why the extended no dive recommendation after DCS?

[zamburinha]

I am curious. Why is it that after a DCS incident there is a standard recommendation to not dive for a few weeks? What does the off time do for you?

[davetowz]

#1: allow your body time to heal.
always follow the advice of a knowledgeable diving physician in these cases, they may seem to be more conservative than you would like, but really....... does this even need questioned?

[vladimir]

I think it's a great question, actually. The naive layman (me) might think that healing would be accomplished equally well while diving as when not. Presumably, however, each instance of decompression is a stress on your body, to some extent, and the idea is to spare your damaged cells that stress? I look forward to an expert's response.

[zamburinha]

#1: allow your body time to heal.
always follow the advice of a knowledgeable diving physician in these cases, they may seem to be more conservative than you would like, but really....... does this even need questioned?

In some ways that is fair enough, but it still does not answer the question. What is it that we are trying to heal from? Assuming that you have a DCS incident that does not do obvious harm to your lungs or other tissue directly related to diving, what is the rationale behind the recommendation not to dive for several weeks (or months)? Is it just a blanket recommendation to take it easy, or is it based on some specific tissue healing? I also understand that having been bent before is a great predictor of future bending incidents, but does the probability of a repeat incident significantly reduce after a few weeks? I would love to hear more opinions on this.

[TSandM]

How do you have a DCS incident that doesn't do damage? Pretty much the definition of DCS is that you have symptoms, and symptoms mean something isn't working properly. If you have joint pain, you have some kind of joint damage; it has to heal. The same, only much more drastically so, if you have neurologic symptoms -- the central nervous system heals very slowly, when it heals at all; even when it just reroutes and reorganizes, it takes significant time.

[zamburinha]

How do you have a DCS incident that doesn't do damage? Pretty much the definition of DCS is that you have symptoms, and symptoms mean something isn't working properly. If you have joint pain, you have some kind of joint damage; it has to heal. The same, only much more drastically so, if you have neurologic symptoms -- the central nervous system heals very slowly, when it heals at all; even when it just reroutes and reorganizes, it takes significant time.

I did not mean "no damage", as you say, something must have happened or it would not result in symtoms to start with. I was referring to relatively mild symtoms that "do not do obvious harm to your lungs or other tissue directly related to diving". Is the recommendation based on the fear that another DCS episode further damages the same tissues, or is it that diving in general will put those same tissues under stress and prevent them from healing? I am thinking of incidents of moderate join pain or skin bends as examples.

[GrumpyOldGuy]

I always assumed that the time was to allow undetected damage to heal 100% before they are stressed by diving again. The mechanisms of DCS are not predictable and thus an over abundance of caution is prudent.

Of course the down time can also be be used to ponder new methods of reduce the risk of future dives. Even if we follow the basic rules, once you have a hit you need to consider what additional measures may be appropriate since you now in a high risk category.

[Duke Dive Medicine]

I am curious. Why is it that after a DCS incident there is a standard recommendation to not dive for a few weeks? What does the off time do for you?

DCS symptoms are caused partly by direct bubble impingement and partly by the inflammatory effects of those bubbles. Inflammatory changes can lead to damage to the vascular endothelium (the lining of the blood vessels). If you dive again before that inflammation has had a chance to resolve and the endothelium has healed, there's an increased chance of further damage. Are the recommendations conservative? Probably, but like Lynne said above, you want to ensure that any damage has healed before putting any more stress on the area. Think of it like an athletic injury - you wouldn't go back to playing football before your ACL repair had healed, and if you did, you'd pay for it in the long run!
Best,
DDM

[zamburinha]

Thanks for all the replies. Did I understand correctly that the recommendations are based on mainly two aspects:

1. There is some inflammation/damage in the vascular system. While this has not healed, another DCS incident is likely to further damage the same tissue, which accumulates with the previous problem.
2. Decompression stress from a normal dive can prevent the tissues to heal properly, extending the recovery time.

I am not questioning whether the recommendations are too conservative or not. I just try to understand what is the basis for them. To me, it seems like a DCS incident is not quite like an athletic injury, where it is relatively simple to judge whether one is "healed" or not. One can be completely devoid of symtoms such that it is only the disclosure of information about a previous DCS incident that prompts a recommendation to avoid some activities. Please forgive my ignorance in medicine and its standards, I come from a very different background.

[koyote1111]

I appreciate the question posed in this thread as I am currently doing a "surface interval" after experiencing DCS. I plan to call DAN to get a list of dive physicians in my area so that I can get a second opinion and a better idea as to when it would be appropriate to begin diving again.

This evening, my instructor suggested that I should not be exercising (told him that I'd done a work-out at the pool last night). The doctors at the chamber had said that it would be fine to exercise...and also said that I would only need a month off. However, I'm getting many opinions from very experienced divers/instructors that the month doesn't sound long enough. So...I'm also curious about whether or not exercising would be OK. Thought I'd use the time away from diving to improve my fitness.

Bottom line...it all feels a bit confusing as I'm getting some contradicting opinions. So...it's to the doctor for me!