Cutaneous decompression sickness (DCS), or “skin bends,” most often manifests as skin mottling on the torso, upper arms and buttocks to various degrees. An associated marbled look to the skin is sometimes referred to as cutis marmorata. While cutaneous DCS is most likely related to gas occurring in body — after decompression or due to lung barotrauma or some medical procedures — there generally is no accepted explanation how the free gas is related to skin changes.
Possible explanations include the occurrence of gas bubbles in subcutaneous tissues, occlusion of subcutaneous arteries with circulating bubbles bypassing the lung filter (as with a patent foramen ovale), inflammatory reaction bubbles present locally or bubbles causing endothelial injury at remote locations.
In the July 2015 issue of Undercurrent, an article titled “A better heart-check tool than a stress test?” discusses the possible benefits of a coronary calcium scan for older divers to reduce the risk of experiencing a heart attack while diving.1 This article is a follow-up to a May 2015 Undercurrent report about an overweight 65-year-old diver who died shortly into his dive while on a dive trip.2 That article, which considered preventive options such as a stress test, also presented views from Dr. Alfred Bove and DAN’s Dr. Petar Denoble and Dr. James Chimiak, who agreed with the American College of Physicians (ACP) guidelines that recommend a graded and individualized approach to preventive testing and diagnostics.
Another physician suggests in the July 2015 article, however, that older divers should have a coronary calcium scan, which he claims may provide information that will help them avoid a heart attack on their dive trips. Many walk-in clinics offer the test at a low price. “A coronary calcium scan can tell you years before a positive stress test that you are headed in that direction [of significant coronary disease] so that you can do some kind of intervention,” he said. While the statement has merit, it may be misleading in this context.
Are some divers prone — or resistant — to gas bubbles after diving?
Decompression sickness (DCS), which may occur in divers after decompression from a dive, is dependent on the combined dose of gas saturation during the dive and the rate and magnitude of decompression. However, there is a great variability of outcomes in subjects exposed to the same dive profiles. The variability decreases as the severity of exposure increases.
DCS is correlated with the degree of venous gas emboli (VGE), or “bubbles”, in circulation after a dive. Generally, the higher the VGE grade (more bubbles) the greater the probability of DCS, and vice versa. Similar to DCS, there is a great variance in the probability of VGE appearing postdive. Some researchers who practice VGE detection have hinted that some divers bubble after most dives and may exhibit a high bubble grade (HBG) and others tend not to bubble at all or rarely exhibit HBG. The former are often labeled as bubblers (or high bubblers), while the latter are labeled as nonbubblers (or low bubblers).
Phosphodiesterase type 5 (PDE5) inhibitors — such as Viagra, Cialis, Levitra, Vivanza, Mvix and Lodenafil — are a class of popular drugs prescribed to treat erectile dysfunction and are often sold on the black market as sexual-function enhancers. It is reasonable to assume that many divers use PDE5 inhibitors while on a diving vacation, although the drugs’ possible effects on decompression safety have not been studied previously. In a recent paper, Blatteau et al.1 presented the results of a study on rats treated with sildenafil (Viagra) and then exposed to a simulated dive.
Venous gas embolism (VGE), or bubbles, in divers postdive indicates that their decompression was too fast, their bodies became supersaturated and free gas emerged from solution in tissues. The occurrence of free gas is considered a necessary condition for decompression sickness (DCS), which can happen even without VGE. However, the presence of VGE increases the number and types of possible harms to the body and thus the probability of DCS.
A number of studies indicate variability in proneness to DCS among divers; however, the question of whether divers who have suffered DCS produce bubbles more readily in general has not been answered yet. To answer this question, researchers would need to identify “bubblers” and “nonbubblers” and observe the outcomes of their dives over some period of time, which would require a lot of resources and time. (more…)
Apple Inc. recently announced the release of ResearchKit, an open-source software framework that is expected to enhance medical research. Apple claims its product enables everyone to take part in research that will advance medical knowledge and that it is “taking research out of the lab and into the real world.”
Mobile health technology, including wearable sensors and mobile applications, has been available for some time. Companies have been developing mobile medical applications (MMAs) for so long that the U.S. Food and Drug Administration (FDA) has already established their classifications and safety-monitoring rules and the Federal Communications Commission (FCC) has established rules and the frequency band for use with wireless body sensors. While it appears that Apple actually was lagging behind, it is encouraging that it finally joined the trend.
In January 2015 engineers from the Creativity Lab at Samsung Electronics introduced a prototype of a smartphone application and device called the Early Detection Sensor & Algorithm Package (EDSAP) as a stroke-detection tool. After two years of development, they are close to delivering the product. EDSAP’s sensors, which are applied to the head via a headset, collect electrical waves caused by brain activity and wirelessly transfer the information to a smartphone application that analyzes the data and determines the threat of stroke. The developers hope the data can provide additional health information such as stress levels, anxiety and quality of sleep.
Each year the Sports and Fitness Industry Association (SFIA), formerly the Sporting Goods Manufacturers Association, releases a report based on a study about participation in 119 sports, recreation and fitness activities. One of the activities addressed in the study is scuba diving; those findings are published in “Scuba Diving Participation Report 2014.”
The 2014 study is based on 19,240 online interviews of a nationwide sample of both individuals (n=7,528) and households (n=11,712). Demographics of the survey participants included the following:
Biological organisms maintain their functional integrity in varying environmental conditions through the activity of the innate immune system and controlled inflammation. During scuba diving, divers are exposed to greater than usual environmental changes, which challenges the entire body. The circulatory system is specifically stressed with an elevated partial pressure of oxygen and by decompression-induced gas bubbles on ascent to the surface. When the stress caused by the pressure changes exceeds a certain threshold, a variety of symptoms may occur after return to the surface — this is usually called decompression sickness (DCS).
DCS has been associated with the presence of a free gas phase in blood and tissues but we know little about the biological pathways and processes involved. While involvement of immune and inflammation cells and processes has been indicated previously, measurable changes are rarely present in asymptomatic divers, making it difficult to study the transition of physiological adaptive stress response into maladaptive or pathological reactions leading to loss of organ functions. We have reported in this blog about recent microparticle studies that may potentially shed more light on this gray area.
A popular article over last few days is one about crystalline salt that can uptake and store oxygen in high concentration. It was published in Chemical Science by Jonas Sundberg and coauthors from University of Southern Denmark.1 The article describes a synthetized crystalline containing cobalt combined with an organic compound, which has some properties of biological carriers of oxygen like iron-based hemoglobin in mammals or similar copper-based carriers in other animals.
The most significant property of this crystalline is that it binds oxygen reversibly – it can uptake oxygen and release it – and that this process may be controlled. Professor Christine McKenzie, the leader of the team that synthetized the crystalline, told the Science Daily2 that among other applications: “When the material is saturated with oxygen, it can be compared to an oxygen tank containing pure oxygen under pressure – the difference is that this material can hold three times as much oxygen. This could be valuable for lung patients who today must carry heavy oxygen tanks with them. But also divers may one day be able to leave the oxygen tanks at home and instead get oxygen from this material as it “filters” and concentrates oxygen from surrounding air or water. A few grains contain enough oxygen for one breath, and as the material can absorb oxygen from the water around the diver and supply the diver with it, the diver will not need to bring more than these few grains.” (more…)