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Diver, diving



What's the similarity with equestrianism, croquet and diving? It's a hard one I know. OK then I'll tell you. They are the only sports where the 2 sexes perform on an equal level. I know diving is not a competitive sport on paper, but in reality, we all know the passion for what we do can spill out into something akin to a hard hitting contact sport, especially when space on the boat is limited and there's only so much vinegar left in the First Aid box after a jelly attack. But where croquet is a battle between getting balls through hoops and arthritis and in equestrianism the horse seems to do all the work, the battle of the sexes in diving is very different. I hate to say it, but when it comes to diving medicine and the fair sex, sometimes things are loaded against them. So let's focus on what a diving doctor has to think about when confronted with the medical issues of the female diver.
Ocean Leisure
The first thing is the most obvious and yet is the most frequently asked question I get when it comes to a lady diver... "Can I dive if I am pregnant?" Well the short answer to this is sadly "no". This is one of those burning medical ethical moot points that founders on theoretical chances. No one has ever done any research on the pregnant human diver and DCS because it wouldn't even get through the door let alone in front of the medical ethics committee. They may have bunged a few goats and pigs into the depths but science has learned that animal model results don't always transfer to humans. So here's the deal with diving and pregnancy. On any dive, whatever the depths, there is always a risk of getting a bend. Nitrogen has an affinity for nerve tissue, especially the spinal cord. In full grown adults there is always a bit of reserve ability if you were to get a bend, so a paralysis can often get better with little long term effects. But imagine the situation if a developing foetus were to get a bubble in the spine. If the mother had no symptoms then it could easily go untreated with potentially disastrous effects at birth and later in life. The parents would never forgive themselves. So I say to pregnant mothers, "please don't dive", just wait the nine months. You'll sleep a lot better. I'm afraid I also say the same for those trying to get pregnant too. There are un-researched risks not worth taking. However this does throw up the situation when a diver has a good long trip with plenty of dives on a liveaboard, gets home and that little test strip turns blue. What then? Well, I always suggest that she doesn't worry, the risks are minute, but if she has any sign at all of DCS, then get treated as soon as possible. If there are any concerns later and she just needs peace of mind then an ultrasound is a good way of confirming developmental normality.
So that's the early days of a child's life, let's move on to when the little scamp gets born. Who gets to hold the baby? I've always been a good sensitive Dad myself and persuaded my partner to hold the lad whilst I do the first dive. By the time it's the second dive she's too tired to go anyway so I get to go again. Enough sexism! In reality the only issues here are when to go back in after giving birth. If it is a normal vaginal delivery then effectively straight away, but if it is a Caesarian then give it at least 4 weeks as there's been a cut through the abdominal musculature which needs 4 to 6 weeks to get back to full strength. This is more of a saving your buddy issue. You must always be in a good enough physical state to do this and post operatively this is our accepted time for recovery to be able to haul your euphoric husband up from the depths and onto a boat with a shoulder push if there were problems. So let that wound heal nicely.

Breastfeeding is something I'm asked about a lot. There is no problem for the lactating diver at all in going back underwater. However if you are new to cold water dives, have never worn a drysuit, then don't wait until you have milk engorged breasts to give it a go for the first time. A drysuit squeeze could easily be messy and painful if it occurs. So I suggest, staying in a wetsuit, expressing your milk into a bottle and handing it to your husband to hold on the jetty as you shout directions on when to use it as he disappears into a speck in the distance, is the best thing to do. And whilst on the subject of breasts, what about implants. You know the thing I mean. Silicone filled sacs to give you that Baywatch look. Well the debate of implants and pressure was brought to the news years ago when a couple exploded on air flights. But the reality here is that the silicone or water filled ones are uncompressible like any other fluid filled cavity in the body. So, if you are debating spending a few dollars with the plastic surgeon, it shouldn't affect your diving. That old wetsuit may not fit anymore though.
Denney Diving
On a more serious note there is a lot of talk amongst the diving medical fraternity about the other thing that the moon seems to affect apart from tides. Periods. It is becoming increasingly more obvious that women seem at greater risk of getting a bend if they are diving around the time of the month. There has been a lot of research in the UK as to why this may be, however the results are not yet fully forthcoming. Every female diver with a hit in the UK has been asked to fill in a form stating whether they were menstruating at the time. However I still await the full results of this. But having treated over 100 female divers with DCS in the last couple of years I would say that about 1 in 4 say they were 'on' at the time. This is where stats take over. Most UK divers go for a weeks holiday diving, and so the chances of it being the same week as a period is 1 in 4 as well. So does that make it an even chance for a hit. I'll let the mathematicians figure that one out. But as to why, it could be that a fraction less blood volume may make a difference. It could be related to hormonal changes. It could be something to with the bloods clotability. But the jury is out at the moment. My personal belief, from always asking a female diver with a certain bend who was diving well within tables is that having a period seems not the only factor but that which tipped them over the edge. Often she has had a bout of diarrhoea, been a little dehydrated from heat and a hangover and struggled with a heavy dive. So it is probably cumulative with other factors. There are other inconveniences with diving and being at that time of the month. You don't need me to tell you what. In fact one of my first ever e-mail enquiries was "can I go shark diving if I'm menstruating?" Well the answer is a resounding "yes". There has never been a shark attack based on this as a reason. Urine, yes as it's a fear and distress response which can attract sharks, but never a period. But where you have to look out is with bull seals in their breeding season. This is a true story, as my mate was there at the time. No, not the surprise party, dog and butter. An Italian girl was snorkelling in Baja Mexico. She was 'on' at the time and a bull seal got the scent of her underwater. The amorous seal came up from the depths and then grabbed her with his flippers. He then took her down to 10 metres in a seal-like bear hug. A passing diver then happened upon the scene and after quickly realising who was the protagonist of this odd tryst, saved the seal from being stabbed in the eye with a snorkel. On the surface the young girl was evacuated for shock and embarrassment. Of course there is a way of stopping the period if it is expected when you are halfway through a dive trip. A drug called norethisterone if taken three times a day can delay a period for as long as you take it. So it could be used for a week if necessary. This is for those not on the Pill. For anyone who is, then simply take the following pack straight after the one just finished, without the 7 day break. This is called tricycling your Pill and you can do it for a maximum of 3 months worth of tablets.
Catfish Dive & Safari
One of the other issues of gender differences and the deep, is to do with body fat ratio. For a standard Body Mass Index (a ratio of height to weight) a woman has more fat to muscle than a man. The effects of this make little real difference to a dive but ladies must remember that nitrogen does also have an affinity for fat. So if there are circumstances where nitrogen loading may be higher, such as an energetic dive. Or where offloading may be slower, like in dehydration, then ladies beware. Most tables are based on using healthy, extremely fit naval "volunteers" who, by dint of the job, were male. So, in any circumstance, where you may affect on and off gassing, then always have a safety stop. Give it as long as you can on surface interval time and another little tip too try to leave that really hot shower straight after a dive to later in the evening. The hot water causes peripheral vasodilatation, so more blood flows to the skin and away from other organs. This can reduce the nitrogen off gassing from these organs and potentially create a bend. I'm not saying that a woman is more likely to have a hot bath sooner than a man, but experience tells me that the guys tend to sit around swapping "who saw the bigger shark" tales with a beer more than the opposite sex straight after surfacing.

Other issues I have written about before in these pages: Women in a state of dehydration are more likely to get a bladder infection that can ruin a liveaboard trip when you are hundreds of miles from a doctor. So it's a good idea to pack some antibiotics like cephalexin or trimethoprim for the trip if you are prone to this annoying infection; With the Pill again, there is a tiny chance of increased likelihood of a deep vein thrombosis if you are taking a certain sort. These are called third generation Pill so if you are going on a long flight to your destination take an aspirin. In fact, I know that some diving doctors often take an aspirin before a dive as one of the things a bubble can do is cause increased clotting around it's surface. So if you have a family history of DVT and are on the Pill it may be wise to take a 75mg tablet daily with any intense diving. Check with your local diving doctor.

The point of this article is not to crudely exploit any gender differences in a demeaning way. Probably the best three Divemasters I have ever had have been female. I find them more understanding and more sensitive to the beautiful nuances underwater. Like the way the light falls on a coral head, or the symbiosis of tiny clown fish and anemones. Isn't that what it should be about really. Long may they reign in the deep!
Ocean Leisure

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