DCS or just plain exhusted?

[gkwalt]

I was recently on a liveaboard with multiple dives over many days. One of our divers on day 3, stayed in bed and slept for alomost 20 hours. We all check on this diver and the diver seemed ok and didn't have any specific complaints, so we left her alone. She woke up and joined the rest of the group after a long snooze and said she felt OK. She continued to make other dives ( mostly shallow) without issue. Later I learned she had made a rapid ascent from about 100' after a bottom time of maybe 15 minutes followed by a prompt return from tthe surface to about
50' for another 15-20 minutes with a 3 minute safety stop, due to bouyancy problems, the day before her Rip Van Wickle nap. Unfortunately I don't know anything else about her dive profile.
I know that unusual fatigue can be a symptom of DCS. I would like to hear from the forum and its experts on weather this could have been a manifestation of DCS. She is doing fine now and has no sequele. Thanks

 

[metaldector]

There are no forum "experts", call DAN 1-800-446-2671, they are the DCS and diving experts.

 

[Bubbletrubble]

The symptoms would seem to be consistent with a bout of "subclinical" DCS.
A non-dive-related possibility is that the diver was just getting sick, and a looooong sleep is how her body reacted.
Since she had a rapid ascent prior to the long sleep, "subclinical" DCS would be higher on the differential.

Someone should tell her that, if she is ever placed in that situation again (rapid ascent to surface from 100 fsw after logging 15 min. of bottom time), she should exit the water, maybe breathe oxygen (if available), and be monitored for signs of AGE or DCS. If nothing abnormal crops up, then it's still probably best to stay out of the water for the rest of the day.

Why did her buddy allow her to re-descend and attempt to finish the dive?
What did the DM and captain (presumably trained in dealing with scuba emergencies) have to say about the turn of events?

 

[TSandM]

Profound fatigue has been described as part of the symptom complex of DCS. I know a friend who had a definite inner ear DCS event described being ridiculously tired as part of the warning part of his experience. My own observation was that one night, when I did a bunch of ascent practice (probably did 7 or more ascents from 20 feet, some of which were not well controlled at all) I almost fell asleep at the wheel going home, although I had no other reason to be tired.

But my suspicion for the 20 hour nap would fall more on jet lag and not sleeping well on a boat. It would be interesting to see what the folks who treat DCS cases regularly have to say about this one.

 

[vladimir]

There are no forum "experts"

Responses from the physicians here who are conversant with the issues diving entails are probably pretty expert. Perhaps you will agree that Duke Dive Medicine's opinion, for example, might be superior to the person answering the phone at DAN. Or that doctormike, an ENT, might have more insight into ear barotrauma.

call DAN 1-800-446-2671, they are the DCS and diving experts.

What should the OP say when he calls? "I have this friend...well, not a friend, an acquaintance, who got really tired on a dive trip a couple of weeks ago..." Do you see how silly this is?

Calling DAN is a great idea, particularly in an emergency. Especially in an emergency that might require their participation in either the evacuation or treatment decisions. Reflexively chanting "Call DAN" whenever somebody has a DCS-related question is not such a great idea.

 

[ianr33]

It's at least possible the symptoms were related to DCS. No way to know for sure.

I've done 2 dives that left me feeling exhausted afterwards. Both were on air and involved a fair amount of deco. I'm convinced they were sub clinical DCS.

 

[DocVikingo]

There are no forum "experts", call DAN 1-800-446-2671, they are the DCS and diving experts.

The "Call DAN" reflex: An involuntary and almost instantaneous abnormal movement of the less than optimally functioning nervous system.

On this and other diving medicine forums I frequently see responders, who appear to be genuine in their desire to be helpful, stating that DAN is the ONLY one qualified to answer the question and should ALWAYS be contacted and there are NO experts on this forum.

Of course emergency diving medicine inquires should be brought to their immediate attention. And, while it often is a wise idea to inquire of DAN about non-urgent situations, one needs to appreciate the likely limitations of doing so.

For example, when one contacts DAN they first, and often only, speak with a paraprofessional (e.g., registered nurse, diving EMT). These folks often simply thumb to DAN's medical FAQs (http://www.diversalertnetwork.org/me...q/Default.aspx) and read or email a paraphrasing to the individual. They frequently are quite busy and give the briefest possible reply. For understandable reasons, DAN provides very limited direct physician access. As such, the answers received from the experts on a diving medicine forum are likely to be longer and more informative than the responses from DAN, even when both are in essence correct.

Also, diving medicine forums typically afford greater opportunity for more rapid give and take between participants than is the case with DAN. Finally, links to previous board threads on the topic, professional magazine and journal articles on the topic, and other reference sources are often given on these forums, another nicety not usually provided in a DAN reply.

And, DAN does occasionally give a rather shaky response. I can cite a number of these. It is a very worthy and valuable organization, but it in fact is not the be all and end all of diving medicine fact and opinion.

It would seem wisest to inquire from a range of sources and see how the opinions rank based on the factual and theoretical support given an opinion, the thoroughness and clarity of the response, and similar factors.

In summary, in non-emergency cases I can see no compelling reason not to seek advice from recognized diving medicine forums and other reputable sources that have knowledgeable physician participation and turning to DAN only if that fails. Some diving medicine inquiries are rather easy to answer and do not require DAN's valuable, but limited, medical resources.

Personally, for almost all diving medicine inquires of a non-emergency nature I would come to this forum first.

Regards,

DocVikingo

 

[Duke Dive Medicine]

I know that unusual fatigue can be a symptom of DCS. I would like to hear from the forum and its experts on weather this could have been a manifestation of DCS. She is doing fine now and has no sequele. Thanks

It could have been but it's impossible to tell after the fact, especially if she didn't receive a thorough neurological examination. The time to call DAN would have been when this event was actually taking place, and they certainly could have guided the divemaster and/or boat captain in a more detailed assessment of the diver.

There are no forum "experts", call DAN 1-800-446-2671, they are the DCS and diving experts.

Though I'm sure you're well-qualified to make such a statement, I disagree. The answers above are at least as thorough as those he'd have received if he'd contacted DAN, especially considering the dearth of detail presented.

Not to mention the fact that we started DAN in the space I'm sitting in right now.

 

[jar546]

I myself, twice in the past have had a similar experience, although I never slept more than a few hours. In both instances, a few hours after the dives I was extremely sleepy and tired (not exhausted from physical exertion) beyond what I normally get. Extremely tired and had to take a nap for a few hours. Both situations were as follows:

1) 3 dives in a wetsuit, shore dives, 45 degree water, approx 45+ minute dives, depths from 25-90, outside temp below 50.
2) 4 dives with drysuit, all in less than 40' of water, off a boat in moderate seas, water temp 68F, all dives 45-60 minutes. 1st day of diving after arriving on plane day before.

Both days diving air.

This has not repeated itself since:

1) I got a pee-valve installed on my drysuit and drink more water when diving dry.
2) No more diving wet in cold conditions
4) Heavy days of diving 4 or more dives, I use Nitrox 32

 

[danvolker]

The symptoms would seem to be consistent with a bout of "subclinical" DCS.
A non-dive-related possibility is that the diver was just getting sick, and a looooong sleep is how her body reacted.
Since she had a rapid ascent prior to the long sleep, "subclinical" DCS would be higher on the differential.

Someone should tell her that, if she is ever placed in that situation again (rapid ascent to surface from 100 fsw after logging 15 min. of bottom time), she should exit the water, maybe breathe oxygen (if available), and be monitored for signs of AGE or DCS. If nothing abnormal crops up, then it's still probably best to stay out of the water for the rest of the day.

Why did her buddy allow her to re-descend and attempt to finish the dive?
What did the DM and captain (presumably trained in dealing with scuba emergencies) have to say about the turn of events?

This is "Mainstream Agency" position on the issue, and I feel it is massively negligent to "misinform" divers in this way...Please do not feel I am saying this about you---you are expressing the clear training agency and DAN position on this...

It is well known, and indisputable, that from dive like described, from 100 feet for 15 minutes, a a sudden and rapid ascent to the surface, with NO embolism( diver had mental control and breathed/exhaled as should be intuitive) , will not cause bubbling in the first minute to 2 minutes following the rapid ascent.

Her decision to go back down to 50 feet, was intelligent, as it PREVENTED the liklihood of much more serious bubbling that could have occurred had she gotten on the boat.....While it may be possible that she could have been picked up and put on oxygen withing 3 to 5 minutes, most charter operations would not be able to guarantee she would be on the boat and on O2 within 5 minutes of hitting the surface, and waving for help.....Meaning, if there was going to be serious bubble formation, Damage would begin to her body prior to the boat being able to get her on O2....

I do not think we should tell a person to ignore the possiblity of getting zero damage, by going straight back down, and remaining uninjured in any way, as hypersaturation NEVER occurred....The Agency position is to tell the DIVER they should ignore the potential for no damage, and expect some damage to occur, damage that may be mitigated somewhat by O2 on the boat, but which may also require a chamber ride. I think that this is a terrible way for the AGENCIES and DAN to behave....it is almost as if they wanted to provide more guaranteed medical and insurance income from diver injuries....

This is a classic case, perfect for me to RANT about