Apologies for the long post, but there is quite a bit of relevant history:
In January 2004, after an uneventful diving history of about 50 dives, my wife (and I) went on a live aboard dive trip. We both did similar dives (9 dives over 3 days. Typically 25 to 34m max depth, 30 to 60min) About 36 hours after the last dive, and immediately after a very hot shower, my wife started to complain of elbow pain and "pins & needles" in her left arm. Thinking this sounds like DCS symptoms -all be it after 36 hours, we called DAN, who advised us to contact a nearby chamber. My wife was checked out, and given 3 chamber rides (I can't remember the table details now), after which, the symptoms were much improved. The thinking at the time was that it was not an entirely "undeserved" hit. A number of contributing factors seemed to explain the incident: reduced sleep due to compressor noise on the boat, dehydration due to hot climate, a few alcoholic drinks, lots of repeated deep dives, a dive computer screw up, and finally a the hot shower, so overall, in spite of the delay in the onset of symptoms, DCS did seem to be the cause. This was confirmed by an observed improvement of symptoms while in the chamber. That said, we later discovered that the chamber in question had a reputation for being very keen to decide on questionably un-necessary chamber treatments....
After a 3 month break from diving, my wife continued to dive occasionally without problem for the next 2 years. Then in April 2006, we went for another live aboard trip. The trip comprised 14 moderately conservative dives over 6 days, towards the end of which my wife again complained of pins & needles in her left arm. This time, she did not seek medical attention as we were a long way from medical services. She skipped the remaining dives of the trip, and the symptoms cleared completely within a day or 2. We obviously suspected a repeat DCS incident, but it was not confirmed or diagnosed by any medically qualified person.
My wife did not then dive again until January 2008, again on a lovebird trip. This time, after just 2 very normal conservative dives (both max 22m / 44 min), she again reported left elbow pain and left arm numbness. She was immediately given oxygen on the boat and transferred to a chamber facility within about 2 hours. Initial tests at the chamber facility revealed that nerve sensation, reflexes and motor power were reduced on the left side of the body. In addition, her left eye lid started to develop a twitch. Recompression treatment was started shortly afterwards, and continued over 3 days, comprising table 6, table 5 and finally HBO. Improvement in symptoms was recorded, but some symptoms remained for several months. At this stage, we (and the doctor at the chamber facility) strongly suspected a PFO.
After returning home, and at DAN's recommendation, she was given an ultrasound scan of the heart (without the saline injection, but with the "latest ultrasound scanner" - I can't remember the make / model of the scanner, but the doctor seemed to think a saline test was not necessary). No PFO was identified, and she was advised not resume diving until she had been symptom free for 12 months. The symptoms finally cleared completely by about April 2008.
In November 2008, she decided that having been symptom free for about 7 months (not the recommended 12 months) to perform a couple of very undemanding shallow dives during a tropical vacation. These dives were both extremely conservative profiles (16m / 40 min. very slow ascents, deepest part first, significant percentage of the time spent at 9m during the ascent, long safety stop). She was well rested, and not dehydrated. Towards the end of the second dive, she reported numbness in her left arm. She stopped diving, but did not seek medical treatment or diagnosis. The symptoms started to improve the same day, and had completely cleared by the following day.
Obviously at this point she (and that probably also means me) is thinking of giving up diving.
So the questions to Doc D & any other experts are:
Is it worth conducting another ultrasound PFO test with the saline IV?
Is there anything else which could be predisposing her to DCS?
She seems to be getting increasingly susceptible to DCS. Why is this? Is it due to injury from the previous incidents?
Is there anything short of giving up diving that we can do? Nitrox on air profiles??
Why is a 12 month break after the last symptoms recommended - what is the body doing during this time?
Why are the symptoms always most apparent (but not limited to) the left arm?
Thanks in advance.
In January 2004, after an uneventful diving history of about 50 dives, my wife (and I) went on a live aboard dive trip. We both did similar dives (9 dives over 3 days. Typically 25 to 34m max depth, 30 to 60min) About 36 hours after the last dive, and immediately after a very hot shower, my wife started to complain of elbow pain and "pins & needles" in her left arm. Thinking this sounds like DCS symptoms -all be it after 36 hours, we called DAN, who advised us to contact a nearby chamber. My wife was checked out, and given 3 chamber rides (I can't remember the table details now), after which, the symptoms were much improved. The thinking at the time was that it was not an entirely "undeserved" hit. A number of contributing factors seemed to explain the incident: reduced sleep due to compressor noise on the boat, dehydration due to hot climate, a few alcoholic drinks, lots of repeated deep dives, a dive computer screw up, and finally a the hot shower, so overall, in spite of the delay in the onset of symptoms, DCS did seem to be the cause. This was confirmed by an observed improvement of symptoms while in the chamber. That said, we later discovered that the chamber in question had a reputation for being very keen to decide on questionably un-necessary chamber treatments....
After a 3 month break from diving, my wife continued to dive occasionally without problem for the next 2 years. Then in April 2006, we went for another live aboard trip. The trip comprised 14 moderately conservative dives over 6 days, towards the end of which my wife again complained of pins & needles in her left arm. This time, she did not seek medical attention as we were a long way from medical services. She skipped the remaining dives of the trip, and the symptoms cleared completely within a day or 2. We obviously suspected a repeat DCS incident, but it was not confirmed or diagnosed by any medically qualified person.
My wife did not then dive again until January 2008, again on a lovebird trip. This time, after just 2 very normal conservative dives (both max 22m / 44 min), she again reported left elbow pain and left arm numbness. She was immediately given oxygen on the boat and transferred to a chamber facility within about 2 hours. Initial tests at the chamber facility revealed that nerve sensation, reflexes and motor power were reduced on the left side of the body. In addition, her left eye lid started to develop a twitch. Recompression treatment was started shortly afterwards, and continued over 3 days, comprising table 6, table 5 and finally HBO. Improvement in symptoms was recorded, but some symptoms remained for several months. At this stage, we (and the doctor at the chamber facility) strongly suspected a PFO.
After returning home, and at DAN's recommendation, she was given an ultrasound scan of the heart (without the saline injection, but with the "latest ultrasound scanner" - I can't remember the make / model of the scanner, but the doctor seemed to think a saline test was not necessary). No PFO was identified, and she was advised not resume diving until she had been symptom free for 12 months. The symptoms finally cleared completely by about April 2008.
In November 2008, she decided that having been symptom free for about 7 months (not the recommended 12 months) to perform a couple of very undemanding shallow dives during a tropical vacation. These dives were both extremely conservative profiles (16m / 40 min. very slow ascents, deepest part first, significant percentage of the time spent at 9m during the ascent, long safety stop). She was well rested, and not dehydrated. Towards the end of the second dive, she reported numbness in her left arm. She stopped diving, but did not seek medical treatment or diagnosis. The symptoms started to improve the same day, and had completely cleared by the following day.
Obviously at this point she (and that probably also means me) is thinking of giving up diving.
So the questions to Doc D & any other experts are:
Is it worth conducting another ultrasound PFO test with the saline IV?
Is there anything else which could be predisposing her to DCS?
She seems to be getting increasingly susceptible to DCS. Why is this? Is it due to injury from the previous incidents?
Is there anything short of giving up diving that we can do? Nitrox on air profiles??
Why is a 12 month break after the last symptoms recommended - what is the body doing during this time?
Why are the symptoms always most apparent (but not limited to) the left arm?
Thanks in advance.
