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MEDICAL FAQs |
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Dive Medical questions & answers for common scuba diving conditions and illness provided in conjunction with the doctors at the London Diving Chamber and Midlands Diving Chamber. | |
All Categories » Central Nervous System » Nerves
QUESTION Recently while diving, I received a blow to the head during a backward roll entry (buddies 15ltr steel tank), after the dive I started to suffer headaches and trouble focusing while reading.The local A&E department checked me over and said it was post concussion syndrome, which would improve on its own. After 2 months the headaches were still quite bad so I made an appointment to see the A&E consultant. As a precautionary measure having already had a skull x-ray he arranged for me to have a head scan. The scan showed up what he thought might be an arterial angioma, which would have stopped me diving again. I was then referred to a consultant neurologist as an outpatient, who after checking my scan showed them to a senior consultant neurologist at Atkinson Morley, they both agreed that what I had was a small venous angioma which I'd had from birth and as I'd never suffered from fit or blackout they could see no reason why it should affect me in the future. The consultant confirmed the post concussion syndrome headache would improve and that I could continue diving (she is willing to confirm this in writing if reqd.) As I am about to do an instructor course, do you see the venous angioma as a problem and would it affect an H.S.E. medical? ANSWER I think that if you have 2 consultants from one of the world's top neurological hospitals agreeing that this angioma poses absolutely no risk of causing you any problems, then who am I to argue! QUESTION I'd like to ask your advice, as an volunteer instructor for Scubatrust (who teach those with disabilities to dive). My 'day job' is being a final yr med student, but I am a long way from having the necessary experience to assess a man I have been asked to see with MND.He was turned away last spring from an organisation who teach divers with disabilities, on the grounds that he had some airway difficulties during initial pool training. In recent years he has dived (untrained) on holiday in Australia and Egypt. I sent him for (yet another) medical, which confirmed he was fit to dive. Yet, I have spoken to his previous instructor who says I would be mad to take him in the water. This instructor feels the diver is at risk from his bulbar palsy, while the doctor who examined him does not - but says I should trial the diver in the pool on mask and reg removal. In the past, this man has had some minor difficulty with swallowing when his disease is very active, but at present his gag reflex is intact. His voice is moderately affected by the effects of the disease. This man is very determined to dive, and if it is at all possible for him to do so safely I will train him on an IAHD level to dive with 2 trained assistants, but initially I must decide if is safe or not to assess him in the pool. ANSWER This is an interesting case where we have to weigh up several issues here. MND or motor neurone disease is a terrible neurological condition where due to degeneration of certain areas of the spinal cord and cells in the nerves that supply the throat, tongue and pharynx, the sufferer can find that they progressively become more disabled but with unaffected mental functioning. Sadly it is a rapidly progressive disease and if there are symptoms of "bulbar palsy" i.e. inability to swallow and problems with speech then death can often be within 2 years. So you can see how determined this man may be to dive right now as the future is bleak. QUESTION I have been on long sick leave since the beginning of July 1999, with Post Viral Fatigue and trigeminal neuralgia. With the Fatigue Syndrome I sometimes feel perfectly OK, but some days I feel totally drained sleeping for periods varying between four and forty hours. There is no way of predicting when the good or bad days are going to be , but they are each unmistakable. With the neuralgia I have a permanent numbness on the right side of my skull. I also experience various aches and pains in the right side of my face, jaw, neck and shoulder, which mainly occur in the morning. I occasionally take Diclofenac to ease the pain. As a 54 year old safety conscious PADI Advanced diver, I would appreciate your opinion to whether there is any reason why I should not carry on with my beloved hobby.ANSWER Your diagnosis of Post Viral Fatigue syndrome is not a bar to diving in itself but there are a few issues surrounding the problem that you should be aware of. When you get your phases of extreme tiredness you can see the problems that would ensue if you were to dive. You may well be in a situation where your buddy needs your physical assistance, so if you were too weak or unable to help this could be disastrous. You say you cannot predict when the bad days are going to be so what would happen if you had planned on diving on a certain day and this fatigue were to set in. Well, I think that you would have to cancel the planned diving as your fatigue would endanger both yourself and your buddy. QUESTION My girlfriend has passed her PADI Open water diver, she now discovers she has Multiple Sclerosis (relapse and remitting) she has no symptoms and has had a diving medical. Should she go on to do her advanced open water diver.Also can you dive with silicone implants? ANSWER The current regulations are that anyone who has MS and dives should stay out of the water for 1 year after a relapse of the problem, and in that year should not experience any symptoms of the problem or worsening of the condition. QUESTION Sorry to trouble you but I have a friend due to travel to Cyprus soon and she had every intention of learning to dive whilst there. About 6 weeks ago she contracted Bell's Palsy. There has to date been no real improvement although she is fine in herself. Should she continue with her plans or shelve them until there is either a full or significant improvement in the condition? Or would this be something that would need to be assessed by a diving doctor?The implications I can think of are the fact that her left eye will not close at the moment and she is obviously now a bit "saggy" around her mouth! Will she be okay to learn to dive? ANSWER Imagine waking up one morning, tottering downstairs for that half asleep bowl of cereal, and the milk won’t stay in – it keeps pouring out of your mouth. Something similar happened to George Clooney when he was a boy, and an astute physician diagnosed him with Bell’s Palsy. It was during his first year in high school too – not a good time to have half of your face paralysed, although it doesn’t seem to have done his career much harm.
QUESTION I am 63 years of age, have been diving since 1994, am qualified to Advanced Open Water with PADI and have completed about 80 recreational dives always in warm climates, e.g. Red Sea, Great Barrier Reef, British Virgin Islands, etc. I was diagnosed some time ago with Peripheral Neuropathy which was mild then but has increased in severity over the years. Luckily I only have problems with my toes/feet, e.g. numbness, pins and needles, burning sensations, occasional cramps, all the usual PN stuff. I take no medication for this but take Lansoprazole (15mg) for Barrett's Oesophagus. Otherwise I am reasonablyfit for my age and take 30 mins of fairly testing cross-country machine training 5 times a week.Do you perceive any problems related to the PN with me continuing scuba diving on a strictly recreational basis? ANSWER Not really with the peripheral neuropathy. This illness where nerves in the periphery stop doing what they are supposed to do can be a real pain, as I am sure you know. But the deal with diving is that as long as you have sufficient strength there to fin, haul out a buddy or get back on the boat then that should be OK. It is worth seeing a dive doc to get passed as fit, as well as getting a neurological mapping of your deficit. Numbness and pins and needles are classic bends symptoms, so you need to have a good idea of what's going on baseline, as it could save 5 hours in a chamber if you had a problematic ascent and an over zealous doctor. QUESTION I hope you will be able to give me some information about my current situation regarding diving. At the beginning of December last year I fell through a glass window. I severed the main artery and median nerve in my left upper arm. The scars have now healed and my strength is coming back. However my hand is still numb and I am only able to move the base joints in my thumb and index finger due to the severed nerve. I have been told that the nerve will have to fully grow back before all the symptoms disappear. What impact does this have on being declared fit to dive, as my self declaration is due at the beginning of May and will need to have a medical?ANSWER In these sort of cases, it's not so much the injury, but the level of recovery, and how it specifically relates to diving and your responsibilities as a good buddy. QUESTION I am writing to you following a referral from Phil Howard from London/Surrey Scuba. I spent the weekend attending the PADI Open Water Referral Course, but unfortunately did not complete the full set of confined dives.While underwater, I experienced a strange pins and needles sensation in my finger tips, on the outer sides of my hands and lower arms. I sometimes have a swollen feeling in my fingers when I am out running and mentioned this to Phil. He felt, given these experiences it would be a good idea to mail you for advice before continuing with my confined dives, and eventually the open water ones. While the pins and needles feeling subsided a short while after I left the pool, and though this may not be anything to worry about, I just wanted to double check to be sure. ANSWER You should be fine. For starters, this has nothing to do with nitrogen, bends or whatever. DCS does not come on under water and go when you get to the surface. With tingling, pins and needles, or paraesthesia as we docs call it to seem intelligent, it might have more to do with the nerves in your arm. A BCD can cut up into your armpits, crunching a nerve and cause these symptoms. Over breathing due to anxiety can also cause these symptoms. So can a borrowed wetsuit tight around certain body parts. QUESTION Hi... I was diagnosed with multiple sclerosis (MS) in 2000 and whilst I have the odd niggle, relapses are happening at about 3 - 4 year intervals. These are not major as such and thus far I have always recovered pretty much 100% with rest. So far, I know when I am overdoing things and heading for a problem, which when I back off and rest, usually averts any major or long lasting.I qualified OW in October, and to be honest, as I wasn't taking any medication (never have before) I didn't actually think about a dive medical as I have been fit and well, doing a full time active job etc. However, over Christmas, I have had some problems with my right arm (usual place it affects) with the pins and needles, numbness, nerve pain etc., waking me at night and some loss of grip to the right hand. It has settled fairly well now but I am still taking the diclofenac sodium 3 times a day, the tramadol only when the pain wakes me at night as these space me out too much. I would never consider diving if I didn't feel 100% okay on the day but will I be okay to dive whilst taking diclofenac? My husband has just presented me with the flight tickets etc., for a diving trip to Dahab this Thursday! ANSWER A nice surprise to be sure. I can reassure you on that point immediately – there are no problems taking diclofenac on a dive. |