Confused about chamber ride

[herefishyfishy]

Too much time has gone by now for additional chamber treatments to be effective even if this was DCS. The bubbles will have already disolved and being recompressed won't repair tissue damage.

You mentioned that you have pre-existing neuro problems. Given that the first treatment had no affect, it would be my GUESS that you problems may not be DCS related.

I thought additional treatments later in the week would be useless too, but that's not what the doctor, nurse, and technicians said. They were encouraging me to come back. But I don't think I'm going to - the odds of this being DCS seem really unlikely to me at this point. The more I read about it, the less this seems to fit the profile.

Though I did find something on Wikipedia saying that preexisting limb injury does make one more susceptible to DCS hits in that area, that would have meant my symptoms would have been in my hands or arms, since that's where I had surgery before.

 

[sschlesi]

I thought additional treatments later in the week would be useless too, but that's not what the doctor, nurse, and technicians said. They were encouraging me to come back. But I don't think I'm going to - the odds of this being DCS seem really unlikely to me at this point. The more I read about it, the less this seems to fit the profile.

I just wanted to point out you may be listening most to what you want to hear.

As I read this thread I see Thalassamania who has a reputation as a VERY widely experienced professional diver, and whose profile indicates has been trained as a chamber operator, and Kevrumbo who has no reputation with me, but whose profile indicates is an intern Hyperbaric Technician, and your existing doctor/nurse/techs suggesting additional consultation/treatment. While DeepSeaExplorer who also has no reputation with me, and whose profile indicates is a widely trained tech diver but inidcates no training in hyperbaric medicine suggesting it's too late to do anything.

IMO, the two people with apparent qualifications to give an opinion in this thread agree on further consulatation/treatment. I'm sure DeepSeaExplorer means well, and on the surface his advice makes some sense to me, but given what I listed above I don't think I'd take his advice.


P.S.
I'm looking at this from a position of being fully insured. If my treatment meant major financial hardship in this borderline situation I may feel differently.

 

[Thalassamania]

I just wanted to point out you may be listening most to what you want to hear.

As I read this thread I see Thalassamania who has a reputation as a VERY widely experienced professional diver, and whose profile indicates has been trained as a chamber operator, and Kevrumbo who has no reputation with me, but whose profile indicates is an intern Hyperbaric Technician, and your existing doctor/nurse/techs suggesting additional consultation/treatment. While DeepSeaExplorer who also has no reputation with me, and whose profile indicates is a widely trained tech diver but inidcates no training in hyperbaric medicine suggesting it's too late to do anything.

IMO, the two people with apparent qualifications to give an opinion in this thread agree on further consulatation/treatment. I'm sure DeepSeaExplorer means well, and on the surface his advice makes some sense to me, but given what I listed above I don't think I'd take his advice.


P.S.
I'm looking at this from a position of being fully insured. If my treatment meant major financial hardship in this borderline situation I may feel differently.

I think that all three of us are correct. I'd seek the best second opinion that I could find (and I think that's Tom) but with the time that's past I suspect that DeepSeaExplorer is correct. I don't know that additional chamber treatment will be useful. But that's not my (or Kev's) call.

BTW: Kev's in regular contact with some of the best in the field. The Catalina Chamber is, in my mind, one of the premier instillations of it's kind.

 

[Dr Deco]

Hello Fishyfishy:

None of the described events has a good time line associated with them. When we are discussing neurological decompression sickness, a few minutes versus tens of minutes is helpful to know in a differential diagnosis – which, by the way, cannot be done later by e-mail.

Missed Deco

The initial truncated decompression would not have caused a problem by itself. To continue to dive that day without some type of extended surface interval would have been unwise. [You indicate that you did not continue to dive that day.]

The difference between DCS and no-DCS is not four minutes versus seven minutes of decompression. It is not that tight. [Seven minutes instead of 27 minutes would be a different matter.]

There is one recorded case of a woman – an experienced diver – who missed a few minutes of deco on a direct ascent. She reentered the water with hasty preparations, against the advice of her dive buddies, and ended up drowning.

DCS and Fatigue

Fatigue is a problem with diving and, yes, it is an indicator of CNS DCS. The mechanism is not known It is not known that the cause of the condition is a gas phase [i.e., bubbles in the brain]. My research colleagues at the US Air Force chamber indicate that they encounter test subjects with lethargy who do not demonstrate any in vivo gas bubbles by Doppler ultrasound. The lassitude might well be psychosomatic.

Back Pain

The type of lower back pain that you indicated is probably from over exertion. Pain from DCS is usually in the trunk and not pointedly in the lumbar spin. [You do not indicate the locus, but I will make the guess.] That you awoke the next day with nothing better or worse [eg, blasdder problems, cannot walk] would indicate to me that it was not DCS but rather a back sprain. This is something you have experienced before. [I would guess that this might be checked out as small paroxysmal back problems can become chronic. Unfortunately, this is my bad personal experience.]

You actually did one of Dr D’s no-nos – straining and lifting during the off gassing period. If you simply “pulled a muscle,” you can count your lucky stars. The easiest thing to demonstrate in laboratory, chamber studies is the dire effect of physical activity. People still debate about sleep deprivation and mild dehydration, but it take on one depressurization [compared to a non-exercise control[ to illustrate the deleterious effect of lifting. This is apparently one of the most closely guarded secrets in all of diving.

Chamber Run

This will always be recommended in such a case because it is a possible gas phase issue. You received no relief within the hour that indicates one of two things.

One, the problem was a sprain and not a gas phase concern. Hydrostatic force would not compress a nonexistent bubble.

Two, the problem was a gas phase issue and it had developed into edema. Pressure will not correct this but many hours of oxygen might.

The claustrophobia you encountered is usually encountered in individuals wearing an oxygen mask, Hyperbaricists switched to head hoods to obviate this problem. You had it anyway, and this is bad luck.

What now?

Do not lift tanks since it is bad for you back.
Do not lift anything following diving as it is bad you your entire body.
More HBO at this time will probably be ineffective.

Dr Deco :doctor:

 

[Kevrumbo]

I disagree Doc . . .a claustrophobic will have a hard time in general because of the confined space of the Chamber to begin with. Don't you think the fear will be even more compounded by the wearing of a plastic hood? From the patient's perspective, you might've just as well placed a suffocating cellophane wrap around his head. . .

 

[Dr Deco]

Hello Kuvrumbo:

There is no doubt that the chamber itself is a fearsome ordeal for some. Where I worked, some patients reported losing sleep for several nights before their treatments. Once inside they remarked, “This is it? For this I lost sleep?”

The mask is probably less a matter of true claustrophobia than it is a source of discomfort. I would guess that few facilities use masks anymore, going instead to the head hood because the patients prefer them. Our facility in Seattle used head hoods, and this was in the late 1980s.

Dr Deco :doctor:

 

[herefishyfishy]

Hi all,

Thanks so much for your thoughts and opinions. I appreciate so many experienced people weighing in on this. I wanted to update you all on things, since it's been a week.

I am still having some lower back pain, but it's become very clear that it isn't DCS-related because of the way it responds to other treatment. The doctor is in agreement on this. It's slowly getting better, as it has done time after time when it's cropped up - I first injured the area when I fell roller skating as a 9-year-old. Too late to prevent it from becoming chronic, unfortunately: that ship sailed long ago!

It's interesting to hear that physical exertion after diving is problematic; I can't see how to avoid it, however. After our dive day, we hired a luggage company to move our bags to the ferry, but no one's is actually even allowed to carry them on board for us. Even with a rolling tank holder, there are still some steps to be navigated, and, as a small person, I have found that carrying my tank on my back attached to my BC makes transport easier than trying to maneuver a rolling cart over the bumps and steps, especially because all my other gear is in a roller bag. Short of a sherpa, I can't really come up with a plan for getting my gear on or off a boat without some degree of lifting. And on beach dives, there's usually a nice big staircase to be navigated in full gear, so taking it easy isn't an option there, either.

As far as the claustrophobia in the chamber goes, I wouldn't really classify it as claustrophobia. As Dr. Deco said, discomfort is probably a better word. But, as Kevrumbo said, the plastic bag over the head was the disturbing part. The chamber itself didn't bother me: if was a fairly large area and I could actually move about. It was very hot in that plastic bubble, though my attendant did do a good job once I expressed this of cooling me down. Still, it was really awkward for me, probably because it's just not a sensation I'm used to. I also am not comfortable with anything tight around my neck: I rarely even wear a hood for this reason. I'm not a drysuit wearer, either, so the rubber-sealed ring around my neck bothered me probably about as much as the hood itself.

I'd say I'm happy I erred on the side of caution initially. But I'm feeling pretty confident that my choice to do a shorter treatment, and to not go back for another, was correct as well.

Now if I could just avoid all the damn paperwork, I'd be happy. But hey, it' a small price to pay for such amazing insurance coverage.

Thanks again!

 

[Dr Deco]

Hello Fishyfishy:

The lugging and hauling of gear of which I spoke was immediately post dive when one has considerable dissolved tissue nitrogen. The tendency to form tissue bubbles is greatest when intense muscle activity occurs; the new bubbles will trap nitrogen and then grow to possibly cause DCS problems.

If you can use this reason as a ruse to get someone else to carry all the gear both on and off the boat, that is pretty slick! Sorry to hear about the sore back from a fall – what’s what happened to me.

Dr Deco :doctor: