Non DCI diving maladies?

[Mr. Dooley]

Long story short - did some repetitive deco dives, had some joint pain / throbbing (started with elbow shortly after dive - then subsided for a bit), felt a unsteady on my feet (not collapsing with vertigo, but not quite 100% either).

Ultimately spoke wtih DAN, went to ER where I was put on O2 for the night, had bloodwork / vitals checked, underwent neurological exam. All came back satisfactory. Discharged without chamber ride - hyperbaric specialists were quite confident I did NOT have DCS - aches were too mild, moving around a bit, and just not consistent with how the symptoms typically progress.

Next day aches seem to worsen slightly (still mild, but now in more parts of the body). Dull aches that seemed transitory and intermittent. Throb in the elbow for a few minutes, then gone. Dull ache in the lower back for a bit, then gone. A quick throb in the knee. Achy knuckles for a few minutes, then gone etc. Called DAN, the hospital, and hyperbaric specialists. Hyperbaric person once again states he's 100% positive I'm not bent - and that it's some other sort of inflammatory thing going on. Told to take a combination of ibuprofen and tylenol - I do, it seems to help a bit. I'm cleared to fly back home. I do, and flight is uneventful although once at altitude I could swear for a minute the original elbow throb returned for a bit. But it remained mild. As of today feeling 100% normal - balance is good, no aches.

To be clear I'm not seeking medical advice - I'm staying out of the water for a few weeks as a precaution, and will ultimately get checked for a PFO because why not.

But I am curious if anyone knows anything about or has experienced diving-related inflammation that was NOT considered to be DCS. The DAN medic on the emergency line didn't seem to know of any diving-related inflammation outside of DCS. So I'll call DAN back to seek more information.

 

[Duke Dive Medicine]

PFO is associated with severe neurological DCS, inner ear DCS, and cutis marmorata (marbled skin rash). From the information you've provided, it doesn't sound like PFO testing would be indicated. If you did get tested and a PFO was found, it would probably be a red herring even if this was DCS, which the provider who evaulated you said it wasn't.

Did your symptoms get any better on surface O2 in the hospital?

Best regards,
DDM

 

[Mr. Dooley]

S

PFO is associated with severe neurological DCS, inner ear DCS, and cutis marmorata (marbled skin rash). From the information you've provided, it doesn't sound like PFO testing would be indicated. If you did get tested and a PFO was found, it would probably be a red herring even if this was DCS, which the provider who evaulated you said it wasn't.

Did your symptoms get any better on surface O2 in the hospital?

Best regards,
DDM

By the time I was put on O2, the aches were quite minimal - so slight it made for sort of a tough baseline to measure against. I was also a bit unsteady on my feet going into the hospital - even lying down I would occasionally have the slight sensation of rocking on a boat.

By the time I left after about six hours of being on O2, I certainly didn’t feel worse but my symptoms hadn’t entirely resolved. The next day is when additional, minor aches started popping up and moving around my body - including one brief instance in (what felt like) my inner ear. Also the very occasional tingling in my forearms. But by then I’d been out of the water for around 48 hours so I realize the timing doesn’t really line up with DCS.

Fast forward to today and I have no discernible symptoms.

So a PFO is only associated with certain DCS symptoms? If the result of a PFO is greater N retention, wouldn’t ANY DCS symptom be more likely? Including the aches in joints?

I’m still trying to wrap my head around the idea of this not being DCS. Because it would seem unlikely to me that whatever I had wasn’t caused by diving, given the timing. So if not DCS, it’d be some other diving malady that causes dizziness and aches and occasional tingling (albeit not in the standard DCS timeline).

 

[scubadada]

So a PFO is only associated with certain DCS symptoms? If the result of a PFO is greater N retention, wouldn’t ANY DCS symptom be more likely? Including the aches in joints?

Hi @Mr. Dooley

The mechanism by which a PFO causes DCS is by shunting bubbles from the right side of the heart, through the PFO defect, to the left side of the body. The bubbles in the systemic circulation are the cause of DCS with a PFO. Bubbles are generally filtered out by the lungs in the right sided circulation.

There is no increased nitrogen accumulation/retention, etc. with a PFO.

 

[J-Vo]

Sounds like how I would feel if I was carrying tanks around for a few days, then didn't pay attention to nutrition one day.

Maybe a little bit of muscle fatigue, a little bit of arthritis, a little bit of hypoglycemia, and a mild ear infection from water exposure?

 

[Duke Dive Medicine]

S

By the time I was put on O2, the aches were quite minimal - so slight it made for sort of a tough baseline to measure against. I was also a bit unsteady on my feet going into the hospital - even lying down I would occasionally have the slight sensation of rocking on a boat.

By the time I left after about six hours of being on O2, I certainly didn’t feel worse but my symptoms hadn’t entirely resolved. The next day is when additional, minor aches started popping up and moving around my body - including one brief instance in (what felt like) my inner ear. Also the very occasional tingling in my forearms. But by then I’d been out of the water for around 48 hours so I realize the timing doesn’t really line up with DCS.

Fast forward to today and I have no discernible symptoms.

So a PFO is only associated with certain DCS symptoms? If the result of a PFO is greater N retention, wouldn’t ANY DCS symptom be more likely? Including the aches in joints?

I’m still trying to wrap my head around the idea of this not being DCS. Because it would seem unlikely to me that whatever I had wasn’t caused by diving, given the timing. So if not DCS, it’d be some other diving malady that causes dizziness and aches and occasional tingling (albeit not in the standard DCS timeline).

Nothing to add to @scubadada 's answer to the PFO question.

Transient pain that moves about is not characteristic for DCS. Some providers may have elected to treat you in the chamber based on the unsteadiness but going by your description that's a soft call. Have you followed up with a diving medical specialist in your area now that you're back home?

Best regards,
DDM

 

[lowwall]

How old are you? How fit are you? How accustomed are you to doing multiple hours of physical activity in a single day including carrying very heavy weights (doubles)?

For me soreness is expected on a diving trip. A bit of unsteadiness on land is also normal after any boat trip.

 

[Duke Dive Medicine]

S

By the time I was put on O2, the aches were quite minimal - so slight it made for sort of a tough baseline to measure against. I was also a bit unsteady on my feet going into the hospital - even lying down I would occasionally have the slight sensation of rocking on a boat.

By the time I left after about six hours of being on O2, I certainly didn’t feel worse but my symptoms hadn’t entirely resolved. The next day is when additional, minor aches started popping up and moving around my body - including one brief instance in (what felt like) my inner ear. Also the very occasional tingling in my forearms. But by then I’d been out of the water for around 48 hours so I realize the timing doesn’t really line up with DCS.

Fast forward to today and I have no discernible symptoms.

So a PFO is only associated with certain DCS symptoms? If the result of a PFO is greater N retention, wouldn’t ANY DCS symptom be more likely? Including the aches in joints?

I’m still trying to wrap my head around the idea of this not being DCS. Because it would seem unlikely to me that whatever I had wasn’t caused by diving, given the timing. So if not DCS, it’d be some other diving malady that causes dizziness and aches and occasional tingling (albeit not in the standard DCS timeline).

DM sent.

 

[Mr. Dooley]

How old are you? How fit are you? How accustomed are you to doing multiple hours of physical activity in a single day including carrying very heavy weights (doubles)?

For me soreness is expected on a diving trip. A bit of unsteadiness on land is also normal after any boat trip.

30's, pretty fit, lift weights 4 x weekly. Probably should have included some of that in my initial post.

The whole experience was odd, and ultimately I'm no expert in hyperbaric medicine so will defer to those who are, but yeah, just a weird thing.

 

[Mr. Dooley]

Hi @Mr. Dooley

The mechanism by which a PFO causes DCS is by shunting bubbles from the right side of the heart, through the PFO defect, to the left side of the body. The bubbles in the systemic circulation are the cause of DCS with a PFO. Bubbles are generally filtered out by the lungs in the right sided circulation.

There is no increased nitrogen accumulation/retention, etc. with a PFO.

Great information - thanks for clarifying.