DCS hit 4 days later

[KD8NPB]

Thank you for posting your experience!

 

[watboy]

DAN's pause before approving treatment was for economic reasons. After some 17 hours on o2, I was feeling 90% with the numbness and tingling gone and only minor shoulder pain. There was no question of the DCS diagnosis. Setting aside the delay, the symptoms and my response to the o2, both DAN and my doc believe it was DCS.

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.

---------- Post added January 17th, 2014 at 11:18 AM ----------

My dives over the last 3 days of the trip. All where multi-level tropical reef dives. Water was 29C.

Date	Start Time	End Time	Length of dive (minutes)	Max Depth (meters)	Surface Interval (Prior to dive)	Nitrox
07-Jan-14	7:29	8:31	62	28	15:10	34%
07-Jan-14	15:34	16:34	60	29	7:03	32%
07-Jan-14	20:47	21:44	57	16	4:13	32%
08-Jan-14	8:32	9:27	55	29	10:47	32%
08-Jan-14	16:01	17:01	60	28	6:34	30%
09-Jan-14	8:04	9:05	61	26	15:02	30%
09-Jan-14	11:33	12:25	52	25	2:28	32%

 

[Akimbo]

Watboy, that doesn’t change the fact that something very unusual has occurred. Any direct effect of dissolved gas coming out of tissues would have passed long before you became symptomatic. Although hyperbaric exposure probably precipitated the event, the likelihood that it was entirely caused by DCS is questionable.

As we have seen many times, relief of symptoms during and after hyperbaric treatment is not proof of DCS. I am only suggesting that there may be undetected contributing factors that are worth investigating. It’s not like this occurred during your first 20 logged dives and you have unusually low tolerance to getting bent. That leaves the possibility open that something different has occurred that a Table 5 won’t resolve.

I am the last guy to suggest that hyperbaric treatment for possible DCS should be delayed or avoided. I doubt anyone on Scubaboard is a bigger advocate of rapidly treating symptoms than me, as reflected in many of my posts. Best of luck and good diving.

 

[boulderjohn]

Where was the overnight in a hotel? Turns out if you fly-after-diving *to altitude*, like Denver for example, DAN recommends more than 24h pre-flight offgassing.

Could you please provide a reference for this? I live just outside of Denver and have never heard anything about that, and I can't find it on the DAN site.

 

[watboy]

What at other contributing factors should I be investigating?

Watboy, that doesn’t change the fact that something very unusual has occurred. Any direct effect of dissolved gas coming out of tissues would have passed long before you became symptomatic. Although hyperbaric exposure probably precipitated the event, the likelihood that it was entirely caused by DCS is questionable.

As we have seen many times, relief of symptoms during and after hyperbaric treatment is not proof of DCS. I am only suggesting that there may be undetected contributing factors that are worth investigating. It’s not like this occurred during your first 20 logged dives and you have unusually low tolerance to getting bent. That leaves the possibility open that something different has occurred that a Table 5 won’t resolve.

I am the last guy to suggest that hyperbaric treatment for possible DCS should be delayed or avoided. I doubt anyone on Scubaboard is a bigger advocate of rapidly treating symptoms than me, as reflected in many of my posts. Best of luck and good diving.

 

[boulderjohn]

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.

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.

As we have seen many times, relief of symptoms during and after hyperbaric treatment is not proof of DCS.

I have some nerve-related issues that give me severe DCS symptoms in one arm when I aggravate thing by carrying heavy stuff around on my shoulders for a while, including scuba tanks. They sometimes come and go in time, in a manner consistent with what would happen if I were receiving hyperbaric treatment--except that I am not.

 

[Akimbo]

What at other contributing factors should I be investigating?

That is a better question for DAN and people active in research like Duke Dive Medicine. Unfortunately, lots of things can cause tingling and numbness. Likewise, hyper-oxygenation is used to successfully treat lots of non-diving maladies.

If you accept the classic decompression theory that symptoms are caused by bubble formation (even micro bubbles) that block blood flow or physically damages tissue, then your case is less likely to be purely DCS. The fact that one hyperbaric treatment worked so well is even more suspicious to me. I have never heard of nerve tissue damage being resolved so suddenly and completely by one Table 5. Not having nerve damage is really fantastic, but what was interfering with those nerves?

Unfortunately, most interest and reimbursement funding tends to disappear along with symptoms unless prompted by the patient. I am sure lots of us are very interested in what you learn.

 

[tursiops]

I'm afraid the reference is a personal communication. A friend took a hit, called DAN, and they told him that. It was some years ago and I do not remember any details. Burt may have been doing deco dives (he did that a lot), I don't remember, but at the time the issue was he did a pre-flight surface interval of 24h, flew to Denver for work (it was not his usual flight home), and called DAN after the pain began. They told him he should have spent 48h pre-flight because of flying to altitude, not flying to sea level.

Sent from my ASUS Transformer Pad TF700T using Tapatalk

 

[underH2Oman]

Here is one reference that recommends 48 hours before going to elevation.

http://www.imca-int.com/media/72854/dmac07.pdf

 

[Rhone Man]

Very interesting thread. I have heard of late onset hits, but this would certainly be a record amongst stories I have heard. Part of the difficulty is that oxygen therapy (and of course time) can cure many things, so we cannot be absolutely sure it was a DCS hit.

However, I have long held the view that heavy repetitive diving of the type people do on a liveaboard creates risks that are not adequately covered by existing decompression theory, particularly with divers who don't have a history of heavy diving. I recall doing a fairly heavy profile on a liveaboard once, but never went into deco (I was with my 73 year old father and was trying to keep him safe) and had elongated safety stops, but by the end of the week everyone on the boat was complaining about aching joints.