Decompression Illness

Question:

I am a 51 year old female, have been diving for 2 years, logging 335 dives. I dive nearly every day and generally dive with 30% Nitrox.
I just experienced an undeserved "hit" of DCI and am concerned about what happens next and when I can dive again. This is how the dive went. It was an air dive for me.
Began dive, descended anchor line following dive leader to 44.6 m in 2:20 min.
Noticed deep drop so ascended to 37 m in 2:20 min. (dive time 4:40 min.) to conserve air and not incur deco time and continued for another 4 min. (dive time 8:40), now at 32 m.
Realized we missed what we were looking for and turned around and began slow ascent as we finned back to the anchor line in 3 min (dive time 11:40), now at 18 m.
Ascended line at controlled rate, reached 5 m in 4 min. (dive time 15:40).
Did 3 min. safety stop between 5-3 m. (dive time 18:40).
Surfaced, discussed next dive.
Post Dive:
Noticed severe shoulder muscle spasm (cramp) and started to feel "strange" while in the water.
Climbed up the ladder with full gear (minus fins) and still feeling "strange" and felt that my legs had turned to "jelly".
Noted by another on the boat that my face was yellow.
Not expecting to develop DCI, I couldn’t figure out what had happened and thought that the shoulder cramp was at fault. Drove home and noticed my right leg was "warmer" than the left one.
4 hours after the dive I was advised to take asprin. Another two hours later when my right leg still felt "warm" and I felt that I staggered when I stood up, I went to the local hyperbaric chamber.
IV inserted to begin fluids and an Aspirine and Zantac injection.
4 ½ hours in the recompression chamber at 2.8 bar, breathing oxygen at short intervals.
5 hours rest and another injection of Aspirine and Zantac.
3 ½ hours in the recompression chamber at 4.0 bar with 1 ½ hours of oxygen at varying intervals.
72 hours after the incident my right leg is still "warm" though I’m steadier on my feet. Now it is feeling "ticklish," does this mean it’s getting better?
What sort of DCI is this "hit" and how long before I should expect to feel normal and when may I consider diving again?
Thank you. Glad I have DAN insurance!
PS: I did hear of another incident of DCI developing when a diver, after a "safe" dive, experienced a severe muscle cramp as he boarded the dive boat with full gear. He then developed symptoms of DCI. Is there such a phenomena of a muscle spasm contributing to a "hit?"

Answer:
Dear Monica,
although, as you said, this case of DCI can be defined as "unexpected", there are a few things to consider: A - This is very likely a case of spinal cord DCI, with possible transitory cerebral involvement; the early onset of symptons - while still in the water during the ascent - followed by the effort of climbing the ladder with full gear on ( this should always be avoided, like any physical effort after a dive ) and continued with the strange "jelly" feeling in the legs, and the rest of the symptoms you described, are all indicative of the presence of a load of gas bubbles during the ascent, which the effort of climbing the ladder may have "circulated" also on the arterial side. The following outcome of the hyperbaric treatment confirms this opinion of mine. The evolution of your clinical condition seems now regular, and it is quite frequent and relatively "normal" to have a certain persistence of sensory symptoms for a while after hyperbaric treatment.
Are the specialists at the local chamber planning for some continuation of the hyperbaric therapy? Was a specialized neurological evaluation made? A contact with the Hyperbaric Physicians at the chamber would be very useful at this stage, possibly via receiving the full medical report about your case directly from them or through yourself. We will be happy to assist you and to evaluate any further medical document you may wish to send us. Kindest regards
Kindest regards

Question:
Last year my son (12 years) and I (41 years) received our OWD brevet from SSI. After some dives in lakes nearby we went for our family holidays to Hurghuada in Egypt. Diving in such marvelous surroundings is really exciting. However, there is one thing which happened to my son which constantly worries me a bit.
My son suffered during a dive at the Careless Reef at Hurghuada from skin itching on his legs(knees). He was wearing a "Shorty" so his legs and arms were exposed directly to the water. It happened first at a depth of approx.
18 m. I can remember this so well because he is very sensitive about his regulations and limits. His instructor told him that his limit is 18 m and so he didn't ever go deeper. As a result of his skin itching we separated from the diving group and ascended with a safety stop a 5 m. The dive at the Careless Reef was my dive # 31 and dive # 18 of my son.
The previous day we had 3 dives - two during the day and one night dive starting at 8 pm of 44 minutes at a maximum depth of 7.5 m. I have included all diving data from my(!) DataTransPlus. My son was using ordinary equipment but always very close to myself.
After all I wonder if he was suffering from a DCS because of our three dives the day before and the relatively deep dive that day - remember that he is only 12. On the other hand some people told us that there is sometimes some ingredients in the water from the corals causing skin irritations. I do not know the English name for the corals which cause itching on contact - but those are the ones.
I would be very grateful to get some response to my questions because I consider DAN as an organization with high expertise. If you need further information please do not hesitate to contact me.

Answer:
The reported symptoms could be considered as a possible sign of DCI, if they had occurred after surfacing. The fact that the symptoms occurred underwater excludes the Decompression nature of the problem and suggest a marine environment relation, such as the small hydroids or jelly-fish you mention, which is a frequent occurrence in tropical waters.

Question:
Can a mild bend clear itself without recompression?
Recently I took a small group of divers to a Caribbean Island.
On the first dive of the first morning one of the group suffered what was diagnosed by the local doctor as a mild bend but was not send to the chamber. Is this right?
We had an eight hour flight on the Wednesday and on arrival Susie was tired and slept for the remainder of the afternoon. She did not drink alcohol with supper but smokes mildly. She has thirteen lifetime dives, twelve month ago, all in the Red Sea but practiced her skills in the pool on the previous Sunday. She was apprehensive and had not done a backward roll before. The first dive on Thursday morning was a gently drift along the reef. It was very unhurried and laidback and the Divemaster gave and excellent boat and dive briefing, including backwards roll. Max depth was 20m but most of the dive was less than 15m. After 40 minutes Susie felt she was going to be sick and started to ascend, her buddy/husband ascended with her and controlled the rate of ascent. He doesn't yet own a computer but is sure that at no time did they ascend faster than their smallest bubbles. On surfacing she was sick and her husband helper her establish positive buoyancy. The boat picked them up immediately and she got on board, after taking off her kit in the water, still feeling sick. Having received OK signals the rest of us did our safety stop and surfaced 5 minutes later.
Back on the beach Susie couldn't walk, she was carried to a chair and the doctor called. She was not given oxygen at that time as the oxygen kit was on another boat (Not very impressive, I have told the owner he must have one set on each boat and one in the centre). Susie still felt nauseous and said the beach was spinning, she couldn't lie comfortably on her back but laid on her side. We kept her warm with towels. The doctor arrived very quickly and took her away for observation. As she left she experienced twingling feelings in her left wrist and left ankle. Emergency evacuation was put on standby and the chamber, on a nearby island, "fired up". She was kept in hospital was nasal oxygen apparently set at 3 for eight hours and felt better. The evacuation and chamber were stood down. Next day she was released after a check-over and told not to dive for the rest of the week.
She flew home the following Wednesday OK.
Although she was not a DAN member she was insured. Was the doctor right to not put her in the chamber, will a mild bend clear itself?
In future anyone joining my groups will have to be a DAN member.

Answer:
Thank you for your detailed report and for your support to DAN!
Yes, Decompression Illness can sometimes resolve spontaneously, even without recompression. This can particularly happen with certain cerebral manifestations of Arterial Gas Embolisms, as much as this may seem strange, due to the serious nature of the undelying injury.
Mild cases of Pain only DCI can also resolve spontaneously, although usually this takes long.
Eventually even more serious cases of Pain Only DCI will resolve and the symptoms will clear, like any other tissue healing process.
The problem is that healing not always leaves a clear situation behind.
For example, it is accepted that undertreated Pain Only DCI, even if eventually non-symptomatic, can lead to permanent bone damage (Aseptic Bone Necrosis) and it is hypothesized that certain anatomical lesions observed in the Brain and Spinal Cord of Divers can be connected with their history of undertreated episodes of even mild neurological DCI.
Therefore:
YES sometimes DCI can clear spontaneously without recompression, but NO, DCI ( even if only suspected ) should not be left untreated, especially if a recompression facility is ready available.
In the DAN Europe accident statistics we have recorded a few cases which resolved completely and without any residual, either spontaneously or after 100% Oxygen First Aid.
These cases were, however, all taken to a hyperbaric chamber for definitive evaluation and treatment, even if, in a handful of these, hyperbaric treatment was not eventually performed, by the decision of the diving and hyperbaric medicine specialist.
The case you describe, however, may not be Decompression Illness, even if mild.
The fact that symptoms started at depth and did not change significantly when at surface, together with their nature and the relative lack of experience of this novice diver, would rather suggest a motion or anxiety connected clinical situation, although DCI could not be excluded.
It is not surprising that such a condition may improve and clear with reassurance, a tranquil environment, feeling attended to, some time, and some oxygen.
In principle, however, I do not agree with the decision of not sending this diver to a specialized hyperbaric facility, especially if close and already alerted, when a diagnosis of Decompression Illness was made, even if mild and spontaneously resolving.

Question:
I have recently come back from a scuba trip in the Red Sea. After a dive to 30 metres, which my dive computer felt was acceptable, I felt sharp elbow pains like tennis elbow. (The actual profile of the dive was very good and included a safety stop of 8 minutes.) The pains faded over the next four hours and though I did a light dive seven hours later, that seemed to cause no further problems. However, a week later I am still having slight pains in my elbows and occasionally in other joints - wrists/knee. I suspect it is a very mild case of DCS, but I am fairly inexperienced and could just be being a hypochondriac. If it is DCS, is this something that will sort itself out over the next few weeks or do I need to contact the London Decompression Chamber?
Any advise gratefully received.
Thank you,
P.S. I will be flying to Portugal on Thursday. Will this be a factor at all?

Answer:
You are quite correct in suspecting that you have suffered a DCI affecting your elbow joint.
At this stage, after such a long delay, there is little you can do other than ask your GP for medication against the pain and inflammation resulting from the untreated condition after ensuring that it is not due to some other unrelated illness.
I sincerely advise against diving again until the condition is completely resolved and advise you in future to seek medical help early when it will still be possible to treat with recompression.
After such a long delay, I consider it unlikley that flying will alter the state of affairs.