A Cautionary Tale, by Jack MacLoughlin
Several years ago, I was diving at Vobster and noticed pins and needles in my hands afterwards which lasted for a number of days. I put this down to diving in cold water with 3mm gloves and with newly replaced and therefore tight wrist seals. However, after one of my buddies mentioned someone he knew getting a bend under similar circumstances, I phoned the Royal Navy Doctor for advice. Given the dives were mostly shallower than 10m, I was told a bend was unlikely and they would call back in a few days for a update. I was diving again the following weekend and everything was back to normal.
One year later, I was diving the Salsette in Lyme Bay. 34 minutes bottom time at an average of 42m, max 45m. The ascent went to plan until we got to 9m. I was faffing around with equipment and therefore late realising the team were moving up to 6m which seemed a little early. By the time I realised we had skipped a couple minutes we were nearly at 6m. However it didn’t seem worth dragging the team back to 9m for the sake of 1-2 minutes. As we approached 6m I noticed tingling in my hands which was a slight concern. Once we settled down at 6m the sensation went away and everything seemed fine. After surfacing I felt great – most likely due to the late afternoon ropes off and continued as normal.
Approximately 3 hours after surfacing from the dive on the journey home, I noticed pins and needles ranging from the tips of my fingers to my elbows on both sides. At the time I was trying to eat a sandwich while driving the car (not recommended!) so it seemed possible I was just tense trying to hold too many things at once. I also had occasional aches in my right hand where I was holding the steering wheel. It’s worth mentioning in the past I have suffered repetitive strain in my wrists and fingers, particularly when I was at university spending each day sat at a computer, so I didn’t think too much of it.
Once I was home and unpacked the car I thought back on the dive, including the tingling sensation when moving from 9->6m and how it hadn’t improved. Baring in mind I had this experience once before and was advised a bend was unlikely, I decided to wait and see how things went. The next day at about 3:00pm I was filling in my log book, still experiencing pins & needles, thinking about how I wasn’t really all that happy with the dive profile. I decided to give DDRC a call simply to put my mind at ease, expecting similar advice to the time I called before with the same issue.
The operator asked where I had been diving, what symptoms I was experiencing and the depth of the dive. As soon as I said 45m I was told to come by straight away. On arrival I realised I was the only patient in the building and all the staff already knew my name. It was a strange experience – all this attention for what seemed like the most minor of troubles. I met with one of the doctors, filled in some paper work and completed a neuro exam. My parents in the waiting room were told I would be going for recompression before the exam had finished, I presume the caution was related to the depth of the dive. The exam was going well until I was asked to differentiate between sharp and blunt impact on my arms and fingers. In particular on my left forearm I couldn’t really tell the difference at all.
It was decided I would be following a U.S. Navy Table 6. On the descent I waiting for improvements, in some ways hoping they wouldn’t come as I really didn’t want to have DCI from a relatively conservative dive. Throughout recompression I felt no improvements at all, so two extensions were added giving vaguely around 6 hours in the chamber. Afterwards, shortly before midnight I was met by two doctors to discuss the situation – I still had the same pins & needles as before. Apparently if I had called in sooner it would be easier for the team to rule out DCI. As I had left it 24 hours before calling, the bubbles would be considered long gone and symptoms would be related to inflammation caused by a bubble. At least, this was my understanding of what was explained to me – there was a significant language barrier between myself and the main doctor I dealt with throughout treatment although this was more than made up by his extensive knowledge. The plan was to go home, have a good nights sleep and come back first thing for further examination and possible recompression. By the time I got home and fed, I had 3 ½ hours to sleep before getting ready to leave for Plymouth again.
The next morning I still had pins & needles ranging from my finger tips to elbows, no better or worse than before. At this point one of the doctors mentioned how divers swim with their necks extended and heads pushed back, causing strain on the neck. This being especially true for technical divers in an attempt to trim out by pinning their heads to the manifold. We also discussed my history of repetitive strain including occasional ache in my back and shoulders. As a computing student, incorrect posture behind a computer and possible strain were also considered in causing a neurological problem.
The team seemed rather unsure what to make of the situation but as a number of NHS referred patients were going for routine 2 hour oxygen therapy that morning, I could join them and see if there was any improvement. There must have been around 10 of us in the chamber this time. Witnessing amputees, patients with throat cancer and diabetics lacking the circulation for wounds to heal, I felt very lucky to be there with only mere pins & needles to put up with.
As expected following a second recompression session, symptoms remained unchanged. The team now felt DCI was fairly unlikely without completely ruling it out as a possibility. I have been told to wait for the symptoms to disappear before diving again but there is no 3 month ban I was fearing. If the problem reappears I am advised to see a neurologist and possibly have an x-ray and MRI. One of the doctors did stress if this is a reoccurring issue I need to find out the cause. At 23 I shouldn’t really be experiencing neurological problems. It could also cause complications with diving, masking a bend or even increasing the chances of a bend depending on the cause. To be honest though I’m just very relieved that it appears I have not had a DCI hit and can continue diving this summer.
The guys at DDRC were absolutely incredible. I have never felt so welcome by people I have never met before in my life. If I am ever asked to recommend a charity for whatever reason, it will take a lot to compete in my mind with DDRC.
What have I learned from this?
- Well I already knew there were no hard and fast rules with DCI but I guess over the last few days this was taken further. One of the doctors told me it’s becoming rare that he sees the typical symptoms of DCI such as an aching elbow and instead witnessing far more unexpected symptoms without elaborating further. Also my assumptions about DCI regarding type 1 vs type 2 symptoms and their corresponding causes such as a bubble in a particular body part were too black and white than reality if that makes sense.
- Although I was right in assuming I did not have a bend, I achieved nothing by waiting 24 hours before making the call. Had I called the moment I arrived home, I would have made diagnosis easier for the team and perhaps not needed the second recompression. If I did in fact have DCI, who knows what damage could have taken place while I delayed treatment.
- I’m very grateful for the DDRC and for the fact that the vast majority of my diving takes place in UK waters. While I was in the chamber I wondered what would have happened had I had a serious bend and been in another country or even just the far side of the English Channel.