Hoping for some direction regarding atypical symptoms

[Brant Emery]

Have any of your health care providers supposed ciguatera fish poisoning? It is very common in certain areas.

 

[MtnDiverColorado]

Have any of your health care providers supposed ciguatera fish poisoning? It is very common in certain areas.

They haven't, but I'll ask. The Extremity Paresthesia symptom seems like a good fit, didn't have any of the digestive or most most of the others however. Thank you!

 

[Brant Emery]

Most of the people that I knew when I lived in South Florida that had it only showed the Neuro symptoms.

 

[MtnDiverColorado]

Most of the people that I knew when I lived in South Florida that had it only showed the Neuro symptoms.

Huh, well this is getting curiouser and curiouser, one more question if you don't mind, did the folks you know who had it, wait it out, or do the IV treatment? or something else?

Thanks so much!

 

[Johnoly]

...did the folks you know who had it, wait it out, or do the IV treatment?

There is no real 'cure' for Cig poisoning. I've known several people that it has taken years for symptoms to 'decrease' but never really 'gone' . It can be a easy hit or a long term hard hit and everyone's body reacts differently to it. Due to the amount of time that has passed since your first symptoms, it's going to be really hard to reliably test for it in the body. Your repeat flare ups don't normally happen with DCS.

 

[duke dive medicine]

Hello, my apologies in advance for a very long post.

Over the last 6 months or so, had some strange medical stuff happen, that, I haven’t been able to get clear answers for, and am posting in the hope of getting some more solid direction, as I am about out of ideas, and directions to go in.

Back at the beginning of Oct, my wife and I did a short but busy dive trip to Belize. Other than fun diving, we were doing open water certs for Stress and Rescue, Deep, and Navigation.

The stress and rescue dives in particular were tiring, but not super extreme. I thought I was well within my dive computer's limits throughout.

I believe it was the night before we left, I woke up with weird burning sensation at the bottom of feet, and strange feeling in my head, kind of like I had a tight band wrapped around it. I wasn’t sure what to make of it, but Googled around, and the symptoms didn’t seem consistent with any sort of DCS.

Flew home, with no real change in the symptoms during the flight. At home, they came and went, but, they mostly sort of hung in there. The second night home, I decided to call DAN, expecting them to tell me I was just going crazy. Dan told me it could be DCS and I should get checked out, I remained skeptical.

The next day, I still had symptoms, so I went into the ER, again expecting them to tell me I was crazy and send me home. Long story short, I ended up doing a couple rides in the chamber, the first was a table 6, after which I felt pretty good. My Dr said to give him a call if I needed another ride, but I didn’t think that would be necessary. The two days following that, however, the symptoms came back in force. I, I felt awful, and called my Dr, and made an appointment for another ride the next day. I awoke that morning, feeling great, but still did the ride as it was already scheduled. It wasn’t a table 6, just 2 ATA’s, and only a couple hours.

After I didn’t notice much change in my symptoms, which tended to wax and wane a little bit, but were generally subtle.

I did have a consult with a dive Dr with which I reviewed my logs and while within limits she suggested my ascents could be a bit slower, and I should spend more time on my safety stops, particularly pointing to the unconscious diver rescue exercise, where there is no safety stops. I thought that meeting was useful, and increased my safety stop time on my Teric to 5 mins.

I also was checked for a PFO, and the bubble test was negative.

Another person pointed out that rather than dive with a SharkSkin, I should be a little warmer to assist with off gassing, so I purchased a Bare wetsuit

Four months later I was excited to go to the Maldives, and spent 9 days on the Manthiri, which I would heartily recommend.

For the first 3 days, I felt fine.

On the fourth day, after the third, and last dive, I noticed my feet starting to really bother me. The next morning, on the Dhoni, because of my feet I decided to call the dive, and I didn’t dive that day; rather I did some snorkeling, and reading.

I noticed that during that day, my feet felt better and better, and that by the end of the day, they felt fine. I had thought about going on O2 early that day, but as I ended up feeling fine, I did not.

Woke up feeling great, and decided to go diving again. Our dive guide, Moosa, was kind enough to take me by myself on pretty easy and shallow dive (30-40 ft, no current), the rest of the group did something more challenging. The dive was fine, but after, my feet really bothered me again for 45 mins or so. I was sort of thinking I was going to go on o2 and be done for trip, but the symptoms went away pretty quickly and I felt fine the rest of the day. I did keep it at one dive, however.

I was trying to decide what the heck I should do, I wanted to dive, but didn’t want to be dumb, so I tried my Dr. in the states, and was unable to get a hold of her. I ended up calling Dan. After some conversation with them, they said I shouldn’t dive until I talked to my Dr, but they didn’t think it likely what I was experiencing was DCS.

I never got a hold of my Dr. but the next day I still felt fine, so did two dives, and felt good.

The next day I did three, the first was a fairly deep channel dive. We were reef hooked in at 90 ft for long enough for most folks (who were on air) to go into Deco, I was on 32%, so I did not, and I also did a super long safety stop (like 8 mins).

I tried to keep the other two dives that day pretty shallow, and felt fine at the end of the day, but that night I woke up feeling like I had that band wrapped around my head (I also described it as I felt like I had just smoked a joint). I once again figured I was done diving and would go on o2, but soon after getting out of bed and being up and about, I felt fine. I still skipped the first dive, but several hours later, l felt good, and did the second, and last of the trip, which was very shallow (avg 26 ft), and relaxing.

I felt fine after the dive, but had the feet symptoms wax and wane in the 36 hours or so until we flew out. Upon returning, again not much of a change, though I had reached out to my primary Dr to set up an appointment to try to figure out what I the world was going on for me.

Day 10 or so from my last dive, I began to notice new symptoms. A burning in the hands that turned into numbness, and creepy crawly things in my legs. As the numbness continued to spread, I contacted my original dive medicine Dr (under whose direction I did my original rides), and he was kind enough to have a fairly lengthy conversation with me. Highlights were that sometimes, folks might have some original resolved symptoms of DCS reoccur in subsequent dives, and that pretty much DCS symptoms will appear 24 hours after the dive which causes them, and after some number of days, those symptoms will stop getting worse. In short, he was pretty sure that the new symptoms I was describing were not DCS.

Since then, I feel better, I noticed that one of the things that bring the symptoms on is greasy/salty food; I feel pretty good after good healthy food such as Sushi.

I also have done some MBHOT treatments, which I am aware are thought of as quackery, and unlikely to do anything, but at least it’s something, and I am the sort of person who feels better doing something rather than nothing.

Most recently, my feet are feeling somewhat better, numbness in the hands comes and goes, but are improved, also noticed my head seems to react to pressure change, and am starting to wonder if that is sinus related.

I did go to a physical therapist who pretty much ruled out some sort of pinched nerve in my neck or back, which was another hypothesis.

So in short, I have these weird symptoms, which correlate with diving, but don’t seem to be consistent with classic DCS symptoms, at least in how they behave.

I adore diving, but am terrified to go back into the water. While I intend to pursue this with my Dr’s, I don’t’ have much in the way of direction right now.

My thinking now is not to dive until well after all the symptoms fully resolve (if that ever happens), and then take it very, very slow. But any additional thoughts or ideas as to what could be going on would be appreciated.

My apologies again for such a long post.

Unfortunately there is no sensitive, specific test for DCS. The fact that your symptoms improved after a TT6 increases the likelihood that that's what happened, but it's not 100%. Just based on your description, this isn't screaming DCS or seafood toxicity though neither can be ruled out, especially via the internet. I would recommend that you see a neurologist for a complete workup. The tinnitus after diving is concerning... from firsthand experience, this isn't something you want to live with for the rest of your life.

Best regards,
DDM

 

[WeRtheOcean]

from firsthand experience, this isn't something you want to live with for the rest of your life.

From firsthand experience, you can get used to it.

 

[duke dive medicine]

From firsthand experience, you can get used to it.

To a point, and depending on the level. I had TMS done for mine it was so bad.
<edit> And, if a diver's ears are being affected to the point of suffering tinnitus, an understanding of why it's happening will help the diver make better decisions about type of diving, equalization techniques, or even whether to continue diving or not.

 

[scubadada]

I'm with @Diver With Altitude and @Duke Dive Medicine

If I were you, I would see a good neurologist

 

[MtnDiverColorado]

Thanks all, I have seen my Dr, and been tested for pretty much everything it could be, that can be tested for. All the tests of course were normal. So, they don't know what caused the nerve damage, or why the symptoms tend to correlate with diving, but on the theory that my nervous system is aggravated, they put me on a low dose of gabapentin to try to settle things down in my extremities... They think my head thing might by sinus related, so I'm doing Flonase there.

Things do seem to generally feel better, not sure if that is the medication, or just time passing...

Thanks all for taking the time to reply, greatly appreciated!