed. I called the Emergency Department and they were able to get Dr. Roehr on the phone since he was on call. He said after my treatments there shouldn’t be residual bubbles any more and it’s likely no cause for concern.
It was helpful to hear but I think I was so amped up on adrenaline and cortisol that I still couldn’t calm down. I put some worship music on, prayed hard, and tried regulating my breath, but just couldn’t relax. At one point I tried to swallow and couldn’t, which put me in more of a panic so I immediately packed up my stuff and called an Uber.
In the Emergency Department they got me in back quickly and had me lay down with oxygen for a while which helped. Honestly just being in the hospital and close to medical care made me feel a bit better. After maybe 20 minutes on oxygen they said I could go wait out in the lobby and they’d come grab me for blood and neurological tests.
Well, hours later, I was still sitting out there. Apparently they forgot about me.
I was starting to feel better so I went up to the nurse’s desk to see if I could go and they ended up taking me back for a blood test.
An hour later I was still sitting in the back with an uncomfortable catheter in my arm (it was at a weird angle so I couldn’t bend my arm) waiting for results or whatever else they wanted to check. I wasn’t done at the Emergency Department until after 2am.
Since we wrapped up so late and I had to be back at 8am for another group dive, I slept in the waiting area.
Dive 3 (November 2, 2022)
I had another of the group 2 hour treatments and tried to “sleep” during most of it to make up for last night’s lack of.
My ears did well on the way down (nose balloon for the win!) and got a little sore on the way up but not as bad as yesterday.
They said the tingling I’m feeling now is from inflammation and not bubbles. Taking ibprofen (which thinking back they did tell me to do, but I’d been neglecting to because I didn’t understand why I needed too. I thought it was for pain, not inflammation, and I wasn’t in pain.) should help.
Dive 4 (November 3, 2022)
I woke up feeling pretty rough this morning as the hyperbaric treatments were giving me a sore throat, cough, and congestion and they kept getting worse with each treatment.
I had my 4th dive this morning (another of the same group session protocol) and after they told me I was cleared to go!
I checked out and paid before leaving the hospital and the bill was $10,402AUD which converted to $6755 USD. I won’t bore you with the details of the insurance claims process, but know I had to pay this amount out of pocket before I could leave the hospital and I received a bill from Cairns hospital the following week for an additional $3128 AUD ($2106 USD) that I also had to pay within two weeks of receipt. Thank goodness I’d purchased travel insurance through World Nomads!
Weeks 1 & 2
After completing hyperbaric treatments, I was instructed to:
- Avoid altitude (heights greater than 200m) for 1 week
- Avoid strenuous exercise for 2 weeks
- Minimal alcohol intake (<2 standard drinks) for 2 weeks
- Avoid air travel for 3 weeks
- No dive for 6 weeks after fully recovered
Most symptoms had resolved by the time I finished hyperbaric treatment and following these guidelines, I saw steady improvement in the lingering symptoms.
The tingles were reduced when I took ibuprofen, and lessened overtime so I stopped taking the ibuprofen after a few days but I did notice occasional flare ups if I did a lot of walking, particularly walking on sand.
The hardest part was not flying. This meant I had to bus all the way back to Sydney (total of 47 hours if you include the bus from Cairns to Townsville). I spent the entire next day (27 hours) after treatment on a bus to Byron Bay. And then after a couple days rest there, I spent another 14 hours on the bus to Sydney.
I continued to notice a little weirdness in my left knee if I walked too much (day 2 post treatment). It felt like a weakness and not getting a good night’s rest definitely exacerbated it.
In my final week in Australia, I was no longer noticing any symptoms.
Nov 23 rolled around and I felt a little nervous for my flight home the next day. I know the doctors said I was good but I had that little voice in the back of my head wondering if they were wrong and if I may become paralyzed in flight. I prayed for God’s protection and peace and found Proverbs 30:5 particularly helpful: “Every word of God is pure; He is a shield to those who put their trust in Him.”
Nov 24 went smoothly and I did not experience the recurrence of any symptoms on my flight home. I was so relieved to walk off that plane and be back in Colorado.
Living in Denver, I also reside at a much higher elevation and did not notice any impacts from the elevation change. What a relief!
All I had left to do was file the insurance claims! If you’re curious to learn more about the World Nomad claim process for medical issues while traveling, leave a comment below. I’m happy to answer questions.
So, would I go scuba diving again? Absolutely, but I would make a few changes:
- I would start with a single dive instead of 9 over 48 hours.
- I would look into adjusting settings on the dive computer to make them more conservative.
- I’d go in the US where I have in-network insurance coverage, ideally somewhere close to a hyperbaric chamber
Interested in learning more about what I did with my unplanned three weeks in Australia? Check out my posts on Townsville, Byron Bay, Bondi Beach, Sydney Central, and Manly!