Breast Pain After Diving

[chardiver]

Dear all who have responded,
I am most appreciative that you have all responded to my
question about Breast Pain after diving. I am most interested in all of your ideas on the subject. I have found people who are aware of other women who have had this symptom and want to let others know what it might be and if it is indeed related to DCS. Only with this kind of discussion and some research of those with the symptom will the real answers be found.
I just returned from a trip to Cozumel with my husband where he dove and I did not. I am really afraid to try it again and that is hard to accept. At least I can try still to find the answers.
Char Sigman

 

[Helen Malnar]

I also have had several occasions of breast
and abdominal pain, tenderness, swelling and
general "bruised" feeling, although no visable
bruising ever showed up. After several years of
this, I have been able to determine that it is
a form of "skin bends". I now dive on nitrox whenever
possible and dive much more conservatively. I am 51
years old, female, and have been diving for 12 years. I
am in good physical condittion and take no medication except
for premerin.

 

[chardiver]

A couple of months ago I received the following letter from a woman who also had the same symptoms and responded to my letter in another board on the net.
I have included parts of her letters to me. Perhaps we should contact the DDRC for their information. Char

Subj: Breast pain after diving
Date: 11/23/2000
To: chardiver@aol.com

Dear Char,
I am also a 60 year old diver. Whilst in Sipadan this year I had breast pain following diving, with the exact symptoms you describe in diver. Extreme pain and engorgement of the breast, with purple discoloration. I was extremely frightened by the events.
On both occasions it was following the third dive of the day. I was well within the tables with a two and a half hour surface interval between all dives. All dives were increasingly shallower than the last. I did not dive
for two days and then restricted my diving to just one dive a day for the rest of the holiday with no further problems.

Just three weeks ago I picked up a copy of Dive Girl in our local store. To my surprise there was a small item which stated that breast pain after diving is a known symptom of a cerebral bend. Apparently it upsets the hormone balance in the breast. I don't know if this is of any help to you.
I must say that I am not sure of these facts because my symptoms disappeared after some hours without recompression treatment ( At the time I thought it couldn't be a bend).

I am very relieved to find that I am not the only one to have suffered these attacks. If you find out any more info. I would be very grateful if you would send me an e-mail.
Regards, Susan

Date: 11/26/2000
Dear Char,

I hadn't realised that you are in the U.S. Your letter was published in the current edition of 'Diver' magazine. I haven't found your Internet letter, which web-site did you use?

I have tracked down a copy of 'Dive Girl', if you let me have your address I will send it to you.

Please feel free to send my letter to DAN, I am quite happy to fill in a questionnaire if necessary.

The question in the magazine was answered by DDRC (Diving Diseases Research Centre): http://www.ddrc.org

Question:
Is it true that diving can make my breasts swell up?

Answer:
One of the symptoms in women of a neurological bend - a bend that affects your brain - is swollen breasts. Damaged brain tissues disrupt hormone production, and this is an easily identifiable sign that something is wrong. If you experience any unusual symptoms after a dive, always assume that it is caused by your diving and get it checked out.

Phone DDRC 01752 261 910 for advice.
I hope this is of help to you. Regards, Sue

 

[octodiver]

Char,

Thank you so much for pursuing this! We need to make this
info common knowledge. I think we've finally reached "critical
mass"! Here's a description of our symptoms:

Symptoms began with skin discoloration in the affected area - mottled
red and sometimes blue. Then the itching would begin and the area would
become extremely tender - like a deep aching bruise, and then painful.
It also felt like it was hardened (but I wonder now if that wasn't my word for "numb",
except that it wasn't on the surface, it was subdermal) Affected areas
varied from abdomen, waist, hips, breast, chest, and occasionally
buttocks. The other symptom was the mandatory need for a one to two
hour nap - as in can't stay awake for another 20 minutes. (More intense
than the standard post dive "nitrogen nap" divers refer to.)
Thinking back on it, Lynn remembered also having the visual disturbance:
wavy, translucent objects that moved across her field of vision...
Symptoms usually began about 2 hours after surfacing from last dive - after the
boat & gear had been cleaned up, etc... After the nap, most of the
symptoms would be gone except for some tenderness, and by the next
morning it was all but forgotten. The first time Lynn's symptoms
appeared they included nausea and vomiting - the next morning she was
fine...

All dives were always within no deco limits (we're dive guides in
Hawaii where deco diving is not "allowed" with customers). We used
either the PADI RDP, Wheel, Oceanic Data Plus computer, Marathon
computer, or Aladin Pro computers. Slow, controlled ascents were
the norm (accept for those few times when we made brief "rushes" trying to stop
customer's "out of control" ascents). 3 - 5 minute safety stops were made
on ALL dives.

I am feeling troubled by the DDRC's statement that these are easily identifiable
signs and Type II DCS.

I hope women divers, doctors, and the dive industry will start recognizing
these signs and symptoms for what they are (whether Type I or Type II -
it's serious!).

octodiver

 

[John Reinertson]

This is long, but worth reading through.


After several very helpful E-mails from Chardiver, Octopus Reef and others, the history and symptoms are much clearer.

The common thread seems to be women experiencing "skin bends" after deeper dives but within the NDL's.
Sometimes the changes were Torso, sometimes breast, but they do not normally occur with shallow or very conservative diving.
The description of these is almost identical to the description of Cutis Marmorata, a type of skin bends, from Dr Ernest Campbell's web site. (http://scuba-doc.com) see excerpt from his site below: (my rambling continues after his info)

DIVING MEDICINE ONLINE



Diving Medicine
is the study, diagnosis and treatment of illnesses related to the undersea environment.


Cutaneous Manifestations of Decompression Sickness


Pruritis

Carl Edmonds feels that this is a common manifestation of diving in a compression chamber, most likely due to the release of small bubbles from gas dissolved in the epidermis. In this mild form, no signs are visible, and the itching is temporary, mild, comes and goes and is more marked around the ears, wrists and hands. He does not consider this a systemic manifestation of decompression sickness.


--------------------------------------------------------------------------------

Patchy erythema (Cutis Marmorata)
Patchy, reddish-purple mottled areas can occur, especially around the shoulders and trunk. These are intensely pruritic and are due to a local vascular reaction from bubbles in the tissues below the dermis. This has a more serious connotation and is thought of as a systemic manifestation of decompression sickness.



--------------------------------------------------------------------------------

Lymphatic Obstruction
Blockage of the dermal and subcuticular lymphatics with bubbles usually results in edema and a peculiar pitting of the skin called peau d'orange (French, meaning skin of the orange, or, orange-peeling). This is pigskin appearance more often seen over the trunk of the body and again is evidence of a more serious form of DCS.

Ref:

Edmonds, et al: Medical Aspects of Diving, The Medical Journal Of Australia; 1972, 2:1199-1416


Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician. I take no responsibility for any conceivable consequence which might be related to any visit to this site.)
--------------------------------------------------------------------------------

This page is compiled and maintained by
Ernest S Campbell, MD, FACS
Latitude 30.29625 Longitude 87.48329


(Of course, attempting to make a clear diagnosis after the fact and over a keyboard is uncertain, but the descriptions match up well)
For any divers experiencing such symptoms, treat this as DCS. I can't tell you if every diving doc would recognize these symptoms, but if they fit, call the doc!

Dr Fred Bove reviewed some of the descriptions for me and noted that Skin Bends often preceded more severe DCS in patients with Patent Foramen Ovale, and suggested possible need for ultrasound studies with bubble contrast.

I'd like to learn more about what the risk factors are and the circumstances that trigger it.
This would require those of you with specific episodes to E-mail as precise a description of symptoms, dive depth, ascent rates, and any other logbook information that we could use to try to find a common thread among these women who seem to be getting Skin bends while withinb the NDL's.

Anyone with episodes matching the above, please use the private messaging function to contact me on the board, with as much info as possible, including location, water temp, exp suit, etc. (including all the details you can be sure of) Anyone having new onset symptoms matching the above should treat it as DCS until carefully evaluated by a diving Doc.

Thanks for your patience while we tried to sort out the specifics.

Please share the "skin bends" description with other divers and students.

Dive safe and painlessly,

John Reinertson

 

[divemed]

An interesting discussion and consideration of central bends, with ant pit involvement. It would be of interest to review was there any correlation of the "breast bends" with a particular point in the women's menstrual cycles. This would at least give some support to a hormonal basis, and let them know at what times they may be more susceptible.

 

[ColdH2Odvr]

Sounds like something is acting as a check valve (fluid can enter the breasts but can’t exit). If I understand correctly, the lymphatic system drains the breasts to lymph nodes in the arm pits. Is it possible for compression from exposure suit/harness etc. to cause these ducts to constrict? Are the ducts invested in lipid tissue and especially susceptible to compression from excess N2? A combination of both? Would antihistamines effect the lymph ducts?

It seams that if there were some simple mechanism that the problem would be more prevalent. Perhaps it is but no one’s thought it serious enough to mention. It seems one common thread in the DCS literature is people’s reluctance to seek help, preferring to shrug it off. Is this rare or, given the sensitive nature of the problem, is it just under reported?

Best of luck,

Dave

 

[divemed]

Those ladies experiencing "breast bends" for lack of a better description... While collecting the above valuable information re: your diving profile and equipment, it may be interesting and valuable to include at what point in your menstrual cycle you are in when this occurs. Various known (and unknown) endocrine substances have profound effects on blood flow, blood vessel characteristics, and tissue perfusion. If this is indeed centrally, and/ or hormonally related, then you may be more susceptible at certain times of the month.

 

[AmyJ]

Just want to say, as new diver, I will follow this thread. Thank you to those of you giving time to help others. Unfortunately, many times women's physical problems are overlooked because they present differently than men. Thanks again for looking into this!

 

[FredT]

I've harped on this before, but it's time to do this again.

Female bodies are shaped differently from men's bodies. (yea!) Part of this is fat distribution which is highly variable between individuals. On top of this the distribution on the same lady can vary markedly over a short time line. This variation makes it more difficult for women to get suits that fit properly.

A wetsuit that fits properly is NOT A LUXURY for most women. It's a critical safety issue. Too tight restricts blood and other fluid flow, reduces respiraton effeciency, and makes the diver more prone to panic attacks. A loose fit simply causes the diver to freeze.

The best advice I can give a new wetsuit clad diver is to "Get a suit that fits YOU and keep it properly tailored as your body changes!" You'll not only enjoy diving more, there is a good chance you'll live (and dive) longer.

FT