Approach Post-DCS Therapy With Care

Despite notable advances by various medical insurers and professional organizations, recompression treatment and, even more so,  hyperbaric oxygen therapy (HBOT)  remain open to abuse by uninformed, unqualified and unscrupulous practitioners. The following inquiry I received a while back is a prime example:

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Dear Doc,

My friend was treated for DCI in Belize. He complained of weak legs, numbness of the feet, restless legs and problems with elimination. After seven chamber treatments, he was told to get examined after returning to the U.S. It is now four weeks later and he is in his second of 10 scheduled hyperbaric sessions, as recommended by the doc he is currently
seeing. The sessions are 2-3 hours each, at less pressure than his original treatments. The possibility remains that more sessions may be recommended. He had a CT scan of the head and MRI of the spine, and these were read as normal. The doc is saying he has tissue damage and that further treatments will be helpful. He states he is improving, gaining strength in his legs, and the bowel and urinary symptoms are gone. I wonder if this is usual treatment for residual effects of DCI?

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To which I replied:

If  I’m reading this accurately, it appears your friend initially underwent a series of recompression treatments in Belize for a significant case of spinal DCI. Since returning to the States over a month ago, he has been
undergoing a large number of additional chamber treatments for extended times at lesser pressures.

It appears that your friend is now undergoing HBOT rather than recompression treatment, although these do share commonalities. If so, to the best of my knowledge this is not the usual treatment for the residual effects of DCI. In some rare cases of severe neurological DCI, recompression treatment proper may long exceed typical protocols, and be continued until no additional improvement is observed, reported or expected. Such extended treatment is carried out by a recognized expert in hyperbaric medicine and often entails intense, protracted and often not successful battles with insurance companies not disposed to pay for an expensive and atypical course of therapy.

You indicate your friend is continuing to improve. While it cannot be said with confidence that HBOT is responsible for his gains as opposed to spontaneous healing, it seems possible it may be making a contribution. In any event, the HBOT is unlikely to do any harm.

Since recompression treatment and HBOT are open to abuse by the uninformed and unscrupulous (and I’m not saying this is the case here), the first thing your friend will want to do is ensure that he is under the care of a reputable hyperbaric medicine physician.

BTW, who is paying for all of this relatively costly treatment? If Divers Alert Network or another diving accident insurer is involved and has approved of this plan of care — which strikes me as quite unlikely — then the level of concern regarding unnecessary therapy would be reduced.

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The inquirer followed up with this:

My friend contacted DAN when we returned to Alaska. We live in Fairbanks and there is definitely no one here who knows diving medicine. They gave him the name of the recompression chamber in Anchorage. He called the chamber and I think spoke to the owner, who then recommended this doctor. I personally felt a little concerned as he told me both docs had the same last name. I also felt more concerned when I learned the recommended doc was a family practitioner who lives in a rural area and only comes into town once a week. He recommended all these treatments and set up an appt a week later. The doc had ‘a lapse in memory’ and did not show up for my friend’s first appt, and did not remember what he had told him. The next day, when asked about his qualifications, he said he was consulting with a diving specialist in Hawaii.

Is there a national or state listing of qualified dive-medicine doctors? Is there a certification to become a specialist in it? Is there any way of checking on this doctor’s qualifications?

As to your question concerning payment for all this: When I learned what was recommended for my friend’s treatment, I told him to personally call his insurance company and ask if this would be covered and if it would be necessary to get preauthorization. I don’t know if he did or not. He has a major medical policy that kicks in after $10,000. His doctor stated it would be covered. Now I am not so sure about any of this.

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My reply:

Frankly, I’m not liking the smell of this seemingly interminable HBOT by a professional of uncertain qualifications and reliability. A primarily semi-rural family practitioner who allegedly is consulting with an unnamed diving medicine expert in Hawaii generally would not be the type of doctor to handle follow-up care for the residual effects of serious neurological DCI. Does he (or the owner/operator of the recompression chamber who shares
the same last name) also happen to own the local oxygen bar?  Also, your remark about the doctor’s “lapse in memory” should give one pause.

I’m also extremely skeptical that your friend’s medical policy is simply going to pick up the entire tab for this care when a bill of this magnitude is submitted after the fact. This should be verified post-haste.

To get a national or state listing of qualified diving doctors, start here: http://www.uhms.org

Is there a certification to become a specialist in diving medicine? Yes.  Start here (http://www.abem.org/public/portal/alias__Rainbow/lang__en-US/tabID__3409/DesktopDefault.aspx) and here
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Yes, there is a way of checking on a doctor’s qualifications. The preferred way to star is by carefully questioning him/her first. You also may check on a local physician’s qualifications and status by contacting your state’s Medical Board.

And the message? Don’t do it without DAN.