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.
Back on the Zenobia
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How practical is a dive on the Zenobia in Cyprus following a spinal operation
I had an L4/L5 spinal fusion in April 2005 and was discharged this February. I am going diving with an instructor in Cyprus in October on a very conservative profile, initially to perhaps 10m, then, if all goes well, to 25m or so with two instructors for buddy cover to dive the Zenobia wreck. I will put my gear on in the water initially, although on land I have full functionality and am back to full strength in terms of lifting ability. Should I stay at a more conservative depth in terms of increased spinal issues, or would diving to 25m max be feasible Im 41, a Dive Master and in good health otherwise.
Lin


From the history you give me, it would appear that you are fit to dive. I am presuming from what you state that there is no residual neurological finding, and that you are now fully fit and back to normal activities.
There remains a question as to whether surgery to areas around the spinal cord could disrupt the blood flow to the area and thus increase risk of spinal DCI. However this, as far as I am aware, is theory only.
I would recommend that you dive cautiously and put in extra safety factors, but other than that I would not look to restrict your diving.

Fits and fitness
I suffered a single one-off fit just over a year ago and have not dived since. It has been confirmed that I am not epileptic, my EEG was normal and a combination
of stress, extreme exhaustion and a viral infection were noted as the probable cause. There has been no reccurrence of the initial episode. On the grounds that the DVLA says I can drive again, can the same be said for diving
Pete


Epilepsy means a definite ban on diving, because of the risk of seizures under water leading to inhalation of water and drowning.
Analysis of a one-off seizure is always difficult. It is said that given enough stimulus anyone can have a fit, and that it doesnt necessarily mean that you have epilepsy. EEGs (electroencephalograms) are of little value in the diagnosis, as they can be normal with epilepsy and abnormal with no epilepsy.
As it has been more than a year since you had a seizure with probable precipitating factors, I would think you are safe to dive.
Out of interest, the UK Sport Diving Medical Councils rule on epilepsy is that you should be fit-free and off all medication for five years before diving.

Double whammy
My husband, 51, is a keen diver but he recently suffered from a minor stroke.
He has fully regained all sensations now. He also suffers from Parkinsons Disease
although he has continued to dive after being given the all-clear from his neurologist. He is very concerned as to whether he will able to continue diving now.
Jane


There are two issues here. The first is recovery from the stroke and assessment of risk factors leading to the stroke and the risk of post-stroke epilepsy.
The second is the Parkinsons Disease, which is a progressive neurological disorder that often requires a lot of medication that is not compatible with diving, and is also associated with mood disturbances, depression and dementia.
While diving in the early stages of Parkinsons Disease is possible, this is often not the case as the disease progresses.
The combination of conditions means that I think your husband should hang up his regulator and give up diving now.

Not-so-Good Friday
I broke my ankle on Good Friday and had surgery the next day to pin it back together. The surgeon says there is no reason not to commence diving again as soon as the cast is off and I feel up to it, but the self-certification does suggest that surgery requires a referees review. Ive attached a copy of the original X-ray so you can see what happened.
Ariel


Thats some heavy-duty metal work, and it will take time to heal. The main problem will be your finning action, and you may lose some flexibility in the ankle.
I would recommend rockerboard exercises for several months. The rockerboard is a device that can be bought for about 20 on the Internet. It helps to strengthen the ankle and
improves flexibility.
Leave eight weeks to allow for decent healing of your ankle, then try some gentle pool-work, with pool fins initially, before building up to full strap fins.
If OK, then go for it.

Coping with a hiatus hernia
About seven months ago, I started to suffer with dyspepsia, mostly excessive belching. My GP prescribed a PPI [proton pump inhibitor], which seemed to alleviate the symptoms but did not eradicate them. I sometimes get reflux, but mainly after eating, and can control
it through diet and medication. I have continued to dive with no adverse effects after my GP deemed me fit to do so. Through endoscopy I have now been diagnosed with a moderate (4cm) hiatus hernia, which requires no further investigation. Am I OK to continue diving
Darren


You are fit to dive with this condition and on proton pumps. Simple measures such as avoiding a full stomach before diving are recommended, but I suspect you already know that.
The hiatus hernia will potentially cause some reflux under water. Adopting a slightly head-up position may be beneficial.
Some people with reflux have been tempted to go for surgical correction of hiatus hernias, but because after the surgery they are unable to burp, they are
at risk of gastric rupture if the air in their stomach expands on ascent. Diving is not allowed post-correction.

Bends, jams and leaks
I am taking my Divemaster course and need some help with understanding decompression illness. As we know, DCI (the bends) occurs when nitrogen comes out of solution within the tissues and forms bubbles, and one of the symptoms is described as difficulty to urinate.
How and why does this occur in men How does this symptom manifest itself
in women, and are the symptoms and effects in women the same as with the men
Dan


The difficulty in urination with DCI usually comes from a spinal bend that affects the sacral nerves that supply the bladder.
This can prevent emptying of the bladder and the person can go into retention of urine, collecting anything up to 2 litres in the bladder. A catheter (a small tube) has to be inserted into the bladder to relieve the blockage.
After treatment in the hyperbaric chamber it is to be hoped that the problem will resolve, but some unfortunate divers may have to self-catheterise for the rest of their lives.
The male urethra (the outflow pipe from the bladder down the penis) is about 12cm or so long, while that in women measures only 2cm. This is the cause of differences between the sexes in lots of bladder problems, and in this situation women are more likely to get an uncontrolled overflow leak than full retention of urine.

Diving with ME
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Temazepam has a sedative effect not compatible with diving.
My daughter (25) is a qualified BSAC diver with four years diving experience.
Last January she suffered a second occurrence of glandular fever which resulted in Post Viral Fatigue syndrome (PVF, or ME). She was unable to work and certainly not dive, but has now done some pool training. She is due to accompany us on a Red Sea liveaboard trip to the Red Sea and knows that her lack of diving over the year will limit her, as well as the fact that she still gets very tired. Sometimes she takes half a Temazepam at night to help her sleep, but is it contraindicative to take sleeping tablets and then go diving


You are correct, Temazepam is not recommended in diving because of its sedative effects, and the fact that its half-life (time in the body) is in excess of eight hours, so it is highly likely still to be in the system the day after being taken.
This could cause some serious effects under water, particularly with the excess nitrogen with depth.
PVF/ME is a difficult condition to manage and methods are controversial.
My own view is that anything positive that can help the individual get back to normal should be encouraged, but tiredness is a major issue.
I use the 70% rule, which is that the person should do only 70% of what they think they can do at any given time. This prevents the body excessively depleting its resources and requiring further excessive recovery time.
This can be difficult to do under water because of unforeseen requirements, stresses and so on, so dives should be short to avoid exhaustion - thermal, mental and physical. Long gaps should be left in-between for full recovery.
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