Letters from Readers
By Fred Bove, M.D., Ph.D.
Q: During a pool training session, my wife had shortness of breath. After the pool session she suddenly became sick. Within two to four hours of the session, she developed flu-like symptoms, including malaise, chills and fever. Although she did not experience other symptoms such as headache, trouble breathing or neurological symptoms, she felt irritation in her lungs and a dry cough. She was OK within 12 hours, except for a bad taste in the mouth. She had asthma in childhood, but had experienced no symptoms for more than 18 years. She is reasonably fit and her physical activity is not limited. Could this have occurred because of dry air from tanks (the air had a definite taste of activated charcoal)?
A: I can only speculate on your wife's problem but will offer some possibilities that might be explored. If she had asthma in the past, she may have reactive airways that respond to the pool water, depending on whether the water contained disinfectants such as Chlorine or Bromine, or to mold in the pool area. She may be reacting to something in the compressed air. If the air doesn't taste right, let your instructor know. There should be no "flavor" to the air. Older compressors can leak fine oil mist into the compressed air, and the oil droplets cause bronchial irritation, fever and cough. Check to be sure she does not have a reactivation of her asthma. Sometimes the environment activates long dormant asthma. Finally, be sure she does not have a heart problem, which can cause shortness of breath.
Positioning an Injured Diver
Q: When a diver is suffering from DCS or other decompression problems, some training programs recommend that the diver be placed with the left side down. Why is this the case? What does this do? How vital is it that this is done?
A: There was an old recommendation based on research done in the 1950s that a patient with air in the veins be placed on the left side down, head down. The idea was that the head down and the left side down position would trap air in the apex of the heart chambers and prevent obstruction of blood flow through the heart. Venous air trapping is not a concern in Decompression Sickness, or in Arterial Gas Embolism (AGE). Some physicians advocate a head down position for a few minutes in victims of AGE, but in some studies, the head down position caused more brain injury, therefore it is not recommended. Most diving physicians favor the supine position. An unconscious victim should have the head turned to the side to avoid the tongue falling back into the throat and obstructing respiration; this should not be done if there is concern for a neck fracture. The victim can be turned partially on either side to protect the airway and to avoid aspiration if the victim vomits.
Antihistamines and Diving
Q: Sea sickness in divers is often treated with Transderm Scop for prevention and an antihistamine for treatment (and prevention). However, these medications often cause impairment of complex motor and cognitive functions, even though a diver might not feel drowsy. Can a diver use non-sedating antihistamines (Claritin and Allegra) for motion sickness?
A: I am not aware of any recommendations for use of the non-sedating antihistamines for motion sickness. I could not find a statement about motion sickness for Claritin in any reference sources. The likely reason is that the antihistamines that are good for motion sickness act centrally on the brain. The non-sedating antihistamines are promoted because they do not get into the brain. They wouldn't be good for motion sickness if they can't get to the area of the brain that is causing the illness.
Round Window Rupture
Q: On completion of a live-aboard dive trip in August, I experienced a "wobbly feeling" like one experiences when one still has "sea legs." However, I still have it today. I have no pain now nor did I have any pain while diving (if something happened, I never knew it). I have no buzzing or "rushing" noises, but I have a noticeable hearing loss in my right ear. I occasionally feel light headed and have had some difficulty with my balance. Medication such as Advil improves my symptoms. I have recently flown and experienced no problems with altitude. Can you offer any thoughts or suggestions regarding this mystery?
A: Your symptoms suggest that you have a round window rupture. This occurs from barotrauma on descent while you are trying to clear your ears. Do you recall any dives where you were forcefully clearing? There is also the possibility that you have an otitis media on the right. This would be caused by fluid accumulation in the right ear, often resulting from ear squeeze. I suggest that you visit with an ENT specialist and ask specifically about testing for a round window rupture. You can read about RWR in a recent Skin Diver article, and there is an explanation on our website. If you go to past Skin Diver articles on www.scubamed.com, you will see a menu that will take you to a description of RWR. You shouldn't dive if you have a RWR. Have the ENT specialist test you before diving again as further diving usually aggravates RWR.