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By Amanda White
“Be the change that you wish to see in the world.”― Mahatma Gandhi
Almost two years after the announcement of the Mission 2020 Pledge, nearly 200 dive industry organizations and businesses have pledged to do their part to reduce their company’s impact on aquatic environments.
For those of you who haven’t heard of it, Mission 2020 is a collection of pledges from organizations in the diving industry to change their business practices in order to help protect and preserve our oceans for the future. The primary focus of the pledge is to reduce or eliminate single-use plastic before World Oceans Day in 2020. Plastic is an issue that is at the forefront of a lot of consumers minds. Scientists from the nonprofit advocacy group “5 Gyres” found there are 5.25 trillion pieces of plastic debris in the ocean. Of that, 269,000 tons float on the surface, while almost four billion plastic microfibers per square kilometer litter the deep sea.
Mission 2020 was founded by UK-based dive garment company, Fourth Element in hopes of combating their contribution to the growing plastic problem. We caught up with 4E co-founder Paul Strike who is in charge of product development to see what the state of Mission 2020 is now.
How did Mission 2020 come about?
Jim [Standing] and I had a number of conversations at the 2017 DEMA tradeshow about doing something for the environment. A couple of months later we were discussing it [Mission 2020] again and came up with an idea: Wouldn’t it be amazing if we could actually encourage other people, other companies, to join us and do something that would make a difference? That’s how Mission 2020, as the industry knows it, was born. It’s not about Fourth Element, but about developing an industry initiative that will allow all of us to speak with one voice.
So it would have more power than just a single company behind it?
Yes, that kind of combined effect of having a number of companies: actually, in fact, a whole range of people and businesses and brands, dive centers, and organizations involved in the scuba diving industry, all coming together with one common cause– to do something positive for the ocean. There are nearly 200 entities that have made a pledge to effect change under that Mission 2020 heading. We are an industry that enjoys the ocean and makes a living off of it, so it’s in our best interest not to screw up our playground.
A strong and powerful message is being presented by the diving industry through Mission 2020. It could be the only and is certainly the first industry in the world to take some kind of combined, unified stance on this, one that is sending a strong message to consumers and other businesses.
Why did Fourth Element choose to focus on single-use plastics?
Well, think about how much plastic is involved in packaging a pair of scuba fins. And that’s a big, relatively heavy-duty plastic bag with a plastic carry handle that sometimes clips together. And I suppose it would be interesting to find out how many pairs of fins are sold in scuba diving. You know, that’s probably hundreds of thousands, isn’t it? And that’s just one product! It’s scary. That is just a huge amount of plastic. The magnitude of these plastic stats and of what’s going on globally is just… It’s mind-boggling. It’s so huge, the impact, it’s almost a bit like when people are talking about distant planets; it’s very difficult to get your head around it because it’s too big.
Thankfully, it’s something that so many people are talking about and obviously not just in the dive industry. You can’t seem to turn on the TV without there being something about plastic. Thankfully, there are lots and lots of companies changing things. But equally scarily, there are lots of companies that don’t seem to be making any changes.
What are you changing in order to reach your Mission 2020 goals?
Jim and I are both equally committed to trying to achieve these goals. The whole company is behind this mission. From the people designing and creating the clothing to those packing and dispatching it everyone in the company is behind this.
With hand on heart, we couldn’t promote an environmentally positive product, something that’s been made from recycled nylon, and then put it in a plastic bag. Obviously, on one hand, we were doing something that was in some way beneficial, while on the other hand, completely eradicating it. So that made us look more carefully at the packaging. And we have found various, or we have tried various means to package our Ocean Positive swimwear, ways that would be without the use of plastic right down to the Kimball tags and everything.
That’s your swimwear line made from recycled ghost finishing net right?
[Note: In 2009 the United Nations Food and Agriculture Organization (FAO) and the U.N. Environment Programme (UNEP) estimated that there were approximately 640,000 tons of abandoned fishing nets in the oceans, accounting for one-tenth of all marine litter.]
What is your timeframe?
Our deadline, our self-imposed deadline, is the World Oceans Day in 2020, by which time our ambition is to be single-use plastic-free from all of our packaging. And it will have taken us the better part of two years to get there. It’s not just a linear progression. We’ve made some leaps ahead, and we’ve changed quite a lot of things already. By the end of this year, we should be almost there, if not all the way there [single-use plastic free]. But I suspect we may have one or two little nuggety ones to solve in the early part of 2020.
And I think again, that’s the sort of message I’d like to put out there to everyone: as much as we all need to change our behavior to reduce the waste of single-use plastic, I think it’s unrealistic to expect individuals and/or companies to change everything overnight and some immediate changes may not be the perfect solution, but steps along the way to achieving a perfect solution and a necessary part of the process.
What are some of the difficulties 4E faced in achieving their plastic-free goals?
I mean there are so many variations, there are so many things to consider in this process. Everybody will have their own challenges, ones that are specific to their company structure and their supply chain. So it’s a multilayered, multi-complex challenge and a huge problem to resolve.
For us, it’s time-consuming, it’s expensive, it’s challenging. Unfortunately, the plastic bag is so good at what it does in terms of protecting a product. It’s clear; you can see the product through the bag. It’s cheap. It’s waterproof, just to name some of the beneficial characteristics of a plastic bag. And it’s incredibly good at doing what you actually want it to do.
The major downfall is that it stays around for hundreds and hundreds of years afterwards. And of course, we’ve seen the result of that in waterways around the world and horrible wildlife footage where you see whales that have been cut open with thousands of these bags inside of them. So trying to find a product, or safe products, that actually replicate the plastic bag is challenging.
What kind of replacements have you found so far?
We have investigated and used bags that are made from vegetable-based or plant-based material. And that works pretty well for a lot of products, for a lot of situations. But it has some limitations. And unfortunately, it’s not a kind of one-stop-shop of going, “oh great, we’ve got a replacement for the plastic bag! However, we do have a plastic bag type thing made from plant material which biodegrades, and it actually will break down in the water, and it can be eaten by a turtle and it doesn’t kill them. It can be digested by sea life. But unfortunately, it has its challenges with temperature, and it can get brittle, and sometimes it can crack. So it doesn’t achieve all of what we need it to achieve.
We’ve used paper bags, we are increasingly using paper bags for our T-shirts, which we then need to label very clearly. And so then, of course, we need to look at a paper-based sticker that is using a glue that is non-toxic. And that’s another little problem to solve.
Every step of the way there seems to be another step or two related to it which is something that needs to be resolved or something that needs to be overcome; whereas your plastic bag is so damn simple. And that is the fundamental problem.
So are there companies working on these problems?
There are companies that are taking the technology a bit further, there are better solutions every day. We are constantly looking at these because we haven’t found the ultimate solution, and they work for some products and not others. Sometimes there are size limitations to what’s possible and sometimes there are cost limitations to what is possible as well. So there are magnitudes of scale and economy like that, which can get quite scary from a cost point of view.
The other challenge is sifting through the actual science, the real science, behind the bags. Because a lot of the bags that are coming out, or at least some, will biodegrade. But they don’t necessarily biodegrade into biomaterial. They biodegrade into small particles of plastic, which is not what we want. The bag ceases to become a bag and it breaks down into little bits of plastic, but that really doesn’t solve the problem at all.
So, not every solution you’ve found solves the problem?
That one solves some element of the problem, that it’s less of a hazard to marine life. But the little bits of plastic will end up getting into the water table and will get into rivers and then end up being flushed out to the ocean. It’s the same way that the microfilaments that washed out of your fabric or your garments when you put them through a domestic washing machine, you’ve got the same fundamental problem there. These little microfilaments of plastic. So it’s pointless replacing a plastic bag with a bag that just breaks down into tiny bits of plastic. So you have got to be careful with regard to what types of solutions you find.
There are some real challenges, and they all take time. But we are getting there. And I think what is really encouraging, and we’re not saying that we’ve solved this problem, but the more little steps that we all take toward achieving the sort of endgame of eliminating single-use plastic, the more solutions that become apparent in the process.
Nice! How do you feel about industry participation in Mission 2020? Has it been well received by the dive industry?
I looked through the list again today to see who has signed up. And I feel really heartened by the fact that a significant number of brands and companies have jumped on board with it and made their commitment to do something different in order to benefit the ocean environment. Obviously, we make quite a few competitive products to some of the brands but it’s really been encouraging to see who has come on board. It’s fantastic that they are seeing the bigger picture.
We’ve got PADI. It was fantastic to get PADI on board. They exert so much influence in the world of diving generally, and they’ve encouraged a lot of their dive centers throughout the world to consider getting involved. GUE has already signed up and is doing the same. It’s fantastic to get major training agencies on board. That creates a great deal of influence amongst the diving industry, the diving market, and people who are involved in diving.
A lot of dive centers have also become involved. We’ve got dive centers that have signed up from Bali to the USA to the UK, virtually globally, and have made a commitment to doing things differently. I’m not exactly sure of the density in the areas that are the most significantly represented, but I was really quite encouraged by how widespread this has actually become.
What challenges do you face with improving the sustainability of your products?
The neoprene that we use in our wetsuits contains between 15 to 20% recycled material from car tires. So it’s an effective recycling process of car tires where 85 % of the car tire is recycled, and the black rubber material is integrated, or is used in the production of the neoprene and accounts for between 15 and 20% of the neoprene that is used in our suits. So again, it’s not the end game, but it’s a step in the right direction.
There is a huge amount of investment going into the reuse and recycle-ability of neoprene. And it may be that the endgame or the ambition of recycling neoprene wetsuits to make more neoprene wetsuits is probably a long, long way off because of the nature of the neoprene once it’s been laminated with the linings inside and out and stitched together etc. And then in order to recycle that material, that suit, there are many processes involved.
And that is one of the biggest impediments and a huge challenge to any recycling process, for when you have mixed materials and mixed construction, it becomes much more challenging to recycle that product. It’s almost impossible to separate different forms of plastic because they have different properties. So that is something, again, in this whole manufacturing process that we’re thinking more about. Like, what we can do to make the product easier to recycle at the end of its life? That’s another thing, going back to wetsuits, I think it’s much more realistic to think of neoprene wetsuits getting recycled for repurposing not as neoprene wetsuits anymore but something else that perhaps requires material similar to neoprene.
How about with your clothing?
Well, basically certain garments shed little microfibers more than others. And it often depends upon how tight-knit that fabric is. And you have a traditional fleece, and the fluffy surface is created by brushing loops, knotted loops of polyester, usually, and breaking them and splitting them and fluffing them up, shall we say. Now that obviously damages these loops and it breaks them and consequently, that is then more susceptible to little fragments breaking off in the washing process. So if you had a garment with the same composition but it’s tightly knitted and hasn’t been brushed, then it sheds fewer filaments.
So a rash guard and swimwear, by the nature of their construction, will shed many, many fewer filaments than a fleece that has been brushed significantly to create a fluffy, soft-feeling texture. Also, there is some evidence that at least suggests that the better the quality of the knit or the better the quality of the fabric, by and large, there is a reduction in the number of filaments that are lost because the knitting process is higher-quality, is a more secure knitting and in effect the garment doesn’t shed its yarn quite as easily. I’m afraid I’ve become a self-confessed fabric geek. I know more about fabric and knitting than I ever wished to know really.
What are the future plans after Mission 2020 has “ended”?
Obviously continued commitment to do what we can do, and hopefully, we will have eliminated single-use plastic from our packaging. I’m pretty confident that we will have achieved that. And part of the Mission 2020 statement is also about our continued quest for using recycled materials in our product range and looking for alternatives to harmful plastics. Some of our products use waterproofing technology which is less chemically toxic. The water runoff is cleaner.
We are actively working with fabric producing fabric knitters that are investing in more sustainable processes in their business. So, basically we will continue to choose a supply chain that minimizes environmental impact over ones that are carrying on as normal, shall we say. It’s about the plastic, in effect, but it’s also about the bigger picture. Therefore, we will continue to invest in and develop less impactful processes in the supply chain and production of our products.
Do you have hope for the future?
Obviously as we are all very aware, elimination of the single-use plastic is a global issue and I’m excited by going online and finding that there’s been a new breakthrough with this or somebody’s investigating this or come up with a technology that may not be the end game, but it’s improving and it’s making progress. We shouldn’t feel like we’ve failed because we haven’t gotten to the end game straightaway.
And what the great thing about all these things is that the more that companies actually look for these products, the more there are manufacturers and companies starting up, creating and selling products to replace plastics. When we started, there seemed to be only one viable option available. I’m sure it wasn’t one, but we found there were very few options in terms of getting something that was like a plastic bag, but not plastic. And now there seem to be more and more alternatives springing up every month.
What about consumers? There are an estimated 500 billion single-use plastic bags used each year by shoppers.
Ultimately, it comes down to consumers because they are one of the most powerful drivers, from a company’s perspective, as we all know. The movement depends on them. Once consumers become aware, take a stand, and actually change their behavior, companies will have to come around. If a company experiences a decline in the sale of a product because aware consumers see little to no effort toward reducing or ending single-use plastic, the company will have to make changes.
And I suppose this is almost a kind of plea or mandate to consumers to think about your choices. Of course, if it costs more to buy the environmental product. And some people may be lucky enough to be able to do that, but many people aren’t. However, we are finding that the price difference between an environmentally friendlier product, whether it’s the way it’s packaged or the way the materials are used, is getting narrower.
As for Mission 2020, it would be great to see the dive industry as a whole adopt this challenge.
Global Underwater Explorers has made a Mission 2020 pledge. At GUE, we pledge to launch an annual GUE Cleanup Event. We feel we can have the greatest impact by utilizing our network of divers in a worldwide cleanup of our waters. We hope to power our office with solar in the near future, will continue to recycle, and eliminate any single-use plastic from our products.
Amanda White is an editor for InDepth. 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 is ecstatic to begin her scuba diving journey. Amanda was a volunteer for Project Baseline for over a year as the communications lead during Baseline Explorer missions. Now she manages communication between Project Baseline and the public and works as the content and marketing manager for GUE. Amanda holds a Bachelor’s degree in Journalism, with an emphasis in Strategic Communications 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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