Neurological Bends

[fins wake]

You may be right though. Due to my left shoulder rotator cuff tear, I started utilizing my right arm more, and developed shoulder problems in that one too, but that has since resolved itself.

I think Dr Deco is spot-on.

3) maybe valve shut down or some other fast twisting action on a joint can cause local DCS.

Ouch, there'd be plenty of us with 'local DCS' then. Isn't it much more reasonable to assume that your fast twisting action on an already overexcerted right arm following the earlier shoulder rotator cuff tear caused joint or tendon trouble?

Yes, one MRI said I had some kind of disruption in the right epicondyl. The other MRI said it was mild tendinitis

Well, there you go.

Of course, I fully agree with you that if one develops symptoms after a dive one should take oxygen and head to a chamber and get qualified medical opinion. I don't think you had DCI, though.

 

[Dr Deco]

Hello crispos:

I was commenting on the phase “ squeezed a bubble or two into the elbow tendon/forearm muscle locally.” That, to me, is different from cause the formation of micronuclei. If nuclei formation by physical work is what you actually had in mind, then I agree with this position.
However, the fact that you had an injured arm and the pain persisted for such a long duration makes DCS unlikely. It is possible that you had DCS
and concurrently an injured tissue. One would not “protect” you against the other. It is actually a horrible possibility, isn’t it?


Dr Deco :doctor:

 

[crispos]

Dr. Deco, your answer was milder than I expected. Good. Now that we are reading from the same physiological page, we can discuss this seriously.

HAS their been a study on the effects of UNtreated DCS on muscle tissue. Please, show it to me. Also, I never said that DCS had any prophylactic effect on muscle tissue.

Fins Wake, just as everyone does NOT get DCS from a table violation, so, everyone who turns a valve off, is not expected to get DCS, and I never said that was the case. My right elbow had absolutely no problem, with the tendon or otherwise, before this dive. So, Ouch, please reread my post. The outstanding fact in this case is that I developed neurological symptoms for two months after a scuba dive.

P.S while I did a degree in biochemistry and worked in the pharmaceutical industry for several years, I used to do many many MRI's (NMR's they were called). They are vague and not perfect, open to interpretation. I know enough about medical science (Even 10 years ago, after quitting science, I was hired to do a study on the unsuitability of artificial blood substitutes, which were rejected as unsafe due to the effect of Nitrogen on the inner walls of capillaries = hypertension= effects on diving)

I studied statistics during my busines career. In fact, I was a top student in that area. Why do you both not think it is highly coincidental that I obtained niggles after a dive, numbness after the niggles, and tendinitis after the numbness? Prior to this I was in excellent physical condition. What is the threat to hypothesizing that, maybe physical exertion can cause DCS, and untreated DCS can cause tendinitis. Wow!

 

[Dr Deco]

Hello crispos:

Residuals of Pain-only DCS

I have not heard of tendonitis being a residual effect of pain-only DCS. There is debate as to whether aseptic osteonecrosis can result from multiple cases of type I decompression sickness but that is strongly debated. It is also debated as to whether there are neurological problems associated with diving, even in the absence of neurological DCS.

The question concerning tendonitis would appear to be clearer since many more commercial divers acquire pain-only DCS that the other forms and this has occurred from one and a half centuries. However, I am not aware of this as a sequel. That does not mean that it is totally impossible, I guess.

Has DAN made any comments on such a relationship?
Dr Deco :doctor:

 

[fins wake]

Why do you both not think it is highly coincidental that I obtained niggles after a dive, numbness after the niggles, and tendinitis after the numbness?

I assume you mean that "we" think it is coincidental, not that we not think it's coincidental? Anyway, I can't recollect anyone saying it's a coincidence. Merely that's unlikely to be DCI. Do you have any reason to mistrust your two MRIs, including one from a dive doctor? Is there any reason you'd prefer it to be DCI rather than something else? :280:

Prior to this I was in excellent physical condition. What is the threat to hypothesizing that, maybe physical exertion can cause DCS, and untreated DCS can cause tendinitis. Wow!

I'm sure untreated DCS can cause a lot of things, but is this really the most logical probability in your case? As for the excellent physical condition, I've probably misunderstood that part as you previously wrote

because I also suffered an accident 2 years ago, putting my shoulder out of commission. I actually taught scuba all summer while waiting for rotator cuff surgery. I put on 25 lbs and grew a belly.

That's rereading all your posts. And discussing it seriously. :linkz:

 

[Saturation]

Interesting, Crispos had asked about residual problems post DCI here a while back:

http://scubaboard.com/showthread.php?p=400987&highlight=crispos+saturation#post400987

FYI.

 

[hermissenda]

It seems like pinched nerves can cause DCS-like symptoms?

Would a Elctro Myography allow to differentiate between the two?

I have DCS like residuals in my left elbow that manifest themselves e.g. when I strain myself or when I am tired or really sick: elbow joint pain with occasional tinteling of the hand.
About a year ago I had DCS in my left arm/elbow which got treated in a chamber successfully (completely symptom free) but then 4 days later after a couple of airplane flights I developed symptoms that looked similar to DCS but that did not respond well to hyperbaric treatment.

Now after reading this thread I am going after the theory that the second time this might have been a pinched nerve. I found out later on a MRI/NMR I do have a bulging disc.

THe issue I am struggling with is that the pinched nerve could mask a real DCS hit?
I am staying away from depths deeper than 10m/30feet thse days - nothing down there anyways.

On the side would there be any potential issues with antibiotics and nitrogen absorbtion/release or some of these neurological symptoms. I am thinking in particular of Zithromax?

 

[Saturation]

It seems like pinched nerves can cause DCS-like symptoms?

Would a Elctro Myography allow to differentiate between the two?

Yes, very much so. Yes, EMG can help differentiate the two if there is nerve pinching but if its bursitis or tendonitis, which is pain in the elbow soft tissue, it won't help. In cases of DCI, if breathing 02 on the surface helps the pain is more likely DCI. One test you can do is breathing 02 with the pain anytime before diving, to insure it doesn't help. O2 has a habit of making many things better, so just to insure it wont' be confused with elbow joint DCI, try it before diving, 100% o2 for 30 min tops.

I have DCS like residuals in my left elbow that manifest themselves e.g. when I strain myself or when I am tired or really sick: elbow joint pain with occasional tinteling of the hand.

Those signs are suggestive of nerve pinching, an EMG will test the functional issue and an MRI will help identify were the pinching occurs.

MRI/NMR I do have a bulging disc.

A vertebral disk?

THe issue I am struggling with is that the pinched nerve could mask a real DCS hit?
I am staying away from depths deeper than 10m/30feet thse days - nothing down there anyways.

All kinds of pain can mask DCI. Stay at 30' tops should almost eliminate a risk for DCI for NSL dives, particularly for a typical dive, i.e., 1hour or less. Deeper dives then 10+min safety stops or nitrox on air tables, can reduce risk further.

On the side would there be any potential issues with antibiotics and nitrogen absorbtion/release or some of these neurological symptoms. I am thinking in particular of Zithromax?

None on record, and nothing theoretically possible. However, if diver has a sore throat or sinus congestion, it could make equalization a problem. Its not the medicine's fault, its the disease. Also, if a diver is not feeling entirely well and has a moderately serious illness like a pneumonia or a bronchitis, an illness, either from chemicals released to combat the disease or just fatigue alone increases a risk for DCI.

 

[hermissenda]

>MRI/NMR I do have a bulging disc.
>A vertebral disk?

Yes, nr 5 if I remember correctly.

On the issue of the antibiotics. Zithromax works for quite an extended period of time. What I had in mind was e.g. diving 4-6 weeks after taking antibiotics with no obvious symptoms or indications that would contradict safe diving (such as ear infection, cold ...).

All the sources I consulted indicate there should be no theoretical connection between nitrogen absorption/release and antibiotics.

Thanks for the O2 tip, I'll give that a shot see what happens.