GERM
00:00:10.480 – 00:00:11.920
Ungli Tutau! My name is Germ.

WORM
00:00:12.320 – 00:00:13.280
I’m Worm.

GERM
00:00:13.760 – 00:00:31.440
Welcome to episode 81 of the germ and worm travel Health podcast. It’s a deep dive with Dr. Greg Davis on Scuba Health. It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of Infectious diseases at the University of Washington in Seattle.

WORM
00:00:32.020 – 00:00:40.020
I’m Dr. Chris Sanford, also known as Worm, Associate Professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:40.820 – 00:02:27.290
Well, here’s a reminder to our listeners. Please contact us with your own travel health questions, your stories and your tips for success.

Or if you want a clarification for something you’ve heard on a previous episode, just Visit our website, germandworm.com or send us an email germandworm@gmail.com. Before we jump into today’s amazing episode, here is our medical disclaimer. This podcast is designed to inform, inspire and entertain, but you should not use this podcast as clinical care. Before you travel, please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

Now, with all the formalities done, here we go, Chris. This is it. We are so stoked to welcome back Dr. Greg Davis to Germ and Worm. Greg, as you know, is a board certified otolaryngologist who has kindly already joined us once on episode 62, Hot Snot Hotshot. And in that episode he talked with us about all things related to ear, nose and throat health for travelers.

Today we have him again, this time focusing on ways to ensure that our listeners can stay healthy when they dive. Questions include how can someone choose the right dive outfitter when they’re on vacation? What are the best ways to avoid middle ear issues when diving, what are some important first aid things to bring on a dive boat when they go, and some general dive safety things to keep in mind on the weather, on team members, on equipment, all things related to SCUBA Health.

Now, Dr. Davis is nationally recognized for his leadership in dive medicine and in medical education in addition to being a wonderful clinical medical doctor. In fact, he chairs the International Otolaryngology Underwater Update course, which I think just wrapped up last month in Curacao. I missed it because I was in Antarctica. I’m hoping he’s going to tell us a little bit about Curacao and what that was like and also the annual ENT update that he chairs through the Seattle Science foundation here in Seattle.

WORM
00:02:27.690 – 00:02:55.480
And Dr. Davis not only has a human clientele, but also for many years he took care of vip, a gorilla at the Woodland Zoo in Seattle. And, and actually Greg and Paul wrote a paper on VIP for a medical journal. Greg has also done surgery on me. He’s my ear, nose, and throat doc. And very politely, he has refrained from comparisons about the thickness of my skull and VIP skull, although I know he wants to.

GERM
00:02:55.800 – 00:02:56.680
Greg, welcome.

Dr. DAVIS
00:02:56.920 – 00:03:11.620
Well, hey, thanks for having me, guys. I love hanging out with you. I love your podcast and, you know, you’ve hit two passions of mine.

We earlier spoke about sinus disease and sinus surgery, and now we get to talk about one of my other passions, and that’s scuba diving. So thanks for having me.

WORM
00:03:11.780 – 00:03:18.340
Hey, our pleasure. And first question, where do you like to travel to? And where do you like to scuba dive?

Dr. DAVIS
00:03:18.500 – 00:04:05.760
I love traveling and it’s, you know, as our kids got older, they’re in grad schools now, but when they were in really middle school, high school, at a ripe age of traveling, we started traveling around the world. And at that same time, that’s when we started diving. So I’ve only been diving about 10 years, but really have embraced it with a passion.

And we’ve traveled to Roatan. When we did a MET medical mission out in Honduras, we traveled to Galapagos. I certainly love to dive in Hawaii and the Florida Keys.

And I tell you, one of my favorite places to dive is right here in the Pacific Northwest. It’s a little chilly, but you bundle up with a thick wetsuit or a dry suit, and it is wonderful.

That giant Pacific octopus is out there and it’s, it’s just beautiful to try to find.

GERM
00:04:06.320 – 00:04:15.310
Well, in fact, if I’m not mistaken, Greg, I think you’ve even got a diving obstacle course of sorts in your own backyard. Is that true? Am I making that up?

Dr. DAVIS
00:04:15.390 – 00:04:18.350
I will neither confirm that nor deny it.

GERM
00:04:19.470 – 00:04:29.790
Okay, well, I think we need to have an in person visit. We’re doing this online. I think we need to come down to your place and check it out. I need to get my open water experience back, so that sounds amazing.

Dr. DAVIS
00:04:30.270 – 00:04:32.670
That would be fantastic. I would love to have you down.

GERM
00:04:32.990 – 00:04:50.710
Hey, here’s another question for those who don’t get to dive out of their own backyard. For people who travel, you know, most people will do this, I think, when they’re on vacation. And so the simple question for you is, how should our listeners go about choosing a dive outfitter? Are there things they should look for, both good and bad?

Dr. DAVIS
00:04:51.430 – 00:07:34.140
Absolutely. So first off, you know, you should probably get trained in how to scuba dive. And let’s hit that. There’s A lot of different organizations out there.

Patti is one of them, NAUI is one of them. PADI would be the largest, and that’s who I trained with.

But the first step, someone who wants to think about scuba diving, is do a Discover Scuba course. And this is where if you’re out anywhere in the tropics, every dive shop will have a Discover Scuba course.

And you will spend an hour or so in a classroom learning how to breathe, what the equipment is like, and then you go into the pool and you just sit there underwater and learn some of the basic skills. How to breathe, breathe, how to change your regulator, how to clear your mask.

And then if you’re feeling good about it, they’ll take you out in the open water and drop you down to 20, 30ft and have a really good time and tell you I’ve, I’ve done that with a few of family members who are hesitant to be divers. And they both embraced it and loved it. So that’s, that’s a great way to start.

And beyond that, once you then decide you want to get certified, you start off with your open water certification. And that’s a couple, it can be a couple weeks in classroom time.

You can do it on your own, you can do it online, and then there’s some pool time where you learn the skills and then certainly go into the open water and you master those skills, or at least you work on those skills, I should say, because it’s a lifelong process improving how you do.

Many people will do the book and pool work near their homes, and then when they travel somewhere fun and exotic and tropical and warm, they’ll do the open water dives at those locations. And that’s a nice kind of hybrid way to do it. Now let’s say you want to travel and you want to dive, Paul, that was your question a bit ago.

So what I do is, you know, certainly Google is nice, but I’ll go to the PADI website and then you type in the location that you’re thinking about going. And it ranks the different dive organizations really by safety standards. And there’s a, I think it’s a five star rating.

And that is exactly what I do to try to pick out the dive organizations, dive groups I want to do. And then I’ll certainly go online and read their reviews. And I’m looking for safety things. That’s the number one goal.

I want to go down in the water, go deep, have fun and get back up. And Paul, just like you climbing your mountains, it doesn’t count if you get to the top, you got to get back down.

And it’s the opposite with scuba diving. You got to get back up. So safety is key.

Beyond the PADI website, you certainly ask friends and family, and there’s a lot of online opportunities to look for reviews.

WORM
00:07:34.620 – 00:07:45.660
Good. I’ve seen some resorts offer courses that are fairly abbreviated. If something looks short and it has a poor safety review, it sounds like you might say, give it a pass.

Dr. DAVIS
00:07:46.460 – 00:08:45.530
You know, this is a lifelong skill, and the more you learn about diving, the safer you’ll be and the more fun you’ll have. To your question, Chris? Yeah, I would not take shortcuts on this. This can be life or death, and that’s a reality of scuba diving.

Just like mountaineering, there are a lot of different certifications you can get in the training process.

And when I was learning how to dive, my son was a middle teenager and I knew someday he was going to be diving alone with probably some of his knucklehead buddies. And so I really wanted him and me trained up.

So we went through our advanced training where you learned to dive deeper, night diving, different certifications, nitrox diving, and eventually worked through rescue diving, which is amazing. And that’s how you learn how to take care of other divers who are in distress and then finally work your way up to being a master scuba diver.

GERM
00:08:45.840 – 00:09:38.390
What a great overview. Yeah, I’m thinking about my own Open Water Padi Journey, St Thomas, around 1988, and three days. Three days, that was it. From soup to nuts.

And I mean, if I go back into the water, I need a full refresher course. I would almost start from scratch. It’s been that long in medicine, we call it continuing medical education, CME. I think we need continuing diving experience. And anyway, I will come to you for your advice on how to do that and get myself back in shape before I get wet again.

Because clearly that’s going to be something I need to do.

But with that in mind, I want to pivot a little bit, please, to your own medical specialty, because ears, nose, and throat concerns, it comes up in diving. What are the most common ENT issues that you encounter among divers?

Dr. DAVIS
00:09:38.630 – 00:12:13.970
Yeah, great question. And that is a big part of the challenges with learning how to scuba dive are the ENT challenges. And the number one would be middle ear barotrauma.

So when you’re unable to clear your ears and everybody has had that situation, if you’re driving out of a mountain pass or descending in an airplane and you just can’t Pop your ears. You know, you eventually get to the ground and you’re fine.

But when you’re scuba diving, you need to be able to clear your ears frequently, all the way down and often, sometimes on the way up.

And that’s because the air pocket behind your eardrum will compress because of the increase in atmospheric pressures of that water column on top of you. That air inside your middle ear space will shrink and that sucks in your eardrum.

And if you don’t clear your ears, that eardrum can rupture and that’s quite problematic. That would end your dive right away. There are ways to clear your ears and we can talk about that in a bit.

But the other situations we see with scuba diving, otitis externa, that’s if you’ve been in the water, often salt water a lot, and you get a swollen, really itchy ear. There are ways to fix that, but that can be a problem.

And then the two big ones, and this is aside from just general decompression sickness or the bends we call it. But there’s a difference called inner ear barotrauma and inner ear decompression sickness. And they both have very similar symptoms.

They occur at different times, but they both need very different treatments. And I’ll just briefly talk about these.

Inner ear barotrauma is an extension of that middle ear barotrauma pressure where you can actually tear the opening of the cochlea. There’s two of them called the oval window and the round window.

And if you tear those, you get what’s called a parilymphatic fistula where that fluid inside of the cochlea and inner ear leaks out. And that’s going to cause severe dizziness, ringing in your ears, hearing loss, that’s concerning, that’s related to pressure.

With pressure, you do not want to go in a hyperbaric tank versus inner ear decompression sickness. That’s going to happen after you’re back on the boat. And it can happen hours to even a day or so later.

That’s where air bubble can form inside the inner ear. Still causes same symptoms, dizziness, hearing loss, ringing in the ears. And that is a scenario where you want to seek a dive chamber.

WORM
00:12:14.770 – 00:12:27.570
And suppose I’ve got a dive coming up in one month. And then second scenario, suppose I’ve got a dive coming up in five minutes. What are some things I can do basically to avoid middle ear issues?

Dr. DAVIS
00:12:28.840 – 00:14:23.470
Well, if you are nice and healthy and not having any problems, enjoy your dive. If you are in the middle of your allergy season or you have a cold, you really need to control your allergies.

And that’s critical because when your nose is stuffy, that same tissue inside your nose goes up your eustachian tube. And so if your nose is stuffy, your eustachian tubes are going to be stuffy.

And you can treat those with over the counter medications, antihistamine pills. There are antihistamine nasal sprays and nasal corticosteroid sprays. All three of those can be helpful to control your allergies.

And those need to be started well before your dive. One week, two weeks ahead of time, at least.

Now let’s say it’s the other scenario five minutes before your dive, or maybe it’s the night before your dive. That’s a different situation. And you’ve spent all this money.

You’re probably in some exotic area in Thailand or you’re on a liveaboard and you went there to dive. There are times where you have to just not dive. But things you can do, you can use those same medications. They do take some time to work.

You can use a nasal decongestant spray like oxymetazoline, that’s commonly called Afrin here in the States. That will temporarily open up your ears to some degree and your nasal congestion to some degree. The challenge with that is it will wear off.

And the concern amongst divers and medical professionals who take care of divers is that, well, what if it wears off while you’re underwater and all of a sudden you’re down at depth and you can’t get up because you have a reverse squeeze? That’s a kind of a scary situation. So my personal philosophy is, if you can’t clear your ears on the surface, you don’t dive. Plain and simple.

GERM
00:14:23.790 – 00:15:38.490
Okay, that’s helpful because I’ve like, you’re reading my own autobiography. I’ve been in exactly that situation, traveling. I think it was actually Cozumel where I had a head cold. Cozumel is a great diving destination for those who haven’t done it, at least. I’d like your opinion about that too, Greg, if you’ve been to cos. But yeah, I was gonna dive. I was like, screw this rhinovirus. I’m going down there.

And I remember from my training that if you dive with a head cold, you may have epistaxis, a nosebleed. And sure enough, we did this dive. I came up and that little water level that was in my mask, I was clearing my, my mask and it was all–It was just blood. It was just red blood that was sitting there. Now there’s no pain, I did not actually have issues with my ears, but the nose was clearly bleeding, so it was kind of maudlin. Maybe it would attract a barracuda or something like that. But I got through it no problem. What you’re saying is, hey, it’s not just a bloody nose.

This is an issue of the potential to be unable to equalize the pressure. That’s a disaster for the reasons you talked about in the previous question. So I’m glad you shined a light on this. nd I love the idea that if you’re on the surface and you can’t clear your nose, for God’s sakes, don’t go down. That’s a great rule of thumb.

Dr. DAVIS
00:15:38.890 – 00:16:26.030
And I’ll say, yeah, Cozumel is absolutely fantastic. One of my favorite places to dive. I left that off the list earlier. But there’s. It’s so such a nice place. You know, they.

The whale sharks migrate through there from time to time. I have yet to see one. It’s on my bucket list. But, you know, Paul, you brought up epistaxis or bloody noses. And that’s. That’s really.

That’s a huge concern because you. If you’re at depth and let’s say your mask fills completely up with blood, now you can clear it just like water.

But if it keeps going and keeps going, you’re essentially blind. Right. You can see through water, but you can’t see through blood. You can’t find your dive buddy.

And so that’s another reason why the teaching is you always stay within a kick or two of your dive buddy. Hopefully your dive buddy would be there to shepherd you back to the surface.

GERM
00:16:26.270 – 00:16:34.350
And I think the other teaching is “Do as Germ says, not as Germ does.” That was bad on me. Okay. So I appreciate that scolding. Thank you. Well done.

WORM
00:16:34.510 – 00:16:52.420
Yeah. Sometimes we use ourselves, not infrequently, as counterexamples of what to do. Related question, Greg.

Suppose I’m descending, and, you know, there’s a pressure here and a small pain there. What are signs that I should abort the dive and return to the surface?

Dr. DAVIS
00:16:52.980 – 00:18:55.240
Well, pains are part of living. And, you know, the older I get that getting out of bed is a painful experience some days.

So if it’s a new pain, I think that’s what you’re really asking about. So let’s say you’re. You’re diving down, you’re having a good time.

And all of a sudden, your shoulder starts to hurt or your chest starts to hurt, or your skin starts sting or burn. That could be a couple things. It could be a wonderful jellyfish that got you, but it could also be a type of decompression sickness.

And usually the decompression sickness is going to happen back when you’re on your way to the surface.

Again, decompression sickness is related to the nitrogen bubbles that we breathe in through our regulators with our oxygen, and it goes into our bloodstream. And those nitrogen bubbles, they shrink as they.

As you descend because of the increase in pressure and Boyle’s law, and then that diffuses out into your tissues.

Now, when you’re ascending, all those little bubbles can expand back to their normal size, and that’s where it can cause blockage of the blood vessels to some critical structures like your brain, your eyes, your spine, your muscles. And that’s decompression sickness. So we try to avoid that.

To answer your question, Chris, if I’m concerned about that, when I’m diving and I’m going down, I’m certainly stopping the dive.

And I’ll say, just from a safety standpoint, if there’s anything that comes up that is really concerning me, and that could be your equipment’s not working right and you can’t fix it. Underwater communication’s not good, Visibility is not good, ideal. The current is too swift, and it just.

You get this feeling in your stomach that it’s not a good situation. That’s the time to go back up to the surface. And maybe you don’t need to go all the way up to the surface.

Maybe you just need to go up 10 meters or so or 15, 20ft, depending on where you are, and kind of recalibrate, catch your breath, you know, decrease your anxiety. Good.

WORM
00:18:55.240 – 00:18:55.760
Thank you.

GERM
00:18:56.230 – 00:19:17.510
Let me return, if I may, to the topic of the ear.

Since you are a rhinologist who thinks about this and a diver, is it possible that someone could have an issue anatomically with their ability to equalize the pressure? And if that’s the case for them, is there anything that can be done to help them dive safely?

Dr. DAVIS
00:19:18.230 – 00:21:00.390
There are. So eustachian tube dysfunction is very common. Many, many, many people have it.

It’s the most common reason that keeps people who want to dive from diving as a passion. And if you can’t clear your ear, you really can’t dive. So you can control your allergies.

As I mentioned, you can use a nasal corticosteroid spray and allergy medicine, and sometimes Even if you don’t have allergies, the nasal steroid sprays like fluticasone or bedesanide, those can help decrease swollen tissue in the eustachian tube. That’s pretty standard to do. Certainly they need to be done on a daily basis for it to be effective.

It’s not something that you do a day or two before your dives. The other thing is, if that doesn’t work, you can see an otolaryngologist, see someone like me who knows about dive medicine.

And there’s a relatively new procedure called balloon dilation of the eustachian tube. And that is very effective for most scuba divers. In fact, the Navy did a study showing 90% success rate in their divers.

And it’s done sometimes under a local anesthesia by numbing up the nose in a clinic setting, sometimes it’s done in the operating room.

But essentially, the ear, nose and throat surgeon will slide a little camera called an endoscope in the nose and then slide a little device that goes up the eustachian tube, which opens up into the back of the nose and it inflates a little balloon, just kind of like a cardiac angioplasty. It’s the same concept, it’s same technology. And that will dilate the cartilaginous portion of the eustachian tube.

And that can be very effective in people. And I’ve done that on quite a few commercial divers as well as people who fly a lot, or recreational divers.

GERM
00:21:00.630 – 00:21:09.430
And am I correct that for people who go through this, is it your clinical experience that it tends to be durable, or do they need to come back for a tune up every six months?

Dr. DAVIS
00:21:09.670 – 00:21:59.610
If it works, it tends to work long term. And long term in any surgical outcome study is usually somewhere between two and four years.

So it’s hard to answer that question longer than four years. The four year data is promising. If it works, it’s going to work.

Now, if people have other ear issues and it’s called middle ear disease, there’s a whole lot of slew of those things.

And part of the workup for considering balloon dilation of the eustachian tube is to get a proper head or sinus CT scan and to have a nasal endoscopy to make sure the sinuses are healthy. But if that all works out, even if someone has middle ear disease to some degree, the success rate’s around 55%.

So again, if you have a healthy ear, success rate around 90%, if you have some middle ear disease, the Success rate is less.

WORM
00:22:00.410 – 00:22:02.010
Greg, what is DAN?

Dr. DAVIS
00:22:02.730 – 00:23:48.940
DAN is the Divers Alert Network.

This is an organization that’s been around for several decades, and I’ve been really fortunate to get to know their chief medical officer over the last few years because he is a contributor to our otolaryngology underwater course. And Dan is. Their mission is to provide free medical advice to divers around the world. And they have an emergency number. It’s 1-919-684-9111.

You can call that number anywhere from the world and somebody will answer the phone. It’s staffed 24. 7, and they know where the dive chambers are everywhere in the world.

They know which dive chambers are operational 24 7, which ones aren’t, which ones have hyperbaric medicine physicians on call. They also do a huge amount of research and education for divers.

And so when we think about, well, how do we know how long of a safety stop you need to do while diving? Or how do we know if you can fly after 12 or 18 or 24 hours after scuba diving? Well, Dan did all that research, and so that’s.

It’s an organization that you can become a member of for a pretty small fee. You can also get dive insurance and travel insurance through them as well. But I encourage all divers to become members.

I have that phone number written in a silver Sharpie on my fins.

So every time I dive, if I forget my Dan card, which is probably in my bag somewhere, if someone pulls me out of the water and I’m unconscious, they’re going to have that phone number on my scuba fins.

WORM
00:23:49.340 – 00:23:51.420
Sounds like a super helpful organization.

GERM
00:23:51.740 – 00:24:15.010
Man, I love the idea of tattooing your phone number for DAN onto the fin. That’s good. I did that on Everest with my down suit. So we are cut from the same cloth.

A minute ago, you just talked about flying after diving. And most people do, they gotta go home, right? So let’s talk a little bit more about that. What’s the concern and what’s the strategy that has worked for you?

Dr. DAVIS
00:24:15.410 – 00:25:48.590
Yeah, it all relates to that vicious nitrogen bubble. So when we are breathing air, compressed air at depth, as I mentioned earlier, the nitrogen gets absorbed into our tissues.

And as we descend, or, sorry, ascend as we go up, back to the surface, everybody will take a safety stop. That’s usually two, three minutes just sitting there, right about 15 to 20ft. And that’s where you’re off gassing.

You’re exchanging that nitrogen, you’re blowing it off, inhaling the air at relatively normal pressures. And so that nitrogen comes out of your tissue and you exhale it, you’re not exhaling all of it.

You still have a nitrogen load in your body tissue when you go to the surface. And if you’re using a fancy dive computer, it’ll kind of tell you your nitrogen load.

And then if you do multiple dives, you still do, your safety stops, but you’re going to build up that nitrogen load. Now if you were to go up into an airplane, they’re pressurized to six to 8,000ft. That’s about two thirds of one atmosphere.

That nitrogen bubble, because there’s less pressure, is going to expand and so that can cause decompression sickness even though you’re at altitude. It can also happen if you’re going up and hiking in the mountains the next day.

So if I’m planning a fun weekend in the Pacific Northwest and I know I want to scuba dive on one day and go hiking or rock climbing up in the mountains on the second day, I’m always going to do the hiking day first and then I’m going to scuba dive the second day.

GERM
00:25:49.310 – 00:26:31.840
I love that idea. And what a great vacation that sounds like. That’s cool.

Let me give you a follow up though, regarding computers and, you know, watches, including the Apple watch. When I trained there was a table like left and right. It looked like an old fashioned Excel table.

We would do that and that’s how you could tell what your time was like before you could fly. And it would also tell your time at depth, for example. Then there was a wheel which is a little easier to use. And now there’s just your wristwatch.

Should people trust their Apple watch? I, the one that I have, I got into the water the other day and it started telling me my dive time.

I was just, I wasn’t even diving, but it automatically started doing this. Do you trust this technology?

Dr. DAVIS
00:26:32.640 – 00:26:42.240
So that. Yes, Apple came out with the new watch. I think it’s the Apple Ultra watch. And Paul, sounds like you have one. You would probably know, I mean, of.

GERM
00:26:42.240 – 00:26:46.640
Course, because if there’s an Ultra, you know, of course I’m going to spend more money on the Ultra. You’re correct.

Dr. DAVIS
00:26:47.040 – 00:28:11.460
I know you’re a techie, so I love that. And I’m actually looking at the Ultra as well. I have a dive computer.

I actually dive with two dive computers because if one goes out, then I have a second one. So yes, you can trust your dive computers as long as the batteries are functioning and they’re charged.

The difference between the old dive tables that you used and that you train with is it assumes, let’s say your max depth is 80ft. That dive table assumes your maximum depth is 80ft the entire dive. Well, that’s not realistic.

We know that you’re going to go from 0 to 10, 20, 30, down to 80 and then spend some time maybe at 60 and sometimes at 40. So the dive computer is constantly adjusting your assumed nitrogen level based off your depth and time at that depth.

So yeah, trust your dive computers. They’re fantastic as long as they’re working. And I haven’t used the Apple Watch, I have a friend who uses it and it seems really nice.

You have to pair it with, I believe the dive app as well.

And you know, the one thing I like, my favorite dive computer is integrated with my regulator and so I can look down at my dive computer and it’ll tell me how much air I have. Now I have a backup system, a backup hose with a, with a pressure gauge.

But that’s another nice twist that I think the Apple Watch doesn’t have right now.

GERM
00:28:11.460 – 00:28:12.340
Thank you so much.

WORM
00:28:12.820 – 00:28:19.440
Suppose, Greg, you’re diving off a dive boat. What are some high priority items you would include in your first aid kit?

Dr. DAVIS
00:28:19.920 – 00:29:56.980
Well, yeah, dive boats present a unique challenge because you don’t have access to medical care right away. And so when I’m on a dive boat there’s always a dive briefing from usually the captain before you leave port.

And this often happens even international. I’ve been in some places where it didn’t quite happen the way I would have felt comfortable. And so it’s okay to ask questions.

The main question is do you have oxygen on board? Where is it? You know how to use it is a whole second topic. But at least do they have it on board? That’s huge.

If they don’t have supplemental oxygen, I’m not diving with them. And that’s just because if you have a problem underwater, the first thing you do when you get to the top is just give that.

Well, if they don’t need cpr, you give that person oxygen.

But things I take with me from a medicine standpoint I really, I don’t take Afrin or decongestants on the dive boat if it’s just a two tank morning dive because again, if I can’t clear my ears, I’m not going to be squirting Afrin up the nose. I just don’t think that’s a safe possibility. But for me it’s really thinking ahead. What happens in a bad situation? Does the dive boat look Safe.

Does the team communicate? If you’re in a third world country, are they able to communicate with you in your language? That’s very important.

Does the boat look like it’s ocean worthy? I’ve been on some pretty janky dive boats before and kind of scratch my head and we make it back.

But it’s one of those concerns that you just got to think about.

GERM
00:29:57.220 – 00:30:17.840
I love it. And in fact, it’s really that gets to the question I was about to ask, which are the pearls of wisdom from Dr. Davis.

Anything else that you want to share with our listeners? Either things that you know now that you wish you’d known back then, or words of encouragement or caution.

We’d love to hear your last parting words of wisdom.

Dr. DAVIS
00:30:18.080 – 00:32:26.860
My biggest advice is learn how to properly equalize your ears. And spend time, spend time. I’m going to, I’ll go over a couple of them, but spend time on YouTube. And there everybody learns the Valsalva maneuver.

And that’s typical. That’s where you pinch your nose and you blow against your closed nose.

You’re blowing a lot of air volume from your lungs up into your middle ear space. And it works great. It’s high volume, high pressure. It’ll pop your ears most of the time.

Kind of the problem with that is it’s a lot of volume and maybe too much volume sometimes. And so there are some gentle ways to do it.

One is the Toynbee, which is where you pinch your nose and you swallow and that you can also jut your jaw out when you pinch and swallow at the same time. That’s using the little muscles that run down the Eustachian tube to pop open the Eustachian tube.

So we actually do have muscles that run down the Eustachian tube, believe it or not. Just like if you tense your neck often, you can get your ears to pop that way.

And then the one, and I’m still working on this one, is the Frenzel maneuver. And that’s if there’s one that I would challenge you all to do.

Frenzel maneuver is where you’re pinching your nose and you put your tongue towards the top, the roof of your mouth like you’re going to say the letter T. And then you kind of squeeze your neck and you push that little air volume up into your Eustachian tubes. And so similar to the Valsalva, you’re getting air into your Eustachian tubes, but it’s not that large volume of you pushing really, really hard.

If you’re having to push really hard. You’ve gone down, you’ve descended too much. You need to go back up 5ft, maybe 10ft. Try some different maneuvers.

Move your head around and work on clearing your ears again. Clear your ears before you get in the water. Pop your ears. Make sure you can do it when you’re starting your descent.

I clear my ears probably five times in the first 10ft. I’m doing it like every two feet and then it gets a lot easier. But that’s my advice to you. Learn how to clear your ears properly.

There’s much better ways than just the Valsalva.

GERM
00:32:27.020 – 00:32:45.570
That’s amazing. And yeah, I hadn’t even thought about it. The technique I use, I didn’t even heard of Franzel. I just thrust my jaw.

I don’t know if that’s a real thing or not, but if I just move. I’m doing it right now, move my jaw forward and then swallow. That seems to somehow open it up for me. And maybe it’s different for each person too.

Dr. DAVIS
00:32:46.440 – 00:32:54.360
It is based on anatomy. And that’s Paul. That’s called the voluntary tubal opening. Let’s have a name. We can call it the P-Squared move too.

GERM
00:32:55.800 – 00:33:54.380
I kind of like “VTO.” But yeah, I’ll do. I’ll do P-squared. P squared maneuver. It’s now a thing. It’s now officially in the lexicon, everyone.

That’s a wrap for episode 81 of Germ and Worm. A very special thanks to our very special expert guest, Dr. Greg Davis. Please learn more about his wonderful ENT practice by visiting him online. www.gregdavismd.com we always welcome your questions on Travel Health. Just send them to us by our website germandworm.com or drop us an email germandworm@gmail.com. If you’ve enjoyed this episode, please join us again, subscribe, rate us favorably on your device and spread the words with friends, family and yep, even on the socials. Those are free ways to support this podcast. I’m Germ.

WORM
00:33:54.380 – 00:33:57.380
I’m Worm. It’s a big planet. See it in good health and we’ll.

GERM
00:33:57.380 – 00:34:19.310
See you next time.

This podcast is designed to inform, inspire and entertain, but this podcast does not establish a doctor patient relationship and therefore it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure. The opinions in this podcast are Dr. Davis, Dr. Sanford’s, and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.