Any experience with long-term symptoms after gas embolism?

[Fabian Guggenberger]

Hi guys

In April I suffered from an episode of DCS after two dives in south Lombok (No limits exceeded). 90 minutes after surfacing my vision changed, parts of my body got numb and I felt pain in my chest. One hour of oxigen cured the symptomes. But since circulation problems (high blood pressure, dizziness) and chest pain reappeared two days later I decided to go for a chamber session. It helped.

However, the circulation problems came over and over again. An echocardiogram, EKG and stress test revealed normal results. After another almost-collapse I decided to immediately stop nikotine and coffein consumption. It was efficient against the circulation issues. But the following day (three weeks after the DCS) I realised for the first time the permanent presence of following symptomes:

- drownsiness (almost like being high)
- visual disturbance (like directly after looking into a bright light source)
- miss-sensations in the limbs (numbness, tingling, cold/hot sensations)

After Indonesian doctors interpreted all following examinations (blood, echocardiogram, OCT, neurological tests, EEG, MRI) as regular, I decided to go back home to Austria to see a neurologist and a professional dive doctor. For the neurologist everything was inconspicuous. But the dive doc immediately found a L/R shunt which turned out to be caused by an enlarged PFO. Thus he diagnosed a gas embolism. The PFO is gonna be closed soon.

Long story short:

The incidence was 10 weeks ago and the symptomes described above are still permanently present (sometimes more, sometimes less). Especially the miss-sensations still seem to dynamically progress and expand. The doctors (of course) think it's neurological sequelae of the DCS and literature research didn't help me to find similar cases. So that's why I try to find divers who experienced similar long-term effects after suffering from neurological DCS. It would be great to exchange experiences cause this situation mentally challenges me a lot!

Anybody out there? What was your experience?

 

[Pedro Burrito]

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[BoltSnap]

Was the flight home to Austria from Indonesia uneventful without more issues? Also, did you have any contact with DAN Europe for further opinions?

 

[Tripp]

I'm sure you know this, but there may be those that don't. PFO = patent foramen ovale. Patent = open. We all have "oval windows" in our heart, to assist blood admixture when a fetus. They begin closing soon after birth, but some remain open, or partially open. The danger is that in some pressure states, they may allow bubbles to flow from the Right Heart to the Left, preventing the bubbles from being removed from the circulation by the lungs, and allowing them to enter the arterial circulation, where they may perhaps lodge in the brain, where they could cause a CVA, or stroke.

 

[boulderjohn]

I am not a doctor, so I am certainly not in a position to diagnose, but I can ask some questions about something that confused me. Your description seems to have a possible self-contradiction.

In April I suffered from an episode of DCS after two dives in south Lombok (No limits exceeded). 90 minutes after surfacing my vision changed, parts of my body got numb and I felt pain in my chest.

ut the dive doc immediately found a L/R shunt which turned out to be caused by an enlarged PFO. Thus he diagnosed a gas embolism.

DCS and gas embolism are two very different conditions, but with similar symptoms. Were you actually ever formally diagnosed with DCS? You said you had DCS after two dives that did not exceed limits. That could have been a gas embolism rather than DCS. You can get a gas embolism after less than a minute in a shallow swimming pool.

If you did have a gas embolism, my non-medical observation would be that the long term effects could be very different from one person to another. It could be very much like a stroke. Effects of stroke - Better Health Channel

 

[BlueTrin]

I'm sure you know this, but there may be those that don't. PFO = patent foramen ovale. Patent = open. We all have "oval windows" in our heart, to assist blood admixture when a fetus. They begin closing soon after birth, but some remain open, or partially open. The danger is that in some pressure states, they may allow bubbles to flow from the Right Heart to the Left, preventing the bubbles from being removed from the circulation by the lungs, and allowing them to enter the arterial circulation, where they may perhaps lodge in the brain, where they could cause a CVA, or stroke.

Also you will probably know this but PFO isn’t rare, about 25% of the population has it.

 

[Fabian Guggenberger]

Was the flight home to Austria from Indonesia uneventful without more issues? Also, did you have any contact with DAN Europe for further opinions?

The flight was without any issues. In fact I did fly home 6 weeks after the incidence and after having a couple of medical examinations to make sure that I'm 'fit to fly'. And yes, I was in contact with DAN, at least before going home! They supported me a lot and I'm very greatful for that.

I'm sure you know this, but there may be those that don't. PFO = patent foramen ovale. Patent = open. We all have "oval windows" in our heart, to assist blood admixture when a fetus. They begin closing soon after birth, but some remain open, or partially open. The danger is that in some pressure states, they may allow bubbles to flow from the Right Heart to the Left, preventing the bubbles from being removed from the circulation by the lungs, and allowing them to enter the arterial circulation, where they may perhaps lodge in the brain, where they could cause a CVA, or stroke.

Thank you for you response! Yes, I know about that. That's exactly what they think happened in my case.

DCS and gas embolism are two very different conditions, but with similar symptoms. Were you actually ever formally diagnosed with DCS? You said you had DCS after two dives that did not exceed limits. That could have been a gas embolism rather than DCS. You can get a gas embolism after less than a minute in a shallow swimming pool. If you did have a gas embolism, my non-medical observation would be that the long term effects could be very different from one person to another. It could be very much like a stroke. Effects of stroke - Better Health Channel

Thanks for the input. I thought a gas embolism is one of the manifestations of DCS type ii. But one never stops learning And thank you for the link, I will check it out!

Well, back then an Indonesian doctor diagnosed DCS type i and sent me to the hyperbaric chamber. The diagnosis 'gas embolism' was done by the dive doc back home (2 months later) after the echocardiograms revealed the L/R shunt caused by the PFO.

Also you will probably know this but PFO isn’t rare, about 25% of the population has it.

Yes, thank you! I'm aware about that Recently I was told that not every PFO is diving-relevant. Obviously it depends on the exact effect that the foramen ovale causes in the individuum.

 

[scubaozy]

Imho, AGE symptoms occur immediately after surfacing. That 90 minutes lag between ascent and symptoms appearing might be key to decide whether this is DCS or AGE.
Your country man Herbert Nitsch made a recovery from severe neurological dcs, I read up online about his experience, you might want to research that. Wish you a speedy recovery!

 

[Water_is_my_blood]

Hi guys

In April I suffered from an episode of DCS after two dives in south Lombok (No limits exceeded). 90 minutes after surfacing my vision changed, parts of my body got numb and I felt pain in my chest. One hour of oxigen cured the symptomes. But since circulation problems (high blood pressure, dizziness) and chest pain reappeared two days later I decided to go for a chamber session. It helped.

However, the circulation problems came over and over again. An echocardiogram, EKG and stress test revealed normal results. After another almost-collapse I decided to immediately stop nikotine and coffein consumption. It was efficient against the circulation issues. But the following day (three weeks after the DCS) I realised for the first time the permanent presence of following symptomes:

- drownsiness (almost like being high)
- visual disturbance (like directly after looking into a bright light source)
- miss-sensations in the limbs (numbness, tingling, cold/hot sensations)

After Indonesian doctors interpreted all following examinations (blood, echocardiogram, OCT, neurological tests, EEG, MRI) as regular, I decided to go back home to Austria to see a neurologist and a professional dive doctor. For the neurologist everything was inconspicuous. But the dive doc immediately found a L/R shunt which turned out to be caused by an enlarged PFO. Thus he diagnosed a gas embolism. The PFO is gonna be closed soon.

Long story short:

The incidence was 10 weeks ago and the symptomes described above are still permanently present (sometimes more, sometimes less). Especially the miss-sensations still seem to dynamically progress and expand. The doctors (of course) think it's neurological sequelae of the DCS and literature research didn't help me to find similar cases. So that's why I try to find divers who experienced similar long-term effects after suffering from neurological DCS. It would be great to exchange experiences cause this situation mentally challenges me a lot!

Anybody out there? What was your experience?

Dive doc found PFO and diagnosis was gas embolism? PFO would increase risk for DCS not for AGE... Or I could be wrong....

 

[rsingler]

Dive doc found PFO and diagnosis was gas embolism? PFO would increase risk for DCS not for AGE... Or I could be wrong....

By definition, a PFO-related event is an embolic phenomenon. No matter how the bubble formed, it snuck over to the arterial side, and did its damage by blocking blood flow. Thus, it's a form of arterial gas embolus. But since the bubbles formed from decompression, it gets lumped in with DCS. But it's a gas embolus, except we can't call it AGE, because it didn't arise from rupturing a paper-tissue-thin alveolus.

AGE, which is exactly the same as a PFO-related embolus in downstream effect, instead arises from... gas expansion and alveolar rupture.

The problem is a limitation in our terminology.

Diving Doc