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.
WAY BACK FOR INSTRUCTOR
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Having a deep-vein thrombosis like this does not necessarily present a bar to diving as long as the healing process is complete.
My boyfriend, a PADI instructor, has just been diagnosed with a superficial thrombosis in his right leg and is being treated with Clexane injections and Voltarol and Omeprazole orally. The incident is not diving-related as he has not been diving for four months. Three years ago, he suffered a more severe deep-vein thrombosis and the results of the ultrasound reveal lasting damage from that. Assuming that this treatment clears up the condition, is he likely to be able to resume a diving career He actually became an instructor a year after the initial DVT.
Mary


The superficial phlebitis relates to the damaged veins from the DVT, and is not a bar to diving once your boyfriends treatment is finished and the leg is back to normal.
If he has not had a clotting screen looking for any problem that could have caused the original DVT, he would be well advised to get this done.
If all checks out, then I see no reason why he should not return to his diving career.
Unfortunately, however, he may well be more prone to these attacks in the future, so he must take care to look after his skin to prevent infections and ulcers.

Diving after leukaemia treatment
I am 13 and have been diagnosed with T-cell ALL leukaemia. I have had a central line fitted and am on the waiting list to have it removed and a port fitted. Will I be able to dive I already have my PADI Junior Advanced Open Water and Emergency First Responder certification and can dive to 21m with no problems, and Im booked to do PADI Rescue Diver. When I go back to diving (I hope) will I have to use a drysuit or any other aid because of the port
Zakk


There are a few issues to sort out before you can consider going back to diving. You do not mention how you are getting on with your treatment, though I presume you are in remission. It is important to know which drugs you have taken and whether they have caused or could cause any damage to your other organs, especially your lungs.
It would be preferable to wait until the central line is removed and the scars healed before restarting diving. As long as the port site is healed, this should not be a problem from an infection point of view. Some adaptation may have to be made regarding kit, dump valves etc, depending on its placement.
I would recommend discussion with a doctor knowledgeable in diving who can examine your case in detail .

Fall-out from flutter
After having an atrial flutter, I spent three days in hospital on Bisoprolol and Warfarin. I reverted to sinus rhythm on my own with no other action by the hospital. After an ultra-sound scan and blood tests I was given the all-clear. I am back at work, on aspirin and some mild beta-blockers. I am 40, pretty fit, and visit a gym two or three times a week. Am I OK to dive
PS


The two issues here are the heart rhythm problem and the medication. It is too soon to tell whether you are going to have significant problems with the atrial flutter, because in some people the problem can re-occur.
A lot will depend on what you are like while in the atrial flutter in terms of disabling symptoms such as shortness of breath, lack of energy and chest pains. These could cause severe problems if they occurred on a dive, and could disable you.
Aspirin is fine but Warfarin, should you end up on it again, can cause problems in diving and is not normally recommended. Beta-blockers also can cause problems in limiting exercise tolerance and causing broncho-constriction (closing) of the airways.
I should wait until you are discharged from hospital, then take as many details as you can to a knowledgeable dive doctor for full evaluation. I do not believe you should dive until you have been properly assessed. Even if passed, there may well be restrictions on depth and no-stop diving.

Prospects without a spleen
I was recently involved in a traffic accident that led to the rupture and removal of my spleen. Im young and recovering well, but none of the doctors has told me when I can go diving again and if there are likely to be any problems or precautions that I should take.
Helena


Provided the spleen was the only damage done and recovery is full and uncomplicated, diving should be possible again. Recovery for fitness to dive depends on the nature, type and severity of the original injury and the recovery from the operation.
For an operation of this size at least 12 weeks would be recommended, and also full return to all daily activities.
The spleen is important in fighting infections, and when removed leaves the individual more susceptible to severe infections. Most people end up on long-term antibiotics to help them fight infections.
Potentially diving could increase the risk of infection and this should be discussed with your doctors, but it should be possible to sort it out.

Ten years after
I had a spontaneous pneumothorax when I was 17 and had a surgical procedure to stop it re-occurring. I am now 27 and want to scuba dive. My GP has advised against but would like an opinion from other medical referees who may know certain exceptions
to my condition. Since the pneumothorax I have been in kick-boxing and karate tournaments, marathons, and can swim 35m under water on one breath. I stopped only because I ran out of pool. Do you think I am fit to dive


A spontaneous pneumothorax at 17 with no reoccurrence for 10 years after treatment would make an occurrence unlikely, so you could possibly be fit to dive. Refer yourself to a local UK medical referee for assessment.
A full examination, flow volume loop spirometry and possibly a high-resolution CT scan to exclude any weaknesses in the lungs would probably be needed.

Grommet concerns
Two years ago I had a T-tube [type of permanent ear grommet] fitted following a cancer operation that left me with glue ear. My audiologist has been unable to tell me whether I can dive again, as he is worried about water entering the ear canal. I do however have ear-plugs that are effective and allow for pressure changes.
Neill


I would be reluctant to allow anyone with a permanent connection into their middle ear to dive. The potential to get infection into the area and end up with severe problems is high.
I would not trust any ear-plugs to be effective enough to allow for the severe changes in pressure in diving. Again, should these fail, severe damage could occur.
I do not regard you as fit to dive while the grommets are in and until the drum is fully healed.

Time out after eye surgery
I had a cataract operation in May which seems to have gone fine, although my near sight isnt as good as I expected.
I am due to have the other eye done, as it has deteriorated faster than I thought, but I am going on a Red Sea liveaboard a month later. Is that too soon, and is there a risk to my sight if I dive with lenses in my eyes
Julie


Cataract operations are no bar to diving provided all the tissues have healed well. This could take from one to three months, depending on the type of surgery.
I would have thought the time frame is too short to allow diving that soon, and the holiday (at least the diving) should be postponed.
I am not sure which lenses you are talking about, either the replacement lenses inside the eye or vision-correction lenses, but the former pose no problems and the latter, provided they are gas permeable soft lenses, are also OK.
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