Could this be DCS?

[pr8]

Hi!
Im from the Philippines, Im a scuba diver, and Im not sure if what I got is DCS, here is my case:

Third week of June, I had a trip around South East Asia as follows:
Flight 1: manila-kuala lumpur
Flight 2: kl-seam reap
Flight 3: seam reap-kuala lumpur
Flight 4: kuala lumpur-phuket
--------- skin dived at phi phi island area to about 10-15ft feet, forgot to exhale air out from lungs while surfacing (mon around afternoon)
Flight 5: phuket-kuala lumpur (tues early morning)
Flight 6: kuala lumpur-manila (tues evening) - just a note on the flight back there was a time i felt a bit hard to breath, short span of dizziness-less than 5 min, but was relieved after i directed the air vent directly to my face.

On getting back (Manila):

slight dizziness on wednesday, worse on thursday ( i just slept it out)
more dizzy, prickly feeling around back of knee starts (thurs)
prickly feeling like sun burn spreads to upper back and chest, shoulder area, with slight rash/change in skin tone (tues),
--went to derma and internist
sometime during the week things got pricklier and dizziness/nausea feeling started, some skin started to look marbled; erratic deep prickling/slight pressure in knee, elbow, and finger area joints. noted that my pulse started to be erratic, at times it reached 110 even at rest.
-- went to allergist/immunologist
--went to doc and referred to a better derma (mon)
condition still continued, started to notice veins on skin
-- went to allergist/immunologist again
condition continued and felt more pressure on my knee cap, and more frequent prickling in my finger joints

went to hyperbaric doctor in one of the better hospitals here, gave me 2+ hour session of hyperabric therapy (mon)
---was relieved of prickly feeling around shoulders, and skin and joint pressure,
other notes: during this session i felt that there were like there were spaces in my knee that were freed, 2 hours after leaving the chamber i felt something like insects running from my knee to pelvis quickly (around 2 sec). I felt totally relieved until after about 4 hours when dizziness started again.
.
went back the next day, tuesday to hyperbaric doc complianing about being dizzy, I told him all previous symptoms were gove except for dizziness (tues)
---gave me 4+ hours of hyperbaric therapy, about an hour before ending the hyperbaric session (still inside the chamber), i started to feel like having bubbles or like your muscles being stimulated by an electronic muscle stimulator this ran from my fingers, then chest, abs, then lips area to under the ear. The session was aborted, and
i was twitching with slight jerks for about 45 min before it subsided. About an hour after i started to feel pressure on my lower back and on the end tip of the bone in my butt area. My hyperbaric doc confined me and referred me
to a neurologist, I complained of the dizziness, and the lower back pressure, slight jerking (sometimes), and light pressure in my molar area (teeth). I was cleared to go home thursday, around 48 hours after the aborted hyperbaric session.
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On thursday evening the pressure on my lower back started to spread to the groin area and up to my knee, I called another hyperbaric doctor affiliated with DAN on his cellphone and I met him at his office at around 11.30pm, he gave me hyperbaric again for 4+ hrs. This was friday, I went in the chamber a bit stressedout/tired. The pressure in my leg and knee was relieved, and lower back was also slightly relieved, still dizzy. I felt ok after but an hour after I felt tired after this session.
notes: during this session I felt the insect sensation again (bubbles as the hyperbaric technician called it) at my lower back and around near my spine.

--on saturday and sunday, i didnt feel better, except that there was no more pressure on my leg and groin area, but still dizzy, and more pressure on my lower back knees, and more pressure on the inside of my teeth, I was in constant communication with the hyperbaric doctor who treated me on friday, and he told me on Sunday evening to go to the chamber on Monday.

On Monday afternoon I was given 4+ hours of hyperbaric treatment. After this pressure on my lower back, knees, and teeth started to subside, except the dizziness and vomit feeling.

when i woke up the next day pulse was a bit high at rest - 97-110, my normal at rest is around 80.

Still felt a bit tired


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three days after still dizzy, pressure on lower back, teeth slowly subsiding, no more joint pressure.
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One week after i still feel dizzy, prickly/itchy sensation is back at a lower intensity though,
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Two weeks after, i still feel dizzy, prickly/itchy with some skin symptoms.
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prior to these events, Im a scuba diver, i participate in water sports, and there were times that I forgot to exhale/remove all air from my lungs when quickly surfacing from a pool dive. My last scuba dive was April this year, and I had a fast ascent about 4 years ago (i had a headache after but it resolved by itself, I didnt have it checked by a hyperbaric doctor then).
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What do you think of my case? Could it be DCS? Should I go for another treatment in the chamber?,

any feedback would be appreciated

 

[martinskarin]

I am not a doctor nor a professional in this area in any way.

DCS normally shows pretty fast (15 minutes to 12h, but can show later), if you did not dive since April it seems unlikely you have DCS (you do not get DCS from skin diving, need to breath air under pressur to disolve nitrogen in your blood or tissues). When you skin dive you do not need to breath out while ascending (since you did not breath pressurized air there is no air that can overexpand your lungs) so that should not be a problem either.

You can call to DAN Asia pacific
+61-3-98869166

Whatever it is, it does not seem very good.. did you have a doctor check your heart recently? Can´t see you write so specific about if you made some general health check.

Anyone who knows better, correct me...

 

[Pliny]

At any point did you get a chest x-ray?

I used to think you couldn't embolize or get pneumothorax skin diving but while swimming I got some water up nose while flip turning and reflexively blew out and pinched nose (in sim goggles not face mask) at the same time. As I floated up I could feel the pressure build in my upper respiratory tract. It made me think that even though the muscles of the diaphragm and chest may not be able to generate enough pressure to embolize when exhaling against a closed glottis, if the chest is already contracted all those muscles need to do is hold position. Since work is F.ds the energy exoenditure would be zero -- the ompressed gas does all the damage by itself.

Note I am not a MD.

 

[TSandM]

I'm confused by the story. Was the only diving you did on the trip the skin diving described? In that case, you do not have and did not have DCS. What you HAVE is not clear to me at all, but skin diving to 15 feet cannot give you DCS, and in fact, there is no need to exhale while ascending from a skin dive, unless you breathed off someone's regulator while you were underwater.

 

[charlesml3]

I'm making the assumption that "Skin Diving" in this context means snorkeling. So:

- Snorkeling means "did not breathe compressed air."

- "Did not breathe compressed air" means this could not in any way be DCS.

If the hospital put you in a hyperbaric chamber then either they don't understand DCS or there's more to the story than we have here.

-Charles

 

[clgsamson]

what did the neurologist say?

 

[Johnnycat]

That's pretty impressive that you got appointments to all those specialists so quickly.

 

[Cave Diver]

- "Did not breathe compressed air" means this could not in any way be DCS.

Highly improbable under the parameters set forth, but not entirely impossible without compressed air. There has been reported cases of free divers suffering DCS, and a couple of documented cases in whales as well.

 

[Wayan]

Very difficult to follow ; no indication if you scuba dived as well as snorkelled? If you did indeed dive dive profiles would help

On the whole a bit strange.

However yes to all of the above it is highly unlikely to get a DCS hit from 15 feet. Some free divers have had DCS and been treated but is ot the norm.

went to hyperbaric doctor in one of the better hospitals here, gave me 2+ hour session of hyperabric therapy (mon)

A little unusual for a Table 5 or Kindwall to be given first (2 hour treatment table) . . .International protocols now recommend USN TT6 first up
and certianly very unsually to have a TT5 followed by a TT6... This is generally accepted by most Hyperbaric Centres as the starting point for all cases with DCS

I felt ok after but an hour after I felt tired after this session.
notes: during this session I felt the insect sensation again (bubbles as the hyperbaric technician called it) at my lower back and around near my spine

Extremely doubtful to have bubbles in the system at this stage. The insect sensation (crawling on/under the skin) is not caused by bubbles moving at this stage but rather nerve damage / interaction with drugs or other means.

I am Not a Doctor, Seroius DCS in the first few minutes of surfacing (normally AGE or CAGE) I have seen people with S+S 24-36 hours after diving (but not a common event). On most occassions some where up to 18 hours -24 hours after. But difficult to say as a ;ot of people are in denial and do not seek medical advice until 2, 3 days and in some cases 1 week or more after diving (after having noticed something the day of the dive). The sooner medical advice is sought and treatment given (if necessary some cases are so slight they may only need normabaric oxygen) the better the prognosis for a chance of complete recovery.

If the problem persists you shoud,seek professional medical advice.

 

[Duke Dive Medicine]

I'm going to go out on a limb here and assume that this was a SCUBA dive. It's pretty unlikely that two separate hyperbaric physicians would have treated a breath-hold diver in a chamber. pr8, please correct me if I'm wrong.

Failure to exhale on ascent is a risk factor for arterial gas embolism, and the symptoms presented are not consistent with that diagnosis. The reported 10-15 foot depth, along with a delay in symptom presentation of over 24 hours, also essentially rules out a diagnosis of decompression sickness. Given the information provided, I don't believe that further hyperbaric treatment will be effective.

pr8, do you know which treatment protocols were used for your hyperbaric treatments? I'm concerned about what appear to be symptoms of CNS oxygen toxicity on the second treatment. If it was indeed an hour before surfacing, and you were treated on a U.S. Navy treatment table 6 (a standard, widely used treatment protocol), then the chamber would have been at 30 feet at that point. CNS O2 toxicity symptoms at 30 feet in a chamber are highly unusual, and typically result from some other aggravating factor like hypoglycemia.