UNCERTAINTY AFTER DIVING: Case Report and Recommendations #2

The Case

A 48-year-old woman completed a dive to 95 feet for 25 minutes on 32 percent nitrox. Approximately 10 hours after surfacing she began to experience widespread but intense muscle pain. She could not find a comfortable position, and nothing seemed to offer relief. She called emergency medical services (EMS), which transported her to the local hospital.

When discussing her medical history, the doctor found out that the woman had begun taking a statin medication to lower her cholesterol three weeks earlier. Muscle pain is a rare side effect of statins, and blood test results suggested that her pain was most likely due to the medication.

However, the hyperbaric physician who was consulted did not want to dismiss the possibility of DCS and treated the diver in the chamber with a U.S. Navy Treatment Table 6 (TT6). The hyperbaric treatment had no effect on her symptoms, which confirmed that the muscle pain was probably due to the medication. Whenever you begin taking a medication, whether prescription or over-the-counter, make sure you familiarize yourself with the potential side effects. As this case illustrated, the side effects of some medications can mimic DCS.

Medications can also affect your ability to function normally, regardless of whether you’re on land or underwater. Common seasickness medications, for example, come with advisories stating that they may cause drowsiness.
 
Recommendations
Physicians trained in dive medicine typically recommend waiting at least 30 days after starting a new prescription medication before diving. Similarly, divers should always try nonprescription medications well in advance of diving so they will know how the drugs affect them. In addition to limiting the risk of disorienting or otherwise hazardous side effects at depth, this recommendation also helps reduce the risk of confusing the medication’s side effects with DCS.

CONCLUSION
The signs and symptoms of DCS are not exclusive to that condition. However, when a person experiences signs or symptoms after diving, DCS is very often presumed to be the diagnosis. This is not all bad, because it encourages divers and dive staff to administer oxygen and ensure the injured diver gets prompt medical care. But it becomes a problem when divers refuse to accept alternative explanations and become fixated on the need for chamber therapy at the expense of other diagnostics and/or treatments that may be delayed.

In addition, the diversion of a nondiving-related emergency from appropriate medical treatment for an unnecessary recompression treatment, especially by air late at night, can introduce additional risks to the patient as well as the aircrew. There are many medical conditions much more serious than DCS for which timely treatment is critical. In the event of symptoms after diving, provide oxygen and get the injured diver to the closest medical facility.

Don’t hesitate to call EMS if the situation is serious, and feel free to call the DAN Emergency Hotline (+1–919– 684–9111) at any time. Tell the doctor that the person was diving, and encourage him or her to contact DAN for consultation. But keep in mind that there are more dangerous ailments than DCS, some of which must be considered first.