Stage 2 hit, no diving for 6 months

[Dr Deco]

Hello farsidefan:

You should be cautious about quickly returning to diving since it appears from your posts that your neurological DCS did not completely resolve following two hyperbaric oxygen treatments. This indicates that proper neural reconnections have not been made. [This is assuming that there is not excessive injury, and reconnections are possible.]

A DCS incident will not preclude you from further diving. [For scientific diving, DCS with unresolved neurologic sequelae is a different matter – this is serious.]

What Happened?

You indicate that nitrogen gas loads were not excessive. A possibility is that venous bubbles formed, and they were arterialize. This arterialization could have resulted from:

- - Pulmonary overload [too many gas bubbles in the capillaries of the lungs], or

- - A PFO and a temporary pressure reversal of the normal L-R pressure gradient, or

- - “Valsalva-like maneuvers” [pulling, straining, coughing] that led to passage from the venous to arterial side.

All of this can be exacerbated by too much physical activity.

Now What?

If you did not overly load nitrogen in you tissues, or run around excessively topside, or perform Valsalva-like maneuvers then you could have an anatomical problem [PFO or pulmonary vessels]. The PFO could be repaired but it is usually easier to dive more conservatively.

Hydration

This is not usually a big player in the normal recreational diver. It has been investigated, and results show that very dehydrated animal subjects have a higher risk of DCS – and this includes neurological DCS.

Gempp E, Blatteau JE, Pontier JM, Balestra C, Louge P. Preventive effect of pre-dive hydration on bubble formation in divers. Br J Sports Med. 2009 Mar;43(3):224-8.

Fahlman A, Dromsky DM. Dehydration effects on the risk of severe decompression sickness in a swine model. Aviat Space Environ Med. 2006 Feb;77(2):102-6.​

Dr Deco :doctor:

 

[farsidefan1]

Thanks for the input (except you Thass, I don't want to be done )As to the cause we (the doctor and I )concluded that dehydration was the primary culprit for the following reasons; 1) I take a water pill for hypertension. Usually I stop taking it during dive trips to avoid dehydration. This trip I spaced it and continued medication. 2) The evening before my 4 dive day I walked into town. It was very hot and humid. I'm from Utah and we joke that high humidity is anything in double digits. I was totally worn out by the time I got back to my room. Probably put in 7 miles walking. Again exasperating my dehydration.

Note: In 140 previous dives I had No problems. Been on liveaboards, been to resorts where with shore diving I was putting in 4-5 dives a day 4 or 5 days in a row(always mindfull of my computer, no silly efforts to trick it). If I had a weakness or propensity toward getting bent one would think it would have shown itself sooner. I think I'll limit myself to 3 per day from here on out with long surface intervals but a total ban seems, well, no fun. I'm not going to quit. I will stay out of the water except for my one dive in shallow Hawaiin waters for the manta dive, till next June. These responses are very educational. Yes even you Thass, actually I really appereciate your input. I have a great deal of respect for your knowedge and that of others here. As far as I know after the second chamber treatment I had no further problems. The neurological involvement was determined as I could't walk a straight line nor follow the doctors moving finger to his satisfaction (I thought I did fine on that one lol). this was Tuesday night and Wednsday. I was cleared to return to my room Wed night but he asked to see me Thrus and Friday morning to verify I was ok to fly home Saturday. I passed so I know of no further problems after the second chamber treatment. Since I don't know anything about spinal bends I assume I had no problem of that severity. The problem was never discussed. My obvious symptoms were pain all over my stomach and chest (yeah, where most my fat lies) and the light blue skin which DAN was caused by nitogen bubbles breaking the capilaries. Since then I have joined weight watchers (sigh) and upped my exercise routine although actually I was doing well on that part. Before dive trips I swim 1.5 miles 3 times a week and mountain bike 2=3 times per week. Weight lifting is also done 3 times a week although in moderation. My resting pulse is in the mid to low 50s with blood pressure of 130 over 70 most days. The swimming is done for 6 weeks prior to dive trips. The other workouts are yr around. In summary, no apparent propensity (too many prior diving trips with greater intensity) and 2 hydration factors. That's where it is at. The doctor was excellent and very experienced,. Dr. Pascual Piccalo in Coz. We concluded hydration was the most likely problem but there is no smoking gun. No definitive proof. I hate that. Hence my question to your collective knowledge. Thanks again. Jay

 

[farsidefan1]

Dr. Deco, I especially liked your experienced thoughts. Especially since they match what I went through and give me at least a carefull ok to keep diving albeit at a more moderate rate. I do kind of go crazy, never missing any dives while on a dive vacation, I mean, it's a DIVE vacation That will change in the future. I'll be a kinder gentler Jay to the ocean. But geez, I didn't start diving till I was 56, so much water, so little time.

 

[Rick Inman]

This is an interesting discussion, and just goes to show that there is no definitive absolutes in hyperbatic medicine, and that your mileage really may very.

I took a Type II hit, and after the treatment the doc gave me a very shoulder-shrugging two weeks off, suggesting that I could probably get back in the water the next day without problems. But then, my symptoms were completely resolved after one ride. In fact, my symptoms complete disappeared in the first 30 mins of treatment, and I spent the remainder of the ride relaxing and watching movies through the glass.

The cause of my hit was obvious. I was within NDL's, but did everything else wrong (dehydrated in freezing cold water, had to urinate badly, exercised immediately following the dive, and then went home and took a long, roaring hot shower ).

So I was diving 2 weeks later. Back then I was rec only, but since then I've done hundreds of dives, many of them deco dives, as deep as 300', and never had another symptom.

Just goes to show that no 2 hit are alike and different people will have different results to treatment and different post-treatment recommendations.

Hope you are 100% and back in the water soon!

 

[robint]

Thanks for the input (except you Thass, I don't want to be done )As to the cause we (the doctor and I )concluded that dehydration was the primary culprit for the following reasons; 1) I take a water pill for hypertension. Usually I stop taking it during dive trips to avoid dehydration. This trip I spaced it and continued medication. 2) The evening before my 4 dive day I walked into town. It was very hot and humid. I'm from Utah and we joke that high humidity is anything in double digits. I was totally worn out by the time I got back to my room. Probably put in 7 miles walking. Again exasperating my dehydration.

Note: In 140 previous dives I had No problems. Been on liveaboards, been to resorts where with shore diving I was putting in 4-5 dives a day 4 or 5 days in a row(always mindfull of my computer, no silly efforts to trick it). If I had a weakness or propensity toward getting bent one would think it would have shown itself sooner. I think I'll limit myself to 3 per day from here on out with long surface intervals but a total ban seems, well, no fun. I'm not going to quit. I will stay out of the water except for my one dive in shallow Hawaiin waters for the manta dive, till next June. These responses are very educational. Yes even you Thass, actually I really appereciate your input. I have a great deal of respect for your knowedge and that of others here. As far as I know after the second chamber treatment I had no further problems. The neurological involvement was determined as I could't walk a straight line nor follow the doctors moving finger to his satisfaction (I thought I did fine on that one lol). this was Tuesday night and Wednsday. I was cleared to return to my room Wed night but he asked to see me Thrus and Friday morning to verify I was ok to fly home Saturday. I passed so I know of no further problems after the second chamber treatment. Since I don't know anything about spinal bends I assume I had no problem of that severity. The problem was never discussed. My obvious symptoms were pain all over my stomach and chest (yeah, where most my fat lies) and the light blue skin which DAN was caused by nitogen bubbles breaking the capilaries. Since then I have joined weight watchers (sigh) and upped my exercise routine although actually I was doing well on that part. Before dive trips I swim 1.5 miles 3 times a week and mountain bike 2=3 times per week. Weight lifting is also done 3 times a week although in moderation. My resting pulse is in the mid to low 50s with blood pressure of 130 over 70 most days. The swimming is done for 6 weeks prior to dive trips. The other workouts are yr around. In summary, no apparent propensity (too many prior diving trips with greater intensity) and 2 hydration factors. That's where it is at. The doctor was excellent and very experienced,. Dr. Pascual Piccalo in Coz. We concluded hydration was the most likely problem but there is no smoking gun. No definitive proof. I hate that. Hence my question to your collective knowledge. Thanks again. Jay

I am no doctor but that doesn't sound like neurological hit, it sounds like skin bends. I know several people who have gotten skin bends hits, one was a 15yr old kid in excellent health, and none were ever told they had to give up diving.

The kid got it, BTW, in cozumel free diving during his SI. The DM actually did it and said it was okay (what a moron) and this kid as well as another woman got bent and ended up doing chamber rides there. The kid's parents didn't realize he was bent, just a bluish rash on his back that got bigger day after day. They finally took him to the doctor after 4 days when they heard about the lady having same symptoms.

Also, many of the people who get skin bends have PFO, from what I have read.

Six months seems a long time to me, but I think I have read other's reports and it sounds like what they all said.

robin

 

[The Surly Mermaid]

Farside....

I also took a Stage 2 hit this past weekend and spent 6 hours in the chamber. I was also WELL within computer limits(air profile/breathing 32) and no fast ascents (we were doing Cavern training). Was overly cold and a bit dehydrated according my husband (although I was no less hydrated than I usually am for diving - but he and I can continue to disagree on that point). My symptoms did not appear until the next day and were numbness, tingling so I thought I had a pinched nerve. Ended up with also being lightheaded but I thought that was due to being nervous about the numbness. Did not end up in the chamber until the following afternoon. Like they say the first symptom of DCS is denial.
My question is this... I am still having sporatic tingling, numbess, fatigue, lightheadness. Did you (or any one else reading that has had a Type 2 hit and treating) have that after your treatment? If so are you still experiencing it? I've already called DAN and they said that the 1 ride 6 hour treatment (2 extensions at 60) was more than enough to rid me of any bubbles, and I don't need another round. Just curious about your "post chamber" experience.

 

[Jax]

Type II DCS is more neurological related as opposed to Type I, which is musculoskelatal. Type II has been linked to medical conditions such as a PFO, so my first question would be whether or not you've been checked for that.

"PFO" stands for what, please?

 

[The Surly Mermaid]

"PFO" stands for what, please?

Patent foramen ovale

While a baby grows in the womb, there is a normal opening between the left and right atria (upper chambers) of the heart. If this opening fails to close naturally soon after the baby is born, the hole is called patent foramen ovale (PFO).

From what I've read people with PFOs seem to have a higher risk for DCS.

 

[Lopaka]

From what I've read people with PFOs seem to have a higher risk for DCS.

I think it is way past "seems" to have a higher risk. Have not kept up on the literature very well, but what I have seen is the correlation with hits is quite clear, particularly with cerebral hits, where one paper apparently (not available to non-subscribers) implying the cause of "inner ear DCS" was not a bubble in the inner ear structure as thought, but a brain infarction. Pardon my lay use of terms.

Another paper was the correlation of PFO and inner ear DCS. This is my little nightmare I have lived with.

Looks like research is moving fast with PFO issues and diving. This is good, and it is good so many divers are becoming familiar with it. Getting it fixed is no big deal these days, unlike ten years ago, and it is possible to get insurance to pay.

/off soap box

 

[The Surly Mermaid]

I think it is way past "seems" to have a higher risk. Have not kept up on the literature very well, but what I have seen is the correlation with hits is quite clear, particularly with cerebral hits, where one paper apparently (not available to non-subscribers) implying the cause of "inner ear DCS" was not a bubble in the inner ear structure as thought, but a brain infarction. Pardon my lay use of terms.

Another paper was the correlation of PFO and inner ear DCS. This is my little nightmare I have lived with.

Looks like research is moving fast with PFO issues and diving. This is good, and it is good so many divers are becoming familiar with it. Getting it fixed is no big deal these days, unlike ten years ago, and it is possible to get insurance to pay.

/off soap box

Yeah... I haven't done enough research to use a word stronger than 'seems' LOL. I'm having an ECHO I had done a few years back pulled to see if I have the same issue. Have to have it checked before they will clear me to return to diving.