Rapid Ascent with Delayed DCS symptoms and Delayed Treatment

[augustib]

I'm hoping someone can tell me what I can expect as I recover from delayed DCS treatment.

On Feb 11th, 2010 I did a rapid ascent from 90' in 42 seconds.
I felt fine following the rapid ascent and flew home about 20 hours later.

Feb 12th, 2010 On my flight I noticed some mild DCS symptoms, (mild joint pain, itchy skin)

Feb 15th, 2010 I still had the nagging DCS symptoms (still not worried, but just to be safe I made a Dr appointment for the next day)

Feb 16th, 2010, still have the same symptoms and my doctor actually calls DAN to discuss the situation. My Doctor concludes that he thinks it is more of a muscular issue and not DCS.

Feb 17th, 2010, joint and muscle pain increases to from a deep pain to periods of sharp pain that come and go.

Feb 18th, 2010 I goto the emergency room and within hours they have me in the mono decompression chamber for a dive targeted for 2.5 hours known as the delayed decompression treatment dive. During the descent in the hyperbaric my symptoms started to get better and after about 20 minutes at 60' I actually felt good. They then started to bring me up to 30' and the symptoms came back. When I told the Doctor. he quickly changed the dive to follow the Navy table 6 dive profile... since it was a modified table 6 dive profile I was in the chamber for about 5 hours. When I came out I felt so much better (not 100%), but quickly started to get back symptoms (tingels in my legs and arms and minor joint pain...although I was still much better than when I went in). I was hospitalized at this point and put on 30 mL/hr Lidocaine drip that within about 4 hours had eliminated ALL my tingels. By the time I got out of the chamber and admitted to the hospital it was now noon on Feb 19th.

Feb 20th, 2010 6AM, I went back in the mono hyperbaric chamber and actual just had minor joint and muscle pain. This time the dive was only about 2 1/2 hours and was called the delayed decompression dive model. I came out of this dive feeling human and life was looking good.

Feb 21st, 2010. My joint and muscle pain came back and quickly escalated to moderate pain by later afternoon. I went back to the hospital and was put on O2 that I believe is why the pain went back to mild. They also started the lidacane drip and eventually decided to dive me one more time following the delayed decompression dive model.... as with all my dives I felt good, and would have a few minor symptoms come back during the ascent. Because I still had minor symptoms and I'm 35 in good shape and had responded good to the delayed treatment they dove me two more times over the next 2 days and when I left I hadn't had anything DCS symptoms in my joints that seemed to go away within 30 minutes or less. My last hyperbaric dive was Feb 24th at 10AM.

What should I expect to take place over the next few weeks.
I've been sleeping 13 hours a night (I typically sleep 6-8 hours)
I have had some symptoms come back... moderate sharp pains in one ankle, and minor discomfort in one knee and both elbows... all of which come and go. Is this what I should expect for a period of time?

Make no mistake when I finally got treatment for DCS I was a mess. I feel 98% recovered, but I'm wondering what happens with the remaining 2% that I'm still dealing with.

Thanks for your help!

[Mr Carcharodon]

I’d suggest this could be better addressed in the Diving Medicine form than in the decompression form.

From a decompression standpoint it seems unlikely that you could have an excess of residual nitrogen this long after your dive. So what you are likely dealing with at this point is the healing process after the injury is complete. If you go to the DAN website the online seminar by Dr. Richard Moon entitled “The Pathophysiology of Decompression Illness” discusses the mechanisms and types of injuries that bubbles cause. These include mechanical damage, hypoxia, immune response and mechanical interaction of bubbles with nerves endings. https://www.diversalertnetwork.org/t.../seminars.aspx I wish you good luck and a speedy recovery.

If you would so we can all learn from your unfortunate experience could you share the details of your dive (duration, depth, gas mix, etc) and of other dives that preceded the one in which the accident occurred.

[augustib]

If you would so we can all learn from your unfortunate experience could you share the details of your dive (duration, depth, gas mix, etc) and of other dives that preceded the one in which the accident occurred.

It was a rapid ascent from 90'. I was on air... probable contaminated with CO...as we had divers black out during descent. Total dive time was just 15 minutes. Most of the dive was at 75'. I had been diving 2-3 times a day for a week. The day of the Ascent I had done one other 50 minute dive at 45-60' for the majority of the dive. This was followed by about a 3 hour surface interval.

Thanks for the info on the DAN website. I will check that out. Thanks.

[Bubbletrubble]

Dr. Moon's presentation discusses putative pathogenetic mechanisms of DCS...but I'm not sure how much that knowledge will help inform you as to how long the DCS symptomatology with persist. Probably the most accurate answer to your question is: "Nobody knows." There can be residual joint pain symptoms even following successful, timely, aggressive hyperbaric treatment for DCS, so the delay in recompression (more than one week post-incident) could be responsible for the lingering pain.

Do you plan to continue hyperbaric therapy?

Sorry to hear about what happened. Thanks for sharing your story.

P.S. I forgot to ask. Were any of the stricken divers on your boat tested (blood sample) for carbon monoxide poisoning? Were the tanks ever analyzed?

[augustib]

Bubbletrubble, The dive shop said they were going to test the tanks. I have not been able to obtain any results. I also do not know what tests the hospital ran on the blood.

No additional hyperbaric therapy is scheduled. The last few didn't seem to be making any further progress... although I felt great during the hyperbaric treatments the remaining symptoms that kept recurring were the same. I understand I was lucky to respond to the treatment as well as I did.

[Bubbletrubble]

No additional hyperbaric therapy is scheduled. The last few didn't seem to be making any further progress... although I felt great during the hyperbaric treatments the remaining symptoms that kept recurring were the same. I understand I was lucky to respond to the treatment as well as I did.

Well, it's great to hear that almost all of the symptoms disappeared. With time, the joint pains may go away, too.

BTW, I read your account of what happened in Cozumel. Strong work. Your uncle is alive because of you. I hope the rest of us have the courage to rise to the occasion as you did. Take care...

[Blue Sparkle]

BTW, I read your account of what happened in Cozumel. Strong work. Your uncle is alive because of you. I hope the rest of us have the courage to rise to the occasion as you did. Take care...

I agree. Reading your [augustib] account, I learned a few things - and I also thought that "I should be so lucky in my choice of dive buddy." You really just kept on going and not giving up, as is always reinforced.

(Link to account: carbon monoxide in tanks - cozumel)

B.

[Wayan]

At our unit where the Dr's see an average of between 50-60 DCI cases a year with varying degrees of severity.

Unfortunately still the biggest problem is the late presentation of people for suspected DCI and thus delay for treatment.

Generally our Dr's will inform patients that they can expect some recurrence of the S+S over the ensuing weeks / month. This should get better with time. They also tend to prescribe some non-steroidal anti-inflammatory drugs (NSAIDs) which have been recommended to be sued in conjunction with re-compression therapy.

[DandyDon]

Damn! First you get negligence nearly leading to manslaughter from one of the biggest Ops on the island, then the local docs didn't treat you - or were you resistant to treatment? Well, as many as they had nearly dying that day, there may have been a lot of turmoil at the clinic. Good luck on your recovery. Iduprophene or aspirin...?

[augustib]

Damn! First you get negligence nearly leading to manslaughter from one of the biggest Ops on the island, then the local docs didn't treat you - or were you resistant to treatment? Well, as many as they had nearly dying that day, there may have been a lot of turmoil at the clinic. Good luck on your recovery. Iduprophene or aspirin...?

It has defiantly been a roller coaster experience. I could have received treatment...and was actually looking for DCS symptoms because my computer said I had decompression issues... but I felt fine... and went to bed that night feeling good. I woke up the next morning a little sore... however I didn't even start to get a minor symptom until mid way through a 4 hour flight... that were so mild I had little concern. I'm happy to report that with the 5 hyperbaric treatments I'm 98% better and seem to be continually getting better. I was able to return to the gym and started with a mild workout. My remaining joint and muscle issues are mild and I seem to be making solid progress towards a full recovery.