ArcticDiver
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Thanks for posting the pictures. You achieved your goal, education.
Pictures of Skin Bends
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wedivebc:
Yep, I have to agree with this, sounds like a PFO or other shunt of some sort. I'd definitely be intersted to know if that's a positive or negative conclusion.
caymaniac
Contributor
metaldector:
I met a gal diving in the Caymans about 6 years ago who said she was on the PH liveaboard in T&C and developed skin-bends on her legs, she too ended up in the chamber. Since that incident she also uses Nitrox and said she hasn't had a reocurrence.
Here is that other picture I was talking about. You can see the distinct marbling when you enlarge this one.
I have been checked for a PFO and came up negative. Unbeknownst to me, the PFO test I had was not thorough as I was not inverted during the test. I had never heard of this inversion problem until last week. Apparently, for some people, the PFO does not lapse until when you are inverted and that is what my Diving Doctor is hypothesizing today. I can confirm that I spent time upside down during the last two dives while taking pictures, so I believe his deduction to be accurate for the time being.
The first time I had skin bends, I had a normal conservative No DCL,two-tank dive day. BUT, I laid out in the sun immediately afterwards and then I got in a car that went directly to a 2,000 foot elevation. I was hit as the car ascended (the dive was at leat an hour and half behind me at that point) and went to a doctor who promptly gave me a shot of Benadryl in the butt because it appeared to be an allergy. It felt like a relief, but in retrospect I think it was that it knocked me out and I was driven to my home at Sea-Level.
I reasoned that I must have touched something inadvertently but it remained a mystery. The first hit was over the quickest so I moved on through life.
The second time I was hit later that year, I had once again, a conservative No DCL two-tank dive.
BUT again, I laid out in the sun immediately upon shedding my wetsuit (no altitude this time). This time I went to the quickie-doctor and received a shot of Benadryl in the butt and was told that I probably had developed a neoprene allergy or chemical sensitivity to the capful of bleach I used to soak my suit in. I took pictures of my belly that time and forwarded them to various dive groups/friends who concurred that it looked like an allergy.
It seems ridiculous now that I did not recognize the correlation, but hindsight is 20/20 and skin bends are tough because they do not happen until you have been off the boat for at least an hour or two. So, I bought a new wetsuit, changed soaps, etc.
The third hit was the hardest. It was a full year after the others and I was diving that year although not nearly as much (maybe 30 dives). I logged an 80 foot dive and a 60 foot dive with a 40 minute surface interval (no notation as to time at each depth although I always stay as long as I have air which is usually an hour). I laid out in the sun while everyone else took their showers first. I fell asleep in the sun, woke up 40 minutes into my nap wracked with pain. By the time I got to the Doctor I had blurred vision and I was crumpled over while the red rash turned to marbling and spread across every fatpad on my body (hips, boobs, belly, butt). I am very tough and this one hurt.
I got my Benadryl shot, passed out in the car on the way home from the Doctor and woke up feeling better several hours later. This was the first time I was scared enough to call DAN. I still did not believe it was dive-related because it did not sound like all the other stories about people being bent.
As a side-note, I have never been hospitalized for anything and one week after this event, following a week of lethargy, I made my first and only trip to the Emergency Room due to waking up with an inexplicable 92 degree temperature, the cause of which has never been determined. I am certain it was related to the fatigue I had been experiencing post-bends.
Anyway, the DAN Diving Doctor used the term "skin bends" for the first time on me and there it was. I realized I was bent. He prescribed a Bubble Doppler Exam and told me that if I had a PFO, I should never dive again. I had said Bubble Doppler Exam and came up negative which I was ecstatic about so I thought it was safe to go back into the water as long as I mended my sloppy surface habits (and controlled ascents).
I carefully began diving again after several months of that hit using Nitrox for the second dive, air on the first and being very timid in ascents, etc. I did not have a problem again for more than 2 and half years. I was hit two weeks ago in Chuuk. I did a three tank day, my deepest being 88 feet on the first dive but I was on all air. We had gotten back to the hotel, I took a warm shower but was hit within about an hour and half of the last dive. I was too worried about looking like a baby so I showed my dive group my belly and went to my room to doctor myself with Benadryl. It progressed to being a neurological problem within about 3 hours as I could not think clearly and had hand tremors/confusion/difficulty speaking as well as the painful crackling underneath my skin. I could not get it together to call DAN until 20 hours after the incident and even then, the satellite delay coupled with my mental bizarreness created not exactly a fruitful situation. So, I went to sleep again and hoped for a better day the next. It got a little better but I could not shake the confusion and hand tremors so I called DAN again and went to the chamber for a 5 hour treatment in Chuuk.
I feel lucky, but I am still exhausted and my belly is tender and becomes painful if I get too hot and I have had these weird red dots called petechia appear due to the damaged tissue. I feel a like a lost a few brain cells as well. I am trying to tell people about skin bends so they can get a diagnosis more quickly and understand that it is dangerous and can quickly become neurological. It requires Oxygen treatment as soon as possible. My Diving Doctor has told me that if I MUST dive here are some things to do that will mitigate the possibility of getting bent again.
shallow diving only (up to 30 feet) or only a moment at depth.
limited time while diving (approximately 30 minute dives)
nitrox
aspirin each day
stay super hydrated to the point of peeing twice in your wetsuit
never position myself upside-down
and he gave me a prescription for my own Oxygen tank to huff on for 10 minutes following each dive.
I hope this helps.
I have been checked for a PFO and came up negative. Unbeknownst to me, the PFO test I had was not thorough as I was not inverted during the test. I had never heard of this inversion problem until last week. Apparently, for some people, the PFO does not lapse until when you are inverted and that is what my Diving Doctor is hypothesizing today. I can confirm that I spent time upside down during the last two dives while taking pictures, so I believe his deduction to be accurate for the time being.
The first time I had skin bends, I had a normal conservative No DCL,two-tank dive day. BUT, I laid out in the sun immediately afterwards and then I got in a car that went directly to a 2,000 foot elevation. I was hit as the car ascended (the dive was at leat an hour and half behind me at that point) and went to a doctor who promptly gave me a shot of Benadryl in the butt because it appeared to be an allergy. It felt like a relief, but in retrospect I think it was that it knocked me out and I was driven to my home at Sea-Level.
I reasoned that I must have touched something inadvertently but it remained a mystery. The first hit was over the quickest so I moved on through life.
The second time I was hit later that year, I had once again, a conservative No DCL two-tank dive.
BUT again, I laid out in the sun immediately upon shedding my wetsuit (no altitude this time). This time I went to the quickie-doctor and received a shot of Benadryl in the butt and was told that I probably had developed a neoprene allergy or chemical sensitivity to the capful of bleach I used to soak my suit in. I took pictures of my belly that time and forwarded them to various dive groups/friends who concurred that it looked like an allergy.
It seems ridiculous now that I did not recognize the correlation, but hindsight is 20/20 and skin bends are tough because they do not happen until you have been off the boat for at least an hour or two. So, I bought a new wetsuit, changed soaps, etc.
The third hit was the hardest. It was a full year after the others and I was diving that year although not nearly as much (maybe 30 dives). I logged an 80 foot dive and a 60 foot dive with a 40 minute surface interval (no notation as to time at each depth although I always stay as long as I have air which is usually an hour). I laid out in the sun while everyone else took their showers first. I fell asleep in the sun, woke up 40 minutes into my nap wracked with pain. By the time I got to the Doctor I had blurred vision and I was crumpled over while the red rash turned to marbling and spread across every fatpad on my body (hips, boobs, belly, butt). I am very tough and this one hurt.
I got my Benadryl shot, passed out in the car on the way home from the Doctor and woke up feeling better several hours later. This was the first time I was scared enough to call DAN. I still did not believe it was dive-related because it did not sound like all the other stories about people being bent.
As a side-note, I have never been hospitalized for anything and one week after this event, following a week of lethargy, I made my first and only trip to the Emergency Room due to waking up with an inexplicable 92 degree temperature, the cause of which has never been determined. I am certain it was related to the fatigue I had been experiencing post-bends.
Anyway, the DAN Diving Doctor used the term "skin bends" for the first time on me and there it was. I realized I was bent. He prescribed a Bubble Doppler Exam and told me that if I had a PFO, I should never dive again. I had said Bubble Doppler Exam and came up negative which I was ecstatic about so I thought it was safe to go back into the water as long as I mended my sloppy surface habits (and controlled ascents).
I carefully began diving again after several months of that hit using Nitrox for the second dive, air on the first and being very timid in ascents, etc. I did not have a problem again for more than 2 and half years. I was hit two weeks ago in Chuuk. I did a three tank day, my deepest being 88 feet on the first dive but I was on all air. We had gotten back to the hotel, I took a warm shower but was hit within about an hour and half of the last dive. I was too worried about looking like a baby so I showed my dive group my belly and went to my room to doctor myself with Benadryl. It progressed to being a neurological problem within about 3 hours as I could not think clearly and had hand tremors/confusion/difficulty speaking as well as the painful crackling underneath my skin. I could not get it together to call DAN until 20 hours after the incident and even then, the satellite delay coupled with my mental bizarreness created not exactly a fruitful situation. So, I went to sleep again and hoped for a better day the next. It got a little better but I could not shake the confusion and hand tremors so I called DAN again and went to the chamber for a 5 hour treatment in Chuuk.
I feel lucky, but I am still exhausted and my belly is tender and becomes painful if I get too hot and I have had these weird red dots called petechia appear due to the damaged tissue. I feel a like a lost a few brain cells as well. I am trying to tell people about skin bends so they can get a diagnosis more quickly and understand that it is dangerous and can quickly become neurological. It requires Oxygen treatment as soon as possible. My Diving Doctor has told me that if I MUST dive here are some things to do that will mitigate the possibility of getting bent again.
shallow diving only (up to 30 feet) or only a moment at depth.
limited time while diving (approximately 30 minute dives)
nitrox
aspirin each day
stay super hydrated to the point of peeing twice in your wetsuit
never position myself upside-down
and he gave me a prescription for my own Oxygen tank to huff on for 10 minutes following each dive.
I hope this helps.
Attachments
Poco, thank you for posting your story, I'll make sure my students hear your message. May I have permission to use the photos in my lecture?
Ber :lilbunny:
Ber :lilbunny:
ianr33
Contributor
At this risk of sidetracking this thread could someone explain the connection between skin bends and PFO ?
Anecdotally there seems to be a connection but I dont understand the mechanism. A PFO would be expected to produce type2 DCS,so how does it produce skin bends?
Thanks
Anecdotally there seems to be a connection but I dont understand the mechanism. A PFO would be expected to produce type2 DCS,so how does it produce skin bends?
Thanks
Poco,
Sorry to hear about your bend, but glad you got it sorted.
Well, this is my 1st post (excluding the intro one, so go easy on me!). A couple of my friends have had skin bends before. The mottled skin effect was very similar to yours but there were also tiny little lumps, that looked like stinging nettle rash. This cleared up after several visits to the chamber for them, and they are both back diving with no apparent long term problems.
The cause was put down to overstraining trying to climb the ladder to get back onto the boat. We had just completed a decompression dive to 60 metres (approx 190 feet), with an 'in water' time of almost 2 hours...All stops had been completed, plus a little extra was added. It's just one of those things and a hazard of our chosen sport.
I've also had 2 other friends 'get bent' this year already, with suspected PFO, so i sent an email to a diving doc with regard to testing, that i thought you might be interested in......Here is the reply:
.........................................................................
There are 3 possible options for a screening test for a PFO. Transthoracic echo cardiogram TTEC, Transoesophageal echo cardiogram, TOEC and Transcranial doppler TCD. These have different sensitivities and all are operator dependent for the examination. Thus like a teaching of a new dive skill the instructor is as important as the training organisation, the operator/investigator is as important as the test.
TOEC is best at seeing the shape of the septum between the 2 atria but it involves a large tube down you gullet and it is more difficult to do a valsalva manouvre to cause the bubble contrast to shift through the hole.
TTEC standard external examination with gel on your chest.
TCD probe attached outside the head "looking " at a major artery in the head.
All of these require an injection of saline shaken to dissolve bubbles into an arm vein. The difference is in where and how the bubbles are looked for.
Also remember that although 25% of people may have a detectable PFO only around 3% are significantly predisposing and there is no firm agreement as to which are or not only that a big one probably does and a small one may not, likewise numbers of bubbles passing across a hole used as an index of possible problem are only now being agreed and no measures of probability exist as yet.
...........................................................................................
I hope this helps...
regards
Steve
Sorry to hear about your bend, but glad you got it sorted.
Well, this is my 1st post (excluding the intro one, so go easy on me!). A couple of my friends have had skin bends before. The mottled skin effect was very similar to yours but there were also tiny little lumps, that looked like stinging nettle rash. This cleared up after several visits to the chamber for them, and they are both back diving with no apparent long term problems.
The cause was put down to overstraining trying to climb the ladder to get back onto the boat. We had just completed a decompression dive to 60 metres (approx 190 feet), with an 'in water' time of almost 2 hours...All stops had been completed, plus a little extra was added. It's just one of those things and a hazard of our chosen sport.
I've also had 2 other friends 'get bent' this year already, with suspected PFO, so i sent an email to a diving doc with regard to testing, that i thought you might be interested in......Here is the reply:
.........................................................................
There are 3 possible options for a screening test for a PFO. Transthoracic echo cardiogram TTEC, Transoesophageal echo cardiogram, TOEC and Transcranial doppler TCD. These have different sensitivities and all are operator dependent for the examination. Thus like a teaching of a new dive skill the instructor is as important as the training organisation, the operator/investigator is as important as the test.
TOEC is best at seeing the shape of the septum between the 2 atria but it involves a large tube down you gullet and it is more difficult to do a valsalva manouvre to cause the bubble contrast to shift through the hole.
TTEC standard external examination with gel on your chest.
TCD probe attached outside the head "looking " at a major artery in the head.
All of these require an injection of saline shaken to dissolve bubbles into an arm vein. The difference is in where and how the bubbles are looked for.
Also remember that although 25% of people may have a detectable PFO only around 3% are significantly predisposing and there is no firm agreement as to which are or not only that a big one probably does and a small one may not, likewise numbers of bubbles passing across a hole used as an index of possible problem are only now being agreed and no measures of probability exist as yet.
...........................................................................................
I hope this helps...
regards
Steve
mfalco
Contributor
In my open water course the instructor told us to never lay out in the sun or take a hot shower immediately after diving. He said eith of the 2 could increase chances of skin bends.
Thank you for the pictures. The scary thing is that the rash only looks like your wet suit was causing friction. My wife has very sensitive skin and I know we both would look at that and think that it was caused by something else other than the bends.
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That is a clasic presentation, Poco.
Thanks so much for posting.
Regards,
DocVikingo
Thanks so much for posting.
Regards,
DocVikingo
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