As a relatively experienced diver (100+ dives), I was greatly disturbed to find my DCI (decompression illness) knowledge shown up on my last scuba diving holiday, especially as the affected diver was actually my mum!
Now all divers should be aware of the common symptoms of DCI. They are, as listed in the PADI open water book (I use PADI as it’s one of the most common training agencies used):
- prolonged fatigue
- difficulty breathing
- varying degrees of joint or limb pain
The PADI rescue diver manual says much the same, though adds in cardiac arrest and nausea.
So we file them away and think ‘Okay, so if ever I come across a diver who has these symptoms, even potentially including myself then I’ll know what to do’.
The reality is somewhat different though. For starters this list isn’t exactly comprehensive, there are also other indications that hint at DCI (see the longer list at the bottom of the page) including for example headaches, red itching skin rashes and vomiting.
Also due to most people’s tendancy to think that “bad things don’t happen to me”, it can be very easy to attribute these symptoms to other causes rather than think “it’s possible there’s something else going on here”. Headaches can be put down to dehydration or skip-breathing, aches can be put down to a pulled muscle, and skin marks can be written off as compression marks or bruising.
In the field it seems that most people, including up-to-now myself and more worryingly some instructors and dive leaders, tend to be more conservative when considering the causes of certain symptoms, especially if they appear to be mild issues only.
But I’ll tell you why you shouldn’t do this. And this is IMPORTANT!
In May I went on a scuba diving holiday to Egypt with my mum. All my family are divers and my mum needed a buddy for her next trip so who was I to say no! Anyway, the trip was going great and for the first few days everything was fine. After about 3 days of diving though my mum found that she had developed bruising marks around her waist, the same as ones she had developed on a seperate holiday the year before.
Her opinion, due to the positioning of the marks, was that they were probably caused by her weight belt, and I was inclined to agree with her. It wasn’t a rash, it looked like bruising with a bit of redness and was around her waist where her weight belt would have been so what else could it be? Luckily she asked the dive centre manager about it who asked ‘Does it have a marbled effect?‘ and upon the answer ‘Yes‘ took my mum straight to the dive doctor on oxygen.
It turned out it was a type of skin bend – cutis marmorata, which shows itself in a kind of mottling or marbling of the skin (not mentioned by PADI at all). Now I didn’t even know that you could get a specific skin bend! An important lesson to learn! Bubbles come out of solution into the skin, causing the red/purple mottling effect, which leads to the area feeling sore and tender.
The weight belt probably did play it’s part by compressing what I shall politely refer to the excess adipose tissue around her waist, thus restricting the circulation making it harder for gaseous build up to be removed during ascent. Her age might also have played a part, but all our diving was performed well within our limits and as she’s relatively fit you wouldn’t expect her to have any undue problems.
Shunts (a minor heart defect present in a lot of adults) have been know to increase ones susceptibility to DCI, so if you have one, or have had any episodes of DCI before, it is very important to get yourself fully checked over by a trained diving medical professional as the causes of DCI can be very specific to each individual through both physiology and dive profiles.
There are a range of opinions within the diving medical community as to the seriousness of skin bends, in particular cutis marmorata, but whichever one is true it is important to remember that this is a bend and it could potentially lead onto full-blown type II DCI if not treated with enough respect. So it is very important that if you or someone you know suspects that they have a skin bend, or are worried about any sign or symptom that appeared after a dive then they should immediately seek medical treatment and advice!
It is also very important to remember that you don’t have to dive outside the decompression limits or dive recklessly to be susceptiable to bends. All our dives on this holiday were conservative dives well within the limits set on our computers, and my mum still got DCI. It may be that she is more susceptible to it, but this does illustrate a few very important lessons:
- Anyone can get DCI after any dive, regardless of their dive profiles.
- If you experience any unusual signs or symptoms after a dive then always seek assistance – treat it as DCI until proven otherwise. It really is better to be safe than sorry!
- If you are a diver or have a close friend who is a diver then read up as much information about DCI and other diving related conditions so that if you or someone you know has a problem, you will be much better placed to recognise it and seek the necessary help.
For more information, the London Diving Chamber has a number of good articles about DCI so go to their site and have a look around. Their articles on Types of DCI and Skin Bends are in particular very interesting.
London Hyperbaric Medicine have a much more comprehensive list of symptoms on their site, which also I include below for reference:
Anorexia, excessive fatigue, malaise, headache, vomiting,
joint pains, ear pain, chest pain,
itching skin, redness of the skin, marbling of the skin,
lowered level of conscious, decreased orientated in time and place, personality change,
dysphasia (difficulty speaking), hearing loss, vertigo, tinnitus, visual impairment,
weakness of limbs, paraesthesia (pins and needles), numbness, lack of co-ordination, poor balance,
incontinance, coughing ,shortness of breath, voice changes, haemoptysis (coughing up blood)
UPDATE: Well it turns out it is a hole in the heart, apparently one in 4 people have them and usually they aren’t anything to worry about. In fact they are only ever checked for after you’ve had a stroke or an issue like the bends so most people don’t need to worry. However if my mum wants to continue diving then she needs to get this sorted out, so now some decisions need to be made but hopefully we’ll get her back in the water soon!