Skin Bends and Future Diving

[uncfnp]

Not at that time. I had an echocardiogram/bubble study/chest X-ray/doppler as part of the Navy Diving medical.

Again, you may not wish to answer this hypothetical question, but given your history and if you were tested now and had a PFO, would you have it closed?

 

[DCBC]

Again, you may not wish to answer this hypothetical question, but given your history and if you were tested now and had a PFO, would you have it closed?

PFO is a congenital heart defect that exists after birth. If I had a PFO, it would have been diagnosed and I would have likely followed a different career path. If I had a PFO that was diagnosed, I would have wanted it closed, as it increases the risk of stroke, or blood clots causing problems in the heart, eyes, or kidneys. Obviously any decision should be made after consultation with a cardiologist.

 

[uncfnp]

PFO is a congenital heart defect that exists after birth. If I had a PFO, it would have been diagnosed and I would have likely followed a different career path. If I had a PFO that was diagnosed, I would have wanted it closed, as it increases the risk of stroke, or blood clots causing problems in the heart, eyes, or kidneys. Obviously any decision should be made after consultation with a cardiologist.

Of course. I guess that was just a round a bout way of asking, with your extensive diving history and degree in Hyperbaric Physiology, if you had developed any personal opinions about PFO repair. Just curious.

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.

Natalieinca. Please let us know how your test and followup go. We are all hoping for a positive outcome (by that I mean no PFO!).

 

[DCBC]

Of course. I guess that was just a round a bout way of asking, with your extensive diving history and degree in Hyperbaric Physiology, if you had developed any personal opinions about PFO repair. Just curious.

Although I have some understanding of Hyperbaric Physiology and diving, I'm not a Physician. Most Physicians I know would likely defer a question like this to a Cardiologist who would discuss this with the Patient. I'm aware that medications are used to control blood clotting so as to reduce the incidence of stroke. Medications do not however treat the PFO itself.

I believe that a PFO can be sealed in some cases without major surgery through cardiac catheritization (a small tube threaded to the heart from a vein in the thigh). A small umbrella-like device is placed at the desired location in the heart, and then opened on both sides sealing the hole. I understand that this procedure greatly reduces recovery time, but an unaware of the conditions in-which this is preferred case management, as I'm not a Cardiologist. In any case, this would be determined by the Cardiologist on a case-by-case basis.

 

[Duke Dive Medicine]

The OP did not show marbling in the photos; so cutis marmorata seemed improbable.

They're a bit nonspecific, especially the first, but if I turn my laptop screen the right way the second rash looks like it has some streaky and blotchy components. You may have a better view than I do.

Best,
DDM

 

[DCBC]

They're a bit nonspecific, especially the first, but if I turn my laptop screen the right way the second rash looks like it has some streaky and blotchy components. You may have a better view than I do.

Best,
DDM

It seemed to me that the rash was pink and not the distinct blue-purple associated with cutis marmorata. Also this discoloration is usually found in the fatty tissue, which the OP stated that it wasn't (post 6). The rashes dispersed relatively quickly without treatment.

I had agreed with you that it was prudent for her to seek a medical diagnosis. Obviously, I'm not a Hyperbaric Physician, nor do I practice medicine. If I did, I wouldn't depend upon making a diagnosis utilizing two Internet based photos.

It is important for people to seek treatment, if they are in-doubt. I suppose because I've experienced "itches" and "rashes" a few times myself and these have been dismissed by Hyperbaric Physicians, if they are experienced and are not accompanied by neurological or musculoskeletal symptoms, I can dismiss them as well (but try to learn from the experience). As I've mentioned, this is usual practice for professional divers.

 

[Duke Dive Medicine]

It seemed to me that the rash was pink and not the distinct blue-purple associated with cutis marmorata. Also this discoloration is usually found in the fatty tissue, which the OP stated that it wasn't (post 6). The rashes dispersed relatively quickly without treatment.

I had agreed with you that it was prudent for her to seek a medical diagnosis. Obviously, I'm not a Hyperbaric Physician, nor do I practice medicine. If I did, I wouldn't depend upon making a diagnosis utilizing two Internet based photos.

It is important for people to seek treatment, if they are in-doubt. I suppose because I've experienced "itches" and "rashes" a few times myself and these have been dismissed by Hyperbaric Physicians, if they are experienced and are not accompanied by neurological or musculoskeletal symptoms, I can dismiss them as well (but try to learn from the experience). As I've mentioned, this is usual practice for professional divers.

Cutis can be somewhat non-specific as well... here's one that differs a bit from the one my Tarheel friend posted:


It's by definition a skin rash so it may not necessarily appear over fatty tissues; here's another example:


I agree that the OP is on the right course. I definitely was not making a diagnosis; hopefully it wasn't interpreted that way (for the record, the guy doing the typing here is not a physician either, I'm a retired U.S. Navy diver, former commercial diver/instructor and certified hyperbaric RN). The only practitioner who has physically laid eyes on her and examined her is the one who recommended she get tested for PFO.

I also agree that it's best to be evaluated if there's doubt, and would caution anyone reading your post that you're a professional - your decision to dismiss a rash as a minor DCS case is based on your training and experience, which not everyone has. For the general recreational diving population a rash after a dive, especially a provocative one, may be an indicator of decompression stress and could be accompanied by other symptoms that aren't immediately noticeable, so should be evaluated by a practitioner trained in diving medicine.

Best regards,
DDM

 

[DCBC]

I definitely was not making a diagnosis; hopefully it wasn't interpreted that way (for the record, the guy doing the typing here is not a physician either, I'm a retired U.S. Navy diver, former commercial diver/instructor and certified hyperbaric RN).

I don't believe that anyone interpreted it this way. It would appear that we have a number of things in-common. While at DCIEM, I had occasion to work with Duke and Dr. Peter Bennett in in the late 70's. I understand that Peter actually had a couple of years working at DCIEM in the early 50's (about the time I was born) before going to Duke. I applaud his tremendous contributions to the field of Hyperbaric research, as well as the contribution Duke Dive Medicine Staff continues to make.

I...would caution anyone reading your post that you're a professional - your decision to dismiss a rash as a minor DCS case is based on your training and experience, which not everyone has. For the general recreational diving population a rash after a dive, especially a provocative one, may be an indicator of decompression stress and could be accompanied by other symptoms that aren't immediately noticeable, so should be evaluated by a practitioner trained in diving medicine.

Absolutely. It wasn't my intention to down-play any symptom experienced by anyone. Seeking professional medical attention is always the prudent course of action.

 

[Duke Dive Medicine]

It would appear that we have a number of things in-common. While at DCIEM, I had occasion to work with Duke and Dr. Peter Bennett in in the late 70's. I understand that Peter actually had a couple of years working at DCIEM in the early 50's (about the time I was born) before going to Duke.

Wow, you look much younger in the photo Were you in on the workup for the Atlantis series?

 

[DCBC]

Wow, you look much younger in the photo Were you in on the workup for the Atlantis series?

I went down to Duke as an Observer from DCIEM. We were undertaking a revision of the Helium tables at that time and Peter was undertaking his Trimix studies. Duke and DCIEM had an excellent relationship (along with the USN, Germans, the UK and several other NATO countries) which existed until I left to go to the Commercial Diving Sector.

I don't know about the current relationship. Dr. Chris Brooks was the Deputy Director of DCIEM at the time I left. Chris was previously a Royal Naval Medical Officer and had a close relationship with Peter (as you know, Peter was born in the UK and worked with the RN previously). I suspect their relationship continued and I'm sure Duke continues to have a close relationship with DRDC.