Skin bend?
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I happened to be reviewing that chapter on the plane the other day and (sadly) left the book in the seat pocket, so I can't check. My memory is that the B version did not do well in NDL dives. It is fine from NDL through hypoxic. I will admit that my memory on this comes from the same mind that did not remember to take the book off the plane.
Yes, pain in left wrist which lasted for days. headache, nausea and my entire chest and mid waist felt tender like I had a sunburn, which also lasted for several days. I have also had just the rash and sunburn feeling on a couple of occasions. Each time I was using RGBM deco model and was diving within the limits of my prescribed deco profile.
Dave,
Did this happen after a dive series or a few days into a dive trip? Being within your deco profile doesn't preclude DCS - this may be a sign that you're coming out too dirty and need to bump up your deco some, or take a break and off-gas for a day, or both. Did you use surface O2 and if so, did you get any relief of symptoms?
I happened to be reviewing that chapter on the plane the other day and (sadly) left the book in the seat pocket, so I can't check. My memory is that the B version did not do well in NDL dives. It is fine from NDL through hypoxic. I will admit that my memory on this comes from the same mind that did not remember to take the book off the plane.
When I said, "It is fine from NDL through hypoxic.", I meant anything from 2mt to 100mt.
As you can't confirm, & this has little (I'm presuming he didn't use VPM on the dive) to do with the OPs question, I'm going to take this to a forum where there may be more people who have read Deco for Divers to see if we can get a definitive answer on what it says. I know, hard to imagine something definitive on the net.
The one I described happened within minutes of surfacing from first dive in several days. I have changed to a different deco algorithm (Buhlmann GF 85/30) I did breath surface O2 which helped with the nausea and stomach cramps. Although I had several similar dives with identical profiles I may not have been as well hydrated as I should be. I have done about a dozen deep dives (and a few deeper) since that one with no ill effects.
Dave,
Hydration may or may not have had an effect. The cutis marmorata is thought to come from bubbles in the blood supply to the skin, which means they're arterial bubbles, which means that, if current thinking is correct, you threw some venous gas emboli through a shunt (intrapulmonary, PFO, or some other area). With shunted bubbles, it's a crapshoot as to where they end up - the brain, the spine, the coronary arteries, the inner ear, we've even seen evidence of liver emboli. So, it's good that you haven't had any such experiences.
If this happens again, I'd strongly recommend getting treated in a chamber. I can understand the rationale behind not wanting to get treated - cost, time, stigma, etc. and I'm assuming you have no residual symptoms, so everything worked out ok. There are a couple of hitches, though. The first is that the injury could easily evolve into something more severe like spinal DCS, and if you were treated when you first felt symptoms, you could halt that process and increase your chances of a full recovery. The second is that a bad DCS hit left untreated can result in aseptic osteonecrosis later in life.
On using only surface O2 to "fix" DCS: we've had a couple of recent incidents where providers have sent divers with DCS home after their symptoms resolved on surface oxygen in the ED, only to have the symptoms recur in more severe form later on. If it's bad enough to need O2 on the surface, it's bad enough to get treated, for the reasons stated above.
I'd be interested to hear if you have any more incidents using the Buhlmann algorithm. If you think of it, can you keep me updated?
Best regards,
DDM
Just so that I am clear, cutis marmorata is the type of DCS you are attributing to the picture in post #14? If so then that is very similar to the type of rash I have experienced on 4 occasions. In two occasions there were other type 1 symptoms. In the two more severe cases chamber treatment was not readily available. I have tested negative for a PFO. I am not sure I understand what an interpulmonary shunt is. I have always felt people experiencing DCS should be open about these experiences in order to help others understand this and I appreciate you taking the time to comment on my case. I am hoping I will never have to take you up on the offer to comment on any future incidents but you can be sure I will be happy to share should the need arise.
Dave,
Yes, both #12 (at least the top one - can't tell with the smaller photo) and #14 look like cutis marmorata. An intrapulmonary shunt is an area of the pulmonary circulation where a bubble or other embolus can pass through to the arterial side. Shunts can also exist elsewhere in the body.
Re chamber treatment not being readily available: this isn't to beat you up for the past, and hopefully you won't ever need to think about it again, but if you're within 24 hours of a chamber, it's worth going.
I'm glad you shared your experiences, and I'm sure anyone reading this will be as well.
Cheers,
DDM
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