Skin bend?

[DrSteve]

My wife and I went diving for the first time this season at the local quarry. She is concerned she may have "skin bend."

The dives we did:
35 mins to 60 foot (max depth) (but mostly around 40 feet)
At least 1h15 surface interval
35 mins to 60 foot max depth (but mostly around 30 feet)

We were diving air and are will within the no-deco limits even when using tables (we were diving computers - Suunto Cobra set on the most conservative setting).

The symptoms:
A blotchy red rash across my wife's stomach which we noticed before bed (6h after being out of the water). She also complained of a numb big toe. My wife is 5'6" and 160 so not exactly a prime candidate for excessive N2 absorption. 24h later the rash is still present. We showered in failry warm water once we were home and the rash was not present immediately afterwards. She also says she say something which looked like bruising around my mouth and on my elbow (I did not see it).

I think this is most likely some kind of allergy (she was wearing a new swim suit and a rental suit) either to her clothing or to something in the water. Can anyone comment?

Thanks!

 

[Wendy]

where were you diving? Could it be sea lice, if not skin bends?

 

[DrSteve]

where were you diving? Could it be sea lice, if not skin bends?

The local quarry (Lake Rawlings, VA). Not sea life but I think there could be any number of other nasty things in the water.

 

[Saturation]

Allergies respond often to antihistamines or corticosteroids. If a skin contact reaction of a sort has happened it may respond to topical hydrocortisone, available over the counter. If it improves, is clearly cannot be bends.

Its hard to say otherwise, but a large PFO will make her predisposed to skin bends with a light inert gas load. Skin bends tend to resolve rather quickly too and rarely present for over 24 hours.

 

[DrSteve]

Thanks for your opinion. Her symptoms have cleared up and she used hydrocortisone last night. We think it is more likely to be some kind of allergy/heat rash than DCS. But we'll keep a close eye on this next time.
Thaanks!

 

[ScubaDadMiami]

Had it been myself, I would not have delayed in at least having this checked out promptly. The numb toe could mean DCS (or something unrelated). Only a physician trained in diving medicine can rule this out.

While skin bends is often not treated with hyperbaric oxygen, there are often subtle neurological symptoms of DCS that one would not notice without conducting a neurological evaluation. Skin bends alone would not likely be an issue if that is all that there is. It is really a question of what else was there that the trained provider would have found by looking in the right places.

 

[archman]

Having lost sensation in a portion of my big toe due to DCS, I would be very cautious with your wife's symptoms. I didn't "catch it" in time for the hyperbaric doc's to fix it altogether, but they did reduce it quite a bit (and from my other toes too).
Have you called DAN? They have a hotline for this sort of thing, and you don't have to be a member.

 

[Saturation]

After 24 hours, with a persistent rash that responds to HC, a very low profile dive, and just a big toe, observation would be a prudent action plan. Did the big toe improve with time? Likely a musculo-tendon issue.

More often, a 'big toe' issue is often flutter kicking issues rather than DCI, although DCI cannot be ruled out, of course. The time course is more telling, untreated DCI still has to apogee in terms of signs and symptoms, the 'big' toe is just the start, if the sensation on the toe worsen or ascend say to the foot or knee, or new symptoms occur on the cranial nerves, it would definitely be concerning.

As the toe is serviced by a branch of a spinal nerve, a DCI episode tends to produce symptoms along a track, rather than an isolated spot, like just the tip of a finger. Often it progresses to the entire finger and ascends up the hand, towards a strip on the arm ... if this is indeed a spinal issue.

 

[DrSteve]

Thank you for all your input.

My wife's toe isn't a problem anymore (I think she may have just gotten it numbed due to her boots/fins/finning style). There were no other "transport" problems. Also her rash is much reduced due to the hydrocortisone. I think we are good in this case, but I will watch her carefully on future dives.

 

[rmediver2002]

I agree this was most likely not a skin bend but would also like to point out the current treatment method for skin bend or DCS type I is treatment as a DCS type II symptom.

It is treated with HBO, in most cases if there is signifigant gas in solution in the divers tissues to present as a symptom of skin bends then there is a signifigant chance that more severe symptoms will follow...

Jeff Lane