DIVE DOC­TOR: Med­i­cal Q&A

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Q: Ear­lier this year I suf­fered two ma­jor at­tacks of pain in my face ( jaw mainly), for no ap­par­ent rea­son. My doc­tor has di­ag­nosed me with trigem­i­nal neu­ral­gia. I was tak­ing 1,000 – 1,200mg of Te­gre­tol daily and still not pain free. If I missed my med­i­ca­tion, even just by a couple of hours, the pain would in­crease con­sid­er­ably. Fun­nily, I did find quite a lot of re­lief from the pain when I went swim­ming and div­ing. I be­lieve this could be due to the cold wa­ter hit­ting my face and the blood ves­sels con­strict­ing, thus not ir­ri­tat­ing the nerve. The re­lief was amaz­ing - I did not re­alise how much the con­stant pain was af­fect­ing me. Any­way, I was re­ferred to a spe­cial­ist neu­ro­sur­geon who con­firmed I had the con­di­tion. Two months ago I un­der­went MVD surgery, where a blood ves­sel was found to be ir­ri­tat­ing the trigem­i­nal nerve. Now I am down to 400mg of Te­gre­tol daily and I have stopped tak­ing all pain killers. So my ques­tion is: when I can safely get back in the wa­ter?

A: Trigem­i­nal neu­ral­gia goes by some won­der­fully colour­ful syn­onyms, ‘tic doloureux’ and ‘sui­cide dis­ease’ to name but two; in­deed, Ed­vard Munch’s ‘ The Scream’ is said by some to de­pict one suf­ferer in the throes of an at­tack. The pain is in­tense, re­put­edly to be among the worst known, and sev­eral the­o­ries ex­ist as to its ori­gin. One par­tic­u­lar ex­pla­na­tion that has gained con­sid­er­able trac­tion in re­cent years is that which you ap­pear to have: an en­larged blood ves­sel - pos­si­bly the su­pe­rior cere­bel­lar artery - com­press­ing or throb­bing against the mi­crovas­cu­la­ture of the trigem­i­nal nerve near its con­nec­tion with the pons in the brain­stem. MVD (or Mi­crovas­cu­larde­com­pres­sion) surgery is usu­ally tried where med­i­cal treat­ments (such as Te­gre­tol, or car­ba­mazepine) have failed, and has pro­duced amaz­ing re­sults, al­though there is a risk of post-op­er­a­tive fa­cial numb­ness. In­ject­ing glyc­erol and fry­ing the er­rant nerve fi­bres with elec­trodes can also be ef­fec­tive. So, pro­vided you have fully re­cov­ered from the MVD surgery, I don’t ex­pect it will cause a prob­lem. How­ever, I am a lit­tle con­cerned about the car­ba­mazepine as it has the po­ten­tial to in­ter­act with dis­solved ni­tro­gen at depth, re­sult­ing in un­pre­dictable and pos­si­bly dan­ger­ous side ef­fects. Ideally you should wait un­til you’ve come off it fully be­fore div­ing, but be aware it should not be stopped abruptly as this can cause seizures, so you need to dis­cuss a wean­ing regime with your doc­tor.

Q: I won­der if you could help, I was given your con­tact de­tails by a friend. Ba­si­cally I was bit­ten by quite a lot of sea urchins a few weeks ago and while I did get med­i­cal treat­ment while I was there, my feet do not seem to be heal­ing. I’ve been on an­tibi­otics. My feet are still slightly swollen in patches and ten­der, parts are itchy and sore. I just won­dered if this was nor­mal, and whether I should be wor­ried.

A: Sea urchins have a num­ber of de­fence mech­a­nisms, in­clud­ing a large ar­ray of ven­omous spines, long enough and sharp enough to pierce neo­prene. Im­me­di­ate treat­ment by im­mers­ing the area in hot wa­ter should de­na­ture the venom and pro­vide some pain re­lief. Large spines should be re­moved with tweez­ers, and smaller frag­ments can some­times be pum­melled into sub­mis­sion, al­though if they per­sist they can cause in­flam­ma­tion and/or in­fec­tion, giv­ing you the typ­i­cal symp­toms you de­scribe - red­ness, heat, ten­der­ness, swelling, itch­ing etc. Pro­vided you are on an­tibi­otics then you can treat the other symp­toms with an­ti­his­tamines, lo­cal creams (eg. calamine, hy­dro­cor­ti­sone) and they should re­solve, but this can take sev­eral weeks or even months. If the symp­toms worsen, then see your GP again for re­view.

Dr Oliver Firth has gained con­sid­er­able ex­pe­ri­ence in the field of div­ing and hy­per­baric medicine since join­ing LDC in 2006. He is an Ap­proved Med­i­cal Examiner of Divers for the UK HSE, and a med­i­cal ref­eree for the UK Sport Div­ing Med­i­cal Com­mit­tee. He is in­volved in the man­age­ment of all types of div­ing-re­lated ill­ness, in­clud­ing re­com­pres­sion treat­ment, as well as pro­vid­ing hy­per­baric oxy­gen ther­apy for non-div­ing con­di­tions. He re­mains a pas­sion­ate diver and has par­tic­i­pated in var­i­ous ex­pe­di­tions and con­ser­va­tion projects through­out the globe.

www.sport­diver.co.uk/dive­doc­tor.

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