Just got cutaneous DCS for the third time...WTF?

[TPenn1]

I just got back from a dive trip and I was hit with a minor case of cutaneous DCS (skin bends). This is actually my third time getting this and I have only 300 lifetime dives. The first time I got it, it wasn’t too bad and since I was in Mexico, I thought that I had some kind of stomach bug, because I only had pain in my abdomen. The second time I got it, I was also on vacation and just figured that it was something with the water or food that I was eating and I continued diving, which was a really bad idea. Since I kept diving, things got much worse for me and I had some neurological issues, like dizziness to the point I collapsed and intense abdominal pain, as well as numbness in the joints. I got put in the chamber that time and I got a full evaluation from a doctor that specializes in dive medicine. Turns out that I have a PFO in my heart, which is pretty common in people, I believe that 20% of the population has one, but for divers, it makes you not as efficient at processing nitrogen. I eventually got the okay to dive again and I definitely changed the way that I dive, I always dive nitrox, I do decompression stops on my ascent, and I usually cap it at 3 dives max per day. On this last trip that I took, I did 2 dives, the first one was deep to 110 feet, but only lasted 18 minutes. Once we went down the line, the viz was horrible and we realized that there was nothing to see on this dive, so we came right back up. I did a 1 minute stop at 50 feet and slowly ascended to 15 where I stopped for 4 minutes. I had about a 2 hour surface interval and on dive 2 I went to a maximum of 80 feet for about 30 minutes and was nowhere near my deco limit. I started my deco stop at 50 feet and slowly ascended to 15 feet (about 3 minutes from 50 to 15) and did a 5 minute safety stop. It was about an hour to an hour and a half after dive 2 that I started feeling symptoms in my abdomen and got on oxygen right away. I guess the reason that I am posting this is to get some insight or if anyone else has a propensity to get DCS and what you do to deal with it. The smart thing would probably be to not dive anymore, but that isn’t an option with me and I rarely do the smart thing, so why start now. Ironically enough I was speaking to someone earlier that day and she has a similar issue and dives with 50% oxygen and will do decompression and safety stop on the 50% starting at 70 feet. I’m open to suggestions on how to deal with this or insight, because I am frustrated and bummed out that this keeps happening. I love diving more than anything else and I won't give it up, but I am also worried that this keeps happening.


Thanks,


Todd

 

[scubadada]

Hi Todd,

Have you discussed this with DAN, I would? Have you considered having your PFO closed?

DAN information number: 919-684-2948

Best, Craig

 

[Serge Tao]

A couple of years ago, a student developed cutaneous DCS within 4 hours after her OW dives 1 and 2, so max 12m. She visited a recompression chamber and came back symptom-free, ready to continue her course. I explained her the possibility of a PFO, since that was the only likely explanation with that depth (DAN suggested this as well over the phone).

She went home, visited a cardiologist and the diagnosis was PFO. Closing it was simple, she wasn't even admitted for the procedure. After the procedure, she never had any symptoms again during/after a dive.

Todd, plan a visit to Cardiology. The measures you're taking to minimize the chance of DCS are of course helping, but you're still taking risks which can be minimized by a very simple procedure.

 

[KevinNM]

PFO closure is certainly possible, but I understand there are risks. So you should talk to the cardiologist and do some reading.

There are multiple people on this board who have had closure done.

 

[Pedro Burrito]

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[NYCNaiad]

I have a PFO which so far (knock on wood) has never affected my diving. There are different levels of PFO and I apparently have a small one.

It sounds like you are being conservative with your diving. I am as well. Speak to a cardiologist, but one that works with divers or have your cardiologist speak to a cardiologist that deals in dive medicine. DAN can recommend one. Also, DAN is doing a big PFO study which is interesting and you may want to get involved with: Diving Medical Research Projects — DAN | Divers Alert Network.

Hang in there!

 

[Alastor]

PFO closure is certainly possible, but I understand there are risks. So you should talk to the cardiologist and do some reading.

There are multiple people on this board who have had closure done.

Anyway, if you should have a PFO, diving is a risk. When you experience a DCS, even light one, is not longer a risk: is a certainty that could have gone worse, so, in your shoes, I would consider the closure a risk managemen option.

 

[WetRocks]

I'll echo what the others have said. If you know you have a PFO, and want to continue diving, you need to seriously consider having it closed. Closure doesn't mean you'll never get bent again, but it should bring your odds back in line with the expected incidence rate (which is something like 4 / 10,000 dives)

I had 3 unexpected cases of cutaneous DCS in a very short time frame (3 out of 9 dives) and chose to have the closure procedure to allow me to responsibly continue the diving I want to be doing.

 

[mattia_v]

Be aware that the evidence supporting a causal link is not very strong - most of it retrospective, and the aboslute risk increase is not very high (one of the more recent retrospective series: 1.8% vs. 0.3% risk; big relative risk, statistically significant, but clinical relevance is debatable). Correlation between severity and size of the PFO appears stronger, and logical.

There's a recent position statement by UK and South Pacific diving societies that recommends screening in cases of DCS, but is (rightly) very careful about recommending closure ('may be considered', which is hardly a ringing endorsement). The level of evidence here is weak. Intracardiac device implantation is not a procedure with zero risk (both perioperative and thromboembolic), with an absolute risk of complications that may well be higher than the risk of DCS; the only case series examining PFO closure for this specific indication I found in a quick PubMed search indicated it was safe, with no major complications, although I'm not sure I'd characterize 2 cases of atrial fibrillation in a mere 107 procedures is inconsequential (very small number considering the numbers of patients with DCS).

The difficulty here is the repetitive nature of the DCS; one episode, and I wouldn't jump to conclusions about a relationship with a purported PFO, but three (or even more in a short time, like the example mentioned above)? Definitely more worrying.

My background: MD, PhD, cardiology resident, solid background in biostatistics, no specific dive medicine expertise.

 

[clownfishsydney]

My wife got skin and breats bends two years ago. Turns out she had a PFO, quite a large one. Amaning that she had done 1700 dives without any problem till then. She had it fixed as there is no way we need to go through what she suffered again, especially since we sail to remote locations and dive.