DrQ&A


Dr Ian Sibley-Calder has been a GP since 1988, is a medical referee for the UK Sports Diving Committee and is involved with hyperbaric medicine and commercial diving activities. He is a BSAC Advanced Diver and Club Instructor.
X-ray showing a double-chamber pacemaker and battery unit fitted over the ribs, with wires running to electrodes on the heart. Solid pacemakers may be suitable for diving.
CAN I DIVE WITH A PACEMAKER
I have a passive pacemaker which does not kick in unless my heart rate drops really low. During normal or even strenuous activity it does nothing but sit there! Would this prevent me from scuba diving for the first time
Thomas


It may do. All pacemakers have to be assessed to check that they are compatible with increased pressure. Some air-filled ones cannot take the pressure under water and stop working. Others, which are resin-filled, are sometimes pressure-tested.
You need to check with your cardiologist as to what type of pacemaker you have fitted and to what depth it is rated. Then your condition should be discussed with a doctor who is interested in diving medicine and can assess both you and the pacemaker.
Please do not go diving until this has all been checked out. If the pacemaker should fail under water, the consequences could be very serious.

What are the creeping bends
My uncle (an old diver from years ago) was recently told by a physiotherapist that he had the creeping bends. I have found lots of information regarding decompression sickness, but nothing on long-term effects.
Beck


This is an interesting question, and one that I cannot answer with any certainty. Diving has not been around long enough and with large-enough numbers of divers for us to understand fully the long-term problems associated with episodes of DCS.
I do however have a theory, which time may prove or disprove. When a diver gets bent, there is usually damage to nervous tissue. We know that this tissue has a limited ability to heal itself and that the body often corrects any deficiency by rerouteing damaged nerves and by re-learning. This is comparable to what happens with those recovering after a stroke.
My theory is simple - as we get older, our nervous system degenerates and becomes less reactive. So any damaged areas that may have coped when we were younger now start to struggle, and symptoms reappear.
If my theory is correct, we should start to see problems in ex-bent divers as they reach their 70s and 80s. It would take both a specific form - around the area that was affected by the bend - and a non-specific form, if there had been more constitutional symptoms that had affected the nervous system.
We need long-term follow up, over many decades, of divers affected by DCS. This is difficult and expensive. Divers who have had problems when younger should mention them if they have problems in their later years, just in case there is a connection.

src="http://diverfiles.net-genie.co.uk/data/archive/medical/pics/0604medqna2.jpg" Epilim, a drug used to treat epilepsy
Epilepsy medication
I was diagnosed with a very mild case of epilepsy 18 months ago. My last seizure was over 12 months ago. I was originally on Tegretol but now take Epilim (twice a day). I could not dive while on Tegretol, but was wondering if Epilim is all right.

Diving is not permitted with a diagnosis of epilepsy while still on medication. The risk of fits underwater and possible side-effects of medication under pressure is too great. If you become fit-free for five years off medication, you could be reassessed to start diving again.

Growing out of ear problems
My son had a tube myringotomy 15 years ago. The grommets are no longer in. He would like to start diving but tube myringotomy appears on the PADI severe risk list. Is there still a risk after all this time
Chris


Grommets are usually inserted to correct glue ear - fluid in the middle part of the ear. This is caused by poor opening of the Eustachian tubes leading to a vacuum which is then filled by fluid. It is a much more common problem in children under six and often corrects itself as the head and face grows and the child learns to equalise his or her ears.
Provided your son has had no recent problems, such as recurrent ear infection, and he can pop his ears, he should be fine. If he has flown without problems, this is a good test.
He should mention it to his instructor so that he can take the ear-clearing bit of his training more slowly.

Diving before diabetes
I have recently been diagnosed with IGT, which is similar, I am told, to diabetes, but simple to control with diet and exercise to stop it developing into Type 2 diabetes.
Can I dive with this condition At times I feel faint and need high-carbohydrate food quickly. My guess is that I could eat a snack before and after diving to make sure that my energy levels are up.
Diane


IGT (Impaired Glucose Tolerance) is a condition where the body does not produce enough insulin in response to a carbohydrate load. This leads the blood sugar to rise after meals, but then it usually settles. It can precede diabetes by months, years or even decades. The progression can be delayed by shedding any excess weight, good exercise and good diet.
The significance of this conditionis that it is now thought that the complications normally associated with diabetes could already be setting in. So doctors now look at extra risk factors, such as smoking, cholesterol and blood pressure, in an attempt to prevent them.
As you are not on medication, there is no risk of hypoglycaemic attacks , so carbohydrate loading should be avoided. Its more likely that you are not eating slow-releasing carbohydrates at regular meals. Try healthy, slow energy-releasing foods such as pasta, rice, potatoes, bananas and raisins. Avoid quick-fix junk snacks. They will not help long-term, will boost your weight and make diabetes far more likely.
You should be checked at least annually (sooner if symptoms such as thirst or increased urination occur). You can dive until you develop diabetes and then must be assessed by a diving doctor for further advice.

src="http://diverfiles.net-genie.co.uk/data/archive/medical/pics/0604medqna3.jpg" A laser beam is aimed at the cornea of an eye to correct a patients sight. Diving should be possible within weeks of the surgery
Eye questions
I am contemplating laser surgery to fix my short sight. Whats the usual recovery time before one can dive again
Liz


To some extent it depends on which type of laser surgery you have had, but in general as soon as the surface of the eye is healed and intact again you should be OK. The main risk is infection which would occur in an open wound.
Two to three weeks should be enough if there are no complications and the surgeon gives the all-clear.

A bang on the head
Last October I fainted and hit my head hard on the ground. I lost consciousness and had a seizure (or what looked a bit like one). I have never had a seizure before or since. Because it was impossible to ascertain whether I lost consciousness before hitting my head or not, or whether the seizure was anything more serious, I was referred to a neurologist. He concluded that it wasnt epilepsy or a neurological problem and reckons I have some form of postural syncope. He has said I may drive and doesnt want to see me again. But can I dive again and how do I fill in the medical forms you are asked to sign before a dive
Vickie


I presume that there was no significant memory-loss arising from the head injury. If so, I think you are fit to dive. A simple fit at the time of a head injury with no further problems makes future fits unlikely. The investigations are reassuring.
Postural hypotension is not usually a problem while in the water due to hydrostatic pressures exerted on the body. But you should be careful on exit, when the pressure is removed.
The only way of sorting out fitness to dive regarding the forms is to have a diving medical, and I would arrange one with a diving doctor for added reassurance. He will assess you and, provided he finds you fit to dive, will issue a fitness to dive certificate.
KEEP YOUR QUERIES COMING
Submit them, marked Medical Questions:
  • by letter, addressed to Diver, or by fax on 020 8943 4312
  • by e-mail by steve@divermag.co.uk
  • on Divernets Medical Talk page. This can also bring you rapid responses from other readers (though these should of course be treated with caution).
    We regret that questions cannot be answered on the telephone or, generally speaking, replied to individually.