dctexan once bubbled...
Hi all, new diver here. Took my open water class this past spring (PADI). Went down to Ft. Lauderdale on 6/20 to complete my check out dives (with a PADI affiliated dive shop). Did dive 1 & 2 on 6/21 and dives 3 & 4 on 6/22. All dives were to 30 ft for about 20 minutes each...probably a 3 minute surface interval between dives 1 & 2 and dives 3 & 4. Loved diving, was very excited about getting certified, however about 10 minutes after I exited the water from dive 4, my skin started to feel prickly and my body felt a tiny bit achy.
About 2 hours later I felt a bit worse, and started kidding around with my friends that I thought I had lyme disease (aching joints and all). Took a shower, went to dinner. During dinner I started hurting really badly and just couldn't sit still. Finally decided (about 6 hours after symptoms first appeared) that I was probably bent and that I needed to go to the ER.
Doc at ER took forever trying to decide whether I had DCS or not (kept checking the dive tables and saying "but you were within the limits. Finally he agreed that I had DCS and arranged to transport me to Miami (Mercy Hospital) for treatment.
While waiting for the ambulance, I received IV fluids, but no O2.
Finally arrived at Mercy around 1:00AM (about 9 hours after symptoms first appeared). At this point I am crying in pain and just basically miserable. I think my favorite thing to tell people was "why do they say skin tingling? It feels like glass shards are being rubbed into my skin". Got assessed by the doc at Mercy where I am asked to rate my pain on a scale of 1-10 (I said 8...but looking back I realized I should have said 10. Not that it was the worst pain that I had ever felt, but it certainly was the most prolonged intense pain I have ever felt). Then I took a 6 (maybe 5? I am not sure) hour chamber ride with O2. Absolutely no relief from the chamber. I become basically hysterical and am screaming at the doctor that the stupid chamber didn't work and that I wasn't going back in, that I was exhausted, and that I REALLY needed my pain to go away. I then tell the doctor that he can either kill me or give me something to stop the pain. I get admitted to the hospital and am given some sort of pain reliever.
An hour later I am still in pain so we try pain reliever number 2. No luck with that so on to pain reliever number 3. At this point it is time for chamber ride #2. Due to my previous hysteria, the doctor has decided that I need to something to help me with my "anxiety" so I also receive some sort of anti-anxiety med. Enter the chamber and go down to 60 ft. Finally the pain lets up and I decide I might actually live through all of this. Whether the pain relief was due to the meds or the pressure I don't know...maybe both? When I get out of the chamber this time I rate my pain at a 6.
4 more chamber rides (2 at 15 feet with the diabetics for 2 hours and another 2 for 6 hours) and 2 days later I am finally discharged from the hospital. My diagnosis was DCS II. My pain level at discharge was a 5....mostly consisting of aching joint pain with some tingling (real tingling this time, the glass feeling is all gone). I am given instructions not to fly for 72 hours.
Okay, so I spend the next 72 hours in Miami, taking it easy. The day I am to fly out my pain is at a 1...present but not unmanageable by any means. There were 3 legs to my flight from Ft Lauderdale to Louisville. First leg, no problems. Second leg, I start to get that stupid ache back...especially in my hips, legs, and back. By the third leg, my pain is back to being a 5. Argh!
My flight home was on Sunday (6/29), it is currently Tuesday (7/1) and my pain is at a 4 with some very minor and very occasional skin creepy-crawlies. My questions are
1). will this go away?
2). can anything else medically be done for me or is it just a wait & see thing? Please keep in mind that I am a graduate student & the health insurance I have basically covers emergencies & then visits to the student health center where we DO NOT have a dive doctor.
3). am I completely stupid to ever dive again? I mean who gets hit during their freaking cert dives?!
Please let me know your thoughts. Thanks.
An unfortunate situation, my sympathies.
Unless proven otherwise, this is a neurologic bend causing neuropathic pain. A clue is the generalized(?) body pain without mention of unstable vital signs. That there is some relief with recompression and aggravation with flight suggests it too. 72 h is a rule of thumb, and since the patient was not pain free after recompression, a relapse is possible. That its localized to a lower torso suggests spinal DCI. Alas, the confusing item is your bottom time profiles are quite short to built up an inert gas load. However, new OW students are oft to nucleate from excessive limb movements and ascend rapidly, often discounted because such dives are short and shallow. The profile you wrote is more a yoyo dive than 2 separate dives.
Beyond your doctor and DAN, I would ask: where exactly did the pain start, where did it go, where is it now? Was the pain the same intensity at these locations? Otherwise, were there no other symptoms or signs? No abnormal tests of any kind?
I concur with Dr. Deco's analysis however as bends requires more urgent action, it should be ruled out first.
Toxic reactions to some bite or ingestion is unusual without some sign or symptom: rash, redness, swelling, nausea, vomiting, diarrhea, abnormal blood tests, and in severe cases blood pressure. Toxic symptoms are more steady and unrelenting, and almost never worsened by flight.
A severe skin manifestation without any noticable rash or changes is a paresthesia or hypeesthesia, and can only occur with a CNS lesion, either brain or spinal cord.
Even if so, as late as it is now, these toxins are non-lethal as the worse manifestations are within 24-48h. Persistent symptoms lead to subtle findings that can be tested again with blood tests or visible signs or symptoms.
However, if this is indeed some form of cerebral arterial gas embolization and/or spinal bends, even late treatment, up to a week, may be of benefit, but the farther one is from the onset, the less likely the success.
The issue of diving again hinges on the finding the cause of these problems.
An approach to treatment requires 3 things: call your doc first for an urgent visit
and call DAN for secondary advice --- if recompression is necessary DAN can make the arrangements ASAP. An ASAP elective recompression a week post the event is near futile without DAN's urging. This late since onset, a CT Scan or better, an MRI of your head and lower back may reveal lesions suggestive of CAGE and should be strongly encouraged before or after recompression.
If all resolves well, then check for a PFO.
Lastly, most agencies consider a surface interval of at least 10 minutes before calling a return to depth a new dive. A minimum dive is ~ 20 minutes. Such, it would be worth investigating in terms of 'dives owed' or money back.
Please keep us posted as to your progress.
There is a species of worms that lives in the sand, they are toxic and very difficult to see.
