DCS recovery and next steps advice

[Duke Dive Medicine]

Thanks again,

Just one more question, is there a time frame for this recovery? I know it’s dependent on the person but, if someone doesn’t recover straight after HBOT, is there a time frame for when someone might expect most healing? Is there anything I can do to promote it? Does the fact that I got HBOT two days after initial symptoms make this worse (including diving in between? I’ve been taking B vitamins and doing exercise as much as I can but, I am currently not working for example.

Thanks so much for taking the time.

Re time frame, months to years depending on the level of disability. There will come a time when your improvement reaches a plateau, and as you said, that's very individual. I'm wondering if the nausea, stiff neck and headache could be secondary symptoms related to having sustained an injury like yours overseas, and the uncertainty and waiting that comes with not knowing whether/when you'll fully recover. That can probably be treated symptomatically. @Trace Malinowski offered an amazing example of medical treatment combined with self-rehabilitation (Trace, thanks for sharing that). If your residual leg weakness is neurological in origin, a good physical therapist could probably get you some targeted exercises for that area. Using it and re-training it would likely be of benefit.

Best regards,
DDM

 

[Arian340]

Re time frame, months to years depending on the level of disability. There will come a time when your improvement reaches a plateau, and as you said, that's very individual. I'm wondering if the nausea, stiff neck and headache could be secondary symptoms related to having sustained an injury like yours overseas, and the uncertainty and waiting that comes with not knowing whether/when you'll fully recover. That can probably be treated symptomatically. @Trace Malinowski offered an amazing example of medical treatment combined with self-rehabilitation (Trace, thanks for sharing that). If your residual leg weakness is neurological in origin, a good physical therapist could probably get you some targeted exercises for that area. Using it and re-training it would likely be of benefit.

Best regards,
DDM

Thanks DDM,

My worry at the moment is that over the counter painkillers don’t seem to do anything so I fear the cause is a bit more sinister. Either way it’s good to hear people’s journeys and to understand that I still have hope. I definitely have anxiety about my prognosis but, hopefully this will be reduced over time.

Thanks again.

 

[Arian340]

I was trying vestibular rehab exercises to try to reduce the dizziness and taking supplements like Nerve Renew. One day, it was like someone flipped a switch and the vertigo stopped. I felt a bit floaty at that point. I started going for walks and doing vestibular exercises while walking and lifting weights in the yard. I dug out the old DP weight set I had as a teenager and did typical bodyweight & weight training. I was getting weaker and blood work found the low Hg level. I was treated with high doses of Prilosec to heal the ulcers and high doses of Rx iron supplementation for the anemia.

As I gained strength, I returned to swimming laps. A state park near me as no lifeguards and a swim area that is 200 yards long. I'd normally swim 1 to 2 miles every morning at sunrise. I would train for lifeguarding and diving. I started out doing an easy 400 yard freestyle swim x 400 yards kick with fins using either a single wing or a spearfishing torpedo buoy as a kick board x 400 free x 400 kick. I increased the distance to 3200 then I began doing all kinds of stuff from straight swims with and without fins to run - swim - runs and working on lifeguard skills. Swimming would made me dizzy at first from turning the head from side to side. It would last a couple hours but kept improving. At the end of summer, I went on 2 freediving vacations to train. Dutch Springs, a quarry near me that operated as a dive park, was perfect for freediving. They closed. That left me without my diving gym where I'd normally train.

The next summer, I couldn't stand not breathing underwater and started scuba diving again no deeper than 30 feet due to the depth of the Delaware River near me. Vis was unusually great all summer. The water reached 80 F. I returned to the St. Lawrence River in the 1000 Islands to scuba dive where I was bent.

This past summer, I began doing recreational dives deeper than 100 feet and doing repetitive dives. I spent the summer as a beach lifeguard in the 1000 Islands which allowed me to freedive or scuba dive daily. I'm headed back to cave country to return to cave diving and decompression diving before snowmaking season. I don't ski or board. I just make the product during 12-hour night shifts working 84-hour weeks with overtime pay. Humping up and down hills all night is good exercise.

My ex-girlfriend is a pro figure skater and health & fitness is very important to her. She believed I wasn't doing enough to get better and lost her attraction to me when I gained 30 pounds due to inactivity. She moved several states away to help her dad who was also having health issues. The distance killed it because even once I was back in shape, earning a living, and living again it still wasn't enough.

That coin should be my relocation money. My goal is to move to Florida and return to a full-time diving career. Pennsylvania was actually a great place to have a diving career. Dutch was the perfect underwater classroom for teaching and the proximity to New York City meant lots of prospective students. The Great Lakes, 1000 Islands, New England, New Jersey/New York wrecks and North Carolina were all easy drives. Lots of airports meant cheaper flights for dive travel. Now, it's dead. Warehouses are killing the scenery. Time to leave.

As some added comfort for you, I was run over by a car in 1999 on Cayman Brac. It hit me in the base of the spine. The driver told the police he was traveling at 40 - 50 mph when he hit me. It took a year to move from crutches to walking to running. I had some strange nerve sensations, some for years, such as a feeling of numbness of the skin in the pelvic area where boxer shorts would cover. If a doc traced a pen up my leg sensation would decrease or I'd feel it as pain instead of a tickle. The benefit of decreased sensation was longer lasting... well... you get the idea. Anyway, I'm sure your headache and neck discomfort will stop. I forgot I had a headache for a long time after DCS. Maybe a few months?

Hi Trace, thanks again mate for sharing such a personal story. Honestly appreciate it so much. It’s helping me just believe a bit more in my recovery and to have some hope. Everything I read online tends to be a bit darker. Thank you.

 

[Duke Dive Medicine]

Thanks DDM,

My worry at the moment is that over the counter painkillers don’t seem to do anything so I fear the cause is a bit more sinister. Either way it’s good to hear people’s journeys and to understand that I still have hope. I definitely have anxiety about my prognosis but, hopefully this will be reduced over time.

Thanks again.

If you think your headache/neck soreness are related to the DCS, a consult with a neurologist may be of benefit. Have you had any luck connecting with a UKDMC medical referee?

Best regards,
DDM

 

[Arian340]

If you think your headache/neck soreness are related to the DCS, a consult with a neurologist may be of benefit. Have you had any luck connecting with a UKDMC medical referee?

Best regards,
DDM

I have an appointment on December the 12th with a referee. I did speak to one on the phone but he essentially recommended I should speak to someone from a hyperbarics unit and when I did, they then said I need to speak to a referee or a neurologist. I’m now going to be referred to a neurologist by the neurosurgeon (have an appointment next week with the neurosurgeon).

 

[Vitesse2l]

I have an appointment on December the 12th with a referee. I did speak to one on the phone but he essentially recommended I should speak to someone from a hyperbarics unit and when I did, they then said I need to speak to a referee or a neurologist. I’m now going to be referred to a neurologist by the neurosurgeon (have an appointment next week with the neurosurgeon).

Sounds like you are on the right path. Have you contacted DDRC in Plymouth?
Good luck with your recovery.

 

[BigAladdin]

Well, guess I’m not gonna make this 2am flight in 4 hours. This was all I had to read to dish out $700 bucks to just wait for the 24 hour mark before I fly. Sorry bud hope you get well soon. But thanks for pasting because you may have saved me from dcs with this: I was going to ignore everyone and just fly

 

[**pYgmY**]

Hi, welcome to SB and thanks for the detailed description. For clarity, the Duke Dive Medicine account does not represent DAN. DAN and Duke are two separate entities though they have a long association.

Residual DCS symptoms do tend to resolve over time. How does what you're experiencing now compare to how you felt at the end of your final chamber treatment?

MRI and other imaging like CT are not diagnostic for DCS, so a clear MRI doesn't mean that your residual symptoms are not caused by DCS.

I recommend you go to the UK Diving Medical Committee website and find a medical referee in your area who is trained in diving medicine. They will help you sort through your symptoms.

Best regards,
DDM

Hi everyone,

can I ask why a MRI is not diagnostic for someone with DCS related neurological symptoms? Would an ischemia due to bubble formation/restricted blood supply not leave a detectable lesion (comparable to a ischemic stroke)?

Thank you for clarifying.

 

[Edward3c]

Hi all,

First of all thanks in advance for taking the time to read this. I have searched everywhere for answers and am struggling at the moment, with my mental health taking a decline.

CONTEXT

I live in the United Kingdom / England and recently was diagnosed with DCS whilst on a trip in the Maldives. I have done about 12 dives in total and am a OW diver. On my trip I did 4 dives all with a single safety stop (profile below).

14th:
PADI refresher (no problems - 18m depth)

15th:
- dive 1: 1pm, 22m depth, 33 mins. I was very low on oxygen when surfacing and had to use buddy’s oxygen. There was a very strong current causing more exertion and a bit of stress. Upon surfacing I had nausea but thought this was due to small boat and sea sickness.

- dive 2: 2.30pm, 20m depth, 40 mins (still had nausea but not severe)

16th august:
6pm, 10.2m depth, 53 mins

To provide more context. I started feeling nausea after the first dive on the 15th. I had fatigue in the evening and in my right leg calf but chalked this up to me not diving for a while and exertion. The next day (16th) I started getting headaches (on and off) and spells of mild dizzyness but again, it wasn’t severe so thought it was unrelated to diving (this was accompanied by bouts of unsteadiness). On the 17th I began getting a tingling feeling in my left arm and after 2/3 hours of this was in a hospital being assessed. I was assessed, given blood tests and told that I likely have type 1 DCS (this was later changed to type 2).

TREATMENT

In this order over three days: 1. HBOT US Navy Table 5, 2. Table 6, 3. Table 6 (12.5 hours).

Medication whilst in hospital:
- oxygen
- IV fluids
- Ondansetron 4mg iv stat
- Pantoprazole 40mg if stat and OD

I was initially given a table 5 as the doctor thought it wasn’t serious however, I saw no improvement.

Overnight, I began getting a tingling feeling in my right leg in addition to my left arm. The next day I was given a table 6, showing minor improvement. I was also made to do an MRI of my brain and cervical spine which were normal.

The third day, I was again given a table 6 with more improvement and minimal tingling left in my left arm and right leg.

At this point I was told that I had enough HBOT treatment and that my prognosis was good.

POST TREATMENT

Medication:
- pregarbalin 75mg once per day for 2 weeks
- mecobion 1 tab for 2 weeks
- Donoan OD PO OD for 5 days
- Allegra 180 mg PO OD for 7 days

2 months later I am currently still presenting symptoms of a weak right leg that is sensitive to hot temperature (can still walk and do most things, just weaker). I also have nausea, a persistent headache in my lower back head and a stiff neck.

I have seen a neurosurgeon and a ENT who have both done MRIs and in-person tests. Both have told me that the MRIs are completely normal and that I should be fine. Despite this, they both acknowledged that they don’t have experience with DCS as the doctors are both in London. I have since read on scientific journals that normal MRI imaging does not necessarily result in full recovery which has made me doubt their advice.

Does anyone have any advice for what my recovery might look like and what I should do next? I am really struggling at the moment and my mental health has taken a massive decline. Any words of advice would be so greatly appreciated. Thanks again.

Hi, being UK based you should consult one of the UKDMC medical referees or DDRC as mentioned earlier.

 

[Duke Dive Medicine]

Hi everyone,

can I ask why a MRI is not diagnostic for someone with DCS related neurological symptoms? Would an ischemia due to bubble formation/restricted blood supply not leave a detectable lesion (comparable to a ischemic stroke)?

Thank you for clarifying.

Great question. Frank ischemia with a very large bubble load, possibly. The more common mechanism of injury of DCS is a relatively short period of reduced blood flow followed by an inflammatory reaction at the capillary level. This is harder to detect on MRI.

Best regards,
DDM