More Than a Sore Shoulder

The recompression chamber at Virginia Mason Medical Center in Seattle, Washington.

What began as a pain in the left shoulder resulted in a U.S. Navy Treatment Table 6 recompression therapy.

I REMEMBER SITTING AT MY COMPUTER while thinking about all the ibuprofen I had been popping for the past 18 hours and wondering why I still had the dull, aching pain in my shoulder. Could this be more than soreness from carrying gear back and forth from our shore entry point or exertion from a windy, wave-filled entry and exit? Could I have decompression sickness (DCS)?

My dive profile from the previous morning was well within safe limits, but something was obviously wrong, so I called DAN. I explained to the DAN medic that I had been using my rebreather on a technical dive and that the dive went fine. I reported the timing of my symptoms, noting that I was cold at the end of the dive but didn’t notice anything else until my left shoulder started hurting about an hour after the dive. The DAN medic recommended I go to the emergency room at Virginia Mason Hospital and tell them I had a dive injury.

The emergency room staff started me on oxygen while doing tests. I had been there for only about 45 minutes before the hyperbaric nurse came in and asked about my dive and if I’d be up for another one. The U.S. Navy Treatment Table 6 recompression gave me plenty of time to recall the dive and think about how I ended up with DCS.

We were diving the PB4Y Privateer, a Navy bomber that crashed during a training flight in 1956 and sank to about 150 feet in Lake Washington, near Seattle, Washington. I’ve made plenty of dives, but on this day the wind was whipping up big waves so strong it felt like a current. The water movement knocked my camera and lights off my scooter, so I had to spend time retrieving them from where they had washed ashore. I kept my stage cylinder on my left side as I walked on shore, unnecessarily carrying the extra weight.

One of our group members got separated from us when his scooter propeller broke, so we surfaced to find him and evaluate the situation before he had to head back while some of us continued the dive. My buddy and I ended up too far south of where we intended to intersect the descent line at 100 feet, so we had to scooter back north. The delays meant that by the time I needed my heater, we weren’t as close to the wreck as we would typically be— and I wondered if we would even make it to the line and down to the wreck.

We found it a few minutes later and had a great dive on the plane. After we had our fill of this gorgeous wreck, we turned the dive and headed back up. Our ascent was uneventful, decompression was easy, and I felt comfortable until suddenly getting cold. My heater’s first battery pack was drained, so I switched the cord leads to my second battery pack and flipped it on to discover there was no heat. It would be an uncomfortably cold last 15 minutes of the dive for me. My buddy still had a few minutes of decompression left when I was theoretically done, so I waited for him to clear before we headed back to the beach.

My left shoulder started bothering me when I was driving home, and I regretted the extra effort I exerted to go ashore and retrieve my camera along with the strain of the extra weight I had carried. I took some ibuprofen when I got home and snuggled up with my pups after putting away all my gear. When I finally stopped moving, I realized how unusually tired I was. I did nothing for the rest of the day and then took more ibuprofen before going to bed, but my shoulder pain kept me from getting a good night’s sleep. I was still in pain in the morning and needed more ibuprofen before going to work, where I finally realized it wasn’t just a sore shoulder.

It was a relatively minor case of DCS, and I had only isolated pain in the muscles and joint that resolved after my chamber treatment. The extra stress from carrying my stage cylinder while out of the water may have also contributed to my pain. My only additional obligations were a 30-day follow-up appointment with the hyperbaric physician and a restriction from diving for at least 30 days.

When reflecting on what likely went wrong, I realized that my 15 minutes of cold decompression after 45 minutes of comfortably warm ongassing at depth was a textbook case of what not to do. While it would be nice to be warm for the whole dive, I typically start and do the deepest part of my dive cool and then turn on my heat when I leave the bottom and start decompression.

I could have avoided all these problems if we had recognized the many difficulties the conditions caused as warning signs to call the dive earlier. We chose to continue, and it turned into a learning experience. Even with plenty of dives under my belt and a site and dive plan with which I was comfortable and familiar — it included additional decompression time to be extra safe — there are other factors you might not consider enough. Your environment, stress, and temperature can contribute to your DCS risk.

I will be more cautious and judicious with my use of heat in the future. This incident reinforced the importance of always checking all your gear. If I had tested the second heat pack before the dive, I would have known it wasn’t working. Without a backup pack, I would have never used the first one early, assuming the second one would work for the later part of the dive and the final decompression.

I have also learned to add a buffer to my gradient factors, which allow you to control your decompression algorithm. Now I run one computer on 30/85 and the other on 15/85. I’m not sure where I’ll land on my final numbers, but they will be more conservative.

I am a safer diver after learning several valuable lessons from a dive we should have canceled — including paying better attention to the full impact of the conditions. The most important lesson is that I should have sought medical care as soon as my shoulder became painful. Waiting could have made it worse.

I was fortunate that my DCS remained mild. On future dives, I will take all symptoms seriously.