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

[L Neal]

L Neal,

If this had been DCS, immediate recompression would have increased the likelihood of complete symptom resolution. Just from your description, DCS cannot be ruled out, which is why I (and others) recommended being examined in person by a qualified practitioner. Also, an internet exam can't catch subtle neurological symptoms. Treatment at this point would just be tincture of time, though hyperbaric oxygen might speed things up a bit and I stand by my recommendation to go get evaluated.

DCS is a sports injury, just like a sprained ankle or torn meniscus, and the risk of DCS can be mitigated. I'd echo Dr. Singler's recommendation to evaluate your level of conservatism when diving, and then carry on. Don't take the less erudite posts on here too seriously.

Best regards,
DDM

Thanks for your reply. I understand the use and benefits of H2BO better. Good to know for the future. Hope to get the current issue resolved soon. I didn’t think I was overdoing it w 2 morning dives/day and only 2 afternoons but I’m 50+

 

[L Neal]

This post presents an interesting problem.

In the UK, it is drummed into us that any adverse symptoms after diving are likely to be DCI, unless an obvious injury has been received. This is even emphasised by insisting that as divers we are required to advise medical personnel NOT to use Entenox to treat a diver after diving, even when treating obvious non diving related injuries. Entenox can make DCI worse and potentially induce a DCI problem in a casualty.
Getting quick early treatment is always advised. Minimising, long term injury, and reducing the amount of treatment required. Delaying treatment, significantly reduces the likely hood of long term injury and increases the treatment cycle (cost).

We have a national / international DCI helpline to ring (this used to be administered by the Navy). If you are walking wounded, then generally the advice is to attend a chamber, or A & E. Where the medical personnel will make the diagnosis.
The alternately is to contact the coastguard.
If anything, divers are very poor on getting treatment, often being in self denial. It is often the others that identify the issue.
In the case of serious DCI, the emergency services will evacuate you by the quickest means to the nearest available chamber (one not in use).

We do of course have the significant advantage that we don't pay for medical care (at point of use). This means there is no excuse not to attend.

There are a number of insurance companies we use when travelling. DAN being one of the preferred, with a reputation for quick action.

I am very aware that in many parts of the world you are required to pay, not only for treatment, but for initial diagnosis. This complicates giving advice to those out side Europe.

However, DAN will give free advice over the phone, if they advise seeming medical support, if only to confirm it is not DCI, I strongly advise that you follow their advice.
I would also strongly advise having appropriate insurance e.g. DAN cover.


Gareth

This post presents an interesting problem.

In the UK, it is drummed into us that any adverse symptoms after diving are likely to be DCI, unless an obvious injury has been received. This is even emphasised by insisting that as divers we are required to advise medical personnel NOT to use Entenox to treat a diver after diving, even when treating obvious non diving related injuries. Entenox can make DCI worse and potentially induce a DCI problem in a casualty.
Getting quick early treatment is always advised. Minimising, long term injury, and reducing the amount of treatment required. Delaying treatment, significantly reduces the likely hood of long term injury and increases the treatment cycle (cost).

We have a national / international DCI helpline to ring (this used to be administered by the Navy). If you are walking wounded, then generally the advice is to attend a chamber, or A & E. Where the medical personnel will make the diagnosis.
The alternately is to contact the coastguard.
If anything, divers are very poor on getting treatment, often being in self denial. It is often the others that identify the issue.
In the case of serious DCI, the emergency services will evacuate you by the quickest means to the nearest available chamber (one not in use).

We do of course have the significant advantage that we don't pay for medical care (at point of use). This means there is no excuse not to attend.

There are a number of insurance companies we use when travelling. DAN being one of the preferred, with a reputation for quick action.

I am very aware that in many parts of the world you are required to pay, not only for treatment, but for initial diagnosis. This complicates giving advice to those out side Europe.

However, DAN will give free advice over the phone, if they advise seeming medical support, if only to confirm it is not DCI, I strongly advise that you follow their advice.
I would also strongly advise having appropriate insurance e.g. DAN cover.


Gareth

My decision making was definitely complicated by the user unfriendly US medical system. I have DAN insurance so $$ was not my primary concern for seeking treatment. DAN didn’t specifically direct me to the nearest chamber. They left it up to me and I couldn’t figure out how to get an appt and didn’t want to show up at the ER with some back pain that may or may not be DCS.

 

[L Neal]

The pain In my right back/shoulder did not subside and several bumps erupted yesterday. I Saw my GP today and he diagnosed SHINGLES!! Who’d have thought?!!

 

[Duke Dive Medicine]

Ouch. Speedy recovery. Glad you have a diagnosis.

Best regards,
DDM

 

[Marie13]

The pain In my right back/shoulder did not subside and several bumps erupted yesterday. I Saw my GP today and he diagnosed SHINGLES!! Who’d have thought?!!

Shingles is the devil. You now know what to wish on your worst enemy! I had it on top of my sciatica (left butt) in March, left leg ended up with significant muscle weakness, which resulted in 10 PT sessions and messed up my diving plans for part of the summer. Mine was originally misdiagnosed as nerve issues from my sciatica. I hadn't had the new vaccine yet as I'm only 49.

Get better. Shingles sucks.

 

[rsingler]

Teaches us in the medical profession to eat a little humble pie from time to time.

As awful as shingles is, I'll bet it's a relief. Congratulations! I am pleased that my Internet diagnostic acumen was wrong.
Safe diving! Get better soon.

Doc

 

[caruso]

Thanks for the update, hope your recovery is fast and complete.

 

[boulderjohn]

Post hoc ergo propter hoc.

When something goes wrong, we have a natural tendency to assume that whatever happened before that was the cause. That is why food poisoning is so often blamed for illnesses for which it is not to blame--when we are sick, it is usually not long after we ate something.

In the only case in which I ever had to fill out a scuba incident report, I was assisting a pool session. Halfway through the class, a student started getting dizzy and showing other signs of some sort of illness. We did what we could on the scene, including administering oxygen, and finally told his wife (also in the class) to take him to the hospital. WHen the class ended, we filled out the incident report and searched our memories for anything that happened during the class that could have been a problem.

That night the wife called with a report. He had the flu.