possible dci? possible psychosomatic?

[gangrel441]

Ok...I tend to be an anxious type who sometimes gets myself worked up about things I don't have a full understanding of, and DCI is one of those things. So here goes...

I returned from a liveaboard trip on Saturday. I was diving all week on EANx29 - 32. On one diving day, I had a small issue with my ear. Ear would clear on a dive, but didn't want to clear once back on the boat. On one dive, I had a bit of a reverse squeeze, but it resolved during a very nice gradual ascent.

After the boat returned to port, felt fine on the boat, but when I got off the boat, I still had the sensation of being on the boat. I felt strange, but saw no other symptoms.

Saturday we flew out, and though I was working myself into a panic, I still showed no symptoms aside from not having my landlegs. Flight was uneventful, but felt fatigued and worried after we landed. I think the fatigue was because I had gotten myself worked up emotionally. I have had aches and pains come and go, but that is not unusual for me.

I have spoken with several DAN medics this week, who have all agreed that based on how I described what I was going through, said it was safe to rule out DCI. I am convinced that most if not all symptoms I experienced were psychosomatic, with the exception of the equilibrium issues. That, I think, is likely a result of a minor ear barotrauma and minor motion sickness.

I got in to see my doc for a full physical today. Though he is not a diving doc, he has some familiarity with DCS, and was in agreement with the DAN docs and my rational thoughts. As for my ears, he noted that the one I think may be inured does possibly have some irritation and a little fluid, but nothing major. He said in all likelihood, it is a panic attack spun out of control. He prescribed Xanax and had me take an EKG and bloodwork.

Tonight, after taking my first Xanax, I am quite calm, and the only symptom I am still experiencing is a slight dulling of sensation in my scalp and temple on the same side of my head as the effected ear. By slight dulling, I mean I would not describe this as numbing or pins-and-needles tingling, just dulled like one would experience when they have been drinking. I noted this before taking the meds and after. My face does not show any signs of paralysis or any type of a rash. Does this sound like it could be some form of DCI, or possibly Barotrauma related, or even imagined?

P.S., I will not be diving any time in the immediate future, and the Xanax is purely a temporary situation. I do not have any history that I am aware of of a panic disorder, though I have had some issues with anxiety, mostly work and school related.

Thanks for your insights!

 

[ScubaDadMiami]

Mellow out, dude! I mean, I am getting anxious just reading your post. :11:

I am no diving physician. So, I can't tell you about things I don't have the proper license to advise about. However, I can share a couple of common sense things with you.

It is quite common for people that have been on a cruise or at sea for a number of days to feel like they are still rolling after returning to land. This typically lasts only for a few days or so. It is no big deal, and it will go away. This feeling might be compounded by your ear barotrauma and the Xanax. So, take that into consideration if it lasts longer.

Pretty much everything else you are talking about sounds like it is related to your ear. That could take some time to calm down depending on the amount of fluid in your ear. Do not return to diving without getting cleared to dive by a diving ENT. DAN can tell you who is qualified in your area.

I am not exactly sure what you are describing about the "dulling sensation" in the scalp and temple area. Regarding that, go by what the doctors say. As a lay person, I can fathom a guess that this is related to the ear. Your problem might also partially involve your sinuses, producing these feelings. Again, go with what the experts say about it.

You should start learning as much about DCS and diving related issues. If there is a local hyperbaric chamber in your area, you might want to find out if you can take a tour of the facility, too. Learning about DCS might take some of the fear away.

I am a retired instructor. Don't take this the wrong way, but if you came to me with a history of anxiety, I would be reluctant to take you on as a student. I would further advise that you get fully tested to see how much of an issue this is for you. I can see being worried about taking a DCS hit, but it sounds like your meters are going off the scale even after seeing physicians and talking to DAN. That is a big, red flag to me.

Diving is supposed to be fun. If it's that much stress, maybe this is not the sport for you. It's not for everyone. On the other hand, if you love it and feel great all of the time that you are diving, and it's only the worry about the DCS now that has caused all of this on a temporary basis, I hope that learning more about it will take the anxiety away and will allow you to return to enjoying diving once again.

 

[gangrel441]

Thanks for the reply. Just a few things.

I don't have any history of clinical anxiety. I have gotten myself worked up over work or school a few times, but have always worked through it. I have never been on meds for this, and the doc was clear that this time it was just to help me even out. I know to be careful with usage, and one dose may well be all I need so I can differentiate between psychosomatic symptoms and those that are really there. I posted this message shortly after taking that dose, and am now replying after it has worn off.

I have already been using this situation as an opportunity to learn all that I can about DCS, and my post last night was intended more as a way of gathering more information than a request for a diagnosis. Perhaps the meds interfered with my judgement in how that came across.

As for me and diving, I have over 65 dives logged, completed rescue, and have logged quite a bit of training in one form or another. This is the first time anxiety has caught up with me in this regard, and it happened well after the diving was completed. There are other things going on which may have contributed to this as well, such as my wife and I trying to start a family after the trip.

I know that anxiety disorders and scuba don't mix, but knowing myself, I think I would hesitate to say that I have an anxiety disorder, and the doctor stopped well short of saying any such thing. I truely belive that this was a case of me experiencing a few weird sensations, getting an idea in my head, and letting it spiral out of control. I sincerely doubt anything of the sort will happen again.

Now for some clarification on my previous post: The reason I was seeking clarification is because I find the terms used to describe DCS to be somewhat vague at times, especially when it comes to a mild hit. Numbness to me can mean anything from a feeling that sense of touch just isn't sharp right down to "I can't feel a thing." Tingling to me can mean anything from hairs standing up on the back of your neck at a horror movie to "Pins and needles, my hand feels like it is on fire." I guess where I needed clarification was not on what the symptoms are, but how to distinguish them from other sensations which may simply be caused by fatigue or (perhaps irrational) worry. In my case, I believe vigilance over a sensation or two which felt strange after diving spiraled out of control until I convinced myself I was feeling things that I wasn't. I have just read an awful lot of accounts of people who experienced symptoms, denied that they were, and failed to seek treatment. Guess maybe I went to the opposite extreme...

Mellow out, dude! I mean, I am getting anxious just reading your post. :11:

I am no diving physician. So, I can't tell you about things I don't have the proper license to advise about. However, I can share a couple of common sense things with you.

It is quite common for people that have been on a cruise or at sea for a number of days to feel like they are still rolling after returning to land. This typically lasts only for a few days or so. It is no big deal, and it will go away. This feeling might be compounded by your ear barotrauma and the Xanax. So, take that into consideration if it lasts longer.

Pretty much everything else you are talking about sounds like it is related to your ear. That could take some time to calm down depending on the amount of fluid in your ear. Do not return to diving without getting cleared to dive by a diving ENT. DAN can tell you who is qualified in your area.

I am not exactly sure what you are describing about the "dulling sensation" in the scalp and temple area. Regarding that, go by what the doctors say. As a lay person, I can fathom a guess that this is related to the ear. Your problem might also partially involve your sinuses, producing these feelings. Again, go with what the experts say about it.

You should start learning as much about DCS and diving related issues. If there is a local hyperbaric chamber in your area, you might want to find out if you can take a tour of the facility, too. Learning about DCS might take some of the fear away.

I am a retired instructor. Don't take this the wrong way, but if you came to me with a history of anxiety, I would be reluctant to take you on as a student. I would further advise that you get fully tested to see how much of an issue this is for you. I can see being worried about taking a DCS hit, but it sounds like your meters are going off the scale even after seeing physicians and talking to DAN. That is a big, red flag to me.

Diving is supposed to be fun. If it's that much stress, maybe this is not the sport for you. It's not for everyone. On the other hand, if you love it and feel great all of the time that you are diving, and it's only the worry about the DCS now that has caused all of this on a temporary basis, I hope that learning more about it will take the anxiety away and will allow you to return to enjoying diving once again.

 

[DA Aquamaster]

The reason I was seeking clarification is because I find the terms used to describe DCS to be somewhat vague at times, especially when it comes to a mild hit. Numbness to me can mean anything from a feeling that sense of touch just isn't sharp right down to "I can't feel a thing." Tingling to me can mean anything from hairs standing up on the back of your neck at a horror movie to "Pins and needles, my hand feels like it is on fire." I guess where I needed clarification was not on what the symptoms are, but how to distinguish them from other sensations which may simply be caused by fatigue or (perhaps irrational) worry.

At 40, having lived a pretty active life so far, I find I have a some aches, pains, etc that I did not have doing the same activites at 18. So when diving, I do a quantitative and qualitative pre-dive inventory of what aches, hurts etc so that I can then eliminate those things as probable DCS symptoms when I surface. I keep a mental list, but you can always write it down if you prefer.

I also take into account the occassional things that may hurt due to the physical requirements of the dive itself. For example I have a history of knee injury and my right knee will ocassionally have a mild pain in it during the dive and after from frog kicking etc, on occasions when something is misaligned, strained etc. This type of joint pain is something that gets consideration during deco stops and if the onset were during the stop instead of at depth during the dive, I would probably regard it differently. Even with the onset at depth, I may extend my stops a bit to add a little more safety margin and to compensate for any reduction in circulation that may result from mild swelling, etc but I don't get anxious or irrational about it.

Currently I have a stress fracture in my left foot acquired about mid April and slowly healing so that is one more pain I ignore.

Symptoms of DCS normally present themselves shortly after surfacing and in the vast majority of cases will present within 2 hours of the dive. And while it is possible for symptoms to appear later, they becomes far less likely as time passes and it is virtually unheard of for a symptom to appear more than 24-48 hours after a dive.

 

[Doc Intrepid]

I agree that you should learn all you can regarding the theoretical foundations for DCS. Moreover, while I’m not ordinarily an advocate of computer diving, for multiple-dive/multiple-day/night diving trips such as live-aboards, IMHO a computer offers significant benefits in terms of being able to track nitrogen absorption in the various tissue compartments over a cyclical series of 24 hour periods. Many begin with pretty conservative algorithms, and can be set for even greater conservatism, which in your case sounds like a good idea.

While some of the text can be dense, and the math is for those who are already fluent in it, nevertheless Weinke’s textbooks are very in-depth and worth the time it takes to examine them at your own pace. I believe Bruce is also on this board, (search for threads with posts by BRW), and his input is often useful.

For more information, these are some excellent references:

http://www.rgbmdiving.com/site/bestpub.htm

http://www.rgbmdiving.com/

Hope this helps,

Doc

 

[gangrel441]

Thanks Doc! I'll check the links when I get a chance.

All of my diving is computer diving, and our profiles were as a whole pretty conservative. I dive with a Suunto, and it was a rare occasion on this trip where I showed a saturation level in any tissue group of higher than 50%.

Also know what you mean about aches and pains. When I am not scuba diving or number crunching (I am a financia analyst by day), I am teaching karate and doing an insane (by many peoples' standards) physical fitness regimen. Also, about 3 years ago, I was a passenger in an accident caused by a drunk driver which could easily have turned out to be fatal. Fortunately, it wasn't, but I had to have a plate placed on my left radius, and to this day I have bruise and a welt on my right shin. So, I guess you could say I am pretty used to taking inventory.

I will read anything I can get my hands on, so please feel free to recommend any reading you find helpful. I may look for a class on Decompression Theory as well, though I would imagine they are hard to come by in Chicago...

I agree that you should learn all you can regarding the theoretical foundations for DCS. Moreover, while I’m not ordinarily an advocate of computer diving, for multiple-dive/multiple-day/night diving trips such as live-aboards, IMHO a computer offers significant benefits in terms of being able to track nitrogen absorption in the various tissue compartments over a cyclical series of 24 hour periods. Many begin with pretty conservative algorithms, and can be set for even greater conservatism, which in your case sounds like a good idea.

While some of the text can be dense, and the math is for those who are already fluent in it, nevertheless Weinke’s textbooks are very in-depth and worth the time it takes to examine them at your own pace. I believe Bruce is also on this board, (search for threads with posts by BRW), and his input is often useful.

For more information, these are some excellent references:

http://www.rgbmdiving.com/site/bestpub.htm

http://www.rgbmdiving.com/

Hope this helps,

Doc

 

[Dr Deco]

Hi gangri:

As the others stated, this does not appear to be a true problem from gas loading.