Your Letters to the Editor

We always welcome your letters, and we recently got a good batch of them that are worth sharing with all readers. (Keep them coming.)

Lowering a Diver's Risk of Lung Infection

Shawn McDermott (Melbourne, FL) has a useful tale to tell about catching a bacterial infection in one lung after returning from a Cozumel dive trip in 2016. "Nasty stuff -- the medics suspected pneumonia and put me on antibiotics and steroids. I made a full recovery, but I didn't figure out how I might have taken sick until later." He guesses it was due to accidentally inhaling from his BC.

His advice: "When rinsing your BC after your last dive, fill it up several times with fresh water and squeeze it dry, and even inflate it with tank air to dump all the water out. For some reason, on that December 2016 trip, I actually sucked the air out of the BC, got some into my lungs, and bingo! A week later, back in Florida, I had to go to the walk-in clinic. Coincidence? I don't think so. Was there some bacteria in Cozumel's fresh water, which isn't potable?"

Ben Davison's reply: Although there have been cases of people suffering aspergillosis caused by a common mold, it has usually been associated with some other lung condition. Shawn was very unlucky to suffer pneumonia, but it could have resulted from a number of sources - like sitting near someone who had it on the plane ride home from Cozumel, for example. Even so, we suggest you avoid inhaling from any BC that hasn't been rinsed out. For extra care, use an over-the-counter cleansing solution mad specifically for BCs, like McNett B.C. Life or Gear Aid Revivex.

Confusion --and a Correction -- about Discover Scuba Diving

There was an element of confusion surrounding instructor-to-trainee ratios in our February article, "Discover Scuba Diving Is Deadly," regarding two tragic fatalities during Discover Scuba Diving (DSD) outings. We should've written, "ought to be" rather than "supposed to be."

Ken Kurtis, a NAUI instructor and owner of Reef Seekers Dive in Beverly Hills, CA, was quick to call us out on it, and wrote, "While I agree with your underlying point totally, when you've got someone uncertified under the observation/care of an instructor, the instructor has no job more important that doing everything in his or her power to guard the safety of that person. But you've got the ratio wrong, and, bad as this was, it makes it sound even worse. You state the ratio is one to one, but it's not. NAUI standards (2019 version) allow for the four-to-one ratio, and six-to-one with a qualified assistant. I believe PADI is the same.

"What may be upsetting the apple cart slightly is there's a requirement in the PADI standards that if you are using a vertical descent line no deeper than six feet in water where shallow water is not available (that's why you're using the line), then the ratio for that specific descent skill is one to one. But the ratio for the dive itself (and it sounds like this is what the 13-year-old boy was on) is still four to one. Whether that makes any sense or not, and while many of us argue that two-to-one is the limit of our comfort (we've only got two hands and can hold one diver in each hand) and that one-to-one is best, a four to-one ratio is still within standards.

"That all being said, having 20 people in the group -- if they were all in the water at the same time, let alone with one instructor -- is way outside the standard."

"Also, although you mention DSDs are to be done in "shallow or confined water," the specific limit is 40 feet. It sounds like the conditions, specifically the visibility, should have precluded the dive, or at a minimum, forced the instructor to go with a lesser ratio. From an older version of the PADI standards, "Good environmental conditions can enhance the experience, while marginal conditions may detract from new diver enjoyment and safety. It's important to make conservative decisions and use good judgment."

Thanks for the corrections, Ken. And we still stand by the point made in the conclusion of the article by Bret Gilliam, founder of the dive training agency TDI/SDI, that DSD's current standards are potentially dangerous, and it's time the scuba industry woke up to that.

Should Dive Guides Be Responsible for Your Safety?

Regarding our death-by-narcosis-focused article, "Rapture of the Deep," in the March issue, John Miller (Lubbock, TX) took issue with our implication that perhaps the dive guide, who didn't descend to save the sinking diver, was partially responsible for the man's death.

"First, we need to consider every dive agency's Rescue Diver training philosophy, as well as that of Public Safety Diver instruction and other emergency first-response training: to only have one victim."

"During the briefing, the divemaster most likely told everyone the maximum depth and time. Certified divers need to pay attention to the briefing, and follow the limits set for the dive by paying close attention to their pressure gauge or dive computer. The wife and divemaster put their own lives at risk by chasing a narc'd diver.

I do not believe it was the guide's responsibility to save this man and his wife. I understand the wife's desire to do so -- but three people could have died. As dive professionals, we will do what we can to 'save' bad divers, but not at the risk of our own lives or that of other divers. One victim is bad enough."

We asked Bret Gilliam to reply to Miller's take: "It's a tough call for the divemaster, with several factors in play that have to be a matter of personal experience and tolerance for stress, narcosis and high PO2. If it was me in that situation, I'd have gone for the rescue and considered the risk to be minimal. But Miller's comments about divers taking responsibility for their own actions if they don't follow the dive briefing are also valid. In today's world, a huge percentage of divers are not trained well to a level of independent capability, and lack much practical experience. That's a fault built into the dumbed-down curricula, and limited ocean dives in training."

"The bottom line: Divers should be responsible for themselves unless they specifically request a supervised dive outing. But I could not leave a diver behind in obvious distress."

Causes and Remedies for a Dive-Related Pulmonary Edema

Swimming-induced pulmonary edema (SIPE) is a medical condition that presents similar symptoms to drowning, but in fact it is the diver's own body fluids that are filling the lungs. Joan Eggert (St. George, UT), a physician now retired from Intermountain Dixie Regional Medical Center Wound Clinic and Hyperbaric Chamber, developed her second case of SIPE on a dive while fighting a current. She surmises it was triggered by a switch from one prescription drug for high blood pressure to another, and suggests that divers with chronic hypertension need frequent evaluations of the cause and prescribed medications.

"Evidently, 10 years ago it was not appreciated how many hypertensive patients had a disease in which the adrenal glands make too much aldosterone, which leads to high blood pressure and low blood potassium levels. A beta blocker is the wrong drug and may harm those diving. Fighting a current may also lead to 'racehorse hypertension,' which is why racehorses get pulmonary edema. Divers who have exercise-induced hypertension should see their physician about medications to reduce it."

"The treatment for SIPE includes oxygen, a diuretic (usually furosemide) and pulmonary-end expiratory pressure, or PEEP for short. One key point we don't teach divers, but I recommend, is an upright position, rather than a lying-down position, allows for easier breathing. Another one is, you can start "self-PEEP," even in the water, by pursing your lips as you slowly exhale, feeling like you are pushing back to keep the air sacs open. It is hard to self-PEEP when all you want to do is gasp air, but you will improve much more rapidly. And finally, evaluate when you want to trade rugged, cold-water diving for easy, warm-water diving with no possibility of strong currents."

Check Those Indonesia Flights

"Thanks to the advice in the April Undercurrent (our article "Why You Had Better Confirm Your Flight Itinerary"), I checked all my flights for my November liveaboard cruise in Indonesia," writes Harvey S. Cohen (Middletown, NJ). "One flight was indeed canceled, with no notification."

"I booked Garuda Indonesia (on its website) from Bali to Maumere and from Sorong to Jakarta. "When I checked my booking on the website, there was a red notice that one flight had been canceled. The other was still scheduled. Now, the website still shows the canceled flight as scheduled, so any automatic monitoring service will be unaware of the cancellation. The only way to find out is to check a specific booking that's already been purchased."

"What have I learned from this? When travel involves flights on a domestic-only airline, book those flights through the dive operator at your destination. They are best positioned to deal with domestic airlines, and they have a direct interest in getting you there and back. This is especially important for liveaboards, where it's crucial to arrive in time for the boat's departure."

Lisa Evans (Fort Collins, CO) also told us she was notified by NusaTrip, an Asia-based online travel booker, of a Garuda flight canceled about a month before her trip last fall. "Notification was September 3 for an October 11 flight. The flight was from Luwuk to Manado, and they rebooked me on a flight that would take two days -- the original flight was around 45 minutes. NusaTrip customer support got me a full refund, which took a while, and I was rebooked easily."