Is It Diving-Related Illness? Symptoms After Scuba Diving - Diving Medicine

Dr. Lin Zhengyan reply Diving Medicine

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Hello, based on your description, you may have decompression sickness (also known as "the bends").
When ascending to the surface after diving, the water pressure on your body gradually decreases (as pressure decreases, the amount of nitrogen gas that can be dissolved in body tissues also decreases).
It is necessary to ascend slowly following a specific decompression procedure to allow the excess nitrogen gas in your body to be released from the tissues at various depths and then expelled through the lungs.
If a diver ascends too quickly or fails to follow the stepwise decompression procedure (similar to opening a shaken soda bottle, where gas bubbles rapidly escape), nitrogen dissolved in body tissues can form bubbles, leading to decompression sickness.

The pathophysiology of decompression sickness involves breathing high-pressure air for an extended period in a high-pressure environment (greater than one atmosphere).
If the diver ascends without following the normal decompression procedure, nitrogen dissolved in body tissues can form bubbles that fill various tissues and organs.
This can cause vascular embolism within blood vessels or stimulate the release of vasodilators in tissues, increasing microvascular permeability and leading to tissue edema, ultimately resulting in ischemia and hypoxia, which can manifest as various clinical symptoms.
The clinical symptoms of decompression sickness can be categorized into Type I (mild) and Type II (severe), with symptoms potentially appearing singly or in combination.
Symptoms of Type I can evolve into those of Type II, and Type II often includes symptoms of Type I, such as skin rashes.
Symptoms of Type I decompression sickness include fatigue, itching, skin rashes, localized edema, and joint and muscle pain.
The most common symptom in this type is pain in the limbs and joints, which may be described as aching or sharp and can sometimes be migratory.
Type II refers to more severe symptoms that affect vital organs.
For instance, if the brain is affected, symptoms may include headache, blurred vision, loss of consciousness, and limb numbness or weakness; if the lungs are involved, symptoms may include cough, chest pain, and difficulty breathing; if the inner ear is affected, symptoms may include dizziness, nausea, vomiting, and unsteady gait; and if the spinal cord is affected, it can lead to numbness or weakness below the navel and difficulties with bowel and bladder control.
Symptoms of Type II decompression sickness include:
(1) Central nervous system: headache, dizziness, nausea, vomiting, facial droop, speech difficulties, altered consciousness, personality changes, stupor, coma, seizures, and death;
(2) Vision: blurred vision, double vision, hemianopia, blindness, and dilated pupils;
(3) Hearing and balance: tinnitus, hearing loss, vertigo, vomiting, and nystagmus;
(4) Sensory nerves: numbness or tingling in the limbs, facial nerve paralysis;
(5) Motor nerves: weakness in the limbs, unsteady gait, hemiparesis, and coordination difficulties;
(6) Spinal nerves: back pain, abdominal pain, diarrhea, lower body paralysis, and incontinence;
(7) Other neurological symptoms.
(2) Respiratory system: dry cough, shortness of breath, chest pain, rapid heartbeat, and hyperventilation.

(3) Cardiovascular system: chest tightness, chest pain, and shock due to myocardial hypoxia.

(4) Severe muscle and joint pain during ascent.
The diagnosis of decompression sickness is primarily based on the following points:
(1) The likelihood of decompression sickness is low if the dive depth is less than 10 meters (meaning the dive must exceed 10 meters), and most cases have a history of rapid ascent to the surface or failure to perform decompression stops.

(2) Any of the aforementioned clinical symptoms appearing within 48 hours after diving, with approximately 85% of neurological symptoms occurring within one hour after surfacing.
Any symptoms occurring during or within 48 hours after diving should be considered decompression sickness.
If decompression sickness is suspected, hyperbaric oxygen therapy should be administered as soon as possible.

Based on your diving history and symptoms, decompression sickness is the primary consideration.
Although your last dive was two weeks ago, bubbles can persist in the body for an extended period.
It is recommended that you seek treatment at a hospital with a diving medicine department (or hyperbaric oxygen therapy unit).

The recent frequent episodes of chest tightness due to mitral valve prolapse are, in my opinion, unrelated to diving.
If you have any unclear points, please call (08) 8881238 or 0929153628 between 8:00 AM and 5:00 PM.

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Reply Date: 2006/07/05