Completely normal nitrox dive to 25m gave me DCS

[Kevrumbo]

Justification: continued symptoms including numbness, nausea, vertigo affecting the CNS.

And what gas were you breathing for the Table 6A treatment upon reaching the depth 50m/165ft (6ATA)?

 

[SFJCody]

I don't know but my voice had a very high pitch.

 

[Kevrumbo]

I don't know but my voice had a very high pitch.

Ok, sounds like breathing Heliox (He/O2) 50/50 or 64/36 at 6ATA for Treatment Table 6A.
And how long was the entire treatment?

 

[SFJCody]

Treatment has been discontinued as an ECG showed a heart rate of 58 bpm. Brachycardia suspected.

 

[SFJCody]

The chamber session lasted 6 hours 10 minutes.

 

[Kevrumbo]

And what gas were you breathing for the Table 6A treatment upon reaching the depth 50m/165ft (6ATA)?

I don't know but my voice had a very high pitch.

Ok, sounds like breathing Heliox (He/O2) 50/50 or 64/36 at 6ATA for Treatment Table 6A.
And how long was the entire treatment?

Treatment has been discontinued as an ECG showed a heart rate of 58 bpm. Brachycardia suspected.

The chamber session lasted 6 hours 10 minutes.

Ok my friend. That's about the proper duration for a Table 6A.

I sincerely hope that you will recover from this malady of symptoms without further prolonged chamber treatments.

Wait for @Duke Dive Medicine 's opinion and differential diagnoses post-Treatment Table 6A on this latest round of Hyperbaric Oxygen Therapy. . .

 

[SFJCody]

Thanks guys. The symptoms (especially aching joints, nausea and dizziness) continue to creep back, 36+ hours after treatment. Are these residuals that I should tolerate and hope that they go away or should I ask to be re admitted once I get my heart checked out?

 

[Kevrumbo]

Thanks guys. The symptoms (especially aching joints, nausea and dizziness) continue to creep back, 36+ hours after treatment. Are these residuals that I should tolerate and hope that they go away or should I ask to be re admitted once I get my heart checked out?

Hopefully just residuals to be routinely followed-up with a hyperbaric physician and/or cardiologist.

However if these develop into acute symptoms like extreme pain, nausea & vomiting with vertigo, or dyspnea/shortness of breath -then return immediately to Hospital Emergency Medicine Department.

 

[Duke Dive Medicine]

Now at a different facilty. Underwent table 6 alpha to 60m- seemingly complete recovery. But 16 hours later the symptoms have been creeping back. First the nausea, now joint aches and dizziness and clouded thinking.

Amateur physical speculation: could the bubbles be forming in a part of my body that doesn't have a strong connection to the nitrogen free blood I'm receiving? Should I take a vasodilator and do more intense exercise in the chamber? What about continuing to breathe o2 after each session, could that stop the symptoms returning? Concerned for my future.

Please help me understand their rationale for this. Given the information you have provided, table 6A is completely inappropriate. 6A was the primary initial treatment for arterial gas embolism, but the deep spike is 165 feet (50 meters), not 197 feet (60 meters). The rationale was that the offending bubbles would be decreased in size to the point where they no longer caused symptoms. 6A fell out of favor even for AGE because of the risk of additional on-gassing during the deep spike.

Taking a recovering DCS patient to almost 200 feet in a chamber is medically unsound and possibly harmful. It is extremely unlikely that there were bubbles left in you after your other treatments. The symptoms you were experiencing were caused by the inflammatory effects of the bubbles that had been there. This treatment may have aggravated that inflammation and caused your symptoms to reoccur.

<edit> I just read the part about discontinuing the treatment because of bradycardia. What is your baseline heart rate? Can you clarify whether the bradycardia was during the treatment or after? If after, how long after? Sinus bradycardia is a well-known and generally harmless side effect of hyperbaric oxygen therapy. The blood vessels constrict, so it doesn't take as much cardiac output to maintain blood pressure. As long as your blood pressure was within normal limits and the bradycardia was sinus in origin (i.e. not related to some sort of conduction block), I can't think of a reason to abort a treatment. If you're in sinus bradycardia between treatments but you're perfusing appropriately (i.e. your blood pressure is within normal limits) I don't know that bradycardia alone would be a reason to not treat you again. It could be transient, and it could also be a worrisome symptom of DCS.

I strongly recommend that you insist that your treating physician consult either DAN or us before proceeding with any additional treatments. DAN U.S. is +1 919 684 9111, our 24-hour consult line is +1 919 684 8111. Please do not do allow them to do another one of these "treatment table 6 alpha" treatments without getting a second opinion.

Best regards,
DDM

 

[scubadada]

@SFJCody

Your story is unusual. I was going to ask you if you ever spoke to DAN about it as was suggested the day you posted, January 31. I was hoping you would have been referred to a dive medicine specialist by DAN and/or had a preferred chamber/staff recommended. At this point you should take @Duke Dive Medicine advice and have your treating physician contact DAN prior to additional treatment.

I wish you the very best of luck in resolving your problems