Hi,
I'm hoping for some assistance with my situation. I apologize for the length of this, but I figured it is better to be thorough.
I've had two undeserved most likely Type-II neurological DCS hits in the past 4 months. At this point, it looks like I am going to have to quit diving unless I can figure out the cause of this and find a way to resolve it. As many of you would imagine, this is a frustrating position to be in, as I really enjoy it and have arranged my vacation travel and plans around being underwater. I'm hoping for some thoughts and suggestions for other areas I can look into, or possible tests I can run to see if there is any resolution. Both my doctors have been very helpful, but I figure it doesn't hurt to have a second/third/etc. opinion!
I've been diving sporadically since 2005, now with about 125 total dives, but more often lately since moving to South East Asia. Prior to the following trips, I did not have any symptoms for DCS and have dived more often/aggressively over the course of as many days via other trips. I'm a 27 year old male, around 5'8" and 144lbs. My body fat is around 14% right now. No other medical issues that I am aware of. I was not drinking anything beyond a couple sodas a day, no alcohol, no prescription or drugs of any kind (except Tylenol), no coffee etc on either trip.
In August, I did a 3 day trip to Bali with an Oceanic Geo computer, wearing a hood and a 3mm and a 5mm wetsuit, with the following profile:
Day 1
Dive 1: 89ft max / 45min, Nitrox 32%, Computer on Nitrox (NX PO2 1.22), 5min 15ft s/s, 78 deg.
1:12 interval
Dive 2: 63ft max / 53 min, Nitrox 33%, Computer on Nitrox (Nx PO2 .96), 5 min 15ft s/s. 78 deg.
1:12 interval
Dive 3: 55ft max / 53 min, Nitrox 31%, Computer on Nitrox (NX PO2 .85), 5 min 15ft s/s. 78 deg.
16:22 interval
Day 2
Dive 4: 42ft max / 45min, Nitrox 33, Computer on Nitrox (NX PO2 .75), 5 min 15ft s/s. 69 deg.
1:17 interval
Dive 5: 114ft max / 34 min, Air (NX PO2 .93), 5 min 15 ft. s/s. 68 deg.
1:10 interval
Dive 6: 91ft max / 33 min, Air (NX PO2 .78), 5 min 15ft s/s. 75 deg.
19:30 interval
Day 3:
Dive 7: 81ft max / 45 min, Nitrox 33, Computer on Nitrox (NX PO2 1.14), 5 min 15ft s/s. 78 deg.
1:14 interval
Dive 8: 79ft max / 39 min, Air (NX PO2 1.12), 5 min 15ft s/s. 69 deg.
1:27 interval
Dive 9: 69ft max / 60 min, Nitrox 33, Computer on Nitrox (NC PO2 1.02), 5 min 15ft s/s. 76 deg.
Before flying: 26 hours
For this trip, I was moderately hydrated with some sun exposure.
I woke up the next morning and had some numbness in my left elbow and some minor tingling. As is usually the case, it didn't seem like much to worry about at the time, as I have had similar feelings in the past, so I went about my day tour. During the tour, the sensation spread mildly to my right arm at which point I suspected it may be DCS. Given my situation and the apparent mild nature of the symptoms, I wanted to get back to where I lived before seeking treatment. I flew back around 6:00pm that Monday night, 26 hours after Dive 9.
The symptoms (which never progressed beyond the numbness and tingling in my left and right hands and arms) did not dissipate on Tuesday, so Wednesday morning I saw the diving physician and he recommended I have a table 6 treatment. The symptoms seemed to slightly ease up during the treatment, but not entirely. I then underwent a Table 5 the following day. The same thing occurred. It took at least around a week for all of the tingling and numbness to go away.
Prior to the treatment, my Romberg's test was very very unsteady, and this did seem to clear up after the Table 5. The doctor cleared me to diving again, suggesting I wait around 3 months.
4 months later, this past weekend I got back in the water. Over the course of 4 days, I did 14 dives with the same Oceanic Geo computer, wearing a hood and a 3mm wetsuit, with the following profile:.
Day 1:
Dive 1: 69ft max / 62min, Nitrox 32%, Computer on Air, 5min 15ft s/s, 78deg.
1:29 interval
Dive 2: 64ft max / 60min, Nitrox 32%, Computer on Air, 5 min 15ft s/s. 78 deg.
3:03 interval
Dive 3: 39ft max / 60min, Air, 5 min 15ft s/s. 78 deg.
11:24 interval
Day 2:
Dive 4: 75ft max / 53min, Nitrox 36%, Computer on Nitrox (Nx PO2 1.17), 1min 44 ft & 5min 15ft s/s, 77deg.
3:15 interval
Dive 5: 49ft max / 66min, Nitrox 32%, Computer on Air (Nx PO2 .52), 5 min 15ft s/s. 78 deg.
3:11 interval
Dive 6: 73ft max / 56min, Nitrox 36% (NX PO2 .67), 5 min 15ft s/s. 77 deg.
1:45 interval
Dive 7: 34ft max / 67min, Air (NX PO2 .42), 5 min 15ft s/s. 78 deg.
11:44 interval
Day 3:
Dive 8: 97ft max / 49min, Nitrox 32%, Computer on Nitrox (Nx PO2 1.26), 1min 44 ft & 5min 15ft s/s, 77deg.
1:30 interval
Dive 9: 80ft max / 48min, Nitrox 36%, Computer on Nitrox (Nx PO2 1.23), 1min 44 ft & 5min 15ft s/s, 77 deg.
5:18 interval
Dive 10: 70ft max / 56min, Air, (NX PO2 .65), 5 min 15ft s/s. 78 deg.
1:42 interval
Dive 11: 29ft max / 65min, Air (NX PO2 .39), 5 min 15ft s/s. 76 deg.
13:00 interval
Day 4:
Dive 12: 78ft max / 54min, Nitrox 36%, Computer on Nitrox (Nx PO2 1.21), 1min 44 ft & 5min 15ft s/s, 77deg.
3:57 interval
Dive 13: 106ft max / 44min, Nitrox 32%, Computer on Air (Nx PO2 1.34), 1min 44 ft & 5min 15ft s/s, 77 deg.
1:35 interval
Dive 14: 75ft max / 65min, Nitrox 36% (NX PO2 1.17), 5 min 15ft s/s. 78 deg.
Before flying: 29 hours
For this trip I was careful to avoid the sun as much as possible and drink water constantly through out the day.
After the final dive, I began to feel very mild tingling in both my hand and a bit in my feet. Again, given my situation and where I was diving, I preferred to come back where I lived to seek treatment. Again on Tuesday the symptoms did not improve so Wednesday morning I saw a different diving doctor and after an examination, he suggested a investigation into if a Patent Foramen Ovale (PFO) was causing my DCS. I had an initial transthoracic echocardiogram (TTE) which was negative and then did a Table 6 treatment. At depth, my Romberg's test was much improved over the one conducted during the examination, and while the symptoms were milder at depth, they returned once I left the chamber.
The following morning (Thursday) I had a transesophageal echocardiogram (TEE) which was also negative, effectively ruling out a PFO as the cause. Based on the day after examination which was yesterday, my doctor did not recommend a further treatment. Through the course of today, the tingling has lessened some, but numbness remains in my right foot and both ring fingers (predominantly my right). There is still periodic more of a shooting tingling and I was a bit unsteady this morning, but that appears to have gone away.
As far as my doctor can tell, he suspects that my m-values are out of the ordinary causing my tissues/organs to off-gas less nitrogen. Beyond PFOs and pinched nerves which seem unlikely in my case, I've read that abnormalities in my thrombotic state could be causing this? The only other factors I can think of are the temperature of the water (pretty much the coldest of my diving experiences), I was very cold towards the end of some of the dives, bordering on shivering, as well as the fact that on both of these trips I have been diving using my newly purchase equipment (I know that this is not a contributing factor to DCS).
Thoughts?
Thanks.
I'm hoping for some assistance with my situation. I apologize for the length of this, but I figured it is better to be thorough.
I've had two undeserved most likely Type-II neurological DCS hits in the past 4 months. At this point, it looks like I am going to have to quit diving unless I can figure out the cause of this and find a way to resolve it. As many of you would imagine, this is a frustrating position to be in, as I really enjoy it and have arranged my vacation travel and plans around being underwater. I'm hoping for some thoughts and suggestions for other areas I can look into, or possible tests I can run to see if there is any resolution. Both my doctors have been very helpful, but I figure it doesn't hurt to have a second/third/etc. opinion!
I've been diving sporadically since 2005, now with about 125 total dives, but more often lately since moving to South East Asia. Prior to the following trips, I did not have any symptoms for DCS and have dived more often/aggressively over the course of as many days via other trips. I'm a 27 year old male, around 5'8" and 144lbs. My body fat is around 14% right now. No other medical issues that I am aware of. I was not drinking anything beyond a couple sodas a day, no alcohol, no prescription or drugs of any kind (except Tylenol), no coffee etc on either trip.
In August, I did a 3 day trip to Bali with an Oceanic Geo computer, wearing a hood and a 3mm and a 5mm wetsuit, with the following profile:
Day 1
Dive 1: 89ft max / 45min, Nitrox 32%, Computer on Nitrox (NX PO2 1.22), 5min 15ft s/s, 78 deg.
1:12 interval
Dive 2: 63ft max / 53 min, Nitrox 33%, Computer on Nitrox (Nx PO2 .96), 5 min 15ft s/s. 78 deg.
1:12 interval
Dive 3: 55ft max / 53 min, Nitrox 31%, Computer on Nitrox (NX PO2 .85), 5 min 15ft s/s. 78 deg.
16:22 interval
Day 2
Dive 4: 42ft max / 45min, Nitrox 33, Computer on Nitrox (NX PO2 .75), 5 min 15ft s/s. 69 deg.
1:17 interval
Dive 5: 114ft max / 34 min, Air (NX PO2 .93), 5 min 15 ft. s/s. 68 deg.
1:10 interval
Dive 6: 91ft max / 33 min, Air (NX PO2 .78), 5 min 15ft s/s. 75 deg.
19:30 interval
Day 3:
Dive 7: 81ft max / 45 min, Nitrox 33, Computer on Nitrox (NX PO2 1.14), 5 min 15ft s/s. 78 deg.
1:14 interval
Dive 8: 79ft max / 39 min, Air (NX PO2 1.12), 5 min 15ft s/s. 69 deg.
1:27 interval
Dive 9: 69ft max / 60 min, Nitrox 33, Computer on Nitrox (NC PO2 1.02), 5 min 15ft s/s. 76 deg.
Before flying: 26 hours
For this trip, I was moderately hydrated with some sun exposure.
I woke up the next morning and had some numbness in my left elbow and some minor tingling. As is usually the case, it didn't seem like much to worry about at the time, as I have had similar feelings in the past, so I went about my day tour. During the tour, the sensation spread mildly to my right arm at which point I suspected it may be DCS. Given my situation and the apparent mild nature of the symptoms, I wanted to get back to where I lived before seeking treatment. I flew back around 6:00pm that Monday night, 26 hours after Dive 9.
The symptoms (which never progressed beyond the numbness and tingling in my left and right hands and arms) did not dissipate on Tuesday, so Wednesday morning I saw the diving physician and he recommended I have a table 6 treatment. The symptoms seemed to slightly ease up during the treatment, but not entirely. I then underwent a Table 5 the following day. The same thing occurred. It took at least around a week for all of the tingling and numbness to go away.
Prior to the treatment, my Romberg's test was very very unsteady, and this did seem to clear up after the Table 5. The doctor cleared me to diving again, suggesting I wait around 3 months.
4 months later, this past weekend I got back in the water. Over the course of 4 days, I did 14 dives with the same Oceanic Geo computer, wearing a hood and a 3mm wetsuit, with the following profile:.
Day 1:
Dive 1: 69ft max / 62min, Nitrox 32%, Computer on Air, 5min 15ft s/s, 78deg.
1:29 interval
Dive 2: 64ft max / 60min, Nitrox 32%, Computer on Air, 5 min 15ft s/s. 78 deg.
3:03 interval
Dive 3: 39ft max / 60min, Air, 5 min 15ft s/s. 78 deg.
11:24 interval
Day 2:
Dive 4: 75ft max / 53min, Nitrox 36%, Computer on Nitrox (Nx PO2 1.17), 1min 44 ft & 5min 15ft s/s, 77deg.
3:15 interval
Dive 5: 49ft max / 66min, Nitrox 32%, Computer on Air (Nx PO2 .52), 5 min 15ft s/s. 78 deg.
3:11 interval
Dive 6: 73ft max / 56min, Nitrox 36% (NX PO2 .67), 5 min 15ft s/s. 77 deg.
1:45 interval
Dive 7: 34ft max / 67min, Air (NX PO2 .42), 5 min 15ft s/s. 78 deg.
11:44 interval
Day 3:
Dive 8: 97ft max / 49min, Nitrox 32%, Computer on Nitrox (Nx PO2 1.26), 1min 44 ft & 5min 15ft s/s, 77deg.
1:30 interval
Dive 9: 80ft max / 48min, Nitrox 36%, Computer on Nitrox (Nx PO2 1.23), 1min 44 ft & 5min 15ft s/s, 77 deg.
5:18 interval
Dive 10: 70ft max / 56min, Air, (NX PO2 .65), 5 min 15ft s/s. 78 deg.
1:42 interval
Dive 11: 29ft max / 65min, Air (NX PO2 .39), 5 min 15ft s/s. 76 deg.
13:00 interval
Day 4:
Dive 12: 78ft max / 54min, Nitrox 36%, Computer on Nitrox (Nx PO2 1.21), 1min 44 ft & 5min 15ft s/s, 77deg.
3:57 interval
Dive 13: 106ft max / 44min, Nitrox 32%, Computer on Air (Nx PO2 1.34), 1min 44 ft & 5min 15ft s/s, 77 deg.
1:35 interval
Dive 14: 75ft max / 65min, Nitrox 36% (NX PO2 1.17), 5 min 15ft s/s. 78 deg.
Before flying: 29 hours
For this trip I was careful to avoid the sun as much as possible and drink water constantly through out the day.
After the final dive, I began to feel very mild tingling in both my hand and a bit in my feet. Again, given my situation and where I was diving, I preferred to come back where I lived to seek treatment. Again on Tuesday the symptoms did not improve so Wednesday morning I saw a different diving doctor and after an examination, he suggested a investigation into if a Patent Foramen Ovale (PFO) was causing my DCS. I had an initial transthoracic echocardiogram (TTE) which was negative and then did a Table 6 treatment. At depth, my Romberg's test was much improved over the one conducted during the examination, and while the symptoms were milder at depth, they returned once I left the chamber.
The following morning (Thursday) I had a transesophageal echocardiogram (TEE) which was also negative, effectively ruling out a PFO as the cause. Based on the day after examination which was yesterday, my doctor did not recommend a further treatment. Through the course of today, the tingling has lessened some, but numbness remains in my right foot and both ring fingers (predominantly my right). There is still periodic more of a shooting tingling and I was a bit unsteady this morning, but that appears to have gone away.
As far as my doctor can tell, he suspects that my m-values are out of the ordinary causing my tissues/organs to off-gas less nitrogen. Beyond PFOs and pinched nerves which seem unlikely in my case, I've read that abnormalities in my thrombotic state could be causing this? The only other factors I can think of are the temperature of the water (pretty much the coldest of my diving experiences), I was very cold towards the end of some of the dives, bordering on shivering, as well as the fact that on both of these trips I have been diving using my newly purchase equipment (I know that this is not a contributing factor to DCS).
Thoughts?
Thanks.
Last edited:
