Monday, August 9, 2010

NO DUMB QUESTIONS, SEPTEMBER 2010: Diving After Flying, How Much is Too Much and Altitude Issues

By Alex Brylske


Q: Joe Plocinski wrote with a question that’s rarely considered concerning flying and diving. “I would like to know if there is a recommendation or rule of thumb for any ‘ground time’ interval between flying and making your first dive? During our certification class we were told that the recommended surface interval for flying after diving is 12 hours after a single dive, and 18 hours after repetitive/multiday diving. However, I do not recall hearing anything about diving after flying, or if there are any possible effects on the body. We will be vacationing in the Caribbean, arriving early afternoon and was wondering if it would be OK to get a dive in that day?”

A:You bring up an interesting point that’s rarely discussed, though given how common your experience is, it certainly should be addressed more often. Most informed divers assume that flying before diving poses no problem. In fact, you can make a logical argument that diving soon after a flight could impose a safety factor because you start the dive with less nitrogen in your tissues than you would if you were saturated at sea-level pressure. In theory, this might make sense. In practice, however, it might lead you to a recompression chamber.

The issue really isn’t the amount of nitrogen in your body, but rather the fact that a diver arriving at a dive resort after several hours of flying is not likely to be in his or her best shape. The stresses of the airplane cabin air, dehydration, restricted circulation from sitting in a confined position, and general fatigue from the journey are all factors that could place the diver under an increased — not decreased — risk for decompression illness. The best advice is to avoid diving until you are completely recovered and rested from the stress of flying to your favorite resort. Of course, that means there can be no hard-and-fast rule. Every individual is different, the actual stress of a flight depends on many factors, and only you know your body well enough to make the final decision of when it has recovered. Do many divers make their first dive just after unpacking their bags? Of course. Do some of them get the bends or incur other problems? Again, yes. Was their flight a factor in the outcome? No one knows. Perhaps a good compromise is that, if you do decide to dive immediately on arrival, make sure it’s a shallow, easy one.

Q: Deidre Levin had a question that I wish more divers considered. “I was on a live-aboard dive trip recently where most of us made between 20 and 25 dives during the five days we were aboard. One evening toward the end of the trip, our discussion centered on an issue that I’ve never seen addressed in any publication or discussed by any diving authority. But it seems like a simple and important matter. Can a diver do too much diving? I’m not talking about decompression sickness. Assuming that’s not an issue — the person feels perfectly fine — is there still a point when, like most things, there’s too much of a good thing?”

A: You have entered a very interesting realm of discussion, and you’re right; it’s rarely if ever addressed. Perhaps the reason almost no one ever talks about it is because we know so little about the long-term effects of diving in recreational divers.

It is, however, well documented that some commercial divers do suffer long-term effects. Hearing loss is one common ailment. However, another is a lesser-known condition called dysbaric osteonecrosis, literally, “bone death due to uneven pressure.” While to my knowledge it hasn’t been proven conclusively, many medical authorities blame this disorder on the extreme and continued conditions encountered by commercial divers, especially those who have a lot of deep-saturation experience. (By the way, it’s even been reported in sperm whales.)

The good news is that it’s believed that recreational divers spend far too little time underwater in their careers for this to be of any concern. However, there has been some evidence that dive professionals who spend extreme amounts of time at depth, such as divemasters and instructors, may be susceptible.

Still, my concern gets back to the issue that you dismissed: decompression. Even if someone does not manifest any symptoms of bends, we really don’t know what the cumulative effect may be. We do know that silent bubbles develop commonly in recreational divers, and that they most often resolve without any problem. But could they have a cumulative effect over many years or decades? Could age have any effect on this mechanism? Or, could more diving actually help build some form of immunity to bends? We just don’t know.

Personally, I’m a cautious person. And, probably like a lot of folks, I’ve gotten more so as I’ve gotten older. Now, in my diving, I almost never make more than two dives a day, and three is the absolute limit. I know that may sound unduly conservative — and I do have the advantage of diving just about any day of the week I care to — but that’s my decision. So, does the concept of too much of a good thing apply to diving? Probably, but we have no idea where that limit lies, and I personally don’t plan to provide any evidence.


Q: Dave Lewis sent in a question about altitude and diving. “I wonder about the oxygen content of compressed air in a scuba tank when it is filled at altitude where the lack of oxygen tires out hikers. Do dive centers at altitude enrich compressed air to normal levels?”

A: Your confusion is understandable given that hypoxia (low oxygen) is a common concern for anyone at high altitude. After all, who hasn’t watched a film about pilots or mountain climbers in which they didn’t see oxygen masks at the ready? As we’re reminded in the required announcement prior to every flight we’ve taken, supplemental oxygen is readily available in the event of loss of cabin pressure.

But let’s think more closely about this for a second. The concentration of oxygen in the atmosphere everywhere on the planet is 21 percent. (If you’re a stickler for accuracy it’s really 20.946 percent.) What’s more, that value holds true no matter where you are in the atmosphere, be it at the surface or about to step on the peak of Mount Everest. That means no matter where you fill a scuba tank, as long as it is somewhere on Earth, it will always contain 21 percent oxygen (assuming it’s not a nitrox fill, of course). So, if the oxygen fraction of air is always the same, where does all the concern over hypoxia come from?

The answer involves not pressure, but percentage. The physiological effect a gas has on our body depends not on the fraction of a gas within the mixture, but on the actual number of molecules we breathe. This is a function of the partial pressure of the gas in question within a gas mixture. An example will illustrate the point.

If you’re a nitrox diver you know that the oxygen partial pressure (ppO) at the surface, 1 atmosphere, is 0.21 ATA (reflecting its gas fraction, 0.21 x 1.0 = 0.21). At 2 atmospheres (33 feet [10 m]), where the pressure doubles, this increases to 0.42 ATA (0.21x 2.0 = 0.42). However, if you ascend in the atmosphere to a height of about five kilometers (16,400 feet), the pressure will halve. This means the oxygen partial pressure drops to 0.105 ATA (0.21 x 0.05 = 0.105). While we’d experience no problem whatsoever at the surface or at 33 feet [10 m], at altitude this low value is insufficient to maintain consciousness and we’d black out. Remember, however, that the percentage of oxygen in every case has not changed; it’s always 21 percent.

Q: Patti W. writes, “What should I use to rinse the inside of my buoyancy compensator (BC) after diving in salt water?”

A: First of all, it’s always good to give your gear a quick rinse in fresh water after an ocean dive, to rinse away the seawater. If you aren’t in the habit of rinsing your gear, you should be, because salt crystals that form on your gear when it dries can abrade surfaces, wear out threads and cause corrosion. A longer soaking at home after a dive trip — ideally in warm water — is also recommended.

Now, to the question of rinsing the inside of the BC, I’ve never actually used anything but fresh water.

Some divers use the eco-friendly product Simple Green® or similar mild detergents. There are also a few commercial products available just for rinsing scuba gear, so ask at your local dive center. Some have speculated that because a BC might be inflated orally, its interior should be disinfected periodically. So, a very mild bleach solution could be used for this purpose. In addition, some rebreather manufacturers offer nonbleaching disinfectant solutions, which are a better choice but, again, I think that good-old water should do the trick.

Monday, July 19, 2010

EDITORIAL, AUGUST 2010: CANDY COATED DIVERS?

By Cathryn Castle Whitman  

I got an e-mail from a reader recently, expressing her concern over a photograph that appeared in a recent issue of Dive Training. Every now and then a “no-no” photo slips past us — maybe the diver is wearing his snorkel on the right side of the mask instead of the left or a way-too-long weight belt is shown dangling. It happens sometimes. And readers take us to task. But this time, rather than point out the problem, the reader simply asked, “What’s wrong with this picture?”

I scanned it carefully, looking for the glaring error that got overlooked. The photo was of a group of wet-suit-clad divers preparing to gear up for a dive. In it, no one had a snorkel attached to a mask incorrectly, or a too-long belt. The scuba units were stowed properly and no one, heaven forbid, had their mask perched on top of their head, or some other obvious “no-no” likely to set off a letter to the editor.

I didn’t get it.

So, I offered to discuss the reader’s concern in a phone conversation. She e-mailed her phone number, I called, and after we exchanged a few polite greetings she asked, “So, what’s wrong with this picture? Do you get it yet?”
I stared harder. Still, nothing jumped out.

“They’re all obese. Or at least overweight.

NO DUMB QUESTIONS, AUGUST 2010: Pacemakers and Diving, Advanced Training, The Effect of Crude Oil on Corals

Q:Thomas McGill had a follow-up question regarding a feature article I did a few months ago called “The Telltale Heart” (April 2010). Could you expand on some information on diving with pacemakers for me? The article states, in part, ‘there is no reason why a pacemaker should automatically disqualify anyone from recreational diving.’ I and the pacemaker manufacturers seem to agree with this. The article goes on, ‘the real issue is why the patient needs a pacemaker. If the device was implanted solely to correct a problem with the rhythm of the heart, then the candidate can dive. If, however, the heart showed other problems or disease, then the pacemaker candidate should not dive.’ Could you expand on that last sentence for me? My pacemaker was installed because of a slow heart rate. Otherwise, I have no heart difficulties, and I do maintain myself in reasonable physical condition for diving.”

A:Thomas, sorry I wasn’t able to answer your question fully in my earlier feature. The issue is not one of technology but the same concern we have with any medical condition: Might the underlying problem for which the pacemaker was installed affect one’s fitness to participate in scuba diving? 

Pacemakers are installed to address abnormalities in the heart’s electrical conduction system. Often, though not always, patients with such abnormalities have some form of cardiac disease as the underlying cause of their abnormality. For example, congenital heart disease, certain valvular heart diseases (aortic stenosis with valvular and AV-ring calcification), cardiomyopathy and coronary heart disease all may be associated with chronic conduction system abnormalities. Any of these conditions can mean that an individual may lack the cardiovascular fitness required to safely participate in diving. In fact, according to the Divers Alert Network, the most common reason for a pacemaker is underlying ischemic heart disease. This is a huge concern in diving because an increasing number of recreational diving fatalities each year are attributable to coronary artery disease. Another complicating factor is that diving often takes place in remote locations far from facilities that provide emergency cardiac care.

In your case, it appears that there was no underlying heart disease, and the pacemaker was installed solely to correct an arrhythmia problem. Assuming you have sufficient exercise tolerance, you are exactly the type of individual who need not be disqualified from diving.

One other issue I also failed to address in the feature involves the pacemaker itself. Any device used while diving must be up to functioning in the underwater environment. Therefore, the pacemaker must be rated to perform at least to a depth of 130 feet (39 m), and must operate satisfactorily during conditions of wide pressure changes, such as during ascent and descent.