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.
In this X-ray of a human skull the pink area represents the pain of headache or migraine. Severe migraines or the sort that come onunexpectedly are not compatible with diving.
DIVING WITH A MIGRAINE
I am a 55-year-old female and have been diving for seven years. I take medication for elevated blood pressure and have suffered with migraines most of my life. I take Maxalt Melt as soon as I feel an attack coming on, which tends to settle it. Last May, after a bad spell of migraines, I had horizontal double vision for 36 hours. An ophthalmologist found a latent squint, though the scans were normal. A neurologist suggested that I might have had a TIA (mini-stroke). I am 1.58m tall and weigh approximately 58kg. I do not smoke or drink. I feel well and work out two to three times a week. What risks would I take if I continued to dive
Elsje


I suspect that the diagnosis is one of a vascular disturbance secondary to your migraine. This is well known to cause these problems in severe migraines. The fact that your scans are normal is reassuring. I would not use the term TIA.
Your blood pressure should be monitored and if treatment is needed, beta blockers should not be used - they are not recommended in diving. ACE inhibitors or calcium channel blockers would be better (verapamil can sometimes be used in migraine prevention)
Migraines are OK with diving provided they do not come on suddenly and are not totally disabling.
Pizotifen can be sedating and should be used with caution with diving. Maxalt is acute treatment and you should not dive for 24 hours after taking it. Consider 75mg aspirin as a preventative treatment.
As an aside, there is some research suggesting a link with severe migraine and PFOs [holes in the heart] - this would obviously be a risk factor in diving.
I cannot see a reason why you cannot dive on the basis of the information you have given me, but some caution should be exercised.

The best cure for sea-sickness
Im going to the Sea of Cortez for a 10-day dive liveaboard holiday. The sea may be rough at times and Id like to take some sea-sickness pills. I have been taking Stugeron but am not sure if theyre OK. Im over 50 and try to dive within the safety curve these days and do all I can to try and minimise any DCI risk, so want to be specially careful with medicines.
Pam


The main thing is to try sea-sickness tablets before you go to check for side-effects such as drowsiness. Remember that increased pressure and nitrogen levels can potentiate the effects of some medications.
Stugeron can be OK but can cause drowsiness in some. Just start gentle and be careful. I use Kwells, but this can cause dry mouth. Get used to one type and stick with it.

Lupus strikes in different ways
During the past 10 years I have had five miscarriages and an ectopic pregnancy. During the breaks diving has helped me retain my sanity. Since the last miscarriage I have been diagnosed with lupus. Does this have any contra-indications to diving
Linda


Lupus or SLE is a common condition but difficult to diagnose because of a lack of specific tests. It is a progressive auto-immune disease; a type of self-allergy. The patients immune system creates antibodies which, instead of protecting the body from bacteria and viruses, attack his or her own body tissues.
This causes symptoms of extreme fatigue, joint pain, muscle aches, anaemia and general malaise, and can result in the destruction of vital organs (including heart and lungs). It is a disease with many manifestations, and each persons profile or list of symptoms is different.
As such, fitness to dive must be assessed on an individual basis, depending on the severity of the condition, what is affected and what treatment is being undertaken. Regular review by a diving physician would be mandatory.

src="http://diverfiles.net-genie.co.uk/data/archive/medical/pics/1203medqna2.jpg" If you had a fatty liver, this is what it would look like, but it is still possible to dive with one
Fatty liver
I am a 50-year-old UK club diver, diving twice a week most of the year in the 20-38m range, and have just been diagnosed with non-alcoholic fatty liver. The diagnosis was made by chance during an abdominal ultrasound for suspected gastritis. I cannot find out whether this will prevent me diving. I dont drink anything alcoholic except shandy as I have to drive, so I know this is not a drinking-related condition!
Tim

Fatty livers are quite common and have been found more since the arrival of ultrasound. They are often seen in the larger individual. There is a form
of non-alcoholic fatty liver that is associated with being overweight, abnormal liver-function tests, high triglycerides and an increased risk of diabetes. It can be diagnosed only by a liver biopsy and can lead to cirrhosis. There is no treatment.
Saying all that, if your tests are all normal there is no reason why you cannot continue to dive. You should have regular checks for all the above problems, however.

Limits on breathing capability
I was recently diagnosed as having a paralysed left hemi-diaphragm, although my lungs are normal and I have a normal lung function. The cause is unknown but I get breathless sometimes (noticeably when swimming). I have dived since and, while feeling a slight shortness of breath under water (no deeper than 30m) it seemed fine. Might there be a connection between the paralysis and diving, and is there likely to be any adverse effect from continuing to dive on air/nitrox
Martyn

The diaphragm is the muscle that divides the lungs and the stomach, liver etc. It is used in breathing to help expand the lung, particularly at times of increased workload.
At small effort-levels, the chest-wall muscles and muscles between the ribs would be sufficient, but when the effort is greater the diaphragm is used as well. Diving is energetic, even in warm waters. Even without currents, there is the increased effort of breathing through regulators, dead space and increased gas density.
Provided your lung function is normal and there is no evidence of air-trapping (which is measured by spirometry and flow volume loops) you should be fit to dive.
Your ability to exercise strongly under water maybe compromised, however, and this must therefore be taken into account with your dive-planning.


Ear infections can be long-lasting
The Diving Doc issues a personal note on a threat to diving pleasure
src="http://diverfiles.net-genie.co.uk/data/archive/medical/pics/1203medqna3.jpg" Suffer an infection in your ears and it may clear up quickly or it may ruin your diving for months
My recent introduction to the world of ear infections has brought a whole new interest in the subject. For years of trouble-free diving, I have paid lip-service to the ears, quoting the standard practices and comments.
Following a cold, however, I proceeded not only to get a middle-ear infection in my right ear, but a canal infection in left ear (with excessive discharge).
My GP (yes, doctors do have GPs) gave me the usual antibiotics and sprays, which did nothing for either ear. I then got my local ENT specialist to suck the muck out, and took his advice for a further two weeks of antibiotics. He also gave me the excellent advice of doing a valsalva regularly.
Four weeks later and still not better, swabs were done which grew a fungal infection: aspergillosis. This caused a major problem and debate on the right treatment - the boys in the lab shook their heads and said I should contact a doctor who was interested in diving, and that sensitivities could not be done in their lab.
So we tried antifungal tablets, to no avail. Eventually, and after the third sucking out of muck, we tried canesten drops - so far so good. So what does this story prove
That doctors have problems too. That even with excellent medical care, it doesnt always work quickly. And that antibiotics should not be overused - they can make the problem worse.
My advice for the future: Look after your ears, because they can cost you a whole seasons diving. Get some knowledgeable medical help (but accept that the experts are not God and that ear infections can be hard to treat); try not to overuse sprays and antibiotics. My GP was excellent in regularly looking in my ears to give me some idea of progress.
General ear care: a few drops of olive oil prior to diving, wash out with clean water post dive, followed by a few more drops of olive oil - and yes, I will be doing that myself now.
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