DAN Medics and Researchers Answer Your Dive Medicine Questions
Q: I am about two and a half months postpartum with no complications and have received clearance from my physician and a dive specialist to resume diving. Are there any potential issues or complications associated with breastfeeding and diving?
A: The combination of diving and breastfeeding is a topic of concern for mothers eager to return to diving while ensuring their infants’ well-being. Diving is generally deemed safe for breastfeeding mothers, but you should postpone it if you have an active breast infection or inflammation. Nitrogen uptake is not a concern due to the offgassing that occurs after diving and the fact that feeding an infant takes place at ambient pressure.
There are two things to be concerned about when breastfeeding after diving: dehydration and constrictive straps and gear. Diving and other activities can result in dehydration, which can potentially impact milk production, so it’s important to maintain optimal hydration. Breastfeeding mothers should also avoid using buoyancy compensators with tight chest straps. Too much pressure could lead to painful, swollen breasts or leaking milk during or after diving.
While you can dive while breastfeeding, we encourage everyone who plans to do so to consult with their obstetrician gynecologist and DAN’s Medical Information Line for personalized guidance about any lingering concerns.
— Shannon Sunset, NCPT, AEMT
Q: I am a dive instructor, and I had some ear pain while descending with a class. I pushed through it to stay with my students, but more than four days later my ears still feel like they have water in them. Should I see a doctor, or will this heal on its own?
A: If you are symptomatic following a dive, DAN always recommends that you seek a physician’s evaluation, preferably by a doctor trained in dive medicine. The symptoms you describe are often the result of middle-ear barotrauma (MEBT), which is a pressure injury typically caused by inadequate or forceful equalization.
Negative pressure in the middle ear causes micro-tears, which lead to the release of blood and serous fluid. This fluid release is what typically causes the feeling of fullness or water in the ear. If you experience MEBT and feel the urge to forcefully equalize or clear your ears, don’t do it. Adding pressure to a pressure-injured area will likely exacerbate the injury and can cause extended healing time.
MEBT with no additional injuries usually heals on its own in about four to six weeks with minimal to no intervention. In some cases, however, a rupture of the tympanic membrane (eardrum) can accompany MEBT. Anti-inflammatory and decongestant medications may help relieve your symptoms. A physician’s evaluation will verify whether you need additional treatment or antibiotics. If your physician refers you to an ear, nose, and throat (ENT) specialist for consultation, any ENT doctor can evaluate and treat these injuries without needing specific training in dive medicine.
It is your responsibility as an instructor to be an example of safe diving practices, including teaching students that it is OK to slow down, especially on descents and ascents. If anyone has difficulty, it’s important not to push through it. A diver may need to ascend to facilitate equalization before attempting to descend again. If it’s still unsuccessful, abort the dive.
MEBT accounts for about 40% of cases reported to DAN, but the dive community can help reduce those numbers by teaching others how to avoid those injuries.
— Ryan Gan, NREMT
© Alert Diver — Q2 2024