I believe my wife had some mild bouts of dsc induced cutis marmorata "skin bends"; while in Grand Cayman, after seeing a couple of pictures and doing some research. The symptoms disapear several hours after the attack. Is it safe for her to continue diving or should she seek medical attention before our next trip.
diving after mild dcs induced marmorata
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First, I am sorry that your wife had this problem. Thankfully, it sounds as if all is well now.
Second, it is very important for you to go back over the events that brought this about. Examine, in your memory, in your logbook, and in your computer's dive log, the sequence of events that led up to this. Skin bends, or any other kind of bends, are uncommon in recreational, NDL diving. Statistically, and in reality, they DO occasionally occur, but they are NOT normal.
I would recommend, if I may, two things: (1) having reconstructed your dive or dives, talk to an instructor whom you know and trust to find out if your diving practices inadvertently led up to this result. (2) Find a diving doctor in your area (call DAN for their list) and have him examine your wife both for any possible physiological sequalae and for any physical condition that could pre-dispose your wife to DCS problems.
I say this not to alarm you, but simply to advise that you check this out and insure that your future diving will be pleasant and free of this kind of worrisome event.
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Here follows the standard warning that, although I am a DMT, I do not know you and have not examined you, therefore this constitutes common sense advice, not medical advice.:doctor:
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Proceeding under the assumption that you've made the correct diagnosis, given multiple occurrences she indeed should seek evaluation by a physician, preferably one with some diving medicine experience.
While cutis marmorata after a dive is often benign, it can be an omen of more serious features of DCS soon to follow. Moreover, this condition may in some cases be associated with patent foramen ovale (PFO), a potentially very problematic cardiac abnormality for divers (See below *).
While I appreciate BigJetDriver69's enthusiasm for DAN, the truth is that DAN's roster of diving physicians, and especially in specialties like cardiology, is quite thin. In other than major metropolitan areas, and even at that it's uncertain, it is very unlikely that they'll have anything to offer. It cannot hurt to inquire, however, and this can be by calling 1-919-684-2948 (Monday through Friday, 9am to 5pm EST) or e-mailing at http://www.diversalertnetwork.org/c...sp?RE=Medicine. If this doesn't pan out, you can contact your local dive clubs, dive shops and hyperbaric facilities to inquire.
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.
Best regards.
DocVikingo
*From my "Ask RSD" column in the April '00 issue of "Rodale's Scuba Diving":
"1. What is patent foramen ovale (PFO)? Larry Lozuk, Dallas, TX
PFO, a type of atrial septal defect, is an abnormal opening between the right and left upper chambers of the heart.
It is normal for blood to flow through a small opening between these two chambers during fetal development when the lungs are inoperative and blood is oxygenated by the mother. At the moment of birth, however, changes in chamber pressures cause this membranous opening to close, shunting blood to the now functioning lungs. While usually permanently sealed by the 3rd month of life, this does not always occur; about one in every four people have an incomplete closure of varying size. Without complete closure, blood can flow from the right to the left side of the heart without passing through the lungs. This causes a decrease in the amount of oxygen reaching the body and may limit exercise tolerance, sometimes severely.
In the absence of shifts in the pressure gradient in these upper chambers of the heart, however, the majority of otherwise healthy persons with PFO, many with only small openings, are unaware they have the condition. It typically requires no treatment in the adult.
Of significance to divers with PFO is the increase in right chamber pressure which occurs with common equalization techniques like the Valsalva maneuver. Under this condition, nitrogen bubbles that can form in the venous bloodstream during decompression may pass directly into the arteries without the filtering action of the lungs. Divers with PFO can develop decompression illness (DCI) manifestations ranging from relatively harmless skin rashes to serious neurological problems such as vertigo or paralysis. Bubbles passing into the brain can obstruct blood vessels, resulting in lesions of various size. Studies of high frequency divers have documented an increased likelihood of large and/or multiple brain lesions, and shown that a high percentage of divers who had otherwise unexplained incidents of DCI turned out to have PFO. In addition, The risk of severe decompression sickness (DCS) appears to be about three to five times greater in those with PFO as compared to the general diving population, although the relationship is much weaker for only mild cases.
PFO is often diagnosed by routine echocardiography, a simple procedure where sound is passed through the chest wall to the heart and its echo measured. If abnormalities are detected or suspected, this may be followed up with a more complicated echocardiogram where the sound transducer is passed down the esophagus to the region of the heart.
Despite some research findings of increased risk of DCI in divers with PFO, the risk is still quite low. Many dive medicine experts do not recommend echocardiogram as a routine procedures in healthy divers. However, if you have signs or symptoms of heart disease, or are concerned about your cardiac status, contact your physician."
While cutis marmorata after a dive is often benign, it can be an omen of more serious features of DCS soon to follow. Moreover, this condition may in some cases be associated with patent foramen ovale (PFO), a potentially very problematic cardiac abnormality for divers (See below *).
While I appreciate BigJetDriver69's enthusiasm for DAN, the truth is that DAN's roster of diving physicians, and especially in specialties like cardiology, is quite thin. In other than major metropolitan areas, and even at that it's uncertain, it is very unlikely that they'll have anything to offer. It cannot hurt to inquire, however, and this can be by calling 1-919-684-2948 (Monday through Friday, 9am to 5pm EST) or e-mailing at http://www.diversalertnetwork.org/c...sp?RE=Medicine. If this doesn't pan out, you can contact your local dive clubs, dive shops and hyperbaric facilities to inquire.
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.
Best regards.
DocVikingo
*From my "Ask RSD" column in the April '00 issue of "Rodale's Scuba Diving":
"1. What is patent foramen ovale (PFO)? Larry Lozuk, Dallas, TX
PFO, a type of atrial septal defect, is an abnormal opening between the right and left upper chambers of the heart.
It is normal for blood to flow through a small opening between these two chambers during fetal development when the lungs are inoperative and blood is oxygenated by the mother. At the moment of birth, however, changes in chamber pressures cause this membranous opening to close, shunting blood to the now functioning lungs. While usually permanently sealed by the 3rd month of life, this does not always occur; about one in every four people have an incomplete closure of varying size. Without complete closure, blood can flow from the right to the left side of the heart without passing through the lungs. This causes a decrease in the amount of oxygen reaching the body and may limit exercise tolerance, sometimes severely.
In the absence of shifts in the pressure gradient in these upper chambers of the heart, however, the majority of otherwise healthy persons with PFO, many with only small openings, are unaware they have the condition. It typically requires no treatment in the adult.
Of significance to divers with PFO is the increase in right chamber pressure which occurs with common equalization techniques like the Valsalva maneuver. Under this condition, nitrogen bubbles that can form in the venous bloodstream during decompression may pass directly into the arteries without the filtering action of the lungs. Divers with PFO can develop decompression illness (DCI) manifestations ranging from relatively harmless skin rashes to serious neurological problems such as vertigo or paralysis. Bubbles passing into the brain can obstruct blood vessels, resulting in lesions of various size. Studies of high frequency divers have documented an increased likelihood of large and/or multiple brain lesions, and shown that a high percentage of divers who had otherwise unexplained incidents of DCI turned out to have PFO. In addition, The risk of severe decompression sickness (DCS) appears to be about three to five times greater in those with PFO as compared to the general diving population, although the relationship is much weaker for only mild cases.
PFO is often diagnosed by routine echocardiography, a simple procedure where sound is passed through the chest wall to the heart and its echo measured. If abnormalities are detected or suspected, this may be followed up with a more complicated echocardiogram where the sound transducer is passed down the esophagus to the region of the heart.
Despite some research findings of increased risk of DCI in divers with PFO, the risk is still quite low. Many dive medicine experts do not recommend echocardiogram as a routine procedures in healthy divers. However, if you have signs or symptoms of heart disease, or are concerned about your cardiac status, contact your physician."
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