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NEW! - The A-Z of Dive Medicine

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Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hi. I've recently started tech diving and have just done the TDI extended range course and am diving around 45m - 65m on air (I'm fully aware of the dangers of such air dives following a huge amount of research :o) I'll be doing the advanced tri-mix course in a few weeks and won't do the air dives after that.

However, I have noticed something rather strange when I go beyond 45m and breathe in (which I have to do from time to time): I hear a very loud beat in my head. If I clear my ears with a small blow, the sound disappears (this happens even if I'm level and not descending or ascending). Once I ascend, it stops. I've just done a couple of 30m dives and no beat in my head. It has only started since I've done deep dives. I've done over 300 dives above 40m and never heard it before.

The sound is like a propeller: thud, thud, thud. It sounds like it's my heart beat or pulse, but really loud, and it gets louder the deeper I go. Is this narcosis, O2 toxicity or as my buddy thinks, could my Eustachian tube be pressing on a vein due to the increased pressure? Do you have any other ideas as to what it could be?

A - From your description of the sound, it can only really be an awareness of your pulse. Quite why this should have arisen now and not on previous dives is anyone's guess, but with increasing depth your Eustachian tubes are likely to be compressed nearer to the blood vessels that are causing the sound, and so I can see some merit in your buddy's explanation. It tends to be louder with exertion (as your blood is being pumped around with more force), which would also tie in with deeper diving. If you have any middle ear congestion, then the sound will get louder too, as the congestion conducts sound much better than air.

The main thing to say is that a lot of people get this from time to time, non-divers as well as divers, and it is simply a heightened awareness of the big arteries pulsing away in the neck. It is, basically, nothing to worry about.

Q - I am an assistant instructor waiting to take my IDC/IE on 1st May. I suffered a bend on 17/02/06 whilst on holiday in Playa Car, Mexico. This was my first dive there. The sea conditions were rough and I appear to have struck my side when entering the dive boat causing injury to my rib and bruising to my lung.

According to the dive specialist in Mexico, I developed pneumonia and septicaemia whilst diving and this caused the bend to occur. I do not fully understand why? My dive profile appears good. About 1 hour after the dive I started shaking. I put this down to shock. I reported to the dive centre that I felt unwell and that my neck hurt. They did nothing. About 4 hours after this I passed out with high blood pressure, red skin to the side of my face, loss of co-ordination. The Doctor was called and took 1.5 hours to stabilise me before I could go into the ambulance for transportation to Cancun private hospital.

When I arrived my wife pressured the doctors for a dive specialist. He arrived 10 mins later and took me to the chamber. I was in decompression for 6 hours. The doctor then declared I was clear of DCI. I went back to the hospital. 4 hours later I started to shake and had difficulty breathing. This occurred again 12 hours later and the next day as well. I thought I was going to die.

I returned home on 2/3/06. On Friday 3/3/06 I had myself checked by my GP and Colchester hospital. Both said my lungs and base line functions were normal. I need to book a Clearance to dive medical and HSE for my instructor. I would like to do a dry dive where I can be monitored for any conditions as I am fearful this will happen again.

A - Hmmmm. Lots more questions from me here. Did you whack yourself before or after the dive? Were you given antibiotics-i.e. was it really a pneumonia? Did the recompression heal any of your symptoms? Fainting with high blood pressure- normally it’s low when you go down.

So you see, a few things don’t really add up here. Certainly neck pain, a rash and poor coordination are symptoms of DCI, and if they got better after treatment then that is diagnostic. But it seems you were all over the place afterwards as well, and as for developing pneumonia AND blood poisoning during a dive. Well unlucky that, or perhaps the doc was full of s***.

Either way, what you need to do is come in for a chat before the HSE medical, bring all your notes from Mexico, and we will try to unravel the truth. If all is OK, then you can roll into the HSE examination afterwards.

Q - I am currently doing a massage practitioner training course that I will complete in June. In May, we are spending a week on a live aboard in the Red Sea. I'd like to practice my massage on my friends but is there any contra-indications for massage after diving? For example, do I need to leave a certain amount of hours after diving before I massage people?

A - Easy Gents, settle down, and form an orderly queue.

What a sweet surprise that would be after the night dive each evening. No, there’s no real issues here. All is suggest is for you to avoid hot oils and towels for anyone immediately after a dive, just simple massage, nothing Thai, Swedish or Hot Rock.

And watch yourself too. Too much exercise post dive can affect off gassing from the right parts, so only do as much massage as does not make you sweaty and breathless.

Q - Extremely sorry to be here at your busy hour. One of my friends got the following problem, need a consultation with a confidential approach to proceed. He was in holiday in an island. Local mafia people counted him as a big time agent and put an electronic tag on his body to trace him every single day. Still now this group following him and breaking his privacy. What is the procedure to find the tag from his body and take it off, please? Thanking you.

A - This is for real, seriously. This guy has CC’ed every medical website in the UK, including the e-med diving questions one. What should I reply? Hmm, how about this…

“Electronic tagging is commonplace now on most islands. Since the release of Casino Royale foreign visitors and holiday makers must be assumed to be Big Time Agents. In the past it was usual to drip poison off a thread of cotton, or put a tarantula in the same bed as the agent. However islanders are more sophisticated now, and the insertion of a tag is deemed both cheaper and kinder to one who would use a local volcano to launch a nuclear missile strike on a nearby superpower.

My suggestion for removal is to get off with a stunning girl, avoid sharks and lasers, and somehow, unbelievably all will be OK in the end. Especially as you snog her in a dinghy as the President of the World is watching you from satellite, and trying to thank you.”

Any better replies welcome.

Q - Hi , I am only 14 years old and have been diving with PADI for about 3 years, I have nearly clocked up 50 dives and I have started diving more up to 4 times a week. I am not 15 yet so I am not old enough to do Nitrox but when I am I would like to know what would be better for me considering I could be diving at this rate for another 30 odd years and considering I am master scubadiver I could end up technical diving etc. What would be best gas for me to use?

A - In theory Nitrox is always a safer gas to use. Less nitrogen, less chance of micro or normal bubbles, and thus DCS. And if you are doing a lot of diving daily, you feel less knackered as well.

However, the thing is not to get to obsessive about what you breathe. An average of 4 a week is way under that of a full on air swigging 4 a day Sharm instructor. And they are all normal aren't they. Mmmm! So if you want, go for the Nitrox now, but don't not dive if it's not available. Anyway if you get into tecchie stuff and deep depths, you'll be on Trimix or Heliox anyway and only using oxygen enriched for long shallow deco stops.

Q - Recently I started SCUBA diving and soon afterwards I started having a salty taste in my mouth almost all the time particularly after eating or drinking. Even after fruit or tea. Do you think that the salty taste might be related to diving?

A - I have changed your name for obvious reasons!
The only way to tell is to go for a freshwater dive. If you still get a salty taste in your mouth then, as a doctor, I would be really confused.

Perhaps I should throw this one open to any other diver out there.

Why should you get a salty taste in your mouth after diving, even after you've eaten a fruit?

Answers to me by e-mail and the most medically correct response wins a night at a club with some of my single male friends or a tub of Saxa.

If you want to stop it though, try breathing through your regulator rather than sipping round the edges.

Q - Can you recommend a good provider of annual multi-trip travel insurance that will provide decent cover for scuba diving?

A - This is one of those questions where I will try not to mention any company by name for fear of forgetting other equally good ones.

In my experience most year round insurance from the main advertised providers will need a SCUBA top up premium. It is worth noting though, what depths they will cover you to. Most will do it to the limits of your training, i.e 18metres for OW and deeper if you have the AOW.

Again check that you are covered for recompression abroad in case you have a bend, but all companies do cover this in reality.

However what may be worth noting is that in the UK, some Health Authorities are now refusing to pay for any recompression treatment if the diver is deemed non-emergency. They are now asking the chambers to ask the diver to bill it against their insurance. This could cause problems, as some companies will not cover you once your feet touch the tarmac at the airport, as you are now deemed under NHS care for any problem caused whilst travelling.

A "non-emergency bend" though is an anachronism as they all are in my mind. But then again I don't write the cheques to the chambers for the costs of recompression.

I guess the lesson here is if you do have any tingle or joint pain, in fact anything abnormal after diving, don't just hope it will go away, call your local unit as soon as you can as you may be footing the bill yourself.

(other dive medical questions)



   


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