Name: Doc Vikingo
Bio: Doc Vikingo has been scuba-certified for more than 35 years and has dived all over the world. He is a practicing doctor in the Washington D.C. area and has held positions at several major hospitals. With an interest in diving medicine, Doc serves as administrator for Scuba Clinic Online and was formerly the Medical moderator at ScubaBoard.com. Doc is a past columnist for Rodale's Scuba Diving and now writes for Undercurrent, Alert Diver and other dive publications.
Posts by DocV
Dive Accident Symptoms Delayed 6 Months?
July 14th, 2011
We flew home to New Zealand 2 days later. I had a panic attack (had only ever had one before in my life) where I felt like I couldn’t breath about 3 weeks later but that was the only “odd” thing that happened. I’ve since flown to the States and back and when I returned from the States (it was almost 5 months post dive) was when I started noticing severe shortness of breath. (tests at the doc confirmed that I am only using 56% of my lung capacity and that my lungs are “restricted”).
I never mentioned my diving because it never crossed my mind… especially since it was several months before the symptoms came on. I’ve had a lung x-ray and it showed no abnormalities. They haven’t found a cause yet and the shortness of breath and chest tightness seems to be getting worse.
Is there ANY chance it could be dive related??”
(A) 06.14.11
“Hi m….,
Given report that there was nothing abnormal in the dives, e.g., uncontrolled ascent, breath holding on ascent, chest discomfort, coughing up blood in the sputum; the first signs or symptoms of any medical problem weren’t until about 3 weeks after the last dive (”panic attack,” not further described); no pulmonary complaints (shortness of breath (SOB)) until about 5 months after the last dive; and a chest x-ray and physical exam that were within normal limits, it appears very unlikely that diving proper is the cause of the current complaints. Lung injuries related to SCUBA typically show signs and symptoms very rapidly.
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
Hastening Drainage of Middle Ear Fluid
April 10th, 2011
(Q) “Hi Doc,
I am absolutely new at diving. Went through the course and then last week-end went to Florida for my 4 check out dives. I didn’t have a cold, but my partner thought it was a good idea to take Sudafed just to make sure. I had a hard time equalizing, had to keep ascending slightly. After the first dive my ears were clogged, went down again, slightly easier to equalize, both dives weren’t more than 10 meters each.
By the next morning my ears were fine, but I took two Sudafed anyway. Dived to 20 meters, my instructor had me do the emergency ascent from 3 meters while saying ahhh, as you need that for check out, and I didn’t want to do it the day before because of my ears. My ears squeaked like crazy on the ascent. But nothing else seemed out of line no pain. Went back down and then while trying to maintain neutral buoyancy at 5 meters, accidentally inflated my BCD rather than deflated, so I shot to the surface.
After the trip three days ago, my ears are still clogged, I saw my general doctor. She says there is blood in my middle ear. She is not a dive doc, and didn’t know about diving, but couldn’t recommend it….actually thought flying was a bad idea too.
We are going to Cozumel next week. Help! I really want to dive. Is there anything I can do to speed up healing? Is seeing an ENT dive doc recommended; would it help?
Is there any hope of diving in a week? Also I started a salt water nasal douche hoping that might drag some of the gunk out of my middle ear.
Thanks, L…”
(A) Hi L….,
That’s unhappy news since SCUBA is out until a diver can equalize the ears in an entirely normal manner.
As regards hastening resolution, sadly steps the diver can take on his or her own tend to be of rather limited effectiveness.
Nasal/sinus lavage is unlikely to be of much benefit. One can try an OTC decongestant such as Sudafed??12 Hour; a heating pad applied to the affected ear; sleeping laying on the side opposite the congested ear; and frequent, gentle clearing maneuvers periodically throughout the day. But don’t expect miracles and do monitor closely for signs of infection such as fever, ear pain and dizziness.
A visit to the ENT would seem the best bet, but it’ll have to quick if one is going to Coz to dive in a week. Treatment with prescription steroids and decongestants sometimes can hasten resolution of swelling and the absorption/drainage of accumulated fluid within in the middle ear space. Mostly, however, it’s a matter of tincture of time.
New diver’s often having difficulty with clearing and the following video may prove quite useful:
“The Diver’s Ear - Under Pressure”
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
Diving with Ear Tubes
February 24th, 2011
(Q) I am a pre-grad med student from South Africa. I have had otitis media (middle ear infection) and in May 2010 received bilateral grommets. The right one gave me recurrent infections and I had it removed but the left one is still in place. I am a scuba diver and spearfisherman and am going down to the coast the end of the month to do mandatory training with a private GP for 2 weeks. I am planning on doing a lot of spearfishing. I have been told that the water will only pass through the grommet at a depth of 30m below surface and seeing that we spearfish on apnea diving I am only able to dive to about 20m. My question is, can I dive up to 20m or not and if not what can I do to make this possible. I have consulted with our local ENT and he gave me the advice that technically speaking the water would only enter my middle ear at 30m. I just want to be certain of this.
(A) It is not unusual to have ventilation/ tympanostomy tubes placed following a history of repeated or intractable middle ear infection.
I am not familiar with the reasoning that water will not enter a patent tympanic grommet until a depth of ~30m or greater is reached, nor can I say that this makes any sense to me. However, I am not an ENT and must assume that yours wouldn’t say this without research, anecdotal or other sort of evidence to support it.
In any event, diving with an open grommet would place you at risk for infection in the middle ear from pathogen-containing seawater and for caloric vertigo from temperature changes in the water column.
The most conservative advice would be not to dive until the opening has healed.
Although I think it unwise, some individuals do continue to dive with tubes in place. They typically use one of the following devices:
- Doc’s Proplugs http://www.proplugs.com
In this regards, the following piece may prove informative. It is compliments of Undercurrent (http://www.undercurrent.org , Oct ‘09 issue):
“Stoppering the Problem: Do Ear Plugs Work Underwater?”
The question of divers using vented ear plugs to ease equalization and keep water out of their ears is often raised on divers’ online message boards. These soft polymer plugs form a tight seal and have a very small hole, or vent, running through them to allow for equalization of the ear. Many responders indicate that the plugs reduce the frequency of external ear canal infections and ease clearing of the ears.
Doc’s Proplugs (Doc’s Proplugs: The Doctor’s Choice for Ear Protection) is the primary purveyor of vented ear plugs. It claims that when fitted properly the plugs reduce “ear squeeze caused by inability to equalize between the outer and middle ear and help “prevent outer ear and inner ear infection, vertigo and thermal reaction. Its Web site includes a list of undated and unverifiable testimonials.
Only the most minimal medical research has been conducted on these ear plugs. A self-published, undated piece by the “Sardinian Institute of Underwater and Hyperbaric Medicine” evaluated two professional divers with histories of perforated eardrums “who in the summer made constantly 3 dives per day.” After observing one diver for 17 months and the other for three months, no problems with inflammation of the middle ear were noted.
Another study found that in patients involved in various watersports, the use of earplugs substantially reduced surfer’s ear/exostosis (benign bony growth in the external ear canal caused by exposure to cold, wet and windy conditions).
If a vented ear plug did lessen the flow of water into the external auditory canal, the expectation is that outer ear infections (swimmer’s ear) would be reduced. As regards the claim of prevention of “inner ear infection,” this isn’t credible and I much suspect the author is confused regarding the anatomy of the ear. Water does not enter the middle ear space from the outer ear unless the eardrum is ruptured. It doesn’t enter the inner ear unless both the eardrum and either the oval or round window are ruptured.
Decreased water flow also would be expected to reduce temperature-related abnormalities, such as caloric vertigo and surfer’s ear.
The claim of easing equalization is difficult to support, as there is no reasonable mechanism of which I am aware to explain how this might occur. Doc’s Proplugs’ Web site states, “Due to surface tension, the vented plug also reduces abrupt pressure changes from reaching the sensitive eardrum which contributes to easier equalization.” I find this assertion not compelling.
I was unable to find any published reports of harm to the ear from such plugs. Provided the vent in the plug remains unobstructed, these devices appear to pose little danger to the ear. However, if a vent should become clogged, especially upon descent, equalization could become impeded and the eardrum damaged.
As for using such plugs to protect a ruptured eardrum, remember that these devices still do admit a small amount of water. Plus, the diver runs the risk of losing the plug altogether, thus allowing water to freely enter the middle ear space and resulting in pain, disorienting vertigo and possible middle ear infection.
The bottom line? If you’re experiencing external ear infections or worried about surfer’s ear, vented plugs may be worth the small investment. However, divers with a history of middle-ear congestion or infection are unlikely to benefit from these plugs, and they should refrain from diving until seen by an ear, nose and throat specialist. For those with continuing difficulty in equalizing, experiment with various clearing techniques before trying vented ear plugs. — Doc Vikingo”
- ProEar200 -> http://www.proear2000.com/
I am acquainted with the man who developed this device and he gave me one some years ago (I’ve since given it to another diver). They’re kind of silly looking and take a while to master, but used properly typically are effective in keeping water out of the outer ear.
I know one diver (a diving medicine doctor!) with ruptured tympanic membranes who uses both simultaneously.
Best of luck.
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
Can I Dive with Sleep Apnea?
January 11th, 2011
I have had sleep apnea for over 10 years and have no problems. I use a CPAP (continuous positive airway pressure) machine every night. Is there any problem with me starting diving?
(A) Hi L…
You don’t mention whether you have obstructive (OSA) or central sleep apnea (CSA), although the former is much more likely.
In either event, it essentially depends upon how well controlled the condition is and the presence of any worrisome signs and symptoms. Uncontrolled sleep apnea can increase the risk for high blood pressure and for heart attack, heart failure and irregular heartbeat. Also of concern to the diver, it can result in sleep deprivation and hypoxia that can impair attention, concentration, memory, and information processing and psychomotor speed.
Moreover, the diver with untreated, improperly treated or unresponsive sleep apnea probably has abnormal levels of CO2. These high levels of CO2 can be further elevated by diving at depth and increase the risk of nitrogen narcosis and of CO2 and O2 toxicity.
BTW, the nasty snoring that may accompany this disorder also can result in one’s significant other severely beating the affected person about the face and body during sleep.
This item that appeared in an Australian daily newspaper may prove informative:
“Coroner raps doctor over diver’s death April 24, 2009
A doctor should have more thoroughly investigated a man’s sleeping disorder before clearing him as medically fit to dive, an inquest has found.
Queensland coroner Michael Barnes found Dr Greg Emerson could have further queried Dr Stephen Broe’s sleep apnoea before certifying him as fit to undertake specialty deep dives in early 2005.
Dr Broe, 45, died on April 28, 2005, shortly after completing a dive to a depth of 50 metres off the coast of Moreton Island near Brisbane.
The inquest, held in Brisbane in March, was told Dr Broe had just completed the final dive in a technical deep-diving course when he immediately complained of burning pain in his chest and severe shortness of breath.
Despite assistance from people on the boat, Dr Broe lapsed into unconsciousness and died a few minutes later.
Mr Barnes on Friday found Dr Broe’s cause of death was decompression sickness, also known as The Bends.
In his findings, Mr Barnes said the effect of Dr Broe’s sleep apnoea on his ability to perform deep dives should have been further investigated.
However, he made no recommendations Dr Emerson be referred to the Medical Board, saying there was “no evidence the doctor was lax or cavalier” in his assessment of Dr Broe.
In his findings, Mr Barnes said diving doctors rarely come across sufferers of sleep apnoea.
Mr Barnes recommended a review of dive medical guidelines in light of evidence given during the inquest.
He also suggested the dive industry review how deep divers exit the water, saying the current standard practice for them to climb onto the back of the boat may place them under unnecessary exertion. AAP”
It should be noted that the article doesn’t mention what, if any, treatment the diver was undergoing for his sleep apnea. The individual who is being properly treated (e.g., CPAP) and responding well, has no worrisome nasal or other upper airway problems, and has none of the other conditions that can be related to obstructive sleep apnea and could raise the risk of SCUBA (e.g., depression, obesity, poor physical conditioning/abnormal exercise tolerance, pulmonary hypertension and other cardiac problems, sleepiness/lack of full alertness) should be able to dive safely.
I know of at least one diving medicine doctor who recommends a max depth of 60′ because of the gas pressure changes that occur at depth, but IMHO this may overly conservative in the diver who is in a state of good general health and fitness and entirely without signs or symptoms of sleep apnea beyond the defining feature of prolonged periods of significantly slowed or absent breathing while asleep.
Regards,
DocVikingo
Diver Allergic to Neoprene?
October 24th, 2010
(Q) Dear DocV,
I got OW certified only a few months ago. When I did, the water was warm enough to wear a swimsuit and a rash guard.
This past weekend I took a buoyancy class and spent a couple hours of each day in a pool wearing a wetsuit. The wetsuit is new and is mine. It was the first time I used it.
After each day of diving I immediately showered at the pool. However, on Sunday evening and more intensely on Monday I noticed an itchy sensation across my arms, legs and chest. Pretty much anywhere the suit was in contact.
It is now 5 days post diving and the generalized itching sensation is gone. When the “rash” occurred I had some raised bumps but no other symptoms.
Over the years and with many injuries (I like challenging sports), I have found that I have sensitivity to medical tapes and other things like that. I develop a rash localized to the area that was taped.
So, the questions are… Is it possible to have an allergic reaction to the neoprene? And if yes, what actions can I take to prevent the reaction?
Thanks for your help! I really do not want to give up diving because of something like this…
(A) Hi TF,
Allergic reactions to neoprene proper are relatively unusual; hypersensitivity to curing/accelerator agents used in neoprene processing and adhesives used in suit assembly is more common.
You’ll want to make sure that your reaction is not simply to some other agent, like chlorine. I find this unlikely, but provide it just as an example of irritating substances to which you might have come into contact. However, your report of a history hypersensitivity to medical/athletic tapes, and the described distribution of this rash, really does rather suggest that the problem is related to contact with natural or synthetic rubber-like compounds.
As your wetsuit is new, you may wish to hand wash it with baby shampoo or a delicate laundry detergent and then allow it to air well until the next wearing. Also be sure to rinse yourself well after each dive and shower with a gentle soap after the last dive of the day.
If the rash occurs again, you can try wearing a rash guard, although there is no guarantee this will work.
If you continue to have this problem, testing for neoprene allergy is probably next. This requires a specific patch test, so be sure to tell the allergist/dermatologist about your contact with neoprene and concerns when making the appointment. Since an allergy patch test for neoprene proper and its chemical accelerators typically is not included in the routine testing procedure, the doctor may have to arrange for a more thorough battery and this may require a small piece of your suit.
If it turns out you are allergic, you can look into a wetsuit made without neoprene such as a Thermocline Neoprene Free wetsuit by Fourth Element.
As for treatment, antihistamines, both oral and topical, often are useful in easing the discomfort of a number of contact skin rashes, but you really do need to find an alternative if this rash is going appear every time you put on neoprene. This is not to mention that such hypersensitivity reactions can become more severe with repeated exposures to the offending agent.
Best of luck.
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
