Follow up treatment for DCS

[Carl P]

I have seen that diving physicians sometimes recommend further follow up recompression treatment, several weeks after main DCS treatment. What is the purpose of this. Does it actually have any effect? I am sure that all the Nitrogen will have been off-gassed by then. Is there any time limit for such treatment?

Thanks..

 

[DocVikingo]

Hi Carl,

I'm not quite sure what you are asking. Perhaps a specific example or more details would prove useful.

It is not common that the initial course of hyperbaric treatment for DCI would be followed by a several week break, and then further recompression therapy provided.

When multiple recompression treatments are given, they usually flow continuously until the signs and symptoms completely or very largely resolve, or are no longer showing response to therapy.

You are correct that after several weeks all excess nitrogen will long have been off-gassed. However, the effects of the hit (e.g., disruption of blood flow to tissues at and distal to the site of a vessel occluded by an event of DCI) can last for some time.

In some cases of severe neurological DCI, residual symptoms may be present even after very aggressive treatment. In these situations, there may be extended follow-up treatments, but a several week break still would be unusual.

Helpful?

DocVikingo

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.

 

[Carl P]

Thanks DocVikingo. The specifics were an incident that occurred at the beginning of a vacation. The main symptoms were; numbness on left side, differences in reflexes between right and left, and pain on the left elbow. Emergency treatment was provided immediately (Table 6, Table 5, HBO), resulting in improvement of the symptoms. A follow on check-up with possible further treatment was recommended on return to the home country. There was a time lag - about 10 days between the conclusion of the emergency treatment and the scheduled return to the home country. Further delays occurred on returning to the home country as it was not clear that the follow up treatment was essential or urgent. This lead to a gap of about 1 month between the conclusion of the emergency treatment and the opportunity to begin the follow up treatment. The real question is whether follow up recompression over a month after the completion of the emergency treatment is likely to have any effect. The remaining symptoms are some left elbow numbness and slight difference in sensation between left & right. The local doctor also believes there is also slight difference in muscle power between left & right. Incidentally, the person in question had 2 extremely conservative dives with no rapid ascents or other obvious contributing factors. This was also not their first case of DCS - a similar incident occurred 5 years earlier, so there is a big suspicion of a PFO. Thanks.

 

[DocVikingo]

The real question is whether follow up recompression over a month after the completion of the emergency treatment is likely to have any effect.

Hi Carl,

The brief answer is, "No." Given the situation as described, additional recompression more than a month following a single emergency treatment has only the tiniest likelihood of resulting in further improvement.

It is possible that some additional resolution will spontaneously occur over time, but this is not guaranteed.

Incidentally, the person in question had 2 extremely conservative dives with no rapid ascents or other obvious contributing factors. This was also not their first case of DCS - a similar incident occurred 5 years earlier, so there is a big suspicion of a PFO. Thanks.

If PFO is strongly suspected, transesophageal echocardiography (TEE) (Echocardiography - Wikipedia, the free encyclopedia) with bubble contrast arguably is the technique of choice. Be advised that if the patient has no overt signs or symptoms of cardiac abnormality, it is quite unlikely that medical insurance will pay for the procedure.

Helpful?

DocVikingo

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.

 

[Dr Deco]

I concur with Doc V. That is a very long interval to restart hyperbaric treatments.

 

[Carl P]

Thanks Dr Deco & DocVikingo.