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.
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Coloured X-ray of a side-view of a patient with the very common condition of hiatus hernia (lower right)
Coping with hiatus hernia
My other half has a hiatus hernia which is controlled by Ranitidine tablets and diet. He says he has no acid reflux now unless he eats a heavy meal and does strenuous exercise afterwards. With proper diet and mealtimes, he is fine. We are off to Kenya soon - can he dive
Carole


Normally, the stomach is completely below the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen. The weakest part of the diaphragm is the hole through which the oesophagus or gullet passes.
A hiatus hernia forms when part of the stomach slides through this hole (hiatus) into the chest cavity.
Often hiatus hernia has no symptoms, but it may cause a feeling of warmth or burning in the chest. This is often called heartburn. It happens when the contents of the stomach, which are acid, flow backward (reflux) into the oesophagus.
Hiatus hernia can cause pain and discomfort behind the breastbone or sternum. Symptoms may occur or become worse after eating, soon after lying down or when bending forwards. They may be worse after drinking coffee or other hot drinks, or eating spicy food.
Ranitidine is one of a group of drugs that reduce the acid of the stomach contents, so that if anything comes up into the gullet, it doesn't burn it.
Other lifestyle measures are useful. These include eating small frequent meals rather than fewer large ones; avoiding bending over or lying down after a meal; avoiding foods that seem to cause more severe symptoms, such as spicy foods, coffee and possibly alcohol; stopping smoking; losing excess weight if overweight; and sleeping propped up on plenty of pillows, or with the head end of the bed raised by 10cm.
The main problem when diving seems to be fluid coming into the mouth and heartburn, after being inverted. There may also be excessive burping.
The medications seem to cause very little trouble regarding side-effects and I regard them as safe to use in diving. The sort of simple measures you mention often help.

Diving after pancreatitis
I have been diving for almost a year and had just completed my 50th dive when I was admitted to hospital for three nights with acute pancreatitis. The cause has not been ascertained, though alcohol abuse or a virus have been mentioned. I am 44, an ex-RN submariner and have always been very fit - I swim 1000m-plus three or four times a week. What effect will this have on my future diving fitness
Tim


The pancreas is a small gland that sits behind the stomach and produces insulin to help use glucose, and enzymes to help with fat absorption. Pancreatitis can be a serious condition that is an inflammation of this gland.
The condition can range from mild, leading to pain but full recovery, to severe and fatal. More severe forms can affect the future functioning of the gland and can lead to diabetes and poor fat absorption.
Both conditions are serious and can seriously affect your future health - let alone diving.
The causes are usually alcohol-related, gallstones or unknown (though viruses and toxins are suspected). If alcohol is the cause, the person would have to have been drinking significant amounts for some time.
Gallstones block the outflow duct to the pancreas and would need to be removed.
Future fitness to dive depends on many factors, such as complications, causes and treatment. Even if there are no current complications, there is an increased risk
of diabetes.
A full assessment would be needed before returning to diving, and regular checks should be made.

Long after the crash
Twenty years ago, I sustained a head injury in a severe car crash. I lost consciousness for around a minute, but have had no problems since. Ive been diving for about a year, am now training for Sports Diver and have been to 22m with no problems, but the head injury does play on my mind. Do you think I am at any risk
Kev


As a rule, we assess the severity of a head injury by the length of time the person was unconscious and the amount of amnesia both before and after the occurrence.
The longer the period of unconsciousness and the greater the amnesia, the more severe the head injury and the greater the risk of complications.
The main risk after a significant head injury is epilepsy. Twenty years after the event without problems means that this risk is now the same as that of the general population, so you are fit to dive.

Is coil a problem
My local hospital wants to fit me with a Mirena to ease my periods and pain each month. Im hoping to go to Aruba, but will I still be able to dive

A Mirena is an IUCD (inter uterine contraceptive device), a small T-shaped unit that has progesterone around the stem. It is inserted through the cervix (neck of womb) and provides contraception and control of heavy periods.
The progesterone (a female hormone) slowly leaks onto the lining of the womb, stabilising it and preventing heavy periods. Very little goes into the bloodstream.
Once the coil is fitted and settled, there is no risk regarding diving. The only complications tend to occur straight after insertion, and could include infection or risk of perforation of the womb. Thankfully, both of these are uncommon.

Fractures and DCI
I am due to go on holiday to Egypt but three weeks ago I broke my left index finger just above the knuckle. A doctor manipulated the finger back into shape.
I have good dexterity in the rest of my hand and am not worried about operating my equipment, but various people tell me I cant dive due to risk of decompression illness. Is this true
Matt


There is no increased risk of DCI from such a small fracture. Indeed it is not proven that any fracture, once healed and settled, would increase risk. There is a presumption that major fractures especially around the spine could affect the blood flow to the area and therefore increase bubbling and risk but this, as far as I know, is speculation.
As long as the pain has settled and the hand is fully functional, you are fit to dive.

Through the keyhole
I am a BSAC Ocean Diver, and have undergone keyhole surgery for removal of my gall bladder. There were no complications, and I was sent home the same day with just anti-inflammatory medication and over-the-counter Paracetamol. I feel fine and am keen to get back in the water, but do not want to rush myself, as I was advised not to lift heavy objects. What time-scale would you recommend
Jennifer


Modern keyhole surgery has revolutionised removal of the gall bladder. This small sac that contains bile is just under the liver and often gets gallstones in it which, if they cause complications, have to be removed.
Past operations involved major cuts to the abdominal wall and lengthy recovery times. Modern surgery is far less invasive and recovery times are quicker, though bear in mind that having had an operation there will be internal inflammation that cannot be seen.
Six weeks should be long enough if you continue to make a good recovery and are back to full activities. The tissues should have healed adequately and gas free in the abdomen be fully reabsorbed by this time.

Pleurisy obstacle
I recently approached my local BSAC dive club to become a member but it is concerned because I have had pleurisy. This was two years ago, and I recovered after being treated by my GP. I have dived since and havent suffered the illness, nor have I had any further symptoms. Could you please confirm that I am fit to dive
David


Pleurisy is an inflammation of the lining that surrounds the lung. Its causes are usually infective (bacteria or viruses) or traumatic (after injury).
Provided the cause is identified and treated, there is not usually any lasting damage and full recovery is to be expected.
Diving should not be a problem, but if doubt remains a lung-function test could be done for reassurance.

hspace=5 Laser recovery
How long after corrective laser eye surgery can diving be resumed
Steve


Basically, once the eye has healed fully. Most heal within a week or two, but there is little data available on exact times.
To be sure, I would leave a month and get the all-clear from the follow-up check that healing has occurred.

Outlook with PMR
I have been diagnosed with polymyalgia rheumatica. It is controllable, and easily managed.
I am in good health aside from this, but can I go on diving as before
Robin


Polymyalgia rheumatica (PMR) is an inflammatory condition that causes aches and pains as well as stiffness in the neck, shoulders, and hips. This disease usually affects people over 50. The cause is unknown.
Morning stiffness, as well as stiffness during the day with inactivity, is characteristic. Other symptoms may include fatigue, weight-loss, low-grade fever, loss of appetite, depression and night sweats.
Treatment consists of prednisone in a dose of 10-20mg a day. After symptoms are controlled, prednisone may be slowly tapered. Patients will be on prednisone for one to two years, so steroid sparing drugs such as methotrexate might be considered.
It is not advisable to dive until symptoms have been controlled and the dose of steroids is at a low level. In high doses they can cause paranoia, low mood and excitability. In the long term they can also cause bone thinning, diabetes and high blood pressure.
Theoretical problems of the steroids affecting your ability to cope with stress and weaken your immune system should not be a problem if you keep your diving sensible.Avoid stressful long dives with decompression.
If you have no symptoms and no side effects on the medication and the dose of steroids is small, diving should be no problem.
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