Bubbletrubble
Contributor
@DandyDon: The OP disclosed his age in Post #1 of this thread. See quote above.
Should I give up diving ?
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@DandyDon: The OP disclosed his age in Post #1 of this thread. See quote above.
Bubbletrubble
Contributor
@photographer:
Which specific fingertips were involved during the "fireworks" episode?
Whenever you experience the tingling is it consistently in the same fingertips?
How far up your hand/arm did the tingling sensation extend?
Specifically where on your arm did you experience numbness?
I'm just trying to establish whether the paresthesia/anesthesia is contained within one dermatome...or affects several simultaneously.
Out of curiosity, are you left-handed or right-handed?
Oh, well. We might be able to throw out the camera hypothesis, but handling a light/torch might be a contributing factor. Is it a large or negatively buoyant light? Did you carry the light with you on the incident-free warm water dives?
I liked the idea of wearing the drysuit around, but it would not really be a replication of your dive, as you would not be in the water, with the drysuit inflated, and carrying your cylinder, weights, etc. in your normal diving position/posture. And I bet you'd get pretty warm if you geared up (w/insulation) like you usually dive. 
I'd suggest replicating the dives in a wetsuit and see if you have the same DCS symptoms. If you don't, then I'd question the diagnosis of DCS.
You could also rent/borrow another brand of drysuit and replicate the dives, but I'd still suggest a wetsuit for a real change.
P.S. I'm a clinical psychologist, with a doctor in psychology, and I have treated PTSD from dive accidents, as well as other anxiety disorders. I'm not suggesting that your symptoms are psychological, but I do think that it is wise that you are asking for objective input as you likely have become very sensitive to monitoring yourself for symptoms.
I'd suggest replicating the dives in a wetsuit and see if you have the same DCS symptoms. If you don't, then I'd question the diagnosis of DCS.
You could also rent/borrow another brand of drysuit and replicate the dives, but I'd still suggest a wetsuit for a real change.
P.S. I'm a clinical psychologist, with a doctor in psychology, and I have treated PTSD from dive accidents, as well as other anxiety disorders. I'm not suggesting that your symptoms are psychological, but I do think that it is wise that you are asking for objective input as you likely have become very sensitive to monitoring yourself for symptoms.
bleeb
Contributor
I'm not a doctor or any form of medical type either. But I did wonder about a couple of things.
First, although your depths, times and stops sounded pretty benign, was there anything unusual in terms of ascent rates? You're far more experienced than I, but I'll mention the frequent warning that the last 3-5 m are the most important in terms of taking it slow.
Another possibility for your consideration is I *think* I've heard some of the real medical types mention here on SB that to be significantly useful, hyperbaric treatments need to start within 24 hours of the original incident, and that after that, any physical damage has set in and may take much longer to heal. This would seem particularly an issue for nerve DCS like what you're describing. Maybe something to consider as you're looking into things is that only the first incident was actual DCS, and the subsequent cases are 'just' re-irritating the injured or now more sensitive nerve.
First, although your depths, times and stops sounded pretty benign, was there anything unusual in terms of ascent rates? You're far more experienced than I, but I'll mention the frequent warning that the last 3-5 m are the most important in terms of taking it slow.
Another possibility for your consideration is I *think* I've heard some of the real medical types mention here on SB that to be significantly useful, hyperbaric treatments need to start within 24 hours of the original incident, and that after that, any physical damage has set in and may take much longer to heal. This would seem particularly an issue for nerve DCS like what you're describing. Maybe something to consider as you're looking into things is that only the first incident was actual DCS, and the subsequent cases are 'just' re-irritating the injured or now more sensitive nerve.
OP
photographer
Registered
Bubbletrubble
the fireworks episode took place 55 hours after the second incident. My hand was cold and as I came inside the hand started to warm up. The extra tingling started suddenly and mostly the index and middle fingers were affected. It was the same sensation as in childhood after having skated for hours on an ice rink, returning home and soaking the frozen feet in hot water.
I have had tingling in all five fingertips but nowhere else. Only the first half inch of each finger tingles. The intensity seems to vary hour by hour. Only the bottom side tingles (not the nail side). Sometimes the thumb tingles the most, other times it is the index or the middle finger.
The numb arm did not have any exact point but it was generally numb below the shoulder level down to elbow (but in joint areas). In the muscle area, on the front and the outside (not body side).
I am very right-handed. I do next to nothing with my left hand.
And about the torch. The torch was attached (second and third incidents)and I did not carry it much but had it hang loose. In warm water, on night dives I carry the same torch all the time, so it might not be a factor.
Drdaddy
I thought of replicating the test dive in a wetsuit. However, at that depth, the temp is 40F so, if at all doable, after 37 min BT I would be freezing cold and that would also be a major factor.
And regarding the selfmonitor issue. I am a sportsman. There is always an ache somewere in my body, jokingly, if you do not feel any pain, you know that you are dead. DCS is sinister though as it has to do with nerves and it is self-inflicted. Rather than keeping this to myself I have shared my story and have got a lot valuable input from a lot of experienced and knowledgeable people. This helps me mentally and helps also in getting to the goal which is to resolve this matter and continue diving if at all possible.
Photographer
the fireworks episode took place 55 hours after the second incident. My hand was cold and as I came inside the hand started to warm up. The extra tingling started suddenly and mostly the index and middle fingers were affected. It was the same sensation as in childhood after having skated for hours on an ice rink, returning home and soaking the frozen feet in hot water.
I have had tingling in all five fingertips but nowhere else. Only the first half inch of each finger tingles. The intensity seems to vary hour by hour. Only the bottom side tingles (not the nail side). Sometimes the thumb tingles the most, other times it is the index or the middle finger.
The numb arm did not have any exact point but it was generally numb below the shoulder level down to elbow (but in joint areas). In the muscle area, on the front and the outside (not body side).
I am very right-handed. I do next to nothing with my left hand.
And about the torch. The torch was attached (second and third incidents)and I did not carry it much but had it hang loose. In warm water, on night dives I carry the same torch all the time, so it might not be a factor.
Drdaddy
I thought of replicating the test dive in a wetsuit. However, at that depth, the temp is 40F so, if at all doable, after 37 min BT I would be freezing cold and that would also be a major factor.
And regarding the selfmonitor issue. I am a sportsman. There is always an ache somewere in my body, jokingly, if you do not feel any pain, you know that you are dead. DCS is sinister though as it has to do with nerves and it is self-inflicted. Rather than keeping this to myself I have shared my story and have got a lot valuable input from a lot of experienced and knowledgeable people. This helps me mentally and helps also in getting to the goal which is to resolve this matter and continue diving if at all possible.
Photographer
Bubbletrubble
Contributor
@photographer:
Thank you for answering all of my questions.
Your arm numbness is suggestive of some kind of nerve impingement, perhaps thoracic outlet syndrome. If this is the case, certain arm positions (arm above head, arm extended laterally, etc.) might be instigating the numbness. It's also plausible that your BCD or BP/W harness strap is too tight on the left side and compressing structures beneath.
The history of the finger paresthesia is consistent with Raynaud's. The asymmetry of the presentation and your age (>30 years old) is suggestive of secondary Raynaud's (caused by some other connective tissue/autoimmune, blood, traumatic, vascular, neurologic, endocrine disorder). A nailfold capillaroscopy which looks for abnormalities in the capillary network at the base of your fingernails may help establish a diagnosis of secondary Raynaud's. Your doctor will likely order several blood tests and perhaps conduct nailfold capillaroscopy.
I would see a physician for evaluation of this. As I stated before, high on the differential diagnosis are neurologic and circulatory disorders. I suspect you'll end up with a diagnosis of secondary Raynaud's.
Thank you for sharing your story. I'm interested in the outcome of your clinical work-up. Please let us know how everything goes. Good luck.
Thank you for answering all of my questions.
Your arm numbness is suggestive of some kind of nerve impingement, perhaps thoracic outlet syndrome. If this is the case, certain arm positions (arm above head, arm extended laterally, etc.) might be instigating the numbness. It's also plausible that your BCD or BP/W harness strap is too tight on the left side and compressing structures beneath.
The history of the finger paresthesia is consistent with Raynaud's. The asymmetry of the presentation and your age (>30 years old) is suggestive of secondary Raynaud's (caused by some other connective tissue/autoimmune, blood, traumatic, vascular, neurologic, endocrine disorder). A nailfold capillaroscopy which looks for abnormalities in the capillary network at the base of your fingernails may help establish a diagnosis of secondary Raynaud's. Your doctor will likely order several blood tests and perhaps conduct nailfold capillaroscopy.
I would see a physician for evaluation of this. As I stated before, high on the differential diagnosis are neurologic and circulatory disorders. I suspect you'll end up with a diagnosis of secondary Raynaud's.
Thank you for sharing your story. I'm interested in the outcome of your clinical work-up. Please let us know how everything goes. Good luck.
OP
photographer
Registered
Hi, this is photographer again.
Today I had time to really go thru this. I studied all the dive profiles
during the past two years. The summary is that I "cannot" have any problem (or any of them but the pieces do not fit into the puzzle).
Incident 1 : I went thru all the profiles. Nothing special there. I don't understand why I got bent (if I did) in the first place. Especially with the extensive diving history that I have before the incident. But then again I had tingles and numb arm, which are typical neurological symptoms.
Between incident 1 and 2. I did five (and a lot more shallow dives) warm water dives, conservative but with a little bit more nitrogen buildup than the subsequent incident 2 and 3 dives. No symptoms. Also five long very shallow (max 15 feet) dives in freezing cold cold (one in 32F) local waters in a dry suit. No symptoms.
Incident 2. On air. Long U-profile dive to 60 feet. Very slow ascent, 8 minutes at 30 feet and 8 minutes at 15-10 feet on an ascent line. Exactly the same but milder symptoms as in nr 1.
Incident 3. On nitrox 32. 46 min U-profile. Textbook ascent with extended safety stop. Very little tingling that disappeared (mostly or completely) in five days.
So a question to the doc. From an engineer's point of view the most plausible scenario would be that the first incident made my fingertips sensitive to DCS. Is this behaviour plausible, ie tingling goes away with time and pressurised O2 treatment (that was performed far too late) and comes back again months later with exactly the same symptoms on too very conservative dives out of which the nr 3 was ultraconservative.
And, I will see a neurologist and my dive doctor.
BR,
Photographer
Today I had time to really go thru this. I studied all the dive profiles
during the past two years. The summary is that I "cannot" have any problem (or any of them but the pieces do not fit into the puzzle).
Incident 1 : I went thru all the profiles. Nothing special there. I don't understand why I got bent (if I did) in the first place. Especially with the extensive diving history that I have before the incident. But then again I had tingles and numb arm, which are typical neurological symptoms.
Between incident 1 and 2. I did five (and a lot more shallow dives) warm water dives, conservative but with a little bit more nitrogen buildup than the subsequent incident 2 and 3 dives. No symptoms. Also five long very shallow (max 15 feet) dives in freezing cold cold (one in 32F) local waters in a dry suit. No symptoms.
Incident 2. On air. Long U-profile dive to 60 feet. Very slow ascent, 8 minutes at 30 feet and 8 minutes at 15-10 feet on an ascent line. Exactly the same but milder symptoms as in nr 1.
Incident 3. On nitrox 32. 46 min U-profile. Textbook ascent with extended safety stop. Very little tingling that disappeared (mostly or completely) in five days.
So a question to the doc. From an engineer's point of view the most plausible scenario would be that the first incident made my fingertips sensitive to DCS. Is this behaviour plausible, ie tingling goes away with time and pressurised O2 treatment (that was performed far too late) and comes back again months later with exactly the same symptoms on too very conservative dives out of which the nr 3 was ultraconservative.
And, I will see a neurologist and my dive doctor.
BR,
Photographer
Photographer,
Thank you for sharing. As a 58 year old diver, I've wondered when I will have to stop. It looks like it, and hopefully will be at least another decade away, but one never knows. This last weekend a windgust (35 knots) pushed me over into the rocks while coming from in from #1 out of 2 jetty dives. I'm feeling OK, 3 days later, but boy did it hurt and I have the bruises to prove it.
I appreciate your transparency and will look forward to hearing the results from your neurologist and dive doctor.
DrDiver (Clinical Psychologist)
Thank you for sharing. As a 58 year old diver, I've wondered when I will have to stop. It looks like it, and hopefully will be at least another decade away, but one never knows. This last weekend a windgust (35 knots) pushed me over into the rocks while coming from in from #1 out of 2 jetty dives. I'm feeling OK, 3 days later, but boy did it hurt and I have the bruises to prove it.
I appreciate your transparency and will look forward to hearing the results from your neurologist and dive doctor.
DrDiver (Clinical Psychologist)
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I hear we break bones easier at our age, heal slower - and I am trying to be more careful. I was in the back of my pickup changing a garage light bulb yesterday; nearly leaned over too far. That would have smarted.
How many psychologists does it take to change a light bulb? It depends on whether the light bulb wants to be changed.
Don,
I went diving last weekend. Still felt a little sore, but we had a great time. Interesting, that my shoulder started acting up (six days after my "accident") while I was sitting in my office with a patient. Probably a pinched nerve/impingement. Come to think of it, it's on the same side I fell. Diving this last Friday loosened it up - feels better. Or I'm I just trying to convince myself (psychological effect)?
My leg and shoulder are still sore, but getting better.PHOTOGRAPHER,
I do not want to highjack your post. I'm hoping for an update about what is happening to you concerning your neurological signs.
I'll keep checking the ScubaBoard updates.
DrDiver
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