Flying after treatment for DCI

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SPuz

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I had a diving accident 8 weeks ago and was hospitalised for DCI for three days. My main symptoms were tingling, which began in the fingers and then spread to most of my body, numbness of the legs and a bubbling sensation under the skin. My treatment consisted of breathing 100% oxygen. I was not referred to a hyperbaric unit for treatment in a recompression chamber. The nearest chamber was over 2000km away and the doctors decided that my symptoms were not severe enough to warrant the risks of transporting me to or treatment within the chamber.

By the time I left hospital I was left only with the tingling sensation. I was told not to embark on any strenous exercise for two weeks or to fly for two weeks. I was told that my tingling would remedy itself within this time.

At this current time I still have the tingling sensation most predominantly in my fingers but in other parts of my body from time to time. I have not flown up until this point, however, I did go to altitude (only 1000 metres) a couple of weeks ago which left me feeling quite unwell (nausea, dizzyness etc). Once I descended my symptoms seemed to resolve which made me wonder if they could be related to the DCI.

To this effect, later that day I visited a hospital in Sydney. They advised me that it was possible that it was the DCI causing the nausea etc but that it was more likely to have been one of a number of other causes. This seemed reasonable to me. They did advise me, however, that the hospital where I was initially treated should not have told me that my symptoms would resolve within 2 weeks. They stated that in their experience symptoms often take 3-6 months to resolve fully.

My concern now is flying before my tingling has fully resolved itself. I have not been able to get much of an answer on this point. The hospital advised me that it was my decision. They said on the one hand I could be fine but on the other I might be quite ill during and after the flight, although they did say that flying would not be dangerous. I couldn't really understand why I might feel ill but that that wasn't dangerous though.

I was basically hoping that you might have some further information to enable me to make a more informed decision on the matter of when I will be absolutely fine to fly again. At some point I need to return from Australia all the way to the UK.

Thanks very much.

Kind regards,
SPuz
 
Welcome to SB Spuz. While DAN is an excellent medical and diving resource that you can consult even if you are not a member, we have some excellent physicians here as well - with DrDeco being the expert here on this forum. Please do keep checking back for medical postings - keeping in mind that non-medical members are also allowed to post opinions here.

You are also welcome to give us a report on your accident, if you would like to do so on the Accidents forum. Link: http://www.scubaboard.com/forumdisplay.php?f=286

I would not think that travel to altitude nor on a commercial jet would be a problem after weeks have passed, even tho the physical damage to your body by the incedent left lingering symptoms. I'll look forward to the experts' postings as well.

Best wishes on your recovery.
 
DAN Flying After Recompression Treatment study.

FLYING AFTER DCI IN PATIENTS DIVING IN REMOTE LOCATIONS: A FOLLOW-UP PROJECT.
Torp and Schaper 2006
RRR ID: 3690
NOTE: This is an abstract so no paper available.
Torp and Schaper 2006 abstract:
CONCLUSIONS: Time to flying home after DCI treatment will have significant impact on the patient in terms of length and cost of the vacation, return to work, cost of a relapse in an airplane and cost of re-treatment at home. Recommendations for an optimal time interval vary considerably. In our pilot study, patient discharged with residuals were more likely to experience symptoms during and after the flight than those discharged without residuals. None of the symptoms were severe. Most patients flew home within 2 weeks. Larger studies with matched controls are necessary.
FLYING AFTER RECOMPRESSION THERAPY.
Vann et. al. 2004
RRR ID: 1474
NOTE: This is an abstract so no paper available.
DAN 2004 abstract:
DISCUSSION: The available data did not indicate that flying after treatment predisposed to DCI relapse or that a delay of many weeks before flying was frequently needed. Relapse due to flying after treatment alone did not appear common. These tentative conclusions require confirmation.
Current Practices In Flying/ High Altitude Travel After Treatment For Decompression Illness.
Barnes et. al. 2004
RRR ID: 1507
NOTE: This is an abstract so no paper available.

AN ASSOCIATION BETWEEN FLYING WITH SYMPTOMS OF DCS AND RESIDUALS AFTER RECOMPRESSION TREATMENT.
Freiberger et. al. 2002
RRR ID: 1141
NOTE: This is an abstract so no paper available.
DAN 2002 abstract:
DISCUSSION: Flying with symptoms is associated with and adverse outcome. This effect is worse if the presenting symptoms are neurological in character and/or associated with pain.
COMMERCIAL AIRFLIGHT AFTER RECOMPRESSION THERAPY FOR DECOMPRESSION ILLNESS.
Uguccioni et. al. 1998
RRR ID: 679
NOTE: This is an abstract so no paper available.
DAN 1998 abstract:
CONCLUSIONS: This retrospective review shows that there was a subset of divers in both groups who experienced a return or worsening of symptoms with commercial flights after treatment. The return was more likely in those divers who did not have completely resolved symptoms prior to flight and symptoms lasted longer in those who flew in less than 72 hours after initial treatment.

NOT Directly involved with this question but worth reading:
REPETITIVE FLYING AFTER DIVING.
Cramer and Sheffield 2006
RRR ID: 3633
NOTE: This is an abstract so no paper available.
 
Hi SPuz,

As can be seen from the summaries of relevant studies provided by Gene Hobbs, hard science has not yet informed this inquiry in a definitive fashion. However, important points of a general nature can be made and it can pretty much be guaranteed that the time spent on the Diving Medicine forum will be far more informative and satisfying than a response from DAN.

Arguably, the facility which provided post-dive treatment may have been faulty in the decision not to recommend recompression. Tingling which spreads from the fingers to most of the rest of the body, paresthesias of the skin and numbness of the lower extremities very strongly suggest Type II/Neurological DCS, a potentially quite serious condition. It apparently was worrisome enough to justify a three day hospitalization with periods on 100% oxygen. Properly done, transporting the diver to a distant chamber, and the hyperbaric treatment itself, would not generally be considered to pose as great a risk as does untreated or inadequately treated neurological DCS. As regards the estimate that the residual tingling would resolve within two weeks, it is well-accepted by the diving medicine community that such resolution can take many months, and in fact may never entirely occur. However, all of this now is a matter of academic interest.

Turning to "nausea, dizzyness, etc (sic)" upon ascent to ~1,000 meters/3,280 feet, which resolved with descent, it seems unlikely that this was directly related to the post-scuba symptoms reported ~6 weeks prior. These complaints could have been the result of heat, over-exertion, dehydration or a combination of factors.

Regarding flying, as it is now more than 8 weeks post-incident and all treatment is completed, there is no apparent basis to anticipate any exacerbation of the tingling or additional damage as a consequence of a normal commercial flight.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

Regards,

DocVikingo
 
https://www.shearwater.com/products/swift/

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