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Mild DCS? Symptoms? What to do?

Discussion in 'Ask Dr. Decompression' started by jplacson, Sep 4, 2003.

  1. jplacson

    jplacson Photographer

    # of Dives: 100 - 199
    Location: Philippines
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    Ok, is there such a thing as really mild DCS? I heard that some symptoms are itching and headaches...

    How can you tell if this is mild DCS or just itching from something in the water, and the headache from lack of sleep or something?

    If you do get mild DCS... can you heal naturally? Or will it just get worse over time? How many hours before you can tell that it really wasn't DCS and just dive fatigue?

    I'm just curious (and paranoid :lol:) I'd like to know as much as I can. Thanks!
     
  2. HammerNoMore

    HammerNoMore Instructor, Scuba

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    There are many things that can cause itching/headache when diving, sun exposure is a big cause.

    For mild a headache I wouldn't be concerned. If it was severe (and you are not prone to migranes or other severe headaches) or there are other DCI symptoms present I would grab the oxygen and find a doctor.

    For mild itching, again no conern. If it is severe and there are no other symptoms I would assume you came into contact with some form of wildlife and treat as approprate. If other DCI symptoms are present, again, grab the oxygen and find a doctor.

    Without going to extremes, remember when in doubt, grab the oxygen. Oxygen is cheap.

    I highly recomend taking a DAN oxygen provider class. It is cheap, takes 1 night to complete and will answer these types of questions. Plus you will gain skills that could save your or someone elses life some day.

    James
     
  3. rmediver2002

    rmediver2002 Instructor, Scuba

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    As a clinical diagnosis? I suppose you could consider type I decompression sickness less severe than type II but not to the point I would refer to it as mild...

    Itching could be a sign of a type I symptom but it is treated as a type II. Skin itching, rashes, and marbling are treated as type II because with enough nitrogen in solution to cause these symptoms there are often other more severe symptoms that may not initially present or go unnoticed by the diver. This is a large amount of dissolved nitrogen.

    Headache is not normally a sign of DCS, but in the event it was a symptom it would most definitely not be a mild symptom.

    Covered quite well by James...


    If you get DCS there is a small chance you could heal naturally, more often the symptom will get worse over time often with additional symptoms presenting as time goes by... I would not gamble with a permanent injury like this... Something else to consider is the fact that delays in treatment severely decrease the success of the treatment...

    After the tissue is cut off from a fresh supply of oxygen by the blockage it uses up the remaining O2 dissolved in the surrounding tissue. Then cell death begins; no amount of hyperbaric treatment can reverse cell death... If the cells effected are neurological then... After this cell death has occurred (in as little as four minutes without O2 brain cells begin to die doing irreversible damage) the main benefit of treating the individual will be saturating the body with O2 in an attempt to stimulate and aid recovery.

    Not a game to play, this is an area where the more you learn the more you will support treatment... There are no side effects to treating someone, often the chamber mantra is "if in doubt, treat..."

    I have seen many divers who went from various stages of paralysis and numbness who upon reaching treatment depth or very son after regain all sensation and have absolutely no residual symptoms after treatment... This has sold me on it!!

    I also treated an individual 46 hours after surfacing who was completely paralyzed... He received two weeks of multiple treatments and was able to recover some usage of his legs... He did regain use of his upper body. This person has a permanent limp and limited use of his lower extremities due to inaction on the part of his buddies... Great thing to live with...

    Do not ever delay treatment, go get checked out


    Jeff Lane
     
  4. jplacson

    jplacson Photographer

    # of Dives: 100 - 199
    Location: Philippines
    591
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    0
    Whew... thanks! Sorry... there are times when the hypochondriac in me wakes up! :p

    The night after a dive, I started to itch along my elbow and saw a small red patch... I kinda freaked... but my DM said that DCS rarely shows up that long after a dive (5 hours)... and those that do, don't show up as 'itching' initially.

    My profile was clean... and on all 3 dives I had that day, I was well within NDL. (Suunto set to P1)

    Just checking... you can never be too safe or too informed... I've never pushed my limits, but it just so happened that I heard of some cases of people getting bent even within NDL (although I have no idea of their profile prior to their last dive...so that's a big issue as well)

    But anyway, thanks for the info. I am planning to take more classes on this. :)
     
  5. rmediver2002

    rmediver2002 Instructor, Scuba

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    I am sorry but I think this was very bad advice for someone without formal medical training in diving injuries to dispense... I also question the value of advice without performance of a neurological examination...


    I am off this week and I have the reference at work. If no one else posts it I will on monday when I get back but...

    But one item I would like to stress is most symptoms do occur within the first few hours after surfaceing...

    I think the figure was 85% within the first 8 hours after surfacing up to 98% within 24 hours of surfacing. (this is from a Navy NEDU study of bends cases in military divers)

    I hope you had some sort of skin irritation in this case but 5 hours is not nearly enough time to rule out DCS symptoms.

    Try these for some more information:

    http://www.rescuediver.org/med/bends.htm
    Time of Onset of Symptoms

    50% occurred within 30 minutes
    85% occurred within 1 hour
    95% occurred within 3 hours
    1% delayed more than 6 hours

    http://www.emedicine.com/emerg/topic121.htm

    http://www.marinemedical.com/articles/diving.htm

    http://www.deep-six.com/page78.htm

    Another interesting set of statistics concerns the time of onset of DCS symptoms. According to DAN in 1990, 60% of divers that get DCS have recognizable symptoms within 30 minutes. That leaves 40% that will not get "a hit" until after they have been out of the water for 30 minutes or more. Of those 40%, 1/4 will feel the effects before 2 hours, another quarter may go as long as 6 hours, and the remainder might go as long as a day or more. Continuing, DAN found that 95% of divers experiencing DCS get symptoms prior to 24 hours after surfacing. It is possible for some divers to have a dive in the morning and have their head fall into their soup at dinner!


    Jeff Lane
     
  6. rmediver2002

    rmediver2002 Instructor, Scuba

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    This post above includes some snips giving the general information from the links included, not my terminology or exact opinions...

    Jeff Lane
     
  7. CBulla

    CBulla ~..facebook conch..~ ScubaBoard Supporter

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    Purely out of curiosity, and seeing numerous posts on DCI, regarding fatigue, headache, etc., what are the chances that these sytmptoms are actually dehydration issues?

    I only ask because I know that if I do not consume enough water through the day, among other symptoms, I do experience fatigue and headaches. Also, I carry at least a 30oz bottle to consume between dives to rehydrate after breathing the dry air of a bottle, and have observed relatively few divers taking time to rehydrate between dives or afterwards.
     
  8. rmediver2002

    rmediver2002 Instructor, Scuba

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    Great point Cbulla, James also mentions sun exposure further up in this thread, another common cause of headache is CO2 retention...

    All these and others may be factors in headache or fatigue symptoms, the procedure in differential diagnosis is attempting to rule out specific causes of an injury and when it can not be firmly determined to not be a DCS or AGE injury, recompression treatment is indicated.

    Sometimes when the treatment is not immediately (upon compression to treatment depth or within the first ten minutes) effective showing complete or marked improvement these other factors are looked at more closely...

    The bottom line is when you can not rule out the most severe injuries (AGE and to a lesser extent DCS) you must treat for them as the result can be nerve death.

    Jeff Lane
     
  9. HammerNoMore

    HammerNoMore Instructor, Scuba

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    Navy times of onset:

    42 percent occurred within 1 hour.
    60 percent occurred within 3 hours.
    83 percent occurred within 8 hours.
    98 percent occurred within 24 hours.

    Pretty close for doing it from memory :).
     
  10. jplacson

    jplacson Photographer

    # of Dives: 100 - 199
    Location: Philippines
    591
    0
    0
    Thanks to everyone who replied. I hope this thread stay alive for a while... it brings a lot of info to other divers as well

    Well... this is why I freaked out after my dive 2 weeks ago... I did feel dizzy... I had mild shoulder pains after the dive... and I had that funny rash (small, about 2" across...light red)

    So I was freaked right? ... I was so dizzy that night... I was already thinking "God, I think I'm bent... I'm probably gonna die in my sleep!!!" :lol:

    Anyway, 2 days later... I figured... hmmm... maybe I wasn't bent! (DUH!):confused:

    So I thought back to everything I did, prior to the dive... here's my stupid story... it makes more sense when you hear this:

    Thursday: Workout - shoulders, arms, chest
    Friday: OT work..meet deadline... slept at 2 am
    Saturday: wake up at 6am to go to dive resort, day-trip only
    -8am light breakfast along the way
    -9am arrive at dive resort
    -10am first dive
    -SIT 1:30
    -12:30 second dive
    -lunch
    -4:30 3rd dive
    -6pm head home
    -7pm dinner
    -8pm arrived home
    -12mn sleep

    Hmmm.... I don't know why I didn't think of all these things... :confused: I felt so stupid when I realized that my workout caused the shoulder pain (ache, now that I think of it) ... my lack of sleep... light breakfast, and probably dehydration...caused the dizziness... and the 3 dives... lack of sleep... hunger... workout... and the drive to and from the resort... all made my head pound... even the next day!

    Well... I'm still here 2 weeks later... so I guess it wasn't DCS. :p

    The itching was just probably an irritation or something... or maybe mild DCS symptoms? I really don't know.

    That's actually why I was asking if it's possible to heal over time.

    Thanks again for all the replies... I now have a lot more links to read
     

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