Medical conditions preventing diving

[Thalassamania]

[h=3]AAUS

Conditions Which May Disqualify Candidates From Diving (Adapted from Bove, 1998)[/h] [h=4]a)Abnormalities of the tympanic membrane, such as perforation, presence of a monomeric membrane, or inability to auto inflate the middle ears.[/h] [h=4]b)Vertigo including Meniere’s Disease.[/h] [h=4]c)Stapedectomy or middle ear reconstructive surgery.[/h] [h=4]d)Recent ocular surgery.[/h] [h=4]e)Psychiatric disorders including claustrophobia, suicidal ideation, psychosis, anxiety states, untreated depression.[/h] [h=4]f)Substance abuse, including alcohol.[/h] [h=4]g)Episodic loss of consciousness.[/h] [h=4]h)History of seizure.[/h] [h=4]i)History of stroke or a fixed neurological deficit.[/h] [h=4]j)Recurring neurologic disorders, including transient ischemic attacks.[/h] [h=4]k)History of intracranial aneurysm, other vascular malformation or intracranial hemorrhage.[/h] [h=4]l)History of neurological decompression illness with residual deficit.[/h] [h=4]m)Head injury with sequelae.[/h] [h=4]n)Hematologic disorders including coagulopathies.[/h] [h=4]o)Evidence of coronary artery disease or high risk for coronary artery disease.[/h] [h=4]p)Atrial septal defects.[/h] [h=4]q)Significant valvular heart disease - isolated mitral valve prolapse is not disqualifying.[/h] [h=4]r)Significant cardiac rhythm or conduction abnormalities.[/h] [h=4]s)Implanted cardiac pacemakers and cardiac defibrillators (ICD).[/h] [h=4]t)Inadequate exercise tolerance.[/h] [h=4]u)Severe hypertension.[/h] [h=4]v)History of spontaneous or traumatic pneumothorax.[/h] [h=4]w)Asthma.[/h] [h=4]x)Chronic pulmonary disease, including radiographic evidence of pulmonary blebs, bullae or cysts.[/h] [h=4]y)Diabetes mellitus.[/h] [h=4]z)Pregnancy.[/h]

 

[FPDocMatt]

AAUS

Conditions Which May Disqualify Candidates From Diving (Adapted from Bove, 1998)

Excellent list!

Interesting about crazy people being on there. Never occurred to me, but I guess being insane is probably a good reason not to dive. sycho:

(Some spouses might attest otherwise.)

 

[Thalassamania]

Keep in mind that these are not (any longer) absolute contra-indicators, and some (e.g., pregnancy) are controversial or based on an absence of information and a medical liability mediated best guess, rather than scientific results (many of our leading women scientists e.g., Sylvia Earle and Eugenie Clark, who dove well into pregnancies with no ill effects).

 

[FPDocMatt]

Keep in mind that these are not (any longer) absolute contra-indicators, and some (e.g., pregnancy) are controversial or based on an absence of information and a medical liability mediated best guess, rather than scientific results (many of our leading women scientists e.g., Sylvia Earle and Eugenie Clark, who dove well into pregnancies with no ill effects).

A friend of mine who is a jazz musician, his wife attended lots of his sets while pregnant, and his son was born with musical talents. Makes me wonder whether babies born of mothers who scuba'd while pregnant have any particular nautical abilities. :fish:

 

[Thalassamania]

Well ... I done a bit of diving with two out of three of Sylvia's and they are pretty good in the water.

 

[freewillie]

Thalassmania's list is from 1998. As stated, some of the conditions have changed.

Direct from DAN publication The Sports Diving Medical whether or not a diver can dive with asthma is one of the most controversial topics in dive medicine.

For those who are not aware, I am a physician as well like Matt and Lynne. From my perspective it is both a medical issue and a legal issue. It is impossible to ignore the fact that this is a litigious society. Even if the doctor cleared a patient for diving certain dive operations and instructors will have their own opinions and guidelines for dealing with people who have underlying chronic medical conditions.

Most doctors may not have specific knowledge of diving, but that does not necessarily discount their ability to assess if a patient is fit enough to participate in a sport or exercise program. Doctor's have to clear patients for surgery and sign clearance forms for exercise programs all the time. It comes down more to whether or not the patient's underlying medical conditions are well controlled or not, and if the patient's exercise capacity is adequate for the surgery or activity. The only unique wrinkle is what is the worse case scenario, in other words, what happens if the disease becomes active while the patient is diving?

If someone suffers a seizure for example, that would most likely be a uniformly fatal event. It would be almost impossible for a diver to suffer a seizure while diving and not drown. The recommendation for diabetics not to dive is their risk of passing out or having a seizure due to low blood sugar while diving. Not an absolute but enough to highly discourage the activity. The recommendation for certain heart conditions as well, although the recommendation for not diving with a PFO (patent foramen ovale) is actually dive specific because of the risk of AGE.

A more difficult question to answer is what about patients who have chronic medical conditions but are otherwise well managed and stable? High blood pressure, underlying stable heart disease (ie remote history of heart attack but otherwise able participate physical activity without restriction), asthma for example. What if one had a heart attack some time ago, changed their habits, started exercising on a regular basis, takes their medications regularly, and has a stress test once a year with a cardiologist and has excellent aerobic capacity. I'd argue they are less of a risk than an overweight, marginally fit smoker who dives even if the latter does not have a history of hypertension, diabetes, and heart disease.

Specifically for asthma it will depend on the type of asthma since there are multiple subcategories of asthma. For patients who have mild intermittent (rarely have symptoms and rarely need to use an inhaler) diving should be fine as long as it has been several months since their last exacerbation. If the patient has history of childhood asthma but has never needed or had symptoms ashtma as an adult I would say that person is fine to dive as well. If a patient is stable on their inhalers and without restrictions to activity it may be a calculated but acceptable risk as well.

Any patient on multiple inhalers and medications and is prone/susceptable to frequent exacerbations should be discouraged from diving.

I find it ironic that we fill out a medical questinaire once when we certify. After that we are never asked about our medical history. Have you started medications for high cholesterol, hypertension, etc. since you certified? Do we routinely screen divers for physical fitness? Nope. You swim 800 yards at your own pace once and tread water for 10 minutes and that's it.

We take risk in our everyday lives, we just tend not to categorize them in terms of having to sign waivers. Driving the the rain for example, we don't have to get a signed waiver from the DMV that we took a safe driving in the rain class. We do for diving. We don't require skiers to certify they are advanced to ride the upper lifts clearly marked as expert only. But we blame dive boat operators for allowing divers to sign up for and dive sites they are not trained nor have the skills to dive.

Any thought of diving with a chronic underlying medical condition should be individual with the diver and with discussion your own physician, preferably one who is familiar with diving or comfort based on the patient's underlying physical fitness levels.

 

[PfcAJ]

Its tough to prove that someone died underwater from asthma...

Pfft @ Asthma ruling out diving. Tell them to pull their heads in. I don't believe there is a single documented case where a diver was injured or killed because of asthma

Divers Alert Network

Personally, i suffer from allergen triggered asthma. Once a year during spring time when there is lots of pollen around, i suffer and have to reach for the puffer from time to time. I've never suffered an "acute" attack.

As we breath filtered air underwater, it's not likely i am going to suffer an attack while diving. I've also done all the various spiro tests required before getting my diving medical, and if I hadn't have been honest, they wouldn' have even known.

 

[Griffo]

Perhaps not (like with almost any diving accident it's often hard to diagnose). But you'd expect to see a statistical anomaly with higher rates of death per 1000 for asthmatic divers.

 

[freewillie]

Perhaps not (like with almost any diving accident it's often hard to diagnose). But you'd expect to see a statistical anomaly with higher rates of death per 1000 for asthmatic divers.

True, but you would have to break down statistically if the diver was asthmatic or not when determining cause of death.

Just from DAN statistics, almost half of diving deaths are not directly scuba related such as having a heart attack while diving. Scuba just happened to be the activity that precipitated the activity. The victim very well could have been playing basketball but then wouldn't be dive related accident. That being said, the ultimate cause of death would likely be drowning and contributing factors would be heart attack.

If someone was to have an asthma attack while diving, it would be very difficult if not impossible to determine exact cause of death since that would not be identifiable (asthma) at autopsy and cause of death would simply be drowning.

 

[Thalassamania]

Historically any asthma was considered an absolute contraindication to diving, more recently that seems to have been lightened up, by some. I guess Sunset House is just, "Old School" about it.

Traditionally any bronchial asthma was regarded an total contraindication to going, more lately that seems to have been lightened up, by some. I think Sundown Home is just, "Old School" about it.

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