A Life-Changing Catch

Published: October 10th, 2018

Category: clinical, GatorWorks

By Adriana Barbat

Kristi Bernot, manager at Cave Country Dive ShopDiving is Kristi Bernot’s life. A few years ago, it started getting in the way of her life. Bernot manages Cave Country Dive Shop in High Springs, FL, about a 30-minute drive from Gainesville. A highly experienced cave diver and scuba instructor, she has significant training and several diving certifications. Yet after years of diving, she began experiencing what most divers are almost afraid to admit to: Time and time again, within 30 minutes of a dive, she was “bent.”

“The bends,” more formally known as decompression sickness, can form when a diver ascends after a dive. The drop in surrounding pressure during the ascent can result in the formation of nitrogen bubbles in the tissues and blood. Normally, decompression dives circumvent this problem, but Bernot continued to see problems despite decompressing.

The sickness appeared as fatigue, rash, swelling and aching in her joints, and sometimes even visual disturbances.

“I made a promise to myself that I would make some lifestyle changes and see if that helped. If I ever had another incident again, I would go get myself looked at,” she said.

Her symptoms did disappear briefly, but when they came back, it was clear that there was a deeper issue. She brought her concerns to the Undersea & Hyperbaric Medicine Clinic at the UF Department of Anesthesiology. The clinic is overseen by Derek Covington, MD, an Assistant Professor in Anesthesiology who dives at least once a week and is well known in the local diving community. “I knew Derek was running a dive clinic,” she said. “He was somebody I was already familiar with, and I felt comfortable going to see him and getting myself checked out.”

A transesophageal echocardiogram confirmed what Bernot and Dr. Covington both suspected: She had a patent foramen ovale (PFO). A PFO is a hole in the heart that allows blood to circulate through the body before birth. Everyone is born with one, Dr. Covington said, but it usually closes soon after birth. If it doesn’t, it usually goes unnoticed, but it can pose a problem to divers like Bernot. She met this news with mixed emotions: relief, but also fear. Relief because she knew there was a path forward; fear because she wasn’t sure it could be fixed.

“Obviously I make a livelihood doing this, but I truly love diving,” she said. “I can’t imagine my life without diving in it.”

Shortly after her visit to the clinic, she underwent surgery to close the PFO. Within 3 months, Bernot was back to diving.

And not only is she diving again — she’s feeling better than ever, she said, with sharper, clearer senses during her dives and less fatigue after. “It’s definitely different. I can tell there’s a difference between how I felt before and how I feel now.”

scuba diver with flashlight

Photo by Derek Covington

The original dive clinic’s purpose was to provide physical examinations for student divers who needed them for certain courses. This clinic was run by Boyd Kellett, MD, a family medicine physician at UF Health, until his retirement in 2017. At the time, Dr. Kellett was the only dive medic at the hospital. He was also the only local physician able to conduct dive physicals. When he retired, UF students were left with no nearby options for medical evaluations. Without clearance from a dive medic, students were unable to participate in courses that involved diving, and the courses were nearly shut down. Ann Zaia, PhD, ARNP, MSN, SM, MHA, Clinical Coordinator of the UF Occupational Medicine Program, began a relentless mission to find a replacement.

“There were no certified dive medics within 100 miles,” Dr. Zaia said. “I couldn’t send students and faculty 200 miles away to get their physicals.” After a frantic search and countless emails and phone calls, she came into contact with Dr. Covington, an experienced and frequent diver. He had completed an undersea and hyperbaric medicine fellowship at a similar clinic with University of California, San Diego two years prior and had hoped to bring a similar service to UF. Together, Dr. Covington and Dr. Zaia established the Undersea & Hyperbaric Clinic, uniting two departments that previously had no connection.

Going beyond satisfying the need to conduct standard examinations for students and faculty, the clinic has evolved under Drs. Zaia and Covington to serve a sizable local diving community as well. Dr. Covington said one of the clinic’s major advantages is its proximity to High Springs. “High Springs is a small town but an international cave diving destination,” he said. “It’s the most popular cave diving place in the country, and arguably the world.”

High Springs, Florida

High Springs, Florida

Bernot’s experience under Dr. Covington’s care is one example of how the clinic is benefitting  the community. Dr. Zaia said she knew of at least one other patient who had received a similar PFO diagnosis at the clinic. “Had he not diagnosed it, something very bad could have happened,” Dr. Zaia said. “Had we not met, two people’s lives could have been very different.”

Dr. Covington is certified to conduct examinations for commercial, scientific, and recreational divers. Though most of his patients are scientific divers from UF, including undergraduate and graduate students as well as faculty, he said he encourages visits from all types of divers and especially hopes to see commercial divers in the future.

Dr. Covington sees patients at the clinic as needed, operating it in his free time. He said working with people in the community — especially a community he is so closely tied to — drives his passion for dive medicine.

“People are participating in an occupation I love,” Dr. Covington said. As a diver, he is especially aware of his patients’ needs. The unique underwater environment gives divers a unique pathology, he said, and this makes divers a particularly interesting patient population.

Dr. Covington’s goals include increasing awareness of the clinic so he can see patients more regularly. He also hopes to begin clinical research as the clinic expands.