Just got cutaneous DCS for the third time...WTF?
- Thread starter TPenn1
- Start date
Please register or login
Welcome to ScubaBoard, the world's largest scuba diving community. Registration is not required to read the forums, but we encourage you to join. Joining has its benefits and enables you to participate in the discussions.
Benefits of registering include
- Ability to post and comment on topics and discussions.
- A Free photo gallery to share your dive photos with the world.
- You can make this box go away
Todd,
To add to the previous replies: the absolute risk in the diving population with a PFO is relatively low - some 30% of the population has one, and presumably this means that 30% of divers have one, but the DCS rate in recreational divers is (thankfully) not 30%, it's closer to 0.01%-0.019%. However, you have demonstrated that your DCS risk is a couple of orders of magnitude higher. There could be a number of explanations for this. If you are diving conservatively, it may be related to your PFO, though there is no definitive proof.
When you describe cutaneous DCS I assume that you're talking about cutis marmorata (type II skin bends; blotchy and mottled) and not a type I rash (more hive-like). You've also described significant neurological DCS. Both cutis and severe neurological DCS are associated with PFO. Some people in your situation have found that closure of the PFO reduces the risk of DCS; however, the procedure itself is not without risk (as was pointed out very well previously). Dr. Doug Ebersole (debersole on Scubaboard) is the resident expert here. You might try sending him a private message.
What made you decide to do stop at 50 feet on the two dives you described?
Best regards,
DDM
To add to the previous replies: the absolute risk in the diving population with a PFO is relatively low - some 30% of the population has one, and presumably this means that 30% of divers have one, but the DCS rate in recreational divers is (thankfully) not 30%, it's closer to 0.01%-0.019%. However, you have demonstrated that your DCS risk is a couple of orders of magnitude higher. There could be a number of explanations for this. If you are diving conservatively, it may be related to your PFO, though there is no definitive proof.
When you describe cutaneous DCS I assume that you're talking about cutis marmorata (type II skin bends; blotchy and mottled) and not a type I rash (more hive-like). You've also described significant neurological DCS. Both cutis and severe neurological DCS are associated with PFO. Some people in your situation have found that closure of the PFO reduces the risk of DCS; however, the procedure itself is not without risk (as was pointed out very well previously). Dr. Doug Ebersole (debersole on Scubaboard) is the resident expert here. You might try sending him a private message.
What made you decide to do stop at 50 feet on the two dives you described?
Best regards,
DDM
I have one question. You mention that you made your safety-stop (decostop) at 15 feet. How did you come up from there? Straight up, or a 5 up?? (I e, 1 minute pr 3 feet)
The biggest difference in pressure happens the last few meters, and hence it makes sense to further slow your ascent to no more than 3ft/min for the last 15feet.
The biggest difference in pressure happens the last few meters, and hence it makes sense to further slow your ascent to no more than 3ft/min for the last 15feet.
TPenn:
When was your PFO diagnosed and how was it diagnosed. Did you get a formal echocardiogram.
It is definitely advisable to get yourself seen by a cardiologist and a repeat cardiac echo done.
As you rightly pointed out, many people have PFOs and dive with no problems.
-since this is your 3rd DCS, it raises several questions and thoughts:
1) Were those events truly DCS?
-have you ruled out other causes of abdominal pain, e.g. abdominal migraine, mesenteric artery atherosclerosis/stenosis and ischaemia
-also, if they were abdominal symptoms and you also mentioned some neurological symptoms, these are NOT cutaneous DCS. These will then be type II DCS and not type I and must then be taken very seriously.
2) Might you have additional conditions other than PFO
-e.g. pulmonary hypertension which will also then cause Right to Left shunting and send bubbles from the right side of the heart to the left side and hence out to the body causing DCS rather than to the lungs where they normally get filtered easily by the lungs with no problems.
3) Is continued (recreational, not a job that your living depends on) diving in the face of previous Type II DCS (if confirmed) worth it?
In summary, go seek a qualified medical review.
If you are interested, more explanation below:
========
Almost all diving will create venous bubbles which are then normally filtered by the lungs. Below a certain limit, the lungs filter them fine and they cause no problems. There are numerous studies looking at cardiac echocardiography demonstrating bubbles.
While it's great that you've tried to take steps to decrease your DCS risk by including a deep stop and prolonging your safety stop to 4 mins from the minimum recommendation of 3 mins, the fact is that when you ascend from depth, you will create some bubble shower.
In recreational no-deco diving, the principle is that the diver only dives up to a limit such that if they surface immediately, the amout of inert gas loaded still would not cause significant bubble formation.
Imla: What you have mentioned is very relevant for dysbarism related dive injuries like middle ear issues, pneumothorax (and related risk of arterial gas embolism) but not so for DCS since an NDL is what it is, a NO decompression limit.
- i.e. if you need to CESA within your NDL, you should not get DCS even if you went from 40m to surface in 30s.
Deep stops and safety stops aim to:
a) Decrease the chance of significant (there will still be some insignificant) bubble formation by adding on a shallower depth for some off-gassing before you hit the surface (hence, decreasing your nitrogen load even further before you hit the surface.
-if you are keen on technical aspects, there is some debate about this as there are also FAST and SLOW components.
-some argue that deep stops can potentially increase the risk as it help with off-gassing of FAST components but actually may continue loading SLOW components
>depending on your dive profile, the risk is that you actually end up more saturated on a SLOW component and get a DCS
b) Spread out this clinical insignificant bubble shower over a slightly longer period of time (i.e. enforced slow ascent =>3 mins longer at least) such that your lung capillaries have a longer time to deal with the bubbles
Cheers!
When was your PFO diagnosed and how was it diagnosed. Did you get a formal echocardiogram.
It is definitely advisable to get yourself seen by a cardiologist and a repeat cardiac echo done.
As you rightly pointed out, many people have PFOs and dive with no problems.
-since this is your 3rd DCS, it raises several questions and thoughts:
1) Were those events truly DCS?
-have you ruled out other causes of abdominal pain, e.g. abdominal migraine, mesenteric artery atherosclerosis/stenosis and ischaemia
-also, if they were abdominal symptoms and you also mentioned some neurological symptoms, these are NOT cutaneous DCS. These will then be type II DCS and not type I and must then be taken very seriously.
2) Might you have additional conditions other than PFO
-e.g. pulmonary hypertension which will also then cause Right to Left shunting and send bubbles from the right side of the heart to the left side and hence out to the body causing DCS rather than to the lungs where they normally get filtered easily by the lungs with no problems.
3) Is continued (recreational, not a job that your living depends on) diving in the face of previous Type II DCS (if confirmed) worth it?
In summary, go seek a qualified medical review.
If you are interested, more explanation below:
========
Almost all diving will create venous bubbles which are then normally filtered by the lungs. Below a certain limit, the lungs filter them fine and they cause no problems. There are numerous studies looking at cardiac echocardiography demonstrating bubbles.
While it's great that you've tried to take steps to decrease your DCS risk by including a deep stop and prolonging your safety stop to 4 mins from the minimum recommendation of 3 mins, the fact is that when you ascend from depth, you will create some bubble shower.
In recreational no-deco diving, the principle is that the diver only dives up to a limit such that if they surface immediately, the amout of inert gas loaded still would not cause significant bubble formation.
Imla: What you have mentioned is very relevant for dysbarism related dive injuries like middle ear issues, pneumothorax (and related risk of arterial gas embolism) but not so for DCS since an NDL is what it is, a NO decompression limit.
- i.e. if you need to CESA within your NDL, you should not get DCS even if you went from 40m to surface in 30s.
Deep stops and safety stops aim to:
a) Decrease the chance of significant (there will still be some insignificant) bubble formation by adding on a shallower depth for some off-gassing before you hit the surface (hence, decreasing your nitrogen load even further before you hit the surface.
-if you are keen on technical aspects, there is some debate about this as there are also FAST and SLOW components.
-some argue that deep stops can potentially increase the risk as it help with off-gassing of FAST components but actually may continue loading SLOW components
>depending on your dive profile, the risk is that you actually end up more saturated on a SLOW component and get a DCS
b) Spread out this clinical insignificant bubble shower over a slightly longer period of time (i.e. enforced slow ascent =>3 mins longer at least) such that your lung capillaries have a longer time to deal with the bubbles
Cheers!
Similar threads
