The Cryptic Patch

An example of the general appearance of skin bends.

A skin bends mystery

After getting my dive certification in 1992, I was instantaneously addicted. Being young, obsessed, and convinced of my immortality, I was not the most conservative diver, but I had no issues with decompression sickness (DCS) for my first decade of diving. I battled breast cancer between 2003 and 2006; after my treatment (chemotherapy and four surgical procedures), I became far less of a daredevil. 

I was every bit as addicted to diving, however, and when I had my first experience with skin bends (cutaneous DCS) in 2008, I was diving multiple times per week in San Diego, California. My first hit — an itchy patch on my abdomen — happened on a liveaboard after my fourth dive of the day. My hit seemed more unlucky than unlikely; I was diving a conservative profile and had cleared my decompression obligations. But it wasn’t a fluke. 

I experienced skin bends — the same presentation in the same location on my abdomen and, curiously, always after diving in a drysuit — several more times during 2008, even following extremely conservative profiles. After multiple DAN calls and medical consultations, I was no closer to understanding why this was happening. 

The author on board a California dive boat after enjoying a dive.
The author on board a California dive boat after enjoying a dive.
The author diving on the HCMS Yukon in San Diego, California
The author diving on the HCMS Yukon in San Diego, California’s wreck alley, one of her favorite local advanced dives

Due to the timeline, presentation of my symptoms, and the types of diving I was pursuing, physicians suspected that my propensity to develop skin bends was associated with my cancer-related surgical history and associated scar tissue rather than a cardiac defect, such as a patent foramen ovale (PFO). The consensus was that an echocardiogram was unlikely to uncover a cardiac issue, so it wasn’t urgent to pursue testing. I felt reassured and was becoming adept at preventing skin bends through a blend of nitrox use, extremely conservative profiles, avoidance of drysuit squeeze, and extended safety stops, so I didn’t bother to get tested.  

Over the subsequent 15 years, I uncommonly experienced skin bends, probably because I spent more than my fair share of time performing long safety stops out of caution. Then a friend who had been diving with a large PFO for years suffered a devastating stroke (PFO is thought to be a risk factor for ischemic stroke). Shaken, I finally reached out to my friend Dr. Douglas Ebersole for advice. After a lengthy discussion and the extraction of a promise from Dr. Ebersole to act as my surgeon if needed, I was ready to move forward with testing. 

I contacted the hyperbaric department at the University of California San Diego, knowing what to expect because the procedure had been recently described in “The Possibility of a PFO” (Third Quarter 2023 Alert Diver). Three months later, I watched nervously as my ultrasound specialist performed a transthoracic ultrasound with a bubble study, trying earnestly to impress him with my Valsalva technique (intended to increase the test’s sensitivity for PFO detection). My results arrived days afterward: They were perfectly normal, with no evidence of intracardiac shunt.

I was flooded with a mixture of emotions. I felt relief, of course, knowing I didn’t need to consider surgical closure of a cardiac defect. But I also felt a little frustration, knowing that there was nothing I could just fix. If I wish to avoid that itchy patch of skin bends, I will always have to dive conservatively. 

Regardless, I’m grateful to have an answer to the question that has always been in the back of my mind. I suppose more obligatory time spent hovering in shallow water is not the worst penalty after all.

© Alert Diver — Q2 2024