untreated minor hits

[colonelchuck]

I just read the article on the death of Free Diver Audrey Mestre in Sports Illustrated. Leaving aside all the safety violations that appeared to be routine in that particular free dive operation, I am left wondering about the impact of untreated DCS.

The "hero" of the story apparently got hit all the time and was at least still more or less mobile. At the other end of the spectrum we have DAN and everybody else sending folks off the the hyperbaric (spell) chamber if they have an unexplained minor pain after diving.

What is the impact of untreated minor or borderline DCS? I certainly don't want to not worry about this issue, but I do want to know what exactly it is that I am worrying about?

Doc: Tell us what happens bad so we know what we are working hard to avoid.

thanks

 

[Dr Deco]

Dear Chuck:

Untreated Decompression Sickness

What is the least that can happen? Nothing.

What is the worst? You can die.

In Between

Certainly, this is what you had in mind. Untreated pain-only DCS (“the bends”) most likely will not result in any permanent problem. It might be a mild pain and disappear, or it might linger a while and become severe in intensity. You cannot necessarily tell in advance unless you know that you were considerably in excess of your decompression obligation. In that case, it would probably be severe.

What If It Is Not Pain-Only DCS?

Because gas bubbles can form in many tissues of the body, you cannot say with certainty that joint-pain DCS will not also appear as neurological DCS. If neurological signs and symptoms appear, there is a good possibility that they will not remit without leaving some disability. You cannot tell in advance about this possibility.

Damaged nerves can die and leave a permanent disability. Other nerves can sometimes take over and provide an alternate pathway for the neural signals. When this occurs, there might not be any neurological residual. On the other hand, if one has had DCS problems before and they have gone untreated, the possibility also exists that the alternate neural pathways are already in use. If alternate nerve connections no longer exist because the alternative pathways have become injured (from DCS), then the diver will find that recovery is not possible.

Roebbling and the Brooklyn Bridge

When Washington Roebbling overextended his bottom time examining the bridge foundation on the Brooklyn side, he became paralyzed. He was lucky and recovered all lost functions. Later, when examining the foundation on the Manhattan side, he again overstayed his bottom time and was again paralyzed. This time he lost bowel and bladder function and the ability to walk. He never recovered since all “alternate neural pathways” were used up from the previous DCS incident. He did not have nine lives. :upset:

This is always a possibility with untreated DCS problems. It has happened, and you will not know until it is over. :nono:

Dr Deco :doctor:

Please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Diver0001]

Dr Deco once bubbled...
Dear Chuck:

<snip>

he lost bowel and bladder function and the ability to walk. He never recovered since all “alternate neural pathways” were used up from the previous DCS incident. He did not have nine lives. :upset:

[/B]

Alternate Neural pathways? Are you saying we get two chances and that's it? Like pinball with two balls?

R..

 

[DocVikingo]

I think it would be prudent to focus on DrDeco's statements that you cannot tell in advance about the possibilities & that you will not know until it is over.

Very little is known about recovery of nervous system function as a result of alternate neural pathways.

You may have two chances, you may have more, or you may have none.

Given this, it's obviously best to avoid sustaining DCS to begin with, and getting it promptly treated if you do.

Best regards.

DocVikingo

 

[colonelchuck]

In other words, don't trifle with it. You might dodge the bullet, but then again............ :reaper:

 

[Dr Deco]

Dear Diver0001 and Readers:

An Honest Appraisal

I had the impression that colonelchuck wanted an honest appraisal of DCS risk. Based on historical evidence, many cases resolved on their own. Many infections will resolve on their own, also, but that does not mean if I were seriously ill, I would decline antibiotics? I don't think so.

It is foolish to think that you will always be lucky. :nono:

If you get a deep cut, what are the chances you will die of tetanus? Definitely not a sure thing. But, would I take the tetanus shot? You bet. Why? Because if nothing happens, well and good, but if something goes wrong, I am in very serious trouble.

There are people who have gone through recompression and still cannot walk. Hindsight of tomorrow will not help you much today. You certainly do not want to take the chance. You might not get even one. :boom:

Dr Deco :doctor:

Please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Diver0001]

Dr Deco once bubbled...
Dear Diver0001 and Readers:

An Honest Appraisal

I had the impression that colonelchuck wanted an honest appraisal of DCS risk. Based on historical evidence, many cases resolved on their own. Many infections will resolve on their own, also, but that does not mean if I were seriously ill, I would decline antibiotics? I don't think so.

It is foolish to think that you will always be lucky. :nono:

If you get a deep cut, what are the chances you will die of tetanus? Definitely not a sure thing. But, would I take the tetanus shot? You bet. Why? Because if nothing happens, well and good, but if something goes wrong, I am in very serious trouble.

There are people who have gone through recompression and still cannot walk. Hindsight of tomorrow will not help you much today. You certainly do not want to take the chance. You might not get even one. :boom:

Dr Deco :doctor:

Please note the next class in Decompression Physiology :grad:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

Well, judging from the responses it must have sounded like a stupid question. I know you can get paralised or worse from one hit. The reason I was asking is becuase I've heard "alternate neural pathways" referenced more than once (not only in this forum) and I've just sort of taken that as phsyological curiosity. But somehow it suddenly struck me as a little odd that you'd have a maximum two sets of neural pathways and that's it.

R..

 

[Dr Deco]

Hello ro:

I don't know what the "maximum" might actually be with respect to recovery from neuro DCS. I doubt that it is fixed at two. That would be "two strokes (strikes) and you're out."

Not being a clinician, I am not familiar with response to multiple strokes. I suspect that some folks have multiple recoveries and some do not. I also suspect that it depends on the severity of the stroke and on the region of the neural system.

It is not really something with which to gamble.


Dr Deco :doctor:

 

[DocVikingo]

It probably is safe to say that whatever neural reserves are involved in this process are not infinite and are depleted with repeated recruitment.

However, it likely does not clarify the matter by speaking of these as "sets," nor as to how many times lost neurological functioning can be fully or partially restored by them.

While not a great deal is known about the recovery of damaged neural tissue or the recruitment of previously uninvolved/only peripherally involved neural networks, it does seem apparent that it is far more complicated than has thus far been entertained in this thread.

Best regards.

DocVikingo

 

[gazzahawkes]

Hello,
In the last 16 months Ive been exposed to over 30 dcs paitents, on a island that is quite simply confused on dcs and dci issues.
as far as untreated dcs is concerned this is my experience of it.

Its very hard with a paitent who has symptoms only such as pain or tingle/numbness to come to a conclusion as differnt people have different pain threshholds and perception of symptoms.

Most people with minor pain only symptoms particulary dive pros will not seek treatment or help based on financial issues, or urban myths such as treatment means no diving again ever.

The danger here is pros will often dive on minor symptoms due to work load and ignorance and compound the problem resulting in a possible major hit.

Some have ignored due to fear or embarresment signs or symptoms such as loss of bladder control, loss of balance,extreme fatigue,and whole limbs feeling numb or heavy.

Bottom line is paitents who go straight on 02 are diagnosed and treated quickly will often make a complete recovery and return to diving within 6wks, those who deny whats happening will often get worse and the longer its left the less succesful treatments are and they often have residual symptoms for months if not permantly.Obviously there are those that simply resolve untreated as well. dcs or not who knows.

so If you have relavent insurance cover and your in doubt get it checked.....

cheers and happy bubble blowing

gary dive medic tech koh tao.:moon: