Mild DCS ongoing effects

[duke dive medicine]

Thank you for all that info. I definitely won't be diving again, unfortunate but not worth the risk.

I've had no issues in the past I terms of bad covid or anything like that. I'm not a smoker and no inhalation of anything either.

If it is an overexpansion, is it OK to fly? Also do you think its strange that I seemed to make a full recovery and then some cardio exercise set me off or is that typical of something like over expansion?

Also, while I think overexpansion seems like a better explanation of what's going on, I'm confused as to why it seemed like I made a full recovery after the chamber and over the past few weeks. Can you shed any light on that?

Thanks again for your time replying to me about this

These are great questions. Re flying, if this was an overexpansion injury, the pressure changes involved in that are much smaller than with diving so there should be little risk with air travel, but if you are concerned, I'd recommend seeing a physician in person before you fly.

Regarding the re-injury, with no more details than 'scarring' on chest x-ray, it's hard to provide a specific answer. If you did have a lung overexpansion injury and the damaged area had not healed, it's theoretically possible that you had additional air entering the chest cavity.

It's also possible that this is muscuolskeletal or spinal in origin. That would explain the lack of response to treatment, the re-injury when the area was stressed again in a specific way, and the slow resolution of symptoms. That's not to discount the x-ray finding of lung scarring, which should definitely be explored further if you want to continue diving.

Where is home for you?

Best regards,
DDM

 

[sophieg1995]

Thank you DDM!

Interestingly since I last wrote I have moved to a city. Before I was in a remote location and I think that was having a psychological impact which was making it worse. Once I moved to the city I noticed a shift in the pain.

I flew today and thankfully all went well however I do feel the symptoms more intense again and they had calmed down a lot over the last 2 days. I'm not sure was it travel stress or the actual flight.

The other interesting thing is the variety of symptoms Ive been feeling. At times it feels like I'm 'chesty' with mucus on my chest. Then at times it feels like what I can only describe as having a stich and feeling little shoots in different parts of my body when taking a breath and then at times its a more central pain to the heart/chest area and feels like there's a weight on it. On more intense moments I feel it almost all at once.

I'm from Dublin and currently travelling South East Asia for a year, so I'm a long way from home!

My plan now is to see a pulmonologist I Manila and hopefully get some answers before travelling again next week. I'm working in staying calm and focused on getting better for the next 8 months of travel.

Hopefully I can get some clarity and report back.
Thanks again DDM

 

[sophieg1995]

In the vast majority of injuries of all kinds, the injured person gets better over time.

Duke Dive Medicine knows what he is talking about. The chances that you had decompression sickness after the dives you describe are incredibly slim. A very mild lung overexpansion injury is a better bet, but still not likely. If I were to place a bet, it would be that your symptoms had nothing to do with the dives.

Thanks for your input boulderjohn! I've been reminding myself of your first sentence a lot over the last few days after reading it. Thank you

 

[Wallowa]

Curious you said: " had DCS at the end of September this year and I went to the diving centre to do 2 hyperbaric sessions of 2.5hrs each.".

Where was the chamber, what was the pressure [schedule] of the chamber and were you on only 100% oxygen or also air in the chamber? And what exactly did the person putting you in the chamber say the hyperbaric treatment was meant to resolve?

"DCI" includes embolism/overexpansion injuries mention here, along with DCS. Were any of the doctors you were seeing trained in diving related injuries? A "diving doc" is invaluable in problem solving and diagnosing then suggesting effective treatment. Otherwise it is a crap shoot.

Sorry for your issues. DAN med gives good advice suggest you follow it.....

 

[sophieg1995]

Hi guys,

Just want to give a quick update here.

I ended up seeing a pulmonologist in Manila who diagnosed Reactive Airway Disease. He told me it was due to the lung getting a bit damaged when scuba diving but he didn't give me an specific details. At the time I was happy because he listened to my full history and answered all of my questions for moving forward. He prescribed a steroid inhaler symbicort which acts as a bronchodialator. Also prescribed some Nasal spray and n-acetyl-cysteine for decongestion.

After 7 days I felt a good bit better and stopped the inhaler. He said use for a week or 2 and then as needed. After thar week I was more or less OK with a few moments of tightness and pain mainly at night.

I arrived in Vietnam and I had another bad episode of tightness and pain so I said **** it and went to see the pulmonologist here. Again due to the on and off nature, I felt 100 percent during the doctor visit.

She did bloods and check for clotting- negative and heart damage/attack- negative. I did an asthma test there too (tough!!!). After scoring 5/5 excellent on this, she said she agreed with doctor 1.

After doctor 1 visit, I came away assured and thinking I had a resolution that made sense. After the second visit I was pissed off with myself for not pushing for more tests.

She told me to take the inhaler for 3 months properly and follow up then if I still had pains. I'm back on the inhaler 5 days. I'm still having these bad episodes, today being the worst of all which freaked me out. For me at this point, I'm noticing the intensity of the pain when it occurs is worse and its impacting my travel experience as well as my partner's.

So, here I am booking an MRI to see if it is nerves or spinal or muscular as you initially suggested Duke Dive Medicine.

I'm hoping it's nothing major but at the same time I'm hoping to have an answer

 

[boulderjohn]

I ended up seeing a pulmonologist in Manila who diagnosed Reactive Airway Disease.

Having never heard of Reactive Airway Disease, I looked it up online, reading several authoritative sources. Here is a paragraph from the Cleveland Clinic:

RAD isn’t an official clinical diagnosis, and it doesn’t have a precise definition. There’s controversy in the medical community over its use because some providers use the terms RAD and asthma interchangeably, but they don’t have the same meaning. Its use should be limited to being a placeholder term until providers can make an official diagnosis.​

​

So, as I understand it, when your doctor says you have reactive airway disease, he or she is actually saying, "Something is wrong with you, but I don't know what it is."

 

[Wallowa]

Yikes! Sorry to hear of the hoops the docs put you through during what seems to have been a failed attempt to diagnose your signs and symptoms...If you can locate one, go to a doctor trained and certified as a hyperbaric/diving physician to at least rule out a diving related issue if that is the case.... A big red flag for me would be: "He told me it was due to the lung getting a bit damaged when scuba diving but he didn't give me an specific details." That means what? ....and the RAD means nothing if not detailed...none of this could be diving related....bottom line if I was you would I get a definitive diagnosis from a truly competent doctor and I would not be taking meds until that diagnosis specified exactly what the meds were meant to accomplish....I am not a physician and only giving my opinions.....good luck and hope you resolve this.....

 

[Juliet of the Sea]

I would agree that the symptoms sound more like pneumomediastinum, or a small pneumothorax. (both pulmonary hyperinflation injuries) If breathhold swimming returns the symptoms I would be concerned about avoiding pressure changes (including flying or breath hold swimming) until the symptoms are well and truly resolved. I also agree with not diving again.
We tend to think that dive injuries occur at depth, and not in the shallows, but the pressure differential is much greater (relatively) in the first 15 feet of water, increasing the risk of pressure related injury from momentary breath holding in surge (like blowing to try to clear your sinuses or ears).

 

[Juliet of the Sea]

Having never heard of Reactive Airway Disease, I looked it up online, reading several authoritative sources. Here is a paragraph from the Cleveland Clinic:

RAD isn’t an official clinical diagnosis, and it doesn’t have a precise definition. There’s controversy in the medical community over its use because some providers use the terms RAD and asthma interchangeably, but they don’t have the same meaning. Its use should be limited to being a placeholder term until providers can make an official diagnosis.​

​

So, as I understand it, when your doctor says you have reactive airway disease, he or she is actually saying, "Something is wrong with you, but I don't know what it is."

Reactive airways disease (RAD) means that you can have temporary narrowing of the bronchi in the lungs, which leads to air trapping distal to this narrowing. When you change depths, the air cannot escape to equalize, and can lead to pneumthorax or pneumomediastinum. This is basically a small rupture in the airways allowing air to escape into the tissue or space outside of the lung. It can be VERY dangerous when diving, leading to a lung collapse. People with asthma are recommended not to dive unless the asthma is completely controlled, for this reason. RAD is a description of the sort of changes caused by asthma.