What's the treatment for mild DCS symptons (shoulder pain) after 48 hours?

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This post presents an interesting problem.

In the UK, it is drummed into us that any adverse symptoms after diving are likely to be DCI, unless an obvious injury has been received. This is even emphasised by insisting that as divers we are required to advise medical personnel NOT to use Entenox to treat a diver after diving, even when treating obvious non diving related injuries. Entenox can make DCI worse and potentially induce a DCI problem in a casualty.
Getting quick early treatment is always advised. Minimising, long term injury, and reducing the amount of treatment required. Delaying treatment, significantly reduces the likely hood of long term injury and increases the treatment cycle (cost).

We have a national / international DCI helpline to ring (this used to be administered by the Navy). If you are walking wounded, then generally the advice is to attend a chamber, or A & E. Where the medical personnel will make the diagnosis.
The alternately is to contact the coastguard.
If anything, divers are very poor on getting treatment, often being in self denial. It is often the others that identify the issue.
In the case of serious DCI, the emergency services will evacuate you by the quickest means to the nearest available chamber (one not in use).

We do of course have the significant advantage that we don't pay for medical care (at point of use). This means there is no excuse not to attend.

There are a number of insurance companies we use when travelling. DAN being one of the preferred, with a reputation for quick action.

I am very aware that in many parts of the world you are required to pay, not only for treatment, but for initial diagnosis. This complicates giving advice to those out side Europe.

However, DAN will give free advice over the phone, if they advise seeming medical support, if only to confirm it is not DCI, I strongly advise that you follow their advice.
I would also strongly advise having appropriate insurance e.g. DAN cover.


Gareth
 
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If DAN told you the chamber is not useful after 48 hours, either they are idiots or you misunderstood.

Understand that with dcs, it is possible that until the bubbles are recompressed they aren't going anywhere.

I was a chamber operator for more than a decade.

It's pretty unlikely for there to be physical bubbles 48 hours out. DCS symptoms at that point are more likely from the inflammatory effects of the bubbles, and HBO2 at that point is treating those inflammatory effects rather than eliminating the bubble itself, which is why the probability of complete symptom resolution during treatment is less likely the further out from the injury the diver is.

Best regards,
DDM
 
It's pretty unlikely for there to be physical bubbles 48 hours out. DCS symptoms at that point are more likely from the inflammatory effects of the bubbles, and HBO2 at that point is treating those inflammatory effects rather than eliminating the bubble itself, which is why the probability of complete symptom resolution during treatment is less likely the further out from the injury the diver is.

Best regards,
DDM

So, guy complaining of pain in his left knee after a full weekend of diving waits until Wednesday before giving up and seeking treatment. Before we even reach 60' in the chamber, the pain is gone. Still going to say a chamber is unlikely to help after 48 hours?

I remember a guy who got bent IN A CHAMBER in comm dive school on Friday by jerking around with his deco. Saturday he woke up with Bilateral pain and skin bends. It was a three day weekend. When he came to class on Tuesday, we drove him to Penn State for Hyperbaric treatment. To state that treatment won't help after 48 hours is stupid. If that were the case all of us would just endure type 1 DCS on oxygen and Tylenol until pain subsided.
 
This forum should be renamed:
DON’T ask Dr. Decompression!!!!

And to clarify —DAN did not recommend going to the chamber. I spoke with them twice and we discussed mildness of symptoms and potential for other causes of back/shoulder pain. DAN told me that chamber treatment unlikely after 48 hours, which is why I asked the question about what is the treatment after that time period. DAN only mentioned the chamber doc at the very end of 2 lengthy conversations.

Thank you to the moderator for treating my question respectfully.

L Neal,

If this had been DCS, immediate recompression would have increased the likelihood of complete symptom resolution. Just from your description, DCS cannot be ruled out, which is why I (and others) recommended being examined in person by a qualified practitioner. Also, an internet exam can't catch subtle neurological symptoms. Treatment at this point would just be tincture of time, though hyperbaric oxygen might speed things up a bit and I stand by my recommendation to go get evaluated.

DCS is a sports injury, just like a sprained ankle or torn meniscus, and the risk of DCS can be mitigated. I'd echo Dr. Singler's recommendation to evaluate your level of conservatism when diving, and then carry on. Don't take the less erudite posts on here too seriously.

Best regards,
DDM
 

A Friendly Reminder...

Let's dial this back a little, shall we? This is an interesting discussion that we should not allow to degenerate.
Thanks to all for their contributions.

A Moderator
 
So, guy complaining of pain in his left knee after a full weekend of diving waits until Wednesday before giving up and seeking treatment. Before we even reach 60' in the chamber, the pain is gone. Still going to say a chamber is unlikely to help after 48 hours?

I remember a guy who got bent IN A CHAMBER in comm dive school on Friday by jerking around with his deco. Saturday he woke up with Bilateral pain and skin bends. It was a three day weekend. When he came to class on Tuesday, we drove him to Penn State for Hyperbaric treatment. To state that treatment won't help after 48 hours is stupid. If that were the case all of us would just endure type 1 DCS on oxygen and Tylenol until pain subsided.

Umm, no. Go back and re-read my post.

Best regards,
DDM

<edit> removed reference to edited post
 
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L Neal,

If this had been DCS, immediate recompression would have increased the likelihood of complete symptom resolution. Just from your description, DCS cannot be ruled out, which is why I (and others) recommended being examined in person by a qualified practitioner. Also, an internet exam can't catch subtle neurological symptoms. Treatment at this point would just be tincture of time, though hyperbaric oxygen might speed things up a bit and I stand by my recommendation to go get evaluated.

DCS is a sports injury, just like a sprained ankle or torn meniscus, and the risk of DCS can be mitigated. I'd echo Dr. Singler's recommendation to evaluate your level of conservatism when diving, and then carry on. Don't take the less erudite posts on here too seriously.

Best regards,
DDM

All I know is I learned a new word today.:thumb:
 
Once during a dive trip to the Florida Keys, my husband developed sharp pain in his right elbow. He hadn't bumped his elbow and we were diving conservatively and hadn't gone into deco, and we hadn't flown anywhere - but sudden, unexplained joint pain shortly after diving was very concerning, so we went to the local hospital emergency department for evaluation.

They x-rayed his elbow and didn't see any damage, and then the doctor arranged for him soak his elbow in hot water for a time. Next he asked my husband if "the elbow felt better or hurt worse from the hot water?" My husband said that it felt better and the doctor said that it wasn't decompression sickness - because the gas bubbles collected in the joint would get bigger and hurt more as the temperature increased.

He diagnosed "tennis elbow" and gave my husband some pills and told him to take it easy and he soon recovered just fine. Tennis elbow made sense because he had been hauling tanks and equipment around and that's something we only do on vacation, but it was still reassuring to know that there were no indications of DCS.

The point of my story is not to take chances, it's better to seek competent medical advice instead of trying to "walk it off" - or at least that's my opinion. We were able to relax and continue diving and enjoying our vacation.

BTW, while we were in the Emergency Department, the doctor suddenly had to rush off to take care of some injured patients that were hurt in a crash during a speedboat race. I imagine that they don't see very many cases of "rule out decompression sickness" or "speedboat trauma" here at home in the Midwest, but it was probably just another "typical day at the office" in the Florida Keys!
 
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