Any experience with long-term symptoms after gas embolism?

[Water_is_my_blood]

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

Thanks. So diagnosis would be DCS with neurological symptoms? Does PFO increase risk of AGE (lung alveoli rupture)?

 

[rsingler]

Does PFO increase risk of AGE (lung alveoli rupture)?

No.

But I am truly concerned that silent COVID-induced pulmonary scarring after an asymptomatic infection might increase the risk of alveolar rupture due to impaired gas flow. The next decade will tell.

 

[Fabian Guggenberger]

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!

Thank you very much! I trust the judgement of my doc. And in the end any gas embolism (doesn't matter how it developed exactly) has similar effects! And thanks, I will check out Herbert Nitsch story!

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

Well, the diganosis (or the most likely reason for the symptomes) was not AGE but gas embolism.

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

Thank you! I totally agree. It can be quite confusing sometimes. Anyway, the most important thing is to have an idea what caused the issues.

 

[scubaozy]

Thank you very much! I trust the judgement of my doc. And in the end any gas embolism (doesn't matter how it developed exactly) has similar effects! And thanks, I will check out Herbert Nitsch story!

You are right, regarding immediate treatment, probably it does not matter. I would personally would want to be sure of the exact cause, if I decide to do a PFO closure operation. Because as others pointed out, existence of PFO does not mean you will develop problems. I have not been checked for a PFO and if I bent my self and later find out that I have PFO (dreaded scenario) I would not right away get an operation, I would first try to manage the risk by more conservative dive profiles and practices. Data I already have is number of dives I did without any problems before.
I recommend you get several opinions from several dive docs and look at the data they can present or see what diagnostics they can do for you. Technically, you do not have a verified problem, all described problems are subjective complaints. I know this sounds harsh but I really do mean well.

 

[Duke Dive Medicine]

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?

@Fabian Guggenberger I'm sorry this happened to you. Even if decompression sickness symptoms resolve on surface oxygen, the standard of care is treatment with hyperbaric oxygen. You should have been immediately evacuated to a hyperbaric chamber and treated, especially as severe as your symptoms were. As you experienced, DCS symptoms can and do reoccur after surface oxygen is discontinued.

There is some literature to support that delayed hyperbaric treatment can be beneficial, although the longer the delay, the higher the likelihood of residual symptoms. I'm surprised that the chamber staff only treated you once. Standard of care is to provide serial hyperbaric treatments until improvement of symptoms reaches a plateau, that is, the symptoms are no longer improving with treatment.

Residual symptoms after treatment for DCS are common, even with prompt and adequate treatment. The good news is that they tend to improve over time; in your case, if they do improve, it will be over a period of months to years. I know it's easy for me to say this while sitting at my desk and sipping coffee, but ten weeks might be a little soon to expect improvement.

Best regards,
DDM

 

[Fabian Guggenberger]

You are right, regarding immediate treatment, probably it does not matter. I would personally would want to be sure of the exact cause, if I decide to do a PFO closure operation. Because as others pointed out, existence of PFO does not mean you will develop problems. I have not been checked for a PFO and if I bent my self and later find out that I have PFO (dreaded scenario) I would not right away get an operation, I would first try to manage the risk by more conservative dive profiles and practices. Data I already have is number of dives I did without any problems before.
I recommend you get several opinions from several dive docs and look at the data they can present or see what diagnostics they can do for you. Technically, you do not have a verified problem, all described problems are subjective complaints. I know this sounds harsh but I really do mean well.

Thanks for you answer, I totally agree with you. In fact, I didn't feel comfortable a couple of times lately after repeated dives. And if I think back, it also happened in the past but I never associated it with anything serious. I learned my lesson now. Moreover, my PFO is large, the L/R shunt pronounced. Without closing it I would not get my dive doc's OK to dive again. Since I spend lot's of time on boats in remote areas I think combining the PFO closure with more conservatism in my diving profiles is the way for me to go in the future

@Fabian Guggenberger I'm sorry this happened to you. Even if decompression sickness symptoms resolve on surface oxygen, the standard of care is treatment with hyperbaric oxygen. You should have been immediately evacuated to a hyperbaric chamber and treated, especially as severe as your symptoms were. As you experienced, DCS symptoms can and do reoccur after surface oxygen is discontinued.

There is some literature to support that delayed hyperbaric treatment can be beneficial, although the longer the delay, the higher the likelihood of residual symptoms. I'm surprised that the chamber staff only treated you once. Standard of care is to provide serial hyperbaric treatments until improvement of symptoms reaches a plateau, that is, the symptoms are no longer improving with treatment.

Residual symptoms after treatment for DCS are common, even with prompt and adequate treatment. The good news is that they tend to improve over time; in your case, if they do improve, it will be over a period of months to years. I know it's easy for me to say this while sitting at my desk and sipping coffee, but ten weeks might be a little soon to expect improvement.

Best regards,
DDM

Thank you very much! Yes I also absolutely agree with you. I was also surprised that the local doctor told me that one treatment is enough. However, back then I trusted her. Later I found out that they don't really have experience with that kind of recreational diving accidents (or guidelines for their treatment). The chamber there is either used by rich people for skin care (I'm not joking!) or for really bad accidents of local compressor-divers/fishermen. But since most of them have no inssurance, they just get a view treatments (even if paralysed). Interestingly, they suggested to visit the chamber every now and then for maintenance!?

And yes, let's hope that the symptomes will improve. I keep thinking positive! Is there any experience with activities that support the healing process? Something like physio therapy, visual training or others?

Enjoy your coffee and thanks

 

[Duke Dive Medicine]

Thanks for you answer, I totally agree with you. In fact, I didn't feel comfortable a couple of times lately after repeated dives. And if I think back, it also happened in the past but I never associated it with anything serious. I learned my lesson now. Moreover, my PFO is large, the L/R shunt pronounced. Without closing it I would not get my dive doc's OK to dive again. Since I spend lot's of time on boats in remote areas I think combining the PFO closure with more conservatism in my diving profiles is the way for me to go in the future




Thank you very much! Yes I also absolutely agree with you. I was also surprised that the local doctor told me that one treatment is enough. However, back then I trusted her. Later I found out that they don't really have experience with that kind of recreational diving accidents (or guidelines for their treatment). The chamber there is either used by rich people for skin care (I'm not joking!) or for really bad accidents of local compressor-divers/fishermen. But since most of them have no inssurance, they just get a view treatments (even if paralysed). Interestingly, they suggested to visit the chamber every now and then for maintenance!?

And yes, let's hope that the symptomes will improve. I keep thinking positive! Is there any experience with activities that support the healing process? Something like physio therapy, visual training or others?

Enjoy your coffee and thanks

I would recommend asking your neurologist for a recommendation about physical and occupational therapy and possibly other recovery modalities. Did the diving physician in Austria say anything about further hyperbaric oxygen treatment? It may not help but it may be reasonable to try it.

Best regards,
DDM

 

[Fabian Guggenberger]

I would recommend asking your neurologist for a recommendation about physical and occupational therapy and possibly other recovery modalities. Did the diving physician in Austria say anything about further hyperbaric oxygen treatment? It may not help but it may be reasonable to try it.

Best regards,
DDM

Ok thanks @Duke Dive Medicine I will consult the neurologist.
No the dive doc here didn't mention further hyperbaric treatments. As well as we don't have a chamber close.

Is there any experience with these mild HBOT 'at home' chambers (tents) which can be rented?
They are used for daily short treatments (~1 hour) at around 1,5 ATM. They are mainly promoted to support healing of brain injuries.

 

[Duke Dive Medicine]

Ok thanks @Duke Dive Medicine I will consult the neurologist.
No the dive doc here didn't mention further hyperbaric treatments. As well as we don't have a chamber close.

Is there any experience with these mild HBOT 'at home' chambers (tents) which can be rented?
They are used for daily short treatments (~1 hour) at around 1,5 ATM. They are mainly promoted to support healing of brain injuries.

You'll see a lot of anecdotal stuff about so-called "mild" hyperbaric therapy that doesn't use oxygen. There is no scientific evidence behind it. The advertisements for it are full of scientific references to legitimate hyperbaric oxygen therapy, probably in the hopes that the general public doesn't understand the difference. A good example that popped up in my RSS feed the other day: a hair and nail salon in Vail, Colorado is now offering it. The owner says she compresses clients on air to a depth equivalent of 9 feet, and according to news reports she is treating professional skiers for soft tissue injuries. If you work the math, her "treatment" pressure is almost exactly the same as if her clients drove down to sea level, and the oxygen level in the chamber is roughly equivalent to using 2 liters per minute of oxygen via nasal cannula at Vail's elevation.

There is a clinical trial of legitimate hyperbaric oxygen going on for traumatic brain injury, but it's not the same as mild hyperbaric exposure. IMO your money would be better spent on OT, PT, and other evidence-based care.

Best regards,
DDM

 

[Fabian Guggenberger]

You'll see a lot of anecdotal stuff about so-called "mild" hyperbaric therapy that doesn't use oxygen. There is no scientific evidence behind it. The advertisements for it are full of scientific references to legitimate hyperbaric oxygen therapy, probably in the hopes that the general public doesn't understand the difference. A good example that popped up in my RSS feed the other day: a hair and nail salon in Vail, Colorado is now offering it. The owner says she compresses clients on air to a depth equivalent of 9 feet, and according to news reports she is treating professional skiers for soft tissue injuries. If you work the math, her "treatment" pressure is almost exactly the same as if her clients drove down to sea level, and the oxygen level in the chamber is roughly equivalent to using 2 liters per minute of oxygen via nasal cannula at Vail's elevation.

There is a clinical trial of legitimate hyperbaric oxygen going on for traumatic brain injury, but it's not the same as mild hyperbaric exposure. IMO your money would be better spent on OT, PT, and other evidence-based care.

Best regards,
DDM

Ok, thank you very much for your assessment and tips