Potential decompression sickness?

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Rayniac

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Hi everyone - I am quite new to diving and although immensely enjoyed my first days of diving, I am actually writing about a pending (perhaps dive related, potentially considering DSC) issue which is haunting my partner for the last 5 weeks and any help/opinions would be much appreciated. In case this is not the right place for the topic - please let me know or of course feel free to move it to the right location.

In short - my partner continues to have symptoms heavily identical to decompression sickness (mild) and she is struggling a lot. Current symptoms (40 days after the dive) are: dizziness, headaches, occasional joint pain, muscular weakness, vertigo and sometimes numbness of leg/palm, she says she often feels like after having drunk a couple of beers ... Long story is below:

Both me and my partner took part in an open water diving course in the beginning of May 2018. The second day of diving we both did 4 dives, 12m , 14m, 17m and 17 m each. Following that we did the tests and passed, got dinner etc. and headed home. As you can imagine we were both shattered after the past two days (on top of the dives we also had 3-4 hrs of sleep each night as the hotel we were staying was very noisy), so her complaints about tiredness and dizziness (4 hours after the dive) were not taken seriously by myself, me being dead tired too. Arrived at the hotel and went to bed quite early, app. 10pm. She then woke up around 2.30 am with severe lower back pain, inability to properly move her right foot (cramps and muscular pain) and more of the dizziness. After an hour or so, we decided to call the DAN and speak to a doctor about this (having learned the risks of diving and whom to talk to). After a 20 or so minute call, the DAN specialist was quite sure that we are not looking at decompression sickness but advised to contact them again if the symptoms do not go away.

The following day we went to the diving school to talk to the instructors there and the opinion was that we are exhausted by the dives and there is not much suggesting decompression sickness. The general dizziness and vertigo settled in, my partner started feeling joint pain (knees and elbows), pain in the neck and headaches, together with general muscular weakness and inability to properly move her right leg and arm. A day later we spoke with DAN again and the doctor mentioned that although they consider DSC could be the culprit, they think it is unlikely to be the case. We were advised to visit the local diving doctor and hyperbarric treatment cabinet - which we did. The local doctor was on the opinion that there do not seem to be a case of severe DSC (quite obvious to us too) and advised we can safely travel home (plane trip of 2x9 hour flights). We flew back to London on the next day, and no new symptoms or issues were observed on the flight.

Upon arrival we also visited another dive center in London, where the doctor having heard the above was more or less convinced we are not looking at a DSC, and that the flight would have made the symptoms worse if this was indeed the case.

As the symptoms continued for the next weeks, we carried out quite an extensive number of tests, including blood, MRI, neurology exams, viral infection checks, lyme disease and so on - all coming out negative and ruling out serious conditions (MLS, tumors etc.). However we noticed that despite that the joint pain started to slowly disappear, we are now faced with a more severe dizziness, vertigo, and heavy difficulty moving the right arm/leg.

I guess any opinions on whether the above can be considered a mild DSC would be welcome, as we are new to diving we lack the experience and are unaware of similar cases. I am aware that DSC is usually quite more severe as symptoms, but as it is extremely difficult to diagnose, I would appreciate any help...

Thanks for reading and apologies for the long post.
 
As DAN and your doctors have said not DCS, I would look elsewhere.

I’m no doctor, but I’d think something else is going on. Muscle strain. Sleeping on a different bed. Other diseases...

Even if DCS was the culprit initially, it would not usually be causing new symptoms 5 weeks later
 
My layperson's guess was going to be a mosquito-borne disease, but you say the tests were negative. All I can recommend is to see more specialists. It doesn't sound at all like DCS--this many weeks later?! I would trust DAN and your doctor on that.
 
Seeing as you have spoken to a number of experts in the field, I would doubt DCS is involved.

It might be that there were underlying conditions that have been exacerbated by the diving. Tiredness especially when new to diving is quite common (I was pretty tired after 2 dives on Sunday).

WRT the dizziness and vertigo, that could be down to an inner ear problem (possibly caused by not clearing properly or maybe just an infection).
 
Thanks for your quick replies - having read quite a bit I think I am also considering this could be due to a mosquito bourne virus - the tests we did were for the main infections but there are in fact quite a few rare ones which nobody actually even tests for ...

Neilwood - in fact we did see an otoneurologist and there is indeed an issue with the inner ear / vestibular apparatus - does not seem physical but rather functional. No infection was detected though in the blood tests.

I also thought the DSC is not so likely but perhaps the dive was a trigger for something else. In any case - thanks for the opinions, any info is useful for us.
 
Hi @Rayniac

I'm sure you have heard that the 4 shallow dive profiles put you at low risk for DCS. You did not give the duration of the dives, but, as your OW checkout dives, I would imagine they were not long

Where were you located for your course and dives? This is useful in considering any infectious etiology
 
Hi Scubadada, the dives we did are indeed quite shalow, the approximate time spent under water was 45, 45, 40 and 35 mins respecticely. We did these in Indonesia, Bali to be precise (Tulamben).
 
I agree with the others that DCS seems unlikely. Not only do the profiles not support that diagnosis, but even if she was bent on these dives (due to perhaps a PFO or something) the symptoms would surely have resolved by now.

I don't think you mentioned where you were diving, but given it took 18 hours to return to London, my guess is SE Asia. It might be worth consulting a tropical medicine specialist. Her symptoms sound like the could be the result of some low-grade illness like Yellow Fever or something.

Best of luck with your investigation, and please keep us updated on her progress!
 
I'm not a doctor, but my first thought was chikungunya. Muscle and joint pain, nausea, and headache are common symptoms. Usually victims will develop a sudden fever, but not everyone experiences the same symptoms. I also thought of dengue, which is rampant across Indonesia. But that's a pretty severe disease that usually comes with a high fever and a rash.

Whatever it is, I wish your partner a speedy diagnosis and recovery.
 
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