DCS aftermath

[aquamarine1]

Following recent DCS, I am quite shocked and surprised at my slow rate of recovery. Having difficulty finding information about the aftermath of treatment, apart from the doctors here, I turned to SCUBA board to find out about the experiences others have had:

- How long they took to recover
- In simple terms, what is happening to my body?
- How can I aid in healing myself? (apart from rest)

Thank you to H20_kat for responding and sharing your progress with me. I have been asked to share my story, so here goes. I will attempt to make the report of the ongoing saga brief!


I was on a liveaboard in Southern Maldives where I completed 17 dives. The deepest dives I had over the week were at around 35 metres and observed required stops. The only unusual thing that happened was a down current that took me from 16m down to 26 very quickly and I had to fight hard to get up to 5 metres, where we surfaced a minute or so later in order to get out of a crazy washing machine. I felt fine afterwards though and went on to complete 2 dives on the next day.

29/3
My second and last dive finished at midday. That afternoon I was a bit lethargic and not too proactive about packing my bags for the flight the next morning. As the afternoon wore on this lethargy increased and I felt numbing down the left side of my face, my left arm and a little down my leg. I put this down to maybe some strain on my neck. When one side of my tongue went numb I started to get concerned. I had dinner but did not have much of an appetite and left quickly with an overwhelming feeling that I needed to lie down. Each attempt to become active and socailise between naps made me feel worse and I began to feel a little disorientated. My dive buddy and room mate called on the boat manager who administered 02 and called DAN, who advised a chamber visit. The problem now was to get me to one.
30/3
Travel Assist and various other people could not get either a sea plane or boat to take me to Male so I ended up taking a 45 min commercial flight in the evening. By the time I boarded the plane the numbing had subsided quite a lot- I was more fatigued and light headed. During the plane ride I felt the numbing come up my face and it felt like there was something moving under the skin of my forehead- creepy.
As soon as I arrived in Male I was taken to a recompression chamber -this was at about 10pm so a good 24 hours+ from when the symptoms started. I was in the chamber for 2 hours-12 meters and told to come back the next morning.
31/3
I was in the chamber for 90 mins at 12m. Numbing was still slight after and I felt incredibly tired and dizzy. Was told I would be fine, the numbing was just the skin healing and I could fly that night or the next day. He even said I could drink alcohol- last thing I felt like. I slept on and off for most of the day, falling into deep sleeps after a few hours of being up.
1/4
After showering I felt incredibly light headed. I walked to breakfast thinking it was because I had not eaten dinner the night before- not much of an appetite. The walk back from breakfast was even worse than the on the way there (like I was not in control of my feet and felt like I was falling to the side) and I went to the clinic straight away. I really did not feel right. He told me it was unrelated and I suggested I was just stressed about flying. The insurance company booked my flight for the next day and I briefly spoke to one of their dive medics who again told me I was just healing.
2/4
Still not feeling great and sleeping a lot. I felt OK on the flight, just the numbing and still light headed. Put it all down to skin being sensitive and being tired and tried to ignore it -put myself on auto pilot to get home. Flew overnight.
3/4
Slept for a few hours in the afternoon when I got home. When I woke up and started moving about I did not feel so great- it was like all of my original symptoms had come back. Again I put it down to stress/healing. Tried a few sips of wine to help me sleep but that just made me feel worse.
4/4
Got on the phone to DAN. Once I got to the doctor and explained my treatment/flights etc he directed me to go back in the chamber. Table6. The chamber was already closed for the day so I was told to come back the next day
5/4
Table 6 treatment. I still quite numb but felt much better straight after treatment. Still exhausted and sleeping a lot.
7/4
Table 5 treatment
8/4
Went to work for a few hours but had a lot of trouble getting my thoughts together and processing information. Getting each sentence out was a big effort and I was getting my words jumbled. Again, slept most of the afternoon. Was told to rest the next day.
9/4
Felt good upon waking so went to work- was home within a few hours as I had the same difficulties as the day before.
10/4
Chamber Table 5
Felt great afterwards- the most clear headed I had been since the beginning. No numbing.
11/4
Felt great- had a massage and numbing came back- think I upset the healing,
12/4
Went to meet friends for lunch- felt good at first but after several hours of conversation was exhausted and light headed again.
14/4
Saw a neurologist who has put me on a combination of vit B₁, B₆, B₁₂, vit E & folic acid as well as citicoline.

20/4
I have had a few half days back at work, but continue to become easily fatigued. My clarity of thought is continuing to improve, if slowly. Have difficulty focusing when there is a lot of noise and more than a 2 way conversation is happening.

I am getting incredibly frustrated at the time it is taking and really thought I would be back in the water, and/or back socialising this weekend.
Any advice/ information/ personal experiences would be much appreciated.

 

[doctormike]

Wow, so sorry to hear this, and thanks for posting your story. These write-ups are very helpful...

I'm certainly not an expert on hyperbaric medicine, hopefully the real experts will chime in here. Most of what I learned about this comes from my own chamber ride.

The one thing that strikes me as a bit unusual is that you didn't get a full table 6 treatment initially despite type II symptoms. Obviously, nothing to do about this now, but might be a good thing for others to keep in mind. The delay in initial treatment can also be associated with the persistence of symptoms as well, but I guess you got there as quick as you could... I certainly know that symptoms can persist for quite a long time after injury.

We don't have a lot of information about how aggressive your profiles were, or what gas you were diving. Certainly, nitrox is a good way to limit inert gas exposure, especially on a trip with a fairly intense diving schedule. Again, more for future learning than for helping you now, I realize.

Hopefully, others will be able to share more helpful information for you going forward.

 

[aquamarine1]

Thanks for the input doctormike. Yes I am questioning my initial treatment now that I know more. I am quite sure if it were more thorough i would be Ok by now. But I guess, being my first- and hopefully only- time, I put trust in what was happening and the advice I was given. Was using nitrox.

 

[doctormike]

Yup... I know that recovery and/or improvement can happen over an extended time frame. Keep us posted!

 

[mathauck0814]

Scary story. Thankfully, my own brushes with DCS have all been the kinds you can treat with oxygen and aspirin. Curious if the initial treatments that you received in Male were prescribed by the DAN physician or by the local chamber physician?

 

[doctormike]

Scary story. Thankfully, my own brushes with DCS have all been the kinds you can treat with oxygen and aspirin.

And aggressive hydration. From what I understand, aspirin is controversial.

 

[h20_kat]

Hi aquamarine1

Thanks for sharing your story. There are definitely some lessons to be learned. Prior to my own incident, I did not know the treatment protocol for DCS. The chamber doctor was going to give me an initial 90 minute treatment at 14m. Fortunately DAN intervened and demanded a table 6 initial treatment for me. They provided advice on a daily basis to the chamber doctor (who was not a diving physician but an anesthesiologist) for further treatments. It seems bizarre that you were told it was okay to fly so soon (and drink alcohol!). DAN advised no flying for 72 hours after my last treatment. When I saw a dive doctor upon arriving back in NZ he said I should have waited even longer because I still had symptoms. Fortunately I did not have any worsening of symptoms during my flight. Unfortunately the people who operate chambers in many places are not diving doctors and it is a good idea for divers to be familiar with appropriate treatment protocols. I was not confident in the treating doctor and so I was very insistent about speaking to DAN and getting them to provide advice to the treating doctor.

I am curious about oxygen. You said you were administered oxygen on the boat. Did you have a continuous supply of oxygen until reaching the chamber? A lack of oxygen provided between my hit and getting into the chamber was also indicated as a reason for my slow recovery. The resort I was staying at had only 2 hours of oxygen! I was unable to leave until the following day. While waiting for ferry transfer I had to battle with the local village nurse to open the medical clinic and provide me oxygen. The ferry only had 3 hours of oxygen and I was on board for about 8 hours. Once at the hospital I had to fight with the nursing staff to be put on oxygen and then demand it be put at a higher flow rate as per DAN's recommendation. One of the biggest lessons learned for me was to ask hard questions of the dive operator regarding their emergency plan and oxygen supply. If they don't provide adequate answers, don't dive with them.

I am surprised you went back to work so soon. Teaching is a very mentally demanding job. I did not return to work until a full 10 days after my last treatment and even that was too soon (and against the advice of the dive doctor). The only reason I did so was because it was the last week with senior students before exams and I really felt like I needed to be there to prepare them. That first week back I crawled into bed by 5pm everyday and slept for 13-14 hours. I struggled for about a month with cognitive problems and even had to tell my students that I was basically brain damaged. I had a hard time putting a sentence together let alone doing maths! You might want to see if you can get a few days off work.

Just my personal opinion, but I would avoid alcohol until your cognitive symptoms resolve. Your brain is trying to repair itself and I think alcohol will hinder the healing process.

I really feel for you as I have been through such a similar experience. Trust that your body will heal itself and that it may take longer that you'd like. But if you want to get back diving you need to give your body the time it needs to fully recover.

 

[miked]

I had a DCS2 hit in August, 2004, I needed 6 USN table 6 treatments before I was released to return home.
Once home, I was fatigued, had the paresthesia (sp?) (tingling in feet and legs,worsening with over-exertion) I was given no specific regimen, just told to "go easy, let yourself heal". The symptoms lessened after about 4 months, and were not noticeable after 7. (The Drs. mentioned that if my symptoms were more severe, physical therapy would be required.)

Please listen to your Drs., and to your body. Best wishes for a complete recovery.

 

[B Lo]

I hope things resolve quickly for you!

 

[aquamarine1]

Hi mathauck0814
As far as I know the treatments were prescribed by the chamber physician in Maldives- from what I remember, he decided straight after he assessed me. This was not the case for my second round of treatment, where i know for sure that the DAN rep here, local doctors and Australian DAN doctors communicated before decisions were made. These decisions, treatments and after care were also thoroughly explained to me here.

---------- Post added April 21st, 2014 at 06:09 PM ----------

Thanks h20_kat
I hear what you are saying about trying to put sentences together. I am having a little more time each day where I can think clearly and starting to know when it is time to go home.
It is encouraging to know that it gets better and your shared experience has helped me realise that I am not going completely insane- although my lack of patience may contribute to that!
I had about 5hrs of oxygen on the boat- we kept some on reserve as we did not know when I was going to be able to leave, and used that when needed.
And yes I am definitely steering clear of alcohol.
There are a lot of lessons learnt and only hope this will help others- particularly to speak up and to talk to DAN dive doctors when unsure.
Go easy and let yourself heal is not the easiest thing when you just want to jump back into your life as you know it- I am aiming for a bit more acceptance that I cannot control things but need to sit back, slow down and wait. Now to be patient, look forward and to appreciate the small steps toward getting better each day.