Need your help: decompression/barotrauma accident or MdDS?

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@Duke Dive Medicine : Thank you very much for the detailed response! There was absolutely no problem to maintain my equilibrium on the boat. However, it's good to know that an MRI cannot rule out a potential DCS. Do you know if there's actually any medical procedure to detect something like this in the ear? The doc I saw didn't do anything about that.

I can definitely feel that my symptomps are sometimes stronger, however, they haven't disappeared fully so far. But I assume DCS symptomps would be more permanent? I'm definitely going to see another diving physician and I hope I could get a quick appointment soon at one who's also an ENT.



Also many thanks @boulderjohn for sharing that story! The weird thing is that I never had any single problem with any form of vertigo in my life so far. I'm even a glider pilot and thus quite used to be shaken up. This is the first time, with the only difference that I've never been exposed to such a long duration (I mean 7 days) of passive motion. Still that's very odd.
 
Chiming in as another person to whom this frequently happens. I have no problem with motion sickness, vertigo, etc.; have never been seasick. And yet anytime I spend 24+ hours on a boat, the minute I'm back on dry land, the land starts moving.

I've noticed this is totally independent of whether or not I'm diving; I do get it after dive liveaboards, but I've also had bad cases of it when I'm on boats and not diving at all. The worst was after staying on a houseboat at a conference for several days; I felt "landsick" for almost a week afterwards. At least for me, it seems tied specifically to *sleeping* on boats.

For me, personally, symptoms are worse in indoor spaces, esp small ones, and when not moving. Staring at a body of water, or being in a moving vehicle (car, plane, etc) seems to help. And, eventually it does go away, but it can take a while. Good luck, it's no fun!
 
@RB7 thank you very much for your post and kind words! Interesting to read that I'm not the only one who encountered this weird situation for a duration of many weeks.

Have you had that situation after all your trips? I'm asking as I'm afraid to face the same situation again after a future dive safari (who knows if I'm even going to do one again after this) or even from a shorter boat trip in the future.
Yes.. have it after each liveaboard trip .. but it doesn't last as long.. was on a 7 day trip in Oct and when I came back it took 3-4 days for the rocking swaying sensation to go away.
Next time try the motion sickness pills before u get on land for a day or two and see if that helps you.
 
@Duke Dive Medicine : Thank you very much for the detailed response! There was absolutely no problem to maintain my equilibrium on the boat. However, it's good to know that an MRI cannot rule out a potential DCS. Do you know if there's actually any medical procedure to detect something like this in the ear? The doc I saw didn't do anything about that.

I can definitely feel that my symptomps are sometimes stronger, however, they haven't disappeared fully so far. But I assume DCS symptomps would be more permanent? I'm definitely going to see another diving physician and I hope I could get a quick appointment soon at one who's also an ENT.



Also many thanks @boulderjohn for sharing that story! The weird thing is that I never had any single problem with any form of vertigo in my life so far. I'm even a glider pilot and thus quite used to be shaken up. This is the first time, with the only difference that I've never been exposed to such a long duration (I mean 7 days) of passive motion. Still that's very odd.
There is no diagnostic test for decompression sickness. Re permanence of DCS symptoms, they do tend to get better over time but that's highly individual and dependent on the severity of the injury. A diving physician may decide to treat you in the chamber if s/he concludes that DCS can't be ruled out.

How is your vertigo now overall compared to how you felt immediately after you left the boat?

Best regards,
DDM
 
@Duke Dive Medicine : Thanks for that description! I assume for a chamber treatment it is too late since it started already 5 weeks ago? To your question, I'd say there's definitely ups and downs and I think the overall symptom level has gone down overall, but not entirely sure about that.

Perhaps as an additional information, the second half of all my dives were with Nitrox, including the 2nd 40 m dive and I never carried around lots of weight on the boat or while leaving it. I should have also mentioned that my buddy which whom I stayed closely together throughout all 18 dives didn't encounter any problem.

@RB7 and @Rilelen : thanks for sharing this! Good to hear that here that we're not alone with this weird thing! Tbh also as I was and still am a bit scared that this might effect my future ability to go diving again, not neccesssarily on a boat trip however. Have you had similar worries?
 
I've only ever had it happen on boats - and I love boats, so I just chalk it up to the price I pay (afterwards) and don't plan on doing anything too strenuous when I'm back home. So it hasn't really affected my diving or my plans. But that may be different if it's lasting for weeks & weeks for you, or if your doctors think it's tied to DCS (rather than just general post-boat landsickness).
 
@Duke Dive Medicine : Thanks for that description! I assume for a chamber treatment it is too late since it started already 5 weeks ago? To your question, I'd say there's definitely ups and downs and I think the overall symptom level has gone down overall, but not entirely sure about that.

Perhaps as an additional information, the second half of all my dives were with Nitrox, including the 2nd 40 m dive and I never carried around lots of weight on the boat or while leaving it. I should have also mentioned that my buddy which whom I stayed closely together throughout all 18 dives didn't encounter any problem.
Good question about delay in treatment. The old dogma was that if treatment was delayed too long, it would be ineffective. There's more current evidence to suggest that delayed treatment can be of benefit in some cases.

If you exhaust your gas supply before you reach your no-stop limit, then you'd take on less inert gas diving nitrox than you would have had you been diving air. If you dive until the computer tells you to ascend and you still have breathing gas in your tank, you've theoretically taken on the same amount of inert gas whether you're breathing air or nitrox. The fact that your dive buddy was fine is not really relevant - DCS often affects one buddy but not the other. I don't know that I've ever personally seen a bent buddy pair, though it does happen in cases where both divers omit a significant amount of decompression.

All that said, from the information you've provided, including the diagnosis of the provider who evaluated you in person, though DCS can't be completely ruled out, it seems more likely that you're suffering from Mal de Debarquement. Here is some information on it from the Cleveland Clinic, a very well-known and reputable health care system in the U.S. Of course nobody on SB can diagnose you from overseas, I still recommend you follow up with a diving physician.

Best regards,
DDM
 
Good question about delay in treatment. The old dogma was that if treatment was delayed too long, it would be ineffective. There's more current evidence to suggest that delayed treatment can be of benefit in some cases.

If you exhaust your gas supply before you reach your no-stop limit, then you'd take on less inert gas diving nitrox than you would have had you been diving air. If you dive until the computer tells you to ascend and you still have breathing gas in your tank, you've theoretically taken on the same amount of inert gas whether you're breathing air or nitrox. The fact that your dive buddy was fine is not really relevant - DCS often affects one buddy but not the other. I don't know that I've ever personally seen a bent buddy pair, though it does happen in cases where both divers omit a significant amount of decompression.

All that said, from the information you've provided, including the diagnosis of the provider who evaluated you in person, though DCS can't be completely ruled out, it seems more likely that you're suffering from Mal de Debarquement. Here is some information on it from the Cleveland Clinic, a very well-known and reputable health care system in the U.S. Of course nobody on SB can diagnose you from overseas, I still recommend you follow up with a diving physician.

Best regards,
DDM
Good question about delay in treatment. The old dogma was that if treatment was delayed too long, it would be ineffective. There's more current evidence to suggest that delayed treatment can be of benefit in some cases.

If you exhaust your gas supply before you reach your no-stop limit, then you'd take on less inert gas diving nitrox than you would have had you been diving air. If you dive until the computer tells you to ascend and you still have breathing gas in your tank, you've theoretically taken on the same amount of inert gas whether you're breathing air or nitrox. The fact that your dive buddy was fine is not really relevant - DCS often affects one buddy but not the other. I don't know that I've ever personally seen a bent buddy pair, though it does happen in cases where both divers omit a significant amount of decompression.

All that said, from the information you've provided, including the diagnosis of the provider who evaluated you in person, though DCS can't be completely ruled out, it seems more likely that you're suffering from Mal de Debarquement. Here is some information on it from the Cleveland Clinic, a very well-known and reputable health care system in the U.S. Of course nobody on SB can diagnose you from overseas, I still recommend you follow up with a diving physician.

Best regards,
DDM


@DDM : thanks for the explanation. My gut feeling is that it's more the Mal the Debarquement, also based on the info under the link you've posted.

I'm actually just coming back from paying a visit to the next hospital that has a chamber and I was able to have a chat with a doctor. I told him that a treatment after a delay of up to 5 weeks might still be helpful but he only referred to it not being potentially effective any longer and didn't see a need for action given that I show/ed no other symptoms. So no treatment
 
A diving physician may decide to treat you in the chamber if s/he concludes that DCS can't be ruled out.
As DDM also pointed out, there is no definitive test for DCS, and sometimes putting people in the chamber is not much more than a guess. That process can lead to some interesting consequences.
  • A study published about a decade ago concluded that people with spinal stenosis are more prone to DCS than the population without spinal stenosis. How did they determine that? They studied people who had had DCS and found an unusually high percentage of these people had spinal stenosis. How did they find the test population? They were people who had been treated for DCS in a chamber. According to a DAN document I saw about the same time as this, the symptoms of spinal stenosis are often mistaken for DCS symptoms, and such people are often given DCS treatment even though they don't have DCS. So here's the question: did the study really find that that people with spinal stenosis are more like to get DCS, or did it find that people with spinal stenosis are more often misdiagnosed as having DCS?
  • Chamber treatments are very expensive, and this has led to an insurance problem. Insurers (including DAN) are concerned and may be reluctant to pay if they feel the DCS treatment was unwarranted. That is why they often insist that the person referring the diver to the chamber be qualified to make a sound decision and not just give an expensive treatment on a whim.
 
Do you think that the dive profiles indicate anything related to a risk of a decompression accident? As I said all the other dives were not deeper than 30 meters and in general there was no signs of a dive accident (all safety stops done, etc)
Not direclty related to the incident, but be aware that ANY kind of dive and profile can induce both barotrauma and/or DCI. There is no 100% safe profile. The profiles you showed do not seem particularily agressiv, but also don't "downplay" the frequent dives to "only" 30 m the days before.
Any nowadays 7 day Safari the way they are conducted are all pushing the limits somewhat. When I learned back in the according CMAS the recommendation was not doing more than 2 dives a day and not more than 3 consecutive days. Both those recommendations are blatantly ignored with the "standard" Red Sea Safari week. Usually it is 3 to even 4 dives a day depending on the and for sure 6 consecutive days. So the divers body is accumulatings substantial ongassing particularily in the medium and slow compartments. There is simply no model and no study that in a scientific frame ever ventured in such prolonged inert gas exposure (other than saturation diving in commercial diving, but that is a complete different venue).
So having said that on a Safari everyone is prone to DCI no matter how subjectively or objectively the profiles have been "conservative".
Then on the bright side. The track record of the Safaris is pretty good as well as in, people are not going to the chamber on a regular basis, it still is more the exception, so it seems to work fairly ok, depite the lack of scientific backup.
I would still think that there might be a fair amount of not severe, mild cases that go frequently undetected as a certain degree of denial and normalisation is just human and Safaris are fun. I used to go four even five times per year in my rec diving "prime"
Also to consider is that particularily at Red Sea Safaris and more prone in Summer there definitely is a very high correlation to DCS when not properly hydrated. So another factor to keep an eye out.
From what you describe I also do not think that there was DCS involved, there is a residual chance though. So definately worth some more checkups and involving a diving medicine specialist rather than your GP
However, it's good to know that an MRI cannot rule out a potential DCS. Do you know if there's actually any medical procedure to detect something like this in the ear? The doc I saw didn't do anything about that.

I can definitely feel that my symptomps are sometimes stronger, however, they haven't disappeared fully so far. But I assume DCS symptomps would be more permanent? I'm definitely going to see another diving physician and I hope I could get a quick appointment soon at one who's also an ENT.
If there was DCI involved then by now any manifested bubble should be capsuled by now. So a chamber treatment will not be effective as well.
I did have balance and ear issues in the past due to a prolonged late detected likely DCS. A lot what you describe reminds me of it. It was never determined 100% but whether it is just "regular vertigo" (for a lack of better term) treatment or if caused by DCS the treatment will be the same. It is a Cortisone IV followed by phasing out with Cortinsone tablets. Thats what they did in my case and it helped tremendously. after the first IV it was like the brain fog was lifted and I experienced a new world which had become somewhat dull due to getting used to the constant disturbance that had affected myself.

The only fall out was after I was treated. For quite several years I did actually very moation sensitive and was seasick on a boat after that for the first time of my life. It got better over the years but was very unusual initially

Go to an inner ear specialist and take it from there! Fingers crossed on your recovery!
 
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