Pain particularly characteristic of DCS?

[Puzzlement]

On another forum I posted a thread about undiagnosed pain after diving for which I sought medical attention, including phone conversations with DAN and a local hyperbaric unit: http://www.scubaboard.com/forums/ba...21547-bad-sunday-night-pain-after-diving.html

Quick summary:
- 2 dives, 46 minutes at a maximum depth of 20 metres and the second 48 minutes at a maximum depth of 17 metres, with an hour on the surface between them
- did not hit deco according to the Suunto computer, came within 5 minutes of it
- slow ascent and safety stops on both dives
- dives finish 5pm
- high severity pain onset 11pm, localises in shoulder joint about 12:30am after painkillers
- hyperbaric chamber suggests visiting an emergency room for consideration of transfer during the morning
- pain diminishes before arrival at emergency room and stays low
- emergency room discharges me at 7am (shift change) after X-Rays

A couple of the commenters are concerned that it is *so* like DCS that I should disregard the emergency room's advice (they thought it was unlikely to be DCS and want me to go to my general practitioner if it doesn't resolve and to them if it gets bad again) and seek further advice from a hyperbaric specialist.

So, my medical question: is there something about this that is VERY like DCS, more so than any other joint pain with onset after diving? (I know, and the hyperbaric specialist reminded me, that treatment should proceed as DCS until proven otherwise. I'm not clear on whether the emergency ward doctors proceeded with this in mind. They were dealing with a fully alert patient whose symptom was by then extremely mild discomfort in my right arm.)

(I understand that you can't offer proper medical advice, but I have already sought attention and spent a night in hospital and I'm now trying to understand the presentation.)

 

[DandyDon]

Until someone more qualified chimes in, I'll suggest - Yes! "I know, and the hyperbaric specialist reminded me, that treatment should proceed as DCS until proven otherwise." The way I would approach the ER is "DAN sent me in, but I need a physicians who will consult with DAN personally after examination." If they don't like that or don't have time, it wouldn't be worth the exam to me. DCS is not an exact science.

 

[Puzzlement]

The way I would approach the ER is "DAN sent me in, but I need a physicians who will consult with DAN personally after examination."

In terms of overall outcomes, this is probably something that the DAN advisory service should be passing on. Neither hyperbaric specialist remotely suggested to me that they wanted or were available to be called for advice (I suspect but do not know that both were woken up while on call). The first deferred to the second, and the second to ER. Getting the word out to divers after an injury that divers are almost entirely responsible for forcing medical professionals to talk to each other was not effective in this case.

Thanks for your response. I'll definitely be more forceful in the event of another incident of pain. I generally have dealt with medical professionals on the assumption that they know better than me when to refer or consult.

 

[DandyDon]

Well if you are in Australia - I guess, not sure - you may well be dealing with different systems at the ER and DAN both? Here, DAN docs are there and ready, 24/7, but finding and ER doc who knows diving can be challening.

In other places, one must be concerned about unneeded treatments at times. "He's got DAN, they'll pay, run him thru it all!"

Either way, it's my body, and I value good, professional treatment, but have survived a lot of bad. I went to see a doc locally for a second opinion when I had he DVT, then went back to the good doc I had asking "Why does she have a license?" They're supposed to police their own here, but often fail. He just shook his head. I guess none want to be in on those needed actions.

 

[DocVikingo]

Hey Don,

DAN Asia-Pacific, which includes Australia, operates very much the same as DAN America. Here are the contact numbers, both emergency and routine:

DAN Asia-Pacific
http://www.diversalertnetwork.org/contact/international.asp#DAN Asia-Pacific

In this instance, it appears that the local hyperbaric professionals involved may have been less than diligent in assuming their proper responsibilities.

It would not be inappropriate for "Puzzlement" to recontact DAN Asia-Pacific to share his experience.

Regards,

DocVikingo

 

[Dr Deco]

Definitely sounds like joint-pain DCS to me.

 

[DandyDon]

There you go, Puzzlement - two of the best opinions available, bar-none...