Diving after DCI

Question:
I am writing for your advice. I know it is still early in the course of my recovery. I have been given very wide ranging advise on my recovery time from 2 weeks to 6 months.
Since my hyperbaric treatment finished last Thursday I have been relaxing and not doing anything strenuous. For the first couple of days my right arm and shoulder felt quite tired from doing normal things. The last couple of there has been a big improvement.
Obviuosly, I shan`t be able to dive for some months. Would it be advisable for me to work in a swimming pool max depth1.9m for max time 40 mins. Maybe once in a day.
There will be a diving Dr available for consultation here in Dec. Please however give me your advice based on the information you have.

Answer:
I can give you the following brief and general advice:
It is advisable for you to refrain from strenuous diving for at least three months Diving in a pool, as you describe, should be no problem, as soon as you feel well and normallu functioning In three - four weeks, if you are well and your clinical and neurological
condition is normal, shallow diving, within 10 meters and 25 minutes max, should equally be no problem.
For the future and you professional diving life:
It will be good to avoid aggressive and excessively repetitive diving, as a general good preventive medicine practice It is proven that respecting a no diving interval day every three-four diving days reduces the undeserved DCI risk greatly.
Diving deeper that 30 meters involves a six-fold increase of the risk of undeserved DCI.
Always remember to keep yourself well hydrated before, between and after your dives Always remember to dive deep-to-shallow, within the same dive as well as on repetitive dives, and not viceversa.
Avoid Yo-Yoing underwater and always ascend slower than 9-10 meters per minute
If at all feasible, you may consider nitrox for yourself, while accompanying your compressed air diving customers, and following air diving time / depth profiles and rules.

Question:
I just need a medical advice about the following:
what is the minimal stay (time) for a people who get decompression sickness (suspicion of air embolism) with neurological trouble and was treated in a decompression chamber (15 m / 4h35) before diving again ?

Answer:
After a neurological decompression illness, with no sequelae, the current recommendations vary from 7 days to six months and more depending on the issuing organisation.
The matter, however, should not be dealt with in this way.
Resuming diving after a neurological decompression incident depends on the level of the neurological injury ( cerebral, spinal, neuromotor, neurosensory ), on its severity, on its mechanisms ( arterial air embolism due to pulmonary overexpansion, spinal cord injury, other..), on the level and amount of recovery / permanent sequelae, and on how much the neurological decompression injury was "deserved" / explainable.
Generally speaking an asymptomatic diver with no significant sequelae and normal neurological functional tests could safely return to dive after a relatively short interval from the hit.
The currently accepted approach of the diving medical doctors is to advice the injured diver to refrain from diving for a period of approximately three months after the full recovery from a "deserved" neurological decompression injury, in the absence of any detectable DCI-predisposing disorder or condition.

Question:
Three years ago a young female suffered from a strike of DCI II mit multifocal neurological disorders, stemming from more or less Kamikaze diving in the read sea. The history of dives is more like a criminal story. After 8 dives she did a rescue attempt for a fellow diver to 52 meters getting the person up to 30 meters where he started to struggle an kicking the lady, at which time she was well into deco. Now she had her vest filled, carriing both her and the sunken victim. letting him go she zoomed to the surface, getting nausea vertig and headache, directly went down to 30 meters emtiing th vest and started ascendig to the deco bar for 15 minutes at 5 meters. On the boat she dedided not to tagk oxygen despite symtpoms. Now , next day still having symptoms she decided to do 2 dives, under water symptoms where better. 1 dive to 36 meters, next the same day 69 (!) meters. Following night symtpoms increased, one day later seh flew home, again increasing symtpoms. (last dive 31.jan, flight home 2.2.) With strong symptoms the treatment started finally at the 3.feb..... with 90 minutes HBO (!). she underwent treatment 84 times (!) leaving her with, as seh says no symtpoms now after 3 years. The letter of the physician is full of mistakes and I believe wrond diagnosis.
The Question she now is asking, is she fit for dive or not. In my opinion NO but since she is a very nice lady I would like to ask your help.
Again the gallery of symptoms she had: Verigo, Nausea,Dysasthesia orally, in the upper extrmitis with loss of power, paraesthesia of left mamma, labia majores, loss of bladder control, change of personalitiy, depression.
Impairment of cranial nerve glossopharyngeus, spinal ischämia C2/3 and TH4 according to neurologist. and last not least adynamic bowl problems.
This is a true story, according to Edmonds and Lowry a person who sufferd DCI II might bei diving up to 9 Meters.
What is your opinion.?

Answer:
The DCI case described is:
A) More than deserved
B) Benign in nature considering the very good response to treatment C) Apparently well and completely healed, considering the reported present clinical condition.
What I would do is a thorough clinical assessment, including MRI and CAT scan of the brain, spinal cord and lungs, SSEPs, VEPs, Electronystagmogram, a full audio-vestibular clinical evaluation, a TEE Doppler evaluation for PFO (unlikely however), on top of the usual fitness to dive evaluation.
If the results are OK, there would seem to be no reason to declare this lady unfit.
Perhaps one could then suggest some more prudence in her future diving and hope that she learnt the lesson!

Question:
After my second diving accident the diving doctors signed a letter "no more diving".
Now the insurance company (not the DAN one) says that I knew that after a second diving accident it is always "no more diving". According to my information there have been case after three time, so it most not be a general rule for this. For the insurance company we need a letter which is stating it like this, if this is the case. The thing is we need a statement if it is always the case "no more diving" after a second diving accident or if it is depending from case to case.
We would like to have a independent opinion about this matter by DAN Europe.
Hope this is enough information for you to do something with this.

Answer:

 

To answer your question, it would be helpful to know in detail the arguments of the insurance company.

 

In general, a repeated diving accident does not (repeat: not) necessarily mean "no more diving at all"!

 

For example: if anybody has repeated "bends only" (decompression sickness type one), and had strange dive profiles before (e.g. yo-yo, rapid ascent, deco dives without deco stops etc.), which can and will explain his/her bends, then he/she might continue diving, but should start thinking when diving!

 

In your case, we did not find any clear explanation for her symptoms, and in the second time, her symptoms proved to be resistant to decompression therapy, initially. These are the reasons why, in this particular case, we had to say "NO".