Symptoms Return After Flying: Did the Diver Fly Too Soon?
In this incident, a diver was evacuated for recompression, but flew home sooner than DAN advised, and unfortunately the symptoms returned and persisted for some time. Could this have been avoided if the diver had delayed his flight home?
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 noted that he felt more tired than usual.
The following day, more than 24 hours after his final dive, he felt an ache/burn in his right shoulder. By the time he called DAN on the next day, 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 he decided to call DAN.
The DAN Diving Emergency Service (DES) doctor was not certain the diver was experiencing DCI based on the information provided. The doctor asked the diver to continue breathing oxygen for a few more hours that evening, take ibuprofen and reassess his condition the following morning.
As the diver was in Timor, where there are no chamber facilities, he would need to be evacuated for treatment if symptoms did not improve.
When DAN spoke to the diver the following day, he advised that he had remained on oxygen for an additional six hours the evening before plus another hour that morning. He thought the ibuprofen relieved the feeling of pressure in his lower back but advised the pain in his right shoulder and the hypersensitivity in his shoulder, arm and chest area were still present, along with the discomfort in his right hip. He was also getting waves of pain in his right elbow and had a stiff right little finger. When he attempted some light activities with his clients he felt short of breath and his breathing was difficult.
The DAN doctor advised the diver to see a hyperbaric medicine specialist and that recompression was a possibility. An evacuation to Darwin was impossible — the diver did not have a visa to enter Australia and an emergency visa was not readily available — so the evacuation was directed to Singapore at a cost of USD$34,500.
While waiting for the evacuation the diver breathed oxygen for another three hours and felt much better. In fact, he nearly called DAN to say he was better, but that evening the symptoms returned.
Once in Singapore, the diver’s evaluation resulted in two recompression treatments. His symptoms mostly resolved but he did express to the doctor that he still had shoulder discomfort after treatment. The doctor believed it was not DCS and discharged him from hospital.
Conflicting ‘Do Not Fly’ Advice
The dive medicine 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 informed 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, but to his frustration, improvement was very slow.
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, he did not follow DAN’s advice to avoid flying for at least a week.
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, the advice by DAN factored in the remoteness of the diver’s location to suggest waiting longer than the doctor’s recommendation. Once the diver flew home to Timor, his symptoms reappearing would put him back in the same situation: experiencing DCI in a location that was not equipped with higher level medical care, including a chamber.
Flying aggravated the diver’s condition, as he likely had residual bubbles in his system, and as such it took a longer time for his 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.
You can review DAN’s Flying After Diving Guidelines HERE.