Diving Medical Questions

Question:

Within the last 2 years I had an episode of rapid atrial fibrillation needing cardioverting with amiodarone. No defibrillator was used. Following a comprehensive set of tests at my cardiothoracic centre I have been given the all clear and was told that I am fitter than the norm. Would it be safe to dive?

Answer:

From what you describe it sounds like your heart has reverted to a normal rhythm. A determination on safety to dive at this point would depend on several factors.

One issue is what actually caused it? Are there any underlying issues, or any existing symptoms which could increase your level of risk?

To be given the all clear prior to diving, you must satisfy your medical examiner on these counts and demonstrate an ability to cope with exercise. Hopefully in your case you will be given the all clear following investigation and can then dive. At that point you will need to make a judgement on the type of diving you will do, based on your experience, age and so on.

So, in summary, it is in your best interest to see a sport diving referee and take it from there.

Question:

I have just been diagnosed with a PFO. What are the safe limits for diving with this condition, if any?

Answer:

There is evidence that suggests a PFO increases risk of decompression illness. How much by will be dependent on a number of factors, such as the type and extent of the PFO and depths of the dives undertaken. In some cases with divers with PFO’s, dives shallower than 15m are thought to be relatively safe, but it very much depends on the PFO.

Ultimately, the extent of the PFO must be known to assist in determining what dives, if any, you could expect to carry out reasonably safely. I suggest your cardiac specialist liaises with a diving medicine specialist to guide you through the pros and cons of closure or continuing to dive without closure.

Question:

I need to have 4 impacted wisdom teeth removed and was wondering how long it would take for my jaw and gums to heal before i can safely dive again.

Answer:

The more difficult the extraction, the longer the recommended break before restarting your diving. If the extractions were easy and went well without complications such as dry sockets and skin has healed then 2 weeks should be fine. If bone was removed during the procedure or you develop a dry socket, then a longer period of a month would be safest. The depths, mixes etc do not have any real impact on your safe return to diving, but regulator comfort may also be a factor for you.

Question:

I have been taking Diclofenac Sodium pills for arhritis for the last 12 months. Are there any problems associated with taking these pills and diving?

Answer:

There are no reported major concerns with taking these whilst diving, certainly as long as you are not on any medication that it is known to interact with, such as Fluoxetine (Prozac) which is used to treat depression.

From memory they were actually used to reduce inflammation in divers with decompression illness in the past. Take normal precautions by ensuring you are well hydrated pre and post dive and so on.

Question:

I have suffered with reflux oesophagitis on and off for years. An endoscopy showed slight inflammation but no hernia. It is treated with 150mg Ranitidine tablets at 1 per day and it settles after 2-3weeks. Can I dive whilst taking this medication as I have no symptoms whilst on the medication?

Answer:

Controlling the reflux should help matters and arguably make your diving safer as excess acid can cause retching underwater. You are taking low doses of Ranitidine and as long as you do not find yourself adversely effected by some of the known side effects, such as dizziness, headaches etc, then you should be fine to dive.

There are many potential causes. Stress, alcohol consumption, smoking and eating fatty foods prior to exercise can all lead to excess acid production in the stomach and consequently to acid reflux. The commercial divers we see are just as likely to suffer from these causes as the sport diving community.

Your body position whilst diving can also increase your chances of acid reflux… swimming with your head down is certainly a common cause, as is swallowing air. Any pressure on the abdomen, from swallowing air to tightly fitting kit can also increase your chances of experiencing it.

Question:

I take Sertraline(Lustral) 50mg daily for depression and have for a long time and have dived to various depths in a variety of climates with no adverse reactions or problems. I am unable to get a Medical Certificate and cannot understand the reasoning behind this.

I knew a diver taking the same medication as myself and he was able to get a Medical Certificate. How did he manage this and where did he go. I take my diving seriously and have full respect for the sport and its requirements.

Answer:

New guidelines have recently been issued with respect to this group of SSRI medication. Certainly, previously it was felt on balance that diving was not safe for users of this group of medicines, the probability of increased bruising or bleeding being one of the reasons as this could potentially make any bend worse.

However, subject to certain conditions being met, an examining diving doctor could well pass you fit to dive now, albeit with a depth limit of 30msw Equivalent Air Depth.

Generally speaking your examiner would need to ensure that you are not taking other medication which would combine with this and increase your risk of bleeding even further, e.g. aspirin, ibuprofen, other psychotropic medication.

I note that you have been taking this medication long-term, so there has been ample time for side-effects to make themselves known – new users should wait 3 months prior to diving. Additionally, their use should be for maintenance only, with the diver otherwise fit and well. If you meet these criteria that should help significantly in being passed fit to dive.

Question:

I take 20mg of Citalopram daily for depression. I have done for a while and suffer no side effects, in fact it seems to suit me quite well. Am I ok to dive?

Answer:

It is good that this medication suits you and you seem to suffer no side-effects as a result of taking it. There is, however, a slight concern regarding the drug increasing bruising or bleeding, particularly if ever used in addition to aspirin or some anti-inflammatory drugs – theoretically it means that you could be more at risk if you do suffer barotrauma, experiencing more bleeding following the event than would be typical. In cases such as these, I feel it is best that you get yourself assessed by a diving doctor, so that your personal circumstances can be taken into account. Also, in the interests of safety I feel that it is not a bad idea to disclose your medication to your dive buddy.

Question:

Everytime I go diving I get earache after a while. I was told that this is an inflammation of the outer ear. Does anybody have an idea how I can prevent this inflammation?

Answer:

Otitis externa, or Swimmer’s Ear as it is more commonly known is a common problem for all frequent water users. Contrary to popular belief, it is not caused by bacteria in the water, but instead the bacteria in your external ear canal.

Frequent immersion in water strips the ear canal of a layer of cells, which provides a perfect breeding ground for the bacteria. It can become itchy, sore and inflamed, spreading to the lymph nodes if untreated. Antibiotics should be used if this point is reached.

Prevention is often better than cure, however, and remedies are available. Over the counter remedies such as Swim-Ear contain alcohol and dessicants, which aim to remove the water in the ear. They are typically used before and after diving and are readily available at any chemists.

More effective prescription medicines, based on acidic solutions such as Otic Acetic Acid (Otic Domeboro Solution) can be used. This mild acid is superb at clearing up the bacteria when used before the first dive, and after the last dive of the day.

You must not use either of these remedies, or indeed any drops, if you are suffering from a ruptured eardrum as it may wash bacteria into the middle-ear

Question:

I was wondering how long it takes for a perforated ear drum to heal and when i can dive again.

Answer:

It varies from a few weeks in the case of a small perforation with no infection, up to 6 months with larger perforations that may be further complicated by infection. Staying out of the water in the mean time is the best thing to do to speed the recovery, preventing water potentially causing infection and slowing the healing process down.

Recovery is usually spontaneous, but in some cases surgical assistance may be necessary. To ensure that you are fit to dive again it would be worth waiting 3 to 4 weeks and then seeing your GP who can check your ear drum. Visiting an ENT specialist is also an option of course.

Question:

What is the general advice for diving with Type 1 diabetes? What are the risks involved? Should scuba diving be avoided as a sport?

Answer:

Well, this can be a difficult question. It is not unusual for diving doctors to say that people with diabetes should not dive. The concern is of course the risk of diving and experiencing a hypoglycaemic attack. Drowning would be a very real possibility and it does potentially also increase the risk for your buddy. Many divers have, and continue, to dive safely.

Studies suggest that blood sugar levels, on the whole, remain the same before, during and after diving, but diabetic divers may be more likely to become dehydrated, which is of course a factor in DCI. At the very least, it would be prudent to consult a diving physician to establish fitness to dive. This way you can also be monitored periodically to ensure no complications are developing that would exclude you from diving.

Question:

I have recently developed severe allergic reaction to a number of foods etc including peanuts and possibly latex. I am looking at investing in my own set of regs to avoid as much as possible the risk of contamination. I am currently having investigative tests carried out by specialist Dermatologist as the symptoms indicate contact rather than digestive reaction. Any guidanceor advice on which diving gear I should invest in. Also any additional complications regarding diving and having to use an epipen. I assume that I shouldn’t dive awardwards but are there any risks or complications in using an epipen following a dive?

Answer:

The patch test from your dermatologist is really the key here. People with latex allergies are reacting to the proteins present in the product, whereas neoprene is a different product without those proteins, but instead has it’s own compounds which you may be allergic too. Testing will guide you as to which triggers you need to avoid, and therefore which equipment would be necessary in your case.

The suit, seals and regulators are all equipment that you will obviously be considering in this respect. Best to find out your specific allergies before you go diving though, you really don’t want to risk a potentially severe adverse reaction underwater. Linings can also be worn to minimise contact with suits and Lycra and Polartec suits are often quoted as options for sufferers.

There should be no specific problems relating to the use of an epipen following diving. One final thought… there have been reports of increased sensitivity to products frequently used becoming a problem, e.g. neoprene suit, leading to an allergy. This is similar to the medical profession where gloves are a hot item of discussion at the moment.

Question:

I am thinking of getting a tattoo but wondered if there were restrictions on diving after having it done? Is it just a case of when the tattoo has stopped flaking/all scabs have healed? Thanks for your help!

Answer:

It is pretty much just that, a case of waiting until the skin has healed over properly. This can take around 3 months and it is worth remembering that this protective skin layer is your barrier to the bacteria found in the water. Other than that just follow the after-care advice from your tattooist!

Question:

Hi,I have just had a ureteric stent put in and it will be left for 3 months.Does anybody know if there is any contraindications for diving as I am off to indonesia!(there was an occlusion due to endometriosis)

Answer:

This should not cause you any problems with your diving at all as it is effectively an open space used to assist drainage.

Question:

What actually happens to a joint after suffering a minor bend. What are the long term consequences of say a shoulder bend, or some similar joint.

Answer:

Well, to look at what happens in the area after a bend, it is helpful to start with what a joint bend really is. In joint bends, pain is caused due to the presence of gas bubbles in and around the joint. The specific reasons for the pains are complex.

Bubbles exert pressure on the pain receptors and further complications can include interaction of the gas bubble around the periosteum, a very sensitive outer layer of bone in the joint. Resulting pain can vary from a mild ache to an excruciating acute pain. Left untreated, joint pain can persist, although it tends to settle after several days.

However, in this time it can cause considerable damage which will effect you further down the line. The bubbles can disrupt the blood supply to areas of bone, leading to an increased risk of dysbaric osteonecrosis, an accelerated form of osteoarthritis.

Commercial and saturation divers have higher risks of this problem due to their frequent higher pressure exposures. More immediately, left untreated you are more likely to experience a problem on a subsequent dive. Joint pains can be confused with strains from lifting equipment and so on, but if you have a sufficient gas load from your dives, or the dive was in any way less than ideal you should get in touch.

It is worth saying of course, that a perfect profile can still leave you with decompression illness. Therefore, if you have these symptoms following a dive you should seek medical help from a diving specialist. And so as you can see, it is potentially not a minor problem, or bend, at all, quite the opposite!

Question:

5 years ago I was diagnosed with Spino Cerebellar ataxia. According to the specialist, it seems to be slow to very slow, it does not affect my every day life, although I will never be a gymnast, working outdoors nor does it affect my diving. According to the specialist, progression started in my mid teens, I am doubtful and believe it started much earlier and was only medically noted when I got to 28 (now 36)

However it has meant I cannot get an hse medical for teaching. I realise the information I have given here is very brief. Is there anyone I could speak to about getting my hse medical? I did try to get one one a few years ago but failed a step test, I don’t know if this was coordination test or a fitness one. My specialist is prepared to discuss this.

Answer:

The step test is used primarily as a rough means of assessing cardiovascular fitness and it attempts to recreate some of the physical endeavour that a commercial diver might reasonably be expected to undertake. I think that your best bet is to speak to a local Approved Medical Examiner. A list of national HSE medical examiners for commercial diving can be found here:

List of HSE Approved Medical Examiners

Question:

I was diagnosed with breast cancer at the beginning of this year and am just finishing 24 weeks of chemo and will be having 4.5 weeks of radiotherapy, so treatment plan is to finish mid September. I hate being out of the water and would like to know a. when I can dive again and b. would I be able to obtain diving insurance and if so, is there a period of time after treatment I would need to wait until I could get insured (I’ve had many different answers on this one from other friendly divers!!). Any help you can give would be greatly received.

Answer:

There are a couple of points to consider with breast cancer. Any surgical scar, when fully healed, would not be a problem at all with diving. However, some of the drugs taken during chemotherapy are thought to have some potentially concerning effects for the diver. The lungs are the main area of concern, with the potential for damage to occur which would increase your risk of lung complications when diving. Lastly, the drugs can make you feel pretty nauseous in many cases and the potential for side effects is at its greatest during treatment. For this reason it is best not to dive during treatment, but instead get checked out by a diving physician when the course is completed. The lungs can then be assessed, in addition to checking your general fitness to dive. At this point, you can be confident before you go back in.

Question:

I am thinking of going to Egypt to learn to dive with my husband. However I have lymphoedema in one leg and a Urostomy. Would either of these conditions prevent me from learning to dive.I am 48 yrs old, and female.

Answer:

The lymphoedema itself should not present a problem with your diving, and a straight urostomy should not present problems either, many people in a similar situation have enjoyed a long and rewarding period diving. It would of course be prudent to drain prior to diving, and to ensure that it is well fastened, with waterproof tape. Not a bad idea to avoid heavy lifting either, so let someone else lift all the kit!

Question:

In Nov last year I had a discectomy and 6 months on I am keen to start getting back into diving. My surgeon has said there is no way I can carry the weight of the equipment on my back. Is this all I should be concerned about or is pressure an issue? If I put my equipment on in the water after a safety check is this going to be OK?

Answer:

Certainly the physical demands of diving are a major concern following a discectomy, but there are other issues as well. Whilst there is no proven link, there is a concern that there may be an increased risk of spinal decompression illness following such surgery, due to the disruption in the local area and its effect on gas exchange.

Obtaining the all-clear from the surgeon is a good first step, but it is also worthwhile seeing a diving doctor for a check-up, where your fitness to dive safely can be assessed. Moving on to your diving, it would be sensible to reduce the depths of the dives, to say under 30m, and consider diving air tables with nitrox to give yourself an additional safety factor. Minimising loading on your spine would certainly help as well.

Question:

My wife would love to dive but 3 years ago she had blood clots in her lungs. she was on warfarin for 8 months and used support stocking for 2 years she is fine now, could she dive?

Answer:

A history of blood clots in the lungs is worrying with respect to diving. This is due to the risk of scarring being present – if so, this could increase the risk of pulmonary barotrauma and ultimately air gas emboli forming. If your wife is absolutely set on diving, then an opinion for a chest specialist with an interest in scuba diving would be essential. A spiral CT scan would probably be advised which would help the specialist reach a decision.

Question:

I have had my appendix out 2 weeks ago and was wondering when it will be OK to dive again. It was a conventional operation and not keyhole surgery.

Answer:

Diving in the sea exposes the skin to a range of organisms. Following any surgery it would be necessary to wait until a full recovery has been made, in this case around 4 to 6 weeks should allow enough time as a guide.

Question:

I had a double arthroscopy 2 weeks ago. There were no repairs requiring stitches, only a bit of trimming. I am walking around now but realise I will have to wait until I can comfortably carry my kit and be able to handle changes of direction before I go diving.

Do I have to wait 8 weeks for the tissue to heal before I dive in order to avoid any DCI problems with unhealed tissue? I was hoping as it was key-hole surgery and trimming that this may not apply or may be reduced.

Answer:

The length of the lay off required in your case really depends on your recovery. As you say, the weight-bearing is the issue, so a period of building yourself up with physio would be prudent. When you feel ready to weight-bear and have had the all clear from the specialist as well, you should be fine to return to diving. I would imagine 6 to 8 weeks on the conservative side, depending how quickly it heals.

Question:

I have early onset glaucoma. I take the medicine (drops) Cosopt in the morning and 12 hours later, the medicine (drops) Xalatan to maintain lower pressure in my eyes. a) Should I be diving? b) If yes, down to what depth can I go? c) what sorts of precautions do I need to take? My doctor is uninformed about this and I need some expert advice.

Answer:

For those taking medication only to reduce the pressure, it is generally safe to dive. Saturation divers have dived to extreme depths with glaucoma without problems. Specific medication taken must be considered, however.

The critical factor for those with glaucoma is not the absolute pressure exerted on the eye, but the difference in pressure inside the eye to that exerted outside. In diving this is low and so should cause no problem, without any limitation on depth.

With the medication you are taking, Xalatan is reported as relatively free of side-effects, certainly nothing that will cause a problem with your diving. Cosopt can potentially slow your heart which theoretically could increase your risk of losing consciousness at depth. As long as your pulse is generally over 60 whilst on this medication you shouldn’t have any problems.

For those who have had surgery there are some additional things to watch out for. Certainly, a two month lay off is advisable following surgery and the only complication noted is caused by face mask squeeze. If this is avoided there should be no issues.

Question:

My father in law successfully underwent surgery for Abdominal Aortic Aneurysm earlier this year. What are the risks associated with diving after AAA surgery? Is it lifting heavy gear or is it proportional to depth? Is the risk of DCI higher now? Any general info appreciated.

Answer:

In itself, there should be no problem directly from the repair. However, having had an aneurysm your father-in-law is likely to have athlerosclerotic disease, a disease in which blood vessels have been damaged. This in turn means sensitive organs may not receive as good a supply as someone of the same age without vascular problems, and can potentially mean that he would be more at risk from decompression illness.

Again, if he were to have DCI then it could potentially be a more serious one. Medication could also be a factor. See a previous forum thread about blood pressure medication for details on that, but there are also other types which could interact with the diving, such as warfarin.

So, in summary, without knowing specific medical history it can be difficult to say, but this should give you an idea of some of the issues involved.

Question:

I am about to have an intramedullary femoral nail removed from my right leg. this has been in place almost 4 years and is causing some discomfort. Can you advise how long i should lay off diving after the op or give any other advice.

Answer:

I think in your case it would be sensible to refrain from diving for a period of 8 weeks. Following surgery the body is undergoing a period of healing and, theoretically at least, inflamed tissue could disrupt normal nitrogen gas diffusion, leading to an increased risk of decompression illness.

Question:

Hi, I have raynauds syndrome and this has caused me problems in the past with snowboarding etc. I have been diving for about 2 years but have only just been diagnosed. Is there anything that I should know about diving with raynauds? I have heard that it can increase the chance of a bend. Also what happens if you continue to dive with symptoms?

Answer:

Raynaud’s syndrome can pose particular problems to divers, especially those diving in cool UK waters. The causes of Raynaud’s are not fully understood but it is a condition which leads to what is known as vasospasm. This term describes a constriction of the vessels carrying blood and particularly effects the extremities – nose, ears, fingers, toes. This can lead to decreased sensitivity and dexterity in a diver.

Triggers to an attack of these spasms can include exposure to cold, emotional stress, smoking, caffeine, sudafed decongestants to name a few. It varies from person to person and so a personalised risk assessment approach is necessary through examination.

Sometimes a type of medication known as vasodilators are recommended in the treatment of Raynaud’s, but caution is necessary in those who dive as there are concerns that such medication could increase the risk of syncope.

Syncope, a restriction of blood supply to the brain leading to a feeling of being light-headed or fainting, is of great concern to the diver due to the risk of drowning. Other autoimmune disorders can be associated with Raynaud’s, some of which can increase the risk factor for those wishing to dive. Ultimately an examination by a specialist diving physician would be prudent.

Either a UKSDMC doctor or HSE AMED (see below) should be able to help. If examination is favourable to you continuing to dive, there are some things you should consider to reduce your personal level of risk. Eliminate caffeine pre- and post-dive, stop smoking (if you do)and ensure that you have equipment which fits you well and provides high-levels of insulation to keep you warm. Keep to shallower depths and avoid enriched oxygen diving as high oxygen levels can increase risk of syncope. Of course it is worth discussing with your buddy and diving safety officer.

List of UK Sports Diving Medical Committee referees

List of HSE Approved Medical Examiners

Question:

My wife gave birth to our second son 18 months ago and is still breast feeding him once a day before he settles for bed. Is it safe for her to resume diving? Are there any potential implications on her continuing to breast feed if she resumes her diving?

Answer:

Providing there is no inflammation or infection of the breasts there is absolutely no reason why your wife should not dive.