Fatigue as DCS Symptom

[ArcticDiver]

Just whan is fatigue a DCS symptom and not a normal sequel to exercise assoicated with diving?

Actual situation: Two guided morning dives from a tourist dive boat. All dives well within accepted dive limits. Typical situation where some divers get out earlier than others due to air consumption. Last divers out of water due to schedule constraints. First dive to 90' with a BT of 20". One hour SI during which food and drink are available. Second dive variable depth from 15' to 40' in moderate surge with a BT of 45" to 60" depending on diver. Several swim throughs and poking in and out of shallow caverns. After second dive everyone looked and acted fatigued.

In van on way back to hotel everyone but me and the driver were sound asleep. Some folks didn't even stir until prodded to awake as we reached their hotel. I felt tired enough to take a nap but felt fine after some rest and nourishment. No complications or sequelae.

Later, in a discussion I was told we all had DCS and should have gone to a medical facility. I didn't think so and put it down to unaccustomed exercise and normal vacation fatigue.

Your opinion?

 

[fins wake]

I didn't think so and put it down to unaccustomed exercise and normal vacation fatigue.

Barring any actual symptoms of DCI, yours would definitely be my opinion, too.

Incidentally, I like to avoid short surface intervals after deep dives if possible. Proper hydration, staying within NDLs, nice slow ascents and a safety stop on every dive are even more important to me on recreational dives, though. Just my 2 cents.

 

[Charlie99]

The fact that your 2nd dive was in moderate surge caught my attention, because I had a similar incident several years ago, after a dive where surge repeatedly moved me up and down about 10' along a 45 degree slope. The depth changes were from about 50' to 60' repeatedly, for a large portion of the dive. While my fatigue was not nearly as severe as what you describe, it was definitely more than normal. I learned my lesson, and although I may still go for a wild up and down ride a few up/down cycles, after that I'll back off the wall and won't bounce up and down for the entire dive.

DCI is not a black and white case of being bent or not bent --- there are lots of shades of grey in between.

On a related note, many divers report less fatigue after diving on nitrox. Others, including me, have noted less fatigue once we started inserted some deep stops, even on dives within no-stop limits. Once I stopped bouncing up and down, started controlling my ascent rates better, and inserted a couple stops on the way up, I no longer saw any difference between nitrox and air dives --- zero fatigue after both.

It's just my personal opinion, but I'm convinced that all of the above is related to very mild, subclinical DCS.

 

[Arnaud]

...DCI is not a black and white case of being bent or not bent --- there are lots of shades of grey in between.

On a related note, many divers report less fatigue after diving on nitrox. Others, including me, have noted less fatigue once we started inserted some deep stops, even on dives within no-stop limits. Once I stopped bouncing up and down, started controlling my ascent rates better, and inserted a couple stops on the way up, I no longer saw any difference between nitrox and air dives --- zero fatigue after both.

It's just my personal opinion, but I'm convinced that all of the above is related to very mild, subclinical DCS.

Absolutely agreed. Also, better insulation (as in never ever feeling cold) helps a lot to get rid of the post dive fatigue, especially when doing several dives a day.

 

[Dr Deco]

Hello ArcticDiver :

I doubt that your fatigue in this case was a mild form of DCS. Sounds to me more like simple overexertion. :54:

Dr Deco :doctor:

 

[ArcticDiver]

Thanks everyone for your confirmation. I was using y'all, perhaps unfairly, to obtain an unscientific and definitely no-liability second opinion. It is my belief that in "tourist diving" most, if not almost all, of the time fatigue unaccompanied by other significant signs or symptoms is the result of unaccustomed exercise, period. In this particular case the reason I had less fatigue had more to do with my relatively more rigorous daily activity and fitness program than anything else.

As for the term "sub-clinical". I'm not sure what its' precise definition is. I see it used many times in diving discussions to support a position that would otherwise be untenable. On the other hand if it means that there is a psychological component to the medical condition called DCS, there is ample evidence that the mind and attitude play a significant role in both medical and trauma scenarios.

 

[IndigoBlue]

Barring any actual symptoms of DCI, yours would definitely be my opinion, too.

Incidentally, I like to avoid short surface intervals after deep dives if possible. Proper hydration, staying within NDLs, nice slow ascents and a safety stop on every dive are even more important to me on recreational dives, though. Just my 2 cents.

I agree with this as well.

I would be on the lookout for some neurological symptoms, such as joint pain, or chest pain, or an NDL violation of some sort, or too rapid ascent, before I would consider a trip to the hospital (followed by a trip to the chamber).

Mere fatigue would not do it for me.

Also remember, you should never go directly to a chamber. You should always go to a hospital first, and call DAN, to get immediate care, O2 administration, and evaluation by a physician. It would be the hospital that then alerts the chamber, to activate it, should it ever come to that.

A 90 ft dive for 20 mins on air is probably fine, since it is 5 mins shy of the NDL limit (if I remember my tables correctly 90 + 25 = 115 the recreational summation). I do not have my tables in front of me now.

Even so, I would normally recommend that any diving deeper than 50 ft be done with EANx, with any subsequent repetitive diving done with EANx as well. That is just my personal recommendation, for safety's sake.

 

[Charlie99]

As for the term "sub-clinical". I'm not sure what its' precise definition is. I see it used many times in diving discussions to support a position that would otherwise be untenable. On the other hand if it means that there is a psychological component to the medical condition called DCS, there is ample evidence that the mind and attitude play a significant role in both medical and trauma scenarios.

In my post above, subclinical is used in the more common sense, rather than anything related to psychosomatic. The dictionary definitions for subclinical have phrases like "without clinical symptoms, as a disease in its early stages".

I'll leave it to the reader to decide whether my statements are untenable. Personally, I find the concept of a continium of DCS from "not bent" to "badly bent" to be very easy to accept since it matches my experience with many other common experiences, such as sunburn, weather exposure, etc.


Only the divers in question would know whether the level of fatigue they felt was appropriate for their level of exertion, how much partying they did the night before, etc.

 

[ArcticDiver]

Sorry you took my comments as an attack on you or your post. I really was speaking in a definitional sense and not making any sly inuendos about that post. Matter of fact, those who know me say I wouldn't know a sly inuendo if it snuck up on me and hit me over the back of my head with a 2x4

 

[fins wake]

... much as it's nice to get support, I have to register my disagreement with the following statement:

Also remember, you should never go directly to a chamber. You should always go to a hospital first, and call DAN, to get immediate care, O2 administration, and evaluation by a physician. It would be the hospital that then alerts the chamber, to activate it, should it ever come to that.

I don't know what the recommendation is in the continental United States, but in the rest of the world you should get to a chamber as quickly as possible if you experience symptoms of DCI. Obviously inhaling O2 all the way, if possible (which it always should be). In many parts of the world - and I guess in much of the U.S. too - most doctors at hospital A&E:s do not understand decompression illness and transfer to the only place of real help - a recompression chamber - will be unnecessarily and perhaps dangerously delayed. Now, at a recompression chamber, the hyperbaric staff will be very used to diving emergencies and they will also have the competence to evaluate your condition. Going to a chamber doesn't mean you will be recompressed, only that they have the means to do so rapidly if needed.

Now, the caveat here is that I don't know or understand the U.S. medical insurance system, so perhaps you guys do it a bit differently (I'm sure someone will correct me if I'm wrong). But in most parts of the world, the evaluation bit will be by a hyperbaric medic and calling DAN etc will be done from the chamber. This is even the case in many top notch hospitals in the developed world. And DAN are best called immediately, i.e. from the dive boat ...

Apart from that, I think Indigo makes some good points.