Quick Fixes for 7 Common Dive Injuries

Diving can be a pain in the ear­and back and stomach, and a lot of other places. Here's what to do about it.

By John Francis

Middle-Ear Squeeze
Scrapes & Cuts
Jellyfish Stings
Lower Back Pain
Hypothermia
Seasickness
Jaw Pain

What About Sharks?

Middle-Ear Squeeze
"Huh? I can't hear you, my ears are stuffed up."

·  Symptoms: You felt pain in your ears while descending. After returning to the surface, your ears feel "full" and your hearing is muffled. You may feel vertigo­dizziness and a sense that the world is spinning.

·  What's going on: Your middle ears, normally air chambers equalized to outside pressure through your eustachian tubes, have become filled with body fluids. That's why your ears feel full. The fluid muffles sound transmission from your eardrum to your inner ear, and may affect the adjacent semicircular canals­your balance mechanism.

 

·  Is this serious? Not usually. Fluid normally drains away or is reabsorbed with no lasting damage. But it can be very serious when diving. If you push deeper despite pain, you can rupture an eardrum. Or you can rupture the membranes between your middle and inner ears. This can result in long-lasting or permanent hearing loss. And, especially if one ear is affected more than the other, you can experience vertigo. Vertigo under water can be deadly.

·  What causes it: Your eustachian tubes are blocked, so equalizing air can't pass from your throat to your middle ears. As you descend, increasing water pressure makes your eardrums bulge inward (causing the pain). Soon, pressure forces fluid (blood or perilymph) from surrounding tissues into your middle ear air spaces. Your eardrums return to their normal position and pain recedes. You may think you've succeeded in equalizing your ears, and you have­but with fluid.

What blocked your eustachian tubes? Maybe too much mucus, produced because your nasal passages are irritated­by a cold, by using nasal sprays and inhalers too much, or by equalizing too forcefully on your previous dive.

Or maybe you pinched your eustachian tubes shut because of poor equalizing technique. The lower ends of your eustachian tubes act almost like one-way valves, opening to let mucus drain easily from your middle ears but closing to prevent mucus, saliva, etc. from being forced up. Pinching your nose and blowing gently (the modified Valsalva technique) will force air up the tubes. But if you blow too hard, the ends of the tubes will close. The harder you blow, the more tightly shut they will be.

How to prevent it:

• Don't dive with a cold. Increased mucus production may make clearing impossible. Even prolonged breathing of cold air increases mucus production­a real problem for frost-belt divers heading south for winter vacations.
• Don't overuse nasal sprays and drops. They too can irritate nasal passages and stimulate mucus production.
• Don't use a forceful Valsalva maneuver. Instead, try: the Frenzel maneuver (with nose, mouth and throat closed, use the tongue as a piston, driving the mass of the tongue backward), the Toynbee maneuver (swallowing with nose pinched and mouth closed), or open your jaw and swallow, or raise your soft palate. If only a Valsalva maneuver will work, blow gently.
• Descend feet first, head up. Looking down tends to pinch your eustachian tubes.
• Pre-pressurize your ears. Start equalizing before you leave the surface, to get ahead of the problem. Once you're four feet down, it's too late to start­your eustachian tubes are shut.
• Descend slowly. Equalize with every breath and every two feet of depth.

Other Squeezes: Bloody Eyes, Sinus Headaches Mask squeeze: When you fail to equalize the pressure in your mask, outside pressure forces the mask against your face. Hydrostatic pressure in your body tries to pop your eyeballs into your mask. No, they won't explode, but tiny blood vessels in your conjunctive tissue (covering the whites of your eyes) may rupture, causing red spots on your eyes. Prevent it by exhaling into your mask when you feel it pressing into your face. Sinus squeeze: Happens like ear squeezes, when passages connecting your sinuses to your throat become blocked, usually with mucus. Don't dive with a cold.

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Scrapes and Cuts
"Ouch, that coral was sharp!"

·  Symptoms: You know: pain, blood.

·  Is this serious? Underwater cuts and scrapes almost always become infected, unless treated quickly and aggressively, because biologic material is normally carried into the wound.

Often, venom is involved too. Coral polyps have a type of venom that normally doesn't hurt your unbroken skin, but if introduced into a deep cut can be painful. Sea urchin spines are not only sharp, some are venomous.

How to prevent it:

• Practice careful buoyancy control. You should not need to push off from the bottom, for example, to maintain your depth. You should be able to concentrate on that fascinating coral without slowly drifting up or down.
• Predict surge. It has a rhythm, like surf, with sets of stronger and weaker flows. Before penetrating a zone of surge, watch it from the edge for a while and learn its pattern.
• Understand currents. As a last resort you may have to hand-over-hand across the bottom to fight a strong current, but avoid that predicament by swimming up-current at the start of the dive, when you're fresh. Learn where current is likely to be unusually strong or unpredictable, such as around corners, pinnacles and walls. For more on dealing with currents, see the March 1999 issue of RSD or on our web site at www.scubadiving.com/training/instruction/currents/.
• Don't reach where you can't see. That seems pretty obvious, but to many of us the lure of a dark hole is irresistible­especially during lobster season. Just remember that any hole is likely to be somebody's home. Though you might not touch the creature, you may touch its defensive perimeter and provoke an aggressive reaction.
• Don't wade barefoot. Sand often hides dead, but still sharp, coral. Stingrays often lie hidden under the sand in tropical areas and even as far north as Cape Cod and British Columbia. They have a sharp spike on their tails and will attack if stepped on. Wear sandals or booties, shuffle your feet and probe the bottom ahead of you with a stick.
• Wear gloves. It's controversial in some areas where divemasters feel that gloves increase the temptation to poke and fondle delicate marine life. But given the chance of infection, our advice is: control your buoyancy, dive smart, use the "don't touch" rule, but wear gloves.

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Photo by Norbert Wu

Jellyfish Stings "Something burned me!"

·  Symptoms: Pain, burning sensation, red rash, sometimes blistering and itching. Sometimes headache, chills and fever. Severity varies with the amount and kind of venom injected and the susceptibility of the victim.

·  Is this serious? Can be. The sting of a box jellyfish can kill a human in five minutes. The lion's mane jellyfish can be lethal too. So can the Portuguese man-of-war (a hydrozoa, not a true jellyfish). These are found in temperate and tropical oceans, though the Indo-Pacific varieties seem to be most dangerous. But most of the 250 species of jellyfish only hurt a lot­though repeated stings can make you more sensitive, and some people have allergic reactions.

·  What causes it? You bumped into something. Jellyfish are just one class of the phylum Cnidaria, which includes 9,000 species of anemones, corals, hydroids and jellyfish. All of them are armed with stinging cells called nematocysts. Each cell is a barbed, venom-injecting arrow smaller than a grain of sand, but an individual animal (or colony) usually has lots of them­for example, up to a million per tentacle in the case of a Portuguese man-of-war. A nematocyst is triggered by contact or by a chemical signal.

Nematocysts can sting even after the animal is dead. Torn-off tentacles stuck to wetsuits can sting, for example.

How to prevent it:

• Cover your skin. Wear a full-length exposure suit. Even a Lycra bodysuit protects from most stings.
• Don't touch. Many venomous creatures, like sea ferns, look soft and feathery and invite touching.
• Control your buoyancy. The other tips for avoiding cuts and abrasions apply as well.

Venom First Aid Many folk remedies have been tried and some work, but not all toxins are alike. Some respond only to specifically developed antitoxins. When nematocysts are involved, wash the wound gently to remove unfired cells. But don't rub it­you'll trigger the cells and make the sting worse. Next, try vinegar on stings by sponges, corals, anemones, hydroids and jellyfish. For sea stars, urchins, stingrays and poisonous fish stings, heat (as much as you can stand, up to 115F) usually breaks down the venom.

Other Things That Sting Nematocysts are not the only venom-delivery system. Some octopuses, including the common Atlantic octopus, have a moderately venomous bite and a few, including the blue-ringed octopus found in Australia, can be lethal. Various sea snakes like the yellow-bellied sea snake introduce venom when biting. And some creatures have venomous fangs. Some large cone snails found in the tropical Pacific, for example, actually harpoon and paralyze passing fish and have been known to kill humans. Besides the invertebrates, there are over 1,000 marine vertebrate species that can sting. Among fish with toxic spines are stonefish, scorpionfish, firefish, catfish, rabbitfish and weeverfish.

To Learn More Venomous & Toxic Marine Life of the World, by Patricia Cunningham and Paul Goetz, Pisces Books, 1996, 152 pgs. Click here to order. Dangerous Marine Creatures, by Carl Edmonds, M.D., Best Publishing Co., 1995, 275 pgs. Subtitle: "A Field Guide For Medical Treatment." Click here to order. A Medical Guide to Hazardous Marine Life, by Paul S. Auerbach, M.D., Best Publishing Co., 1996, 68 pgs. Click here to order.

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Lower back pain
"Oh, my aching back!"

·  Symptoms: Stabbing pain in lower back. If you don't know it yet, you probably will someday: 80 percent of adults have lower back pain eventually.

·  Is this serious? How much do you like daytime TV? Thousands of micro-injuries, most of which you don't notice, accumulate over the years. The result can be pain so intense as to prohibit any activity but bed rest.

·  What causes it? Typically, uneven strains stretch ligaments supporting your spinal column. That allows vertebrae to rock on the discs separating them, pinching nerves. Scuba diving itself does not put uneven strain on your back, but lifting tanks and weights easily can. Tanks are especially awkward, having a natural handle at only one end, and integrated weight systems make the weight/tank/BC combo a heavy one.

How to prevent it:

• Hug it. Carry a tank across your chest in both arms. Or:
• Wear it. To carry your tank to the boat, wear it (and your BC) on your back. Likewise, wear your weight belt when carrying it.
• Get help. Many divers don their BC and tank like an overcoat: put one arm in, shrug it onto a shoulder, then put the other arm in. Instead, with the BC held by your buddy (or with the tank standing on a bench), put both arms in and settle the BC on both shoulders before bearing the weight.
• Use your legs. Bend from the knees when lifting, not from the waist.
• Lift close to your body. Holding weights at arm's length increases leverage, and stress, on your back.
• Pivot from your feet. When passing gear bucket-brigade-style, don't pivot at your waist.
• Roll it. Use a cart or a dive bag with wheels to transport gear.
• Exercise. A program of stretching and strengthening exercises can prevent back pain.
• Say no. If you have to jerk something to lift it, it's too heavy.

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Photo by Chris Jaffe

Hyperthermia You can also get too hot. Heat exhaustion, and even heat stroke, are common in cold-water diving where divers wear thick exposure suits and wrestle heavy weight belts. Symptoms include confusion, delirium and disorientation. Plan your dive preparation to minimize sweat. Lay out your dive gear and get the heavy lifting done before you put on your exposure suit. Don't zip up until you have to.

Hypothermia
"Brrrr!"

·  Symptoms: It's more than feeling cold and shivering. Signs of moderate to severe hypothermia include mental confusion, slurred speech, amnesia, apathy, lassitude and poor muscle coordination.

·  Is this serious? Hypothermia increases your risk of DCS. By degrading your physical and mental capacities it makes you less able to deal with other problems under water. Hypothermia alone, if serious enough, can lead to heart failure, coma and death.

·  What causes it? Water sucks heat from your body 26 times faster than air, which means 80F water chills you as fast as 42F air. That's why you need thermal protection even in the tropics, where "silent hypothermia" builds up from dive to dive and degrades your abilities even though you never feel cold.

How to prevent it:

• Wear a hood. It should be the first piece of thermal protection you consider, not the last­because 40 percent of your heat loss is through your head.
• Stop the leaks. The best wetsuit or dry suit is worthless if it lets in too much cold water. Repair broken zippers and split seams. Wear a hood if for no other reason than to seal the neck opening.
• Cover up. Heat loss is huge where cold water flows over skin, so a thin full-length suit is warmer than a much thicker shorty.
• Break the wind. Between dives, a wet exposure suit becomes a swamp cooler. Many divers actually lose more heat between dives than when in the water. Wear a parka or a windbreaker, or take off the suit and dry off.
• Stay shallow. Wetsuits are more effective in shallow water.
• Surface if you shiver. Uncontrollable shivering is the warning sign of hypothermia.

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Photo by Norbert Wu

What About "Sea-Bands"? Many people wear elastic wristbands with bumps on the inside that press on the "Neiguan" acupuncture point inside your wrist. This is claimed to relieve nausea. But there are no numbers to prove it. No scientific tests have been published showing Sea-Bands to have any effect at all. The explanation for their popularity may lie in the fact that the placebo effect is strong in controlling nausea. So if this device works for you­believe in it.

Seasickness
"Ralph!"

·  Symptoms: Anxiety, pale skin, yawning, lethargy and headache are early signs. Then comes nausea.

·  What causes it? The complex and unfamiliar motions of a boat (or floating diver or airplane or car), but experts disagree on the exact mechanism. One theory is that it's your brain's disgust at the argument between your middle ears, which insist everything is moving, and your eyes, which look around the cabin and say everything is normal.

How to prevent it:

• Start healthy. Be rested, recovered from jet lag, and not "hung over."
• No doughnuts. Avoid greasy food, or anything you find hard to digest. An empty stomach is usually more stable than a full one.
• Minimize motion. Find a seat near the center of the boat, where motion is less. The stern is good too, but beware of diesel fumes.
• Watch the horizon. Let the eyes see that you are, in fact, in motion. (This supports the sensory argument theory.) If you must stay below, close your eyes.
• Medicate early. If you use medications like Dramamine, start four to six hours early to build up a level of the drug in your system. But beware of side effects, especially drowsiness, and don't use unfamiliar medications. Scopolamine patches are again available by prescription and are said to be effective with few side effects.
• Be patient. Most people feel better in a few hours or, in some cases, a few days.

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Jaw Pain "Waiter, may I have a straw for my soup?"

·  Symptoms: It began as a dull ache just forward of your ear after your second day of diving. It continued to worsen day by day until holding a reg in your mouth became an exercise in agony.

·  What's going on: Jaw pain is usually a result of temporomandibular dysfunction (TMD), one of the most common complaints of divers. Conventional mouthpieces on regulator second stages are thought to force the jaw into an anatomically awkward position that can lead to muscle strain and inflammation around the temporomandibular joint (TM), which opens and closes the jaw.

·  Is this serious? For most divers, a few days without the strain of holding a reg in their mouth is usually enough for the joint to return to normal. But if the pain continues even when you aren't on a dive vacation, chances are that a congenital deformity, trauma, or clenching your teeth while sleeping may be the culprit. In the case of unresolved pain, you should consult your physician.

How to prevent it:

• Get some mouth peace. Several companies make alternatives to conventional mouthpieces. One of the most popular is SeaCure's moldable mouthpiece that allows you to customize it exactly to your bite. You can find it in most dive stores.

The Comfo-Bite from Aqua Lung doesn't require you to bite down as hard as conventional mouthpieces. Our ScubaLab tests have shown it to work well for many divers, but not all.

If you can't find relief from any commercially available mouthpiece, many dentists and orthodontists can make a mouthpiece to fit you­more expensive, but so is a dive vacation.

• Regulate it. Multidirectional swivels on the regulator first stage can help. So can a second stage that is neutrally buoyant.
• Put your face in it. Divers with severe TMD or other problems that prevent them from holding a regulator in their mouth may have to consider a full-face mask to get relief and keep on diving.

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Photo by Norbert Wu

What About Sharks?

Shark attack is very rare. Most of the several hundred species of sharks have no interest in eating humans. Those that do­the great white being most famous­probably mistake humans for seals and sea lions, their normal meal. In most attacks on humans, the shark bites, tastes and lets go.

But it's difficult to minimize the risk when first-aid manuals describe the injury as "amputation of major body parts," and it's true that shark behavior can be unpredictable. It's best to do what golfers do about lightning: take sensible precautions, but don't be afraid. Don't dive when blood is in the water. If you cut yourself, leave the water. If you see a shark, watch it but don't panic and don't antagonize it. Listen to local advice: many sharks are territorial, and some areas are more dangerous than others.

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