My friend just got her OW and she's been diagnosed with DCS

[DevonDiver]

One of the biggest and most serious issues that impacts upon successful DCS treatment is 'Denial'. Added to this is the issue of poor DCS education amongst both the professional medical community and the recreational diving community..

Here is a good article by Dr Jules Eden (London Diving Chamber):
Late Presentation of Decompression Sickness - Diver Denial

From London Diving Chamber:

Having treated many patients over the years DCI denial is a real factor in divers.
A medical cliche is that "common things are common, rare things rare".
If you have been diving the week before and develop a joint pain, tingling, fatigue or numbness, then do not assume it is anything other than DCI.
It will not be a rare neurological illness; it is most likely to be a bend.
It's not that you have wrenched your shoulder lifting kit; assume it's a bend.
It's probably not a rare tropical bug; assume it's a bend.
Until proven otherwise.
Due to the nature and unpredictability of nitrogen out of solution in the body, DCI must be treated as an emergency and treated quickly

From the DAN website, article:

Decompression Illness: What Is It and What Is The Treatment?
By Dr. E.D. Thalmann, DAN Assistant Medical Director

DCS - Denial and Recognition

The most common manifestations of DCS are joint pain and numbness or tingling. Next most common are muscular weakness and inability to empty a full bladder. Severe DCS is easy to identify because the signs and symptoms are obvious. However, most DCS manifests subtly with a minor joint ache or a paresthesia (an abnormal sensation like burning, tingling or ticking) in an extremity.

In many cases these symptoms are ascribed to another cause such as overexertion, heavy lifting or even a tight wetsuit. This delays seeking help and is why it is often noted that the first symptom of DCS is denial. Sometimes these symptoms remain mild and go away by themselves, but many times they increase in severity until it is obvious to you that something is wrong and that you need help.

What happens if you don't seek treatment? In severe DCS, a permanent residual handicap may result: this can be a bladder dysfunction, sexual dysfunction or muscular weakness, to name a few.

In some cases of neurological DCS, there mat be permanent damage to the spinal cord, which may or may not cause symptoms. However, this type of damage may decrease the likelihood of recovery from a subsequent bout of DCS.

Untreated joint pains that subside are thought to cause small areas of bone damage called osteonecrosis. Usually this will not cause symptoms unless there are many bouts of untreated DCS. If this happens, however, there may be enough damage to cause the bone to become brittle or for joints to collapse or become arthritic.

 

[bleeb]

Well, yesterday, seven days after we last dove, she went to the hospital and they told her she has DCS. However, they said it is too late to go into a hyperbaric chamber and that too much time had passed. I thought that the only way to cure DCS is to put someone under pressure?

Another question to consider is whether she was seen by someone sufficiently knowledgeable about dive medicine, particularly treatments and after-effects. As a non-medic diver, I don't know that a general practitioner in the ER or your average personal physician would reliably known enough for other than basic diagnosis. Similarly, even if the hospital had a hyperbaric chamber, many aren't set up, staffed or oriented towards treating DCS emergencies. As others have suggested, DAN would be a good reference towards determining the knowledge level of the doctors and hospital she visited and/or locating an adequately knowledgeable second opinion.

 

[Bubbletrubble]

A separate but related issue to DevonDiver's discussion of "diver denial" is that it's a good thing to remove barriers to treatment in situations where DCS is possible. In the vast majority of "questionable" DCS cases, hyperbaric treatment will not do any harm (assuming the patient was worked up properly) and could be beneficial, so the likely recommendation is to treat.

I'd be willing to bet that a major determining factor in the patient seeking timely medical evaluation/treatment is whether he/she is medically insured for diving-related accidents (including DCI). For divers based in the U.S., DAN coverage is relatively affordable and probably a good idea to get.

 

[Arkman]

I don't know very much about DCS but I am curious about this situation.

As some had alluded to, it might be to late to get hyperbaric chamber treatment. So what does this mean for her recovery? Generally speaking. I realize that none of you can say whats going of for sure but.

I guess I don't understand whats next. Does she have to wait out the symptoms? Do they go away after time or what?

 

[TSandM]

The prognosis is certainly going to be based on the amount of tissue damage.

I have read accounts (for example, Bernie Chowdury's) of severe DCS cases, where substantial resolution occurred after the cessation of treatment, but it required a lot of time. The body's capacity to heal is substantial. On the other hand, severe DCS can result in, for example, bone death (osteonecrosis) or neurologic injury which is beyond the body's capacity to repair. This is why prompt treatment of even suspected DCS is so important.

 

[dmoore19]

The only reason I bring this up is if the DCS hit was during training maybe she would be covered by Dan. I don't know about in Cancun. I don't know about other shops either but when I did my training the students in the group were covered by Dan Insurance during the pool and certification dives. I thought it was a standard for PADI OW training, maybe not?

 

[DandyDon]

I hope the best for your friend.

I was also curious if waiting 24 hours after diving okay to fly, or should it really had been 48 hours?

DAN recommends 18 hours and finds no significant benefit for waiting longer after recreational dives with no issues.

I'm curious if your friend had any runaway ascents or missed safety stops?

 

[Jim Lapenta]

I'd also like to know why she ever went deeper than 60 ft on any of her dives if your intial post is correct where you stated that

"I took my friend with me to Cancun to get her OW. We did six dives over the coarse of three days. Two were shallow at 30 feet, and the rest were between 50 and 80."

How was her buoyancy control and did you do the entire course there or just the dives? If the entire course was done there what was she told about her recommended limits as an OW diver and what her ascent rates should be? Was she able to control her ascents? What were the actual dive profiles with times at depth, times at safety stops if they were done, and total dive times with surface intervals? This info, at least for the checkout dives, should have been recorded in her logbook and signed by the instructor.

I'd also like to hear what DAN says and hope she recovers fully.

 

[Kilili]

Join DAN, worth every cent.

 

[tholden1]

I use DAN and recommended it to her, but she decided not to join. I usually only used them when I did dives outside the U.S. but with this experience, I'm going to use them any time I dive no matter what.

DAN said that at this late stage (seven days post dive), there is no point to hyperbaric treatment.

She presented symptoms before we flew. In fact, now that I know, she presented symptoms on our dives but she didn't realize it and never called it out. Apparently, she felt like she was being choked and didn't know why. And, from what DAN said, that's a sign of DCS too.

She spoke with DAN and a dive doctor that DAN referred her to. Even though she didn't join, DAN still helped. Kudos to DAN!

I didn't see her do this, but she shot to the surface on a dive at 48 feet. I saw her once she was already on the surface. Basically, she was behind me and her/our instructor (I was getting my AOW) was in front of me. I saw him look up, then noticed she was up there. It was after that dive that she now has told me that she felt the choking sensation. That was on dive three of six. And, it was her third dive ever. She descended again four minutes after she shot to the surface and continued the dive. Of course, I say "shot" to the surface, but maybe she swam up normally. She was fumbling with a camera and not paying attention. I didn't see it, maybe the instructor did. When I saw him looking up at her, she was already at the top.

She didn't have a dive computer, but I did. Here is the info from it for the dives:

Day one:
#1 - Depth 29, Bottom Time 27 minutes
#2 - Depth 27, Bottom time 35 minutes

Day two:
#3 - Depth 53, Bottom time 29 minutes. She shot to the surface maybe from 48 feet, 10 minutes into the dive. At the surface at least four minutes, then descended and continued on the dive. I have no idea what her ascent rate was. Maybe it was normal.
#4 - Depth 50, Bottom time 36 minutes

Day three:
#5 - Depth 77, Bottom time 24 minutes
#6 - Depth 47, Botton time 31 minutes

Of course, her profile may be slightly different than mine, but I think she followed me relatively close.

I didn't really ask her if it was okay to post this information. In hindsight, I probably should have. But, I'm hoping by not revealing her name, I can save her from any embarrasment nevertheless.

I shot to the surface once. I was at depth and saw a manta ray. I got so excited, I went to meet it and then felt my head hit the surface. It happens. I've had other embarrasing moments to. But, I've been trying to explain to her that these things happen, and it's just a learning experience.

In this case, I feel kind of bad that I didn't see her shoot up and/or stop her. I can't remember on that dive whether I was her dive buddy, or the instructor. He probably should have been right there by her side, but they were kind of trying to combine my AOW with her dives, so he might have been doing something else in regards to that. And, I was messing with my camera too taking pics which was probably diverting my attention. It doesn't take long to go from 48 to 0 if you're not paying attention!

Luckily for me though, the pics I took and my dive computer somewhat document the event so at least I can remember more details about what happened.