Scubadoc’s Ten Foot Stop

October 24, 2009

Diving and ED Medications?

Filed under: Article — admin @ 9:51 am

Some thoughts on scuba diving while taking erectile dysfunction drugs.
‘Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body’s ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.’

Side effects include a bluish tinge to the vision in some  – which should not have any untoward effect on divers. Also, reported possible more serious eye problems and increased stroke haven’t panned out in large studies. If your doctor finds you healthy enough to dive, then you should not have any qualms about using the medications before, during and after your diving trip.

An interesting recent finding is that increased levels of nitric oxide seem to reduce the incidence of bubbling during and after a dive. Thus, it would seem that taking daily doses of Cialis would decrease your chances of getting bubble related diving illnesses. See the abstract of a study printed below.

1: Med Sci Sports Exerc. 2006 Aug;38(8):1432-5.

Exogenous nitric oxide and bubble formation in divers.

Departments of Physiology, University of Split School of Medicine, Split, Croatia. zdujic@bsb.mefst.hr

PURPOSE: Prevention of bubble formation is a central goal in standard decompression procedures. Previously we have shown that exercise 20-24 h prior to a dive reduces bubble formation and increases survival in rats exposed to a simulated dive. Furthermore, we have demonstrated that nitric oxide (NO) may be involved in this protection; blocking the production of NO increases bubble formation while giving rats a long-lasting NO donor 20 h and immediately prior to a dive reduces bubble formation. This study determined whether a short-lasting NO donor, nitroglycerine, reduced bubble formation after standard dives and decompression in man. METHODS: A total of 16 experienced divers were randomly assigned into two groups. One group performed two dives to 30 m of seawater (msw) for 30 min breathing air, and performed exercise at an intensity corresponding to 30% of maximal oxygen uptake during the bottom time. The second group performed two simulated dives to 18 msw for 80 min breathing air in a hyperbaric chamber, and remained sedentary during the bottom period. The first dive for each diver served as the control dive, whereas the divers received 0.4 mg of nitroglycerine by oral spray 30 min before the second dive. Following the dive, gas bubbles in the pulmonary artery were recorded using ultrasound. RESULTS: The open-water dive resulted in significantly more gas bubbles than the dry dive (0.87 +/- 1.3 vs 0.12 +/- 0.23 bubbles per square centimeter). Nitroglycerine reduced bubble formation significantly in both dives from 0.87 +/- 1.3 to 0.32 +/- 0.7 in the in-water dive and from 0.12 +/- 0.23 to 0.03 +/- 0.03 bubbles per square centimeter in the chamber dive. CONCLUSION: The present study demonstrates that intake of a short-lasting NO donor reduces bubble formation following decompression after different dives.

So – my take on all this is that it really won’t cause any problems, but would possibly be beneficial in addition to it’s wanted sexual activity.

October 19, 2009

Diving Medicine – A Review and Update

Filed under: Article — admin @ 12:59 pm

Your attention is directed to an article in the American Journal of Family Practice, printed in full and free. This is written by James Lynch and Fred Bove and provides the latest in thinking about management of Diving problems. There is an excellent reference listing and numerous links in the article. The article is located at http://www.jabfm.org/cgi/content/full/22/4/399#SEC13 .

October 13, 2009

NASA Signs Licensing Agreement With Oxyheal

Filed under: News — admin @ 4:40 pm

NASA has signed a patent license agreement with a California company to improve the medical community’s access to hyperbaric chambers used to treat many medical conditions and emergencies. OxyHeal Medical Systems Inc. of National City, Calif., will develop new products based on technologies NASA originally developed for space.

The partially exclusive patent license agreement allows the company to use three technologies developed at NASA’s Johnson Space Center in Houston that are associated with inflatable spacecraft modules and portable hyperbaric chambers.

NASA developed the technologies as part of a program to plan for how astronauts in space might be treated for decompression sickness. Decompression sickness, commonly called “the bends,” can occur in astronauts as they undergo pressure changes returning from spacewalks and in divers as they return to the water’s surface.

The NASA inventors of the portable hyperbaric chamber, Dr. James Locke, William Schneider and Horacio de la Fuente, recently were recognized by the Federal Laboratory Consortium with a Notable Technology Development Award.

“NASA has a long history of making space-aged technologies available for commercialization, creating new markets that power the economy,” said Michele Brekke, director of the Innovation Partnership Program Office at Johnson. “These commercial products and services, known as ’spinoffs,’ allow the taxpayers to benefit from space exploration.”

For more information visit:

http://www.nasa.gov/offices/ipp/home

SOURCE NASA

Fitness To Dive, Chapter VI, Medications, Drugs and Substance Abuse

Filed under: Publication — admin @ 4:08 pm

Guidelines useful in considering the relationships between drugs and diving:

  • Consider the condition/illness/disease for which the medication is being given.
  • Are there any effects of the drug that alter consciousness or cause alteration in decision making ability.
  • Check in the linked ‘Databases’ below for any side effects of the drug that could be dangerous underwater.
  • Consider complex relationships between drugs, the individual, other medications, diet and the conditions for which the drugs are taken.

  • Write us if you still have a problem finding or deciding about a specific drug, condition or drug combination after using the process above.


  • Use these Databases to Search for Your Medication, then apply the above diving factors in your decision to dive!

  • Medscape Drug Search (Requires free registration)
  • Intelihealth Drug database
  • Health Touch
  • Drug Information Databases
  • RxList of 1300 drugs


  • Substance Abuse

    Alcohol
    Marijuana
    Kava



    Diving and Drugs


    Class of Drugs Condition Adverse to Diving Drug Effects Adverse to Diving Other Factors Related to Diving
    Anticoagulants Various cardiovascular conditions Hematomas from minor trauma, hemorrhage from barotrauma Tendency to bleed from barotrauma (ears, sinuses, lungs – possibly worsens spinal DCS)
    Analgesics None GI bleeding Aspirin possibly beneficial by blocking effects of bubbles
    Narcotics, Marijuana & Alcohol Substance Abuse Decreased sensorium & problem solving Possible additive effect of nitrogen
    Tranquillizers State anxiety, panic Decreased sensorium & problem solving Possible additive effect of nitrogen
    Anti-depressants Depression, mania, risk of suicide Decreased sensorium & problem solving Risk of seizures
    Decongestants & Antihistamines Upper respiratory infection Sleepiness, nasal rebound congestion Risk of ear and pulmonary barotrauma
    Antacids and H2 blockers Gastroesophageal reflux of ascent None Drugs beneficial due to effect on GERD
    Motion sickness drugs
    Draminine (Dimenhydrinate)
    Seasickness, dehydration Sedation, loss of judgment, and aggravation of
    nitrogen narcosis
    Scopolamine and Meclizine are additive (both cholinergic)
    Calcium blockers Hypertension Postural hypotension Fainting can occur.
    Beta blockers Hypertension
    Arrhythmias
    Inability to respond to needs of stress Constriction of blood vessels to hands, aggravate asthma
    ACE inhibitors Hypertension, heart disease None Produces cough & airway swelling
    Diuretics Water and salt retention Possible dehydration Loss of potassium
    Steroids Asthma, dermatitis, None Possible increase in O2 toxicity (animals)
    Antiarrhythmics Abnormal heart rhythym None, with properly adjusted dosages Solar sensitivity with amiodarone
    Antibiotics Ear, sinus, lung infections None Solar sensitivity with tetracycline
    Anti-malarials Prevention of malaria more important than side effects of the drugs. Lariam (Mefloquine) – psychological & neurological problems.
    Few problems with chloroquine, Malarone (Proguanil+Atavaquone), Doxycycline
    Side effects of Lariam similar to symptoms of DCS.

    LINKS
    ‘Medications and Diving’
    Bruce V. Voss, MD

    October 8, 2009

    Fitness to Dive, Chapter V, Surgery and Diving

    Filed under: Publication — admin @ 12:13 pm
    Surgical Considerations Related to Diving

    General Guidelines

    A. Consider the illness or condition being operated upon and any relationship to the diving environment

    B. Consider the physical limitations imposed as a result of the operation
    Short term
    Rate of wound healing of the specific body system
    Complications (infection, wound disruption, temporary loss of function)
    Long term
    Disability from any source reducing the diver’s functional ability.

    C. Implants of any nature
    Any implant that does not contain air or gas should not be a contraindication to diving. This includes all metallic, silicone, composite and fluid filled sacs. These objects are not compressible and therefore pose no danger to the diver. Any air or gas filled implant, such as an artificial eye or any other reconstructive body part is at hazard to explode or rupture due to the action of Boyle’s Law.

    D. Return to diving after surgery (See this web site under specific body system)
    Neurological System
    Link includes ‘Brain, shunt surgery, herniated disc’
    Eye
    Link includes ‘Diving after Eye Surgery’, ‘Post-surgical Waiting Period’
    ENT
    Absolute post-operative contraindications
    Tympanoplasty, other than myringoplasty (Type I)
    History of stapedectomy [This is being debated at this time].
    Most recently there have been good studies to show that stapedectomy is not the risk that
    was once thought.

    See this article:

    Otolaryngol Head Neck Surg 2001 Oct;125(4):356-60
    Diving after stapedectomy: clinical experience and recommendations.
    House JW, Toh EH, Perez A.
    Clinical Studies Department, House Ear Clinic and Institute, 2100 West Third
    Street, Los Angeles, CA 90057, USA.

    CONCLUSIONS: Stapedectomy does not appear to increase the risk of inner ear
    barotrauma in scuba and sky divers. These activities may be pursued with
    relative safety after stapes surgery, provided adequate eustachian tube
    function has been established.

    History of inner ear surgery
    Status post laryngectomy or partial laryngectomy
    Radical mastoidectomy (posterior) involving the external canal is
    disqualifying. (Closed childhood OK)
    Tracheostomy, tracheostoma
    Incompetent larynx due to surgery (Cannot close for valsalva
    maneuver)


    Heart
    Cardiac and valvular surgery
    Surgery without entering the chest cavity; six to eight weeks or whenever the diver has physically rehabilitated to reach 13 METS on the treadmill.
    Surgery with entry into the chest for whatever reason; see thoracotomy.

    Patent  Foramen Ovale – A button closure (Amplatzer) is performed trans venously without entering the chest. Four weeks after the surgery, another echocardiogram is done to verify that the device is still in position.

    After two-three weeks there is an overgrowth of endothelial cells covering the device, reducing the risk of infection.

    After six to eight weeks the connective tissue has completely filled the spaces in the device and it becomes invisible to ultrasound. Return to diving is usually in six weeks (Wilmshurst), given the full recovery to the satisfaction of the cardiologist/surgeon. Others require a longer wait of twelve weeks.

    See article by Wilmshurst, et al at http://heart.bmjjournals.com/cgi/content/full/81/3/257 .


    Pulmonary
    Thoracotomy
    Pulmonary System: Patients with a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. Post operative wait of 12 weeks; surgical release recommended. Should be studied to rule out air trapping.

    Lobectomy or pneumonectomy patients usually fill in the ‘dead space’ from the loss of tissue with fluid and scar. Depending on the cause of the surgery, postoperative course and results of pulmonary function and scans a person might be allowed to return to diving with the approval of their physician.

    Divers with pulmonary barotrauma may return to diving after no less than a three month wait and a certification from a diving physician that there is no air trapping.


    Gastrointestinal
    A history of bowel obstruction is not disqualifying if the person is asymptomatic 3 months after corrective surgery. Wait six to 12 weeks postoperative before diving. Surgeon’s advice recommended.

    The postoperative wait after laparotomy depends greatly upon the cause for the surgery and the extent of surgery involved. A postoperative wait of six to twelve weeks is recommended, again with the approval of the diver’s surgeon. Continent urostomy or ileostomy contraindicates diving because of Boyle’s law.

    A hernia that includes bowel is disqualifying until surgically repaired. A wait of 6 weeks is suggested for the simple repair. Advice of surgeon suggested.

    Bone & Joint
    Prostheses, joint surgery, fractures
    Return to diving is entirely dependent on evidence of complete healing. Weight-bearing with 100 plus pounds of gear, exits and entries should be carefully considered by the surgeon before certifying return to diving. The effects of pressure and bubbling on the operative site are unknown at this time.

    General Advice About Diving

    Whether or not a person having had surgery should be certified as ‘fit to dive’ should be decided on the merits of each case, the type of surgery required, if symtomatic or on medication, and the length of time postoperative free of problems. Most probably can return to diving. Decision making ability, ability to self rescue and rescue other divers residual disabilities that would limit ability to gear up and move in the water should be taken into consideration. Prospective divers should in all cases provide full disclosure to the dive instructor and certifying agency – bearing in mind the safety of buddies, dive instructors, divemasters and other individuals who are always affected by diving incidents.

    New DAN Training Online Available for Members

    Filed under: News — admin @ 10:22 am

    New DAN Training Online Seminar Available

    THE OPTIMAL PATH Explores the Challenges of Decompression on Deep Dives

    DURHAM, NC – In early 2009, DAN® announced the addition of online training seminars to the lineup of member benefits, along with a promise to add new seminars along the way. DAN keeps that promise with the addition of “The Optimal Path” to the online seminar collection.

    “The Optimal Path” is a look at the search for the optimal path to safe decompression from a dive and the struggle to determine acceptable risk. Presented by Richard Vann, vice president of DAN Research, this topic was first explored during the 2008 DAN/Undersea and Hyperbaric Medical Society Deep Stop Workshop. The online seminar even includes audio excerpts from the original presentation.

    “Divers have really been enjoying the new online seminars,” says Eric Douglas, director of DAN Training. “We’re certainly enjoying putting them together. They’re a great way to explore topics of interest to divers in a different but in-depth way. Deep stops are a perfect example. They’re a hot topic in the dive industry, and one where there’s still a lot to learn. Divers need all the information they can get to be able to make informed decisions about their dive profiles.”

    All online seminars are free to DAN Members, and access is automatically included with DAN Membership. To access the seminars, simply visit the link and log in as a DAN Member.

    If you’re not already a DAN Member and wish to take advantage of this and all of DAN’s valuable membership benefits, join today!

    For additional information, please visit www.DiversAlertNetwork.org or call (800) 446-2671

    October 7, 2009

    U N D E R C U R R E N T O N L I N E U P D A T E

    Filed under: News — admin @ 1:50 pm

    U N D E R C U R R E N T   O N L I N E    U P D A T E
    F O R    N O N – S U B S C R I B E R S

    Undercurrent — Consumer Reporting for
    the Scuba Diving Community since 1975
    www.undercurrent.org

    Dive News

    October 6, 2009

    You have received this message because you have signed up on our website to receive this email or you are a former subscriber or Online Member of Undercurrent . Removal instructions are below.

    Subscribers/Online Members can get all the articles
    from the current issue of Undercurrent here

    Serious Problems with 20,000 Halcyon Over Pressure Valves: Virtually everything Halcyon manufactures with an over pressure valve – BCDs, surface marker buoys, safety sausages, lift bags, etc., has been recalled because of leaking valves which can deflate the devices and eliminate their buoyancy. This recall involves the Halcyon Explorer, Eclipse, CCR35, Evolve and Pioneer BCDs and Halcyon Surface Marker Buoys, Lift Bags, Diver Alert Markers (DAMs) Surf Shuttle and Diver Lift Raft Inflatable Devices. “Halcyon” is printed on the equipment. The recalled items were sold between January 2006 and December 2008. If you’ve got a piece of gear with this valve, return it to an authorized Halcyon dealer for a free replacement of the overpressure valve spring. Contact Halcyon at (800) 425-2966 between 8 a.m. and 5 p.m. ET Monday through Friday; Web site is www.halcyon.net/opv-recall; email address is techservices@halcyon.net. If you had an incident using any of this gear, report it at https://www.cpsc.gov/cgibin/incident.aspx

    The Fragile Edge, Diving and Other Adventures in the South Pacific: Documentary film maker and diver Julia Whitty paints a mesmerizing scientifically rich portrait of the coral reefs of the South Pacific. Her thoughtful and spiritual vision provides unique reporting of encounters with humpbacks, hammerheads eagle rays and the usual reef inhabitants, described in a lyrical, beautiful verse rarely found in book aimed at literate divers. I think the review in O, the Oprah magazine says it best: “The product of a scientist’s mind, a sociologist’s eye, a Zen Buddhist’s soul, and a poet’s heart, it is at once a call to action, a natural history, a love song and a prayer … about our oceans, it’s reefs and critters”. Paperback, 292 pages. Click here (http://www.undercurrent.org/UCnow/bookpicks.shtml) to get it at Amazon.com’s best prices. Undercurrent’s profit from this sale and anything else you buy during this transaction will go to preserve coral reefs. Current price $10.17.

    Well Done, Palau: In our June e-newsletter, we told you about Palau’s Senate bills to allow and expand shark fishing and finning. Now the country has done an about-face. On September 25, President Johnson Toribiong announced a nationwide ban against commercial shark fishing during a speech at the United Nations. While a few countries like the Maldives have initiated some shark protection, Palau takes it to a whole new level as its ban will apply to waters covering an area the size of Texas. With just 20,000 people, the tiny country will have trouble enforcing the ban but in his speech, Toribiong urged other countries to follow Palau’s lead. Bravo.

    Special Discounted Introductory Offer: Sign up now for a one-year trial membership to Undercurrent for $29.95, $10 off the standard offer. PLUS that includes a free (hard)copy of our Travelin’ Divers’ Chapbook 2010, with reviews of more than 1,000 dive resorts and liveaboards worldwide (due to postage costs, the Chapbook is only available to US and Canadian residents). Sign up for this special offer to email subscribers now here (http://www.undercurrent.org/4email).

    The Cove: This remarkable documentary describes the annual round up in a small Japanese town of more than 2000 dolphins, not only to capture a few to send to circus school, but to butcher the rest for meat. It follows the clandestine effort of film maker Louie Psihoyas and his crew to sneak in under the cover of darkness to film the event. It’s raised international consciousness worldwide, but it needs to be translated into Japanese to motivate the citizens of that country to stop the slaughter. See the trailer at www.thecovemovie.com and make your donation.

    California Scuba Diver Makes Fatal Error: When you’re on the surface, don’t take off your BCD if you are still wearing your weight belt. Sadly, Daniel Forchione, 46, overlooked that basic rule and died September 29 while scuba diving off the coast of Point Loma. According to Rich Sillanpa, president of Dive Connections in Mission Bay, Forchione had completed a second dive and was heading back to the boat when he became separated from his two companions. Forchione took off his tank at the surface, but still had his weight belt on and it appears he may have panicked and sank, Sillanpa said. Something all we divers must keep in mind.

    Divers Descend on The Philippines: We’ve often praised the country for its inexpensive dive tourism and good range of healthy dive sites. The number of visiting divers grew by 63 percent in the first quarter of 2009. Cebu, Bohol and Palawan were the most visited. The number of American divers increased by 37 percent, thanks to recession-friendly prices. We have plenty of reader reports about dive resorts all over the Philippines at Undercurrent. Clicking on “Dive Travel” followed by “Instant Reader Reports,” then scroll down to “Philippines.”

    Anatomy of a Dive Lawsuit – Part I: Dive veteran and frequent Undercurrent contributor Bret Gilliam has reported on a recent trial where he was an expert witness and litigation consultant. The families of two divers gone missing and presumed dead while diving with the Okeanos Aggressor at Cocos Island filed a multi-million-dollar lawsuit against the Aggressor Fleet. The case involves issues directly affecting anyone diving with a dive operator anywhere in the world. Read Bret’s summary of the incident for free in the September issue – go to Undercurrent and click on “Anatomy of a Dive Lawsuit. To read Part II about the ensuing trial and the verdict, you’ll have to subscribe!

    Coming Up in Undercurrent: Become an online member (http://www.undercurrent.org/4email) so you can read these great stories – - Part II of Bret Gilliam’s article about the lawsuit against the Aggressor Fleet filed by families of two dead divers at Cocos Island . . . arguing for and against giving your health history to the dive operator . . . are ear plugs a good idea for divers . . . a handy way to beat airlines’ excess luggage fees and restrictive carry-on rules for your next dive trip . . .can you really use a cell phone underwater . . . and much more. Click here to sign up (http://www.undercurrent.org/4email)

    Ben Davison, editor/publisher

    Fitness to Dive, Chapter IV, Diving With Disabilities

    Filed under: Publication — admin @ 10:35 am

    A Real Diving ChallengeThis page is written and maintained by
    Ernest S Campbell, MD, FACS


    Have you ever been on a night dive and had your lights go out? Or, imagine yourself doing a shore dive and you find that someone has tied your feet together; just imagine the difficulty of dragging yourself in and out of the water.

    These are just two of the challenges that face disabled people who want to experience the serenity and beauty of scuba diving: the blind person is forever in pitch darkness, the paraplegic faces this wall every day.

    In spite of these seemingly insurmountable obstacles, there are many disabled who are participating in scuba diving programs especially designed to assist them to experience our sport safely.

    Below are listed various services and contacts for disabled persons who wish to learn more about diving:

    Articles

    • Dive Training for the Disabled: What is it Worth? Diver Magazine, August 1997
    • “Soaring Below”, by Vicki Stiefel.
    • ‘Alert Diver’, March/April 1996; a publication of
      DAN (Divers Alert Network)

    • “Diving With Care”,
    • Training and Medical Aspects of Diving With Disabilities,
      Kimberly P. Walker, NREMT-P, DAN Training
      Alert Diver, March-April 1996, p. 40.

    • Scuba Diving With Disabilities Robinson, Jill. & A. Dale Fox:
    • (Champagne, Illinois:  Leisure Press, a Division of Human
      Kinetics Publishers, Inc.  Box 5076 Champagne, Il 61820.  1987)
      “A valuable supplement to any diving manual or class. For the disabled diver or the instructor who wants to teach disabled divers, the book is must reading.”


    Associations and Clubs and Training


    Amazing Seals

    amazingseals.com

    St. Paul/ Minneapolis Minnesota

    Masha Bowen coordinator

    (651)263-9707
    We have recently started this exiting new program and working with local rehabilitation centers providing scuba experience for disabled divers. We have PADI and HSA certified instructors.


    Arizona Disabled Scuba Divers Foundation
    www.azcandive.com

    Dawn Callahan
    VP ADSDF
    480-968-6465

    ——————————————————————————————————————————————————————————————————

    Disabled Diver training in the San Diego area.

    John Ellerbrock
    PADI Master Instructor
    Pinnacle Divers

    PinnacleDiver@home.com
    619.997.DIVE (3483)


    Eels on Wheels Adaptive Scuba Club
    Aron Waisman,
    12338 Limerick Ave,
    Austin, Texas, 78758
    (512) 873-9121
    awaisman@austin.rr.com
    http://www.Eels.org

    Article “Challenges of Diving With Disabilities”, by Tammie Shelton
    http://scuba-doc.com/DivingDisabilities.pdf


    National Instructors Association for Divers with Disabilities (NIADD), Dorothy Shrout, P.O. Box 112223, Campbell; CA 95011-2223; (408) 379-6536, (408) 244- 8652 fax
    NIADD, San Jose, CA.  Contact Frank Degnan at Any Water Sports, (408)244-4433.  Frank and Dorothy Shrout organize this.


    Handicapped Scuba Association, Jim Gatacre, 1104 El Prado, San Clemente, CA 92672-4637, (714) 498-6128,   HSA@HSASCUBA.COM


    Houston Disabled Scuba Divers Association, 403 East Nasa Road 1, Suite 325, Webster TX 77598-5314, (713) 477-5556, swa@neosoft.com

    Southern Wheelchair Adventurers Association of Galveston-Houston, 403 East Nasa Road 1, Suite 325, Webster TX 77598-5314, (713) 477-5556, (Lytle Seibert); swa@neosoft.com,


    Canadian Scuba Diving Clubs for Divers with Disabilities

    • Club Challenge, 3108 Woodland Park Drive, Burlington, Ontario L7N 1L2 Canada; (905) 634-8234 (Joan Muir; Burlington), (905) 844-4160 (Annis Dixon; Oakville), (519) 658-5838 (Margaret Sanderson; Kitchener), (416) 485-7355 (Jerry Ford; Toronto)
    • Pacific Northwest Scuba Challenge Association, 14286 72nd Avenue, Surrey, British ColumbIa V3W 2R1 Canada; (604) 525-7149 (Ron Stead)
    • Persephone Scuba Diving Club, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec H4B 1R6 Canada; Louis Jankowski, Ph.D., (514) 848-3320 (office), (514) 630-1429 (home)

    Diving With Disabilities
    Bruce Van Hoorn
    14960 Penitencia Creek Road
    San Jose, CA 95132
    (408)258-9789


    Dis-A-Dive
    Bart Schassoort
    3530 Warrensville Center Road
    Suite 200
    Shaker Heights, OH 44122
    (216)241-3483


    Open Waters, Paul A. Rollins, Project Coordinator, or Steven Tremblay, Project Director, c/o Alpha One, 127 Main St., South Portland, ME 04106-2622; (800) 640- 7200 (voice or TTY) or (207) 767-2189 (voice or TTY), (207) 799-0355 fax, open_waters@alpha-one.org , http://www.alpha-one.org


    The Australian Underwater Federation has published a booklet on teaching disabled divers.  It can be obtained from theAUF Office,
    PO BOX 1006,
    Civic Square, ACT, 2608, Australia.


    IAHD, is a non-profit organization for disabled divers.
    www.iahd.org and www.iahd-americas.org


    Norges handikapfellesskap in Norway,
    Dive Training for the disabled.
    www.handikap.no
    e-mail:tomm.fredriksen@handikap.no

    October 6, 2009

    Fitness To Dive, Chapter III, Diving Exclusions and Qualifications

    Filed under: Publication — admin @ 1:47 pm

    Sports Scuba Divers Medical History and Physical Examination

    The examination of prospective divers, sports scuba divers, underwater photographers and diving instructors should include the pertinent aspects of present and past history, review of systems and physical examination directed and designed to specifically detect those conditions that place a person in jeopardy for the following:

    1). decompression illness

    2). pulmonary over pressure accidents

    3). loss of consciousness

    4). inability to mentally or physically handle the in-water environment.

    • Post-surgical or post-debilitating illness
    • Diabetes
    • Asthmatic
    • Age Related

    The physician should sign a certificate stating he “can find no contra-indication to diving” rather than “the diver is fit to dive”.

    The obvious reasons why a person should not be allowed to dive are as follows:

    • Disorders that lead to altered consciousness
    • Disorders that inhibit the “natural evolution of Boyle’s Law”
    • Disorders that may lead to erratic and irresponsible behavior.

    Absolute ContraindicationsENT

    • Inability to equalize pressure in the middle ear by auto-inflation. This may be due to a correctable problem such as polyps, nasal septal deviation or coryza in which case the diver can be reevaluated after correction of the problem.
    • Perforation of the tympanic membrane. Until fully healed or successfully repaired with good Eustachian tube function, diving is contraindicated.
    • See http://www.merck.com/pubs/mmanual/section7/chapter84/84h.htm
      http://www.audiologynet.com/tympanoplasty.html

    • Open, nonhealed perforation of the TM.
    • Monomeric TM
    • Tympanoplasty, other than myringoplasty (Type I)
    • See http://www.audiologynet.com/tympanoplasty.html

    • History of stapedectomy *This is being debated. See below.
    • See http://www.med.umn.edu/otol/library/otoscler.htm

    • History of inner ear surgery
    • Status post laryngectomy or partial laryngectomy
    • History of vestibular decompression sickness
    • Radical mastoidectomy (posterior) involving the external canal is disqualifying. (Closed childhood OK)
    • Meniere’s disease is disqualifying, as well as surgical procedures designed to treat the condition.
    • Labyrinthitis
    • Perilymphatic fistula
    • Cholesteatoma is disqualifying
    • Cerumen impactions -remove before allowing to dive.
    • Stenosis or atresia of the ear canal- disqualifying.
    • Facial paralysis secondary to barotrauma
    • Tracheostomy, tracheostoma
    • Incompetent larynx due to surgery (Cannot close for valsalva maneuver)
    • Laryngocoele
    • Congenital or Acquired hearing loss

    • *Most recently there have been good studies to show that stapedectomy is not the risk that
      was once thought.See this article:

      Otolaryngol Head Neck Surg 2001 Oct;125(4):356-60
      Diving after stapedectomy: clinical experience and recommendations.
      House JW, Toh EH, Perez A.
      Clinical Studies Department, House Ear Clinic and Institute, 2100 West Third
      Street, Los Angeles, CA 90057, USA.

      CONCLUSIONS: Stapedectomy does not appear to increase the risk of inner ear
      barotrauma in scuba and sky divers. These activities may be pursued with
      relative safety after stapes surgery, provided adequate eustachian tube
      function has been established.


      Neurological

    • History of Seizure disorder: After head injury, disallow diving during that period of time that the diver is at risk for seizures.
    • Intracranial tumor or aneurysm
    • History of TIA (transient ischemic attacks) or CVA (Cerebral vascular accidents)
    • History of spinal cord injury, disease or surgery with residual sequelae. This includes a history of having had Type II neurological DCS with permanent neurological deficits.
    • A history of unexplained syncopal episodes, whether cardiovascular or neurogenic.
    • Peripheral neuropathies are disqualifying.

    • Heart

    • Coronary artery disease: Because of the need for cardiac reserve in an in-water emergency, the carrying of tanks, donning of equipment, swimming against a current represent significant stresses. A history of myocardial infarction is considered a disqualification for sport diving; there are unusual cases of exceptional rehabilitation after dilations and revascularization procedures.
    • Intracardiac shunts (particularly large right to left shunts), PFO
    • Asymmetric Septal Hypertrophy: this can lead to sudden loss of consciousness.
    • Valvular stenosis: Can lead to sudden loss of consciousness.
    • Congestive heart failure
    • Hypertension-Controlled can dive but drugs that limit exercise response (beta blockers) need to be evaluated. OK if person can reach 13 METS on the treadmill. *(See below)
    • Angina controlled with medications is disqualifying.
    • Coronary spasm is disqualifying ( can be cold or exercise induced).
    • Silent ischemia on Holter- disqualifying
    • Status post op CAB with no symptoms and negative treadmill OK to dive if can reach   13 METS. *METS are multiples of resting O2 consumption. Eight to nine METS equal 1 knot or 100 feet per minute swimming. (70% maximal). Thirteen METS equal 40 ml./kg./minute.. One cannot swim at 1 knot so don’t dive in an environment requiring more. In currents of 7-8 knots, it’s best to go with the flow. (p=KpV2).
    • Valvular Lesions:
    • Mitral regurgitation, aortic insufficiency with no left ventricular dysfunction can dive
    • Aortic and mitral stenosis are disqualified
    • Mitral valve prolapse with no symptoms such as chest pain, syncope, dyspnea can dive
    • Intracardiac defects, right and left should be disqualifying.

    • Arrhythmias

    • Heart block that is unassociated with other cardiac dysfunction
      • Primary-can dive after the usual exercise evaluation
      • Higher grades of block are disqualifying
      • Right bundle branch block can dive
      • Left bundle branch block can dive with a normal thallium and angiogram test.
      • Wolf-Parkinson-White syndrome is disqualifiedSupraventricular tachycardia can dive 6 months after the causes are removed

    • Lungs

    • Spontaneous pneumothorax; A history of previous spontaneous pneumothorax carries a high incidence of recurrence and the candidate must be advise against compressed-gas diving.. A pneumothorax that occurs under water or in a chamber can become a “tension” pneumothorax on ascent and be immediately life-threatening as the pleural cavity expands because of Boyle’s Law.
    • Traumatic or surgical pneumothoraces can be allowed to dive after appropriate clearance from a diving physician, chest surgeon or pulmonary disease specialist.
    • Significant obstructive pulmonary disease
    • Air-containing pulmonary cysts or blebs which can trap air and lead to local pulmonary overpressure accident during decompression (Ascent).
    • Asthma in the active phases. May dive when the pulmonary functions have returned to normal at rest. The mid-expiratory flow needs to return to baseline.
    • Other Problems

    • (There are changing recommendations concerning diabetes and sickle cell anemia)
    • Sickle cell disease or trait: There is the remote possibility that the sport diver will breathe a hypoxic mixture of gas or start the sickling process with exertion in cold water or with bubbles during decompression-thereby leading to sickling->hypoxia-> and a vicious cycle of more hypoxia and sickling. (See section on endocrine and metabolic problems. )
    • Dental Considerations
      • Major oral surgery with prosthetic devices
      • Carious teeth
      • Osteomyelitis of the mandible
      • Osteoradionecrosis of the jaw
    • Psychiatric Considerations

    • Persons with a history of panic attacks
    • http://www.scuba-doc.com/bluorb.htm

    • The dragooned, reluctant diver
    • The “macho” buccaneer
    • The counter-phobe
    • Truly psychotic disorders
    • Chronic substance abuse, including alcohol
      • Recurrent otitis externa or media
      • Eustachian tube dysfunction
      • History of Tympanic Membrane perforation
      • Significant hearing loss in one ear
      • Midface fracture
      • Facial nerve paralysis
      • Full mouth prosthetic devices
      • Head and neck radiation
      • Migraine, severe (scotomata, CNS symptoms and stroke after diving)
    • *Pregnancy or intention to become pregnant*

      (See Women and Diving)

      Relative Contraindications

      ENT


      Ophthalmic

    • Corrective lenses can dive, including contacts
    • Lens implants can dive when completely healed (6 weeks).
    • Radial Keratotomy can dive when healed (3 months).
    • Glaucoma can dive if vision is not affected

    • Neurologic

    • Migraine: Those persons who have migraine with any of the following should not dive: Aura, impairment of one of the senses, nausea and vomiting or photophobia.
    • Head injuries: Persons can be cleared for diving following head injuries if they have no history of:
    • intracranial hemorrhage
    • Brain contusion
    • unconsciousness lasting 24 hours or longer
    • Unconsciousness lasted 2-24 hours and the person has been seizure free for 2 years
    • Unconsciousness lasted less than 2 hours and the person has a normal neurological workup.
    • Person is neurologically normal one year after experiencing 3-4 weeks of amnesia.
    • Neurologically normal nine months after experiencing 2-3 weeks of amnesia.
    • Neurologically normal 6 months after amnesia for 1-2 weeks
    • Neurologically normal 6 weeks after momentary amnesia.
    • Simple febrile seizures; Seizures accompanying febrile episodes below the age of 6 with no history of abnormal neurological exams, seizures of longer than 15 minutes duration or nonfebrile seizures in family members.
    • Ruptured disc without neurological or physical impairments. Successful disc surgery below L1-L2 and uncomplicated, successful cervical disc surgery from an anterior approach after 3 months.
    • CNS (Brain or spinal cord) decompresion sickness with complete resolution of signs and symptoms within 24 hours.
    • Cerebral gas embolism with complete resolution of signs and symptoms within 24 hours assuming no complications from pulmonary considerations (Some say 3 months).
    • Successful brain surgery (tumor or aneurysm) with no residuals or sequelae after 3 months (with the approval of the surgeon)

    • Other conditions

      Diabetes Mellitus: Insulin dependent diabetics represent a gamut of severity; the more brittle diabetic who should not dive and a less serious one which should not increase the hypoglycemia risk enough to exclude diving. The long-standing diabetic who has lost the normal defense mechanism against hypoglycemia should not dive. Newer methods for testing and steps to regulate blood sugar can eliminate the risk of hypoglycemia. As diabetics are more prone to coronary disease, a good physical examination, and exercise testing when indicated, can reduce the risk for a heart problem while diving.
    • Cardiovascular System: Diagnoses potentially rendering the person incapable of performing the exertional requirements necessary to meet the needs of diving. Formal stress testing with a minimum criterion of *13 METS needed for qualification.
    • Pulmonary System: Patients with a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. Divers with pulmonary barotrauma may return to diving after no less than a three month wait and a certification from a diving physician that there is no air trapping.
      • Reflux disease and gastric outlet obstruction need to be evaluated prior to qualification.
      • A history of bowel obstruction is not disqualifying if the person is asymptomatic 6 months after corrective surgery.
      • A hernia that includes bowel is disqualifying until surgically repaired.
      • Esophageal diverticulae, severe reflux, hiatal hernias, achalasia, gas bloat syndrome, (s/p hiatal hernia repair) and gastric outlet obstruction are all disqualifying.
      • A person should not dive while fractures are healing and until acute inflammatory conditions of bone and joints subside.
      • Aseptic osteobaric necrosis is a contraindication.
      • Amputees, stable paraplegics, scoliosis without respiratory limitation should be able to dive.




    • Gastrointestinal System:


      Musculoskeletal System:

    October 5, 2009

    Fitness To Dive, Chapter II, Why Have Medical Examinations

    Filed under: Publication — admin @ 1:07 pm


    Why A Medical Exam?

    The only real reason for recreational divers to have an examination is to “maximize personal in-water safety”. Other reasons possibly include the safety of others, limiting the progression of diseases (skin diseases), and prevention of long-term sequelae. Edmonds reported on 100 fatalities: 25 had known disqualifying factors –9 had been told not to dive.

    Working divers have a need to anticipate the progression of natural disease, detect any long-term consequences of diving, check for other occupational requirements and protect the employers by ascertaining expected effective performance.


    What is Fitness to Dive?

    Australia and Malta

    • Insist that recreational divers have an exam by a doctor trained in diving medicine before taking any diving courses.

    BSAC (British Subaqua Club)

    • Family practitioner assists filling out a special form and suggests referral to a BSAC “medical referee’ who charges no fee.

    France

    • Sports medicine doctors

    North America


  • “Advisory” only. Physicians associated with hyperbaric chambers, emergency room doctors and DAN doctor members are usually knowledgeable about diving medicine and may give opinions and advice.


  • Links
    http://www.diverescue.com/sopnasar.html
    http://www.aaus.org/downloads/AAUSSTDS.doc
    http://www.ndc.noaa.gov/#ndp


    • Fitness to Dive: US Navy

    Diver Screening Questionnaire

    http://www.disam.dsca.mil/itm/Functional/HealthCare/Diving-Physical.pdf



    Fitness to Dive? When? Exams

    • Before training
    • Periodically
    • After surgery, diving accident, other illness or accident

    Medical assessment is enhanced by a physician who has any diving knowledge or is himself a diver.


    Diving Medical History and Physical Exams


    Fitness Problems

    • The novice diver
    • The asthmatic diver
    • The diabetic diver
        • Questions to ask the diabetic diver:
            • Any changes in insulin requirement over the past year?
            • Any hypoglycemia in the past year?
            • Any hospitalizations in the past year?
            • Is control well managed?

    • The physically handicapped
    • The aging diver
    • After head injury
    • The diver who has had CAGE or DCS with residual damage

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