breast/lymphatic pain after an easy shallow dive

[munkfish]

Note this post talks about boobs and their parts. Of necessity!

We had some time to kill yesterday, so drove out for a single dive at the Rothesay in Prescott... easy 32' max depth, wetsuit, 65º temp, bottom time 47 mins, ascent leisurely and gradual. A bit of exertion required to get to and from dive site (short walk > down/up stairs > walk-out shore access > surface swim to line). I'm recreationally athletic, 32yrs old, have lost 25lbs of fat over the spring/summer - BMI (FWIW) is currently 25.9 with 27% body fat. I am a lifetime asthmatic, but it is well controlled with zero symptoms surrounding dive. I believe I was slightly dehydrated.

About three hours after the dive, I started to feel some pain in my right breast. It started out as a constant sharp-ish pain in the nipple (which has been stiff and angry since) almost as if someone had flicked it really f-ing hard. By bedtime the pain had spread to the lymph node in my underarm, which felt deeply bruised. I figured I had just hurt/pulled something lugging gear bags around.

This morning I woke up with the same deep tissue bruise-like pain radiating from my underarm (tender to the touch) disappearing into my breast and peaking again at the nipple. There are no visible bruises, but I'm now noticing light pink areas on the skin of the breast itself, which is what has me a bit worried. Mostly connected but splotchy and puffy, not spidery.

I've read that skin bends are typically accompanied by itching/irritation, but due to a breast reduction about ten years ago, those specific parts of my breast showing the pink markings are largely numb. Ductwork is intact, but I can't really tell whether the rest would otherwise have pain/itching or not.

I have not had any common DCS symptoms, I was fatigued after the dive but no more than usual. Had a slight headache which is explained by not enough fluids. I feel fine otherwise. Besides, I can't see anything in my dive profile that would suggest DCS as a possibility. Moreover, the pain seems to be improving, slowly.

Just wondering, well, is any of this familiar to someone with experience in this area? Should I be concerned?

 

[TSandM]

Although lymphatic DCS is described, the nitrogen loading from the dive described is so low that I think it would be extremely unlikely to produce any symptoms. If the pain and color changes persist, I would see a physician. It is possible to get both infectious and inflammatory processes in the breast that can produce those complaints.

 

[Duke Dive Medicine]

Hi Munkfish,
I agree that judging simply by your dive profile, it's highly unlikely that you have DCS. However, you're working with tissue that may have circulatory and/or lymphatic compromise from the reduction surgery. It's worth getting checked out by a physician familiar with diving medicine. Like TS&M mentioned above, you may also have a case of mastitis that would be amenable to antibiotic treatment.

I've asked Dawn Kernagis, one of our grad students who's studying this specific phenomena, to join in and provide some additional insight.

Best,
DDM

 

[lulubelle]

Thank you for sharing and please continue to share what you learn. I am in a "waiting period" of sorts to have a breast reduction perhaps a year from now and would certainly like to understand any issues around diving that it might pose.

 

[DocVikingo]

Hi munkfish,

I tend to agree with TSandM and DDM that the reported dive profile is so benign as to pretty well preclude a nitrogen loading sufficient to precipitate DCI.

Nevertheless, you may find the following recent thread to be informative regarding lymphatic DCS--> http://www.scubaboard.com/forums/di...unusual-dci-inquiry-i-received-last-week.html

I would add that none of the women I mentioned in that thread reported itchiness of the affected breast areas. Resolution of the discomfort, which was rather acute at onset, took from one to three days. All were slightly overweight and one was later diagnosed as having a PFO.

If you wish to read still more, I suggest this short and understandable read --> Decompression illness presenting as breast pain http://rubicon-foundation.org/dspace/bitstream/123456789/5024/1/16716055.pdf

Please keep the board abreast of your progress.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[Insta-Gator]

You are a champ for sharing this personal information. As a male I may not experience your symptoms, but it's possible my wife may someday, so sharing personal information like this in a mature way is beneficial to all. Thank you.

 

[munkfish]

Thanks all. I'd seen the case study publication, and had read through a few other threads describing similar symptoms. I knew it would be an unlikely case given the dive profile is so benign, but the symptoms were unsettling to say the least - people here really seem to know their stuff.

I spoke with the medics at DAN - they were concerned it may be lymphatic DCS but obviously couldn't rule anything out over the phone, so advised me to get myself to the hospital right away.

I've learned that the Ottawa area clearly doesn't see many divers in need of medical consult.

I was put flat on my back on oxygen while the nurses and doctors 'read up on' diving issues. They did their professional best, but simply didn't have the knowledge. At least they admitted it and worked to get the right info, rather than dangerously pretending to know about things they did not.

Eventually, with considerable effort on their part, they did get hold of an 'expert' in a nearby hyperbaric facility for consult. There was a lot of back and forth, but the consensus was level one lymphatic DCS. At any rate, it's a relatively mild case, and well undeserved.

I'm scheduled to be tested for PFO July 29th - something the expert ordered without our mentioning it, so, a bit of confidence restored there.

 

[DocVikingo]

I'm scheduled to be tested for PFO July 29th - something the expert ordered without our mentioning it, so, a bit of confidence restored there.

Hi munkfish,

Not all tests for PFO are created equal.

Transesophageal echocardiogram (TEE) with bubble contrast and Valsalva generally yields the best results.

Regards,

DocVikingo

 

[Duke Dive Medicine]

Hi Munkfish,
Glad to hear that you got the attention that you needed. I'm guessing they decided not to treat you in the chamber.
I ran this one by Drs. Moon, Piantadosi and Freiberger (caught them all in the same place at the same time, kind of like the planets aligning) and the concensus is that it's extremely unlikely that this was DCS.
For the sake of argument, if you do have decompression sickness, I think it's worth pointing out that PFO is not associated with lymphatic DCS. If your ultrasound shows a PFO, please consider carefully what you'll do with that information, because it's in all likelihood a red herring.

Please keep the board abreast of your progress.

Ditto! Doc, you are the man.

Best,
DDM

 

[DocVikingo]

For the sake of argument, if you do have decompression sickness, I think it's worth pointing out that PFO is not associated with lymphatic DCS. If your ultrasound shows a PFO, please consider carefully what you'll do with that information, because it's in all likelihood a red herring.
Best, DDM

Hi DDM,

Could you please cite the research reference(s) supporting that assertion? Along with everything else I'm unfamiliar with, that seems to be on the pile ; )

Thanks,

Doc