DCI after conservative dives

[bg63]

Hi. Sorry for the long post but I am getting conflicting advice from a range of diving medical experts in relation to a DCI that I was diagnosed with.

My history started 10 weeks ago when I flew in a light plane 16 hours after diving to 20 feet for 25 minutes. I experienced mild joint pain in my fingers and small patches of skin on my back became itchy. Some of the areas that became itchy was scar tissue involved in recently removed basil cell carcinomas.

I did not seek treatment and the symptoms quickly disappeared.

Eight weeks later after a further 10 dives I dived to 65 feet for 39 minutes. 7 days later I began to experience lightheadedness and extreme fatigue. In the intevening period I had done a 100' dive to the limit of the table followed by a shorter shallower dive and then drove home over a 2000' hill with no symptoms.

After visits to 2 diving doctors with conflicting diagnosis, I was refered to a hyperbaric chamber and diagnosed with a neurological DCI and treated in the chamber for 5 hours followed by a further two.

I have a number of concerns with the situation that I would like advice on.

1/ Could DCI symptoms present seven days after a dive within the limits of the tables?

2/ Could these symptoms following relatively conservative dives (at least in the fisrt incident) signify a PFO? (The hyperbaric doctors suggested that because I had done 50 dives, if I had a PFO it would have been evident before now and commented that there was some risk with the echocardiagram necessary to diagnose a PFO)

3/ Did I fly too soon after diving?

4/ Can DCI be accumulative?

I have been under stress at work recently and have wondered if these symptoms are just manifestations of that stress and/or completely unrelated to diving.

The diagnosis has significant implications for my employment and sporting interests as I am a professional pilot.

Any thoughts or advice would be appreciated.

 

[Dr Deco]

Dear bg63:

1/ Could DCI symptoms present seven days after a dive within the limits of the tables?

On the basis of gas loading alone, I would doubt DCI. Diving and then flying could yield problems with smaller gas loads, but these loads would have reached equilibrium after several days. Several days later would really argue against this as a decompression problem.

Could these symptoms following relatively conservative dives (at least in the first incident) signify a PFO?

A PFO cannot be ruled out simply because you have made many safe dives. If the gas loads were always small and there were not any venous gas bubbles then the PFO would make no difference. It is only when bubbles are present that you can have an arterialization problem. In addition, it may be that a Valsalva-like maneuver is necessary for arterialization. Perhaps this dive you coughed and on all of the others you did not. I doubt that you case is PFO and duiving related. That does not exclude a vein to artery stroke problem from a clot (doubtful).

3/ Did I fly too soon after diving?

I am not sure that I can follow exactly all of the dive and fly times, but it does not appear that they were too close to each other.

Can DCI be accumulative?

By this I guess you mean, are problems of neurological DCI cumulative. I regret to say that they are indeed cumulative. In some cases, the nerves are actually damaged and the nerve signals are transmitted by other nerves or areas of the brain recruited from this purpose. This recruitment is other what happens when one recovers from a stroke. If the injury is repeated, soon there will not be anything left to recruit.

You had a conflicting diagnosis with respect, I guess, to DCI. I can see why. When you went into the chamber, did the situation improve? I will guess that it did because your were given follow up treatments. Oxygen is helpful for many problems, at least in the person’s mind. That is why so professional athletes have it to breathe at the side of the playing filed. If you think it is good, it probably will make a difference (the placebo effect). I believe that a visit to a neurologist is in order if this problem of lightheadedness and fatigue continue. Many things can cause these symptoms, some of which are psychological – but none the less very real to you.

Dr Deco :doctor:

 

[bg63]

Thanks for your reply.

As a point of clarification, I have not flown since my last dive, only after the first. (I did travel by road to a location at about 1500 feet elevation two days after the last dive and stayed there for two days, but otherwise no flying).

I did improve slightly in the chamber but I strongly suspect a placebo effect also. I was there 10 days after the onset of symptoms, there is relief at a diagnosis and a nice long rest.

I did have minor chest symptoms when I got the lightheadedness (minor dull ache) and a bleeding ulcer was suspected, but blood tests were normal and as you say, numerous other ailments including psycological ones could explain things.

I think I prefer this possibility to a neurological DCI diagnosis.

Thanks again.