undeserved DCI & PFOs

[SarahB]

Hi,
I've just read a number of threads on PFOs and undeserved DCI and rather than try and add my bit to them I thought it would be easier to post a new thread.

I have been diving for 10 years with more than 500dives behind me (am a FCD/AI). I've a history of undeserved skin bends (shoulders and upper arms for me), having had at least 13 skin bends to date, from what would be considered simple dives (shallowest bend was a recent 28m wall dive on 24%, no-deco with lots of deep safety stops). I had been tested for a PFO in my local hospital (Dublin, Ireland) 5 years ago but was given the all clear. I continued to dive and continued to get 'hit' despite modifying my diving practice (nitrox, no deco dives on air tables, deep safety stops on high nitrox mixes etc..). Last week I went to see to Dr P Wilmshurst to see if he could throw some light on the subject. Surprise, surprise he found a large PFO (how it was missed previously I do not know).

From my conversation with him my understanding is that 27% of the general population have a PFO (approx 3-6mm in diameter) however, divers presenting with undeserved DCI are often found to have much larger PFOs (approx 8-12mm in diameter). So while 27% of the diving population have a PFO, it is only a much small percentage that have a large one (which is obviously high risk for DCI).

Having seen some of the threads posted to date I feel very lucky that I managed to come this far without suffering anything more debilitating than a skin rash and occasionally bad headache. Am also relieved to finally know the cause of my undeserved skin bends.

I should also mention that I've even had a skin bend diving off DCIEM tables (which Dr W was surprised to hear).

I hope this information is helpful

Sarah.

[Adrian Kelland]

Hi Sarah, and welcome to the forum.

What's the odds your original test was the wrong one? Especially as your PFO is no big and I assume more likely to allow bubbles across.

And yes, I think you have been very lucky that none of those skins bends has developed into anything more serious. Or lucky 13 perhaps.

Adrian

[Wills]

Hope all goes well for you, Dr W was surprised to find out I was getting skin bends from much shallower dives too - I think I had a 8mm hole - If you go for the fix-up be prepared to feel a complete fraud - you'll be in Hospital with people who are quite Ill!!!

[SarahB]

What's the odds your original test was the wrong one?

The original test was exact same as the recent test - both were agitated saline, transthoracic echcardiographs.

[Andy Wade]

The original test was exact same as the recent test - both were agitated saline, transthoracic echcardiographs.

Go on then, I have to ask.
Given that you've had all these 'minor' skin bends (which could have been symptomatic of something far worse), did you ever consider that diving was not for you?
I'm well aware of the attraction of the sport and the desire, nay need, to go diving, but I wondered at what point you would draw the line. 13 does seem an awful lot to me.

[Josepherely]

Had a similar problem of a medical exam for a PFO negative, followed by DCI, followed by ...... surprise surprise a big PFO:mad: , diagnosed by professionals (military diving docs). Unfortunatly not all medical professionals are the same, just as in all other walks of life there are better ones and worse ones.

There is evidence to suggest that PFOs can change over time, however I would be surprised given your history if yours wasn't present (like I suspect mine was) at the time of the first diagnosis scan.

Joe

[SarahB]

Go on then, I have to ask.
Given that you've had all these 'minor' skin bends (which could have been symptomatic of something far worse), did you ever consider that diving was not for you?
I'm well aware of the attraction of the sport and the desire, nay need, to go diving, but I wondered at what point you would draw the line. 13 does seem an awful lot to me.

After my first skin bend (and probably the worst of the lot) I was told by the doctor in the A&E dept of my local hospital (where I was sent after calling the coastguard) that my symptoms were not that of DCI. I was a young SD and believed him (he was the professional after all). I also have sensitve skin and get rashes, itches and inflammation all the time, so it was easy not to get too worried. Several more rashes came and went until a BSAC medical referee spotted one and suggested it could be DCI and sent me for a PFO test (which was negative).

After that I started to ask alot of questions of the medical profession and was given a lot of conflicting answers. I was told by a leading doctor in DAN Europe that my symptoms were attributable to that of cold water diving (i.e. vasoconstriction of peripeheral blood vessels after immersion in cold water and thus difficulty in skin tissue off-gassing), thus I did not feel my condition was 'symptomatic of something far worse'. I had never suffered any skin bends diving in warm water (despite doing some very provocative dives) so again this was an easy theory for me to believe and accept.

Despite this I wasn't entirely happy as I had never met anyone else with similar problem. It wasn't until 2 years ago when I actually spoke to someone with a similar history to me that I revisited the PFO theory (she had just had a spinal bend after a long history of skin bends and was subsequently found to have a PFO).

I arranged to get another PFO test and seriously modified my diving practice in the interim (during which i haven't had any skin bends).

I had the test last week.
Line drawn.

For those of you who have never experienced 'undeserved skin DCI' it is difficult to articulate the frame of mind that you enter into. You are aware that something is not quite right, you ask loads of questions, you are told lots of different things, you don't want to make a fuss over something as insignificant as an occasional itch, you try desperately to find plausible answers to explain the cause of this little itch (is there something in my diet that i'm allergic too, is my suit not fitting properly, did i get enough sleep last night, should I have had that glass of wine with my dinner, have I been drinking enough water, am I really stressed in work, was I overly anxious on that dive...and the list goes on and on). You try and eliminate each possible explanation one by one to see if it solves the problem and this takes years.

Had a PFO been diagnosed first time or had I experienced a more serious cerebral/neurological bend then I'm sure the line would have been drawn much earlier.

[Andy Wade]

After my first skin bend (and probably the worst of the lot) I was told by the doctor in the A&E dept of my local hospital (where I was sent after calling the coastguard) that my symptoms were not that of DCI. I was a young SD and believed him (he was the professional after all). I also have sensitve skin and get rashes, itches and inflammation all the time, so it was easy not to get too worried. Several more rashes came and went until a BSAC medical referee spotted one and suggested it could be DCI and sent me for a PFO test (which was negative).

After that I started to ask alot of questions of the medical profession and was given a lot of conflicting answers. I was told by a leading doctor in DAN Europe that my symptoms were attributable to that of cold water diving (i.e. vasoconstriction of peripeheral blood vessels after immersion in cold water and thus difficulty in skin tissue off-gassing), thus I did not feel my condition was 'symptomatic of something far worse'. I had never suffered any skin bends diving in warm water (despite doing some very provocative dives) so again this was an easy theory for me to believe and accept.

Despite this I wasn't entirely happy as I had never met anyone else with similar problem. It wasn't until 2 years ago when I actually spoke to someone with a similar history to me that I revisited the PFO theory (she had just had a spinal bend after a long history of skin bends and was subsequently found to have a PFO).

I arranged to get another PFO test and seriously modified my diving practice in the interim (during which i haven't had any skin bends).

I had the test last week.
Line drawn.

For those of you who have never experienced 'undeserved skin DCI' it is difficult to articulate the frame of mind that you enter into. You are aware that something is not quite right, you ask loads of questions, you are told lots of different things, you don't want to make a fuss over something as insignificant as an occasional itch, you try desperately to find plausible answers to explain the cause of this little itch (is there something in my diet that i'm allergic too, is my suit not fitting properly, did i get enough sleep last night, should I have had that glass of wine with my dinner, have I been drinking enough water, am I really stressed in work, was I overly anxious on that dive...and the list goes on and on). You try and eliminate each possible explanation one by one to see if it solves the problem and this takes years.

Had a PFO been diagnosed first time or had I experienced a more serious cerebral/neurological bend then I'm sure the line would have been drawn much earlier.

Thanks for that Sarah, it's very interesting how your awareness of it has developed over the years. It takes guts to share it too. Considering what you've been diagnosed with you must feel quite lucky to have got off so lightly. If skin bends are 'getting off lightly' that is...

I had a skin bend once.
Well ...at least that's what I think it was.
In about 1982 or 1983 I did a dive in Hodge Close quarry in the Lake District and afterwards we visited Wastwater to check out the next weeks potential dive site, we then came back home over Wrynose/Hardnott passes which are pretty high and shortly afterwards I felt a bit itchy and had a bit of redness on my forearms when I got home.
At the time I guess I was in denial about it, I did also have a really good kip in the car on the way home (Not that unusual after diving on air but at least I wasn't driving :D). This may also have been an unusual tiredness symptom of DCI but we'll never know, although along with a skin rash and itching it's a fair bet. All the symptoms had disappeared by the time I'd had a shower and cleaned/put away all my kit.
I've done a lot of dives since then and not had anything since so I reckon I must have just been a bit close with the altitude thing.

Maybe we should start a 'sticky' thread where people post 'possible' symptoms of DCI after they've dived?
It might help to raise awareness of it, if people could read first hand accounts. And there's nothing like a load of first hand accounts to help people understand their own 'possible' symptoms.

Or maybe another forum dedicated to a 'DCI sufferers club'.
Kind of a: "My name is Andy Wade and I think I've had DCI. It was like this".
Think of the wealth of anecdotal evidence...