Hospital of St John & St Elizabeth WHATISBOBO

All Categories » Bends » Neurological

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I am a diving instructor from Switzerland, I am at the moment in UK in Cambridge where my fiance is from. Last May, I had a bend and had to go three times into the chamber. It happened in the Maldives where I was working. My left hand and the left forearm was numb and I could not feel the difference when the doctor was doing the numb and sharp test. After the treatment the hyperbaric doctor told me to stay out of the water for 2 weeks. I thought it was a bit short but he guarantee me it was fine and as I am diving instructor I could lose my job if I stayed out of the water too long... Anyway after 2 weeks I went back in the water doing very shallow dive max 16 meters and diving with Nitrox.

I was fine, at the beginning I was feeling very tired for doing practically nothing compared to what I am used to doing but unfortunately I hurt my lower back. In September I finished my contract in the Maldives and stopped diving, since September I have not dived and I have done some treatment (acupuncture) for my back and feel much better. In January I am going to dive again as I am a diving instructor and really love my job. I am going to work in Asia.

My question is do you think I should go to see a hyperbaric doctor to do some tests before I go in the water or is it fine as I have been back in the water 2 weeks after my deco ?

Also I would like to know if my body is weaker as I had deco, also I am taking contraceptive pills should I stop?

It would be very nice from you if you could answer those question ands if you need more details, please do not hesitate to ask me.

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This is a real point of debate amongst diving docs. When should you go back in after treatment for a bend. In the UK the regulations from the HSE state that after a neurological bend you should wait for 28 days before going back in. But these are figures really meant for full time commercial divers. In some Navies they will let you back in after only 7 days with a bend like yours, but again here the expectation is that these Naval divers are young and at the peak of their fitness. At our facility in London we generally say 6 weeks off diving but again there is a degree of flexibility. We wouldn't tell a poor old unbent diver to cancel his trip of a lifetime if it was 5 weeks away.

But the bottom line in your case is that 2 weeks off after a Type II hit in a non- Naval diver is too short a time. 4 weeks would have been better. There is another factor here and that concerns the realities of life. All too often a doc will dispense completely unworkable advice, you know the sort. "Oh, just take 2 weeks off work and you'll be fine." "Just ignore your child and it'll learn to behave." That sort of stuff. So there may well be issues in your contract there, the roll on effects of taking time off as well, that may affect a decision to go back in. As I said, there has to be flexibility.

Do you need to be checked over before you go in again? No Neither will you suddenly become bends prone after this incident, and finally only come off the Pill if you want to have a baby, as there is no reason you cannot dive on this in your case.

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At the time I was put on oxygen and after about 30 minutes my sight was fine. I suffered no other symptoms. After a couple of days I resumed diving with no problems.

However - and four years later - on a plane journey yesterday I was sitting at the front of the aircraft right next to the main door. On ascent, I experienced very similar visual disturbances - this time very specific, with arcs and triangles of red and yellow. Clearly this worried me, but it stopped about 25 minutes into the flight. My colleague said it was the first flight where he had experienced a very marked change in pressure. Although the episode passed I would like to know if the two incidents (although years apart - and I have flown many times since) are related, and if you have any advice to give me. I am not one to panic, but this has disturbed me somewhat!

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They could well be related, but there are a few possible causes for these episodes. In the first case this could have been a symptom of DCI as it responded so well to oxygen. In the second, although cases of overt cabin depressurisation are unusual, a similar DCI could happen...

But there are a variety of other possible explanations. Migraine with visual symptoms is not uncommon and bizarrely doesn't always give you a headache. Your arcs, triangles and flashing lights do fit the criteria for migraine with aura, and migraine is often under- or misdiagnosed. Your GP might be able to help if you are getting more episodes. Occasionally floaters and flashing lights can signify an imminent retinal tear or detachment, so a visit to the optician should be top of your list as if caught early these conditions can be treated. There are a few weird and wonderful neurological problems that can present with visual hallucinations but most are rare. Importantly though, if it occurs again after a dive, then get some oxygen and call your nearest chamber.

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