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by Amanda White
Header photo by Matthew Coutts. Annika diving at the Mokohinau-Islands.
As a way to empower the next generation of divers, Global Underwater Explorers (GUE) created the NextGen Scholarship, which provides a year of training and other benefits to deserving divers on their quest for excellence.
We are excited to announce that the first-ever NextGen scholarship recipient has been selected. Annika Andresen from New Zealand will be our 2019-2020 NextGen scholarship winner! Annika is 25 years old with a Masters of Architecture, where she studied the role architecture plays on the connection people have with their environment. She has also worked on dive boats, is a PADI open water dive instructor, and currently works for Blake, an environmental trust, as an environmental educator.
InDepth caught up with Annika to learn a bit more about her and how this scholarship will help her achieve her goals.
We got to know you a little bit through your video and application, but we have a couple more questions to get to know you a little bit better and share your story with our community. What influenced you to pursue diving, and how old were you when you started?
I grew up sailing around the east coast of the North Island on a little 9-meter (30-foot) yacht with my family— my parents and two brothers. We were always around or in the water, and my dad let us have a go on his dive gear when we were seven to see what it was like to breathe underwater. We didn’t really go under the water, we were just on the surface, but as we got older we joined him on more of his dives. It wasn’t until my first year of university where I got enough money to do my open water course in 2013, but it feels like I have been diving my whole life.
What attracted you to diving over other water sports?
Just being closer to everything and being fully immersed. If I was snorkelling, there is only so long I could hold my breath, so I really wanted to learn how to dive so I could actually stay submerged and watch the different marine life swimming around and become part of the environment. That’s kind of what started it off. I had a good friend in the Auckland University Underwater Club who was also interested, so we did the course together. After my first year at University I wanted to get a summer job that involved something to do with the ocean. I emailed Kate Malcolm at Dive! Tutukaka, asking if there were any jobs working on the boats as crew. On my trial we saw dolphins almost every day, got to take customers in the water to experience the marine life, and were teaching everyone about the importance of our marine environment. I couldn’t believe this was a real job. I moved up to Tutukaka, where I got to go out to the Poor Knights Islands every day, and on my days off, I was able to gain more diving experience, joining the dive masters with their group. I think it was then when I really fell in love with diving. I was like, “This is what I want to do. This is what I want to fully throw myself into and learn as much as I can.”
How has your connection with the underwater world influenced the rest of your, I guess, so to speak, dry land life?
At the moment, it’s very much influenced… well, I guess the underwater world has always influenced my life. I remember at primary school, every time I was drawing something, it was something to do with the water. My teachers said, “Oh, you’ve got to expand and draw other things,” but that’s all that I wanted to do. In intermediate, we were doing a project about the ocean and I remember sitting down with the teacher and saying, ‘“Instead of just reading about it, why don’t we actually take them out to Goat Island (New Zealand’s oldest marine reserve)?” So somehow, I convinced my teacher and parents to take my whole class to my teacher’s house who had a pool. During one afternoon, we taught them how to snorkel, going through how to put on a mask, and snorkel, and how to be comfortable in the water.
Then the following week, we went up to Goat Island. My dad and I guided my class around the bay, pointing out all the different species while my mom rowed our dinghy (that had a little glass bottom) for the three people that didn’t like being in the water. Everyone was really excited to see the fish. In my architectural degree, all of my designs always included water or a connection to the environment. One of my favorite designs was a marine rehabilitation center sited in the Bay of Islands for different marine species. So I guess everything has always been influenced by the underwater world…for me, it’s my home. I always feel very calm on the water and then diving just ramped everything up a lot more. Now whatever I do seems to be associated with or to revolve around diving or anything to do with water.
Do you participate in any other water sports besides snorkeling and swimming?
Yeah, I love sailing. I do a lot of sailing. Normally every Friday night, I will go down with a group of girls and we do rum racing. So if you win the race, you get a bottle of rum, and then there’s other sailing regattas during the weekend if I’m not diving. If I can’t go diving or sailing, normally the weather is perfect for surfing. My car always has a combination of dive gear, surfboard on top, my wet weather gear, and a towel. I also really like free-diving as well because it’s just very different from scuba-diving, and there are some species I don’t want to scare off with my bubbles.
We saw from your video that you work for Blake. How did you get involved in conservation?
I have always been interested in volunteering for conservation projects and encouraging others to do the same. I was very lucky. In 2016-2017, I was chosen for Blake’s ambassador program where I worked with Antarctica, New Zealand, and the Antarctic Heritage Trust. Through the program, I was able to go to Antarctica and work with the team down there to conserve Sir Edmund Hillary’s Hut.
When I finished my thesis last year, BLAKE approached me over the summer and asked me to help kickstart a new project. This has been the pilot year for NZ-VR, where we have a roadshow traveling to different schools in Auckland. We have 60 VR headsets and spent the year teaching four classes a day, ranging from 10-year-olds to 15-year-olds, about our underwater environment. We put a headset on each student showing 360° footage from New Zealand Geographic that is taken all around New Zealand, comparing and contrasting environments from the very pristine northern parts of New Zealand to degraded environments from human impact that are closer to human populations.
By the end of the year, my colleague and I will have taught 20,000 students in the Auckland region. Hopefully, depending on funding for the project, we want to get two more educators and double the amount of headsets to reach twice as many students and further expand into the surrounding regions. It’s a really awesome organization where they were able to just give me the support that I needed to really push the idea of learning through experience. This is really exciting, as this was what my thesis was based around, and I can combine my passion for the underwater world and creative thinking towards conservation.
Wow. What an inspiring job to have.
Yeah, it’s pretty incredible to be able to get students excited about the ocean, to remove that element of fear if they don’t like the water for some students, and show others that don’t get the opportunity to be able to experience what it is like beneath the surface. It gets students to be immersed and learn empathy toward our environment. The other awesome addition to the videos is the natural underwater sounds New Zealand Geographic recorded, so when the students are experiencing these videos, they can hear everything that you would be able to hear underwater.
What attracted you to GUE?
Very good question. It was actually when I had just started scuba diving, I think I had done 20 dives. At the time, I was seeing someone who had done the GUE Tech One course and he said it would be a really good way of refining my skills and gaining a lot more confidence in the water. I had previously met Mel Jeavons and Jamie Obern on the dive boats and was really interested in the diving they were doing.
I did the Fundamentals course with Jamie on a single tank with a wetsuit just because that’s what I was diving in at the time and what I was comfortable with. Over the next two years, I worked on gaining more diving experience and talking to Jamie, and finally, I was like, okay, I’m ready to go on to twins now. I got my tech pass a year after that. I really valued being able to dive and not disturb any of the environment around me, especially while working at the Poor Knights.
It wasn’t until I started working as a divemaster and guiding people around that it really showed the difference. I was very conscious that I didn’t want to destroy the environment that I was showing people. And being able to share that with people, sharing techniques I had learned or explaining certain elements in diving, I realized this gave confidence to my divers as well. I wanted to ensure every diver had a positive experience, and so they could enjoy their dive and fall in love with the ocean just like I have, giving them a reason to protect it.
What are your diving goals now?
To spend as much time in the water as I can. I would love to dive along the side of a huge iceberg in Antarctica, explore the wrecks of Truk Lagoon, or swim alongside schooling hammerheads in the Galapagos. This list could go on forever…
Furthering my diving skills, I’ve always wanted to try cave diving, and I am truly fascinated by the amazing pictures I have seen from cave divers. There are some caves in New Zealand, which is not an easy place to learn to cave dive, but it has always been one of my life goals to see first-hand what this incredible environment is like.
Over the last year, I have been looking into the GUE Tech One course, and this came after a dive on the MV Rena (a container ship that ran aground on the Astrolabe Reef in 2011). Four and a half years later, the exclusion zone was lifted, and I was lucky enough to dive the wreck a couple of days later. The wreck was split in two and the stern section of the Rena starts in 26 m/85 ft, continuing further down the reef face to 70 m/230 ft. I was stuck at 30 m/100 ft, and I was looking down at this amazing container ship, and I was just like, ‘oh, this is why I want to get my Tech One,’ because looking down on the wreck is just not the same, and the wreck, although so close, seemed so far away.
I have always dreamt of taking every single person beneath the surface and showing them some of the amazing things I have been lucky enough to see. So, one of my main personal goals would be to inspire as many people as I can and take them on my journey to share the importance and beauty of our ocean.
How do you feel the GUE scholarship will help you achieve these? As both a diver and a conservationist?
Just meeting everyone, building on my knowledge, and developing my skills as a diver. Gaining a greater understanding of conservation projects, hearing their diving stories, what they’ve learned, and then being able to share these experiences with everyone. That would be awesome. This scholarship is an amazing platform for me to be an ambassador for the protection of our oceans as well as for women in the marine environment and diving.
It’s a great community, that’s for sure. Had you heard of Jarrod Jablonski before he called you to tell you that you were awarded the scholarship?
I had, because I read everyone’s profiles. I was really nervous when I got the phone call. I started my interview talking to Dorota, and then she got up to get someone. I didn’t know what was going on. Jarrod sat down and it took a little bit to register, and when he said his name I went into a bit of a shock and I was like, ‘What? He’s actually talking to me?’ But yes, it was a bit of a stunned moment; that it was actually him that was talking to me online.
Annika will be joining GUE for their 2019 Conference in Florida from November 9-11th. If you are interested in attending the conference, registration closes on November 4th.
Amanda White is the editor for InDepth, and Global Underwater Explorers Content and Brand manager. Her main passion in life is protecting the environment; whether that means working to minimize her own footprint or working on a broader scale to protect wildlife, the oceans, and other bodies of water. She received her GUE Recreational Level 1 certificate in November 2016 and has been lucky enough to join GUE and Project Baseline projects. Amanda holds a bachelor’s degree in journalism with an emphasis on strategic communications and a minor in creative writing from the University of Nevada, Reno.
No Fault DCI? The Story of My Wife’s PFO
What does it mean if you keep getting bent, even when you follow all the rules? Avid tech diver James Fraser recounts his and his wife’s Deana journey of discovery that led them to realize she had a PFO. Does any of this sound familiar? Read on!
by James Fraser
All photos courtesy of James Fraser
When you follow all the rules and still get decompression illness, what’s up?
The person I hold most dear in this life has now had three incidents of decompression illness (DCI) over a two-year period. The latest episode required recompression, so we began investigating her frequent illness to determine if there was a possible solution. Deana is a very conservative diver, diving within her training, computer limits, and dive planning tools such as Deco Planner. On all of the dives where she had DCI, her training, tools, and dive profiles say she should not have gotten bent. But she got bent just the same.
DCI is a risk for any diver, even when following the rules. However, we have to remember that DCI is a potential sports injury, no different than a football player risking a concussion. Despite this fact, DCI seems stigmatized, and people feel ashamed to admit it happened to them. So Deana and I decided to share her experiences with DCI, to help others realize, Sh*t, I mean, DCI happens! Experiences with DCI should be shared, so that the diving community can continue to learn, grow, and be safer divers.
Deana Fraser has been a registered nurse (RN) for over 25 years, and received her BSN in 2002. Throughout her career, she has specialized in ER, ICU, and OR nursing. Currently, she manages the Overlake Operating Roomin Bellevue, Wash. When Deana is not managing the OR, she is usually diving in the extreme conditions of the Pacific Northwest (PNW), where all dives are cold (46-55℉/8-13°C), dark, and wonderful. Deana has been a recreational diver since 2004, and loves diving in Seattle and the surrounding areas as often as three days a week. It is her number one passion.
She just completed her Global Underwater Explorers (GUE) Technical 1 course (normoxic trimix) in September 2019, and as of this article she has completed over 500 dives, 150 during 2019 alone. Deana always looks forward to expanding her skills and experience in the recreational and technical diving arena.
Deana is also a breast cancer survivor; she was diagnosed with Stage Two breast cancer in May 2016, and underwent a lumpectomy and six weeks of radiation treatment, until July 2016. She is in full recovery, but continues to take Tamoxifen (20mg) daily. This information is not intended to draw any type of correlation of breast cancer and DCI, but to give all details about Deana’s fitness and health in respect to her history with DCI.
Deana is one of those people that lets nothing hold her back. She was not able to dive for a few months after her radiation treatment, so she turned to her second love: hiking. She proceeded to hike over 200 miles (dragging her husband with her) over the next six months while she was recovering. Deana has been cancer free for over three years now and is back to her first love of diving. When she returned to diving, she pursued her dream of technical diving and signed up for GUE Fundamentals in 2017. She has been unstoppable since then and again has dragged her husband along for the ride.
After cancer treatment, Deana spent a lot of time building up her strength and dexterity in order to pack double 100s over the rocky beaches of the PNW. She trained relentlessly to reach the goal of being a GUE Tech 1 Diver, a mission that she accomplished. In addition to her regular dives, Deana leads a weekly Skills Refinery Dive, offering opportunities for other local divers to hone their techniques and commit to excellence. Many are working on their GUE Tech skills to prepare for Tech 1. Deana is not done with her education and has dreams of completing GUE’s Tech 2 course in the future. Now that you know the type of person Deana is, let’s talk about the reason she and I have written this article.
Look, James. I Got Stung by Something!
Deana and I went on a 16-day trip to the Maldives in April 2018. We spent the first week at Olhuveli Beach Resort resting, flipping our internal clocks, and doing a few recreational shore and boat charter dives. The second week, we joined up with our local Seattle dive group on Blue Force One, a fantastic live-aboard charter, for seven days of additional recreational diving; no dives on this trip were below 100 ft/30 m. On day three of diving on Blue Force, after her second dive, Deana talked to me about being stung on her abdomen. She presented with redness, point tenderness, and stinging in an area about the size of a silver dollar. She was wearing a full length 3mm wet so it definitely was not something she would have brushed against during the dive. She took a Benadryl, feeling that something stung her, got some sleep, and by the next morning it had cleared up. Deana continued diving for the rest of the trip and had no further symptoms. We now suspect that she had a minor case of skin bends, based on the other two episodes she has had since.
Deana and I also dived in Loreto, Mexico, six months after the Maldives, in October 2018, and performed ten dives over four days with a max depth of 80 ft/24 m; Deana showed no symptoms of DCI.
Could I Have Skin Bends?
In April this year, 2019, Deana and I were in Hurghada, Egypt, on a live-aboard dive trip with Red Sea Explorers aboard MV Nouran. Deana had completed eight recreational nitrox dives over three days, the deepest dive being 98 ft/30 m, when she showed signs of skin bends. Below are the dive profiles of the two dives the day she presented with skin bends. She again had symptoms of stinging and itching on her thighs and abdomen and point tenderness. The area was larger than the first experience she had in the Maldives.
Deana again wondered if it was some kind of sting or allergic reaction and asked me and some of the more experienced divers for our opinions. A couple of the more senior technical divers on board agreed: Her symptoms looked and presented like skin bends. Deana went on 100% oxygen (O2) for a few hours, and the symptoms went away. She took the next day off and then continued to dive recreationally with more conservatism for the remainder of the trip. One other person on the trip who was doing Tech 1 level dives also showed signs of skin bends; they were treated with O2 and continued to dive for the rest of the trip with no further issues.
After this episode we thought about the Maldives: Since it presented the same way and resolved itself with some time and O2, we now assumed that was also an incident of minor skin bends.
Skin Bends Again, But Nothing a Bit of O2 Can’t Fix
Deana and I were attending Tek week at Buddy Dive in Bonaire. We were both looking forward to a week of Tech 1 dives (Max depth 170 ft/50 m, max deco: 30 min), as this was Deana’s first trip since passing her course. We had done three dives total over days one and two at recreational depths on nitrox 32 (32% oxygen, 68% nitrogen) with no required deco.
On day three we planned to dive to 150 ft/46 m on trimix 21/35 (21% oxygen, 35% helium), with 25 min bottom time with a gas switch to nitrox 50 at 70 ft/21 m. Our decompression profile used GUE modified deco based on Deco Planner with 2 min stops from 70 ft/21 m to 30 ft/10 m and a 16 min stop at 20 ft/6 m. The total planned run time for that dive was 58 min. At the start of our ascent, our average depth was only 132 ft/40 m, as we had worked our way slowly up the reef after hitting a max depth of 152 ft/46 m.
After a three-and-a-half-hour surface interval, we planned a 100 ft/30 m dive on nitrox 32 with a bottom time of 40 min with a gas switch to 100% O2 at 20 tf/6 m for 10 minutes for added conservativism. Total run time for that dive was 69 min, as we extended our 20 ft/6 m stop a lot longer to just hang and enjoy the reef.
Roughly two hours after this dive, Deana complained of itchy stinging skin on her hips and abdomen; she described it as being like stinging nettles. She was not concerned as this felt like what she had in Egypt, so we put her on 100% O2 for about an hour and a half and all symptoms resolved. Deana and I considered this a minor issue, and we did not talk to anyone about the symptoms since they quickly resolved. No further issues were experienced that evening.
It is here that human factors really played into the scenario. Deana and I made the mistake of not talking about the issue we had just experienced. We found out later the next day that Dr. Douglas Ebersole (cardiologist and consultant to Divers Alert Network) and the late Dr. Fiona Sharp (diving physician and anesthetist) were active participants of Buddy Dive Tek week. If we had spoken up, we most likely would have been able to talk to one or both of them and potentially decide not to dive the next morning. However, hindsight is 20/20, and we just didn’t feel the need to talk about it since Deana’s symptoms had been resolved.
The next morning Deana felt fine and showed no rash or issues from the previous day. She wanted to do the planned trimix dive to 150 ft. It was the same profile as the previous day’s dive, and the dive went without issue. We had completed an 18-hour surface interval, and Deco Planner showed we could dive the same profile with no additional decompression obligation.
About 45 min to an hour post dive, Deana complained of similar skin pain and stinging, but this time it extended down her thighs. When we returned to shore, we shared her symptoms with the technical diving supervisor, Mr. G, and placed her back on medical O2 for about two hours. This resolved the stinging, but Deana showed edema in her thighs, hips, and abdomen and deeper tissue pain. She had resolved to sit by the pool and have a Corona while I took a nap beside her to see if it would resolve itself.
We Called DAN
About an hour later Deana said, “We have DAN insurance, maybe we should call them and get their advice.” She placed a call to DAN, and within minutes was talking to Dr. Matías Nochetto. After a thorough assessment, Dr. Nochetto stated that, while they cannot diagnose over the phone, there were enough signs and symptoms to recommend we go into the ER and be assessed for DCI. DAN said that Bonaire had a hyperbaric chamber with an excellent team, and they gave us contact information for some of their team members. I cannot say enough good things about how DAN took so much worry away, offered a wealth of knowledge, and confirmed the direction we should take.
We followed DAN’s advice and told Mr. G what the plan was. Mr. G told us that Dr. Douglas Ebersole was one of the guest speakers and an active diver, and he located him for us before we went to the ER. Dr. Ebersole performed a neurological assessment in the parking lot and talked to Deana about her symptoms. He concurred that she needed to be assessed at the ER, and he felt she was showing signs of lymphatic DCI; his opinion gave us peace of mind, that while her condition wasn’t critical, it should still be checked at the ER.
After listening to Deana’s diving history over the last few years, he suggested undergoing a Transthoracic Echo (TTE) bubble study to rule out a Patent Forum Ovale (PFO), as this could explain her susceptibility to DCI. PFOs exist in almost a third of the population; although the condition isn’t rare, the condition can be activated due to the pressures exerted on our bodies at depth.
I drove Deana to the Bonaire ER, where the nursing team did a thorough assessment and showed great care, humor, and understanding. The ER nurse who took initial care of Deana was also a paramedic and technical diver and was wonderful to work with. After a full assessment, the ER doctor, who was not a diver, suggested that Deana made a poor choice in deciding to continue diving after a possible bout of skin bends. Deana later mentioned this comment to the ER nurse, adding that the doctor was not a diver and so likely didn’t understand. The ER nurse just smiled and agreed with her.
We were then visited by one of the hyperbaric physicians, who completed Deana’s neurological exam, which showed no signs of neurological DCI. He diagnosed her with DCI of the lymphatic system and said that recompression would be necessary to treat her symptoms. He gave her a saline IV and a Table 5 treatment in the chamber.
Deana did her 2.5 hour run in the chamber and did not notice any improvement in the pain or edema. However, her doctor told us that the pain and swelling of lymphatic DCI does not go away right after a chamber ride like with other types of DCI; DAN confirmed this when they followed up with us the next morning. We were told that the edema could take a few weeks to normalize. By the next day the pain had decreased, and Deana felt she was recovering. She did not dive any more on this trip, but still had a happy, positive demeanor, and she was the life of the party: Everyone wanted to know all about her chamber ride and experience.
Without undermining the risks associated with DCI, I want to mention the general positive outcome of this experience: we learned a great deal about Type 1 DCI, no one at our resort made Deana feel like she did something wrong, and everyone offered their support and understanding.
In Search of a PFO
In closing, I want to offer clarity on some frequent inquiries we’ve received about this story. Some suspected that dehydration may have played a part, but as an RN, Deana had more than doubled her water intake and was always staying hydrated. While dehydration can be a contributing factor to DCI, we do not feel that it was an issue in this case. People also asked about her alcohol intake. By the time of her second DCI hit that required recompression, she had had three Coronas and one mixed drink in three days. Her alcohol consumption was not an issue.
After coming back to the United States, Deana saw Dr. James Holm, who is one of the leading hyperbaric physicians at Virginia Mason in Seattle, and was highly recommended by DAN. Dr. Holm did a follow up examination and agreed that, based on her history, dive profiles, and the lymphatic DCI experience, Deana should get a TTE bubble study to check for a PFO. Deana scheduled a TTE through Overlake Hospital’s Advanced Cardiac Imagery Department. The results revealed that she does, in fact, have a mild-to-moderate PFO.
This diagnosis was bittersweet, as it explained why Deana had frequent incidents of DCI while diving within limits, but it now puts Deana in a position to weigh the risks and determine her next course of action. Both Dr. Holms and Dr. Aviles, an interventional cardiologist who diagnosed the PFO, did not recommend rushing into a PFO repair, which they said was not a silver bullet that would guarantee a DCI-free future.
Both physicians offered several suggestions for Deana to consider:
1. Stop diving, as this eliminates any risk of DCI in the future. For Deana this is not an option.
2. Modify her dive profile to be more conservative: diving only once per day, diving nitrox 32 but basing her profiles as if she was diving air, and/or extending her decompression profiles and safety stops.
3. Have the PFO repaired, knowing it is not a guarantee, and continue diving being as conservative as possible.
Dr. Aviles did say that if Deana plans on continuing the frequency and type of diving she has been currently doing, getting the PFO repaired is probably her best option. These are all choices that divers who have been diagnosed with a PFO have to wrestle with, and there is no right or wrong answer. While Deana is considering her options, she will look to be more conservative with her dives.
Like all types of higher risk sports, divers choose to accept the risk of being injured. For most divers, this is an acceptable risk, so we can enjoy the experiences we so cherish in exploring our aquatic environment. As divers we need to continually educate ourselves so we can make well-informed decisions that attempt to lower our risk of being injured.
Deana and I highly recommend Gareth Lock’s work on human factors for understanding how our decisions play into potential diving accidents. However, even with research and advancements in technology at our disposal, we still don’t understand DCI. There is no guarantee, even if we follow all the rules, that we will not get bent unless, of course, we stop diving. It is a risk we all take when we submerge beneath the water.
We have been amazed by the number of people we have met who discovered that they had a PFO in a way similar to Deana. Many have chosen to have their PFO corrected, though some have not, but all of them have been willing to share their experiences with us, helping us make a more informed decision. Next time you or a teammate shows any signs of DCI, tell someone and have it checked out. Sharing our experiences makes us safer, more educated divers.
James D. Fraser is a PADI MSDT and NAUI Scuba Instructor and has been diving in the Pacific Northwest for over 30 years. James currently lives in Seattle, WA, with his wife and dive teammate Deana Fraser. Both James and Deana work at growing the local diving community and sharing their passion with all who are interested. James recently embraced technical diving, becoming certified as a Technical 1 diver with Global Underwater Explorers. James and Deana have had opportunities to travel all over the world to experience their passion in amazing places such as Egypt and the Maldives. James currently works as a Cyber Security Director with a Fortune 500 Defense Contractor and has been a residential construction business owner as an Emergency Medical Technician (EMT). James wants to expand his knowledge in the diving field and grow his experience in technical diving.
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