Dive long enough and you will surface with a headache at one time or another. According to DAN, headaches are one of the most common complaints of divers who contact the organization. To get to the bottom of the problem, it’s important to look at when post-dive headaches occur to try and find a common cause.

Generally, a one-off headache that goes away spontaneously after a dive, or after taking mild headache medication, is rarely a cause for concern. Repetitive headaches, or those not clearing easily, may require a closer look, however.

Ill-fitting equipment

Ill-fitting equipment can be one of the main culprits when it comes to post-dive headaches. New divers, in particular, often over-tighten their mask strap, hoping it will prevent water from entering the mask. Over the course of a dive, however, the strap can put tension on the face and around the skull, leading to a headache.

Another culprit might be a hood that’s too tight or the neck seal of a drysuit that doesn’t quite fit right. At the same time, a hood that’s too wide is a poor insulator against cold water and may lead to too much of the diver’s face being exposed. A so-called ‘ice cream headache’ is often the consequence.

It’s worth taking the time to try on various masks, hoods, and adjusting neck seals until they fit well. The more comfortable you feel underwater, the more likely you are to dive more, and vice versa.

Another pain point could be your tank valve. Especially if you have previously experienced neck or shoulder problems and feel that your neck is in an unnatural position throughout the dive, this may result in a tension headache. Some divers report this problem when they start diving in trim. Just like holding a yoga position, your body may take a bit of time to get used to the position, so take a few minutes during your dive to relax and stretch to avoid excessive tension.

Sinus problems and squeezes

It’s worth considering where your head hurts. If your headache manifests in the frontal area, behind your forehead, for example, poorly equalized sinuses might be the cause. Equalization may be one of the first skills diving students learn, but not everyone masters it right away.

Divers may also sometimes dive with a slight cold and equalize forcefully or perhaps incompletely, which may lead to a reverse squeeze on ascent. All these scenarios can cause headaches.

Mask squeezes may be another cause. If you are task-loaded on your descent and equalizing your mask is not yet automatic, a mask squeeze will manifest with some trauma around your eyes (in bad cases, you may end up with two black eyes) and with a headache. The easiest prevention is to include equalizing your mask in your descent routine.

Dehydration

Dehydration plays a role in many dive-related problems. Especially when tech diving or diving on consecutive days, it’s crucial for divers to hydrate regularly and prevent dehydration in the first place. That doesn’t mean downing ½-gallon of water first thing in the morning after a big night out, but instead hydrating regularly and limiting alcohol, caffeine, and other diuretics to avoid creating an electrolyte imbalance in the body.

Dehydration has also been linked to decompression sickness, giving divers even more reason to prioritize regular and consistent hydration.

Gases

Other sources of post-dive headaches are carbon monoxide and carbon dioxide. Carbon monoxide is most often associated with cylinders filled from unsuitable sources, such as a compressor air intake near a busy road pulling in car exhaust fumes, for example. A badly maintained compressor pumping insufficiently filtered breathing gas may be another reason.

Carbon monoxide headaches tend to be severe and can be accompanied by nausea, dizziness, and vomiting. They often start during the dive and, contrary to minor headaches, they are impossible to ignore. If you suspect someone has a carbon monoxide headache, it’s best to get the diver out of the water and give them oxygen. Depending on the severity,  you may also require professional medical treatment.

Carbon dioxide headaches, on the other hand, are mostly related to improper breathing techniques such as skip-breathing and overexertion. Our bodies produce CO₂ when we metabolize oxygen, and it is needed to trigger our breathing reflex. However, too much CO₂ starts causing several problems.

Overexertion leads to excessive CO₂ build-up and retention in our body. If the diver doesn’t stop to relax, the CO₂ excess can lead to strong gas narcosis, thus negatively influencing decision-making underwater. CO₂ build-up has also been associated with a higher susceptibility to oxygen toxicity and DCS.

Skip-breathing is another cause of CO₂ retention as divers limit the gas exchange taking place in their lungs. By skipping breaths, we minimize both the amount of CO₂ that is removed from our bodies and the amount of O₂ that is inhaled and distributed from our lungs to the rest of the body. In the short term, skip-breathing may appear to reduce gas consumption, but it’s not worth it considering the consequences of allowing CO₂ build-up and retention.

Another factor in CO₂ retention is gas density. Associated with taking dense gases, like air, to greater depths, this is especially a concern for technical and rebreather divers.

Some divers report feeling better when diving nitrox. While there appear to be quite a few divers who feel this effect, there is no real scientific evidence of this to the best of the author’s knowledge. Saying that, if diving nitrox fits your dive profile, either by extending bottom time or making your dive more conservative, this should be enough reason to use it.

Stress and Anxiety

How did you feel about the dive? If you enter the water stressed out or anxious about the dive ahead, this is likely to lead to a headache. Stress itself cannot be avoided— maybe this is the check-out dive for your next qualification? Maybe there are certain skills that you must perform on this dive to stay on track? But our response to stress is under our control. Ensuring a thorough briefing, sharing your concerns with your buddies, dive team, or your instructor will all go a long way toward managing the stress or anxiety you feel.

DCS

Most diving headaches are not serious and are easily resolved. However, they can be a sign of decompression sickness. If your post-dive headache accompanies a particularly deep or long dive profile or a rapid ascent, or if you surface with any other DCS-related symptoms, it’s time to contact DAN or the nearest hyperbaric chamber for guidance.

If you have serious concerns about your post-dive headaches or if they become anything more than a minor inconvenience, consult a diving physician for professional medical advice. After all, dive trips should be something enjoyable, and post-dive headaches should never ruin the fun.

The post What Causes Post-Dive Headaches? appeared first on Scuba Diver Life.

Most of us have seen or heard of the CDC’s guidelines: wash your hands for 20 seconds with soap and warm water; use hand sanitizer when soap and water aren’t available; don’t touch your face with unwashed hands; keep 6 feet away from others, cover your cough; and wear a mask. Many divers are wondering how we can apply these guidelines to diving. Furthermore, what extra precautions must divers take when renting equipment?

The dive community is rightly scrutinizing quite a few diving practices that have existed for decades. These practices include spitting in masks instead of using a defog product, dunking masks in a communal bucket, and rinsing equipment with fresh water only. In order to lessen the potential for viral spread, the dive community must work together to update some of these practices.

Spitting in masks

While most divers swear by using spit as defog, this practice is risky in our new reality. According to the CDC, the virus that causes COVID-19 is spread mainly by “respiratory droplets” that are produced when someone who is infected coughs, sneezes or talks. These droplets then land in or on the mouths and noses of nearby people. They can also be generated when a person spits, and droplets that don’t land in a mask could be carried to another diver.

Communal mask bucket

We don’t currently know whether the virus can survive in a communal mask bucket if someone infected with the virus contaminates the water. The good news is that these buckets aren’t essential, so getting rid of them is likely the best way forward to help reduce the potential for spread of infection.

Freshwater rinse tank

There is evidence that coronaviruses can survive in fresh water, although time and conditions are currently unknown. Thusly, it’s a good idea to avoid potentially contaminating the water with dirty equipment. Luckily, the solution to this is easy — disinfect equipment before rinsing.

Use the proper disinfectant

If your product is on List N, the next step is to check the product registration in the EPA Pesticide Product and Label System. Most products do not specify that they can be used on scuba equipment, but they do specify that they can be used on “respirators” or “full face breathing apparatuses.” Checking for appropriate applications in the product registration is incredibly important, because this shows that the product is safe to use on breathing equipment.

Once you’ve picked your disinfectant, follow the directions carefully. If you don’t, you will not reap the advertised effects — that is, a too-weak dilution or too-short soaking time could fail to disinfect your equipment. A too-strong dilution or too-long soaking time could damage gear.

If you don’t have access to a product on List N, you can use a solution made of 1/3 cup of bleach per gallon of water instead, with a soaking time of one minute. Thoroughly rinse equipment after disinfecting and allow it to dry completely. You must follow these directions, as long soak times could harm equipment as stated above.

What about wetsuits?

Many divers and dive operators also ask about wetsuit disinfection. There are not very many products that outline neoprene or wetsuits in their registrations, so here we turn again to the CDC’s guidelines. You can clean wetsuits with a combination of soap, water, and agitation (such as scrubbing with a soft brush) or launder them using the warmest appropriate settings and allow them to dry completely. It would be best to check with your suit’s manufacturer to ask for their advice as well.

Divers must realize the importance of using proven disinfectants on their equipment and refrain from falling back on old practices. This includes some products common in the dive industry that are not on List N or not approved for use on respirators or other breathing equipment.

For more information about disinfection, check out DAN’s disinfection webinar and COVID-19 page.

Advocate for yourself

Divers who are concerned about COVID-19 must take the correct precautions to protect themselves and others. If you’re thinking about booking a trip, call the dive operator and ask what disinfection procedures they’ve put in place. If they don’t seem adequate to you, book elsewhere. This is especially important if you plant to rent equipment.

If your dive destination is close to home or otherwise convenient, bring your own equipment, or at least the equipment that will come into contact with your eyes, nose and mouth. You should also consider cleaning your gear by yourself, away from other people or communal rinse tanks.

Make the rules and enforce them

If you work at a dive shop, create a clear plan and let customers know ahead of time about any special procedures they will have to follow. Consistency is key, so even divers who bring their own equipment should follow relevant procedures, such as disinfecting equipment before rinsing in a communal rinse tank.

Some top-notch examples of dive centers taking disinfection seriously have surfaced. This video of Mares Ecuador’s infection control procedure is a fantastic example of steps that dive operations can take to reduce the spread of COVID-19.

Moving forward

With a somewhat uncertain future, it’s hard to know what diving will look like this time next year, but we do know that COVID-19 will change the diving community’s practices for the better. Greater attention to infection control can only serve our community well.

For more information, check out Divers Alert Network’s COVID-19 page. If you have additional questions, email DAN at RiskMitigation@DAN.org.

Guest post by DAN staff; images courtesy of DAN

The post COVID-19 Diving Precautions and Practices: Protecting Yourself and Others appeared first on Scuba Diver Life.

Avoidance only worsens the problem and unchecked panic during a dive can result in injury, or even death. Check out the detailed plan below with techniques compiled with the help of a psychologist.

Note: Do not use this article as a substitute for medical, psychological, or dive instructor advice, or as a guide to get back into the water before you’re ready.

Understand the problem

Panic is both a biological and a psychological response to what the body perceives as a life or death situation. Physically, your breathing rate often initially increases, and you’ll feel a strong urge to inhale. Your heart rate increases, and faster, shallow breaths build up carbon dioxide (CO₂) in your system. These physical processes can convince the brain that something bad is occurring. The brain then increases the reaction, sending out stress hormones and convincing your lungs and heart to work even harder. This can turn into a vicious cycle, spiraling into a panic response made even worse since you know that fast breathing can deplete your tank and panic can kill divers.

First, figure out what triggered your panic attack. Some common triggers include:

• A prior dive accident/incident you experienced or witnessed
• A situation/environment you faced for the first time (e.g., low visibility, fast current, cold water, etc.)
• New or different equipment (e.g., different fins, heavier weight, thicker neoprene, etc.)
• Ill-fitting equipment
• Equipment that feels restrictive
• Too much gear
• The physical shock of cold water
• Overexertion
• Stress in your life built up to a critical level
• Lack of sleep
• A combination of the above

Recognizing what caused the initial panic can mitigate the problem in the future.

Increase your confidence with repeated, easy dives

Every time you experience a bad dive, it increases your panic response. Build up your confidence with repeated easy dives where you feel safe to help overcome the previous trauma.

• Dive in a pool or start with easy dives in shallow water, preferably with good visibility and no current. Dive when relaxed and well-rested to ensure a good experience.
• Slow things down and dive at your own pace.
• Dive with someone you trust and not with a group.
• Don’t increase the difficulty of your dives until you’ve completed many dives successfully without even a hint of panic.

Dive with a supportive instructor or DM

Hire a well-trained and supportive instructor/DM to dive alone with you—not as a course or a group dive. You may not be able to dive as often, but fewer successful dives are better than lots of dives with a higher chance of an issue.

Talk honestly with the instructor/DM about your panic and agree on how they can help you underwater detailing all the specifics. For example:

• Should they touch you or not during the dive or a panic attack? Some people prefer their hand held. Sometimes, touch feels more claustrophobic.
• How close should they stay during the dive or a panic attack? Some people desire someone next to them. Others prefer no one invade their personal space.
• Should they signal you during the dive or a panic attack? Repeatedly questioning if you’re ok can increase anxiety. During a panic attack, the person calmly performing the “slow down” hand signal timed with exaggerated slow breathing may be more helpful.

Don’t rush diving down

Enter the water, but remain on the surface and calm yourself for a few minutes before you descend. There’s no harm in ever telling a buddy or your instructor/DM that you need time to compose yourself before diving.

Then, slowly descend with no rush. Remain extremely shallow for a while if it feels safer to you or descend in stages, dropping down a few feet at a time while holding onto a line.

Dive with solid equipment

Your equipment impacts how you feel on a dive:

• Only dive with regularly-serviced equipment you know you can count on.
• Avoid ill-fitting equipment. A tight suit feels claustrophobic whereas a loose suit won’t maintain good warmth. A leaky or fog-prone mask can restrict your sight. Even if you can’t afford a full dive kit, purchasing a mask, fins, and wet suit that all fit perfectly can mitigate many problems.
• New equipment—even just a new pair of fins—feels uncomfortable. Test it out in a pool first.
• Hoods can feel restrictive around your throat. Instead, wear a dive cap or beanie with an adjustable strap for iwarmth with less constriction.
• Don’t dive with any unnecessary equipment while you’re working through your issues (e.g., a camera, a lift bag, etc.).
• Don’t dive with equipment that’s even slightly problematic on the surface—it doesn’t get better underwater.
• Ensure you’re diving with the correct amount of weight. Too much and you’ll feel like you’re being dragged down. Too little and you’ll fight floating to the surface. Perform a weight/buoyancy check before diving.

Adjust for narcosis

If you’re deeper than 100 feet (30 meters) and feel panicky, ascend to a shallower depth at a safe rate to avoid the complication of nitrogen narcosis.

Mitigate cold-water shock

Cold shock is the physiological response to sudden cold, especially immersion in cold water. Cold-water shock increases your breathing rate and can spiral you down into a panic response. Wearing heavier weight, more equipment, or a thicker wet suit can feel far more restrictive. Minimize these issues during a dive by first jumping into the water without equipment, aside from the barest essentials like your suit, mask, fins, and hood. Swim around.

Once you feel comfortable, remove your mask and place your face fully in the water for a little bit to accelerate the adjustment. All air-breathing mammals possess the “mammalian diving reflex,” a physiological response triggered by cold water hitting the face. The reflex slows the heart rate and constricts blood vessels, which can affect breathing. Adjust for this before you dive to ensure you’re not gulping for air as you descend.

Note: If you’re diving in a wetsuit, then flood it by actively separating the suit’s neck from your body. Flood water into your hood/beanie. Then, wiggle around until you feel the cold water spread everywhere. This forces your body to heat that water up, kicking off the adaptation process. It also loosens up the thick wetsuit, relieving that constricted feeling. Once you’ve adjusted to the cold water and feel relaxed with easy breathing, then don the rest of your equipment to dive.

Prevent overheating

Feeling hot before a dive increases feelings of suffocation. Prevent overheating on land with the following methods:

• Reduce the amount of time you’re geared up.
• Prevent overexertion by finding easier ways to slip on a suit (e.g., use a dive skin under a wetsuit).
• Leave the top of your suit down around your waist until the last minute.
• Pour water inside your wet suit. If you’re in a dry suit, pour water on your head.

Practice techniques to deal with panic

Ending a dive prematurely due to panic only solidifies your body/mind’s association that dives equal panic-inducing situations. Instead, try helping your brain and body deal with panic by practicing the methods below on land first.

• Recognize that you’re having a panic attack, that you’re ok, and that you can disrupt the panic response cycle.
• Utilize deep, diaphragmatic breathing. A slow inhale, and a slow and even fuller exhale will signal to your brain and body that everything’s fine. This will force your body to relax and combat the physical stress response. Your breathing urges are driven by excessive CO₂, not by a lack of oxygen. Ridding yourself of the CO₂ with those deep exhales relieves the out-of-breath distress.
• If it’s safe, stop swimming and relax your body in the water.
• Recite a simple mantra internally and repeat it slowly (e.g., “I’m ok” or “I am calm” or “breathe in; breathe out”).
• Focus on a single object that isn’t moving and consciously note everything about it. Something on your gear or your own body you can easily examine like your hand works well. Become as detailed as possible with your observations to distract yourself from focusing on your panic. For example: Cuticles require trimming, cuticle on thumb is fairly short, nails are filed into an oval shape, etc.
• Practice mindfulness to ground you in the reality around you. Focus on all the familiar physical sensations, such as how your hands feel clasping each other or how your arms feel during a dive, how your fingers feel touching your dive watch, how the water feels on your skin, etc. All of these specific sensations keep you in the moment and focus you on something objective.
• Use muscle relaxation techniques.
• If all else fails, swim a little shallower ascending at a safe rate without surfacing. This can help you feel near enough to surface easily but allow you to push through the panic during the dive. The more often you can process panic underwater, the easier all of this will become.

Determine what may help long-term

Figure out how to feel safer long-term. Don’t take a dive course or make major changes while still working through your panic. Instead, keep these thoughts as a part of a future plan. For example:

• Secure a back-up source of air — not one of those mini tanks with little air for an emergency, but a pony bottle or a full-size second tank to feel more at ease. Train with it first in a pool before diving.
• Take a self-reliant/solo diving course — not to solo dive, but so you can self-rescue.
• Only dive with trusted buddies or a DM/instructor, and not insta-buddies.
• Swap your gear: For instance, your fins may not mesh well with the type of kicks you prefer. Maybe a different style of BCD (or a backplate and wing) would better fit the way you dive. If you’re diving in cold water with a thick wetsuit, perhaps a drysuit class is in store.
• Evaluate your diving with a skilled instructor: Your buoyancy skills, your trim, and your kicks can affect how much you push your body during a dive. Practice an instructor to dramatically improve your diving and reduce your overall air consumption rate.

Secure professional help

Sometimes, the best way to address a traumatic experience or recurring panic is to secure professional support for the anxiety related to the event(s). You may want to enlist a professional to walk you through the techniques to deal with panic — and help you get back in the water confidently once and for all.

Note: Perform due diligence and choose a trained and licensed professional with experience in treating panic. If you live in the United States, search using the Psychologist Locator from the American Psychological Association including “panic” as the keyword under practice area. Most psychologists will offer you a free 15-minute introductory call where you can pepper them with questions and see if you click. You may have to attend multiple intro calls or even full-on sessions with different psychologists until you determine the perfect professional for you, but the right person can calm your world.

The post Overcoming Dive Panic appeared first on Scuba Diver Life.

While pregnant

Before we discuss diving after giving birth it’s important to remember that you should not scuba dive while pregnant. This sucks, especially when you dive for work. It can be tempting to ignore this advice as being in the water is so comforting when pregnant, but because we know very little about the effect scuba diving can have on the unborn baby it’s better to stop all together. Like thousands of other women, I was still scuba diving before I found out I was pregnant but as long as this is in the early days and you stop as soon as you find out please try not to worry.

To help with your ocean-withdrawal symptoms I highly recommend snorkeling throughout your pregnancy as this is a great form of gentle exercise and wonderful for your mental relaxation. As you grow large, it’s also fantastic to take the weight off your feet and float around with the fish. Be careful entering and exiting the water and take care walking on any boat. Visit snorkel sites close to shore and have friends or family onboard to assist you on boat trips.

How long should you wait before scuba diving again?

Only your own doctor, who dealt with your delivery and after care, can answer this question. From my personal experience and discussions with many doctors, the general advice — when no major complications are involved — is that after a vaginal delivery you should wait at least four weeks and after a Cesarean delivery (C-section), wait at least six to eight weeks.

The Divers Alert Network (DAN) additionally states that any moderate or severe medical complications of pregnancy, such as twins, pre-term labor, hypertension or diabetes, may further delay a return to diving. Prolonged bed rest in these cases may have led to profound de-conditioning and loss of aerobic capacity and muscle mass. For women who have had deliveries with medical complications, a medical screening and clearance are advisable before returning to diving. I personally had a C-section, so I waited six weeks before going diving again.

Equipment

There are several things to discuss with respect to dive equipment involving safety, fit and comfort. If you have your own gear, the first thing you will want to do is have your regulator and BCD checked and serviced. Turn on your dive computer to check battery is good or if it needs replacing.

Your body has changed dramatically, and you may notice you still have swollen feet. It’s normal to carry a few extra pounds of body fat, so check that your wetsuit boots and/or fins and your wetsuit/drysuit still fits comfortably. After a C-section your abdomen will be sore, so you do not want to fight to put on a wetsuit or have one that is too tight across your stomach. If you’re struggling, get a bigger size.

You should not do any heavy lifting of the dive gear or tank until you have fully regained strength and fitness (this varies for each woman). Someone should carry your gear to and from the boat/shore and you should put it on in the water. Remove it in the water as well before exiting onto the boat/shore.

Before the dive, complete a buoyancy check to know exactly how much weight you need, as your requirements may have changed. For comfort, use a BCD with an integrated weight system rather than a weight belt.

Fitness and strength

After giving birth it will take time to regain your fitness, so build up slowly. As mentioned, avoid carrying heavy tanks and dive gear until you are fully recovered. Start with some easy dives and avoid strong currents, waves and other environmental factors that could lead to overexertion. Outside of diving, participate in other exercise and weight training to get you ready to deal with more challenging dives.

Dive skills

If you are a recreational diver, I propose doing a refresher course first as you may have been out of the water for nearly 12 months with the pregnancy and recovery time. Most agencies and dive shops offer some type of refresher program. This will really help your confidence and make you feel ready to jump back in.

Dive professionals may not feel it’s necessary to take a refresher course. Instead, I recommend starting off with a few easy dives to see how your body responds. Only start teaching again once you are fully fit and able to physically rescue a diver if necessary. Do not feel pressure to start working again until the time is right for you.

Breastfeeding

It felt so good to be back underwater after just six weeks. I was breastfeeding, however, and if I went diving for half a day, my breasts would become full and start to ache. To help overcome this I purchased a portable battery-operated breast pump and pumped before and immediately after diving. Not all boats have a private area for you to do this, so sometimes you may have to wait until you’re back at the dive shop.

Hair and skin protection

Your hair will suffer during and after having a baby. Sun and salt are not good for your hair either, so it’s vital to use a good conditioner in your hair. Take a bottle of leave-in conditioner to top up between dives and wear a hat while on the surface to protect against harmful rays. Coconut oil is a great moisturizer for your hair as well and just a few drops will help keep it supple and smooth.

Protected your skin with a high-factor sunscreen that does not contain chemicals harmful to the ocean. There are many excellent reef-safe products to choose from now on the market. If you are not loving your post-baby belly or want to keep your C-section scar out of the sun, like I did, choose a cute one-piece bathing suit to provide more cover.

Dive planning

At the beginning, dive at familiar dive sites with good conditions if possible. Ask a dive buddy who won’t mind doing your heavy lifting and assisting you in and out of the water. Stay within your comfort zone and well within your no-decompression limits while you listen to your body’s needs and rebuild your strength, fitness and confidence.

Jump back in

Not diving for nearly 12 months was such a challenge for me and jumping back in after just six weeks was complete heaven. Diving quickly helped me recover my fitness levels and gave me a much-needed break from caring for the baby, which helps so much mentally.

It’s important to resume activities again that you love, especially those that will help you recover from childbirth both physically and emotionally. My best advice is to jump back in as soon as you can, however, if it’s been months — or even years — then reach out to your local dive shop for a refresher. It’s never too late to start scuba diving again…you’ll be so glad you took the plunge.

Images courtesy of the author

The post Jumping Back into Scuba Diving After Having a Baby appeared first on Scuba Diver Life.

Account for your risk

Although recent statistics show a decrease in incidents that lead to decompression illness, they might not necessarily take into consideration that some dives carry a higher risk than others, including deep and multi-day diving. More-complex dives affect how your dive computer calculates decompression models, especially if you enter decompression on a dive. This could lead you to exceed the limits that your dive computer manufacturer placed on the unit.

Don’t misread your computer

You could also misunderstand the readings that your computer is giving you, or worse, ignore them. This is especially tempting if your dive buddy’s computer displays less-conservative decompression times, longer time in the water, or shorter surface intervals.

While misreading your computer can lead to post-dive complications, so too can using it incorrectly. Diving with a computer programmed to the wrong settings (this includes altitude settings and blended-gas settings) can increase your risk of post-dive complications. And diving on your buddy’s computer — while you go without — can have the same effect. Finally, misunderstanding (or even ignoring) your dive computer’s error messages can have some serious negative consequences.

How to dive safely while using a dive computer

• Become familiar with your computer’s decompression model and error messages.
• Never try to “cheat” your dive computer’s decompression model by hanging it on a shot line to ‘de-gas’ while on your surface interval.
• Follow the most conservative computer in the group.
• Use the same computer for all your dives on one trip. Do not change your computer to one that has a clear profile (no residual nitrogen reading) in between dives.
• Monitor your air throughout your dive. Just because you might be far from your decompression limit in minutes doesn’t mean that you have enough breathing gas.
• Consider diving with two dive computers and following the most conservative one.

Staying safe

While it is impractical to return to dive tables, it is beneficial to have a thorough grasp of how they work and the decompression theory behind them. This knowledge will give you a better understanding of how your dive computer works.

While diving is becoming safer, becoming complacent or overly reliant on your equipment without fully understanding how it works can place you at a higher risk of suffering post-dive complications. It is therefore important that you know how your computer works, what the error messages mean, and to always dive the more-conservative profile.

The post Are We Too Reliant on Dive Computers? appeared first on Scuba Diver Life.

You’d be forgiven to think about diving as not much of a “sport.” Gently drifting along a reef, pushed by a current, hardly requires any effort. However, this tranquil scene can change quickly when the gentle current picks up or turns into an up- or downcurrent. An equipment problem might take a diver’s composure away, or, on a technical dive, divers might face the added pressure of being unable to go directly to the surface, be it thanks to an overhead environment or a decompression obligation.

For all of those reasons, divers should be reasonably fit. But what does that mean and how do we measure it? Apart from the self-assessment forms at the beginning of training courses, there are relatively few health checks later on in a diver’s career with the exception of professional levels. As a consequence, the divers themselves must usually determine whether or not they are ready to dive.

Physical fitness for diving

On a physical level, divers need both a degree of cardiovascular fitness and strength.

Diver’s Alert Network (DAN) is a great place to find more information on diving fitness. In relation to our heart and circulatory system, one statement stands out: ‘Nearly one-third of all diving fatalities are associated with an acute cardiac event.’ According to DAN, immersion alone puts stress on our cardiovascular system, meaning that it doesn’t take a challenging dive for problems to occur.

On the other hand, this clear connection makes it easy for divers to prevent these kinds of problems by improving their cardiovascular or aerobic fitness. You’ll accomplish this basically done through endurance exercises, including running, swimming, walking briskly and even dancing.

Divers also need a degree of muscular fitness, which includes both strength and endurance. What’s the difference? Strength is basically the maximum force a muscle can generate. Endurance is a muscle or muscle group’s ability to contract repeatedly without causing muscle fatigue.

Divers need endurance when finning through a current, for example. A reasonably fit, frog-kicking diver should expect his or her leg muscles to propel them through the current at a reasonable speed without overexertion.

Divers need strength, most obviously, when handling equipment. Most technical divers are used to lugging their equipment to and from the shore, cave entrance or boat. Taking care of your own gear, with help, is part and parcel of the sport for techies. Instructors will usually ask recreational divers to take care of their own gear during courses, but afterward new divers often take advantage of boat crew or support staff helping out.

Underwater, while you may not feel like you’re working (out), your body is busy. You need muscular strength to overcome drag that your diving equipment creates. This is especially relevant for tech divers who carry more than one tank.

And, going back to the beginning of this article, your muscles need oxygen to work, which puts pressure on your cardiovascular system. How do you train your muscles? Dive professionals sometimes carry lots of tanks, but for everyone else, a reasonable amount of weight training is useful. You don’t even have to hit the gym: you can do squats, lunges and push-ups at home.

Mental fitness for diving

An equally important component of diving fitness is your state of mind — your mental fitness to perform the planned dive.

While there are some differences between training organizations, most divers start thinking about mental diving fitness at the rescue-diver level. The most obvious topic here is pre-dive stress. During technical-training courses, learning to deal with, and mitigate, stress is a key component, as is learning to call a dive, i.e. cancel rather than go ahead in adverse conditions.

There is, however, more to mental dive readiness than dealing with stress. The dive industry is beginning to recognize this, with PADI recently offering a distinctive specialty covering psychological aspects of scuba diving. The idea is to train divers to understand how their brains work underwater, how they make decisions, and how they can better deal with their instinctive reactions to potentially adverse events.

Another part of the industry’s discussion of mental diving fitness relates to diving’s culture as a whole. Focus areas here include minimizing the potential for human error as well as looking at team dynamics and creating a ‘just culture,’ in which divers not only feel they can speak up when they think something is wrong but are also happy to share their mistakes to prevent others from repeating them.

On a practical level, this involves creating and following checklists, to name just one example. Although this is normal in the aviation industry, for example, this practice is largely restricted to CCR divers. However, other divers could benefit from it just as much.

In conclusion, there is more to scuba diving fitness than initially meets the eye. While medical questionnaires are required at the beginning of training courses, with few exceptions there is no such requirement for guided dives. So, it is up to the individual to be honest with himself and accurately assess his own diving fitness on any given day.

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Take part in ocean cleanups

Taking part in local beach, river and underwater clean-up events is a great way to spend a morning or afternoon. These events remove hundreds of tons of ghost nets, abandoned crab and lobster traps, cigarette butts, straws and other marine debris annually from our waters. Give local conservation a hand by staying up-to-date on events near you, or make your next dive part of a global cleanup effort.  Also consider making it your personal mission to pick up trash whenever you’re spending time outdoors. Be sure to bring along a biodegradable or reusable bag for trash collecting. We love #Take3ForTheSea, an organization that encourages the habit of removing three pieces of trash when you leave the beach, waterway or anywhere to make a positive difference.  

Use safe body-care products

Ocean-friendly products have quickly gaining attention, but using them is also important for inland communities and at home. Many marine-toxic personal care ingredients like oxybenzone and parabens are not filtered out by wastewater treatment facilities, which discharge them directly into marine-sensitive environments. Just 62 parts per trillion of oxybenzone can kill coral larvae — that’s equivalent to just one drop in six Olympic-sized swimming pools.  It’s so important to be aware of what you’re putting on your body and introducing into the environment. What many assume is safe for you has been proven to not be safe for marine-life.  Everyone is talking about reef-safe sunscreen, but the eco-conscious diver should also look at the ingredients in shampoos, conditioners and other products.

If you’re overwhelmed by the options that line the store shelves, don’t worry — we’ve got you. Check out the top-notch mineral sunscreens from Stream2Sea. All of their products are tested and proven to be reef-safe — all the way down to their recyclable bio-packaging. The sunscreen tubes are made from sugarcane resins and their larger sizes come in containers made from recycled milk jugs. They even have an assortment of soothing lip balms, hair-care products and after-sun products, all tested and proven safe.

Take a stand against ghost-net pollution

Abandoned fishing nets are very destructive to marine life, often horrifically catching turtles, sharks, and other pelagic species. You may not be able to remove these “ghost” fishing nets from the waters yourself, but you can support their removal by purchasing products made from marine-recycled products, helping to sustain a market for recovered nets.

Various companies are committed to up-cycling this harmful pollutant, including Fourth Element’s swimsuits and Stream2Sea’s eco rash guards. You can reduce the amount of sunscreen you use by wearing UPF clothing like these rash guards made from recycled ghost nets. We also love these recycled ghost-net bracelets from Planet Love Life. Every purchase supports ghost-net recovery and a specific conservation activity.

Call to Action

Your personal choices matter — from the products you use on your skin and hair to choosing to help clean up a messy beach. Knowledge is power, so be sure to learn how to read an ingredient label, rather than just trust the company’s marking materials. Stream2Sea’s Education Center can help empower you with free education modules to learn more about the science and importance of protecting the oceans.

Once you’ve fortified your reef-safe knowledge, spread the word and advocate for the oceans and reefs. Stay informed on the major steps that are happening toward sunscreen bans. So far, Palau, Hawaii, Bonaire, Aruba, and Key West have all banned some harmful chemicals contained in sunscreen.

Our oceans are facing enormous challenges today, including ocean acidification and marine debris. But we believe every small action has the ability to create significant positive change. Protect what you love by making eco-conscious and informed decisions about what you put on your body, sharing your knowledge and keeping our beaches and oceans clean for future generations of divers and ocean-lovers.

The post Easy Ways to Take Part in Ocean Conservation appeared first on Scuba Diver Life.

In 2003, the Undersea Journal published research by David and Lynn Colvard on panic among recreational scuba divers. The study states that researchers think that a panicked response to stress plays a large role in dive fatalities. Alfred Bove, author of Medical Examination of Sport Scuba Divers, echoes this sentiment: “panic, or ineffective behavior in the emergency situation when fear is present, is the single biggest killer of sport divers.” Unfortunately, we cannot know this for sure, but what do we know about panic and diving?

What does the research say?

The Recreational Scuba Training Council’s (RSTC) 1998 guidelines for the recreational scuba diver’s physical examination listed ‘a history of panic disorder’ as a no-go zone for divers. This means that individuals with a history of panic disorder were deemed medically unfit to dive. In 2001, the guidelines changed to include a ‘history of untreated panic disorder’ as a high-risk condition for diving, but also acknowledged that with treatment, such conditions pose a lower risk to diving activities.

What causes panic attacks?

First, we need to define a panic attack. For their research, the Colvards defined it as “an intense fear of losing control or dying.” They linked this to the definition of a panic attack found in the 5^th edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders, which defines an attack as “a discrete period of intense fear or discomfort that is accompanied by at least four of 13 somatic or cognitive symptoms…often accompanied by a sense of imminent danger or impending doom and an urge to escape…or desire to flee from wherever the attack is occurring.”

For divers this could turn into an uncontrolled ascent or other kind of flight response. The Colvards found that 15 percent of divers who experience their first panic while diving engaged in a rapid or uncontrolled ascent. While this number seems relatively low, it is based on a survey of current divers. To date there is no information on how many divers stopped diving due to experiencing panic. We also cannot establish how many diving fatalities panic has caused. Investigators often label these cases as drowning deaths, with little information on the events leading up to the incident.

Who is at risk?

Women, and especially women who have a history of panic attacks, tend to experience more panic attacks than men. On the other hand, the men who participated in the Colvards’ research viewed their first panic during a dive as life-threatening. They also found that women tend to accept help more often than men and attribute this to the possibility that in many cultures men are conditioned to be self-reliant.

People who have a history of panic attacks above water are about twice as likely to panic while diving as those who have never experienced a panic attack before. They are also more likely to have more than one panic experience while diving.

Triggers are unique to every individual. We do know that it is not dependent on when you last dived or on your certification level.

How can you address scuba-related panic?

Happily, the Colvards found that most divers who had experienced a panic episode while diving remembered and used their training on how to deal with the situation. They also found that most divers who experienced a panic situation while diving went for additional training afterwards.

Panic happens when an individual does not have any solutions for a serious problem. The quality of training will help provide divers the skills they need in these situations. Repeating and practicing skills to become familiar with them can change the way a diver reacts in a panic situation as well. Furthermore, by continuing their education, divers increase their available skills, which they can rely on if they do feel panicky.

How to recognize a panic attack

A panic is a distinct episode of fear and discomfort with four or more of the following symptoms present. They develop quickly and peak in about 10 minutes:

1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded or faint
9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flashes

The post The Science of a Scuba-Related Panic Episode appeared first on Scuba Diver Life.

It will premiere on “CBC Docs POV” on October 26^th.

The first reports about the accident

Within days of Stewart’s death, some media reported that he died because a self-serving, Svengali-like instructor named Peter Sotis urged him to perform a dangerous — and ultimately fatal — dive. According to reports, Sotis convinced Stewart to conduct a series of dives that were too deep for his skill level. On the final dive, he came up too fast, paying the ultimate price. Some media also suggested that Sotis survived the dive by clawing his way onto the boat first, leaving Stewart to drown when he passed out in the water.

The world lost an important figure in the fight to prevent shark extinction. But Stewart was a hugely experienced diver. By one estimate he may have topped the 10,000-dive mark. He was also a certified instructor and had used rebreathers before when filming of “Sharkwater.” So it just didn’t make sense that a diver with his credentials would blindly follow what another diver said without question.

Talking to the Keys’ medical examiner

Stewart’s parents hold Sotis and the dive operation, Horizon Divers, responsible for their son’s death, and their lawyers consequently filed a negligence lawsuit. But when I began scratching beneath the surface, parts of the accepted storyline fell apart. Dr. Thomas Beaver, the Keys’ medical examiner, told me he knew the case would be high-profile from the beginning and wanted everything done by the proverbial book, yet from the outset, he ran into considerable opposition.

“They threw Rob Stewart under the bus from the beginning,” he says. “They tried to tell me that Rob Stewart panicked and shot to the surface and that’s how he died.”

Beaver says he was excluded from the search for the body (though Florida law places that task under the M.E.’s jurisdiction) and also discovered anomalies in the chain of evidence that suggested Rob’s body might have been tampered with when it was recovered. Yet when he complained to the local sheriff, he says he was ignored.

Regardless, Beaver continued to push hard for answers.  His determination has cost him dearly.  He found himself vilified by the small, close community in the Keys. Despite the opposition, Beaver has painstakingly reconstructed the forensic evidence. Slowly he began to understand what occurred, which wasn’t necessarily what the world has been told to this point. 

Talking to Peter Sotis

I also spoke with Peter Sotis, the last person to dive with Rob Stewart. He had a very different story to tell when I finally tracked him down, suggesting that he’s been set up as the perfect fall guy. “It’s easy to blame me, but it doesn’t mean it’s true,” he says.

Sotis is right about that. He’s confident and a little self-important. He likes to brag that his dive school is the best in the world. All reasons he says he’s an easy target, but he claims that all he was trying to do was help Stewart get the best film possible for “Sharkwater Extinction.”

He says that when Stewart asked him for his support, he saw an opportunity: he could help Stewart and at the same time get some publicity for his company. When it came time to film, Sotis volunteered to act as their safety diver.

Digging for answers

After talking with Beaver and Sotis and dozens of other people involved in the accident, I realized that what really happened on the day Stewart died and in the few days following was a much more complicated and disturbing narrative than the one that’s gained popular traction. The real narrative involves the ruined life of the medical examiner who tried to get to the bottom of the story; allegations of tampering with evidence by the people with the most to lose in a lawsuit; an incestuously closed community that tried to blame the victim; and a grieving family that may not be ready to hear about their son and the risks he took to get the footage he needed for his film. We can sum up what happened that day with one quote from Dr. Beaver, “There’s a lot of blame to go around, a lot of blame.”

The CBC will broadcast the documentary in Canada on October 26^th  on CBC Docs POV at 9 p.m. A U.S. broadcast is currently being negotiated and should be available shortly afterwards.

The post The Third Dive: What Really Happened to Rob Stewart appeared first on Scuba Diver Life.

Hyperbaric chambers – what exactly are they?

Hyperbaric chambers are tiny rooms — capsules, really. They’re large enough to hold two or more people at a time depending on the facility. The chamber is sealed while the pressure inside the chamber as well as the oxygen content slowly increases. It’s possible to attain and keep different ambient pressures inside the chamber to simulate the body’s experience at depth.

As we know, when we’re underwater the higher ambient pressure means our body tissues are absorbing more nitrogen. Upon surfacing, the pressure around a diver’s body decreases drastically, which leads to the evacuation of the absorbed nitrogen.  While other factors can put divers at higher risk of getting decompression illness, it usually happens when a diver either stays too deep for too long (absorbing more nitrogen) or ascends too quickly (resulting in an accelerated release of nitrogen). When nitrogen moves out of a diver’s cells too quickly it forms expanding bubbles. This can lead to DCI symptoms and likely a trip to a hyperbaric chamber.

The chamber works by simulating a higher ambient pressure, which recompresses the nitrogen bubbles. The pressure slowly decreases, simulating a very slow ascent, which allows a diver’s tissues to slow degas the nitrogen. Simultaneously, the partial pressure of oxygen in the body tissues increases. This is called hyperbaric oxygen therapy, wherein a higher blood-oxygen content speeds the healing of body cells. Basically, the body heals more efficiently when exposed to higher concentrations of oxygen.

Decompression chambers vs. recompression chambers

We can categorize hyperbaric chambers into two types in relation to scuba divers: decompression chambers and recompression chambers. Recompression chambers treat DCI in scuba divers, as well as preventing it in certain cases.

We use decompression chambers for surface-supplied divers, usually commercial divers who spend lots of time underwater. The chamber allows the divers to decompress out of the water instead of making long decompression stops while submerged. Decompression chambers can be either in the water or, more commonly, on land.

So, where is the closest chamber?

Ask the staff at the dive center in your destination and it’s not uncommon to hear that the closest hyperbaric chamber is at least a couple of hours’ flight away. Regardless, it’s important to make sure you know the location of the closest hyperbaric chamber. You should know approximately how long it would take to get there, and whether there is ample emergency oxygen for the trip.

Speaking to the dive center about their emergency plans will not only prepare you in the unfortunate event of a dive emergency but will also give you some insight into their safety procedures.

I have to go to a chamber — now what?

Amir Hadanny from the Sagol Center for Hyperbaric Medicine and Research and his colleagues found that between 76 and 78 percent of patients who were treated for DCI in a hyperbaric chamber recovered fully. Late recompression (48 hours or longer after the accident occurred) showed to be nearly as effective as immediate treatment, especially if the treatment was based on the U.S. Navy Table 6. However, timely treatment of DCI is vital to decrease the size of the nitrogen bubbles and avoid any additional injury.

Treatment takes at least a few hours. If the chamber is using the U.S. Navy Table 6, patients will be compressed to a depth of 59 feet (18 m) while breathing oxygen, then slowly decompressed to 29 feet (9 m), eventually reaching surface pressure. This procedure usually takes around 4 hours and 45 minutes.

Treatment might span a number of days with the longest session on the first day. Treatment will continue until the patient reaches a ‘treatment plateau’ and shows no symptoms between treatments.

Once treatment ends, the medical professional will advise the diver on when s/he can dive again. Divers should make sure to get medical clearance before returning to the water.

The importance of dive insurance

The cost of hyperbaric treatment including hospital bills, doctors’ fees and transportation to the facility (often with a helicopter) can easily reach tens of thousands of dollars. Having good dive insurance, such as DAN, is absolutely vital. Dive insurance companies offer a variety of plans. These range from cover for a few days to yearly and even lifetime coverage. It is definitely worth investing in comprehensive dive emergency coverage for your next dive trip.

According to DAN, injuries sustained by the accumulation of a number of small bubbles can cause as much damage as a car accident. If you suspect that you have DCI, do not delay treatment. Start breathing 100 percent oxygen and contact your medical professional or dive-insurance company immediately to assist a speedy transfer to the nearest hyperbaric chamber. Cutting your holiday short is a small price to pay for a continued lifetime of diving.

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Serious dive accidents like collapsed lungs and decompression sickness require medical clearance before returning to the water. But there are other, less well-known conditions that could also require medical clearance before you get in — or back in — the water. Although you may not think they’re serious at the time, honesty is still the best policy. Here are a few medical conditions, some relatively minor, that could affect your safety underwater.

Patent foramen ovale (PFO)

A patent foramen ovale (PFO) is a small opening between the right and left upper chambers of the heart (atria). Everyone is born with this and it closes after birth in about 80 percent of the population. The 20 percent of people with PFO usually have no symptoms and don’t even know they have the condition, but it could put them at a higher risk for DCI. According to the Mayo Clinic, “in decompression illness, which can occur in scuba diving, an air blood clot can travel through a patent foramen ovale.”

Gastroenteritis with vomiting and diarrhea

Also known as stomach flu or traveler’s diarrhea, gastroenteritis is quite common. If you suffer from a bout while on a dive trip, do not brush it off. Gastroenteritis can cause severe dehydration and the symptoms (vomiting and diarrhea) are not conducive to diving. Furthermore, the medications you may take to deal with nausea, vomiting and diarrhea can have undesirable side effects like sedation. If you’re sick, stay out of the water.

Chronic reflux

Chronic reflux, also known as Gastroesophageal Reflux Disease (GERD), causes chronic heartburn and indigestion when acid or food from the stomach flows backward into the esophagus. Although most of us occasionally experience mild heartburn, if it happens while diving it could be detrimental to you. According to Divers Alert Network, “if reflux of gastric contents occurs while one is diving, a diver could be at significant risk. Aspirating food or acid into the lungs or into the regulator could be fatal.” They recommend that individuals with significant reflux should not dive. Speak to your medical practitioner if you experience significant reflux.

Liver cirrhosis

Liver cirrhosis is a degenerative disease wherein healthy liver cells suffer damage and scar tissue replaces them. This is usually caused by toxic substances (like alcohol) or viral infections (like hepatitis). Your medical professional can advise you whether it is prudent to dive with cirrhosis based on your symptoms.

Anemia

Any blood disorder that can affect transportation of oxygen in your body, as well as the degassing process, places you at a higher risk of getting DCI. Anemia could also lead to hypoxia. If you suffer from anemia, consult your medical professional before diving.

Honesty is the best — and safest — policy

It can be tempting to answer “no” for a question that doesn’t seem like a big deal, especially when you’ve traveled so far to dive. However, you must be completely honest when you answer these questionnaires. Refresh your memory when it comes to some of the lesser-known conditions listed on these forms and answer truthfully.

If you are unsure of whether you are fit to dive, skip the dive. It’s far better to cancel a dive than put yourself and other divers in danger. The best policy is to speak to your medical professional before you leave for your trip if you have any questions or concerns. That way you can both be honest on your questionnaire and safely enjoy your dives.

The post The Importance of the Medical Questionnaire When Diving appeared first on Scuba Diver Life.

Having said that, when I came upon the research done by Mandy Shackleton, a marine scientist, at Hull University in 2007 on how women are better divers than men, I had a chuckle. But is she right? Are women better scuba divers than men?

The power of hormones

Male divers often seek sensations. They look for novel, exciting and intense experiences. This leads to the secretion of cortisol, testosterone and adrenaline, which can lead them to take more risks underwater. Dr. Magnus Johnson, head of Hull University’s center of environmental and marine sciences, also notes that men might take more risks while diving with a woman in order to impress her. Women, on the other hand, are more safety conscious and thus take fewer risks while diving, said Shackleton in her study.

Buoyancy, efficient movement and heat

Michael Messner from the University of Southern California notes that women tend to have a higher percentage of body fat than men. This makes them naturally more buoyant. Sure, they might need an extra weight or two. But this also means that women use less energy while swimming and enjoy a higher degree of insulation against cold water.

The big picture

Women are better at reading non-verbal cues, such as body language and visual cues, as summarized by Nancy Briton and colleagues. Talking underwater is largely limited to grunts and squeals of delight, and divers rely exclusively on non-verbal communication.

Nigel Forman, a professor of psychology at Middlesex University, also found that women were better at picking up on non-verbal, situational and environmental cues.

Because they are fluent in non-verbal communication, women are better able to navigate the underwater environment and adapt to changes.

Spatial awareness

Forman also mentions that because women see the bigger picture, they have a better spatial awareness underwater. This is the opposite of what is true on the surface, where men tend to be more skilled. This, combined with the tendency for women to be more-cautious divers and have better buoyancy control, means women divers make less contact with — and break less — coral than their male buddies.

It’s all in the legs

In general, women tend to harness their lower-body strength more than men, who rely more on their upper body. Scott Mclean and Richard Hinrichs found that men generally kick more than women to cover the same distance while swimming. Combining this with fins designed to propel you further with fewer kick cycles, as explained by Zamparo and colleagues, leads to a more efficient dive-kicking style and thus to lower air consumption in women.

Air consumption

Because women move more efficiently through water and have smaller lungs, they tend to use less air than men. This enables them to dive for longer and leaves more air available in if a buddy runs out.

On your next dive, observe your buddies — male and female — and examine how they dive. Do you notice any differences? Whether or not women are better divers than men, each of us can undoubtedly learn something from the other.

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When does DCS occur?

Decompression sickness manifests after inadequate decompression following exposure to increased ambient pressure while scuba diving. Some instances are mild and not immediately life-threatening while other instances can be quite serious, even deadly. If you get DCS, the more swiftly you begin treatment, the greater likelihood that you’ll recover fully.

Students learn the basics of DCS during initial open-water training. Many factors can predispose you to DCS, including illness, age, alcohol or drug use, extreme heat or cold, old injuries, proneness to blood clotting, obesity, medication, lack of sleep, extreme fatigue and dehydration.

Nitrogen bubbles forming at the joints are the cause of the joint pain experienced in a classical “bend.” However, the signs and symptoms of decompression sickness are also quite wide-ranging and, in some cases, divers may confuse them with other causes, leading to an incorrect diagnosis.

Essentially, we break down signs and symptoms into ‘Type 1’ and ‘Type 2.’

Type 1 symptoms of DCS

DCS Type 1 symptoms are generally milder and less immediately critical than Type 2 DCS symptoms.

Type 1 is often identified with musculoskeletal pain, such as the classic pain the joints at the elbow or knee. Alternatively, or sometimes in addition, they may also include skin symptoms. Skin manifestations include mild rashes and itching, which may present on the torso, such as around the stomach, chest or shoulders. Sometimes Type 1 DCS is associated with obstruction of the lymphatic system. Tissues surrounding the lymph nodes — such as in the armpits, behind the ears or in the groin area — may become painful.

Left untreated, symptoms of Type 1 DCS can intensify and become acutely painful. For example, a Type 1 DCS issue may originate as a gentle, throbbing ache in the elbow and increase in severity. Many divers instinctively clutch painful limbs in these cases, as holding the limb in one stable position may reduce discomfort.

Many divers experiencing these symptoms will impulsively deny that it’s DCS. Often, they’ll ascribe their symptoms to non-diving problems, such as straining when lifting their bags onto the boat. 

Type 2 symptoms of DCS

Considerably more serious and, potentially, life-threatening, Type 2 DCS symptoms characteristically fall into three categories: inner ear, neurological and cardiopulmonary.

Inner-ear symptoms may include a sensation of tinnitus (ringing in the ears) or hearing loss. Linked to inner-ear damage, other symptoms may include dizziness or vertigo and, as a side-effect of that, impaired balance, nausea and vomiting.

Neurological symptoms may include numbness, a ‘pins and needles’ sensation in the limbs, or muscle weakness. This may also manifest in difficulty walking and the patient struggling to support his body weight. Physical coordination may diminish, and subjects may appear confused, lacking clarity and alertness. Bladder control can be affected as well, with some patients desperately needing to pass water but unable to do so.

Cardiopulmonary symptoms include a dry cough and difficulty breathing. This is sometimes referred to as having “the chokes.” Some patients report pain in the chest behind the breastbone and suffer dyspnea, a struggle to breathe. These are some of the most serious symptoms as the issues compromise the lungs’ ability to function.

Recognition and acceptance

In the most severe cases, signs and symptoms of decompression sickness can appear even before surfacing, during ascent or immediately on reaching the surface. Those outlined above usually appear within 15 minutes of surfacing, however, but may occur up to 12 hours after the end of the dive. The likelihood of symptoms developing after that window of time is low. However, symptoms may occur, especially if the diver flies home before the recommended time at sea level has passed.

Symptom denial is often a problem for divers. An instance of DCS is sometimes associated with divers making a mistake — overstaying their time limits at depth or ascending too quickly, for example. This stigmatization leads divers to hide or misattribute their symptoms rather than seeking assistance. In many cases, however, a diver will have done everything right and dived a safe plan, but a combination of predisposing factors led to the problem.

Divers in denial will assign the symptoms to another cause — tight exposure suits, heavy lifting, or even sea sickness often blamed rather than a possible instance of DCS. However, denial simply delays assitance as the diver hopes the symptoms will subside on their own. In some cases, symptoms may remain mild or even go away by themselves. Often, however, they strengthen in severity until you must seek medical attention, and they may have longer-term repercussions.

Treating DCS

If you feel unwell after a dive, tell someone. You may simply have a headache after a dive, most likely a symptom of overexertion, heavy breathing or dehydration. But if you’re experiencing any of the DCS symptoms outlined above following a dive, acknowledge them. If you’re diving independently with buddies, let them know your symptoms and consider if DCS might be to blame. If you’ve planned your dive trip correctly you’ll have oxygen, first aid kit and an emergency assistance plan in place. Now is the time to enact it. If you have any doubts, call DAN or your local emergency-assistance provider.

If you’re on a dive boat such as a liveaboard, tell the dive crew. The vessel’s trip leader will make an initial assessment of the situation. If they suspect DCS it will often be classified as an ‘emergency,’ (immediately life-threatening), ‘urgent’ (the diver is in severe pain but is stable) or ‘timely’ (symptoms are either inconsistent or have progressed slowly for several days). A responsible dive operator will have an emergency assistance plan onboard, administer immediate first aid and monitor the patient’s condition. They will simultaneously gather dive data for the past 48 hours and liaise with DAN and/or local EMS or chamber facilities to arrange the evacuation of the patient as required. 

Scuba diving is a safe sport. Nevertheless, diving safely and staying mindful of the predisposing factors of DCS — and how to recognize symptoms if they occur — will help you get the necessary treatment quicker and lessen the chances of long-term residual symptoms.

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How often should you scuba dive?

Diving is addictive. But it can also feel challenging, especially to new divers who are still getting used to the underwater world. If that sounds like you, then diving more often really is your best option. How often? As often as possible, and as soon as possible after your certification course. If possible, brand-new divers should add a few days of fun diving at the end of their certification course. This is the ideal time to practice all the basics any diver needs, such as equalizing, buoyancy, controlled ascents and descents and staying with a buddy.

Another option is completing your second level of certification — Advanced Open Water or Advanced Adventure Diver with most agencies — right after your Open Water course. There are pros and cons to this and opinions differ. Advantages include not developing bad habits as an instructor is there to watch and correct any developing mistakes. On the other hand, not everyone is ready to move on right after their initial certification. Some divers are simply better off practicing what they learned as opposed to charging ahead.

Most certified divers stop training after their advanced course and simply continue with fun dives. Depending on how keen divers are on their new hobby, they might dive once a year or as regularly as once a month.

Once a year is not enough

While not everyone can get in the water once a month, only diving once a year has its pitfalls. Especially for recently qualified divers, diving every 12 months means remembering skills, rules and procedures almost from scratch. Once-a-year divers will often spend the first two days of a five-day dive package reestablishing comfort in the water.

As a rule of thumb, the fewer dives someone has, the more important it is to dive regularly. You’ll need dozens — if not more — dives to establish muscle memory. So, if dive travel isn’t an option, how do you make sure you don’t get rusty?

Keep your skills fresh

The best option to keep your skills fresh is to join a group of local divers and discover what’s in your local waters. It might not sound exciting at first, but there are lots of advantages: having dive friends close by and diving with regular buddies can really make a difference. And, there’s always something new to see underwater.

The second-best option is to take a refresher course or go on a few dives before heading off on vacation. This would work for those who don’t have enough time to dive regularly at home and will certainly help you avoid spending the first few vacation days trying to remember how to attach a regulator to a tank.

Stay fit for diving

Finally, there is the question of dive fitness. While it’s similar to aerobic fitness, other aspects of dive fitness have to do with carrying heavy dive gear on land, as well as becoming used to breathing and moving underwater.

Many dive professionals develop dive fitness simply by being underwater every day. But even the most seasoned pros need to look after themselves by being well-hydrated, for example. This is just as important for vacation divers.

To prepare yourself for a dive trip, make sure you are at a reasonable level of general fitness. Look after your ears while on vacation by rinsing them with fresh water after each dive and stay hydrated. Obviously the more often you can dive, the better, but even out of the water there’s much you can do to stay ready for your next trip.

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Equalize slowly and often

Equalizing often while descending is important to allow the ears to adjust to pressure changes and help prevent vertigo from occurring. Divers should also take their time descending and never “push through” ear pain when equalizing. If the ears won’t equalize, ascend a few feet and try again before descending further. Different equalization techniques work for different people and divers should try a variety to find what works best for them.

Choose the right type of dive

Divers who are prone to vertigo should give extra consideration to what type of dive will work best for them to minimize the chances of vertigo. Visual references are helpful and diving above a coral reef or sand bank can provide a visual depth-limit to focus on. Shallow dives are best for vertigo sufferers who may begin to panic, as they can ascend to the surface easily if a problem occurs. Shallow dives also provide extra light and marine life to focus on, which can help take a diver’s mind off any vertigo anxiety.

Divers who prefer to look straight ahead to prevent vertigo or nausea can opt for a wall dive with a defined depth limit below.

Open-ocean dives can be challenging for any diver. The lack of visual references or defined depth limit can trigger vertigo. It is difficult to maintain a sense of space and depth in the deep blue, so vertigo sufferers may want to avoid open-ocean dives.

Be proactive and retrain the brain

It is possible to retrain the brain to lessen anxiety-driven vertigo and to remain calm when it occurs. A calm diver experiencing vertigo is more likely to react safely and prevent a dangerous situation from developing. Two of the treatment options for vertigo are hypnotherapy and visualizations.

Athletes and other professionals use visualization when training the brain to remain calm when faced with anxiety-inducing triggers. The idea is that, with practice, the person can completely remove the anxiety response. Divers can practice visualization at home by sitting with their eyes closed and focusing on deep breathing. Visualize the scenario that brings on vertigo. Do this slowly, with the visualization ending at a point where the person is still calm. Practitioners should gradually increase the length of the visualization to include the trigger that causes anxiety to the point that anxiety no longer occurs.

Hypnotherapy is another great technique for reducing anxiety-driven responses, and a course of sessions can help address the problem. Divers can undergo hypnotherapy in-person with a therapist or use hypnotherapy recordings and distance sessions.

Stay hydrated and eat well

A vertigo attack is stressful on the body and mind.

Staying hydrated and well-nourished will help divers cope with the attack and the demands it places on the body. Divers should remember to drink plenty of water in-between dives and avoid alcohol. Eat healthy food to be in the best shape possible to manage vertigo.

This article was written by Kathryn Curzon, a diver and writer for Liveaboard.com.

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The touch that sets you free

Divers all know that underwater world is a touch-free zone. But while we’re underwater we’re actually touching and being touched by water the entire time. Few things equal the sensory experience of feeling the water moving against your bare skin, although we do spend much of our time underwater in wetsuits. But the nature of the water’s touch holds us suspended weightless in the water, allowing us to move in ways that we cannot on land. This leads to a feeling of absolute freedom.

Entering into this space is almost like entering a bubble where the focus point becomes you and your body in relation to the world around you. Once their focus moves from their equipment and skill practice, experienced divers become more spatially aware based on signals from their body. For example, they may notice the difference in depth of a few feet or a meter based on how their ears or buoyancy reacts. They begin to control their buoyancy, as well as slight depth changes, by controlling the volume of air in their lungs. ***Dive tip: you can keep the air volume in your lungs fairly constant for short amounts of time by breathing with your diaphragm.

All you need is the air that you breathe

Diving elicits other feelings besides that of being free. Because we cannot verbally communicate underwater, diving also often creates a sense of stillness. With the sounds and distractions of the world topside drowned out, you become more aware of the unique sounds of the ocean: waves breaking, shells tumbling against each other, a boat in the distance, fish feeding… and most of all, your own breathing.

Diving requires you to pay attention to your breath to maintain your buoyancy. Doing so can also help you identify when you are overexerting yourself or entering into an uncomfortable situation that might escalate. If you think about the advice instructors give for these situations — Stop. Breathe. Act. — it becomes clear that breath-control is important in diving

By paying attention and listening to your breathing, as noting the physical sensations of the water surrounding you, you enter a kind of meditative state. While diving you become more and more aware of the present moment and how you interact with the world around you. External demands fall away and all you must do is focus on the moment. This meditative state can last once you’re back on the boat as well, leaving you calm and relaxed.

This meditative effect has led some to call diving and being submerged in water as a “therapeutic landscape,” where reconnection with self and healing can take place.

And who knows, perhaps in time, insurance companies will offer divers a discount for the health benefit of diving. Until then, we can all remember to just breathe.

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Flying after diving

According to the PADI/DSAT RDP table, if you’re flying after a single no-decompression dive, wait a minimum of 12 hours. For repetitive and/or multi-day diving, leave a minimum pre-flight surface interval of 18 hours. SSI recommends that you always wait at least 24 hours after diving before flying to avoid decompression problems.

Altitude

According to both PADI and SSI, special procedures apply for diving at an altitude of greater than 1,000 feet (300 m).

So, when it comes to scuba diving and altitude, it’s clear that something is happening that may adversely impact our bodies. But what exactly is going on?

Changing ambient pressure

The answer has to do with relative compression and the rate and which our bodies absorb and release nitrogen. At sea level, we’re exposed to one bar of ambient pressure. However, as altitude increases, such as when in a mountainous region or flying, the relative ambient pressure drops.

Standard dive tables and most computer algorithms calculate dive times based on a hypothetical diver returning to the surface at sea level. Here, the partial pressure of nitrogen (ppN₂) is 0.79 bar.

Now, imagine we dive to 33 feet (10 m). We are now under two bars of pressure and the ppN₂ is 1.58 bar (2 x 0.79). The difference is 0.79 bar, which is called the pressure gradient. If the diver stayed at 33 feet (10 m) for long enough, the body would eventually become saturated with nitrogen in accordance with the ambient pressure. The diver could, hypothetically, remain at that depth indefinitely without absorbing additional nitrogen.

However, when the diver begins to ascend, the pressure gradient changes. The partial pressure of the gases decreases and the saturation process reverses. The inert gas diffuses from the body’s tissues into the bloodstream. From the blood the gas goes into the lungs and, eventually, out of the body with each exhalation.

Decompression theory

Historically, Captain Robert Workman of the U.S. Navy Experimental Diving Unit (NEDU) made fundamental progress in decompression theory when he discovered that there was a maximum amount of nitrogen pressure gradient that any tissue could contain upon surfacing. Captain Workman called this calculated maximum amount the “m-value.”

The pressure gradient of dissolved nitrogen in the body in relation to the partial pressure of nitrogen at the current depth (or on returning to the surface) is the key factor. Managing this gradient is the art of managing potential decompression sickness risk with regard to safe ascent rates and — as we’re discussing here — managing that risk of DCS when diving at altitude or flying after diving.

Altitude considerations

Diving at altitude or flying after diving plays havoc with the nitrogen exposure and pressure-gradient calculations that standard dive tables and computers models use.

For example, if you’re diving in a mountain lake there’s lower atmospheric pressure. The relative difference (and corresponding pressure gradient) between the atmospheric pressure and the pressure underwater increases. Therefore, the impact of scuba diving to any given depth is proportionally greater than it would on the same dive at sea level. Because of this, altitude dives have shorter no-decompression/no-stop times.

Divers can use simple altitude tables with typical ambient pressure at various elevations when conducting these types of dives. Also, many modern dive computers allow users to adjust and re-calibrate the unit for the different ambient pressure. Altitude-diver specialty training courses teach the correct procedures and planning considerations.

You must also take precautions if you need to drive to altitude after a dive at sea level. For example, driving back over a mountain range after a day of diving at sea would require an extended surface interval before safely undertaking the journey. Failure to do so creates an increased pressure gradient between the nitrogen in your tissues and your surroundings. This forces your body to dispel the nitrogen faster — perhaps too fast to do so safely. Doing so can trigger decompression sickness.

Altitude and flying

The same is true for flying. Aircraft cabins are pressurized to the equivalent of approximately 7,800 feet, or 2,400 meters of altitude. This, again, means that flying directly after diving heightens the pressure gradient of the absorbed gas in comparison to the surrounding pressure. It may reach a point where the body can’t keep up. Bubbles form and decompression sickness occurs.

If you’re planning to dive at an altitude of greater than 1,000 feet (300 m), obtain the proper training to plan and execute your dives safely. And, similarly, if you’re planning a dive trip, allow for a sufficient surface interval before returning to an altitude of higher than 1,000 feet or flying home. Scuba diving and altitude needn’t be at odds, as long as you plan well and take the proper precautions.

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Scuba diving with a hangover

Drinking and diving don’t mix — we’ve all heard the saying, “first drink, last dive,” meaning that once you crack a cold one, your dive day is done. But what if you overdo it one evening after a dive day, with another day underwater yet to come? Drinking and vacations go together like rum and Coke. But no matter when you imbibe, drinking and diving make a less perfect match. Not only will drinking the night before a dive lead to an unpleasant morning, but doing so might also pose a safety risk.

Scuba diving with a hangover often means dehydration and a higher risk of DCS. A hangover can make you feel foggy, influencing your awareness and reaction time in potential emergencies, even if you don’t think so at the time. A hangover will make you feel colder faster and can cause nitrogen narcosis to occur more intensely or at shallower depths.

With that in mind — and knowing that you likely don’t want to skip the cocktails entirely on your next dive vacation — try some of these tips to have a better and safer dive after a night out.

Keeping up with the Joneses

Diving is a very social sport. With that, and the vacation vibes, we tend to drink a bit more than usual. On top of that, no one wants to be the boring one at the bar. But you needn’t match other divers drink for drink. We all get caught in a night out sometimes, but by pacing yourself and drinking smaller drinks — ideally ones with a lower alcohol content — you will still have a good time while consuming less alcohol. Use the money you save on alcohol to give your dive guide a great tip — they will love you for it.

Line your stomach

Eat a proper meal before you start drinking and, while you’re drinking, much on filling snacks to slow down the absorption of alcohol in your body.

One for the diver, one for the dive

Alternate each alcoholic drink with a non-alcoholic beverage like water, fruit juice or soda. We tend to start drinking a lot earlier while on holiday than we would back home — cocktails often begin at sunset or before. Remember though, that if you start drinking at 4 p.m. and finish at 11 p.m., that’s the equivalent of drinking from 8 p.m. until 3 a.m. in the morning. Recommendations state that you stop drinking 12 hours before your next dive. When it comes down to it, If you feel like you need to take the hair of the dog to function the next day, you should skip the dive and sleep it off. Better to nurse a hangover at the hotel pool than in 60 feet of water. And on your next trip to the bar, take it a bit easier and enjoy your next day underwater.

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