Unexpected Skin Bends--Why

[kelemvor]

Obviously, "from the horses mouth" is going to be best. Fortunately, @Duke Dive Medicine does not usually disappoint. In the meantime, this article suggests a month: Diving After the Bends

 

[guyharrisonphoto]

Thanks for that reference!

 

[scubadada]

The question lingers, why 2 episodes of skin bends after so long a history of similar dives. Inquisitive minds want to know.

 

[Superlyte27]

Guy-
There has been some mention in recent (this or last year) DAN articles about aging and gas transport. While there was nothing specific, there are apparently indications that as we age, the same way that skin may wrinkle, the spacing between out cells may change, and that small change in interstitial spacing may cause a difference in the way gasses can pass through. The bottom line was that as you age, you may need to get more conservative than the tables--because the tables are written for youngsters, and there's not enough information to say more.
So other than getting over any remaining sensitivity caused by the past incidents? Yeah, the only answer is to be more conservative. I'd say to use a safety factor of "2", the most that computer usually allow, and take whatever other steps you can. (Be hydrated, stay warm, etc.) And if you are using air, consider moving to nitrox--but still using the more conservative air tables. Another bump in your safety factor.

Superlyte-
I wouldn't knock all hyperbaric docs over that one. all doctors, all specialists, all hospitals, vary in quality. There are even some that think along your lines, saying that every patient should have a "patient advocate" to speak for the patient, whether that's a spouse or friend. Because as critical as medical care may be, the people at the hospital are just human, and they don't always know their business. Once you get into the medical equivalent of unicorns (DCS is *how* common?) there are reasons why they may foolishly be sticking to diagnostic scripts, and 12/14 hour shifts do tend to make forgetful idiots out of the best of them.
Even if it is a chamber--CALL DAN and get a liaison who really knows their business on the phone with the local medics.

This was one account at one hospital. I have 11 accounts at 10 hospitals. They're all the same so far.

 

[WetRocks]

This was one account at one hospital. I have 11 accounts at 10 hospitals. They're all the same so far.

Friend had a similar account at UF Shands. Lots of similar stories in cave country. A shame really but why we tend to self treat unless it's a serious hit like you described and then I would be bringing in my own O2 while they diddle around and rule everything else out.

 

[kelemvor]

Friend had a similar account at UF Shands. Lots of similar stories in cave country. A shame really but why we tend to self treat unless it's a serious hit like you described and then I would be bringing in my own O2 while they diddle around and rule everything else out.

In other areas, those guys at shands are all right. They saved my son's life a few years ago but it wasn't diving related.

 

[Superlyte27]

We were at Ginnie when he got bent. Shands doesn't treat DCS anymore

 

[Duke Dive Medicine]

After a lifetime of diving (45 years and 2500+ dives), including maybe a dozen dives every year to 100', on my two most recent trips I have developed what seems to be skin bends. I am 60 years old, 210 pounds, in pretty good fitness, exercise very regularly, and have never had anything like this happen before.

Painful deep pink rash over my abdomen (and around my side) that feels like bruising and showing up about 3 hours after the dives. I went to the ER at the local hospital that has a chamber and each time they also diagnosed skin bends. Each time I was put on O2 for a while, observed, and because no other more serious symptoms developed, and the skin symptoms were beginning to recede, they decided I did not need a chamber treatment.

The first set of dives were deeper profiles (first dive 80 to 90 feet, second dive 60 feet), on 35% nitrox. I dove close to the computer limit (ascent with 2 mins NDL), but had a slow ascent and a three minute safety stop.

Two weeks later, the same thing happened. But, because of the first episode, I had increased the conservatism of my computer (which shortened my NDL about 3-5 mins each dive) and also gave myself a 5 minute stop each dive instead of 3. Same outcome.

I have an appointment with a local doctor who works at the chamber, but I wanted to post here. What is the possible explanation for this occurring now, and on pretty standard dive profiles for me, and even in fact more conservative on the second set of dives?

Guy, just to cover all the bases, did you check the O2 percentage in your tanks? Were you particularly cold on the two dives where you suffered skin bends? Regarding returning to diving, two weeks might not have been long enough to allow the inflammation from the first bends incident to resolve. Of course the recommendations you receive from the physician who sees you in person should take precedence, but I'd recommend waiting a minimum of 30 days after complete symptom resolution, and six weeks would not be unreasonable.

I'm afraid I don't have many recommendations for prevention aside from diving more conservatively. Tthis could mean switching to the air setting on your computer while diving nitrox, not diving the computer to the edge of the NDL, and lengthening your safety stop. If you have the training and equipment you could consider breathing 100% O2 at your safety stop as well. The hyperbaric physician may have more to offer you. May I ask where you're being seen?

Best regards,
DDM

 

[aquacat8]

If you were really cold maybe a heated vest turned off at the early part of the dive then turned on to warm your core at your stop, and also maybe mild exercise at your safety stop like gentle swimming or a little safety stop shimmy might help?

 

[aquacat8]

Is your wetsuit really tight in ahem the affected area? That might not be good for circulation.