The Dive medicine FAQ people often dont want to ask....



Dive medicine FAQ - We all have some medical condition afflicting us in one form or another, some of these are conditions that you may think ‘if I tell anyone, they may say I shouldn’t be diving!’ so I’ll just keep quiet about it and hope for the best.

Hopefully by posing these questions and answers here, your position may be either clarified or convince you to seek professional advice.

I have mentioned before, that a consideration which MUST be taken into account in this sphere of scuba diving safety, is what impact could your condition have upon the people you are diving with?

In some instances your condition may well result in you encountering a life threatening situation at depth, which in turn means another person may have to risk their life to try to save yours.

A person has been prescribed Warfarin, to thin their blood – are they able to continue scuba diving?

The blood thinning means that blood clotting is inhibited and the potential for bleeding underwater is quite high.

  • Cuts and scratches from contact with coral.
  • Barotrauma – difficulties in equalising can cause minor bleeding into the inner ear or sinuses which may be clinically more significant in a person taking Warfarin.
  • Barotrauman of the lungs could be catastrophic for a diver on Warfarin.
  • Many manifestations of Decompression sickness are associated with bleeding, in particular but not exclusively associated with the inner ear and the spinal cord. If clotting is not normal, treatment of the decompression sickness may be even more difficult and as a result of poor clotting permanent disability like deafness or paralysis may result.
  • Diving commonly takes place in remote locations, complications arising from use of Warfarin may be difficult to manage if the appropriate medical facilities are not available.

  • Warfarin is considered a ‘relative contra-indication’ to diving. If the persons blood clotting parameters are within normal or well controlled limits, a person may consider scuba diving.

    The advice is that a person under these circumstances should consult a specific ‘Diving Doctor’ who would assess the risk pertaining to the individual and an informed decision may be made.

    The condition leading to being prescribed Warfarin may in itself, be reason to reassess the wisdom of undertaking scuba diving and be more of a danger to ones safety than the Warfarin.

    Again a doctor with the dive medicine experience needs to be consulted to view the situation from a holistic perspective. Dive medicine FAQ source: Divers Alert Network

    A diver is in an emergency situation and requires revival by way of automatic external defibrillators. He is however fitted with a pacemaker, is this a problem and if so what are the alternatives?

    You can use the automatic external defibrillators for someone with a pacemaker fitted. One must simply avoid placing the pads over the bulge in the skin where the pacemaker is located, rather place it adjacent or below the bulge.

    It is also important to distinguish between an implanted defibrillator and a pacemaker. An internal defibrillator should not require the use of an external defibrillator.

    Having addressed that it is more important to consider whether a person with a pacemaker should be diving in the first place.

    • Why does the person have a pacemaker?
    • What medication is the person taking in addition?
    • Is the pacemaker pressure tested and rated?
    Dive medicine FAQ source: Divers Alert Network

    How soon can a woman return to diving after giving birth?

    After a natural birth canal delivery a woman can usually resume light to moderate activity within two to three weeks.

    This also depends on prior conditioning, exercise and condition during pregnancy, pregnancy related complications, post-partum fatigue and anaemia amongst other conditions.

    Women who had exercise regimens prior to pregnancy and birth generally resume exercise programs and sports in earnest three to four weeks after the birth.

    Obstetricians generally recommend avoiding immersion for 21 days post partum. This is to allow the cervix time to close and avoid the introduction of infection into the genital tract.
    A good rule of thumb advised by dive medicine practitioners, is to wait for four weeks before returning to diving.

    After a Caesarean section, wound healing has to be included in the considerations.
    Most obstetricians advise waiting for at least six weeks after delivery before resuming full activity.

    Taking into consideration lost conditioning, coupled with wound healing and the significant weight bearing carrying dive gear, it is advisable to wait at least eight weeks after a caesarean section before returning to diving.

    Any complications like pre-term delivery, twins, hypertension and diabetes may further delay a return to diving.

    Prolonged bed rest may have resulted in loss of conditioning, muscle mass and aerobic capacity.

    In these instances a consultation with a dive medicine practitioner and clearance are advisable in deciding when it is safe to return to diving. Dive medicine FAQ source: Divers Alert Network

    I am overweight by about 25kg and have had an angioplasty with three stents placed in my right coronary artery a month ago. My cardiologist is reluctant to advise whether or not I should be able to scuba dive again.

    This close to the surgery it is difficult to give a definitive answer. A few years prior to this you would be deemed unfit to dive. More recently the cases are judged upon a case by case basis and upon the merits of the individual.

    The guidelines were applicable to commercial diving where the criteria are more stringent and one is less able to choose the diving conditions.

    The opinion of the Divers Alert Network is that if you recover fully, including reduction of weight to ideal levels, cholesterol levels, fitness pass a normal cardiac stress test and are cleared by your cardiologist, that you are able to do exercise, you aren’t taking medication that is contr-indicated to do diving, e.g. some blood pressure medications, Beta blockers and more, your case could be submitted to the The Undersea and Hyperbaric Medical Society (UHMS) for detailed recommendations which would be individualised for your specific health and fitness status.

    It is strongly advised that you consult an experienced diving doctor to advise you on the relevant parameters and to conduct a fitness to dive medical on you when you have attained optimal fitness. The doctor would then provide your information to the UHMS panel.

    The European Diving Technology guidelines for Ischaemic heart disease:

    An individual found during the examination to have Ischaemic heart disease prior to dive training should be declared permanently unfit to dive. All persons with symptomatic Ischaemic heart disease are considered unfit to dive.

    The requirement for medication to control a cardiac condition is a contra-indication as well.

    Commercial divers who are symptom free following a coronary bypass surgery remain unfit to dive, but an individual who has had percutaneous transluminal coronary angioplasty might be considered fit if after six months of the procedure:

    • The procedure has been demonstrated to produce revascularisation
    • The person remains symptom free
    • The person has a normal stress ECG test
    • The person can meet the physical requirements

    Such individuals will require careful assessment by a cardiologist, and if considered fit will require careful follow up. Annual assessments, including full specialist evaluation, exercise testing and further investigation when considered appropriate(eg. Angiography), are required to assess the risk of an acute event occurring during diving.

    The British Health and safety Exuctive guidelines on Ischaemic heart disease:

    Symptomatic ischaemic heart disease is incompatible with diving. The requirement for medication to control symptoms is a contra-indication, but preventative medications such as aspirin or lipid lowering agents are acceptable.

    At the intitial examination, an individual found incidentally to have ischaemic heart disease should be declared unfit.

    An individual who is symptom free following conventional coronary bypass surgery remains unfit to dive.

    An individual who has had percutaneous coronary intervention (angioplasty) or minimally invasive surgery surgical revascularisation Might be considered if:

    • The procedure has been demonstrated to produce revascularisation
    • The person remains symptom free
    • The person has a normal cardiac stress test to the relevant cardiological levels
    • The person can meet the physical requirements

    Individuals who have undergone revascularisation, as above, will require careful assessment by a cardiologist (with an interest in diving) who will decide about the need for further follow up.
    Dive medicine FAQ source: Divers Alert Network

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