Skin Bends and Future Diving

[Instructor_Tom]

based on using air both your first dives where deco dives. hitting Deco is not an issue as long as use did a proper deco stop as indicated by your computer. if you never hit deco on your computer then you need to check the settings of you computer and adjust the gradient factor to a safer setting. if you where using Nitrox what mix where you using.

this could explain you issue if you did not get a deco indicator on your computer or if you missed it.


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[natalieinca]

They were all air. I did not get a deco indicator on my computer, although it was close the first two times. Doesn't it depend on how long I was at each depth? These were not "square" dive profiles. I know you can't use other people's computers - but I did have a buddy with me that stayed close and his computer did not hit deco either. At any rate, I do agree that the first two incidents were pushing it, but the third time wasn't -at least according to my computer.

I don't think it is anything location related in the water - the dives were: April in Fiji, May in Belize (two years later) and November in Hawaii.

I will definitely plan to use Nitrox and be more conservative with my computer on any future dives.

 

[Quero]

My rash looked exactly like the rash in your two photos, natatlieinca, and I would sometimes get it in that same place on the torso. It was much like what uncfnp describes as the less serious skin bends type, which was why I was concerned. It would swell and be itchy, hot, and tender, but sometimes it took a couple of days to go away, and it disturbed my sleep it was so sensitive and bruised-feeling. I'm still amazed that it's just a sunlight auto-immune reaction. I never get it any more unless I'm desperate to warm up after a dive and tell myself "just a few minutes can't hurt, can it?" And then the answer is "yes." I hope you find out what's causing your rash, whether it really is skin bends or something else, since that way you can strategise a solution. My solution is to stay out of direct sunlight (through glass is okay), but yours might be to use nitrox on air tables as sealark is suggesting. Duke Dive Medicine always has great insights so I'm looking forward to his response.

 

[DandyDon]

The first time it happened on the 5th day of diving. That day I did a 38 min dive, max depth 85 ft and 2nd dive was 52 min, max of 68 ft. Looking at the details on my computer, it does look like I pushed the limits on my computer. I have an Oceanic VT Pro - it has a "tissue loading bar graph" where the 8th bar is a decompression dive. I did hit 7 bars on both of those dives, and got out of the water with 5 and 6 bars respectively.

The second time, it happened on the second day of diving. First dive that day was 50 min, 74 ft max and second dive was 47 min, max depth of 68 ft. I did hit seven bars on the second dive and came out of the water with 6.

The third time was also on the second day of diving. The evening before I did the Manta dive in Kona - where most of the second dive was spent at 15 feet. The day it happened I did a 52 min dive max depth of 57 feet and a 59 min dive max depth of 76 feet. The highest my tissue loading bar graph got was 5 and I ended the 2nd dive with 4. So that trip I never went beyond 5 bars on my tissue loading graph.

None of the dive profiles show any alarming ascent rates.

I don't know if you were bent or allergic, but Oceanic computers are liberal enough that I try to avoid ever leaving the water in the yellow - like you did on some. Looks at your dive downloads would be interesting if you have them. Good luck & take care....

 

[natalieinca]

Thanks. I really hope it is just an allergy of some type. If it is, it's irritating, but nothing that would keep me from diving. So far, it has always gone away within an hour or two for me. I know it's not the sun though - I am always covered up with a rash guard or T-shirt.

It is just hard not knowing what it is and being afraid that it may mean it would be more likely that I'd have a serious problem in the future.

 

[natalieinca]

Well, I went to a doctor that DAN recommended. She thinks it probably was skin bends, but obviously can't tell for sure. She suggested I dive nitrox and only do one dive a day from now on. She also wants me to get tested for a PFO. It sounded like if they found one she wouldn't want me to dive anymore. She wants me to come back after the PFO test to discuss.

I am bummed - no point in spending the money on a live aboard to do one dive a day. From everything I've read on this board it seems like her recommendations are on the extreme side, but I guess with my history she thinks it is best. She didn't seem to think there were two different types of skin bends. She said I would be at higher risk of more serious DCS.

 

[Superlyte27]

If you have a PFO, you can very easily get it fixed. It's quite routine in the USA. There's no way I'd let something fixable keep me from diving. But, the fact that you've had skin bends more than once with conservative dives does lead me to think there's PFO.

 

[Quero]

Your doctor is being cautious because of your history. If you've got a PFO and have had several bends, of course she would want to prohibit diving once that's confirmed. When I suspected I had skin bends and possibly a PFO (which I didn't), the doctor told me I could dive conservatively, but not to climb the boat ladder geared up, so placing limitations on diving activities while the situation is being investigated would seem to be usual and wise.

I've had two of my divers get PFO repairs in the past few years--both of them Europeans. One (from England) suffered skin bends on the first day of a liveaboard, thought it was sunburn or something, went diving the second day and got sicker. He spent three days doing chamber treatments before he could go home to be tested for a PFO, and it turned out that he did have one. The dive doctors there told him not to get a repair ONLY to dive, but to consider other factors as well. In his case, the risks of the surgery were outweighed by the risk of stroke given his physique, so he had it done and now is diving again, only on nitrox, and following conservative profiles. The other one (a Swiss) had no issues while diving and had been on a liveaboard, done the Rescue class with me, and had about 100 dives, but at dinner with his wife a week later suffered a stroke, which surprised everybody since he's a very slender and fit triathlete. He also had the repair after much thought and more as a consequence of possible future strokes than as a way to keep diving; but he is indeed back diving, though since he doesn't have a history of DCS he isn't limited to diving with nitrox.

Best of luck to you.

 

[tracydr]

My rash looked exactly like the rash in your two photos, natatlieinca, and I would sometimes get it in that same place on the torso. It was much like what uncfnp describes as the less serious skin bends type, which was why I was concerned. It would swell and be itchy, hot, and tender, but sometimes it took a couple of days to go away, and it disturbed my sleep it was so sensitive and bruised-feeling. I'm still amazed that it's just a sunlight auto-immune reaction. I never get it any more unless I'm desperate to warm up after a dive and tell myself "just a few minutes can't hurt, can it?" And then the answer is "yes." I hope you find out what's causing your rash, whether it really is skin bends or something else, since that way you can strategise a solution. My solution is to stay out of direct sunlight (through glass is okay), but yours might be to use nitrox on air tables as sealark is suggesting. Duke Dive Medicine always has great insights so I'm looking forward to his response.

Were you ever tested for the lupus antibodies?
I had a similar rash once after my ex- husband sucked down all my air at 65 feet and than bolted for the surface.
I was recently tested after I found out I had osteonecrosis in both knees. Possibly from diving, possibly from a heavy dose of steroids several years ago. I have a high level of anti-cardio lipid antibodies.
This type of rash could also be a sort of vasculitis, possibly related to something like lupus or one of the other autoimmune disorders.
interestingly, my mother developed a similar rash to the son years ago, although she never got another one. She's never been tested for anything like this.

 

[Quero]

No, Tracy, never. I'll keep that in mind if I have a flare up.