DCS Symptoms

[bambam]

I have read and been told over the years the symptoms of DCS.

But I now as I get older worry more and more about DCS.
With symptoms like joint pain or headaches. Heck, who as they get old don't have these.

What would the severity of joint pain be? Worse than a sprain or jambed thumb, less than arthritis?

I have heard and read on-line that it can set in days later,
this could be mask if you have DCs or not since after a dive while loading gear you could twist a wrist and not really know it until later. Hmmm....DCS or twisted wrist? Time to hit the local chamber or not?

What I guess my point is; When is it DCS when would it not?
Are there better signs than these fairly vague symptoms in the PADI manual?

 

[Dr Deco]

Dear bambam:

It is true that aches and pains of age are a problem. Sometimes sorting this out is difficult for divers.

Joint Pain Decompression Sickness (the “bends”)

If we are speaking about joint-pain only DCS, then the symptom are not necessarily clear. In a laboratory setting, test subjects are repressurized and a determination is made if the pain lessens or remits completely. This recompression is not as easy to perform in the field.

We could make these general statements:

• joint pain DCS usually appears within one or two hours of surfacing;
• the pain feels deep within the joint;
• it can be quite mild, so mild in fact that it is often missed;
• it can progress to the point where it is extremely painful and would not be missed.

It is easy to attribute it to an injury from lugging some piece of equipment. Heavy physical activity will also generate the tissue micronuclei needed for decompression bubble formation. It is often difficult to separate one from the other.

Neurological Decompression Sickness

This form of DCS is the real bad one. It will appear within a few minutes of surfacing if its etiology (= it is caused by) is in arterial gas bubbles in the brain or the spinal cord . It can also have an onset of up to a day if the cause is the slow growth of a gas bubble(s).

It might be as “trivial” as numbness or tingling” in any part of the body or as bad as weakness or paralysis of a limb. Joint pain, or any painful sensation for that matter, does not necessarily accompany neurological DCS. Certainly a bilateral problem (with both legs or both arms) or one sided (unilateral) with one arm and a leg on the same side of the body is an indication of DCS.

It is important that provision be made for some form of treatment, such as starting to return to port. It is true that many times, the problem will remit. It can also reappear again without warning. :boom:

The medical difficulty in this case is that nerves have been deprived of oxygen because of an interruption of blood flow. This is not unlike a stroke cause by a blood clod in an artery. Nerves can die and leave one with a permanent disability. This is not an urban legend. It is one of the main hazards of diving.

Dr Deco
-- on vacation this week :mean:

 

[bambam]

Dr Deco

What is strange is how it can be masked and ignored as an injury from something else and be "blown off". Like, Oh I must have twisted my ankle getting out of the water when it could be DCS.

I have been told the pain will continue to get more painful until something is done. Is this a true statement?

Would the pain stay in a particular joint or could it make its rounds and move from joint to joint? or does it stay put?

If recompression is not done would minor DCS get worse or would it be absorbed and dissipated and go away with time?

I think back to years past before chambers like when the Brooklyn Bridge was piers were set. Many workers go the bends when sever enough death. But if it were minor would it disappear over time or would the effects be accumulative with re-exposure?

Definately an interesting subject
BAMBAM

 

[DocVikingo]

Hi bambam,

1. It is not at all unusual for divers to deny that they have sustained DCS.

If they interpret DCS as incontrovertible proof of a bad diver, fear the condition or its treatment, or just don't want to spoil their/their buddy's dive vacation, the vagueness of many of the signs/symptoms of DCS, and the ease with which these can be blamed on some other cause, make denial an enticing path.

2. It is not generally true that joint-pain only DCS pain will continue to get worse until something is done. Although it may get increasingly painful over some period of time, such DCS-related pain often dissipates without recompression or other intervention.

3. DCS may cause pain in multiple joints, but the pain does not move from joint to joint. It stays put until it is treated or dissipates on its own. The gas bubbles that precipitate the pain do not migrate about, and in fact are believed to disappear after several hours.

4. Whether the effects of repeated bouts of DCS are cumulative or not depends on the type of hit. In the type of neurological DCS referenced by Dr. Deco, the effects likely will be cumulative and can be quite serious.

Best regards.

DocVikingo

 

[Dr Deco]

Dear bambam:

Pain of DCS (the “bends”)

If the “dose” of nitrogen is large enough (or there were enough tissue micronuclei to trap the exiting dissolved nitrogen, the pain will last for more that a few minutes. Divers do not always recognize that there is a steady progression of effects from gas bubbles in your body following decompression. If there is only a small “dose” of nitrogen, then we get only “silent bubbles” in the tissue. As the “dose” of nitrogen increases (long bottom ties, for example), the “silent bubble” stage may progress to a fleeting ache. As more nitrogen is added to the body (deeper and longer), we get a steady pain that persist for hours. Even more nitrogen can give real torments; you can not say in advance.

Therefore, depending on the amount of dissolved nitrogen, the pain might increase over the next few hours or it might remit. Neurological problems must not be neglected on the hopes that they will vanish since permanent damage (nerve death) can occur in these situations.

Location of DCS

The pain of “the bends” does not move from joint to joint. It will stay in place. It is possible for discomfort to appear in more than one place in the body, however. That might give the appearance that “the bubbles” are actually moving around. They do not actually “make rounds.”

Persistence of DCS

Mild joint pain will disappear in a few hours. More intense joint pain does not persist beyond several days (that sounds nice, does it not?). However, you do not know in advance if the problem will remit or exacerbate.

Neurological problems can cause paralysis for the remainder of one’s life. It must not be neglected. Oxygen administered while on the way to recompression therapy is a good first aid measure.

Early “Sand Hogs” on the Brooklyn Bridge

The men who work in the caissons of the bridge between Brooklyn and Manhattan often experienced incapacitating pain. The same was true of those who labored on the Ead’s bridge project in St. Louis (1869). This was a dangerous time, as the cause of “caisson workers’ disease” was not known. It was attributed to rapid compression, cold, and damp working conditions. It was treated by repressurization (returning to work with the next shift) and in between with liniment and beverage alcohol.

Exposures were considerably in excess of what would be permitted today. Some men died and many experienced neurological difficulties. Their stage walk was reminiscent of the Grecian Bend and they were taunted by their fellows of “doing the bend.” Their misfortune carries as its legacy our term for joint-pain DCS.

The job was difficult and the pay was high. Many did become permanently disabled. The chief engineer of the project was Washington Roebling who acquired neurological problems while inspecting the Brooklyn caisson (under high pressure for several hours). He recovered. While inspecting the Manhattan caisson, he again remained at high pressure for hours and was stricken again. The second injury left him with a nerve deficit on top of the first injury. He did not recover this time. As an invalid, he had to supervise the construction from off site. His wife Emily contributed greatly to the effort, as she was the “field engineer” for the project, even making presentations before the American Society of Engineers.

Dr Deco
-- on vacation this week :mean:

 

[DocVikingo]

You're mighty productive for one on vacation.

Have some fun.

DocVikingo