What's the treatment for mild DCS symptons (shoulder pain) after 48 hours?

[L Neal]

Not sure if this is the right forum for my question but others seem to be asking similar. I returned Sunday evening from a 7 d dive trip completing 16 tanks, using a Suunto Zoop computer. I stayed within the no deco limits except on 1 dive midweek when I when I needed a brief deco stop, which I completed. My maximum depth was 85 ft. on the last dive, but ascended gradually and included a safety stop. That night (about 8 - 10 hours later) I awoke with pain in the right back/shoulder area. Flew home the next day, thinking it was probably muscle strain, but pain increased slightly and discomfort included burning/ sore sensation on my skin in the same general area.

My last dive was on Saturday afternoon, flew out early Sunday morning (18 hours later) and wondering now if this could be DCS and if so should I be treating it any differently than I would a muscle strain or pull (ie, pain relievers like Advil & Tylenol). DAN suggested I consider visiting a nearby hospital with chamber doctor, but I'm wondering whether it's worth the trouble and I should just wait it out.

I spoke with DAN twice and the lady did not say I had DCS. She indicated it was just as likely that I injured my shoulder during the trip. The question I asked is not for medical advice, but rather wondering whether anything could be done outside of the 48 hours. The DAN rep told me that chamber not useful beyond a certain amount of time. She agreed that its really hard to know the difference and lots of divers have similar concerns and there is no definitive way to know whether or not it's DCS. I'm pretty new to diving and felt confident that I was diving conservatively. I'm using a Zoop and diving shallower than most others in our group.

Interesting....Any additional details of what you did between diving and sleep that night?

 

[L Neal]

This forum should be renamed:
DON’T ask Dr. Decompression!!!!

And to clarify —DAN did not recommend going to the chamber. I spoke with them twice and we discussed mildness of symptoms and potential for other causes of back/shoulder pain. DAN told me that chamber treatment unlikely after 48 hours, which is why I asked the question about what is the treatment after that time period. DAN only mentioned the chamber doc at the very end of 2 lengthy conversations.

Thank you to the moderator for treating my question respectfully.

 

[flyboy08]

If someone comes to this forum seeking medical advice then that advice should be offered without judgement. Health care professionals see this kind of thing all the time and it's not limited to potential DCS patients. If you have something productive to contribute feel free, but kindly save the prosaic sarcasm for other forums.

Best regards,
DDM

Yep!

 

[Superlyte27]

If DAN told you the chamber is not useful after 48 hours, either they are idiots or you misunderstood. - or I misunderstood.

Understand that with dcs, it is possible that until the bubbles are recompressed they aren't going anywhere.

I was a chamber operator for more than a decade.

 

[hammet]

I find these threads interesting as it's seemingly hard to choose to attribute minor pains in the body to DCS, muscle strains, general fatigue, or even a fleeting cold or flu virus. I'm sure most of us that have had more than a few dives where we have wondered several hours after surfacing if that sore joint was from lifting a tank improperly or just maybe DCS.

 

[hammet]

I was a chamber operated for more than a decade.

Sounds like an interesting story. Care to elaborate?

 

[rsingler]

Bony cartilage and joint spaces have relatively lower perfusion with blood compared with other tissues. Therefore, it is possible that you still have bubbles that have not disappeared spontaneously over 48 hours.
Physics tells us that due to wall tension, the smallest bubbles are the hardest to reduce further in size, much less obliterate, notwithstanding a favorable nitrogen gradient out of the bubble.
If you are still having pain symptoms, I would urge you to follow up with a hyperbaric physician familiar with diving. Bring your computer. If he/she concurs that DCS is a reasonable possibility, then the first descent in the chamber MAY confirm the diagnosis as your pain improves.
See the post above about the potential consequences of impaired perfusion of bone areas.
Although there is a declining potential benefit at two days, it is definitely not zero. Additionally, if you confirm a DCS diagnosis with pain improvement during a chamber ride, that will definitely be useful information as you refine your concept of a "conservatively" dived 16-tank trip that included deco and a plane ride.
If you currently have zero pain or other symptoms, then your hyperbaric physician will have a harder time making a diagnosis based upon history alone.
I truly wish you success in solving this problem!

Diving Doc

 

[Superlyte27]

Sounds like an interesting story. Care to elaborate?

It was a typo. Spell check does the weirdest stuff on this forum for me. I've fixed it.

 

[hammet]

It was a typo. Spell check does the weirdest stuff on this forum for me. I've fixed it.

lol

 

[Superlyte27]

Bony cartilage and joint spaces have relatively lower perfusion with blood compared with other tissues. Therefore, it is possible that you still have bubbles that have not disappeared spontaneously over 48 hours.
Physics tells us that due to wall tension, the smallest bubbles are the hardest to reduce further in size, much less obliterate, notwithstanding a favorable nitrogen gradient out of the bubble.
If you are still having pain symptoms, I would urge you to follow up with a hyperbaric physician familiar with diving. Bring your computer. If he/she concurs that DCS is a reasonable possibility, then the first descent in the chamber MAY confirm the diagnosis as your pain improves.
See the post above about the potential consequences of impaired perfusion of bone areas.
Although there is a declining potential benefit at two days, it is definitely not zero. Additionally, if you confirm a DCS diagnosis with pain improvement during a chamber ride, that will definitely be useful information as you refine your concept of a "conservatively" dived 16-tank trip that included deco and a plane ride.
If you currently have zero pain or other symptoms, then your hyperbaric physician will have a harder time making a diagnosis based upon history alone.
I truly wish you success in solving this problem!

Diving Doc

Thanks Doc for putting into proper English the words I would not have adequately explained.