Which animal is the most hazardous to scuba divers?
a) Great White Shark
b) Tiger Shark
c) Barracuda
d) Sea Urchin
While nearly everyone chooses a, b or c, I am living proof that the correct answer is d. A recent minor sea urchin stick required six doctor visits, antibiotics, steroids, surgery (not the wimpy out-patient kind, but an honest-to-goodness surgery in a hospital while under a general anesthetic) and physical therapy.
It started out simply: About two months ago I forgot to pack my dive gloves. I didnt think it was a big deal, because the water temperature was 72 degrees and Id been doing dives with students all summer without gloves (it gives us better manual dexterity to resolve issues students might have with straps, buckles, etc.) I led the dive and stopped to check how much air my buddy had left. A large wave swept overhead, creating surge that pushed me backward into the reef. Three tines of a sea urchin stuck about an eighth inch into the middle finger of my left hand, breaking off as they did so.
It wasnt very painful and I wasnt concerned, since it had happened before. The treatment was the same as for a splinter: Remove the tines and soak the finger in a very hot solution of water and iodine. The tips of sea urchin spines, however, are much more difficult to dig out than splinters. They are hard to grab with tweezers, break off easily, and have small barbs that cause them to dig deeper into the skin. Because of this my wife was unable to remove the one of the tines.
The next morning there was no evidence of any injury, and I wondered if the tine had simply fallen out while I slept. It hadnt; about a week later my finger swelled up significantly, with lots of stiffness and tenderness. My doctor isnt a diver, so I checked the D.A.N. website for direction. Their advice was a course of anti-inflammatory steroids. I showed a printout of the D.A.N. article the doctor, who dutifully prescribed Prednisone.
The Prednisone worked wonderfully. The swelling disappeared immediately but returned worse than ever a week later once the Prednisone taper ended. The finger was sore and stiff and, if bumped in the middle of the night, would jolt me awake in a flash of pain. A return trip to my doctor didnt yield much except a recommendation to see an Orthopedist specializing in hands. The Orthopedist, in turn, sent me off to get an MRI that surprise surprise confirmed that my finger was swollen and nothing else! Sea creatures sometimes carry a variant of the TB virus on their skins. The urchin spine had evidently worked its way into my finger, penetrating the nerve sheath and infected it with the virus.
His recommendation was surgery to open up the entire finger in a saw tooth cut. This would allow him to inspect the nerve sheath for damage, search for the urchin tine, drain and clean it before stitching it back up. This seemed pretty extreme to me, so I sent and e-mail off to D.A.N. They responded within a day and, unfortunately, concurred with the Orthopedic surgeon. While waiting for the operating room to be scheduled I took antibiotics but, like the steroids, they didnt seem to have much of an impact.
The surgery took about an hour and required general anesthesia. No urchin spine was found; like a guided missile it delivered its infection payload and was then absorbed. The extent of the surgery, as well as the pain and swelling afterward, were frankly a bit more than I expected. The picture attached was taken a few days after the surgery.
I hobbled around for a week, hopped up on Vicodin and with a hand so wrapped in bandages that it looked like a club. To my wifes immense credit I never once heard I told you so or a suggestion to curtail my diving.
Its been about a month since the surgery. The stitches are out and the skin is healing well. The scar tissue, however, makes the finger very stiff and I still cant bend it fully. The prognosis is good, although it requires daily physical therapy.
No one seems to believe that a small, immobile, non-threatening sea urchin could cause all this grief. Given the saw tooth shape of the profile, Ive taken to giving out a more believable story of how I was bitten by a Great White while saving a small child trapped in a rip current. Even so, you now know the true story!
Take Away Lessons
- Always wear gloves, especially when diving through narrow notches in the reef when its surgy.
- Watch your buoyancy closely.
- If you get stuck by a sea urchin, be sure to remove all tines, then soak the affected area in as hot a solution of water & iodine as possible.
- If you cant remove the urchin spine get to an ER immediately. Over time the urchin tine will burrow in too deeply to be removed. If treated immediately only a local anesthetic and a small incision will be needed (I know from experience, but thats another article!) and it will heal quickly.
- Never turn your back on a sea urchin. They may be small and slow, but they are very hazardous!
a) Great White Shark
b) Tiger Shark
c) Barracuda
d) Sea Urchin
While nearly everyone chooses a, b or c, I am living proof that the correct answer is d. A recent minor sea urchin stick required six doctor visits, antibiotics, steroids, surgery (not the wimpy out-patient kind, but an honest-to-goodness surgery in a hospital while under a general anesthetic) and physical therapy.
It started out simply: About two months ago I forgot to pack my dive gloves. I didnt think it was a big deal, because the water temperature was 72 degrees and Id been doing dives with students all summer without gloves (it gives us better manual dexterity to resolve issues students might have with straps, buckles, etc.) I led the dive and stopped to check how much air my buddy had left. A large wave swept overhead, creating surge that pushed me backward into the reef. Three tines of a sea urchin stuck about an eighth inch into the middle finger of my left hand, breaking off as they did so.
It wasnt very painful and I wasnt concerned, since it had happened before. The treatment was the same as for a splinter: Remove the tines and soak the finger in a very hot solution of water and iodine. The tips of sea urchin spines, however, are much more difficult to dig out than splinters. They are hard to grab with tweezers, break off easily, and have small barbs that cause them to dig deeper into the skin. Because of this my wife was unable to remove the one of the tines.
The next morning there was no evidence of any injury, and I wondered if the tine had simply fallen out while I slept. It hadnt; about a week later my finger swelled up significantly, with lots of stiffness and tenderness. My doctor isnt a diver, so I checked the D.A.N. website for direction. Their advice was a course of anti-inflammatory steroids. I showed a printout of the D.A.N. article the doctor, who dutifully prescribed Prednisone.
The Prednisone worked wonderfully. The swelling disappeared immediately but returned worse than ever a week later once the Prednisone taper ended. The finger was sore and stiff and, if bumped in the middle of the night, would jolt me awake in a flash of pain. A return trip to my doctor didnt yield much except a recommendation to see an Orthopedist specializing in hands. The Orthopedist, in turn, sent me off to get an MRI that surprise surprise confirmed that my finger was swollen and nothing else! Sea creatures sometimes carry a variant of the TB virus on their skins. The urchin spine had evidently worked its way into my finger, penetrating the nerve sheath and infected it with the virus.
His recommendation was surgery to open up the entire finger in a saw tooth cut. This would allow him to inspect the nerve sheath for damage, search for the urchin tine, drain and clean it before stitching it back up. This seemed pretty extreme to me, so I sent and e-mail off to D.A.N. They responded within a day and, unfortunately, concurred with the Orthopedic surgeon. While waiting for the operating room to be scheduled I took antibiotics but, like the steroids, they didnt seem to have much of an impact.
The surgery took about an hour and required general anesthesia. No urchin spine was found; like a guided missile it delivered its infection payload and was then absorbed. The extent of the surgery, as well as the pain and swelling afterward, were frankly a bit more than I expected. The picture attached was taken a few days after the surgery.
I hobbled around for a week, hopped up on Vicodin and with a hand so wrapped in bandages that it looked like a club. To my wifes immense credit I never once heard I told you so or a suggestion to curtail my diving.
Its been about a month since the surgery. The stitches are out and the skin is healing well. The scar tissue, however, makes the finger very stiff and I still cant bend it fully. The prognosis is good, although it requires daily physical therapy.
No one seems to believe that a small, immobile, non-threatening sea urchin could cause all this grief. Given the saw tooth shape of the profile, Ive taken to giving out a more believable story of how I was bitten by a Great White while saving a small child trapped in a rip current. Even so, you now know the true story!
Take Away Lessons
- Always wear gloves, especially when diving through narrow notches in the reef when its surgy.
- Watch your buoyancy closely.
- If you get stuck by a sea urchin, be sure to remove all tines, then soak the affected area in as hot a solution of water & iodine as possible.
- If you cant remove the urchin spine get to an ER immediately. Over time the urchin tine will burrow in too deeply to be removed. If treated immediately only a local anesthetic and a small incision will be needed (I know from experience, but thats another article!) and it will heal quickly.
- Never turn your back on a sea urchin. They may be small and slow, but they are very hazardous!
