Cant believe this was a DCS hit but ??

[Chris66]

Hi, was diving with a friend and had completed 2 dives. First dive was to 65 feet (multilevel) for 45 mins with max bars on his oceanic of 5 (8 is deco). Surface interval was 1 hr and 5 mins and second dive maxed out at 55 feet for 50 mins (multilevel but mostly at the 45 range. Again surfaced well within decompression limits and with a max of 5 bars (8 bieng deco). He told me that 10mins after he got on the boat he had suddenly developed severe pain (8-9/10) in his shoulder. He said he had had it for 15 mins when it started to get better slowly and by 30-40 mins it had all but resolved with only 1-2/10 pain on extreme movement of the shoulder. By one hour even that had gone and he had no further issues or pain. I do believe him as he is always honest with me. Watching him wiggle out of his harness makes me think he pulled something although I am not sure why the pain would have started only 10-15 mins after and not immediately. He is worried that he suffered a DCS hit and that he should never dive again. I have suggested that his profile was safe (although not a guarantee) and although it was a little worrying that his pain started 10 mins after getting on board if it was so severe that it was 8-9/10 that it would not have improved and resolved in total by 45 mins. There were n oskins signs and no other pains and the shoulder pain did not return.

Anyone have any ideas?

Thanks

Chris

 

[Code Monkey]

Have him go to a diving doctor (you can get a referral from the Diver's Alert Network) and get tested for a PFO. This is a pretty common heart condition that seems to be responsible for many undeserved DCS hits. It's treatable with surgery. I have a friend that got permanently disabled by a hit exacerbated by a PFO.

 

[DocVikingo]

He told me that 10mins after he got on the boat he had suddenly developed severe pain (8-9/10) in his shoulder. He said he had had it for 15mins when it started to get better slowly and by 30-40 mins it had all but resolved with only 1-2/10 pain on extreme movement of the shoulder. By one hour even that had gone and he had no further issues or pain.

Hi Chris,

Given the dive profiles described and associated estimated nitrogen loading, DCS seems unlikely, although not impossible.

More compellingly, the description of the shoulder pain is quite inconsistent with DCS-related joint pain. In the absence of some immediate and appropriate treatment attempt, e.g., mask breathing 100% 02, such pain does not reach a subjective rating of 8-9/10 only to resolve almost entirely after 30-40 mins. DCS-related joint pain also typically is not exacerbated by movement of the joint.

Based on the description given, this event has a very low likelihood of being DCS-related.

If your friend desires, he can contact at --> DAN Scuba Diving Medical Services.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[DocVikingo]

Have him go to a diving doctor (you can get a referral from the Diver's Alert Network) and get tested for a PFO.

Hi Code Monkey,

This is a common misconception.

While DAN does maintain a diving medicine doctor referral data base and does endeavor to direct divers to savvy professionals in their respective geographical areas, the reality is that DAN's physician referral base, and especially its specialist (e.g., cardiologist) referral base, can be thin to non-existent in many locations, especially locations that are distant or remote from major North American metropolitan areas, not to mention foreign countries. It may not be as simple and convenient as that.

In this particular case, the affected diver appears to live in NJ and therefore DAN hopefuly will have an appropriate referral with an office that is not too far away.

Regards,

DocVikingo

 

[Duke Dive Medicine]

Have him go to a diving doctor (you can get a referral from the Diver's Alert Network) and get tested for a PFO.

I'll ride on DocV's coattails here... I don't think a PFO test is indicated in this situation. PFO is not associated with shoulder pain, and as Doc already pointed out, this incident has a pretty low probability of being DCS.

Best,
DDM

 

[DocVikingo]

I'll ride on DocV's coattails here... I don't think a PFO test is indicated in this situation. PFO is not associated with shoulder pain, and as Doc already pointed out, this incident has a pretty low probability of being DCS.

Thanks, DDM.

Not to mention that what the affected diver's medical coverage would say when asked to pre-authorize TEE with contrast under such a circumstance likely would not be fit for polite company ; )

Regards,

Doc