Breast Pain After Diving

[chardiver]

Breast Pain After Diving

I am a 60-year old woman who has been diving for 23 years and have made about 975 dives. For the last 8 or so years I have had a problem that develops after diving. I develop severe pain, swelling, and a very full feeling in my normally large breasts. It is as if the breasts are engorged. The skin becomes very stretched. There is some itching under the breasts also. I have contacted numerous dive medicine specialists including DAN and they have not heard of this post diving problem. None of their numerous suggestions (looser wetsuit, sports bra, women's style BC, antihistamines, change in blood pressure meds, and Sudafed) were of any help in preventing or in alleviating the problem. I feel this may be a symptom of impending bends as I have had two occurrences of DCS in the last three years. Both seemed to be undeserved hits. They both required hyperbaric treatment. The breast pain however was not alleviated either by breathing oxygen or by the treatments and took about a week to subside.
I am concerned about other women who might be experiencing this symptom and are not reporting it, as I did not for a number of years. If there are others, we women may be able to convince the doctors that it is an unreported precursor to the bends. So far, they are skeptical. If you have had this symptom or have any second hand knowledge or experience with it, please contact me:

Phone (920) 734-2479
E-mail chardiver@aol.com
Snail mail: Char Sigman, W6589 Fire Lane 7, and Menasha, WI 54952

Thanks for your time and attention to this problem.
Char Sigman

 

[John Reinertson]

I'm not sure, by any means. I've been to a few diving medicine courses and it hasn't come up. The only thing that comes to mind would be the fluid shifts that normally occur with weightlessness, especially in someone prone to fluid retention.
Are there any other medical conditions that (blood pressure medicines or hormones, etc) that would be likely to make you more prone to fluid retention?
That would be the route I would pursue. hope this helps.
John

 

[King_Neptune]

chardiver,

You still with us?

The doctors may be able to help...

=-)

 

[scubadoc]

Hello Chardiver!

We have recently had a question similar to yours on our web site, Diving Medicine Online, and none of our consultants could come up with a consistently reasonable answer. (If this was you, please forgive me!)

The best answer that I could find was in relationship to the effects of immersion, which has many widespread effects on the body - the most noticeable being the diuresis of diving (the pee factor). This is a complicated feedback mechanism that is started by a shift of body fluids centrally, stretching some receptors in the heart. This in turn sets off all sorts of neuroendocrine hormonal reactions.The basic response to any sort of immersion is a redistribution of blood volume.The intrathoracic blood volume expansion is
associated with an increased release of the Atrial Natriuretic Peptide (ANP) and an alteration of the activity of the posterior pituitary gland.

Studies also suggest that hormones of anterior pituitary origin are required for ANP secretion in response to acute volume loading.

To make a long story short - the possible cause of your breast engorgement may be due to stimulation of your anterior pituitary gland with the production of hormones that act on certain end organs in the body - in your case, your breasts. This is somewhat analagous to the premenstrual engorgement of the breasts that so many women experience. Why this happens to you and not to other women is the question and might cause you to want to check in with your physician with the problem.

You must understand that this is all supposition, as we could not come up with a better answer to your question.

Best regards for safe diving!
scubadoc
Diving Medicine Online

The Ten Foot Stop (Newsletter for all divers)

 

[scywin]

If you have had two experiences of DCS, have you considered diving Nitrox? If you dive using air tables, you should get an additional safety factor.

 

[octodiver]

Get ready - I have some VERY strong feelings & opinions on this!

I know of two women (myself included) who have also experienced this and who would call
this Type I DCS. In one instance it progressed to Type II within several hours of onset.
Why is it that this apparently common DCS symptom is misdiagnosed/ignored in women?
The paramedic who helped my friend instantly recognized the symptom.
However, the male patients he had treated over the years (on Maui, where we teach diving,
DCS is not "unheard" of), had this itchy/rashy symptom/sign on thier buttocks,
rather than breasts, abdomen, hips. Doesn't it seem possible (or even likely) that it's
the difference in the distribution of fatty tissue between genders that's causing this confusion?
Why are women divers and the people who treat/advise them not recognizing (or even suggesting)
that this is quite likely "pain only" Type I DCS? And if "pain in the torso" isn't getting the
message accross, maybe it's time to do some revamping! Also, why is there a hesitancy
in the diving medicine field to take these symptoms seriously? Who wants to help solve this?

Aloha, Rene

 

[DocVikingo]

Hi ocotdiver,

Clearly you do have strong feelings about this, and understandably the women affected by this malady find it uncomfortable & distressing. I'm afraid, however, that I'm unable to discern on what basis you would assert this is a Type I DCS manifestation in the instant case.

Based on chardiver's report, specifically her statement that: "The breast pain however was not alleviated either by breathing oxygen or by the [hyperbaric]treatments and took about a week to subside," on what basis is it that DCS would be diagnosed? This not to mention the fact that scubadoc (world-recognized dive medicine expert)& and his panel of consultants did not feel such a classification fit the findings. Given this, I would suggest that misdiagnosis would be calling it Type I DCS based on the clinical picture presented thus far.

Perhaps I have missed something.

Best regards.

DocVikingo

 

[octodiver]

Hi DocVikingo,

Thanks for your reply. I really appreciate the opportunity to dialogue on this.
Actually, I do think you and others are missing something.
The question is WHY NOT DCS??? Women who have experienced this have made the
connection between these symptoms & DCS regardless of what we're being told by doctors.
(Call it intuition, call it breaking through denial, call it recognizing the symptoms!)

The diagnosis for DCS comes from a wide variety of sources (from expert to basic). Here's just
a few:
**Bove and Davis, "Diving Medicine" page 178,
**Every list of signs & symptoms of DCS includes chest (breast?), abdominal/torso pain, skin itch
blotchy rash, swelling
**PADI Diving Accident Management Flowchart
**Think about this: my friend's Type II hit came after experiencing these "torso symptoms" for the first
time on a surface interval rather than after the final dive of the day. She ignored them (no need to worry, not DCS right?), made another dive and within hours was on her way to the emergency room with her hit!
**Oh, and how about this one: several of us who've had these symptoms quite frequently in the past, no longer experience them AT ALL since reducing our nitrogen exposure and diving very conservatively. The majority of our diving is now in the 30 ft. range rather than 60 ft., and when we dive deeper than 50 ft., we use Nitrox and air profiles.

As far as Chardiver goes, are you suggesting that because her symptoms didn't resolve after hyperbaric treatments they're not DCS related? I would beg to differ: Other classically recognized residual symptoms
have been known to subside/improve weeks or months after hyperbaric treatment - why not these?

While I do not mean to "dis" the experts, I am suggesting that they take a closer look at this. This may
very well be new information for those in the industry, but it cannot be ignored. Eventually, more and more women will start reporting this as they, unfortunately, experience it more & more as they age, have longer bottom times, go through hormonal changes, etc... My hope (and obviously Chardiver's too) is that they'll
be properly advised so they won't have to get seriously bent like Chardiver and my friend did!!

Aloha,
octodiver

 

[John Reinertson]

As I read Chardiver's description, it sounded like this is a regular occurrence with diving, not occasional or once.
With her DCS episode, the other symptoms resolved but there was no benefit in terms of breast pain.
Chardiver also describes her breasts as feeling very full and stretched larger, which doesn't fit nearly as well with DCS as it does with fluid shifts.
We obviously can't rule out DCS, but the presenting symptoms and the frequency of the occurrence and the swelling all suggest other possibilities. The mention of a recommendation to change Blood pressure medicines suggests that Chardiver has hypertension, and fluid shifts that occur in everyone in Zero-G conditions are likely to be more prominent with some blood pressure medications. Your comments about other women divers experiencing this does interest me. As Chardiver noted, it's not been discussed before.
If those of you that have had these symptoms would be willing to share more details either on the board or in a private E-mail to one or more of the Docs on the board, we might be able to move ahead on finding out more about it.
Dive safe and painlessly,
John Reinertson

 

[octodiver]

Hi John,

Thanks for your interest. I'm willing to discuss this with you on the board, but it seems like there's just too much to cover. I'll email you the long version...

octodiver