A personal account of DCS...or is it just a trapped nerve?

[danvolker]

---------- Post added February 25th, 2014 at 04:59 AM ----------



Hey, Dan, how goes it?

Not to nit-pick, but the resolution of symptoms like pain & numbness of the upper arm & shoulder that result from etiologies other than scuba-related free-gas phase issues (e.g., strains, sprains) not uncommonly do show improvement when subjected to hyperbaric 02 therapy.

Cheers,

DocV

Hi Doc,
Thanks for the clarification. And I will add that when I have done my 20 foot decos on 100% O2, I feel great afterwards-- almost like having taken the ultimate aspirin

In several of my chats with my GUE friends, they want to move a diver into doubles for "safety" as you reach 90 foot dives and deeper---to allow the amount of gas GUE likes to have for both buddies (needing to do an air share from the max duration of the planned dive, and the slow ascent with all stops planned.... ).
My problem with this, for the large number of 90 and 120 foot dives this impacts, is that the safety margin for less chance of DCS from this move to Doubles, now creates an incident curve for back injuries and muscle tears in a large percentage of this diver population...I think that many people that can carry an lp120 on their back without injury, can NOT do this with the alternative set of doubles without potential for serious long term injury. It just passes the "critical threshold" of what they can handle without injury.

 

[Duke Dive Medicine]

Not to nit-pick, but the resolution of symptoms like pain & numbness of the upper arm & shoulder that result from etiologies other than scuba-related free-gas phase issues (e.g., strains, sprains, nerve impingement) not uncommonly do show improvement when subjected to hyperbaric 02 therapy.

Cheers,

DocV

Hi Doc,

True to a certain extent, but it's typically not quite as dramatic as the OP made his improvement out to be. That's what drove my opinion and likely Dan's too. Also, he got significant relief with surface O2 on his second hit. Makes a good argument for DCS. In any event it's an interesting case.

Best regards,
DDM

 

[DocVikingo]

Hi Doc, True to a certain extent, but it's typically not quite as dramatic as the OP made his improvement out to be. Best regards, DDM

Hey DDM,

Agreed.

Regards,

Doc

 

[IWantToBeAFish]

Hi all and thanks again for your replies. First in reply to you:

dan - I'm not sure that walking iin a twinset is a problem for me. I don't find the weight a problem, I have a strong frame and a history of doing big hikes with a large amount of weight on my back without problem. Also, the time of the first incident was about two months into a daily schedule of twinset diving and hauling it around in the same way.

shoredivr - thanks for the advice. Sadly attempting that test for compression yielded no symptoms.

doc - useful to know that the degree of pain can still be so variable in DCS cases. Also concerning to hear that manifestations of numbness in the shoulder can be indicative of type II!

DDM - I still wonder whether the relief from surface O2 was simply due to sitting still and allowing my upper body and arm to relax. This would coincide with what the DAN doctor suggested that if I found a comfortable position causing cessation of the pain this was not DCS.


Ultimately, I see I may have to play the long game on this one. Supposing these have all been DCS hits, and given that of late they seem to be resolving on their own, what degree of damage could occur? If the local hyperbaric doctor believes it not to be DCS, it isn't like I can just go and jump into a chamber myself if I did have another incident.

I guess what I would really appreciate your advice on is...at what point do I turn around and say, this really looks like DCS, I need to really change my approach here?

Thanks all!

 

[flots am]

After minutes on O2 at 2.8 bar in the chamber, all bad sensation in my arm had gone leaving me to conclude that it must have been DCS and I had a further 5 hours to think about just what implications this now had upon my diving and my career. I know plenty of people in all parts of the industry across the world that have been bent to some degree (thankfully no serious cases) at various times in the past. Still, I did struggle to accept that it had actually happened to me given the meticulous way with which I typically conduct all dives I perform.

. . . e morning I woke feeling fine but within minutes of getting out of bed, the pain and numbness intensified again. Feeling experimental, with nothing to do, I went to the dive shop, put myself on O2 and waited for 45 minutes. There was a drastic improvement again, I took anti-inflammatories and went home to rest for the day. The next day I was also dry and felt fine. Must be a muscular issue. The following day I was in the water at 5m teaching a sidemount course and after the dive, back came the same sensation.

Considering that the cost of your self-diagnosis being wrong could be that you spend the rest of your life in a wheelchair, or at the very least, with one useless arm, and that actual medical treatment by a real doctor, in a chamber, costs you nothing, I'm not sure I see any benefit in avoiding a chamber ride, although I do see a huge amount of risk.

flots.

 

[Duke Dive Medicine]

DDM - I still wonder whether the relief from surface O2 was simply due to sitting still and allowing my upper body and arm to relax. This would coincide with what the DAN doctor suggested that if I found a comfortable position causing cessation of the pain this was not DCS.


Ultimately, I see I may have to play the long game on this one. Supposing these have all been DCS hits, and given that of late they seem to be resolving on their own, what degree of damage could occur? If the local hyperbaric doctor believes it not to be DCS, it isn't like I can just go and jump into a chamber myself if I did have another incident.

I guess what I would really appreciate your advice on is...at what point do I turn around and say, this really looks like DCS, I need to really change my approach here?

Thanks all!

Hard to say about the surface O2. That's a causation vs. correlation question and I can't give you a concrete answer. I think it points more toward DCS, but I could be wrong and this could turn out to be neurological or musculoskeletal in origin. One thing you could do is ask yourself if you've ever felt similar symptoms on the surface (absent any diving), and if so, under what circumstances? If the only time you've ever experienced these symptoms is after decompression from a deep dive, that could also lead you to conclude that this is DCS. Having said that, it's not entirely clear from your first post when the symptoms occurred on the second incident (the one where you used surface O2 and the symptoms resolved). Did the symptoms happen after you surfaced? If so, how long after? I should have asked this before, but what were you doing when these symptoms set in (both times)? Do you recall straining that area at any point, maybe climbing the ladder back on to the boat?

Best regards,
DDM

 

[IWantToBeAFish]

A perfectly valid point of view. I won't defend my actions at all, they were misguided and inappropriate for sure but there was a strongly mental reluctance to accept the possibility which steered me in that direction.

---------- Post added February 27th, 2014 at 06:58 PM ----------

Hi Duke. The symptoms generally occur almost immediately or within 5-10 mins after the dive. I do all shore diving, no ladders to climb but obviously have to carry my twinset out of the water but no more than 20m.

 

[DocVikingo]

Hi Duke. The symptoms generally occur almost immediately or within 5-10 mins after the dive. I do all shore diving, no ladders to climb but obviously have to carry my twinset out of the water but no more than 20m.

Onset of signs & symptoms of DCS at five-ten minutes after surfacing is a bit quick, but certainly not particularly uncommon.

Time to onset figures vary a bit depending upon the source, but the following from the U.S. Navy/TDI is representative of time of onset of DCS (not otherwise specified):

Time to onset (% of cases)

- within 1 hour=42%
- within 3 hours=60%
- within 8 hours=83%
- within 24 hours=98%
- within 48 hours=99%

And, it apears that Type II (aka neurological) DCS often has a more rapid onset than Type I (aka musculoskeletal) DCS.

Regards,

DocVikingo

 

[flots am]

A perfectly valid point of view. I won't defend my actions at all, they were misguided and inappropriate for sure but there was a strongly mental reluctance to accept the possibility which steered me in that direction.

You know what they say . . . The first sign of DCS is denial.

 

[IWantToBeAFish]

Onset of signs & symptoms of DCS at five-ten minutes after surfacing is a bit quick, but certainly not particularly uncommon.

Time to onset figures vary a bit depending upon the source, but the following from the U.S. Navy/TDI is representative of time of onset of DCS (not otherwise specified):

Time to onset (% of cases)

- within 1 hour=42%
- within 3 hours=60%
- within 8 hours=83%
- within 24 hours=98%
- within 48 hours=99%

And, it apears that Type II (aka neurological) DCS often has a more rapid onset than Type I (aka musculoskeletal) DCS.

Regards,

DocVikingo

An item of curiosity...what about symptoms that start underwater - muscular aches and pains on the last few deco stops (9, 6 and 3)? I have heard people talk about these before but have claimed that given a reasonable profile, there is no way that this would be DCS. How accurate can that statement be? How severe would a DCS incidence have to be to cause symptoms at this point during the dive? Cheers!