Any pointers to nerve regeneration sites?

[Hugh B. Maynard]

My SO had, the conjecture is, a PFO which resulted in Spinal DCS leaving her with serious problems in the lower half of her body. Basically a very normal dive, which I've had thousands and she has had hundreds and nowhere close to deco. Normal slow ascent with a 3 minute safety stop at 15 feet. When she climbed onto the boat she felt a pain in her left arm and wondered whether this was what a heart attack felt like. We were at the dive store in about 10-15 minutes and they put her on oxygen.

I road my bike back to the condo and got my car and had her at the chamber in Playa Del Carmen within
two hours of water exit. She walked in to the chamber and could not walk out. For the next week she did the standard table 6a treatment but after the first deco treatment could only move her foot back and forth.

After this treatment and discussions with Dan we flew her back to New Orleans where they immediately
dropped her to 165 feet for 7 hours. We then did deco and O2 hyperbarics (1.75 atm) for the next three
weeks. During this time she improved so that she could use a walker (very slowly).

I then drove her back to San Antonio where we did another 3 weeks of O2 hyperbarics at 1.75 atm.

It has now been about a year and a half since the incident and she can walk about a mile with two walking sticks but has very little feeling below her waist.

So my question is whether anyone knows of any discussion or research on regeneration of nerves that might relate to this type of injury. The doctors, although very helpful, don't have any pointers along these lines and do not have much experience with DCS. In general they do not hold out much hope.

 

[Bubblesong]

Have you looked at Boston Area?
Here is one article talking about nerve grafting:
Nerve Injury and Repair - Massachusetts General Hospital, Boston, MA

 

[lowviz]

Unfortunately, the central nervous system (CNS) responds differently to injury than the peripheral nervous system (PNS) A readable discussion can be found in this link: Wallerian degeneration - Wikipedia

Note the sections on Clearance in the PNS and Clearance in the CNS. I had to do a presentation on exactly this subject for biomed. You may wish to ask a mod to move this thread to one of the medical threads so that real docs will reply to your concern.

Very best wishes.

 

[Bubblesong]

Please don’t give up hope. Although may not be an immediate cure, there are many research doctors trying new experimental techniques.

 

[lowviz]

Indeed. Anatomical Recruitment of Spinal V2a Interneurons into Phrenic Motor Circuitry after High Cervical Spinal Cord Injury. - PubMed - NCBI

 

[Hugh B. Maynard]

Thank you for the information and the references.

 

[USMC CPL.]

My SO had, the conjecture is, a PFO which resulted in Spinal DCS leaving her with serious problems in the lower half of her body. Basically a very normal dive, which I've had thousands and she has had hundreds and nowhere close to deco. Normal slow ascent with a 3 minute safety stop at 15 feet. When she climbed onto the boat she felt a pain in her left arm and wondered whether this was what a heart attack felt like. We were at the dive store in about 10-15 minutes and they put her on oxygen.

I road my bike back to the condo and got my car and had her at the chamber in Playa Del Carmen within
two hours of water exit. She walked in to the chamber and could not walk out. For the next week she did the standard table 6a treatment but after the first deco treatment could only move her foot back and forth.

After this treatment and discussions with Dan we flew her back to New Orleans where they immediately
dropped her to 165 feet for 7 hours. We then did deco and O2 hyperbarics (1.75 atm) for the next three
weeks. During this time she improved so that she could use a walker (very slowly).

I then drove her back to San Antonio where we did another 3 weeks of O2 hyperbarics at 1.75 atm.

It has now been about a year and a half since the incident and she can walk about a mile with two walking sticks but has very little feeling below her waist.

So my question is whether anyone knows of any discussion or research on regeneration of nerves that might relate to this type of injury. The doctors, although very helpful, don't have any pointers along these lines and do not have much experience with DCS. In general they do not hold out much hope.

See if you can make contact with Bernie Chowdhurry. He went thru something similar with a DC's hit he took.

 

[Duke Dive Medicine]

Hugh,

I'm puzzled as to why your SO's condition would have deteriorated so much during hyperbaric treatment. What were her symptoms before treatment, and what table was she treated on initially?

It's difficult to say whether the follow-up treatments have had any effect since injuries like this often improve over time anyway. We typically stop hyperbaric treatment when improvement plateaus, that is, does not improve measurably with further daily treatments. There's little evidence to suggest that hyperbaric oxygen treatment helps after that point, but there are facilities out there who will treat her.

Best regards,
DDM

 

[Hugh B. Maynard]

Hugh,

I'm puzzled as to why your SO's condition would have deteriorated so much during hyperbaric treatment. What were her symptoms before treatment, and what table was she treated on initially?

It's difficult to say whether the follow-up treatments have had any effect since injuries like this often improve over time anyway. We typically stop hyperbaric treatment when improvement plateaus, that is, does not improve measurably with further daily treatments. There's little evidence to suggest that hyperbaric oxygen treatment helps after that point, but there are facilities out there who will treat her.

Best regards,
DDM

She was treated on table 6a. My impression was that she started the decompression when her damage
was still occuring. This did not appear to be a normal DCS hit. As I mentioned the conjecture is that
she passed a bubble via the PFO which caused damage. The DAN doctor that we talked to also suggested
that something other than simple DCS had occured. The doctors always expected on the deep chamber dives,
(165 feet for 7 hours) that she would feel some relief but basically she was the same. There was one thing that
confused one of the doctors in the chamber with her, her legs would occasionally reflexively jerk with no apparent
cause.

The doctors there do think that the O2 hyperbaric treatments are useful while there is improvement. On plateau
they suggest not doing any for 6 months (or more) and then another set might be useful. I suppose this might
be useful for any damage but, of course, am completely in the dark about what is really happening.

Thank you for your comments.

 

[Duke Dive Medicine]

She was treated on table 6a. My impression was that she started the decompression when her damage
was still occuring. This did not appear to be a normal DCS hit. As I mentioned the conjecture is that
she passed a bubble via the PFO which caused damage. The DAN doctor that we talked to also suggested
that something other than simple DCS had occured. The doctors always expected on the deep chamber dives,
(165 feet for 7 hours) that she would feel some relief but basically she was the same. There was one thing that
confused one of the doctors in the chamber with her, her legs would occasionally reflexively jerk with no apparent
cause.

The doctors there do think that the O2 hyperbaric treatments are useful while there is improvement. On plateau
they suggest not doing any for 6 months (or more) and then another set might be useful. I suppose this might
be useful for any damage but, of course, am completely in the dark about what is really happening.

Thank you for your comments.

That's interesting. A 6A is not standard treatment for decompression sickness and can actually be counterproductive - if bubbles are present, they can grow with the added nitrogen uptake. Still, 120 minutes of O2 afterward should make a significant dent in that. You didn't mention what symptoms she had before she started treatment. You said she couldn't walk afterward; did this happen gradually in the chamber, or all at once?

Best regards,
DDM