Did/do I have DCI?

[xabain2003]

Hi

All this happenned almost two weeks ago and still I am not sure if I have suffered DCI or not.

On August 6th we were doing a dive from the cost, we have been there many times so we know the area pretty well and the weather was fine .

After descent we always take direcction 30 but after 10 minutes at 19 m we realised that we were lost. My buddy told me that he was sure to find our way..

After another 20 minutes we saw that we were really lost so started to ascend. The ascent rate was correct and we did the 3 minutes security stop.

Once surfaced we got really scare as we were around a mile fron the coast with a heavy current taking as away.

We decide to tried finning at the surface for 30 minutes and oce we got closer to the coast descent this time to 12 m and after 30 more minutes fighting the current underwater decided to go up again to take a look where we were.

Ascended at right speed a did a 3 min stop again.
Another 30 min overwater finning and descend again to 4 m until finally after another 20 min arrived to the coast eshausted.

We finished the dive around 10 pm and the day after Wednesday I was fine. The same on Thursday...

Just had a little paint on mi right knee but that was clearly due to the exercise.

The problem came on Friday morning aproximately 60 hours after the dive I woke up with a strange feeling on two fingers from my right hand. A lost of sensibility. Four hours later called the insurance and ask to speak with a hyperbaric doc Who told me that have passed many hours but if the problem continue to go to the chamber.

The Saturday afternoon after felling the same, I was compressed during two hours and twenty minutes at twenty meters feeeling not improving after the recompression.

Still I feel the same and the docs are unable to tell me if it has been DCI or not.

The next step is to visit a Neurologist which I will do in September.

At this moment I am not sure if the problem comes from the neck or from the dive.

I know the dive profile and the effort with water at 20 degrees it is no good.

But to feel symphons afert 60 hours.

Now also I do not know what to do as I am going on holiday to a destination were I was planning to do a double tank dive..

Thanks
Kind Regards
Xabain2003

 

[Ray and Pam]

It it's numbness in your pinkie and ring finger, it's ulnar neuropathy, don't know if DCI can cause this or not. I've had it in both hands, it was due to resting my arms on the edge of my workbench.

Ray

 

[rsingler]

PM me, or call me. We can talk about this. See my profile.
And join DAN, if you haven't already.

Doc S.

 

[xabain2003]

It was the thumb and index, but now it is only the top right part of the thumb.

 

[rsingler]

It was the thumb and index, but now it is only the top right part of the thumb.

Radial nerve distribution - somewhat susceptible to stretch injury. Or a C5-6 cervical root, susceptible to pressure injury from being pinched by the collarbone or compressed by heavy shoulder straps, though usually in root compression "neuropraxia" there are adjacent areas affected. An isolated thumb/index distribution suggests (if it's not DCS) that you probably banged your forearm during all the activity and didn't even notice it during all the exertion. It will go away.

As for DCS, as docs we are always taught to listen to the history.
1) your depths were reasonable; your durations were not consistent with huge nitrogen loading (though your exertion was)
2) you did your safety stops every time
3) 2 1/2 day time to onset is a bit long
4) lack of improvement in the chamber
That speaks against DCS.
On the other hand, not noticing a neuropraxia before 2 1/2 days speaks against a traumatic origin, and a 2 day old DCS induced nerve injury would probably not improve immediately - recompression only improves symptoms that are directly related to the bubble pressure.

So, could be one, could be the other. I think what you really are asking is: is it safe for me to dive again?
Now, we're taught that if you get bent, you're more susceptible to getting bent another time. Maybe true, maybe not - there are LOTS of variables here.
You had (technically) a neurologic injury, but it falls well outside the spinal cord bends that are the real worrisome DCS neuro injuries. It really is more like a musculoskeletal injury because it was peripheral. So I'd call this a Type 1 DCS, if anything. But was it DCS? Assuming it was, you had a reason for an unexpected bubble despite normal precautions and conservative depths: exercise. But it still doesn't fit the usual scenario.

Therefore, I'd tell you (standard medicolegal disclaimer here: I haven't examined you and have only the above history) that you will be fine with your diving, but you should tune in to any other DCS symptoms you might acquire on a subsequent dive. It won't happen in the same place again, unlike a joint or a lung risk. And I'd be careful of heavy exertion with this history. After you've done another bunch of conservative dives and there's no recurrence, try more depth/nitrogen loading. After you see that you can dump nitrogen without symptoms, only then would I be tempted to add back the exercise component, because that's the one thing in your history that was consistent with DCS. I'd concentrate on places where I could drift dive, until you have proven to yourself that this wasn't DCS.

In a few years, you'll look back and say, "What was I worried about?"
Or, having had a second minor (Type 1) incident, you'll sell your gear and pick up a new hobby. No harm, no foul. We're all different.

Hope this helps!

Doc

 

[xabain2003]

Thanks for the reply very appreciatted.
Just one question if it was a DCI that affected the nerve and at the point I did the recompresion made no effect because there were not bubbles How could be possible I did not felt anything until 60 hours from the dive.

 

[rsingler]

Since I don't really think it was DCS, I'm going to have to be speculative here.

We know that DCS can appear up to 48 hours (or more) later. That's because the growth of microbubbles can be very slow as excess N2 from your system diffuses into them. The local growth of a bubble causes release of "kinins" from adjacent injured tissue, which is an inflammatory response that creates a vicious cycle. It's kind of like the swelling when you sprain your wrist: the injury is bad enough, but the body's attempt to immobilize the joint seems to make the pain from that little tissue tear much, much worse. Those are local injury hormones at work.
So in your case, if it WAS a DCS event, and I have to come up with a plausible expansion, I'll say that the pressure on that one tiny nerve root was caused not by a nearby bubble, but by the local swelling from kinins released by a bubble that was not actually at the nerve.
When you got recompressed, the bubble got squeezed, but the tissue swelling didn't. Once you damage a nerve, healing is VERY slow.

That's the best explanation I can invent for a weird occurrence which, in order to be DCS, we have to come up with a plausible chain of events for.

 

[Duke Dive Medicine]

Concur with Doc Singler - if these symptoms didn't appear until 60 hours after your dive it was almost certainly not decompression illness. Also, as he said, isolated neurological symptoms like that can rarely be blamed on DCI and are much more likely neuropathic/musculoskeletal in origin.

Best regards,
DDM

 

[xabain2003]

It is great to have this kind of support. Thanks guy. I was going two do a double tank dive during my holidays in one week from now but I have call my insurance and they have comment that until I have the incidence closed they do not advise me to dive as in case of any problems the insurance may consider that I was no fully recover for the activity. I have the Neurologist at September.

By the way I checked the DAN dive insurance and I recalll that I decided to go with my actual insurance as it was convering more ...for less.

DAN it is not so extent in Spain as it is in America or UK. In fact I do not know any coleague that has DAN.

 

[rsingler]

I'm sorry to hear you aren't able to find good local DAN resources in Spain. I'm sure they're there. As for coverage, I believe you when you say your private insurance covers "more." DAN is very specialized insurance and doesn't try to do more than scuba rescue coverage and medical, unlike many all-purpose policies that promise a lot but then come up short in the event. But DAN's reputation in this one critical area is unsurpassed, and your company's apparent temporary exclusion for this incident is surprising for "dive insurance". I wonder what DAN would have done with this case?

Anyway, no one can fault you for being conservative! Happy diving! I'm sure you'll continue to get better over the coming weeks.
As for your neurologist visit? If he does sophisticated nerve conduction studies, he can localize the site of the injury to your brachial plexus in the neck or arm, or confirm that it's a peripheral lesion. But that still won't likely reveal the cause of the injury. Therefore, waiting to dive again just because the tip of your thumb is still numb doesn't make medical sense. The nerve healing may take weeks or months more to completely disappear, and another dive won't affect that. Welcome to the world of insurance bean-counters!

Doc