Flying home after DCS treatment

[AFdivedoc]

The post-treatment return of symptoms during flight even after a 72 hour delay is common enough to warrant mention in Dr. Bove's DIVING MEDICINE book. ..."Occasionally, altitude exposure precipitates a return of symptoms (usually mild and reversible) after more than a week following recompression treatment."

I've seen this in both diving and high altitude hits (no previous diving), and treated them successfully even after return of CNS symptoms a week after the initial treatment. The recommendation for supplemental oxygen for flight is fairly new, and is starting to gain ground, especially after the more severe hits.

Glad you made it home OK!

[kell490]

Thanks AFdivedoc took about 3 weeks for all the symptoms to go away although I noticed I still feel some tingling when I ascended to about 3800 feet not sure if this is going to be ongoing I normally snowboard in the winter at 8-11k feet high mountains and I'm hoping in January I won't have issues. The only thing I have left from the event was my left ear is ringing (tinnitus). The left ear was plugged and low frequency were muffled but higher frequency's like the beeping noise a truck makes when backing up was really loud I had to cover my ear. The plugged feeling has gone away as of a week ago but this tinnitus is still there I'm hoping that goes away.

[AFdivedoc]

I went back and read the "other thread" to get the details of your dives and your injury. You were doing some pretty aggressive dives for a relative newcomer, for sure. Being so close to the no-stop limits the day before a long flight out is not a good idea. It makes the possibility of a flying after diving hit even more unpredictable than usual. From your discussion, you've owned up to it and plan to take steps and training to mitigate this in the future--good on you.

I'm glad to hear everything but the hearing issues have cleared. At this point, only time will tell whether your tinnitus will clear up, but prepare yourself for the possibility it may be permanent. You may want to discuss the tinnitus or any perceived hearing loss with your private or company physician.

[Gene_Hobbs]

There is very little literature available on this available. I did add a section on this to the bottom of our suggested reading list on flying after diving.

The best stats for flights with active symptoms come from: Freiberger, JJ; DeNoble, PJ; Uguccioni, DM; Vann, RD. (2002) An association between flying with symptoms of DCS and residuals after recompression treatment. Undersea and Hyperbaric Medical Society Annual Scientific Meeting. RRR ID: 1141

Flying with symptoms is associated with and adverse outcome. This effect is worse if the presenting symptoms are neurological in character and/or associated with pain.

The results from the 2004 DAN survey were also interesting:

Vann, RD; Freiberger, JJ; DeNoble, PJ; Dovenbarger, JA; Nord, D; Winkler, P; Marroni, A. (2004) Flying after recompression therapy. Undersea and Hyperbaric Medical Society Annual Scientific Meeting. RRR ID: 1474

The available data did not indicate that flying after treatment predisposed to DCI relapse or that a delay of many weeks before flying was frequently needed. Relapse due to flying after treatment alone did not appear common. These tentative conclusions require confirmation.

[Duke Dive Medicine]

Gene,
To clarify, Jake's study looked at divers who flew with symptoms but hadn't been treated beforehand, correct? That's the way I read it, anyway.

[Gene_Hobbs]

Gene,
To clarify, Jake's study looked at divers who flew with symptoms but hadn't been treated beforehand, correct? That's the way I read it, anyway.

If I remember correctly, this was the lead up work for the recommendations for evacuation so the patients were being flown to a chamber for their treatment. I would be willing to make the jump with his data to flying with residual symptoms though. If it is not resolved, it's still DCS in my book. <g>

More on this would likely be in the Remote Locations Workshop.


--BTW - Had issues with our embargo test last night... might be middle of next week before I can get the profiles back to you

[farsidefan1]

I had dcs type 2 followed by a couple chamber ides (about 6 hours and later another 3 hours). I was afraid I was going to miss my flight as the doc in Coz had me check in every morning to see if he would clear me for my flight home. Fortunately it was 48 hours so he cleared me with a day to spare. I later was checked and found to have a condition similar to a pfo which I had corrected. My hit was also an "unexplained" episode.