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I am reporting on an interesting occurrence related to diving.
On the first day of diving on a recent trip (approximately 24 hours
after having deplaned) a female diver (experienced, dives year
around, age ca. 40) completed 3 dives in warm water (26-27 deg
C).
Computer: Legend (Buhlman)
Conditions: close to ideal flat calm, good viz current, but
dive was a 'drift dive'.
Dive 1 90ft 22 min slow ascent followed by 3 min stop @
15ft.
SIT - 36 min
Dive 2 60ft 30 min 3 min stop.
SIT - 35 min
Dive 3 60ft 30 min, ..3 min stop
Following the dives, within 2 hours, diver was noticed to not be
'self'. Inquiry produced two signs:
1. An ocular disorder mimicking those experienced in past
independent of diving.
2. Tenderness in breast to the extent that they were
uncomfortable/sore. Diver was on the last day of her menses.
(at that point, no visible signs noticed. Showered & donned
supportive bra. Complete relief in approx 2-3 hrs)
The next morning diver did two more dives of 60 ft of 40 min
each with SIT =
The same pattern of dives were completed in the afternoon.
Details of all for dives of that day follow. .
60 ft for 30 min..3 min stop
SIT - 38 min
56 for 32 , 3 min stop
SIT 2hr 35 min
59 for 30 , 3 min stop
SIT 37
61 for 25 - minimal stop
After 2nd dive, breasts were very painful
After last dive, noticed that Breasts were swollen with patchy
redness and visible veins.
Diver recalls no relief of pain during last 2 dives (while under
pressure).
Ocular disorders did recur, lasted 30 min.
When S&S were present early the third morning the question of DCI
with lymphatic involvement was raised and DAN contacted. DAN
counseled diver to seek hyperbaric medical consult, though they
had not heard of such an occurrence.
Patient was treated at a hyperbaric facility on USN Table 6 with
no relief. Patient was discharged with a potential for contact
dermatitis being the cause of the problem. Although an
additional chamber ride was mentioned directly after the first,
it was not addressed during subsequent conversation with
physician. In addition, no further medical consult with a
dermatologist or other specialist was suggested. Patient was
advised to take anti-inflammatory medication.
Patient took ibuprofen and aspirin as advised
Patient did not dive for balance of trip and flew back
(commercial airliner) approximately 100 h following the first
dive of the trip.
The S&S subsided over the next several days with final relief 6-7
days after first dive
Further consults initially were not firm, but physician handling
case upon arrival at city of residence (was not a hyperbarisist)
sought a telephone consult with a hyperbaric fellow (originally
said he was sure it was contact dermatitis). Based on the
opinion of the latter, who had never seen or examined the
patient, the final diagnosis at the follow-up facility was:
Type II DCS with skin & lymphatic involvement.
Thus, though two physicians had originally decided that this was
not DCS, the final diagnosis was exactly that!
An exact science it is not!
Esat Atikkan
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