Possible DCS

[Luke_Gordon]

Hi Guys,

I have seen many professionals on here so looking to gain a third opinion from you guys. Just for context of this post I suffer from severe health anxiety, regardless of if any condition is currently afflicting me I am very much anxious about it.

I am quite remote right now, this isn't as far as I am aware a diving emergency. I am a pretty experienced DM with almost 3000 dives. Right now I am gaining experience in research and have currently been at my island location for 17 days or so. I would say I have done around 10/11 dives in those 17 days. No one day had multiple dives and all but 2 dives have been very conservative on a Suunto Zoop.

Let me explain the situation, my last dive was Sunday. Was a deep dive on air, to 30.1m with a total bottom time of 71min. A multi-level dive where I slowly made my way up the reef staying within my NDL. At 23m I crept into deco, I ascended slowly up the reef as I normally do and by 12m I was out of deco. I then stayed at between 7-9m for around 10-15min and moved up to do my safety stop at 4-5m for around 4-5min possibly longer but definitely no shorter. I then stayed at around 2m for 15min taking photographs. Dive over. Nothing out of the ordinary for me. Had my lunch felt fine, then went to do some laptop work, around 3hours after surfacing I felt what i would say is my normal after dive fatigue, maybe slightly more. Took a nap of 40-50min and fatigue had gone.

However until the next morning I would say I felt slightly off. Only slightly though. This made me think of DCS and was worrying ever since 4 hours after my dive. I have seemed to develop a headache which I can't pinpoint when I got. However it is very mild and shifts in it's nature and is not always present. (when i wake in the morning I feel great)

I haven't dived since and have been out the water now 76 hours. No other symptoms what so ever. I have had a paramedic and dive professional conduct neuro assessments, which I seem to pass. I would say I have felt pretty good since Mon afternoon. But my worry has got me and I am petrified to enter the water again.

I phoned DAN after 26 hours who promptly told me I am ok and that just a headache is not DCS, and that I should have off gassed by now. However I wasn't convinced so I called DDRC? I think. Anyway they were much more thorough and told me to err on the side of caution I should be checked or abstain from diving for a week to 2 weeks.

Now I am definitely not diving for a week, agreed with my employer, however because my symptom is so mild they really don't believe I have DCS. My worry and anxiety however has me convinced I can feel a bubble/s in my brain.

I also breathed continuous flow oxygen for abut 20min around 20 hours after dive. Didn't notice any change of my very diffuse symptom.

My questions are, if I have a constitutional bend and do not dive for 2 weeks or even just 1 week will I off gas?

Does this sound like DCS? I am very remote so going to a hyperbaric doctor will end my 2 month trip and experience that is very very important to me. This is my only hesitation about going.

I have had to deal with AGE's before and just have a vision in my head of if I dive again that will be me.

Any help/advice would be greatly appreciated.

Thanks Guys,

 

[Luke_Gordon]

Hi Guys,

Wondering if anyone maybe had some insight or advice? Headache still is the only symptom and it changes from being in the centre of my brow/forehead area to temple to top of head and sometimes not there at all. When it is, it is mild.

I care only for my health and am not in denial but at the same time, my health anxiety this year has had me go down rabbit holes that very much were not there.

Sorry if this is wrong of me to do but @doctormike @dukedivemedicine @scubadada any comments?

Thanks again,

 

[Duke Dive Medicine]

Hi Luke,

From your description I think it's highly unlikely that you had decompression sickness. Maybe you had a very mild subclinical case, but if you're asymptomatic now (save for the headache, which by your description does not appear to be diving-related), I think you're probably fine. If staying out of diving for a week would make you more comfortable by all means do so. I might also consider diving a little more conservatively by not pushing the computer to the edge of the algorithm. Re feeling the bubble in your brain, if you really could feel one we wouldn't be having this conversation, so I think that's probably one of those rabbit holes.

Best regards,
DDM

 

[TrimixToo]

Several years ago, another diver I did not yet know and I buddied up on a dive trip in the Spring, IIRC. After the first dive on Day 2 or 3 to a depth in the 140-170' range, when the seas had kicked up moderately (one had to time the grab for the ladder but it wasn't hard to climb yet), we separately noticed some minor right shoulder discomfort. After some thought, I grabbed my primary computer and went into the cabin to increase the conservatism a bit, to find him doing exactly the same thing! He was even sore in the same shoulder, the right one.

On Dive 2, I noted that the discomfort did not either go away at depth or increase on ascent. His experience was the same.

It was just muscular fatigue. Neither of us used a jon line, and hanging onto the surging line led to a bit of muscular soreness. Since then, I have noticed similar shoulder discomfort under similar circumstances when I have not been doing a lot of boat diving. I've learned.

The point of this story is that not everything that causes discomfort after diving is caused by DCS. Sometimes, it's just life, and happens to occur after diving. Sometimes, it's diving related (see above) but has nothing to do with DCS. It can be hard to be sure sometimes, and erring on the side of caution is good, but I no longer automatically assume DCS is the cause of any discomfort without considering other causes.

 

[Luke_Gordon]

@dukedivemedicine and @TrimixToo thanks for the replies and advice, very much appreciated.

If this is/was a case of subclinical DCS would a week out of the water or 2 weeks do anything for me?

Excuse my naivety but i understand the concept of both AGE's and DCI, however if a case of constitutional DCI is a case where the tissue has too much inert gas still present at ambient pressure, i.e. I loaded too much and didn't off gas successfully, then will off gassing happen naturally with time out of the water or will the inert bubbles always be present until chamber therapy.

Or is chamber therapy merely a means to speed up the off gassing process to avoid injury?

For me my headache comes and goes, but seems to be more present than not, as I said I haven't taken any painkillers, but I am not witnessing a reduction in the symptom when it is there, i.e. I thought I would if I should be off gassing?

Thanks,

 

[doctormike]

DDM is the DCS expert here, I'm just the earwax expert, so I would defer to him on this issue. But since you asked me, I would say that it doesn't sound like DCS given the symptoms. Once you are at the surface, you have a gradient driving any residual dissolved inert gas and bubbles across the lung capillaries (outgassing), and I wouldn't think that there would be any residual N2 after 3-4 days.

That having been said, it would be interesting to see your actual profile and to hear what your dive plan was (gradient factors or conservatism settings, gas plan, etc...). Was this planned deco?

 

[JohnnyC]

Sounds like you're dehydrated. Drink more water, see if headache goes away.

 

[Kevrumbo]

Hi Guys,

Wondering if anyone maybe had some insight or advice? Headache still is the only symptom and it changes from being in the centre of my brow/forehead area to temple to top of head and sometimes not there at all. When it is, it is mild.

I care only for my health and am not in denial but at the same time, my health anxiety this year has had me go down rabbit holes that very much were not there.

Sorry if this is wrong of me to do but @doctormike @dukedivemedicine @scubadada any comments?

Thanks again,

Rule Out Diffuse Sinus Headache, Sinusitis.

Mild Sinus Squeeze vs Mild Infection/Inflammation -although no reported sinus pain on descent/ascent or congestion/nasal discharge.

 

[Luke_Gordon]

Thanks for replies everyone,

@doctormike once again excuse my naivety, does this mean that the chamber is used only to save lives/prevent permanent damage in DCS cases? What I mean is say someone had DCS, that affected their vision for example and joints, if they didn't attend a chamber but abstained from diving, it means that the body would still off gas but the N2 could have caused permanent damage due to being in the affected tissue for soo long?

Profile was not planned for deco but photography gets hold of me and a nice bommie appeared at 23/22m which held my attention for too long. Mistake I know, hopefully one I haven't paid for. But they are the lessons you learn.

@JohnnyC drank lots of water and rehydration salts since, dull headache still comes and goes.

@Kevrumbo interesting you say this. Right now I can equalise and have no sinus issue, I didn't feel anything on the dive. However a sinus infection has been affecting others on island, my headache shifts, when it is there, from between my brow/above each brow to almost top of head, also I do feel a bit of pain when I push on the sinuses and underneath my brow.

Basically I have this idea that some tissue in my head is still afflicted with N2 that for some reason or another hasn't been able to off gas. Maybe bubbles too big? I don't know if that is actually a thing? or some tissue is still inflamed from N2 that was there?

Thanks everyone,

 

[RainPilot]

Everything on WebMD is cancer, everything on ScubaBoard is DCS.

I believe, based on your description as well as the doctors feedback, that it is VERY unlikely that you suffered from DCS. DCS in a way that would affect your brain would be pretty rare, hard to develop on the dive profile as I understand it and since you show very very few of the classic symptoms of DCS I would relax a bit.

Even if it was DCS, what would that diagnosis mean to you? Headaches won't be long term, no other permanent issues. After a week you would be completely off gassed in any conceivable sense so where's the problem? Believe me, I get the paranoia. In my line of work any DCS hit of any kind would be life altering. That twinge in the shoulder (after I have just carried 10 tanks to the car) after a one hour dive at 30 feet on 32% still has me in a light sweat.

If I'm missing something I'm sure @Duke Dive Medicine or @Dr Simon Mitchell can set me straight.