DCS hit 4 days later

[underH2Oman]

There have been DCI symptoms that have been noticed after the 24 hour mark since diving but 4 days is a long time.
I too am curious as to your profiles.

Hope you are home soon, symptom free..

 

[watboy]

Thanks for all the support guys. To answer some of the questions...

I'm 38 and 86kg. In an ideal world I'd be 75kg. I'm a little stocky built. I'm not in the greatest shape, but I manage about 5 hours a week in the gym. I have a heart rate monitor and keep my heart rate at around 150 during those sessions. I used to socially/ casually smoke. I say I averaged 3 cigarettes a day for 10 years, but I quit cold turkey in the beginning of the year, I've had 20 cigarettes in total for 2013. I consumed less alcohol on the trip than usual. I had 5 beers in 10 days. I did have 2 drinks on the 12th back at home. As for my flights, all the airports on my route where near sea level. I drink water frequently, as I normally do for all my divings.

as for earlier symptoms, there was just muscle aches from diving for 10 days then traveling for 2 days getting home with 60kg of luggage. That was it.

I'm at a hospital now that has a chamber. Spent the night with IV and o2. Felt better after a few hours. Woke up this morning much much better. Should see the specialist soon and expecting a call from DAN. Oh yeah, they poked me and tested my strength so don't think it's a stroke. Docs here offered a CT scan, but Dan felt unnecessary. Any typos are due to my iPads autocorrect, not a stroke. I'm in a very fancy hospital, Bumrungrad in Bangkok for those familiar with medical tourism.

---------- Post added January 14th, 2014 at 06:35 PM ----------

Finished my table 5 chamber ride. All symptoms are gone, hope to be discharged soon.

 

[Duke Dive Medicine]

So, you were completely asymptomatic for 27 hours prior to your flight? No neurological issues, no constitutional symptoms (i.e. extreme fatigue), no rash, no inner ear symptoms, nothing? Any symptoms on ascent to altitude in the airplane? Did you only notice the muscle aches after you got home, or were they present right after your dives?

From your description, this sounds less like DCS and more like brachial plexus injury or some sort of thrombotic event. Neurological DCS symptoms that profound would have in all likelihood presented well before this.

Best regards,
DDM

 

[watboy]

I had no symptoms of any kind between my last dive and my 1st flight, 27 hours later. It took me 3 flights over 24 hours to get home, all the airports along the way were near sea level. Once home, I again had no symptoms of any kind for 48 hours. My symptoms suddenly appeared as a tingling and numb arm, nothing anywhere else. I had thought I fell asleep on it, but I didn't. After 3 hours it still did not improve, so i called DAN who told me to seek treatment for DCS. I went to a nearby hospital that has chamber and a doctor who specializes in dive medicine (i was quite lucky, he's a flight surgeon for the Royal Thai Navy and runs their decompression chamber too). I got there late so was in the ER. The ER doc didn't think it was DCS, again since I had no problems before and after flying for so long, and started testing if i had a stroke. But we got DAN on the phone, and they were certain it was DCS and I was put on O2 overnight. By the time I went to bed, I had been on o2 for 5 hours, and there was a noticeable decrease in the tingling and numbness. Dive doc showed up early afternoon and by then the tingling was gone, some numbing and a little ache in the shoulder. Both the Doc and DAN agreed it was a mild type 1 hit. DAN didn't think a chamber ride was necessary, but the Doctor said its only $500, so DAN said they would pay for it and up to the Doctor. I did a table 5 treatment, was about 2.5 hours long, and started off at 2.8ATA of o2. Chamber wasn't that bad, it was a giant clear tube and they had a big screen TV I could watch and a cute technician. Was hard to tell if there was improvement since i couldn't really move my arm around. But when I got out i was feeling 100%, even the ache in the shoulder was gone. I maybe forgetting some details, but I tried to keep up with what they were saying, happy to answer more questions. Looking back, I've done this sort of diving frequently, I'm always careful. I don't ride my ndl limits, I keep myself fully hydrated (easily 2 liters a day). I don't drink much, I think I had 5 beers on the 10 day trip. Docs and DAN say while its unusual, its not impossible. At some point i have to think about how i will be modifying my diving going forward, but I still want to do multi day / multi dive liveaboards.

FYI - Total cost of treatment, including ER admit, overnight stay in a private room with satellite TV and wifi (its pretty swank), decompression chamber, doc fees etc: $1,200. My regular health insurance covered it, my co-pay is $200.

 

[DandyDon]

Glad to see experts posting, as it is a very interesting dilemma.

And very glad you responded to treatment well.

 

[miketsp]

However, it is fairly rare to be entirely without symptoms for four days, especially considering that you had an airplane flight in the meantime. You didn't tell us anything about your age or general health, but is there any chance you could have had a stroke?

Glad to see experts posting, as it is a very interesting dilemma.

And very glad you responded to treatment well.

Very interesting reading this thread as something similar just happened to me and I had completely dismissed any relation with my dives.
I was on holiday diving regularly up to Thursday Jan 2, last 2 dives in 30m range with Nitrox.
No symptoms, pains or bruises on the last day or the 2 following days.

Sunday Jan 5 caught a 4 hour flight back to São Paulo (800m altitude). Went to sleep with no issues.
Monday Jan 6 woke at 05:30 with a bruise middle of lower right leg as if I'd had an impact with something small and hard (I didn't remember anything).
Tuesday Jan 7 small hematoma on right ankle.
Wednesday Jan 8, hematoma on ankle growing in size and intensity and area now really tender.
Continued hematoma growth up to Friday
Saturday went to hospital. Doctors nonplussed by the format of the large hematoma covering lower leg, ankle and part of foot. Most probable explanation was a fracture(?). X-rays revealed nothing (and I was walking normally). So Doppler ultrasound to check for DVT (or anything else). Nothing. Flows all normal.

I didn't even think of mentioning my dives - after all this was now 1 1/2 weeks after the last dive, right.

They sent me home with instructions to return in case of any deterioration. Fortunately the following day it all started to subside. Now I'm well on the way to full recovery.
But a totally unexplained incident. No previous history of anything similar.

Dive profiles were all to at least computer NDL limits and several with some minutes of obligatory deco as per CMAS tables. These were square wreck dives so reverted to tables whenever the computer complained but then extended the last stop to clear the computer. Not an issue as we would generally be waiting for other divers to clear the ladder anyway. So we always got back on board clear by both the PDC and the tables.

 

[TSandM]

A visible hematoma is almost certain not to be a nitrogen-associated injury. That's mechanical trauma.

 

[Akimbo]

I have seen symptoms alleviated by hyperbaric treatments that later proved not to be DCS. Hyperbaric treatments are effective on many non-diving related maladies. I can’t help but think that this was the case here.

Example:
http://www.scubaboard.com/forums/ask-dr-decompression/467632-dcs-treatment.html#post6929822

Any excess Nitrogen would have dissipated long before symptoms occurred. Granted, there’s a lot we don’t understand about hyperbaric physiology. I can see why DAN was reluctant to approve treatment but didn’t want to override the onsite doc.

I would be inclined to seek tests into other causes of these symptoms.

 

[iamrushman]

very interesting read.......just goes to show that you can do everything right and things still go wrong.

 

[miketsp]

I found an interesting statement on the London Diving Chamber site where they refer to an interval of a "week":

DCI Denial, decompression sickness / DCS / decompression illness / DCI / diving and the bends, London Recompression & Hyperbaric facilities - The London Diving Chamber

DCI Denial:
Having treated many patients over the years DCI denial is a real factor in divers.
A medical cliche is that "common things are common, rare things rare".
If you have been diving the week before and develop a joint pain, tingling, fatigue or numbness, then do not assume it is anything other than DCI.
It will not be a rare neurological illness; it is most likely to be a bend.
It's not that you have wrenched your shoulder lifting kit; assume it's a bend.
It's probably not a rare tropical bug; assume it's a bend.
Until proven otherwise.