Neurological Bends

[gazza]

Hello Doctors,

I was wondering if you had thought anymore about my condition since i posted last?

I've spent the last couple of months trying to get referred to a diving doctor on the NHS in the UK, but it's a slow process.

To add insult to injury, i spent christmas in egypt and ended up with a similar dci like sensation in my right arm. i spoke to several doctors in egypt, but they were all convinced that it was just stress.
On returning to the UK i spoke to the local diving hospital, who thought that it was probably due to mirco-blood clots from the longish haul flight attaching themselves to the site(s) of my previous dci.

 

[fins wake]

I've spent the last couple of months trying to get referred to a diving doctor on the NHS in the UK, but it's a slow process.

Gazza, given that most people on this board - including me (but I'm not a physician) - don't really lean to the DCI hypothesis, perhaps you should see a neurologist as well? Or even a physiotherapist? Just for a second opinion.

To add insult to injury, i spent christmas in egypt and ended up with a similar dci like sensation in my right arm.

Had you been diving?

On returning to the UK i spoke to the local diving hospital, who thought that it was probably due to mirco-blood clots from the longish haul flight attaching themselves to the site(s) of my previous dci.

If indeed it was DCI. I know of some places in the world where you would not have been recompressed in the first place as the doctors would have been adamant you could not have DCI ...

I think you should get a second opinion from other doctors. Just my 2 pence.

 

[gazza]

Hello Fin,

Thanks a lot for your reply. To be honest, i've absolutely no idea what to do. I took the dci hpyothesis for granted as it's what the diving doctors at the recompression centre were sure it was, and as they've seen a lot more bent divers that i have, so i had no reason to doubt their opinion.
At the moment, i'm going through the nhs to get a referal to a diving doctor, but this is taking forever and a day, the down side of living in a low tax country .

I hadn't been diving on holiday, but the sympotms did dissapear after a few days, which wasn't consistent with the previous dci incidents i had, and i did have new symptoms when i got back to the UK, so it does look like it's probably flying related.

 

[cscartwright69]

gazza

I can give you details of a few dive docs if u need them in London. I just called them direct and sorted out GP referrals etc later. no point waiting around.....

c

 

[Dr Deco]

Hello gazza:

I am sorry to hear that you problem has not vanished. Please remember, however, that many people have paresthesias (= abnormal sensation of the skin, i.e., numbness, tingling, pricking, burning, or creeping on the skin that has no objective cause) and these people have never gone diving in their life.

I believe you should also consult a neurologist about your situation.

Dr Deco :doctor:

 

[divemed]

Head position is key with a pinched cervical nerve. The horizontal, head extended (looking up) position puts the most stress on a bulging disc, for example. Time and looking straight/ or down, will take the strain off the disc/ nerve. Your symptoms also developed while driving. This is seem in this condition, with the head straight, but the arms up (neck/ shoulder muscles can pinch the nerves)./
I agree with the Dr's that the cause is almost certainly not DCI. Unfortunately, it takes quite the dive physician to say so with cetainty.
If not a neurologist, try an orthopedic surgeon or physiatrist. One with knowledge of the nerve pathways and the ability to test for compression.
Don't get rid of your dive gear yet!
Good Luck

 

[diverrick]

I posted earlier this week about numbness and tingling in my thumb and index finger after diving. after talking it over here on the board it was suggested that maybe my suits cuffs were too tight, thus pushing on a nerve.
You had mentioned that you were a bit over weight, and were working out weekly, both would cause you to bulk up some. coult it bee that your suit is now too small, wher it fit well before. That could cause some of the symtoms.
I am no doc, but I know it certainly got my attention.. I plan on going to warm water in March. and dive with out the dry suit suit to see if the symptoms reoccur. That will iliminate the suit as a cause.

 

[crispos]

I had a similar experience to gazza's. Please note the history.

I developed paraethesia in the right arm after a dive that shouldn't have been anywhere near a bend (Nitrox, 10 minute bottom time at 100 feet). It is now 1 1/2 years, one of the worst times of my life, because I also suffered an accident 2 years ago, putting my shoulder out of commission. I actually taught scuba all summer while waiting for rotator cuff surgery. I put on 25 lbs and grew a belly.

I also had to do a dive shutdown with the right arm on that bad dive. Four hours later I wasn't sure about it, but I felt my elbow was tingling. If it was worse, I would have sought a chamber ride. At home, I breathed off the rest of my 50% EANx bottle, but that of course, was at only 1 atm pressure.

My incident resulted in on and off tingling in the elbow for a month until it drove me so crazy, and I went to see a dive doctor. He also thought it was mechanical and suggested I not lean on my elbow while on the computer. I changed mouse hand to left all winter and there was no improvement. In fact by January 2003 both my small fingers went numb for two months so I had to quit swimming.

By August 2003, after doing a full PADI Instructor crossover course, I had developed severe knawing pain in the inner elbow. With MRI, this was diagnosed as some sort of disruptive event which had caused tendinitis in the inner elbow (medial epicondilytis).

After carefully giving up all strain on the elbow, quitting weights, diving, doing physiotherapy, and then light swimming, after six months, it has finally, thankfully receded to the point where I think it is gone, and I am diving again. Just got back from Cozumel, but haven't done a deep cold dive yet.

My take on this is 1) I know it sounds crazy, but I think I actually squeezed d a bubble or two into the elbow tendon/forearm muscle locally. So no PFO.

2) the bubbles disrupted my tendon and caused the tendinitis 3) maybe valve shut down or some other fast twisting action on a joint can cause local DCS.

4) it takes a LONG while to go away, but it isn't life threatening.

5) always seek O2 and the chamber immediately if you get even the slightest case of tingling or symptoms.

6) I was really tired and dehydrated from coffee before the dive, so that is why you won't see me doing anymore 5:30am wakeups to make the boat at 9am. Why do the boats leave that early anyways?

 

[Dr Deco]

Hello crispos:

DCS

[a.] I cannot tell you what your problem is but I seriously doubt that it has a cause tracable to decompression gas bubbles.

[b.] While it is possible to generate or enlarge tissue micronuclei, it is not really possible that you “ squeezed a bubble or two into the elbow tendon/forearm muscle locally.” Gas bubbles do not migrate that way between tissues.

[c.] Likewise, I would doubt “the bubbles disrupted my tendon and caused the tendonitis.” Residual effects of a gas phase do not produce this effect or many would experience untoward feeling following decompression sickness.

[d.] While pain-oily DCS (the “bends”) requires a bit of time to remit, experience does not show that “it takes a LONG while to go away…”

I would suspect that you have a joint problem unassociated with diving, since decompression sickness does not seem to me to be the cause of these problems as you describe them.

Dr Deco :doctor:

 

[crispos]

Dr. Deco, thanks for your response.

It seems very coincidental. Please note I am an ex-biochemist and familiar with how the body works.

If my physical exertion of my arm could not cause micronuclei to come out of solution, then why are divers often warned not to exercise or take a hot shower after diving? Is that an old wives tale?

You may be right though. Due to my left shoulder rotator cuff tear, I started utilizing my right arm more, and developed shoulder problems in that one too, but that has since resolved itself.

I am not qualified to say that a left shoulder problem could lead to a right shoulder problem could lead to a right elbow epicondilytis. But that would seem to be the only thing to explain it other than DCS.

Yes, one MRI said I had some kind of disruption in the right epicondyl. The other MRI said it was mild tendinitis, but neither was an arthrogram either.

I'm not a doctor, but it's funny how patients are the ones most aware of their own bodies. Maybe there is something here that is not yet in the dive medicine textbooks?