Because it's unusual. A DCI inquiry I received last week.+

[Duke Dive Medicine]

I also have to wonder if this diver gave DAN the same details that he gave DocV. None of the DAN medics I know would have said "that's not DCI" given that scenario. They'd have at least recommended that the diver be evaluated.

 

[Wookie]

I thought this was a forum that allowed discussion of best practices for treatment...and prevention of further injury.

If a diver sustains some sort of unknown dive-related injury, it would be prudent to stop diving and seek appropriate medical attention consisting of a proper history and physical exam.
This is really the basis for all of the medical advice doled out to interested parties in this forum. I think it bears repeating, particularly in light of this case.

The services that DAN provides are great. DAN is arguably one of the best resources a hurt diver can utilize.
However, just because the initial impression from DAN is that the injury "didn't sound like DCI," the diver/patient shouldn't feel justified in continuing to dive. There are lots of reasons why the initial impression may be misleading or flat-out wrong.

Special thanks to DocVikingo for sharing the details of this case. It's useful to read about some of the rarer manifestations of DCS.

My apologies. When I see someone describe someone elses diving practices as "reckless", I tend to think the first someone is perhaps criticizing the second someone's diving practices, not making an attempt to learn from the situation. Again, my bad for the misunderstanding.

I also have to wonder if this diver gave DAN the same details that he gave DocV. None of the DAN medics I know would have said "that's not DCI" given that scenario. They'd have at least recommended that the diver be evaluated.

Funny, my thoughts, also. When I took a vestibular hit is a small island dive destination not so long ago, I couldn't get a chamber tech on the island to do more than prescribe anti-nausea meds, even though I was there. The good Dr. was on the mainland, and unable to evaluate. Upon my return to the states, I couldn't get the wonderful folks at Hermann to even look at me. It took a call to a DAN tech who immediately said "Frank, didn't you read the latest issue of Alert Diver? You have a vestibular DCS" and get me into the chamber. Symptoms resolved in about 20 min. I have made many many DCS calls to DAN as a operator. Every call, even the ones that we didn't think were DCS, but the customer had symptoms, resulted in an evacuation except one. In the case of the one, DAN recommended an evaluation. That one was a cutaneous skin hit that resolved on O2.

 

[wedivebc]

I've seen a case of orange peel skin. It resolved with O2 treatment before we ever thought to take photos. Is orange peel a positive indicator of lymphatic DCI, or does it also present during regular cutaneous DCS also? Dr. Carolyn Fife was our doc at the time, and she was bummed we didn't get photos. She had never seen orange peel skin at that time. Our victim was a 38 y.o. female.

Well I just came upon this thread after suffering from similar symptoms. I have a rather painful swelling on my right shoulder that has a definite orange peel texture.

 

[Duke Dive Medicine]

Great photos... did you get evaluated/treated?

 

[TSandM]

That's peau d'orange, all right. I'm with DDM -- did you get evaluated?

 

[wedivebc]

Great photos... did you get evaluated/treated?

I have had this a few times. I have always considered it more of a nuisance than a serious condition but I am at the point where I get symptoms on any multi day, multi dive series where I am doing mandatory deco or close to NDL profiles. Two weeks in Mexico averaging 2.5hrs a day without symptoms. Cold water may be a common factor.

The problem with getting treatment is for me to get to a chamber is either 5 hours by car/ferry or getting medevac by aircraft. I would gladly call DAN about the issue except they will just tell me to get treated and there are no doctors in this area (that I know of) that have any expertise in dive medicine.

 

[Duke Dive Medicine]

I have had this a few times. I have always considered it more of a nuisance than a serious condition but I am at the point where I get symptoms on any multi day, multi dive series where I am doing mandatory deco or close to NDL profiles. Two weeks in Mexico averaging 2.5hrs a day without symptoms. Cold water may be a common factor.

Sounds like it might be time to consider bumping up your deco if you haven't already. Is the pain in the joint? If you're having repeated incidents of DCS involving a joint and you're not being treated, you're at risk for aseptic osteonecrosis. It would be prudent to get this evaluated the next time it happens, no matter what the transport time is. How far away are you from Vancouver General?

 

[wedivebc]

Sounds like it might be time to consider bumping up your deco if you haven't already. Is the pain in the joint? If you're having repeated incidents of DCS involving a joint and you're not being treated, you're at risk for aseptic osteonecrosis. It would be prudent to get this evaluated the next time it happens, no matter what the transport time is. How far away are you from Vancouver General?

No joint pain just tenderness to touch like a sunburn. VGH would take about 4-5 hrs depending on traffic and ferry schedule. In an emergency a helicopter could get you there in under an hour from a 911 call.