DCS versus Neurological Symptoms

[TSandM]

Since both disc-related and DCS tingling and numbness are due to nerve injury, I think it could be almost impossible to tell them apart. In fact, I seem to recall a case here on SB where someone did a couple of chamber rides before his cervical disc disease was diagnosed.

Someone with intermittent neurological symptoms due to structural problems could be misled into ignoring serious DCS symptoms if they closely enough resembled familiar problems. I can't remember where I read it, but I have seen a physician opine that someone with neurological symptoms due to disc disease should not dive for precisely that reason. I think that's a little harsh, but anyone diving with this type of issue should be aware of their increased risk.

 

[Eric Sedletzky]

I had what called a transverve mielinitis once. It was the freakiest thing that ever happened to me.
I knew it wasn't DCS because I hadn't been in the water for 6 weeks prior to this incident.

I'm sure Lynne knows what transverse mielinitis is, but for the rest of you basically it's a rapid deterioration of the mielin shieth that surrounds each nerve fiber in your spinal cord due to a chemical or biological attack of some sort. It's like somebody pouring acid into a wiring loom of a car or computer and all the wires (nerves) short out.
In my case they never did identify the culprit but I feel it was some sort of rare and exotic virus that caused it. After a spinal tap and a full readout the findings were inconclusive.

The symtoms took about 10 days to fully bloom before they halted. Basically all the skin on my body went numb starting on at my pinkies and ring fingers then the bottoms of my feet felt like I was walking on marbles when there was nothing there. Day by day the numbness would claim more of my body untill finally I couldn't feel my legs, lower torso, upper torso chest or arms at all. When I slept I could not feel what I was laying on. My hands finally took it the worst. It felt like I had gloves on all the time and I couldn't feel anything in my pocket. I would go to take my keys out of my pocket and I would have handfull of change instead that I couldn't hold and it would hit the floor. I couldn't drive because I couldn't feel the steering wheel even though I had full coordination and muscle strength in my body.
If I had been diving a few days before I would have sworn it was DCS and probably would have taken a few chamber rides all in vain.

They did finally find the spot in my spinal cord in my neck that showed up as a cloudy spot on the MRI.
There is no medication or remedy for it, it has to heal naturally. It took about a year for the symtoms to clear up.
That was 5 years ago and pretty much all symptoms have resolved. I sometimes get a twinge in my hands still but I have to look for it.

Since that incident I have sworn off any deep diving or tech diving in case anybody is wondering why I don't tech dive anymore.

 

[Kevrumbo]

Since both disc-related and DCS tingling and numbness are due to nerve injury, I think it could be almost impossible to tell them apart. In fact, I seem to recall a case here on SB where someone did a couple of chamber rides before his cervical disc disease was diagnosed.

Someone with intermittent neurological symptoms due to structural problems could be misled into ignoring serious DCS symptoms if they closely enough resembled familiar problems. I can't remember where I read it, but I have seen a physician opine that someone with neurological symptoms due to disc disease should not dive for precisely that reason. I think that's a little harsh, but anyone diving with this type of issue should be aware of their increased risk.

Post-dive with nominal ascent and deco profiles, if the pain, tingling and numbness radiating from my neck down the right shoulder & arm is instantly relieved somewhat by flexing my neck forward and by traction (i.e. "unloading" or uncompressing the pinch on the nerve root to a degree), then I'm confident the cause is due to chronic Cervical Radiculopathy --DCS ruled out.

But that's just speaking for myself and my own Neuro-Physio (and some might add Psycho?) Pathology. . .

 

[Cave Diver]

Since both disc-related and DCS tingling and numbness are due to nerve injury, I think it could be almost impossible to tell them apart. In fact, I seem to recall a case here on SB where someone did a couple of chamber rides before his cervical disc disease was diagnosed.

Someone with intermittent neurological symptoms due to structural problems could be misled into ignoring serious DCS symptoms if they closely enough resembled familiar problems. I can't remember where I read it, but I have seen a physician opine that someone with neurological symptoms due to disc disease should not dive for precisely that reason. I think that's a little harsh, but anyone diving with this type of issue should be aware of their increased risk.

Two questions on this if you'll entertain them Lynne.

1. Do you have an opinion on whether a pre-existing injury such as a compressed disc would pre-dispose someone to DCS by providing a 'starting point'?

2. Do you feel that relief of symptoms after treating with 100% would be enough of a diagnostic differential to conclude DCS?

 

[Kevrumbo]

In my type I DCS incident (joint pain left shoulder & upper arm), I suffered a painful musculoskeletal strain of the left shoulder while manipulating stage bottles at depth, before ascending on a non-optimal decompression profile. (My dive buddy on the same flawed profile, on-the-other-hand, did not exhibit any signs/symptoms of DCS post-dive). Based on my anecdotal experience as a patient, I'm very much interested as well, in the Immuno/Inflammatory pathophysiological response as related or contributory to DCS. . .
__________________

. . .Long thought to be a simple process of blockage of vessels and infarction, it has now been shown that there is a tripping of the complement system and the immune system (T- and B- leucocytes) when bubbles form from decompression. This immune response has a domino effect on blood chemistry that leads to marked changes in the tissues long after the bubbles are gone.

Work has also been done that shows the importance of early treatment. The longer the period of waiting after a decompression incident, the more blood chemistry changes occur and the greater the damage done, emphasizing the importance of early recompression in the treatment of decompression illness.

Very interesting studies have also shown that activation of the complement system may acclimate you to the effects of a decompression accident. This might be a 'using up' process of multiple shallow dives with sub clinical bubbling causing complement activation and having little or none present when a subsequent deeper dive is done. This same process might be the explanation of the excessive fatigue that many divers describe after diving - the fatigue actually being the complement activation damage that is know to occur distant from local bubble sites and the hemoconcentration that occurs.

Individuals who have greater sensitivity to complement activation may be at greater risk for DCS manifestation and more severe DCS injury. Conversely, those with chronically 'used up' complement may be a lesser risk, as in the chronic asthmatic or the atopic patient. . .

The Complement System and Diving

 

[Jax]

Post-dive with nominal ascent and deco profiles, if the pain, tingling and numbness radiating from my neck down the right shoulder & arm is instantly relieved somewhat by flexing my neck forward and by traction (i.e. "unloading" or uncompressing the pinch on the nerve root to a degree), then I'm confident the cause is due to chronic Cervical Radiculopathy --DCS ruled out.

But that's just speaking for myself and my own Neuro-Physio (and some might add Psycho?) Pathology. . .

Wonderful! I, too, can relieve my cervical spine symptoms by neck manipulation.

That is good to know. Thank you.

 

[Jax]

Since both disc-related and DCS tingling and numbness are due to nerve injury, I think it could be almost impossible to tell them apart. In fact, I seem to recall a case here on SB where someone did a couple of chamber rides before his cervical disc disease was diagnosed.

Someone with intermittent neurological symptoms due to structural problems could be misled into ignoring serious DCS symptoms if they closely enough resembled familiar problems. I can't remember where I read it, but I have seen a physician opine that someone with neurological symptoms due to disc disease should not dive for precisely that reason. I think that's a little harsh, but anyone diving with this type of issue should be aware of their increased risk.

I clicked "Like" but actually hate to hear this, as it is as I feared. I have, however, made the personal decision that this will not interfere with my life as much as it is in my power to do so.

I do know a few positions that will relieve the burgeoning symptoms of my lumbar pressed nerves . . . I'm thinking some crews are in for a trip when I do the dying cockroach on their deck . . . just sayin' . . .

 

[Cave Diver]

I do know a few positions that will relieve the burgeoning symptoms of my lumbar pressed nerves . . . I'm thinking some crews are in for a trip when I do the dying cockroach on their deck . . . just sayin' . . .

Please advise them in advance so they don't initiate a stressful response.

 

[Doubler]

"Next most common are muscular weakness and inability to empty a full bladder."

This is daily for me. The bottom line is you have to know your own body and when "Normal" isn't normal. My shoulders and upper arms have muscle pain all the time from being on the computer, I know what that feels like. I'm over sixty so my stream is not what it used to be. If I felt the same thing after a dive with a normal conservative profile I wouldn't give it a second thought. If however the pain increased and my profile was more aggressive I would at a minimum start O2 treatment.

 

[TSandM]

There is certainly a theoretical concern with any area of tissue damage being a nidus for DCS, due to reduced perfusion (or perhaps activated immunological activity) but I don't think there are any data to show that this actually occurs.

Response to oxygen is only information. The placebo response is pretty well-developed in humans.

The information on complement activation has not been reproducible.

The actual intracellular changes that the NEDU guys were talking about were changes in membrane permeability and thickness, especially in mitochondria, if I am remembering a rather brew-laden evening's discussion correctly. They were beginning to think there was actually some cellular phenomena, in addition to the ischemia and inflammation concepts that have been long-standing.