possible mild DCS?

[asdfzxcvasdf]

Hello,

Was wondering if anyone thought this could be a case of mild DCS? And if so, will it just go away eventually? I have an appointment with a doctor in about 4 days (great healthcare system, huh?), so any input or suggestions would be appreciated, especially what I should say to the doctor, that would be helpful, but not freak anyone out. Symptoms are mild, so I decided not to go to the emergency room. Symptoms have not gotten worse, nor improved in the last 36 hours since onset. I'm a brand new diver.

Symptoms:
-Red rash on the inner upper left arm, from the elbow to the armpit (no rash on the elbow nor armpit, and not on right arm).
-What feels like a bruised muscle (but no blue/black discoloration) underneath red rash, with pain concentrating at the upper arm and at the armpit (If you hold your left arm out palms up, it would be where the bicep starts, but all the way on the right side; and the muscle about 1 inch down from the deepest point of the armpit - both only on the left side).
-No joint pain whatsoever, and no pain at rest - sensitive only when pressed.
-slight pain if I extend my arm out (at the upper arm) and when I extend my arm over my head (armpit).

Timeline:
(no previous dive experience)
Day 1: Fly into Oahu from Maui
Day 2: Classroom and pool dive (~12ft)
Day 3: 2 dives down to 35 feet
Day 4: 2 dives down to 40 feet (open water certification complete)
Day 5: 2 dives down to 85-90 feet
No symptoms, except slight dizziness for 6hrs - most likely due to rocky boat ride (25min to site and 25 min back). No other dives.
Day 9: 8 hour flight from HNL to DFW to ORD
Day 10: Symptoms begin feeling like a bruised armpit
Day 13: Writing this post

Day 2-4 was part of a scuba certification program, and I was with instructor at all times. Day 5 was part of the advanced open water certification, and I was with the same instructor at all times. Diving school was reputable, instructor was very safety-conscious. According to the RDP tables, we blew through decomp for a couple minutes on day 4 and day 5, but instructor had a dive computer which said we were safely within parameters. Probably, bc/ we took both descents and ascents very slowly and did not stay at the bottom for most of the time. Safety stops on all dives, with 2 safety stops on the 2 deeper dives.

Other complicating issues / symptoms:
Been generally miserable since getting back
Low-grade fever, especially at night, but no sinus or chest congestion
On Day 5, I cut myself on the palm of my left hand, going through the door of an overturned barge (wreck dive). Continued second dive with open wound.
Day 6, 7, 8 - went surfing (fairly vigorous exercise), multiple cuts on both feet from rocks (possible I pulled muscle while paddling, but not likely bc/I didn't notice until arriving home)
Had massages about 6 hours after every diving session, the last session was fairly intense (possible could have bruised muscle, but not likely bc/I didn't notice until arriving home) - in retrospect, probably not a good idea!
Jumped off of Waimea Bay rock (maybe 20-25feet) on Day 6 (possible could have bruised muscle on impact of water, but not likely bc/I didnt notice until arriving home)
Went snorkeling Day 6 and Day 9 (had bandage wounds, could have gotten infected)
Developed some sort of psorasis on the left elbow on coming back
One cut on left foot still currently infected
Cut on palm just finally healed
For the last 36 hours, I've been taking tylenol for the fever, ibuprofen for the arm, and benadryl / claritin for the rash.

In all likelihood, with all the cuts I got on the trip and being in the open water, I probably picked up some sort of infection which accounts for the low-grade fever - so I'm definitely going to get checked out by the doctor. The question is whether the arm is DCS related and will it go away if it is?

 

[aquaregia]

Call DAN? 1-800-446-2671.

Also, I'm surprised that your instructor asked you to trust his computer and blow your NDL on a training dive (or at all, really), especially if he was safety-conscious. What exactly does two safety stops on one dive entail?

 

[TSandM]

Symptoms which began more than five days after the last dive are vanishingly unlikely to be DCS. I'd be much more concerned about wound infection.

Many very acceptable dives put tables into deco, because tables do not take into account that you may spend very little of your time at max depth. This is precisely why people use dive computers.

 

[aquaregia]

Many very acceptable dives put tables into deco, because tables do not take into account that you may spend very little of your time at max depth. This is precisely why people use dive computers.

I don't disagree with that, but should a student be using the instructors computer on a training dive? That seems in direct contrast to everything I've learned.

 

[Mr Carcharodon]

The most common decompression models use the concept of half times to describe the rate that inert gas enters and leaves tissues. The longest half time used in most models is 635 minutes. You did not say how long you were down on the deeper dives but unless you were down for days, which seems highly unlikely, you were not saturated in the 635 minute compartment. So you were completely decompressed after not more than 3 days. Since symptoms did not appear for 5 days it is safe to assume it is not DCS. If for some reason your peripheral circulation was restricted those half times might not apply. But that would require being very cold which seems unlikely for Hawaii.

On a tangential note waiting 4 days to get treatment would not be a good idea if you thought it was likely DCS. There are multiple mechanisms for the pathophysiology of DCS but restriction of oxygen supply leading to tissue death seems to be chief among them. After 4 days it is really too late to have effective treatment. The DAN website does have a number of worthwhile papers on this subject.

 

[Kendall Raine]

I don't think it's DCS. Time to onset and nature of symptoms are generally inconsistent with a skin hit. You have no other symptoms it seems. Even if it were a skin hit, they resolve on their own and should have by now. If it were me, I would:

1. Go see a doc about the rash
2. Avoid seeking medical advice on the internet

 

[Scott L]

I have an appointment with a doctor in about 4 days (great healthcare system, huh

These circumstances aways seem to involve the weekends with few option other than the ER. That's where I would go if truly misrable...

 

[Mr Carcharodon]

I don't disagree with that, but should a student be using the instructors computer on a training dive? That seems in direct contrast to everything I've learned.

Generally if you are within 10 fsw, and 5 minutes the other persons dive computer is close enough. Of course the preference is to use independent computers. If they were staying together this should not have been an issue. The "if" is important however. The slow ascents and safety stops were mitigating as well.

All the jumping off rocks, possible infections, and even the massage seems like more likely causes. Sounds like an active vacation.

 

[asdfzxcvasdf]

Thank you very much for all of your responses! I agree with Kendall and Mr Carcharodon, I didn't think it was DCS, but wanted to be sure so that's why I posted. And I'm miserable, but not in any real pain, so I didn't want to go to an ER and say, my fever barely hit 100, I have a rash and an infected wound, please save me.

I went to play tennis today, and came back inheriting another "non-discolored bruise" but now on my inner thigh. At this point, I'm pretty sure that it is not DCS, because upon doing some research, the exact points of pain correspond to my lymph nodes. I think I just have swollen lymph nodes from an infection… why they're just on my left side is another matter. In certain cases, swollen lymph nodes can cause a skin rash, as well.

On all of my dives, I didn't have a watch so I was dependent on my instructor (which I stayed very close to, never went deeper nor ascended ahead of him). He didn't intentionally blow through the RDP tables, we just found that out once I did the numbers after the dive. He wasn't worried because of his dive computer.

We were "in deco" according to the tables only for 4 minutes on one day and 2 minutes in the other. According to the tables, if a no decompression limit is exceeded by no more than 5 minutes, an 8 minute safety stop at 15 ft is required and no diving for 6 hours. In both cases, we stayed at 15ft for at least that amount if not more (waiting for other people - and I didn't want my remaining tank to go to waste) and there was always at least 15 hours, if not 19 hours in between the 2 days of diving. Plus, as I said before, I was sure we weren't truly in deco because I took a long time descending and ascending and didn't spend much time at the bottom because I was paranoid about the very issue.

For the 90ft dive, we did a 3 minute safety stop at half-point (45 ft) and a 3 minute (though this was much longer) safety stop at 15 feet. The water was not cold at all (quite nice) and on the deep dive to 90 feet, I was only down for 22 minutes, with the second dive only to 50 feet for 40 minutes. I totally would have gone to the ER if my joints were in pain or more serious, but since it was so minimal, I decided to wait and see. Oahu was pretty awesome, and I had a wonderful time. I'm not usually that active, but I was in Hawaii for a wedding (not mine), and I generally hate weddings, so I tried to keep busy.

Again, thanks for every one's response. I will post a final conclusion.

 

[Al Mialkovsky]

2. Avoid seeking medical advice on the internet

BINGO

Don't have to wait 4 days to see a doctor. If you went to an emergency room and gave them your symptoms they would have examined you on the spot. DAN is always available. So maybe the health care system didn't fail you. Maybe you needed to be responsible for getting yourself to the right spot first.