2 DCS hits and a PFO closure

[WetRocks]

That's interesting. What you're describing sounds more like type I skin bends and possibly lymphatic bends which aren't associated with PFO, but it could also be an atypical cutis. Did you have any swelling anywhere?

What type of diving do you do? Breathing gas mixes? Wetsuit or drysuit? If you use a drysuit, what do you inflate it with? What decompression algorithm do you use, and if you use a computer, what settings are you using?

Best regards,
DDM

Didn't notice swelling but redness/pain were in the upper left arm/shoulder area both times. Pre-closure, cutis symptoms were thighs/abdomen/buttocks. Also pre-closure, I experienced severe fatigue after most dives, even if no other DCS symptoms were observed. Post-closure, that has resolved.

My dives are almost exclusively N. FL cave dives, 68F water temp, swimming dives on 32% nitrox. Drysuit, inflated with nitrox. Profiles of the 2 dives after which I had the upper arm pain are shown below. Similarities I noticed: same cave, first dive after a long break (20-30 days), high flow (moderate work on the way in, started feeling cool on the way out). Things I'm thinking of implementing: try 30/30 instead of 32% (further reduce nitrogen uptake), thicker undergarment and/or heater vest at deco (more efficient deco), DPV (less work)...

edited to add: these are not my longest dives, deepest dives, only deco dives, etc. I have 58 dives post-PFO closure, 18 in this cave and only 2 with symptoms. A definite improvement but before I start going deeper and even longer I want to better understand what might be going on.

 

[Pullnglide]

This is a picture of what I get on a regular basis, sometimes on other area's of my body, usually shoulders and backs of the arms. Now that's what you do see.
Shortness of breath and pain in the chest making it hard to breath is worse.
All usually dissapates within 24 hours.
Now the pain in the Base of my back and neck that crackles when you twist normally takes 3 to 5 days to ease.
One day I'll take myself to the chamber.

What I think is all these bends must be fairly minor all beit a little inconvenient as the body repairs itself ready for the next bout the next time you dive. Think a lot of it has been over dramatised. The body is just telling you to take it easy.

I hope.

That sounds terrible, I would have stopped diving with all of those problems. Out of @ 1100 dives I've been hit with DCS II twice and both were "unexplained" I would say roughly 225 are decompression dives with half being decompression of more than 30 mins. Again, I'm not a Dr. but I'd be willing to say that at this point your experiencing recurring effects from previous hits and some of the pain may eventually be permanent and you are on the road to necrosis.

 

[vladodessit]

What if I know that I have PFO? Haven't had an issue with conservative rec diving, sometime pushing NDL, a lot of more aggressive dives were with GUE group, Nitrox and variable ascent rate, sometime adding few minutes at 20 and 10 stops.

 

[Pullnglide]

What if I know that I have PFO? Haven't had an issue with conservative rec diving, sometime pushing NDL, a lot of more aggressive dives were with GUE group, Nitrox and variable ascent rate, sometime adding few minutes at 20 and 10 stops.

This is just my opinion but I'd say not to worry with it at this point. If your doing NDL dives and even with approaching the limit, if you haven't had any problems I'd leave it be.

 

[vladodessit]

Oh, sorry, I didnt make my point. Slowly but surely I'm moving toward T1 training. Anything to consider for deco diving?

 

[uncfnp]

Oh, sorry, I didnt make my point. Slowly but surely I'm moving toward T1 training. Anything to consider for deco diving?

Alert Diver | PFO and Decompression Illness in Recreational Divers

Its a bit dated, 2010 but still a good source of info. I'm not sure that transitioning into tech will change much unless you do get a hit. Arming yourself with information and diving with a conservative algorithm may be your best bet.

 

[boulderjohn]

Skin bends can be an interesting example of something I mentioned earlier--misdiagnosis of DCS.

Last year after cleaning up after a dive, I took a nice hot shower. When I was done, I saw a rash on my chest. I immediately thought of skin bends, and it sure as heck looked like the pictures I had seen. (I have never seen an actual case of it, though.) I couldn't believe it--my diving had been very simple, shallow, recreational dives--nowhere near NDLs.I had a deco bottle with oxygen in it, and I gave myself some oxygen therapy, but it did not help. I was in denial, so like others in denial, I did nothing else. I felt fine, and I did not dive for several days. The rash did not go away, though, and it was always worse after a shower.

To cut to the chase, it turned out to be a fungal infection that I cured with an anti-fungal ointment.

 

[Pullnglide]

Oh, sorry, I didnt make my point. Slowly but surely I'm moving toward T1 training. Anything to consider for deco diving?

I couldn't really say for certain either way but I'd leave it be for the time being even going into T1. If you start having problems than I'd look further into it. Even though the complication percentage is very low it is nevertheless a heart procedure. On a side note I was running 30/75 on the first DCS and 30/70 on the 2nd.

 

[Kevrumbo]

What if I know that I have PFO? Haven't had an issue with conservative rec diving, sometime pushing NDL, a lot of more aggressive dives were with GUE group, Nitrox and variable ascent rate, sometime adding few minutes at 20 and 10 stops.

Oh, sorry, I didnt make my point. Slowly but surely I'm moving toward T1 training. Anything to consider for deco diving?

If you're planning to do your GUE T1 (and T2 for @C Dub ) training here in offshore Southern California, be aware that you have the 24/7 365 days a year staff support of the only non-profit general public Hyperbaric Recompression Chamber in the United States on stand-by solely for the treatment of Dive Accidents and Casualties.

Home > USC Catalina Hyperbaric Chamber > USC Dana and David Dornsife College of Letters, Arts and Sciences

 

[Duke Dive Medicine]

What if I know that I have PFO? Haven't had an issue with conservative rec diving, sometime pushing NDL, a lot of more aggressive dives were with GUE group, Nitrox and variable ascent rate, sometime adding few minutes at 20 and 10 stops.

Our advice to divers with PFO is to avoid diving, but we generally see those divers after they've had DCS and we've had them tested. What were you being worked up for when you were tested?

Assuming that you plan to continue diving: Provided you're otherwise healthy, if you haven't had DCS yet then I would say continue to dive conservatively, e.g. high conservatism settings on the computer, padding deco where it's prudent as you have. Closure at this point is probably not a reasonable thing to do.

Best regards,
DDM