How late is relapse possible on a flight after DCI?

[BA3]

Hi all, I’m just wondering what the latest time is that anyone has heard of someone worsening from flying after a DCI hit, either treated or untreated.

I’ve seen recommendations of no-fly times after treated DCS go as high as 6 weeks, but also seen people saying that after a week or two there’s no way that you will have any bubbles left in your system, so no way you could relapse.

I've also seen the graph on page 138 of this document, which shows people relapsing after 29 days:

https://www.diversalertnetwork.org/files/RemoteWrkshpFinal05.pdf

Just wondering if anyone has heard of someone relapsing this late?

I'm wondering what the point is after which you could guarantee the risk from flying is zero. I would guess in the case of untreated or undertreated DCI, that the risk would also be higher.

 

[Angelo Farina]

The risk is never zero, as flying exposes also not-divers to a significant risk of thrombosis (DVT).
See here: Air travel and the risk of thromboembolism. - PubMed - NCBI
So the question should be: after how much time the risk of a cardiovascular event becomes substantially the same as general population?

 

[Duke Dive Medicine]

Hi all, I’m just wondering what the latest time is that anyone has heard of someone worsening from flying after a DCI hit, either treated or untreated.

I’ve seen recommendations of no-fly times after treated DCS go as high as 6 weeks, but also seen people saying that after a week or two there’s no way that you will have any bubbles left in your system, so no way you could relapse.

I've also seen the graph on page 138 of this document, which shows people relapsing after 29 days:

https://www.diversalertnetwork.org/files/RemoteWrkshpFinal05.pdf

Just wondering if anyone has heard of someone relapsing this late?

I'm wondering what the point is after which you could guarantee the risk from flying is zero. I would guess in the case of untreated or undertreated DCI, that the risk would also be higher.

I think it's highly individual. There shouldn't be any bubbles after appropriate hyperbaric treatment, but with significant inflammatory damage and possible circulatory compromise, the hypoxia of altitude can lead to a recurrence of symptoms. From the US Navy Diving Manual, revision 7:

Flying After Treatments. Patients with residual symptoms should fly only with the concurrence of a Diving Medical Officer. Patients who have been treated for decompression sickness or arterial gas embolism and have complete relief should not fly for 72 hours after treatment, at a minimum.

Best regards,
DDM

 

[Dsix36]

I took a pretty bad hit and was paralyzed from the waist down. I took ended up taking four table 6 and 2 modified table 5 chamber rides over 4 days. I left the ER walking on my own but very unsteady. The next day I flew home on my regularly scheduled commercial flight. I was in constant contact with the doctors at DAN and was assured that there was absolutely no chance of having any bubbles left in my system and that I should get on the plane.

I am certainly no kind of expert on any of this considering I was the one who ended up in the chamber, so please follow your doctors advice rather than any thing you can learn on a forum.

 

[BA3]

Thank you all so much for the replies. This forum really is an amazing place.

For my case, I've been cleared to fly for some time by the Doctors that have treated me, and it's been 6 weeks since my last treatment, so definitely at the longer end of recommendations (though I've now seen one place says 90 days), but I am just absolutely terrified to fly home from Bali to the UK. The thought of doing any damage(/further damage) to my brain really freaks me out.

I actually had symptoms that developed following the last hyperbaric treatment I had, so I am worried about a bubble having formed during it, which I know is unlikely, but technically possible. I felt like the mask I was breathing through was leaking a fair bit so I may have been breathing some air rather than oxygen. Again I know that it's maybe unlikely, but to my mind I may be dealing with an untreated rather than treated hit. I'm just wondering if there is a point where I can say with some certainty I should be fine to fly, despite still having symptoms.

 

[Bob DBF]

For my case, I've been cleared to fly for some time by the Doctors that have treated me, and it's been 6 weeks since my last treatment, so definitely at the longer end of recommendations (though I've now seen one place says 90 days), but I am just absolutely terrified to fly home from Bali to the UK. The thought of doing any damage(/further damage) to my brain really freaks me out.

If it becomes too much of a concern, you could look into ships and surface transportation. It wouldn’t be as elegant a solution as air travel, but it would keep you off aircraft if that is necessary for your peace of mind.


Bob

 

[Duke Dive Medicine]

Thank you all so much for the replies. This forum really is an amazing place.

For my case, I've been cleared to fly for some time by the Doctors that have treated me, and it's been 6 weeks since my last treatment, so definitely at the longer end of recommendations (though I've now seen one place says 90 days), but I am just absolutely terrified to fly home from Bali to the UK. The thought of doing any damage(/further damage) to my brain really freaks me out.

I actually had symptoms that developed following the last hyperbaric treatment I had, so I am worried about a bubble having formed during it, which I know is unlikely, but technically possible. I felt like the mask I was breathing through was leaking a fair bit so I may have been breathing some air rather than oxygen. Again I know that it's maybe unlikely, but to my mind I may be dealing with an untreated rather than treated hit. I'm just wondering if there is a point where I can say with some certainty I should be fine to fly, despite still having symptoms.

Developing symptoms after hyperbaric oxygen treatment for DCS is concerning. I've heard of this happening before, and it turned out that the diver was administered air instead of O2 through the mask. What are your symptoms at present?

Best regards,
DDM

 

[Schwob]

Very good thread, good and important question good answers. Please accept my apology for this immature detour as I cannot resist:

but I am just absolutely terrified to fly home from Bali to the UK.

I so understand!

 

[BA3]

Developing symptoms after hyperbaric oxygen treatment for DCS is concerning. I've heard of this happening before, and it turned out that the diver was administered air instead of O2 through the mask. What are your symptoms at present?

Best regards,
DDM

My main complaint currently is constant lightheadedness. It's just always there and I feel a bit faint and like I can't quite think straight.

I also have some parasthesia on the left side of my face, where it sort of feels tight, or like something is touching my cheek (left sided symptoms have been common throughout my experience). The left side of my face, and my left palm, also feel like they have slight reduced sensation. The eyelid on that side has also been twitching on occasion, though that's mostly stopped. Also Intermittent tingling under my right shoulder blade and occasionally in my fingers (both hands), and a weird feeling in one of my fingers (that finger was twitching for a few days post the hyperbaric treatment). A weird one is my left hand seems also to sort of fall asleep a lot. Like when i'm lying on my back with my hands resting anywhere, it will be completely asleep and numb after a little while.

There's actually been two occasions here where I feel like I've had symptoms develop post treatment, which has kept me from going home.

I've seen a neurologist here and had an MRI and EMG which both came back clear.

 

[Duke Dive Medicine]

My main complaint currently is constant lightheadedness. It's just always there and I feel a bit faint and like I can't quite think straight.

I also have some parasthesia on the left side of my face, where it sort of feels tight, or like something is touching my cheek (left sided symptoms have been common throughout my experience). The left side of my face, and my left palm, also feel like they have slight reduced sensation. The eyelid on that side has also been twitching on occasion, though that's mostly stopped. Also Intermittent tingling under my right shoulder blade and occasionally in my fingers (both hands), and a weird feeling in one of my fingers (that finger was twitching for a few days post the hyperbaric treatment). A weird one is my left hand seems also to sort of fall asleep a lot. Like when i'm lying on my back with my hands resting anywhere, it will be completely asleep and numb after a little while.

There's actually been two occasions here where I feel like I've had symptoms develop post treatment, which has kept me from going home.

I've seen a neurologist here and had an MRI and EMG which both came back clear.

I recommend that you contact staff at the London Hyperbaric Medicine facility. Their website is linked below.

London Hyperbaric | DCI Treatment, Dive Medicals and much more

In your situation, it would not be unreasonable to travel on supplemental oxygen as a precaution.

Best regards,
DDM