Remote DCI

Question:
What happened: on 22/12/99 I made two dives on the wreck The USS AARON Ward, located in Solomon Islands, off the floridas. The first dive was started at 10.15 am, max.depth 61,3/m (suunto) 63.1m(uwatec computer).
This is the PROFILE. 1 min 25m-, 2min- 49m, 3min 60.7m, 4 min 61.3m, til 10 mins around 60m. then 10 min 56.7m, 11 mins 53.3 m, 12 min 54,3m, 13 mins 52,4m, 14 mins 40.2m, 15 mins 28.9m, 16 mins 18.6m, 17 mins 12 m, 18 mins and further deco and safety stops at 9-6-3 meters.
Then we had a surface interval, and made the next dive at 14.10 pm, so I had an 3 hour surface interval.
SECOND DIVE : Same dive again : 1 min 22m- 2min 46m- 3 min 59m- 4 mins 61.3m- till 12 mins at 63.4m- then ,13 mins 58.5m-,14 mins 42.4m-,15 mins 32m-, 16 mins 21m,- 17 mins 12,8 m-,18min 11.8m,- 19 min 9.1m,- 20mins 9.1m,- till 24 mins, then at 7.3 m at 25mins, 26mins 6.4m/ , 26min 6.4m-, for 8 minutes, from 34mins till 44mins at 4.2meter, and 7 mins at 3 meter.
Then I surfaced ,got in the boat ready to leave, when I noticed some pain in my left shoulders and left underarm. It got like kind of paralised, couldn't use it anymore. We changed the tanks, and I went down again, hanging on a rope , in open sea, spending about 20 mins: 11 mins at about 6metre, and 5 mins 5,5m, asnd 4 mins at 3 meter. When I went back on the boat, the pain in my left underarm was less/gone, and much less in my left shoulders. we headed back to the dive shop, about an hour away from divesite. On arrivasl I still had pain in my left shoulders, so we decided I'd go back in the water. I spend 104 mins at depts ranging from 10 to 3 meters. I also breath nitros 36 % at 6 meters (100 bar in tank ,emptied the tank). On surfacing, the pain was less, but still present. For about 15 mins I breath also oxygen. I took some aspirins to dilute ?? the blood. The pain remained for some days. 3 days later I had an international flight and didn't have anymore problems, although I was concerned, and still had some pain in my left shoulders.
What do you think what happened ? (did I get slightly bend ?) If this ever happens again what would you recommend me to do, being in remote locations..?

Answer:
The case you describe seems clearly a Decompression Illness Case, with both pain and some slight neurological involvement.
The dives you describe are certainly heavy dives, even if the ascent profiles were followed with caution and apparently did not imply any decompression stop skipping or shortening.
What our experience has shown in the last years is the importance of the average ( as well as fractional ) speed of ascent, where the speed of 18 meters / minute is clearly excessive and potentially dangerous. This applies to all the phases of the ascent, from the bottom up, and includes the final ascent from the last deco stop to the surface. We feel that a safe ascent rate should never exceed 9 meters / minute and be even slower in the last meters before the surface.
The way you fronted the problem has only been partially adequate, as an in-water recompression / decompression - expecaly if in air - should have been longer. However, such procedures do imply additional inert gas absorption and added DCI risk, and are generally not advisable.
Similar heavy dives in remote areas, where hyperbaric services are not readily available, must be approached with the awareness of a higher risk of DCI than in more "normal" dives, and with consequent higher "preparedness".
First: is is stronlgly recommended that an adequate surface oxygen first aid unit is available and functional on site, to be used according to the current DAN recommendations.
The Australian "Underwater Oxygen Table" procedures have been used successfully to treat DCI in remote areas; these imply the use of a surface supplied 100% oxygen breathing system, with full face mask, adequate thermal protection, availability of in-water assistants, a shot line of at least 10 meters with a seat or harness for the injured diver rigged to the shot. The decompression profile is the following: stay at 9 meters for 30 to 60 - 90 minutes, depending on initial severity and response to treatment, then ascend at a rate of 1 meter every 12 minutes. In case of recurrence of symptoms during the ascent, remain at depth for a further 30 minutes before continuing ascent. In case oxygen is exhausted, it is advised to return to surface rather than breathing air. After surfacing 100% oxygen should be continued, 1 hour on and 1 hour off, for a further 12 hours.
Obviously such a modality implies a certain logistical preparation, as well as adequate equipment and supplies.
Preventive-wise, a revision of your decompression scheduling, with the use of enriched air and also oxygen during the decompression stops, while keeping to the planned air deco-stop times, may be advisable.