DCS type 2 case

[**pYgmY**]

Hi,

I have a question about DCS/DCS recovery and hope someone can help me with the profiles and hopefully some personal experience!?

I had a DCS type 2 hit one year ago after diving in Indonesia. The symptoms were tingling/pins+needles and weakness of one arm, starting about 8h after surfacing from the last dive. No numbness, no paralysis, no cns symptoms like changes in vision/speech/thinking/memory/...

It was my 36th dive, so I have not been a very experienced diver and did not have my own gear. That's why I went with a guide and rented a computer. Unfortunately, by the time I realised I got hit I didn't have access to the computer anymore. I contacted the resort afterwards, but the only information I have are the details they sent me. I hope and think they are correct, remembering the dives I think they are.

It was warm, there was no current at all and I didn't drink any alcohol (basically just spent those few days reading and diving). The computers said the dives were ok, as did everyone else I showed the profiles to so far (the guide was fine as well).

Unfortunately I'm still dealing with the results of this DCS hit today.

So first question: do those dive profiles look terribly wrong to you?
day 1 15:00: 15m / 42min
day 2 10:00: 26m / 62min
day 2 15:00: 22.4m / 37min
day 3 08:15: 28m / 45min
day 3 11:00: 28m / 41min
all dives done with a 3min safety stop at 5m

Problem on the last dive was: The guide seemed like he wanted to leave the resort as quickly as possible. I already had to convince him to do a 2h SI. We then agreed on a 20m max. depth for the last dive. For some reason – I was never able to find out why – he went off deeper.

Thanks for your time, comments and thoughts are much appreciated!!

 

[Nirvana]

Hi, pYgmY. Welcome to scubaboard.

I am not sure what your questions are. Regarding the profiles you posted, it is hard to say anything just looking at maximum depth and time. Had they been square profiles (entire time spent at maximum depth followed by ascent to safety stop), I would say some dives were overly aggressive. However, I think it is more likely they were multilevel dives, which are much more usual. Assuming they were multilevel, nothing strikes out immediately.

As to your illness, I am sorry to hear about it. I have never had DCS, nor have I had someone close to me have any significant episode, so I do not have any personal story to tell.

In any case, I believe the physicians on this board will ask the following questions: are your sure it was DCS? How soon were you diagnosed, and what treatment did you undergo? What symptoms do you still have?

I hope you can recover completely and soon.

 

[Alastor]

Without the profiles those dives have nothing suspect. You say you were hit, was it a diagnosis from a qualified hyperbaric medical personnel ?
If no, did you contact DAN for example, or any other qualified medical structure ?
Did they suggest you to check if you have a FOP ?
I think, if it is not already done, that you should contact some qualified doctor.
Just my two cents

 

[fmerkel]

What do you mean? You still have lingering symptoms? Did you get hyperbaric treatment?

Unfortunately I'm still dealing with the results of this DCS hit today

 

[Duke Dive Medicine]

Ditto the other posters regarding dive profile - if they were square profile dives you'd have blown quite a bit of decompression. As multilevel dives they'd be considered moderately provocative. Did the computer go into deco at all? Unfortunate about your hit - were you treated in a hyperbaric chamber?

Best regards,
DDM

 

[**pYgmY**]

Thanks for your quick responses!

You're absolutely right, there's a lot of information missing. It's not so easy to summarise the whole story, but I'll try!

First I should add that all dives were shore dives and I was diving on air.
Dive 1, 3 and 4 were wreck dives (Tulamben). So definitely only a very short stay at the max. depth. The other dives were multileveled as well. Unfortunately I don't have the exact details anymore.

Here's the whole story:
28.8.15:
About 30min after my last dive my right shoulder felt a tiny bit sore, almost not noticable – not in the joint though, more in the Trapezius area. As it was my last dive anyway I didn't really think about it much longer. I had a taxi pick me up at 15:00 to get back to the south of the island. Even crossed some hills on the way there, nothing special happened.

Went to bed around 23:00 with a very subtle tingling sensation in my right forearm. As I wasn't sure what to do about it, I thought I'd wait until the next morning to see how I'd feel.

29.8.15:
Woke up at 1:00 – the tingling had increased, I could definitely feel it now. I got more and more concerned about what was happening so I decided to go to the hospital with a decompression chamber.

A doctor performed a super quick neurological test and then put me on oxygen for the rest of the night. Talked to DAN on the phone: they suggested to have a chamber treatment. Although on oxygen the symptoms did not improve, they got worse until I felt the pins+needles in my whole body (mostly in my arms and legs, not so much in my torso) and my right arm felt really heavy. Again - no numbness, no paralysis, no changes in vison/thinking/...

USN TT6 at noon, so about 16h after neurological symptom onset → a lot of the tingling disappeared. Felt very relieved for having managed everything ok and went to bed early. The doctors there told me that 1 treatment would be enough as the nitrogen would be removed and the rest would just take time to heal (I was told 1 single treatment is their standard unless you show very severe neurological symptoms). New symptoms: tingling on the left side of my face (I know that's weird; everyone told me that's impossible but I really don't think I had it before).

The symptoms improved but didn't disappear completely in the next days. Therefore talked to DAN again and went back another 4 times for a 2h-ride (table 18.60.30) spread over the following 2 weeks. Because DAN doctors weren't sure if I really needed more treatment and because I didn't know better back then I had some days inbetween those treatments – I know now, not ideal but better then nothing and it was still helping. The staff at the chamber was very friendly but already laughing about me for coming back. I tried to ignored it, but they made me feel like I was completely exaggerating with what I was doing, basically taking care of my treatment myself. As for aftercare I was told no alcohol, no exercise, no hot showers, no altitude for at least 10 days. And of course no diving. Did not do any of this, even for longer.

23.9.15:
Finally the tingling was gone for 1 week, only my right arm still felt a bit weak. Had 2 long flights back to Europe. Felt ok.

Back home I have basically been symptom free. I saw a dive doctor at home, who is a neurologist as well. MRI of the brain and whole spine, xray of the lungs, ecg and transthoracic echo of the heart was done - everything completely normal. The only thing he found was weakness of the right arm.

16.10.15:
Still feeling fine, I got on a plane for less then 2 hours – and many of the symptoms returned, esp. the tingling on the left side of my face and in my right forearm and right foot (the locations where I had the tingling the longest and most intense before I got in the chamber the first time).

Contacted DAN again: I was assured that this was no new injury, more an irritation of the existing one. They said many people are sensitive for pressure changes for an indefinite amount of time and that this should settle with time. I should take it easy and rest.

Since then I had another 5 2h-rides in the chamber at home (without great expectations to change much in the symptoms), vit B supplements and osteopathic treatments (which actually helped). A year has gone by and I still feel the tingling in my face, right arm and right foot and my right arm still wears out a bit quicker then my left one. It got less intense and therefore less disturbing, but the process is super slow and I just don't know if I will ever recover completely. I did fly again, fist time in April 2016 - apparently I don't react to pressure changes of that kind any more (I was super scared of getting on that plane though), didn't have problems on any other flights anymore.

Please don't get me wrong - I know that DCS can be much worse! But for having had mild/moderate neurological symptoms and having already been symptomfree for a while I don't really understand the reason for the setback and the long way of recovery.

I will be checked for a PFO in February. I was told it's not urgent, if I have it I have it.Unless I want to go diving. But I guess I'm done with diving anyway


So questions:
- any explanations why symptoms got worse on the second flight but not the first one back from Indonesia?
- let's assume nerve tissue "died" due to hypoxia -- wouldn't that cause symptoms like numbness or paralysis more than tingling (= lack in nerval conductivity? sorry not my mother language
- with all the details given -- did I do anything wrong, any obvious mistakes?? That's one of the things that haunts me the most..
- anybody with personal experience with such a slow recovery out there??


Sorry for the long text! It's been a year.. Your comments are great help for me!!

 

[**pYgmY**]

@DDM: According to the computer everything within no-deco limits. Personally, this last dive seemed very long and deep to me, considering that it was a repetitive dive. I have never done 2 deep dives like that in one day before. As I said, we agreed on another profile before the dive. I wasn't happy about the guide changing his mind.

 

[tursiops]

@DDM: According to the computer everything within no-deco limits. Personally, this last dive seemed very long and deep to me, considering that it was a repetitive dive. I have never done 2 deep dives like that in one day before. As I said, we agreed on another profile before the dive. I wasn't happy about the guide changing his mind.

Do you remember what kind of computer it was?

 

[**pYgmY**]

@tursiops: Unfortunately not. In all the chaos I tried to sort many things out but didn't think of asking about the type of computer back then..

 

[**pYgmY**]

Maybe important to add: the symptoms have always been on/off since my first hyperbaric treatment. I'm 30 and physically fit, normal weight and without any other predisposing factors I know of (only not checked for PFO yet).