Symptoms return after flying: Did the diver fly too soon?
Divers Alert Network looks at a case where a diver was evacuated for recompression but flew home sooner than DAN advised, and his symptoms returned – could this have been avoided if the diver delayed his flight?
About the dive
A 28-year-old dive instructor completed a long 45m dive on mixed gas with decompression. The next day he completed a dive (on air) to 26m for 65 minutes and afterwards felt more tired than usual.
Symptoms present
The following day, 24-plus hours since his final dive, he felt an ache/burn in his right shoulder. The next day, when DAN was called, he had some altered sensation in his hip and elbow. He had been receiving oxygen first aid for six hours without any significant improvement when the call to DAN was made.
DAN’s advice
The DAN doctor wasn’t certain the diver was experiencing DCI based on the information provided. He was asked to continue breathing oxygen for a few more hours that evening and take Ibuprofen. In the morning, he would be re-assessed.
The diver was in Timor, where there are no chamber facilities, and he would need to be evacuated for treatment if symptoms did not improve.
When DAN spoke to the diver the following day, he had continued breathing oxygen for six more hours, and another hour that morning. He thought the Ibuprofen relieved the ‘pressure’ he felt in his lower back, but said the pain in his right shoulder and the hypersensitivity in his shoulder, arm and chest area were still present. He also had discomfort in his right hip, felt waves of pain flow through his right elbow, and had a stiff right little finger. When attempting some light activities, he had difficulty breathing and experienced shortness of breath.
Evacuation required
The DAN doctor recommended the diver be seen by a Hyperbaric Medical Specialist and told him that recompression treatment was a possibility. DAN determined that the closest facility capable and available to treat this diver at the time of his accident was in Singapore, so DAN began to co-ordinate his evacuation.
While waiting to be evacuated to Singapore, the diver breathed oxygen for another three hours and reported feeling much better.
Treatment
Once in Singapore, the diver was evaluated and ended up receiving two recompression treatments. His symptoms mostly resolved but he still had shoulder discomfort post treatment.
Conflicting ‘Do Not Fly’ advice
The diving doctor advised the diver not to fly for three days, but DAN advised that this was insufficient and that he should wait at least a week before flying back to Timor given the remoteness of his destination.
The diver ended up flying home four days after treatment and upon his return, the diver advised DAN that he was experiencing residual symptoms in his hip, shoulder and elbow.
The DAN doctors advised the diver to continue taking Ibuprofen for several days to help with the residual inflammation, remain hydrated and refrain from exercising or going to altitude. The diver’s condition did not deteriorate further, however improvement was very slow, to his frustration.
DAN comment
While the diver’s symptoms in this case were mild, they were persistent. The diver was evacuated to Singapore and received two treatments, and unfortunately DAN’s advice to avoid flying for at least a week was not followed.
In many cases divers are cleared to fly after three days from their final treatment if they remain asymptomatic. This is often fine and many divers following this advice have no further issues – although a small number will.
In this case, DAN’s recommendation was more conservative than the doctor’s recommendation, as DAN factored in the remoteness of the diver’s location.
It is not surprising that flying prematurely aggravated this diver’s condition, because it is likely that he had residual bubbles in his system. When divers have residual bubbles, it often takes a longer time for persistent symptoms to fully resolve.
This case serves as an important reminder to adhere to the advice of DAN, as our case managers factor in all aspects of a diver’s situation when providing advice.
