I've been thinking about DCS

[JustJoe]

A strange incident diving this weekend got me to thinking about DCS and how would you know in some cases.

A little history and what happened over the weekend. In the second week of Feb. I had knee surgery. It was minor (torn meniscus) comparatively but I was out of action for awhile. I waited until I was comfortable stepping up on a 3' high stool with the bad leg before diving again knowing that I would have to climb up a boat ladder.

So, I went diving on Saturday. We did two morning dives and a night dive. Nothing deep or long, all within the guidelines for time, depth and gas (using EANx and still stayed within air tables). During the first SI, I slipped a little on the wet deck and felt a twinge in my knee (surgery side). Nothing bad but I felt it. I loaded my gear on the boat twice and unloaded it once. Up the ladder three times in my gear, you get the picture, I was using a sore knee. Also, it was just a little chilly (3mm wetsuit in 71F water and about the same on the surface, a slight breeze).

On the last dive, as I was climbing out of the water, I took a step up on the bad knee and I grunted a little. The bad knee hurt a little but nothing out of the ordinary. The crewman who was working the back of the boat asked if I was alright and I stated that I had a little knee pain. The look on his face was one of getting ready to take action when someone standing close by and knowing of my surgery spoke up and said that the crewman thought I had DCS.

I assured him that I was fine. I explained that I had surgery and the whole nine yards, and that kind of alleviated his concern. He did still keep an eye on me and checked me a few more times.

This whole situation prompted some thinking on my part. These little aches and pains that I get as I get older are also symptomatic of DCS as well as the common problems associated with being out of shape or typical wear and tear.

There are other things that happen to me on an occuring basis as well. When I sleep my hands and arms fall asleep and I get tingling sensations (this is without diving). My elbow gets sore (tennis elbow) from other sports. If I combine these symptoms, I could have a case of DCS.

How would I know if I got hit? I could have been hit over the weekend and had symptoms in my knee, yet did not take notice because knee pain is not uncommon for me. Or I could have gone to bed and had tingling in my hands and put it off as normal. How would I know when to seek treatment?

Joe

 

[plankspanker]

Good question and something I wondered about myself. Someone else here made a reference to "taking inventory" of all your aches and twinges which seems like a good idea and I have read quite often that dcs pains don't feel like normal pains. In other words you might have pain in your knee from dcs but it will feel different from the usual pains from the surgery.
Would like to hear what someone who has felt dcs pains has to say about it.

 

[otter-cat]

I also think that "taking inventory" of your aches and pains before you dive is a good idea. With that said, however, there is still a risk of getting DCS in the same spot as the pain you had before, and then missing or misdiagnosing the DCS symtoms because you attribute the pain to another source. So, if you do have certain areas that are injured/painful normally, you still want to pay close attention to any pains or other potential DCS symtoms after a dive. While I'm sure that DCS pains CAN feel different than other injury pains, I also know that sometimes they are confused.

I also write in my logbook if I get any unexplained pains or sensations over the 24 hours or so after I dive, so if any problem persists or reoccurs, I have a record of when it started and what my dive profile was so I can go back to it if I need to.

Hopefully we can get some more input from Dr. Deco and the medical regulators about how to handle that type of situation.

 

[Dr Deco]

Hello readers:

DCS Pains and “Old” Pains

Confusion with other aches and pains is a real problem in the differential diagnosis of decompression sickness. At NASA, DCS can develop during extravehicular activity (EVA) when the pressure in the space suit is much lower than that of the space craft cabin. Unfortunately, the suit itself is tight fitting and has many points where soreness can develop and irritate the arms and legs. So crew members have been asked to note these “sore points” and to log them for future reference. This will aid the crew surgeons in developing a correct diagnosis should such a problem occur. Recreational divers should likewise develop a good memory concerning their own body.

In altitude decompression, the problems often will remit when the subject returns to ground level pressure. This is in essence repressurization of the type that a diver would experience if paced into a recompression chamber. Astronauts are asked to note if pains remit when repressurized back in the air lock of the space craft. Many experiencing pressure changes will experience pains and not know the definite cause – you are not alone.

Keeping Track

There are some things that can be done.

• You should always be aware of reoccurring aches and pains apart from diving. Know that many people get these without ever having dived in their life.
• A test of pressure is the best way to perform a differential diagnosis for DCS. This is not possible in the case of recreational divers, since a chamber is not available at the dive site. [A chamber is present at military and commercial operations. This is an important distinction of these groups. You can see why.]
• One possibility is to wait and see if the pain develops into something more severe. If so, it is likely that one is dealing with a DCS problem and plans should be made for a chamber visit.
• NEUROLOGICAL PROBLEMS are different. Numbness, tingling, and weakness are not good signs. “If you see a little, you have found a lot” as Dr Lambertsen would say. One should not wait and see if numbness progresses to paralysis!
• Divers who are sleeping may have actually lost consciousness or some degree of mental capacity. They may look asleep but are actually experiencing neurological DCS. All divers should be watched during the surface interval and at the end of the dive day. They should not go off by themselves alone.

Dr Deco :doctor:

 

[cmalinowski]

A strange incident diving this weekend got me to thinking about DCS and how would you know in some cases.

A little history and what happened over the weekend. In the second week of Feb. I had knee surgery. It was minor (torn meniscus) comparatively but I was out of action for awhile. I waited until I was comfortable stepping up on a 3' high stool with the bad leg before diving again knowing that I would have to climb up a boat ladder.

So, I went diving on Saturday. We did two morning dives and a night dive. Nothing deep or long, all within the guidelines for time, depth and gas (using EANx and still stayed within air tables). During the first SI, I slipped a little on the wet deck and felt a twinge in my knee (surgery side). Nothing bad but I felt it. I loaded my gear on the boat twice and unloaded it once. Up the ladder three times in my gear, you get the picture, I was using a sore knee. Also, it was just a little chilly (3mm wetsuit in 71F water and about the same on the surface, a slight breeze).

On the last dive, as I was climbing out of the water, I took a step up on the bad knee and I grunted a little. The bad knee hurt a little but nothing out of the ordinary. The crewman who was working the back of the boat asked if I was alright and I stated that I had a little knee pain. The look on his face was one of getting ready to take action when someone standing close by and knowing of my surgery spoke up and said that the crewman thought I had DCS.

I assured him that I was fine. I explained that I had surgery and the whole nine yards, and that kind of alleviated his concern. He did still keep an eye on me and checked me a few more times.

This whole situation prompted some thinking on my part. These little aches and pains that I get as I get older are also symptomatic of DCS as well as the common problems associated with being out of shape or typical wear and tear.

There are other things that happen to me on an occuring basis as well. When I sleep my hands and arms fall asleep and I get tingling sensations (this is without diving). My elbow gets sore (tennis elbow) from other sports. If I combine these symptoms, I could have a case of DCS.

How would I know if I got hit? I could have been hit over the weekend and had symptoms in my knee, yet did not take notice because knee pain is not uncommon for me. Or I could have gone to bed and had tingling in my hands and put it off as normal. How would I know when to seek treatment?

Joe

Jeeze, you sound like me.
Bad knees (ACL replacements on both): Don't really hurt much any more. So if they start hurting after a dive... uh oh.
Bad neck (disks): pain. Would need to have additional symptoms to know if it hurt from DCS.
Arm pain/tingling: from bad neck disks. Fingers tingle on left hand. If right hand starts to tingle... uh oh.
Elbow pain: Not sure why, but it will have to get worse for me to consider it DCS.

Gettin' old.

 

[ArcticDiver]

How would I know if I got hit? I could have been hit over the weekend and had symptoms in my knee, yet did not take notice because knee pain is not uncommon for me. Or I could have gone to bed and had tingling in my hands and put it off as normal. How would I know when to seek treatment?

Joe

There is no substitute for knowing your own body. I personally make the decision to seek treatment when one of two things happens. Either I've done something out of the normal that has brought additional pain or discomfort AND it isn't obvious what the cause was. Or, I have a sign or symptom that hasn't gone away in a reasonable time. Further I'll go the EMS/ER route when it is either unsafe for me to self-transport, or I want the assurance of enroute treatment.

These rules, for me, apply for all injuries; not just DCS.

Sorting it all out demands a bit of mental discipline and self-honesty. But it works.