Question Fizzy/bubbly tissues in limbs after dives

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uncfnp

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I know you are frustrated but if the medical professionals that have examined you are telling you it is not subcutaneous emphysema then it is indeed not air trapped in the tissue but something else you are experiencing since by definition subcutaneous emphysema is air (gas) trapped under the skin. So I would look for another explanation. Subcutaneous emphysema = air trapped in tissue. And yes, if it is not trapped air then it is likely something minor occurring at the site and should pose little long term risk. I am not saying this is so but simply my take on what you have said.

If however you are still convinced it is indeed air, then yes it is subcutaneous emphysema and you do need to pursue the source more thoroughly as DDM suggested.
 

Lorenzoid

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Have you considered contaminated breathing gas as a possibility? You said that on one dive another diver had similar symptoms. I believe a tingling sensation is sometimes a symptom of CO. But another person being able to actually feel something under your skin ....? This is just wild speculation on my part.
 

Imla

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Have exerienced the same symptom once before and agree with @Duke Dive Medicine that it sounds like (a benign form) of temporary subq/cutaneous emphyzema.
Mine was going from cold cave water to warm jacuzzi. It disappeared as soon as I took a cold shower.
So... in my simple brain, this could be as simple as a certain amount of air in slow fatty tissues that were not able to dissapate and offgass. For it to disapear within 10 minutes isn't horribly unlikely.
In my example, the difference in cold water, hot water, cold water was enough to trigger/solve it.
 

Duke Dive Medicine

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Have exerienced the same symptom once before and agree with @Duke Dive Medicine that it sounds like (a benign form) of temporary subq/cutaneous emphyzema.
Mine was going from cold cave water to warm jacuzzi. It disappeared as soon as I took a cold shower.
So... in my simple brain, this could be as simple as a certain amount of air in slow fatty tissues that were not able to dissapate and offgass. For it to disapear within 10 minutes isn't horribly unlikely.
In my example, the difference in cold water, hot water, cold water was enough to trigger/solve it.
That is really interesting. If you don't mind, can you describe this event a little more? What was your dive profile, how long after you exited the water were you in the jacuzzi, what did you notice and where did you notice it, and how quickly did it resolve after the shower? Please feel free to PM if you don't feel comfortable discussing details on a public forum.

Best regards,
DDM
 

kinoons

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Hi all,
I’ve had a strange symptom a few times recently after dives, and am hoping someone here might have thoughts on this or heard of something similar before. After four dives within a month, after surfacing from a dive, the tissues of my arms feel bubbly/fizzy to touch, like my muscles had Coca-Cola in them.

For background, I’m a fresh dive master in Thailand, first certified as OWD 4 years ago and now recently as DM. I have 98 dives, of which around 75 are within the last two months. I was about to start my IDC to become an instructor. These symptoms have however now put me out of the water for at least a month, and doctors do not know what it could be.

About the symptom: I do not have any sensation of the bubbles, only when I press on my arms or legs, and it feels fizzy/bubbly like soda. Others can feel this fizzing under my skin as well, if they press my limbs. The symptom does not cause any discomfort or pain, and goes away by itself within 10-15 minutes after the dive. I have no other symptoms than the fizzy feeling under my skin, no joint pain, no rash, nothing. Only once I had a strong headache start during one of these dives.
The fizzy symptom feels harmless, but as we know, bubbles are trouble and therefore my instructors and employers wanted me to get checked to be sure this is not decompression related. I know some of you will be thinking about subcutaneous emphysema, but it doesn’t make sense for it to go away 10 minutes after a dive, and being in the limbs?

About the dives: The symptoms do not occur every time I dive. This has happened on four dives within forty dives in a period of one month. I have gathered the information of the dives this happened on at the end of this message. If you have a look at them, you’ll notice they happened at rather shallow depths: 6m/12m/12m/16m. I cannot find any common denominator for these dives.

About doctors: I was sent to Bangkok Royal Navy hospital to get checked up. I passed all the fit to dive tests: blood, urine, chest x ray, pulmonary power, neurological, vision, hearing, dental, no problems whatsoever. The doctors examined my dive log and same as me, could not find many similarities between the dives the symptoms had occurred on. They did seem to believe it could be decompression-related, but were not sure. Therefore I was sent to get tested for PFO and told to be out of the water for a month. I tested negative for PFO in Koh Samui.

This now puts me in a position where nobody knows what I have or whether it is dangerous. I have no idea if I will able to continue diving professionally.

A few things I already know you might ask about
- my equipment or wetsuits have not been too tight.
- I haven’t drank alcohol before these dives and I don’t smoke.
- I consider my diving pretty conservative/safe, not pushing limits.

Has anyone heard of anything like this before? Your help is much appreciated.

Thanks in advance,
Emma

Dive log:

26.6. Long shallow dive, reef survey

Max depth: 6,7m
Average depth: 5,2m
Time: 13:54
Duration: 83min
Surf: 45h
Previous day: no dive

19.7. AOW assist dive 4
Max depth: 16,4m
Average depth: 13,4m
Time: 16:21
Duration: 46min
Surf: 1h16 (Previous dive: 46min at 10m)
Previous day: 2 dives, 15m, 45min & 47 min
-> on this dive, one of the students had the similar symptom as me.

28.7. OW assist dive 1
Max depth: 12,3m
Average depth: 7,6m
Time: 13:34
Duration: 47min
Surf: 21h
Previous day: all day pool (OW assist)
-> headache started on this dive

OW assist dive 2
Max depth: 12,9m
Average depth: 9,8
Time: 15:44
Duration: 45min
Surf: 1h21

Like DDM has eluded to, this very much sounds like SQ emphysema from when i was trained, although in a very odd distribution.

Perhaps I overlooked it, but how tall/large are you? Spontaneous air leaks from the lung are a thing, in particular for tall skinny athletic people. I would have expected more along the spontaneous pneumothorax type presentation for this, but we’re already down the zebra portion of this episode of House, so why not.
 
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femmma

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I’m not tall and am normal weight, 158cm/54kg.

I actually met three Divers yesterday, one DM and two instructors and they say they have always had this bubbling under the skin after dives! Same as me, lasts 5-10 minutes and is gone! They’ve been diving for 27 years and it’s never caused any problems. They’ve also met plenty of people who have this fizziness as well. Super interesting.
 

kinoons

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So a rather cursory literature search for prepherial or extremity subcutaneous emphysema only came up with things related to infection or trauma. In all instances the resolution of the SQ air took days, not minutes.

So, in my mildly informed and trained opinion, what we’re looking at here is a condition that Mimics SQ air without actually being SQ air.

For my physician counterparts, or advanced A&P doctorate types, what kind of condition could mimic SQ air of the SQ tissue without actually being air? Is there some property of the SQ fat that could result in the rice crispy sensation transiently after additional pressure from diving? Additional pressure should push gas into solution, not out. I wouldn’t expect any gas coming out of solution from depth to surface to resolve within minutes on the surface. Is there a property of adipose tissue that can mimic SQ air that I’m (APRN) not familiar with?
 

Nick_Radov

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What was the air temperature on the days when you experienced symptoms? Gas solubility decreases with temperature, hence the recommendation to not jump into a hot tub immediately after a dive.


Is it possible that your limbs warmed up rapidly enough to cause nitrogen to come out of solution in the subcutaneous fat and briefly form some bubbles?
 

kinoons

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What was the air temperature on the days when you experienced symptoms? Gas solubility decreases with temperature, hence the recommendation to not jump into a hot tub immediately after a dive.


Is it possible that your limbs warmed up rapidly enough to cause nitrogen to come out of solution in the subcutaneous fat and briefly form some bubbles?


I wouldn’t expect air to have the same thermal conductive properties as a hot tub. Yes, coming up from depth (cooler to down right cold) compared to ambient air would be a difference, but the evaporation from wet skin should mitigate this. If it’s a hot day out sweating shortly there after would also mitigate raising the temp of the SQ tissue unless someone is standing around in a wetsuit and cooking themselves to get warm.

Perhaps if there was a good amount of vascular shunting from the extremities because of cold, then relatively brisk rewarding on the surface caused a quick return to preperial circulation…maybe you could get this sort of temperature change in the SQ tissue.
 
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