Author Archive

Diving Doctor: Can High Blood Pressure Affect my Ability to Dive?

Tuesday, April 5th, 2016
Beta blockers and diving. Does high blood pressure really affect someones ability to dive?

Diving Doctor: Why Do I Get Nosebleeds After Diving?

Wednesday, February 24th, 2016
nosebleed after a scuba diving

Shutterstock

Nosebleeds After Diving
Are they normal, or should I be concerned?

Q: After my last dive, I got a nosebleed. What could have caused this?

A: When I was a junior Navy officer my recreational dive buddy was the unit’s supply officer. He warned me that nearly every time he came up from a dive, there would be blood in his mask and advised me not to be concerned. He was right, but despite making dozens of dives with him, watching my dive buddy clear blood out of his mask as soon as we reached the surface was always a bit unnerving.

The source of my dive buddy’s blood was likely his sinuses. Polyps and inflammation are common in the sinuses. In fact, mucous plugs within the sinuses can cause sinus squeezes, resulting in very painful headaches during and after a dive. Many people suffer from chronic sinusitis, which leaves the lining of the sinuses inflamed and friable. The pressure changes from diving can injure this cell lining, and the result is bleeding from the sinuses. The other possible cause of a bloody nose can be the lining of the nose itself. Drying out the tissue lining the nasal passages can make it susceptible to bleeding from the slightest trauma. Something as subtle as pinching the nose during ear equalization can result in a nosebleed.

If the nosebleed is a one-time event, I would not be too concerned. If it becomes frequent, I would recommend having an ear, nose and throat surgeon look into your nose and sinuses with a special instrument in order to identify the source of the bleeding.


James L. Caruso is a 30-year veteran of the U.S. Navy, serving as ship’s doctor, undersea medical officer and flight surgeon. His experience includes a fellowship in Diving and Hyperbaric Medicine at Duke University Medical Center; today he is Denver’s chief medical examiner.

Diving Doctor: Can You Dive While You’re Pregnant?

Friday, December 11th, 2015
Illustration of Pregnant Mother

Ask the Diving Doctor: Can you dive when you’re pregnant?

Shutterstock

Question: My husband and I have been looking forward to an upcoming dive trip for months. However, I just found out that I’m pregnant with our first child. Should we change our plans for diving?

Answer: This is a very common question that diving doctors address routinely. It might surprise you to learn that the patent answer of absolutely no diving during pregnancy isn’t based on sound medical research — even though it is the right answer!
The developing fetus is not protected from nitrogen bubbles, so there is at least a theoretical risk for injury.

However, most of the animal experiments focusing on this matter have not conclusively shown that exposure to breathing compressed air at depth results in any increased risk of birth defects or pregnancy loss.

In fact, a pregnant woman suffering from another kind of gas poisoning, carbon monoxide, must absolutely be treated in a hyperbaric chamber because the fetus is more sensitive to the toxin than Mom. Of course, Mom breathes oxygen during the treatment.

The best reason for avoiding diving while pregnant actually has psychological roots. Miscarriage is a common enough occurrence whether or not the mother is participating in activities such as scuba diving.

There is the potential risk for self-blame and anguish on the woman’s part if she thinks that her decision to go scuba diving resulted in any negative outcome for the pregnancy, even if that was not the case.

My advice is to snorkel and swim but avoid breathing compressed air at depth during the pregnancy. However, if a woman finds out after a dive trip that she was pregnant while diving, there is absolutely nothing in the medical literature that would warrant significant concern or support elective termination of the pregnancy.


James L. Caruso is a 30-year veteran of the U.S. Navy, serving as ship’s doctor, undersea medical officer and flight surgeon. His experience includes a fellowship in Diving and Hyperbaric Medicine at Duke University Medical Center; today he is Denver’s chief medical examiner.

Diving Doctor: Can People with Depression Dive Safely?

Wednesday, October 21st, 2015
Depression medication and diving

Shutterstock

Feeling Blue

Can a person being treated for depression dive safely?

Q: I TAKE AN ANTIDEPRESSANT. WHAT’S THE LATEST THINKING ON THESE MEDS AND DIVING?

A: Depression can have a profound effect on a person. Today, medications to treat depression are frequently prescribed.

Many years ago, a diagnosis of depression that was severe enough to warrant treatment with prescription medication would be grounds for a from recommendation of no diving until complete recovery is maintained of medication. The antidepressant medications at the time had significant side effects, particularly drowsiness.

Fast forward to the 21st century: Today, newer prescription medications are available to treat depression, and there is a much lower threshold for physicians to prescribe them. The side effects are less severe than with previous medications, and treatment of routine mental health illnesses is not solely the scope of psychiatrists. Physicians who have divers as patients — including yours truly — have somewhat softened our stance on the issue.

Not every diver who is taking an antidepressant medication should be cleared for diving, however. Some patients with depression have cognitive impairments — such as difficulty focusing on details and keeping a clear mind — and making important, quick decisions is difficult or impossible for them.

Others who do not have these deficits are able to handle even the toughest of situations during a dive. There are also individuals who are being treated with antidepressant medication who do not have the typical symptoms that characterize depression.

Any diver who is being treated with antidepressant medication should have a frank discussion with his or her physician to discuss the potential risks involved. If there is any doubt about the diver’s ability to make quick decisions and appropriately handle emergency situations, any diving activity should be delayed until complete recovery of medication is maintained.

James L. Caruso is a 30-year veteran of the U.S. Navy, serving as ship’s doctor, undersea medical officer and flight surgeon. His experience includes a fellowship in Diving and Hyperbaric Medicine at Duke University Medical Center; today he is Denver’s chief medical examiner.

Dive Doc: Why Are My Ears “Full” After Diving?

Saturday, September 19th, 2015
Ear Fullness After Diving

Shutterstock

Scuba’s Diving Doctor explains ear fullness and how post-care tips.

Question: My ears are always “full” after a dive. Do you have some tips for post-dive care?

Answer Perhaps second only to the lungs, the ears are extremely important organs when it comes to diving. The inability to equalize pressure between the middle ear and the environment will keep you on the surface every time. Because the outer ear is exposed to the environment, infections are quite common.

The usual reason for ear “fullness” after a dive is inadequate pressure equalization during the dive. You might be equalizing enough to make it through the dive, but the eardrum might be undergoing mild trauma that will persist as pain or fullness after surfacing. The best way to keep your tympanic membranes happy is to begin gentle equalizing maneuvers immediately after leaving the surface, and clear regularly and frequently during a slow, gradual descent. It’s a good idea to begin equalizing on the surface and assessing if all feels well, even before experiencing any pressure changes. Taking over-the-counter decongestants prior to the dive has been shown to be effective.

Infection is another major issue. Certain bacteria thrive in wet environments and can cause a serious and painful infection known as otitis externa. Antibiotic drops and abstinence from diving are required once infection is present. Prevention includes good ear hygiene such as avoiding any scratches or other breaks in the skin surface lining the ear canal (earplugs and cotton swabs frequently cause trauma). The use of weak acetic acid (vinegar) solutions before and after diving might decrease the risk of infections by eliminating the bacteria and drying the canal.

James L. Caruso is a 30-year veteran of the U.S. Navy, serving as ship’s doctor, undersea medical officer and flight surgeon. His experience includes a fellowship in Diving and Hyperbaric Medicine at Duke University Medical Center; today he is Denver’s chief medical examiner.