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I’m on my way to get some sun…

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We are excited to welcome The Diver Medic’s Chantelle Newman to Scubaverse. Chantelle will be writing about health and medical matters for Scubaverse readers… in her first post, some important travel advice!

Are you thinking of travelling soon? Are you prepared? Do you have your travel arrangements? Do you know what vaccinations you need? Will you require anti-malarial prophylactic medications, for example, especially in tropical, sub-tropical regions of the World? Perhaps certain antibiotics, which will protect you and treat traveller’s diarrhoea, also known as ‘Montezuma’s Revenge’ when travelling to Mexico and Central America.

Eating & Drinking

Water and food-borne illnesses are particularly burdensome to divers and water sports enthusiasts, and these are often preventable, with just a few simple precautions – such as anything consumed orally. Start by ensuring that hot foods are hot and consumed as soon as possible after cooking. Cold foods should be cold and consumed right after removal from proper refrigeration, especially in the tropics.

Remember that ice cubes may be frozen using contaminated water, in regions of the World lacking chlorination. These present the risk of melting into your frozen cocktail, at the Tiki bar on the beach, thereby releasing germs into your exotic libation when the ice cubes melt.

Even though your drink and container may have been handled in a perfectly exemplary sanitary manner by your waiter, remember always to use a straw, which you have un-wrapped yourself, for sipping those drinks. It’s also advisable to avoid contact with the edge of any glass directly with your lips and mouth in order to prevent hepatitis and notwithstanding when everything else goes well, NEVER DRINK (Alcohol) & DIVE!

Food ought to be served in covered dishes, to prevent access to insects and other bugs and / or parasites. It is safer and more advisable to use sealed and sanitized eating utensils, which you have opened yourself. After your personal use, recycle, thus presenting a perfect teachable moment in countries which do not re-cycle plastic. Share the valuable information of not discarding rubbish, especially non-biodegradable plastics into the Oceans and waterways, consequently helping to save our fragile and precious seas.

Common Sense Guidelines

Avoid walking barefoot on the beach or along the margins of dense vegetation near the beach. The possibility of direct contact of the soles of your feet with the urinary and fecal remnants of rodents and other exotic vermin can produce conditions such as  Leptospirosis, Cutaneous Larva migrans; whilst a large variety of terrestrial and marine organisms may lead to a broad variety of skin rashes, both pigmented and raised, accompanied by swollen lymph glands, fever, and sometimes even more serious generalized medical syndromes and illnesses.

Even so, do not let all of this dissuade you from enjoying your holiday! As long as you follow some basic precautions and common sense guidelines, you have every prospect of experiencing a fabulous vacation and dive trip to a safe region of the Globe, with access to knowledgeable medical personnel.

Just think…it is possible to contract a grave and intractable medical condition from staying home and simply working improperly on your Aquarium with un-gloved hands. Fish-Handler’s Granuloma – caused by a serious germ – Mycobacterium Marinum, may take weeks or months to manifest itself and requires months of medical and surgical care presuming it is properly recognized, evaluated, and dealt with…

Travelling can be exciting but also stressful for some of us, even before we get to go on holiday. Going to another country may be very daunting. Have you packed everything you need? Here is a little help!

What to pack? 

Sunscreen – attempt to purchase sunscreen that is labelled “broad spectrum” as this means it protects you against both UVB and UVA rays. Ensure you get sunscreen with a sun protector factor (SPF) of at least 20.

Insect Repellent – research has shown that products that contain the chemical DEET (N, N- Diethyl-meta-toluamide) are the most effective insect repellents against mosquitoes, ticks, fleas, harvest mites and many other bugs if used correctly. DEET products can be applied onto clothing and skin and are available in sprays, sticks, roll-ons and creams. 100% DEET when applied can be effective up to 12 hours. When using DEET on your skin for the first time, try to use a very small amount, around the size of the tip of your little finger and leave for 5 to 15 minutes. If you develop redness, blisters or itching, then seek medical advice on what other products you can use as you may have a DEET allergy.

Anti-Diarrhoea pills – Traveller’s diarrhoea is the most common illness affecting travellers. Diarrhoea is when there are three or more unformed stools in 24 hours passed by a traveller, accompanied by nausea, bloating and abdominal cramps. Traveller’s diarrhoea is more common in the developing world, where rates exceed 60% compared to advanced countries. A drug used to relieve the symptom is loperamide but it should not be overused. In most countries, it is available generically and under brand names such as Lopex, Dimor, Fortasec, Lopedium, Gastro-Stop, Pepto Diarrhoea Control, Imodium and Lomotil.

Ensure you read the label of any drug before use. Do not take anti-diarrhoea drugs if there is blood in your stools, or if you have a high temperature (check with your pharmacist). Do not give anti-diarrhoea drugs to your child, seek medical advice first. Anti-spasmodics, which are used to treat abdominal cramps ought to be avoided as well as pharmaceuticals such as Motilium – these have recently been removed from the market in many but perhaps not ALL countries and therefore, you are well advised to seek qualified medical assistance, evaluation and treatment.

Rehydration sachets – most travel clinics advise travellers to carry rehydration sachets when travelling in developing countries. As safeguarding, it will not harm you to add some sachets in with your travel kit. Rehydration sachets contain rehydration salts consisting of sugars and salts (anhydrous glucose, sodium chloride, potassium chloride and sodium bicarbonate). They are used to replace body fluids lost as a result of acute diarrhoea.

Anti-malarial drugs  Anti-malaria medications, also known as antimalarials, are designed to prevent or cure malaria. Mosquitoes may cause an inconvenience because of local reactions to the bites themselves and from the infections they transmit. Mosquitoes spread malaria, yellow fever, dengue and Japanese encephalitis. Remember Garlic, Vitamin B and ultrasound devices do not prevent bites. Recommendations for drugs to prevent malaria differ by country of travel and can be found in the country-specific tables of the Yellow Book.

Recommended drugs for each country are listed in alphabetical order and have comparable efficacy in that country. See this link for more information on the country you may be travelling too: www.cdc.gov/malaria/travelers/country_table/a.html 

Antihistamines  Antihistamines are mainly used to treat hay fever (seasonal allergic rhinitis), hives (urticaria), itching (pruritus) and insect bites and stings. They may be used to help reduce feeling sick (nausea) and vomiting. Antihistamines are available as tablets (oral antihistamines), creams (topical antihistamines) and nasal sprays. They work by blocking the effects of a protein called histamine. Many antihistamines are available over the counter at a pharmacy, although some require a prescription. Here are some brands of antihistamines: Atarax, Benadryl, Clarinex, Dramamine, Optimine, Quenalin, Zyrtec, Cinnarizine and Piriton. Some antihistamines cause drowsiness, and once again, excessive alcohol use ought to be avoided.

Diabetics should arrange for an adequate supply of materials and equipment, for blood sugar testing because travellers are likely to experience inordinate delays in obtaining authorized access to such supplies in most countries and ought to bring their own lancets, test strips, Glucometers etc.

Contracting Airborne diseases can be minimized by use of tight N-95 masks, which are the recommended barrier method, particularly on long international flights with prolonged exposure to re-circulated air in the aircraft cabin, which places air travellers at risks for inhalation of particulate droplet spread of viruses and other organisms.

Pain relief medication – Pain is a signal from our body that something is not right. It can be due to a physical injury or some kind of illness. Most types of physical pain can be treated with pain relievers. Over-the-counter medications are good for many types of pain. Analgesics (pain relief) such as acetaminophen (Tylenol) or paracetamol are used to treat mild or moderate pain and can also be used to reduce temperature in fevers. Commonly prescribed medication such as codeine can be used alone or in combination with other analgesics for stronger pain, such as dental pain, menstrual pain or migraines. Non-steroidal anti-inflammatory drugs (including aspirin) are used to reduce pain associated with inflammation, such as sports injuries, and can also be used to relieve fever. Always seek medical advice before taking any off the shelf medication. What a lot of people do not realise is that their prescribed medication may not be suitably compatible when being used with certain over the counter medication and may cause serious health issues.  

First-Aid Kit – The Lifesystems World Traveller Kit is a very comprehensive first-aid kit and has the following items included in the kit: Primary Care Leaflet, Fabric Plasters, Woven Bandage, Crepe Bandage, Triangular Bandage, Gauze Swabs, Paracetamol, Loperamide, Ibuprofen, Low Adherent Dressing, Medium Dressing, Eye pad Dressing, Fabric Dressing Strip, Wound Closure Strips, Zinc Oxide Tape, Micropore Tape, Duct Tape, Scalpel, Hypodermic Needles & Syringes, Forehead Thermometer, Antiseptic Wipes, Scissors, Tweezers, Safety Pins, Powder Free Vinyl Gloves. The Lifesystems Traveller Kit is the basic kit without the Needles and Syringes. However, going to your local supermarket or pharmacy you can make your own kit up with the list provided. Check out some first-aid kits and travel product available by going to www.lifesystems.co.uk and for the US and Canada www.adventuremedicalkits.com.

You might want to add products for marine life injuries such as 5% Acetic acid (Vinegar is roughly 4%-8% acetic acid by volume) for Jelly fish stings. Unfortunately, in the real world treating a jellyfish sting by urinating on it may, in fact, cause someone even more pain, rather than relief. Urine can, in reality, aggravate the jellyfish’s stingers into releasing more venom. Another item that may help is a heat pack. In the event you don’t have hot water on hand using a heat pack stored in your first-aid kit will help relieve some pain from a Stingray or Stonefish injury. Ultimately water heated up to a temperature of 40 to 50C but limiting the contact to prevent scalding burns, is the best treatment for Sea urchins, Devil, Scorpion, Stone fish and Stingrays.

Certain marine venoms and toxins, may be treated with anti-venoms, which may not be available everywhere. Australia and the Great Barrier Reef coastal regions have some of the best and most experienced and skilled emergency rescue personnel as well as doctors, nurses and medics, who implement standardised protocols for rapid triage, evacuation and possible expedient treatment including hyperbaric oxygen therapy for Scuba Divers suffering from a variety of medical conditions associated with diving.

Travel Insurance – this is the most important product when travelling, never leave home without it! What travel insurance does, of course, is to prevent you from financial disaster if something actually does go wrong. There might be rare cases where someone without insurance gets air-lifted out at sea, but without insurance your costs for possible repatriation may cause you to have to re-mortgage your house… but honestly, your chances of being killed by a falling coconut are probably greater in the long run.

Travel safe always! 

Find out more at www.thedivermedic.com.

Chantelle Newman is a diver, instructor, publisher and a Women Divers Hall of Fame honouree in 2016. She is the founder of The Diver Medic - a Medical Training Company - and the AMTECS charity. Find out more at www.thedivermedic.com and www.amtecs.global.

Dive Training Blogs

Deptherapy returns to its Roots – Part 4

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Join Richard Cullen from Deptherapy for part 4 of his Blog about the charity’s recent expedition to Roots Red Sea, El Quseir, Egypt.

We are all back to the house reef today; the weather is lovely, the sea calm, the tide will soon be slack, so a great day’s diving in store.

A few yards away from the beach dive centre, on the Roots’ beach is their day time restaurant. It is where we take lunch when diving, and there is a continual supply of tea, coffee and soft drinks, and some marvellous lunches.  There are also male and female toilets and a fully accessible toilet for those using wheelchairs.

A few thoughts around working with amputees and those who have paraplegia. Firstly amputees – the part of the limb remaining is known as the ‘stump’, and we have worked with a substantial number of bilateral leg amputees (both legs), single leg amputees and single arm amputees.  The level of amputation can be above or below the knee or elbow, or through the knee. In one case the amputation was transpelvic and in another through the shoulder.  Some like Chris Middleton have one leg amputated above the knee and one below the knee.  This is rare, but each type of amputation offers a different challenge.

Many people think the amputation is clean and the skin neatly tidied up after surgery. Although that occurs in a few cases, in most the stump is rather rugged.  Elasticity of the skin around the stump is often exceptionally poor and can easily be damaged.  Some of our beneficiaries, as they were injured as young men, suffered from heterotopic ossification – this is where the bone tries to grow after amputation and often penetrates the skin, resulting in further surgery being required to cut back the bone and of course the stump needs to be restitched.  Very often stumps are sealed with skin from elsewhere on the body.

Swars kitting up

Few divers have never experienced a graze or cut underwater but such an experience for those with amputations can have serious consequences.  Stumps are more likely to get cut or grazed as the skin is so tight. We all know that there are lots of infections in seawater and if infected the cut or graze can cause very serious problems for the amputee.  Tailored wetsuits are one preventative measure, as are daily stump checks, making sure there is no damage and if there is, applying medication and or protecting the stump.

Those with paraplegia provide an additional challenge, not being able to feel their lower limbs they can easily damage them, so cuts, abrasions, and even sunburn can go unnoticed.  Donning a full-length wetsuit can be a challenge as toes can easily be broken and hairs pulled out of legs.  On the Deptherapy Education Professionals’ Course we show how to fit a wetsuit properly.

In recent discussions between our dive medicine advisor Mark Downs and our VP Richard Castle, who is a consultant psychologist, we have been looking at areas for further medical research in terms of diving for those with disabilities.  One area of suggested study is thermoregulation. The theory is that those with amputations and those with paraplegia suffer more with the cold as their body is unable to regulate heat. Certainly, in Corey’s case, he feels the cold more quickly than those diving with him. Chris Middleton can feel the cold more quickly than others with amputations but that may well be that Chris is muscle and bone where, to put it nicely, others have a more substantial covering.

Some AMEDs and Dive Referees will not sign off amputees as being fit to dive. That is their professional opinion and although we can show that even triple amputees are more than capable divers, capable of progressing to Rescue Diver standard even, they still refuse to sign them off. Last year Oli and Mark invited us to speak at the UK Annual Hyperbaric Medicine Conference in London where Josh Boggi, the world’s first triple amputee Rescue Diver and a Deptherapy beneficiary spoke about how amputees can become safe and successful divers.

Corey, Swars and Michael

For Corey, he wears full leg coverings and diving boots in the water; as he cannot use his legs there is no purpose in wearing fins.

Another point around amputations is that most of the general population make an assumption that a leg amputation is the result of a traumatic incident.  That is incorrect; by far the majority of leg amputations in the UK are the result of diabetes. Those whose legs are amputated as a result as diabetes are more likely to have poor healing of the stumps.  This also presents an issue of comorbidity that may well result in an AMED or Dive Referee declining to sign them off as ‘fit to dive’.  If signed off you would need to be very aware of the health of a stump; I certainly would not take someone with an open wound diving and the fact that they will be on medication for the diabetes.  You also have to be aware that they may well be on other medication to manage pain etc.

You need to be very clear with those who have paraplegia and other conditions that they must let you know if they start to feel cold.

Managing air – diving just using your arms for propulsion can, for many, be very tiring and a considerable amount of effort is required.  This, plus other factors, may result in enhanced air consumption by the diver.  This may increase if a current is encountered, even one which most divers who have use of their legs and dive with fins would not cause the least concern.

Within Deptherapy we very much work on the ‘rule of thirds’ – a third of your air to get you down and to see what you want to see, a third to get you back to the surface and a third in reserve.  This in most circumstances will ensure no ‘low on air’ or ‘out of air’ situations.

Say if we have 210 bar in a cylinder that means 70 bar out, so turn on 140 bar, 70 bar to return and to the surface so we should have 70 bar reserve at the surface.

We also work our students through SAC rates and looking at the air consumption of others in their team.

Checking the team’s air frequently during a dive is stressed to all our Pro team.

Keiron became very engaged with this concept as the result of the online RAID study for his Master Rescue Diver.

On expeditions we normally dive in small teams, a DM/TDM with three programme members.  They work as a team and understand each other’s air consumption. Of course, they also dive as buddy pairs.

Today offered perfect conditions for diving, and Keiron, Moudi, and this time TDM Oatsie were kitted up and in the water within minutes.

Pause for thought… those with paraplegia will have different toileting arrangements to those who do not have the condition. This also applies to some who have suffered traumatic limb loss.  They may use catheters for urination, some may have Stoma bags etc.  This all has to be planned into your dive schedule to ensure the safety and comfort of your student.  For young people talking about these very personal arrangements may be very difficult.  Those with Stoma bags may be embarrassed by people seeing them.  This is another part of seeing beyond the injury or condition – it is the person inside that you are dealing with.

Corey on the Roots House Reef

So, Corey, Michael and myself were joined by Swars.  Swars, although he joined the DM programme at the same time as the other guys, because of work commitments was unable to join us in September 2019 at Roots where we ran a DM introductory programme alongside the crossover of our Pro Team to RAID.  Swars has become a really good mate; he is a great diver, with an engaging personality.

Michael and Oatsie were a known quantity to me as they had been on the September 2019 programme and both have travelled to my home dive centre Divecrew in Crowthorne, Berkshire, to work on courses, pre-COVID.  During COVID Michael and I, plus a few of the guys from Divecrew, have dived at Wraysbury together.

Just as Roots is our base in Egypt, Divecrew is our base in the UK, and through this relationship, Martin (who owns Divecrew with his wife Sue) is one of our trustees. Together they have established a centre where pretty much 100% of the Pros are Deptherapy Education trained.

I asked Swars straight away to brief a dive for Corey. I gave him the briefing slate, a few tips and then ten minutes later he came back with a perfect briefing… and I mean perfect.  So, a great briefing under his belt; now to watch him work with Corey in open water. He looked the Pro, he knew what he should be doing, he understood his role. We assigned Michael as Corey’s buddy and said he would lead the dive. I was there to assess the TDMs and supervise very closely Corey’s skill demonstrations.

Again, it comes as no surprise that many beneficiaries in Deptherapy can move straight into dive management, as several were NCOs, as was Swars, and they are used to briefing individuals and teams.

We had decided that we would mix up the dives required to complete Corey’s OW 20 RAID dives with some general diving as trim and swimming arm action are all important. We also needed to concentrate on spatial awareness.

We agreed a signal for horizontal trim and Swars reinforced the swim stroke that Corey needed to do to get propulsion.  Every time Corey moved out of horizontal trim Swars was there reminding him about trim and reminding him of his swim stroke.

The Roots’ House Reef is amazing – at a metre you encounter a shoal of black Damselfish, at 3 metres a shoal of Unicornfish, there are Butterflyfish and all manner of other fishes in great profusion.  The coral is in great condition. It really is a place of beauty and tranquillity.

Oatsie and Swars relaxing by the Roots pool after a long day

Although we had problems getting Corey underwater again, once we got him in skill demonstration mode his anxieties disappeared.  We then took him diving. Steve Rattle, the owner of Roots joined us and was taking photos that provide a great record of the week’s diving.  Steve commented on the quality of Swars and Michael’s supervision and control underwater of Corey and gave them feedback on how impressed he was.

Meanwhile on the RAID Master Rescue Course, Oatsie who was in the same Regiment, same Platoon and Section as Keiron in Afghanistan was more than willing to be a very uncooperative victim for his brother-in-arms.  I think Keiron gave Oatsie some feedback about this!

For me this was a hard week, combining running the RAID OW 20 for Corey but also the assessment of our three TDMs.  A week underwater but no opportunity to dive for myself.  People often think Deptherapy Expeditions are holidays for the Dive Team; they are not, it is hard work and I mean hard work.

Tomorrow is Day 4 in the water Day 5 of our trip. We are on the House Reef again, and things are starting to come together. Join us back here on Monday 26th October…

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WIN an XDEEP Radical Frameless Mask!!!

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Yes, XDEEP have now officially called their excellent frameless mask the ‘Radical’, and in this week’s competition, we’ve got another one to give away in our latest competition!

The XDEEP Radical Frameless Mask is a large single lens dive mask with a soft silicone skirt and traditional strap. The frameless design brings the lens closer to your face so you get a wider FOV and less internal volume that you have to equalise and clear. The larger nose pocket makes the mask more comfortable and easier to equalise, even with thick gloves.

To be in with a chance of winning this awesome prize, all you have to do is answer the following question:

In a recent post on Scubaverse.com (which you can find here), we reported that you can join Reef-World and a panel of industry experts at the first ever Scuba.Digital for an open discussion on green tourism and how this might be shaped by a post-corona world. But when can you join Reef-Word’s Sustainable Diving event on the main stage of Scuba.Digital 2020?

Is it:

  • A) 3pm BST on Friday 23rd October 2020
  • B) 3pm BST on Saturday 24th October 2020
  • C) 3pm BST on Sunday 25th October 2020

Answer, A, B or C to the question above:

Nautilus Diving XDEEP Frameless Mask October 2020

Competition
  • Enter the country you live in
  • Terms and Conditions: This competition is open to all visitors to www.scubaverse.com except for members of the Scubaverse team and their families, employees of Nautilus Diving and their families, or XDEEP and their families. A valid answer to the competition’s question must be entered. If no valid answer to the competition’s question is entered, your entry will be invalid. Only one competition entry per entrant permitted (multiple entries will lead to disqualification). Only one prize per winner. All prizes are non-transferable, and no cash alternative will be offered. In the event that the prize cannot be supplied, no liability will be attached to www.scubaverse.com. When prizes are supplied by third parties, www.scubaverse.com is acting as their agents and as such we exclude all liability for loss or damage you may suffer as a result of this competition. This competition closes on 02/11/20. The winner will be notified by email. The Editor-in-Chief’s decision is final.

  • The following fields are optional, however if you fill them in it will help us to determine what prizes to source in the future.

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