Incident (?) and questions

[ggunn]

Here's what happened:

On my last trip to Cozumel (May 1-11, 2010), on my second to last dive day, I went on two dives, both of which topped the yellow on my computer and got within a couple of minutes of going into deco. I did long safety stops and came up either in the green or one tick into the yellow on both dives. I had gone into deco on my first dive the day before, but I had done what my computer told me to do and come up only one or two ticks into the yellow. I had not dived at all the day before that. All dives were on air.

Two or three hours after the dives on the day in question, my left shoulder began to ache. The pain intensified and began to spread, and within 30 minutes or so the pain was about a 5 or a 6 on a 10 point scale and involved my shoulder, elbow, and wrist. I had no other symptoms.

Naturally, I thought of the possibility of DCS, and after about an hour I was just about to the point where I was going to call DAN and start asking some questions, when I noticed the pain had diminished somewhat. I went into "wait and see" mode. The pain slowly subsided, and by dinnertime it was completely gone. The next day was my last dive day; I had normal dives and no more discomfort either that day or on the plane ride home the following day. I still feel fine.

My questions:

What are the chances I experienced a DCS incident? Do the symptoms ever just go away?

What happens if one has minor DCS and does not treat it? Do the bubbles eventually dissolve, or do they roam silently around in your bloodstream waiting to kill you months later?

 

[HateCheese]

It is possible you had a small hit, but you'd need to post more info:
dive time / depth / ascent rates / SIs / etc.

Was it also your left elbow and wrist that hurt? If it was all on one side of your body is there a chance you did something (lifting tanks / hauling gear bags / etc) that could have caused pain on one side?

Calling DAN at that time would have been a great idea, but that is in the past. I'm sure others will post to address your other questions.

 

[ianr33]

What type of computer do you use?

 

[Divedoggie]

Wow Gordon! Its always scary to consider the possibility of DCS.
I recently had a friend go through some rough stuff after a dive. In fact there is a thread on it in this section.

In the future, during the "wait and see" process, a call to DAN can't hurt. If DCS is causing a nerve impingement, after some time there can be tissue necrosis due to lack of blood and oxygen supplied to the affected area. That is why they say the sooner treated, the better.

After this much time with no symptoms, you are probabaly totally fine and it was something else, but it might be worth a call to DAN with these questions.

 

[Bubbletrubble]

If DCS is causing a nerve impingement, after some time there can be tissue necrosis due to lack of blood and oxygen supplied to the affected area. That is why they say the sooner treated, the better.

@Divedoggie: There are nerves, and there are blood vessels. Nerve dysfunction does not necessarily imply lack of blood flow in nearby blood vessels. However, in certain anatomical areas, vessels and nerves may run in close proximity to one another.

If you are worried about blood perfusion to extremities distal to the site of injury, do a quick-and-dirty check of capillary refill.

I agree with what you said about seeking medical treatment sooner rather than later.

The OP may have benefited from presumptive DCS treatment in the form of a hyperbaric chamber ride.

@ggunn: It's possible that the shoulder pain was DCS-related. It's hard to say, though, in the absence of any information regarding how aggressive the profile was (time at depth, ascent rates, length of safety stop, computer deco algorithm used, surface intervals) and prior nitrogen loading. Of course, the other possibility high on the list of differential diagnoses is musculoskeletal pain due to some sort of mechanical injury (strenuous swimming combined with a lack of physical conditioning, hitting the shoulder on the boat, lifting a tank, etc.). Shoulder/arm pain might also indicate the presence of a medical condition, e.g., heart attack, that requires immediate attention.

Many minor DCS symptoms will abate over time, whereas others, due to permanent nerve damage, will persist. We still don't know much about DCS pathophysiology.

Minor DCS symptoms will probably disappear on their own and not "roam silently around in your bloodstream waiting to kill you months later." If this ever happened again, I'd recommend giving DAN a call right away. You may also want to consider getting some dive insurance if you don't already have it.

 

[Dirty-Dog]

I would echo what BubbleTrouble said, and would add one thing.

Are you trained for and intentionally going into deco? I ask, because what you posted doesn't really sound like it, to me. If not, it might be worth considering being a little more conservative in your dive profiles. DCS, like so many things, is easier to avoid than to treat.

 

[ianr33]

I would echo what BubbleTrouble said, and would add one thing.

Are you trained for and intentionally going into deco? I ask, because what you posted doesn't really sound like it, to me. If not, it might be worth considering being a little more conservative in your dive profiles. DCS, like so many things, is easier to avoid than to treat.

Dude, This is the Near Misses and Lessons Learned forum.

Getting slapped on the wrist by a self professed noob is hardly an incentive to post.

 

[Jim Lapenta]

Except that the Dog is right. If you have no deco training a diver has no business approaching deco. That it happened in Cozumel does not surprise me. There are too many stories of so-called professionals taking divers beyond their recommended limits. Mr. Gun would have been better off planning the dive himself and sticking to that plan. No matter what the guide says, what they do is IMO not safe.

I am also concerned about the apparent lack of understanding regarding DCS and it's effects. I am at this minute awaiting one of my OW classes. Tonites topic is indirect effects of pressure that includes a review of the respiratory and circulatory processes and gas laws leading into the following areas- oxygen toxicity, nitrogen narcosis, and decompression sickness. We'll cover the causes, effects, how to recognize it, and treatment. This will lead into the first table lecture.

The next lecture will cover deco procedures and air deco tables along with proper dive planning. This is one of the big reasons I will not push computers for new divers. I'll discuss them but not promote them. Too many people, myself included, get a computer and operate under the FALSE notion that just because it did not go into the red that the dive they did was safe. The computer in my classes is not the primary tool for dive planning. It is a back up for tables and the brain.

I will say I love threads like this. They go a long way to help students understand why I teach the way I do. I show them posts like this and others use it to demonstrate why the classroom is so important and a vital part of the entire training experience. Not disparaging Mr Gun because he most likely is only diving the way he was taught.

 

[Bubbletrubble]

I am also concerned about the apparent lack of understanding regarding DCS and it's effects. I am at this minute awaiting one of my OW classes. Tonites topic is indirect effects of pressure that includes a review of the respiratory and circulatory processes and gas laws leading into the following areas- oxygen toxicity, nitrogen narcosis, and decompression sickness. We'll cover the causes, effects, how to recognize it, and treatment. This will lead into the first table lecture.

@Jim Lapenta: AFAIK, researchers still don't know much about what specifically causes oxygen toxicity, narcosis, and DCS. I would think that any well-taught course would have a healthy dose of we-don't-know-all-of-the-variables-involved-so-it's-advisable-to-dive-conservatively sentiment.

I think it's great that you are introducing all of these topics in an OW class. I've had to pick up details on these subjects on my own. Although it has been an enjoyable process, I would have appreciated a little more guidance in the beginning from a knowledgeable instructor/mentor.

FWIW, I suspect that ggunn did plan his dives on his own. His profile indicates that he is a relatively experienced diver. I realize that, from his post, it sounds like he was mindlessly following the "instructions" spat out by his dive computer...but I think there's more to it than that. I think he was simply trying to say that on the dive in question he didn't violate the dive computer, i.e., did not exceed recommended ascent rate, did not exceed NDLs, etc. Even for a well-trained medical professional, figuring out the cause of shoulder/arm pain after a dive is not a trivial thing. He could have pre-existing back issues, sustained a new back injury during the dive, or damaged a nerve root in his brachial plexus due to stretching the shoulder in an odd way. Arguably, the most conservative approach would have been to treat him as if the injury were DCS-related (hyperbaric treatment) since, even if the injury turned out to be something else, a chamber dive probably wouldn't have made the condition any worse.

 

[lamont]

What are the chances I experienced a DCS incident?

What do you mean by a "long" safety stop? 10 minutes?

FWIW, my layman's opinion is that assuming you haven't omitted anything, your story sounds more like some kind of mechanical injury, and less like DCS. With a computer in the yellow you weren't in deco yet. If you cleaned that up with a good amount of time shallow that makes a hit unlikely (5-10 minutes of deco cleans up a lot of sins committed deeper). The symptoms going away like that also suggest something mechanical rather than bubbles. Can't say it definitely isn't DCS, but it doesn't sound typical.