Healthy Diver Handbook

Rip it out, take it along and dive in good health--our exclusive guide to curing what ails the traveling diver.

By Samuel Shelanski, M.D.

Motion Sickness | Cuts, Bites & Stings | Dehydration | Headaches | Traveler's Diarrhea

Doctors never really get away from their work because people are always asking for medical advice. We're happy to help, but most of the ailments our fellow divers ask us about can be self-treated. With that in mind, here's a travel-ready guide to beating the most common ailments.

Motion Sickness

Traveling divers spend a lot of time in planes and boats, environments that challenge our sense of equilibrium. When the inner ears, eyes and various other sensors give conflicting messages to the brain--if the ears say right while the eyes say left--the brain revolts and the result is revolting. Other factors that can contribute to that queasy feeling are anxiety, fatigue, being overheated or any coexisting ailment.

Beat It

• Position yourself smartly. The lower down and closer to the middle of a boat you get, the less you will pitch and rock.
• Avoid fumes. Nothing will tip you over the edge faster than the stench of diesel. If you're feeling ill, it's usually better to be on deck with the fresh air (it's also a shorter trip to the rail).
• Face up. Look forward and fix your eyes on a stationary object close to the horizon line--a cloud, oil rig, palm tree, ship, etc. This way you help ensure that your eyes will see the same motion that your body is feeling.
• Get wet. Most people feel much better as soon as they get in the water and below the surface.
• Eat right. If you are prone to motion sickness, eat light and allow at least one hour between breakfast and boarding the boat or plane. Avoid heavy, greasy foods like bacon, hash browns and eggs. Opt for simple foods like toast, fruit and juice.
• Pop a pill. Over-the-counter and prescription medications can prevent and relieve the effects of motion sickness. Common brand names include Dramamine, Bonine, Marezine and the Scopolamine patch. They work, but almost all cause significant drowsiness. This makes them fine for the flight down to Roatan or the 30-hour crossing to Cocos, but they should be used with caution on the day of diving. Medications work best when taken before travel starts. Follow the instructions on the label.

Treat It

If you've already "screamed at the submarines," the good news is that you're probably feeling better. For the rest of the ride:

• Replace lost fluids with small sips of water or flat soda.
• If you feel like eating, stick to bland foods like plain crackers and dry toast.
• Although you may have already become nauseated, medications such as Bonine and Marezine can reduce your symptoms.

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Cuts, Bites & Stings

So, your encounter with the local marine life was a little too close for comfort, eh? Here's basic first aid for the most common diving scrapes.

Beat It

The key to avoiding all these problems is a respect for the ocean environment. So:

• Get neutrally buoyant.
• Keep your hands to yourself.
• Beware of surge, current or swells that can sweep you into these thorny hazards.

Sea Urchin & Stonefish Wounds

Urchin spines are like hypodermic needles that break off once deep inside you, injecting their venom. The venom from stonefish spines is also delivered deep into the wound. Both cause excruciating pain, redness, swelling and bleeding. More severe complications can include infection, weakness, paralysis, breathing difficulty--even death if the victim has an anaphylactic reaction.

Treat It

• Elevate the affected area and apply a pressure bandage to slow the absorption of venom. Do not apply a tourniquet.
• Immerse the wound in 45C/115F water, or as hot as you can tolerate, for 30 to 90 minutes. The heat will break down the toxins and can dramatically reduce the pain.
• Control the pain. The excruciating pain from marine stings can lead to shock. Use local anesthetics to reduce the sensation.
• Cleanse the wound with an antiseptic solution. Washing out remaining venom and pieces of spine will help minimize damage, speed healing and prevent infection. Leave an inaccessible spine alone only if it hasn't penetrated a joint, nerve or blood vessel.
• Seek appropriate medical care. Some wounds will require surgical cleansing and repair, antibiotics for infection control, as well as antivenins and life support for severe stings.

Jellyfish & Coelenterate Stings

Stinging hydroids, fire coral (not a true coral) and jellyfish all have nematocysts, barb-shaped stinging cells filled with venom. Hydroids such as fire coral produce an immediate burning sensation followed within 30 minutes by an itchy rash that takes several days to heal. Jellyfish stings cause burning and leave a trail of bumps and welts. Serious jelly encounters can result in a severe burning sensation, muscle spasms, vomiting, shock, even collapse.

Treat It

• Remove tentacles with a gloved hand or tweezers to avoid getting stung, then rinse thoroughly with salt water--fresh water or rubbing will trigger unfired nematocysts.
• Deactivate remaining nematocysts with a 5 percent vinegar solution until the stinging stops. Use isopropyl alcohol if you don't have vinegar. Meat tenderizer also neutralizes venom--add to the solution if you have it.
• Apply shaving cream and scrape skin with a razor to remove nematocysts. A paste of mud, flour or talc scraped with a dive knife or credit card also works.
• Dry the skin and apply hydrocortisone ointment and take diphenhydramine for mild allergic reactions.
• Keep the victim still to prevent venom from spreading, with the injured part elevated above the heart.
• Serious stings that result in life-threatening reactions like spasms, breathing difficulty and shock require emergency medical attention.

Reef Rash

Although the nematocysts of the soft coral polyps can't do much damage to humans, cuts and abrasions from the sharp points and razor edges of the stony skeleton can create burning pain and itchy welts. This "reef rash" (a form of coral poisoning) can take up to six weeks to heal completely.

Treat It

• Scrub area with soap and water, rinse stinging wounds with 5 percent vinegar solution or isopropyl alcohol.
• Apply hydrocortisone ointment.

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Dehydration

Water is the traveling diver's best friend. Without enough of it, you'll become dehydrated, a condition that puts you at higher risk of DCS and causes fatigue. Perspiration, breathing dry air (such as in airplanes, air-conditioned hotel rooms and scuba tanks), urination, diuretic beverages (those that contain caffeine or alcohol) and medications, menstruation and traveler's diarrhea all cause fluid loss.

Your body will tell you if you need more fluid. Common early-warning signs of dehydration include constant thirst, headache, fatigue, nausea and dark urine. If you experience these signs, get out of the sun and drink plenty of fluids. If they persist, leave the diving for another day.

Beat It

• Drink a minimum of two liters of water or juice each day; more if it's very hot or if you're diving multiple tanks. The drinks should be spaced out over the course of the day rather than all in a short period of time.
• Avoid caffeinated beverages and alcohol--both have a diuretic effect.

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Headaches

Diving can trigger headaches in several different ways: neck and back strain from improperly adjusted or too-heavy gear, dehydration, sun glare, masks that are too tight, aspiration of salt water, and the mental strain of calculating repetitive dive tables. However, the four most serious dive-related headaches are:

Carbon Dioxide Headaches

Symptom: Dull, throbbing headache after diving that does not respond to analgesics or migraine medications.

Cause: Carbon dioxide buildup in the body, usually due to improper breathing, which triggers increased blood flow to the brain.

Beat It/Treat It

• Take deeper breaths. Check the fit of gear. A too-tight wetsuit or jacket-style BC can prevent your lungs from fully expanding.
• Take more breaths. An abnormal time between breaths allows carbon dioxide buildup in the lungs and blood. Don't skip breathe.

Anxiety/Tension Headaches

Symptoms: Pain in the back of neck and head.

Cause: Muscular tension in the neck and jaw caused by stress or anxiety over unfamiliar diving conditions.

Beat It/Treat It

• Dive within your capabilities. Divers generally stop getting these headaches as they become more comfortable in their diving environment and learn to relax.

Sinus Headaches

Symptoms: Forehead or face pain on ascent or descent.

Cause: Inability to equalize pressure in the sinuses. Contributing factors include inflammation in the nose and sinuses, often caused by allergies or a cold.

Beat It/Treat It

• Long-acting decongestants can help relieve these headaches. Make slow descents and ascents, equalizing often.

Decompression Sickness Headaches

Symptom: Headache with neurological deficit.

Cause: Type II decompression sickness or arterial gas embolism.

Beat It/Treat It

·  Hyperbaric oxygen therapy. If you have a headache and any symptom of DCS--pain in a joint or limb, itching, skin rash, localized swelling, nausea or vomiting, dizziness, ringing in the ears, extreme exhaustion--call the Divers Alert Network and get to the nearest chamber. Headache, along with neurological deficit, can be symptomatic of arterial gas embolism or Type II DCS.

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Traveler's Diarrhea

Traveler's diarrhea is the most common ailment afflicting divers, and it's caused by food and water containing bacteria different from those your gut is accustomed to. When you swallow these bacteria, they end up in hand-to-hand combat with your native bacteria--and you wind up the loser.

Beat It

• Drink only bottled water, juices and sodas. If you must tap into the local water supply, treat it with iodine pills, a portable water filter (or both) before drinking. Another option is to boil your water for at least 15 minutes.
• Avoid ice made from tap water--it can also make you sick.
• Fruits and vegetables washed in tap water may also carry disease-causing organisms. Stick to those fruits and vegetables that can be peeled.

Treat It

·  Almost everyone will recover from simple traveler's diarrhea within three to five days, even without treatment. I recommend divers use Pepto-Bismol. It won't speed recovery, but it will lessen the severity of the symptoms. Medications such as Imodium may delay recovery by trapping the offending bacteria in the intestines. If symptoms last for more than a few days, seek medical attention. If you experience any form of diarrhea, you're losing enormous amounts of fluid, so stay well-hydrated.

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