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Multiple cases of skin bends - what now?

Discussion in 'Ask Dr. Decompression' started by FindingMenno, Jun 22, 2019.

  1. divinh

    divinh ScubaBoard Supporter ScubaBoard Supporter

    # of Dives: 100 - 199
    Location: San Francisco
    I guess it's no coincidence that the liveaboard I went on in Komodo apologized for not having hot showers as advertised... (not that it mattered anyway, as the weather was so hot that cold showers were a welcome, even after diving)
    mac64 likes this.
  2. FindingMenno

    FindingMenno PADI Pro

    # of Dives: 1,000 - 2,499
    Location: Amsterdam, Netherlands

    first of all thanks for all the support and nice words. As anyone who has encountered something like this, is does kind of throw your world upside down. Your faith in your own body disappears and suddenly every dive feels like playing russian roulette (albeit with better odds!). You feel you might be losing one of the things in life you love, and in my case also might end a career you have been working to create.

    So thanks for all your comments, truly appreciated. In response to the various issues raised.

    For the first bend (Apr 2017) I was only Tec40 certified, so up to 50% O2. Since that dive I have done around 10 or so OC dives, several with multiple deco gasses including O2. The majority are 'lighter' deco dives using 50%.

    The Apr 2017 dive was my one and only dive in a 3 day period leading up to the dive.
    The November 2018 dive was my one and only dive in a 21 day period leading up to the dive. No dives were conducted between this dive and the occurrence of the DCS symptoms 77 hours later.
    Looking at my dive and run logs: The dive finished 13 Nov 3.20 PM. My run finished 16 Nov 6.20 PM. I estimate between getting home, showering etc I noticed the marbling around 2 hours later.

    Dropping weight is certainly something that I must do. Being in a more dry role on the island, and with a lot of greasy food, I estimate the last 2 years alone I have gained 15 pounds. When I was in the water more, I was a lot lighter. I have also lost around 35 pound a few years back with a diet when I was around the same weight range as I was now, so that should be possible. It was actually quite easy but does require a certain positive mindset to do that, which to be honest I'm struggling to find at the moment.

    I'm reading up on the latest on (deep) stop theory GF, and am most likely going to switch to 50/70 or 60/70.

    That is something I considered, but it would surprise me if that came that long after wearing it.

    Agree. I am fully taking responsibility for that first bend, it was 'earned'. Just to be clear, the boozy lunch was the day before, and I estimate I took my last drink about 24 hours before the dive. Although I've seen other get away with it, for me certainly it doesn't work. So I'm trying to rest and no alcohol in advance of any diving.

    The hot shower I sort of knew about, but it never seemed an issue in all my diving, so you become complacent there. For now only lukewarm showers at best after diving.

    You are correct, I'm a full-time dive professional and currently in a sales/marketing management position at a dive shop in the Caribbean.

    In any career, you want to advance, develop and challenge yourself. A goal to strive for. That is not different in a diving career, at least for me. My goal is not to teach DSD/OW's and hang in the bar every evening on a tropical island for the next 20 years, no offence intended.
    Of the many career paths that I saw once I started in the business, tech was the one that grabbed me the most. Being an engineer and self-confessed geek, the equipment, planning, skills, it all appeals to me. More than becoming for example a Course Director, UW photo/videographer, fish nerd.
    If that career path would become unachievable due to medical reasons, right now I would be struggling to define a new goal to pursue.

    With regards to your question, with the first bend I had some irritation in the tissue in the groin area. On the second incident I can't recall any physical sensations (itch, pain).

    Thanks. As mentioned earlier, the first one was certainly 'earned'.

    And thanks for the insights in the second DCS incident. I noted I forgot to mention one detail (that I did share with DAN and doctors at the time). The morning after the dive I has what I would call a bit of a very light reddish glow on that side of my body. I usually sleep on that side on my body, and it disappeared quickly after getting out of bed, including taking a warm morning shower. There was no itching or anything, or any other sensations/pain in my body. It was certainly not a well defined discolouration as I saw on my first skin bend, and seeing that the dive was an easy recreational dive, at the time I discarded it as just have slept at a strange angle, or crease in the sheets. The thought of DCS didn't occur at all at the time.
    After the marbling occurred later this might have been an earlier sign of DCS. Your hypotheses of subclinical DCS with inflammation might fit this history.
    But even then, if DCS had occurred, I'm at a loss how this dive profile, on a CCR, so high % O2 gasses breathed in the shallows, well within NDL, could lead to a case of DCS.

    I do live on Grand Cayman and have visited Dr. Osterloh, who is highly regarded by the dive staff on island. Her take on it was that skin bends could be (not 'are') a precursor of a future spinal hit. She recommended to dive conservatively, and only when well rested and feeling fit.

    Since the last DCS incident I have done around 50 recreational dives with no issues.
    chillyinCanada and uncfnp like this.
  3. Jcp2

    Jcp2 Literally virtually diving ScubaBoard Supporter

    In the photograph of the second incident, away from the purple mottling and above it, I think I can see a subtle lacy pink pattern to the skin. Is this the reddish glow that you are referring to? If so, then maybe the DCS was already there and the mottling just an exacerbation?
  4. FindingMenno

    FindingMenno PADI Pro

    # of Dives: 1,000 - 2,499
    Location: Amsterdam, Netherlands
    As I recall, it was a lot 'softer' and evenly spread out. I couldn't discern any clear demarkation where the 'glow' started on my body.
  5. Tippytoes12

    Tippytoes12 Manta Ray

    # of Dives: 500 - 999
    Location: UK
    Definitely loose weight , your BMI is over 31 and all of this extra weight is so harmful for you. At 45 you will find it harder and harder to loose weight as you get older. Quitting alcohol altogether while you are trying to drop weight will help a lot.
    chillyinCanada likes this.
  6. chillyinCanada

    chillyinCanada ScubaBoard Supporter Staff Member ScubaBoard Supporter

    High protein, low carbs, fats but not the fried kind. I mean a little oil dressing on your salad. :p

    Lord knows it's not easy and I've still got a ways to go.
    RayfromTX and Blueringocto_73 like this.
  7. michael-fisch

    michael-fisch ScubaBoard Supporter ScubaBoard Supporter

    # of Dives: 2,500 - 4,999
    Location: Finally Lake City FL
    The cheap Jail method works great at losing weight:
    4 oz of bread or water - but never both on the same day.

  8. drk5036

    drk5036 ScubaBoard Supporter ScubaBoard Supporter

    # of Dives: 100 - 199
    Location: Sapporo, Japan
    His BMI is 28. Maybe he’s a bit overweight, if he has no muscle. If he is decently athletic he’s normal. OP, do you lift at all? Can you bench your weight, or deadlift 2x your weight? These things all play a role.

    Last time I went to the doctor, he looked at my file and told me I need to lost 35 kg. I could stand to lose 5, but 35 is absurd. I can bench 10 kilo over my weight and deadlift 190 kg. BMI doesn’t care about that tho.
  9. FindingMenno

    FindingMenno PADI Pro

    # of Dives: 1,000 - 2,499
    Location: Amsterdam, Netherlands
    Hi, I certainly consider myself overweight. I'm not a massive athletic figure so a part of that is fat.

    I do some mild exercises (push-up, squat, sit-up etc), as well as 5K runs regularly. I'd say on average 2 times a week. I not a gym fan so wouldn't know about what would be able to bench or deadlift.

    I weighed myself again this morning, it was 220 lbs. I'd say I should be able to drop that by 35 lbs and still be in form.
  10. divinh

    divinh ScubaBoard Supporter ScubaBoard Supporter

    # of Dives: 100 - 199
    Location: San Francisco
    BMI penalizes people who have a lot of muscle mass. Athletes do poorly on BMI.

    Athletes and muscular sport stars demonstrate the shortcomings of BMI

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