Ongoing lightheadedness months after open water diver

[Decado]

Hi,

I am looking for opinions / advice for what I would describe as a "weird" medical condition I am currently in.
The whole story is rather long, and maybe isn't even related to diving in the end, but I will still try to give all the details.

I am 29 years old, normal/sportive physique, work on a computer every day, do sports basically every day or every second day, completely new to diving.
One thing that has been the case for me as long as I can remember is I have to equalize very often when flying or going by train through tunnels etc, and I have had problems with blockades in my lower back over the last 8 years or so, mostly due to bad sitting and muscular imbalances.

In early February I did my PADI Open Water diver during a holiday with a private dive instructor on a weekend.
Saturday:
- Early morning basics in a pool, around 1.5hrs or so of talking, swimming, diving, "skills" tests, etc.
- Went to dive shop, geared up, went to dive site
- Two dives with the dive instructor, another diver, and me, water temperature ~16 degrees
1) max depth ~9m, 36min
2) max depth ~6m, 42min
- Dives felt good, from a technical point of view I guess I was learning pretty quickly except I had problems descending and I surfaced often unwantedly when we were very near to the surface. As I had expected I had to equalize very often.
- Exhausted afterwards, slight headache if I recall correctly, but overall good
- Had some drinks in the evening, but slept long and felt totally fit in the morning

Sunday:
- Two dives with only the instructor and me, temperature ~16 degrees again, same bay but different dive site
1) max depth ~11m, 41min
2) max depth ~9m, 43min
- First dive was mostly skills stuff (compass navigation, diver tow)
- In the second dive, it felt like my instructor was going much faster than the day before, anyways I felt a bit exhausted after the first 10 minutes of the dive (actually, I was a bit exhausted before going underwater already, I had terrible trouble getting on my fins in the water).
- Grabbed the fin of my instructor, signaled I was a bit exhausted, rested a few seconds on the bottom at 11m
- Instructor decided it was a good time to just do the skills tests, and so we did, surfacing with buddy breathing (no stopping)
- After that, descended back to 11m with the following incident:
- For the first time, descending actually worked for me like it should, which caught me off guard. Descended way too fast, lost control of my body, resulting in sinking backwards feet up looking up. Instructor signaled I should put back some air into the BCD to stop "falling", which I did, but that prevented me from equalizing in time, resulting in a sharp squeeze of about a second until I had used the BCD, got my hand free again and equalized.
- Pain in the ears went away and I did not bother after a few seconds of recovery at the bottom.
- After that, the dive got gradually more relaxed as I was beginning to get the hang of buoancy control etc.
- The only thing I remember is that I had a harder time equalizing, including one or two unsuccessful tries with strong vertigo

I felt really exhausted after the second dive, but also very happy, it was a lot of fun despite the short scary moment when descending.
I will try to describe the next days as good as possible, but it's hard to remember the exact order of things.

The rest of the day I felt exhausted and dizzy, while showering at home I had a sharp pain in the right side of my back which only went away the next day or so.
Monday, I still felt dizzy/lightheaded (without strong vertigo) and noticed joint and limb pain in my upper body, shoulders, elbows, and itching tops of my feet as if I had been biten.
I got really worried of DCS or whatsoever and called my instructor, who told me it was long enough after the dives and calmed me down, said I should visit the doctor if it should not go away or get worse.
I slept really bad the next days because I was very worried and confused with my body signals, which were not strong enough to signal anything severe, yet clear enough to know something was wrong.
I went to the doctor the next day, who couldn't find anything except for a red right eardrum (he had no idea about diving I might have to add).
He prescribed me some anti-inflammatory medicine which I took over the next days, but they did not really change anything.
Tuesday I decided to do some sports to get moving and shake off my bad thoughts, which was okay but my condition did not change.
The next day in the evening my feet and hands started to tingle, similar to when they fall asleep, just not so strong.
I went to the doctor again on Thursday or Friday. He called another doctor at the nearest hyperbaric center (about 450km away) who said DCS could never be excluded even with the shallow dives.
I finally started to calm down after talking to that man or another from that center directly a few days later and hearing that it might have been some weak form of DCS (I had no idea such thing existed until then) which apparently happens more often and symptoms should go away on their own within a few weeks. My flight back would only be 4 weeks later, so that seemed not to be a problem as well. He also said that if anything should get worse I should immediately go to the hospital.
Anyways, basically all symptoms did vanish about 15 days after the last dive.

However, this is not where the story ends - or, at least, I am trying to find out whether my current condition could still be linked to that.

I flew back (very long flight, I basically did not sleep longer than 4-5hrs straight for 3 days in a row, and not much overall as well) in mid March.
During the flight I had some slight pain in my upper chest and shoulders again, but really nothing to worry about (although of course it made me worry, but it could very well be the long sitting, not sleeping etc.)
After landing, I immediately noticed a dizzyness/lightheadedness similar to the one in the days after the dives again.
I decided sleeping, getting rest, and getting rid of the jetlag was the first thing to do before worrying too much again, but nothing changed, and I noticed some slight tingling in feet/fingers again as well.

Long story short: It has been 6 weeks now since I came back, and I still feel lightheaded/dizzy (I try to describe it like "as if I was a little bit drunk" because there is no or very little vertigo).
All other symptoms have gone away, and I had two times in those 6 weeks where my head felt normal as well for about two days just to be dizzy again when I just thought it was over.
I went from one doctor to the next (ENT, neurologist, orthopaedic, internist), had a CCT of my head done, an xray of my back, all without diagnosis. The orthopaedic sent me to a physio just in case (and my neck and back muscles can always use some treatment due to sports), but this also did not change anything.

Now the latest thing that occurred to me was that what happened when I felt okay last week and the next day the feeling was back:
I did not drink enough over the day and had one longdrink and one glass of wine in the evening. I felt tiddly, and so I still did the next morning and still do now.

I would appreciate any help, advice, opinions or whatsoever, since this starts to get really annoying .
I'll also be happy to answer any further questions of course.

Thanks!

 

[mala]

maybe you should have a chat with a diving doctor.

ow in 2 days - wow that was quicker than normal.

 

[Duke Dive Medicine]

Decado,

From the thorough history you've given, it seems very unlikely that this is related to decompression sickness. You just didn't have enough of a nitrogen load. You did have a good bit of difficulty equalizing, and when combined with your symptoms, it sounds like you may have suffered from inner ear barotrauma. Some ENT physicians are not familiar with diving physiology. I recommend you find one who is, and schedule an appointment to be seen as soon as possible. The ENT physician may perform an audiology exam and/or an electronsytagmogram to determine if your vestibular apparatus are affected.

The peripheral neurological symptoms you had are most likely unrelated to this incident, unless you aggravated an existing injury by carrying around diving gear.

Best regards,
DDM

 

[emoreira]

ow in 2 days - wow that was quicker than normal.

The course that I took (SSI) was 16 classroom sessions of 90 minutes and 16 pool sessions of 90 minutes. One classroom + one pool session per week. This means 4 months. Besides this I did one extra 90 minutes pool session per week to improve my swimming and other drills. This extra pool session was also under the instructor suppervision.

 

[Decado]

Thanks mala, and DDM,

It seems like my report was not thorough enough, sorry for that.
An ear barotrauma was suspected by the doctor on site already, that's why he prescribed the anti-inflammatory medicine.
The ENT here did perform a few exams, I believe he tested whether the eardrums were okay and whether my hearing and balance were okay.
The neurologist also did a test where I had to stare at a screen with black/white squares with one eye with electrodes on my head.
All without any findings.
I am not sure, however, if the ENT actually knew what I was saying when I mentioned a barotrauma (not to mention an inner ear barotrauma, which I was not aware of until a week ago or so), so I will double-check with another one.
The Problem is there seems to be no certified diving doctor within 150km here, so I have to take a day off for that .

DDM mentioned another point I forgot: My gear felt *extremely* heavy, I could barely walk with it. Since I have no experience I don't know if that is normal or not of course. And, removing blockades from the spine and physiotherapy did not help either...

And I may add another thing that just comes to my mind: My blood picture showed no abnormalty except for high uric acid (which some other doctor noticed a few years ago already).

 

[tb2]

hello Decado
just found your post by chance but: I have almost exactly the same symptoms and problems as you describe!!!
I did not scuba dive for 5 years now but wanted to start diving again. so i went on a dive with a dive club 3 months ago.
The dive was not very deep and long (13m, 40min). But in the middle of the dive I popped up towards the surface but went down again.
After the dive I just felt a bit tired and exhausted so I did not care much about it any more....
But 5 days later I had all of a sudden an attack of dizziness and lightheadedness which last for 3 days. As i was very concerned after that, i wend to a hyperbaric specialist to check for DCI or similar - but nothing was found. In the following weeks I always felt tired, had random joint pain that came and went. went to the GP to check again - could not find anything at all. His diagnosis was just: Concern and anxiete.
so i tried to accept this and hoped it will get better. last week i realy felt much better and thought it is over. but it was not: 2 days ago i had now the 3rd "attack" of dizziness and lightedheadness... i really have no idea why and what this is... neither has the doctor makes it a little scarry...

would be very interested to know if you come closer to a reason, explanation or solution for your problem!
cheers

 

[tb2]

i forgot to mention: also the tingling in feet, back pain and randomly pain in the chest are also present in my case. i also have problems with cold hands and feet - coming and going randomly.

what else could it be than DCI? what else could happen while diving that could cause such variety of problems? i thought about damage lung while ascending. but i cant see why this should cause all these problems...

 

[TSandM]

One of the big problems with DCS is that the symptoms are protean and unpredictable, which makes it a difficult diagnosis to make. However, in any exercise in diagnosis, one has to put the things that support the disease in question in one column, and the things that argue against it in another, and see how they add up at the end.

The beginning, with DCS, is total nitrogen exposure. People who are doing pool dives, or OW checkout dives, simply aren't at sufficient depth for enough time to get any significant nitrogen loading. Neither of the cases described here involves depths or times that are immediately suggestive of DCS, although even such shallow dives might be problematic if combined with a history of a week's aggressive diving or immediate ascent to altitude. But those things aren't present in these cases.

Then you can look at onset time. The VAST majority of DCS cases present within the first 12 hours; presentations later than that lower the likelihood of DCS as the correct diagnosis.

Then you can look at the symptom complex. DCS associated with long exposures tends to present as joint pain. DCS associated with poor ascent control tends to present as neurologic symptoms, but once the symptoms begin, they tend to persist -- they don't come and go.

Both of the stories presented here involve delayed presentations of relatively subtle symptoms which come and go and change; neither involves significant nitrogen exposure, and at least one has been extensively evaluated by physicians and even treated in a chamber without resolution.

There are a lot of people out there with vague symptoms that come and go, which may not all even be related to the same physical system. Sometimes we eventually diagnose odd syndromes in those people, but more often, no explanation is found. When diving has been involved, DCS has to be examined as a possibility, but in neither of the presented cases does that sound like a likely explanation for what is going on.