What happened to me?

[clgreenmd17]

I am a family physician and Aunt of this diver. Since positng this history he has had minimal symptms. However he has had a few episodes of parasthesia, fasciculation and sharp pains since he has posted this history. Most of these, but not all have occurred with altitude change. They are mild and occur every 2-3 weeks.

My dilemma is this patient had Lyme disease in 1989. B burgdorferi the Lyme bacterium is known to invade the CNS and have an L form that is inert and can become active some years post the initial infection. Antibody titers suggest this may have occurred, but the distinct relationship of symptoms with the pressure changes is not typical of Lyme. HOwever some doctors feel Hyperbaric 100% O2 at 2.5 atmospheres has the capacity to kill the bacterium and in this regard could also resul in influencing the steady state.

Any further comments given this information?

"The most common manifestations of DCS are joint pain and numbness or tingling. ...Severe DCS is easy to identify because the signs and symptoms are obvious. However, most DCS manifests subtly with a minor joint ache or a paresthesia (an abnormal sensation like burning, tingling or ticking) in an extremity."

From this citation:
http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=65

(see paragraph 1 of Section V - Denial and Recognition)(emphasis added)

See also "Skin Bends".

The recurrence of symptoms during aircraft transportation is also suggestive.

(I'm not a medical doctor, and this constitutes nothing more than speculation based on the symptoms you described correllating to defined symptoms.)

I'd keep on talking to DAN. Sounds like you overdid it a bit on your trip. It may be prudent to do some more reading on the topic, so that during your next trip you're tracking things like exertion and fatigue as well as nitrogen loading and SI.

If you're up for a little in-depth reading about what happened to you, here is an excellent place to start:
http://www.immersed.com/Articles/PDFs/hit.pdf

Hope this helps.

Regards,

Doc

 

[clgreenmd17]

I am a family physician and Aunt of this diver. Since positng this history he has had minimal symptms. However he has had a few episodes of parasthesia, fasciculation and sharp pains since he has posted this history. Most of these, but not all have occurred with altitude change. They are mild and occur every 2-3 weeks.

My dilemma is this patient had Lyme disease in 1989. B burgdorferi the Lyme bacterium is known to invade the CNS and have an L form that is inert and can become active some years post the initial infection. Antibody titers suggest this may have occurred, but the distinct relationship of symptoms with the pressure changes is not typical of Lyme. HOwever some doctors feel Hyperbaric 100% O2 at 2.5 atmospheres has the capacity to kill the bacterium and in this regard could also resul in influencing the steady state.

Any further comments given this information?

Hello seaweedsteve :

I certainly not tell you what occurred, since I was not there. However, I can give some ideas based on my research experience.

Dive profile

Thoughts:

• While gas loading is a very important aspect of DCS, if one is within the boundaries of the model, problems should not arise in the vast percentage of divers.
• Gas loading analysis is a historical fact with diving, and virtually all analysis of injury will reflect this type of thinking. It is a poor analytical tool and will not explain most DCS problems.
• The fact that others dived this profile without problems is an indication that gas loads were not at the root of the problem.

Activity Level

I suspect this factor because:

• There are no real NDLs; they are all exercise dependent.
• Physical activity is the best way to generate a free gas phase [= bubbles] when you have a supersaturated condition.
• You do in fact indicate that you went for a surface swim. You are now aware that this is not a good idea.

Arterialization

It sounds to me as though you were experiencing problems associated with gas bubbles coming from the venous side into the arterial side. As a new diver, you were not aware of a potential anatomical problem.

• These bubbles were generated in a large measure during the surface swim.
• Somewhere along the line, gas bubbles passed into the arterial system. This is either through lung capillaries [pulmonary shunts] or a PFO. This could have been assisted by Valsalva-like maneuvers, e.g. during swimming.
• The persistence of effects is, I suspect, partially a result of capillary blockage and partially from secondary biochemical effects of the bubbles themselves.

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Dr Deco]

Hello clgreenmd:

Looking at some material on the internet, it does appear that elevated oxygen is unfavorable to this particular species of bacteria. The general problem with hyperbaric oxygen is that it often is not at a very high partial pressure in the particular volume of tissue where it is most needed. This is a result of metabolism of this gas as it diffuses to a particular volume of tissue.

Arterial oxygen tensions can always be easily estimated, but, once oxygen leaves the capillary, there can be a considerable decrease in partial pressure depending on the diffusion distance and the metabolic activity of the particular tissue through which it is diffusing.

In addition, one is dealing with a disease with a highly variable in its course. This makes the determination of efficacy very difficult. :xeye:

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology is September 10 – 11, 2005 :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm