Need your help: decompression/barotrauma accident or MdDS?

[soarManu]

Hey everyone,

I'm writing you, now 5 weeks after a fantastic 7 days scuba safari in the Red Sea. Had a fantastic time there in which I found such a joy in diving which made me so happy to pursue this wonderful hobby. Unfortunately, ever since I arrived on land, I have this super unpleasant feeling of rocking, bobbing, swaying, and the fear of a potential dive accident.

I did 18 dives in total - 16 in the depth range of 20-30 meters/60-90 feet, and 2 down to 40 meters/127 feet on the second and last day of the safari. All dives were without any direct problems, no deco dives, and I made sure that all safety stops were executed. After the second 40 meters dive I did one last dive of the safari, only down to 20 meters, before I took my flight back home some 31 hours later. You can find the profiles of the two 40 meter/127 feet dives here:

Do you find anything unusual that could explain a decompression accident or an ear barotrauma based on the info/the profiles?

I had and have no other symptoms that might speak for one of the two (no nausea, vomiting, ataxia, tinnitus, hearing loss, sensation of ear fullness),. I dive for 5 years now, got 50 dives under my belt, and even though 40 meters was new to me I never had any problems.

An MRI of my inner ear was made stating that there is no anomaly of the semicircular canals and of the bony labyrinth. But could there still have been an inner ear decompression/barotrauma?

Weirdly this feeling of rocking, bobbing, swaying is sometimes less strong and has even almost fully disappeared for a few days.

Based on all this info, my GP thinks it could be MdDS, or Mal de Debarquement syndrome. The feeling of rocking, bobbing, swaying that about 80% of all people get after a longer boat ride, with very few that only get rid of this after weeks or even months. I think I felt no vertigo after all the dives on the boat, it only started once I left the boat which might speak for MdDS and don't feel it when being exposed to passive motion on a train, car, etc.
Has anyone of you ever experienced this?

I'd be very happy to hear what you think about this.

 

[Angelo Farina]

I suffered of this sensation after one week on boat, but it lasted just a few hours.
It was really disturbing, I was feeling the ground moving under my feet...
I experienced this almost every time I spent a week on board, which means possibly 4 times.
It did never happen, instead, for a short daily trip.
As your medical examination excluded other problems, I think this could be the probable cause.
But it should resolve quickly... How much time passed after you disembarked?

 

[Capt Jim Wyatt]

Good luck with this!!

 

[Seaweed Doc]

Your doctor says it MdDS and you're asking ScubaBoard members for comments?

Well, I'm not a doc for people, but there are two reasons I think they're right:

1. They ARE a doc and told you so.
2. Sounds like classic MdDS to me.

 

[Duke Dive Medicine]

Hey everyone,

I'm writing you, now 5 weeks after a fantastic 7 days scuba safari in the Red Sea. Had a fantastic time there in which I found such a joy in diving which made me so happy to pursue this wonderful hobby. Unfortunately, ever since I arrived on land, I have this super unpleasant feeling of rocking, bobbing, swaying, and the fear of a potential dive accident.

I did 18 dives in total - 16 in the depth range of 20-30 meters/60-90 feet, and 2 down to 40 meters/127 feet on the second and last day of the safari. All dives were without any direct problems, no deco dives, and I made sure that all safety stops were executed. After the second 40 meters dive I did one last dive of the safari, only down to 20 meters, before I took my flight back home some 31 hours later. You can find the profiles of the two 40 meter/127 feet dives here:

View attachment 803110
Do you find anything unusual that could explain a decompression accident or an ear barotrauma based on the info/the profiles?

I had and have no other symptoms that might speak for one of the two (no nausea, vomiting, ataxia, tinnitus, hearing loss, sensation of ear fullness),. I dive for 5 years now, got 50 dives under my belt, and even though 40 meters was new to me I never had any problems.

An MRI of my inner ear was made stating that there is no anomaly of the semicircular canals and of the bony labyrinth. But could there still have been an inner ear decompression/barotrauma?

Weirdly this feeling of rocking, bobbing, swaying is sometimes less strong and has even almost fully disappeared for a few days.

Based on all this info, my GP thinks it could be MdDS, or Mal de Debarquement syndrome. The feeling of rocking, bobbing, swaying that about 80% of all people get after a longer boat ride, with very few that only get rid of this after weeks or even months. I think I felt no vertigo after all the dives on the boat, it only started once I left the boat which might speak for MdDS and don't feel it when being exposed to passive motion on a train, car, etc.
Has anyone of you ever experienced this?

I'd be very happy to hear what you think about this.

These are provocative dives, that is, they would be more likely to produce DCS. You said you'd had symptoms "...ever since I arrived on land...". How long after your last dive did you arrive on land, and at exactly what point after leaving the boat/arriving on land did your symptoms appear?

Best regards,
DDM

 

[RB7]

I have done a couple of 1 week to 10 day Liveaboard trips and have faced the similar swaying sensation on land post trip. Each lasted anywhere from 3 or 4 days to the longest lasting almost 3 weeks.
What I found helpful for me was to continue taking the motion sickness pills for 2-3 days even after I was back on land.

Hope you feel better soon !

 

[soarManu]

Hey Capt Jim Wyatt, SeaweedDoc, Duke Dive Medicine, ciao Angelo,

Thank you very much for your posts!

@Angelo Farina: thanks for sharing this! Indeed it only seems to occur when you're exposed to passive motion such as on a boat for a longer duration than just a day (which is also my hope that it won't come back in the future during short boat trips). My safari was 7 days, of which at least during 2 days there were lots of waves. I got it for 5 weeks now but I think I can see a positive trend now. Here it is a bit different though, it feels more like my head is grasping the sensation of still being on a boat instead of having the feeling that the ground is moving.

@Seaweed Doc : I saw 3 ENTs of which 2 said it might have been a dive accident, without any further explanation, detailed understanding of my dives, or dive related subject knowledge in general. The doc who made the MRI also didn't want to rule out a dive accident and didn't have dive medicine knowledge either but thinks this is unlikely given the absence of an anomaly of the semicircular canals and of the bony labyrinth. So not really clear what this means. I finally found this doc you're referring to, who thinks it is MdDS, but he's not sure. In general doctors don't seem to really know MdDS and none of them had an interest/or could fully rule out a dive accident or give a clear diagnosis so far.

@Duke Dive Medicine : On the last day we did two dives, the 2nd 40 meter one (see image above) and then like 2 hours before entering the port a last one to 20 meters. The symptoms per se only started once I left the boat, as I could not feel any during diving or on the boat before. However, since the boat was also moving in the waves I might not have felt that vertigo while still being on the boat.


Do you think that the dive profiles indicate anything related to a risk of a decompression accident? As I said all the other dives were not deeper than 30 meters and in general there was no signs of a dive accident (all safety stops done, etc)

 

[soarManu]

@RB7 thank you very much for your post and kind words! Interesting to read that I'm not the only one who encountered this weird situation for a duration of many weeks.

Have you had that situation after all your trips? I'm asking as I'm afraid to face the same situation again after a future dive safari (who knows if I'm even going to do one again after this) or even from a shorter boat trip in the future.

 

[Duke Dive Medicine]

Hey Capt Jim Wyatt, SeaweedDoc, Duke Dive Medicine, ciao Angelo,

Thank you very much for your posts!

@Angelo Farina: thanks for sharing this! Indeed it only seems to occur when you're exposed to passive motion such as on a boat for a longer duration than just a day (which is also my hope that it won't come back in the future during short boat trips). My safari was 7 days, of which at least during 2 days there were lots of waves. I got it for 5 weeks now but I think I can see a positive trend now. Here it is a bit different though, it feels more like my head is grasping the sensation of still being on a boat instead of having the feeling that the ground is moving.

@Seaweed Doc : I saw 3 ENTs of which 2 said it might have been a dive accident, without any further explanation, detailed understanding of my dives, or dive related subject knowledge in general. The doc who made the MRI also didn't want to rule out a dive accident and didn't have dive medicine knowledge either but thinks this is unlikely given the absence of an anomaly of the semicircular canals and of the bony labyrinth. So not really clear what this means. I finally found this doc you're referring to, who thinks it is MdDS, but he's not sure. In general doctors don't seem to really know MdDS and none of them had an interest/or could fully rule out a dive accident or give a clear diagnosis so far.

@Duke Dive Medicine : On the last day we did two dives, the 2nd 40 meter one (see image above) and then like 2 hours before entering the port a last one to 20 meters. The symptoms per se only started once I left the boat, as I could not feel any during diving or on the boat before. However, since the boat was also moving in the waves I might not have felt that vertigo while still being on the boat.


Do you think that the dive profiles indicate anything related to a risk of a decompression accident? As I said all the other dives were not deeper than 30 meters and in general there was no signs of a dive accident (all safety stops done, etc)

Thanks for those details. If you had vertigo immediately following the dive then you'd have known it on the boat. It would have been much harder to maintain your equilibrium on the boat than on land.

Any dive to 40 m would be considered provocative but it appears from the profile that you did a long, slow ascent afterward that would have helped with off-gassing. Another 20 m dive after that would have added to your nitrogen load though, and it's likely that you had "silent" venous bubbles, especially after 18 dives over 7 days. Theoretically, if you exerted yourself (carrying heavy gear while disembarking a boat, for example), the bubbles could have traveled through a shunt and caused inner ear DCS symptoms like vertigo.

No imaging study (MRI, CT, or other) is diagnostic of any type of DCS, so absence of anomaly on MRI doesn't allow one to rule out DCS.

To my knowledge, inner ear DCS symptoms don't wax and wane the way you're describing. Though I don't think DCS can be completely ruled out, it seems more likely that you have a particularly nasty case of Mal de Debarquement. In some cases it can take quite a while to resolve. You may want to reach out to DAN Europe for a recommendation for a diving physician near you and get yourself evaluated.

Best regards,
DDM

 

[boulderjohn]

I have a close friend who suffered from MdDS, and from what happened to him, I would say it is pretty likely. In his case, he has had a lifetime of motion sickness--frequently car sick as a child and suffering from sea sickness as an adult. His wife booked a vacation once that included a few days staying on a boat docked in the harbor, and he absolutely could not handle that very gentle swaying.

In the case I am talking about, he was on a cruise ship to Alaska, the kind of trip most people would say had no ocean motion at all. He was pretty much OK during the trip, but after the trip was a nightmare. He constantly felt like he was on a rocking boat, and one night it was so bad he got out of bed and had his wife take him to the hospital. I don't know what his treatment was, but he was affected for weeks.