Diving and Epilepsy

[TexasMike]

A friend of mine is a huge fan of the water. Many is the time he is either in the pool, swimming in the lake, or water skiing. But I only recently found out he hasn't had a chance to breath underwater.

When I asked why not, he told me that he always wanted to, but he has epilepsy and the doctors he has seen won't sign of on him doing scuba.

Can some of the Docs and other knowledgeable folks help me understand why he's prevented from diving?

I know one obvious reason is if he had an episode underwater the chance of drowning is there, but what else would keep him from getting below the surface?

[carlislere]

Mike,
Isn't that enough reason? I have been called to numerous epileptic seizure calls when I was with a volunteer FD and they have no control over themselves at all. Drowning is very likely.

[DocVikingo]

Evening Texas Mike,

Here's an edited version of an article I wrote for "Rodale's Scuba Diving" early last year:

"While medical nemeses such as diabetes and asthma have recently become subject to clearance to dive under conditions of proper control, seizure disorder has not fared as well. PADI, DAN and other major dive organizations continue to view adult epilepsy, controlled or not, as precluding scuba. Certain types of early childhood convulsions can be medically excused, but it is mandatory that a potential diver with such a history have a completely normal neurological examination.

This rankles many of those desiring to dive who have only a distant history of seizure and are not on anticonvulsants, or are well or completely controlled by medication.

The reason for the prohibition is that an epileptic event underwater can have fatal consequences, and can occur even in those long seizure-free or well-controlled on medication.

While there are numerous types of seizure disorder, nearly all involve both motor dyscontrol and an alteration of consciousness, in varying degrees of severity. In the most serious forms, consciousness is lost and a major motor convulsion occurs.

During such a serious event, loss of the second stage is almost certain and this could result in drowning. Furthermore, breath holding can be occasioned by spasmodic phases of the motor activity. This increases the risk of pulmonary barotrauma during attempts to bring the stricken diver to the surface.

Even when the seizure does not involve unconsciousness and significant motor dyscontrol, the disturbances of awareness can be life-threatening.

Finally, seizure medications, to a greater or lesser extent, have sedative side effects and could exacerbate nitrogen narcosis or cause its appearance at shallower than expected depths.

The outlook overseas is somewhat rosier for those with a history seizure disorder who are not currently on medication. The British Sub-Aqua Club (BSAC), for example, suggests requirements for medical clearance to dive that include five years free from a convulsion off medication, reduced to 3 years when the convulsions were exclusively nocturnal."

Hope this clarifies the matter somewhat.

Happy holidays.

DocVikingo

[TexasMike]

Thanks DV, this was the info I was hoping to get.

[wingflyer152]

I have one question for you guys. What if somebody told you you couldn't dive? There are avenues that you people are failing to see that we epileptics have so that we can scuba dive. As a diagnosed epileptic, I was told that I would never fly my airplane or scuba dive again. However, I safely do both. I fly as a private pilot with a Certified Flight Instructor as a safety pilot in the right seat. I scuba dive with an AGA full face mask with an oral nasal cavity in case I have a seizure underwater, I will not lose the second stage and drown like you guys have said. You didnt even explore the possibility of this. You left it out alltogether. I also have underwater communications with my dive buddy, who is knowledgeable of my condition and what to do.
I am sick and tired of you losers trying to make diving sound more serious than it really is. It is not space flight, where you muset be in the best shape of anyone on earth. You people should really have much more of a sane and open mind about diving and things of this nature. Sure, there are concerns for safety, but most of the time, this can be resolved and the person still be able to scuba dive. After all, what right do you or DAN or PADI or anybody have to say that I can not scuba dive? You can say that until you are blue in the face, but until you are faced with a bad health situation that was not your fault and those in better health are denouncing you just to make themselves feel better or to make them selves sound more "elite" as divers, you will never understand our position. Also, nitrogen narcosis is a mild effect and a very mild risk when diving with a buddy in shallow water, all you must do is surface, or ascend for a time, after all people narc for fun!!! This is a prime example of you, DocVikingo trying to make the sport sound more "elite" as I stated before. Dont worry though, you are not alone, you have a lot of company in this sport. We disabled divers have a voice, and I will soon be hosting a URL to acnowledge the efforts of those who have overcome their disability, whatever it may be. Anyone who disagrees or agrees with me, feel free to email me at wingflyer152@aol.com with your concerns.

[ckharlan66]

Wingflyer152,

I love to dive but to answer you question if someone told me that I had a medical condition that made it infinately more dangerous to dive I would have to resign myself to never dive again.

Having an episode underwater would not only endanger yourself but also your buddy. If you go into convulsions you could also drown your buddy as he tried to save you.

You know these risk and choose to dive anyway. I hope you have taken the precaution of only diving with a qualified rescue diver and that you have informed your buddy of the risk.

Please don't take this as an attack but with the concern with which it was intended.

Chad

[jbd]

wingflyer152--having dealt with people experiencing an epileptic seizure on dry land I am curious as to what the the prodedures are in the event you have a seizure while underwater.

[wingflyer152]

since you cannot swallow your tongue, there is no precaution needed there. I have complex partial seizures where you just lose motor control and awareness. The chances of somebody going into a seizure and having the motor skills to hit their LP inflator hose, or anything of that nature is highly unlikely. Of course there are always risks that one must take, and I am not saying that I am not above these risks, nor can I say I do not take them, but all divers do take risks, that is a part of the sport. Of course us epileptics would be at a higher risk of something going wrong, from what I see, this is a somewhat trivial risk. And to answer Chad's questions, I am not meaning to be mean or to try to provoke a fight, but I do know the risks and I take them. If I have to pay the price to be like everybody else, to life my life to the fullest, then so be it. Is life really worth living if you cannot do what makes you happy? I made the choice, and I am the one to blame if something were to go wrong.

[jbd]

Wingflyer152--I was simply curious as to what needed to be done by your buddy that you mentioned knows what to do. I was not being judgemental about your diving or flying. If you're over 18 I could care less what risks you take in your life. It's your life--live it as you see fit. However, given the fact that you refer to the people in this thread as losers and the tone of the private message you sent to me I consider you to be a crock of cr*p.

[decapoddiver]

...I agree that if you want to do something that could possibly be risky for you , go right ahead. The day you ask me to partake in something that could be dangerous to me though, HELL NO! People do all sorts of dangerous stuff all the time but it doesn't bother me until I am somehow involved.
I assume that you only go diving with the same buddy and NEVER go as part of a group that would have no idea what to do in case of emergency. What if I was on the same boat as you and saw you have a seizure and didn't know about your condition? Assuming your buddy wasn't right next to you (which happens all the time).
You mentioned the type of seizures you have and I can understand how you could dive safely with the precautions you have taken. There is more than one type though and I've seen some that would be fatal underwater. By all means fight for your rights but please don't get upset when others show concern.

P.S. If you informed me prior to the dive about your condition, I would not have a problem diving with you, considering your type of symptoms. I'm not out to stop all people with seizures from enjoying our sport.

[scubadoc]

Hello:

We often get indignant letters asking why people who have convulsions cannot dive. The answer is fairly simple - without special equipment and a knowledgeable buddy - they will drown. In addition they will endanger the lives of others on the dive.


1. People with seizures (any kind) should not dive or drive a motor vehicle until they have met the usual criteria of seizure free periods before returning. (See #5 below)

2. US training agencies, dive operations and dive medicine organizations would be unlikely to grant clearance to dive to an individual with seizures and on anti convulsant therapy.

3. One consultant states that if you require any anticonvulsant medication, all of which to a greater or lesser extent effect level of consciousness and information-processing speed, the response must be negative.

4. Dr. Carl Edmonds writes that there are epileptogenic provocations associated with diving (nitrogen narcotic effect, oxygen toxic effect, ?CO2, and the immersion effects). There is a frequent observation that the first epileptic attack encountered
by divers often develops during a dive.

5. A knowledgeable UK diving physician provides this information from the UK Sport Diving Medical Committee. There should be no diving until off medication and entirely free of seizures for three years. Diving while on medication is not advised.

Finally, one must recognize that there are situations and 'triggers' that will cause you to be more at risk for convulsions accompanied by unconsciousness. The additive effect of nitrogen narcosis, even at shallow depths could be dangerous. Increased partial pressures of oxygen can cause seizures and there is a risk of oxygen toxicity lowering the seizure threshold of an epileptic. Hyperventilation is a known seizure trigger and occurs frequently in anxious diver or divers who have to exert themselves physically.

There is a real danger of drowning with a seizure. The regulator falls out of the mouth, there is a sudden intake of water into the lungs and the diver drowns. Compounding this is the fact that the diver then has to ascend in the water column - subjecting him/her to pulmonary barotrauma and gas embolism.

Our consultant, Bruce Miller, MD points out this succinct passage in Bove's 'Medical Examination of Sport Scuba Divers', 3rd edition, p.27; "Because of the risk of drowning and the serious risk to would-be rescuers, seizure disorders are absolutely disqualifying for diving, regardless of control by anticonvulsant medication."

[AllenG]

ScubaDoc, Doc Vikingo -

It seems that about once a month, someone posts a thread asking if it is ok to dive if they have medical condition XYZ. This post is rapidly followed up by divers with no medical background responding "absolutely not" and then one diver saying "I dive with XYZ, so let's be a little more open minded" or "I know a person with condition XYZ who successfully dives and isn't he/she so brave to overcome a disability." Somewhere in the middle of this exchange, one or more diving docs opine on the generic risks of diving with XYZ and then support it with the opinion of another medical writer and/or a certifying agency. And then I suggest that the original person with XYZ speak with a diving doc (not his/her original specialist who diagnosed XYZ) to assess the particular risks associated with the special mix of symptom that he/she uniquely presents, because each person's particular situation is DIFFERENT!

Just as old edict of "asthma is an absolute contradiction to diving" faded with today's enlightenment re different severities and etiologies of asthma, doesn't it seem reasonable to recognize that the mere label of epilepsy warrants individualized risk assessment (rather than absolute contradictions), especially in light of the fact that GPs and neurologists alike drop the epilepsy label on top of a lot of conditions that are not epilepsy.

And there is a tendency to ignore the "accomodations" that the diver may have established to address some of the risks. This particular diver had communication systems and a trained buddy. Does this mean he is risk-free? Of course not. But I don't see the diving doc community or the certifying agencies recommending that smokers, whose lungs have been primed to create respiratory complications, be banned from diving.

You can drape yourself in medical terminology all you want, but the logical extrapolation of your assessment is that all people diagnosed with epilepsy should dig a hole in the ground and bury themselves. As you scoff with indignation, the person diagnosed with epilepsy might fall in the shower and crack open his/her skull, so showering is absolutely contraindicated? They could black out walking down a flight of stairs, so they should never go above the first floor of a building? They could have a seizure while eating, which would create a number of potentially serious problems, so they should never eat?

And citing the policy of a certifying agency is absolute folly! Certifying agencies do not practice medicine, they are self-serving agents of the dive INDUSTRY. Yes, they may assemble physicians for task forces, but those task forces are practicing policy-making, not patient-specific medicine.

Am I saying every person with epilepsy is safe to dive? Of course not! Am I saying that I wouldn't think it important to know that a potential dive buddy has epilepsy? Of course not! It actually strikes me as ironic that in times of old, some physicians recommended that individuals with epilepsy be treated by dunking them in water for an extended period of time; and today you would ban these same individuals from the water. I might be tempted to draw some comparison re the medical use of leeches in days of old, but leeches are staging a comeback in some circles.

Individuals with all different types of disabilities thrive on meaningful leisure and adventure activities, selecting a given activity mindful of the risks associated with their particular condition and deficits. Some blind individuals ski, parachute, and dive. Some spinal cord survivors and individuals with mobility limitations may dive. To the venerable and valued physicians on this board, I make the request that you focus your remarks on helping any individual assess the risks he/she may be taking in view of his/her PERSONAL array of symptoms and the strategies that lessen the risk if he/she decides to pursue diving.

[jbd]

AllenG--Your last paragraph would,IMHO, be tantamount to asking the docs to practice medicine over the internet. The nature of dive agency policies and any recommendations made by any physicians as to the appropriateness of anyone diving is based on liability.

As for people diving with XYZ conditions that is something that should be done based on an actual face to face hands on evaluation of the individual by a physcian competent to make that assessment.

I do agree that individuals with XYZ conditions should have the option of pursuing whatever recreational activities they want as long as the risks involved can be brought to an acceptable level through equipment or technique or extra support personnel if needed.

[John Reinertson]

As some of you have mentioned, an individual has a right to take risks with their life that they consider reasonable.

You mentioned flying with an instructor pilot in the copilot seat as a safety pilot, and I don't have a problem with that, nor does the FAA, apparently.

You describe a situation in SCUBA where you wear a full face mask, presumably securely strapped on, and you have a buddy that you have communications with so I'm assuming he has similar gear. That strikes me as a reasonable accomodation to mitigate the known risks.

If a diver with a "disability" makes intelligent and reasonable accomodations to that disability to reduce their risk, and he/she and his buddy and their physician/medical adviser are comfortable with the risks and accomodations, I don't have a problem with that.

It is always important to remember, however, that in SCUBA, any excess risk affects not only the person taking that risk and his or her buddy, it affects the safety of all potential rescue persons in the area.

This applies just as much to a diver who is fit but knowingly practices high-risk diving practices as it does to a diver with a "disability" who dives with increased risk.

There is some risk in all diving. We need to assess the risk on each dive, take steps to minimize risk, and be aware that the consequences of a bad event will not affect just you and your buddy, but a whole bunch of other people.
Minimize risks not only for your sake, but for theirs, also.

If the risk is high, think twice, for the other people's sake.

Dive safe,
John Reinertson

[AllenG]

JBD - I must certainly agree with you that it would be inappropriate for a physician or any other health care professional to "treat" an individual patient over the Internet and if I left that impression that I might otherwise condone or even encourage such practice, I do apologize. As someone who has spent the past 25 years helping individuals with disabilities to do things, perhaps I get a little annoyed when I see my colleagues engaged in over-generalizations that undercut individuals with disabilities . . .

And Dr. Reinertson, thanks for the well articulated and balanced assessment!

[Laurence Stein DDS]

Wingflyer 152,

How about a little different “take” on your position? Have you ever had to rescue a diver at depth? I can tell you that I have, on two occasions, and it leaves a very deep impression on both the victim and the rescuer. The odds are as much as 50% that both divers will drown. Neither one of these divers were my buddies.

As much as I believe in using the buddy system, I also believe that every diver should be proficient with self-extrication. He is ultimately responsible to himself. Do not EXPECT that your buddy will be the rescuer. Most likely, it will be someone else and if that happens, that person may not know what your problem is and how you got that way.

Since when did scuba diving become a right. It is a privilege. You are granted a certificate after training and passing all tests and requirements, including medical. Just like driving a car. It is a privilege to have a driver’s license—after passing the tests, eye exams and medical questions. If you believe you have this RIGHT, then you are full of c—p!

I was in college in the “60’s. It was a time of hippies, flower power, and drugs. The mantra was that everyone should have the right to do anything they wanted as long as it didn’t affect someone else. Well’ let me tell you, unless you lived as a hermit in Montana, there is NOTHING you do that doesn’t affect others, be it family, friends or strangers. You have absolutely NO RIGHT to ram you ideas down my throat and your actions may very well affect my life or well being.

I suppose you also drive a car without the seat belts on and motorcycle without a helmet. If you participate in an activity that has increased risk, you have no right to have others suffer the consequences. The trauma rooms are full of these people. They drive drunk, motorcycle without helmets, etc. They end up in public hospitals and often end up having their medical treatment paid for by tax dollars—something everyone contributes to. That affects me!

I commend you wish and ability to participate in a sport normally left to people with less medical problems. I do not agree that you have any right to put others at risk. If I were on a boat with you I would welcome you advising me that you have epilepsy and it would not deter me from trying to help if you become incapacitated. However, never think that your problem is yours alone when diving.

Finally, I harbor no prejudice toward you and other people with disabilities. I admire those who are able to overcome those problems. However, putting others at risk is not a proper strategy for you to do your thing because your thing DOES put others at risk. All the medical providers in this forum know that their first duty is to Do No Harm. It is about time that others like you realize that they have that same obligation too.

Respectfully,


Laurence Stein, DDS


:box:

[sunfish]

This is an internet message board. Saying a particular person can dive, which is contrary to the general consensus of the medical community, would be practicing medicine on the internet, which is not only illegal, it is dangerous. The original question was about diving and epilepsy. Can a person with epilepsy dive? To me, it looks like Mike was asking about the general concensus of the medical community. He did NOT give details about his friend's condition. He did NOT ask if people thought his friends should be allowed to dive. The general consensus among the medical community was given by Doc V and scubadoc. They quoted respected texts and posted links from websites. They put time and effort and expertiese into their posts, and then they got flamed and called "losers" for posting exactly what was requested. I think this is extremely unfair, and I am kind of surprised that the regulators didn't jump in or at least comment.

But let's leave that aside for the moment. For the sake of discussion, let's say that certain people with seizure disorder may have the privilage (I truly believe it is a privelage and not a right) of diving provided adequate precautions including special equipment are put to use. Do you think that this means all diving shops become required to be equipped with such specialized equipment during certification, or would the divers with seizure disorder be required to provide the equipment themselves? I am assuming that the equipment mentioned by wingflyer 152 in his post would be much more costly than standard regs and masks of the same performance. Would dive shops running cert courses be required to own and maintain, or at least have access to, such equipment for training purposes?

[Laurence Stein DDS]

As you have pointed out the original question was answered with valid medical advice based on scienfice medical evidence.

Wingflyer 152 has allowed his personal agenda color the realities of diving with this condition. In the process he also managed to change the focus of this discussion.

Until the scientific evidence says otherwise, like it has for asthma, the only prudent advice is not to dive. That said, Wingflyer can do anything he wants to. He is an adult and knows the risks. However, he better become proficient in getting himself out of trouble when the time comes. Oh! What's that you said, you go limp and would not be able to remove the regulator from your mouth or press the inflator button--naaa, that's not scary! Pretty soon he will accuse himself of failing to have saved himself and if he survives, he may then blame his buddy or non-responsible 3rd parties for failure to rescue him in a time of need.

Does his buddy realize the jepordy he has put himself into? This is a disaster waiting to happen. Telling others that they are unsymathetic to his disability is hogwash. I doubt that anyone reading this thread actually wishes that this person shouldn't dive and we even give him high marks for his moxie but it doesn't change anything. He is also engaged in a very masculine behavior--denial. It keeps men away from the doctor for check ups, it leads to preventive measures in treatment for cardiac symptoms and it leads to the spread of malignancies far beyond a stage when it is treatable.

Again, Respectfully,


Laurence Stein

[wingflyer152]

Stein,

Exactly who are you to give PROFESSIONAL advice about diving? Arent you a dentist? A dentist is not any more trained about diving and epilepsy than a man on the moon. Sorry for the attitude, but you started it by saying that I was full of crap.
You said that the odds are 50% that both divers will drown during a rescue situation at depth. How many times do I have to explain that this is physically impossible???? The only way it can happen is if you run out of air. You saying scuba diving is a right and not a privilege, this is exactly what I am talking about people trying to make diving sound "elite." Trust me, I do things sophisticated far beyond the bounds of diving, and it is in no way as "elite" and as sophisticated as many people try to make it sound. The day you are brought to your knees by something that you cannot control, the day that you wake up and cannot drive, realizing that your life dream of being a pilot that you have attained has been taken from you and you will never get it back, when that day happens to you then, one day you can tell me about what is a privilege and what is a responsibility. Also, to sunfish.....It is definately something that needs more study...that question of would the diveshops have to have the masks is something that would need to be found out with research. Also, yeah the masks were expensive, but I want to dive, and dive SAFELY, so that is something I had to buy. Take Care all.

Love,
Wingflyer152

[Laurence Stein DDS]

Dear Wingflyer152,

First, my sincerest apologies for the use of crap in the post. It was meant a figure of speach but it was inappropriate. You are right. I'm sorry.

I'd like to answer your question about what a dentist has to do with epilepsy. I have a number of patients who have seizure disorders. All dentists do and part of our training is the emergency treatment to provide to them.

No, a dentist does not treat seizure disorders and if I had them I would want a physician to see me. Given a choice though, I would want an ER physican, paramedic, or neurologist to provide treatment.

The reason why I mention that I have participated in dive rescues, is that I have first hand experience with these emergencies, which, in general, are usually a chain of events that lead toward a disaster. Following the disaster, the chain may continue and further consequences may follow. These can also be disasterous.

In both of emergencies I participated in...out of air emergencies, the victims had to use a source of air other than their own. Had the victim been you, your full face mask would have been useless. The stress of the situation, the hypoxia, could have triggered a seizure. Your little safety cocoon would not exist. I know from personal life experience that the first thing you or any other diver would do if out of air, is to remove their regulator or, in your case, a full face mask in an effort to get to another source of air. What would you do then? Your solution for your disability addresses only one aspect of what can happen. I am certain that there are other scenerios that would render your full face mask unworkable.

I hope you see my point. I give you a great deal of credit for overcoming your disablility. Divers are NOT elite. It's just a sport. Something to have fun at and explore this world. View its diversity and beauty. Anyone who makes it competetive and elitist is stupid. To assume that divers, certifing agencies, dive boats and dive shops are somehow behaving elite is wrong. Until they have scientific evidence that a fool proof work around is available, seizures (and until families of those who perish or are injured for life stop filing law suits) and diving do not really mix. That being said, enjoy yourself and its a beautiful world out there.



Respectfully, and with sincerest apologies,

Laurence Stein--just a tooth doc.

[sharpenu]

I have to say to those that say diving is a privledge:
Why do I need the permission of any certifying agency to dive? NAUI, PADI, SSI. Are any of them law making bodies? No, they are private companies. Sure, it is a good idea to get the training that they offer, but in reality all that is needed to dive is the equipment and a compressor. The only reason that the main agencies say no, is to protect thamselves from liability. It is certainly not out of some altruistic motive.

The question of whether it is safe for divers who have seizures to go diving is like most other medical issues and is answered only after consulting one on one with a competant physician. I have a buddy I dive with who has a seizure disorder that was caused by a blow to the head at a young age. This diver is taking Dilantin. I not only have dived to 120 feet with this diver, and I have been on EANx dives to a PPO2 level of 1.4 with the same person. No problems in over 75 dives with the same diver in all sorts of conditions.

[devjr]

A benefit of a socialist society like ours is that everyone is responsible for you and me. If you screw up, we ante up. Unfortunately, that is also interpreted as giving society the right to tell you what you can and can't do, mainly because we wish to limit payouts for any consequences which we previously assumed in the name of said society. For example, in fairness to non risk takers, the Coast Guard will no longer rescue us dizzy types from routine foibles, and if you really screw up they will charge you for services rendered. Furthermore, they reserve the right to tell you what safety equipment to carry, how much booze you can drink, and etc.

Personally, I believe in the right of self destruction. No pain, no gain. Look at free basers, free climbers, bungee jumpers, etc. They have a right to commit suicide, or die trying. Same with epileptic divers.

The costs can be spread over society without using the tax paid institutions as a cover. For example, the self indulgent blind man who climbed Mount X used private funding. There was the usual payback through endorsements. An upside can be found for most anything involving the poor, dispossessed, discriminated, handicapped and infirm. Lawsuits work especially well.

[wingflyer152]

Just like DevJr said, epilepsy is protected under the ADA (Americans with Disabilities Act) and since there is no federal law outlawing epileptics to dive, such as in flying, (FAR part 63) one could probably sue the pants off of PADI or NAUI for discrimination until they let them into the program with the proper precautions taken care of. However, I have yet to hear of this in a court of law.

[sharpenu]

Devjr:

The Coast Guard is an agency of the US Government. They have enforcement powers. NAUI, PADI and all of the rest are private companies and have no power to enforce their rulings. Under your reasoning of "protecting" people from themselves because we have a form of socialized medicine would also have us outlaw booze, fast food, red meat, getting a tan, driving a car and living in any large city or the entire state of New Jersey.

[sunfish]

So this kind of brings us back to the question I was asking about dive shops being required to have seizure-resistant (can't say seizure-proof, 'cause, as the toothdoc said, theoretically someone in a disoriented post-ictal state could just take off the full-face mask and all bets would be off...) equipment, and also the financial issue devjr pointed out. IF such a discrimination law suit were filed, and if the courts ruled in favor of the seizure disorder patients wanting to dive. just exactly WHO would become responsible for their training?

Before I say anything more, I want to make perfectly clear that I have nothing against wingflyer himself diving, although I would not feel comfortable being his buddy, because I am not familiar with his equipment and I am just a newbie diver who can barely take care of herself and still always dives with a DM at the very least. Nothing personal, and I am hoping he understands why I say this. Also, I'm not a neurologist, but I have read a bit on the subject.

As the toothdoc mentioned, I've read there are a lot of situations that can trigger a seizure, all of which vary with the particular patient in question. For example, some women have changes in the frequency of their seizures according to the phase of their menstrual cycle! That's why I think it is pretty safe to say that there probably are people with seizure disorder whose seizures are triggered by something associated with diving. wingflyer is probably not one of these people, sharpenu's dive buddy is probably not one of these people, but it seems reasonable to say that somewhere in this world, there are people like that. OK, I haven't said anything THAT far-fetched yet, have I?

Let's say for purposes of discussion, the cert agencies became required to accept patients with seizure disorder to their training courses, with the potential to be certified (duh). Would this mean every single dive shop on the face of the planet would be required to have instructors familiar with seizure disorder and the seizure-resistant equipment, and also to own and maintain the equipment so that it would be available for anyone who would need to use it during the cert course and beyond, regardless of how small the shop was? wingflyer said that the equipment was pretty darned expensive. What if the shop were so small, they couldn't afford to own and maintain that kind of equpment, and also that kind of training for their instructors? Or would the individual shops still have the right to refuse to train someone based on someone's being diagnosed with seizure disorder, and instead would there be certain "seizure disorder friendly" shops designated by the respective agencies, that would have appropriately trained instructors and also the right equipment?

[sharpenu]

You misunderstand me. I don't think that anyone should be REQUIRED to do anything. I just am saying that the agency shouldn't restrict the diver. Diving is (somewhat) dangerous and I think that people need to learn to accept that and stop trying to protect people from themselves.

[Laurence Stein DDS]

Actually, the ADA (Americans With Disabilities Act) is kind of a strange bird. It provides certain protections to the disabled but these protections are not necessarily to provide exteraneous equipment to make their lives easier. At my office,
I lease space. I am not the landlord. If the landlord were to install ramps (this is a one level building, then I would be required to install wheelchair access in my leased office space. My doors would have to meet design specs. for wheelchair access. I do not, however, have to provide wheelchairs.

I don't believe that a certifying agency or dive shop is required to provide equipment for the disabled to undergo training.
The burden would be for the disabled to provide the necessary equipment to make their training possible.

There is certain equipment that I may install which qualifies for a deduction based on ADA wording. However, I do not have to install that equipment if I choose not to. I do not have to supply TTY phones or special audio visual devices to help me communicate with the disabled.

The specialized, expensive equipment is not a required purchase by dive instructors , dive shops, or in some way provided by dive organizations.

On the otherhand, I am required to make some adjustments for staff if disabled. Since it is not my building, an exterior ramp would not be required for me to install.

Getting away from the ADA issue. No one may sign away their liability. If someone comes to my office and want me to perform a treatment which I know to be wrong or inadequate but the patient insists that is what they want, I cannot absolve myself of that responsiblity to the patient by having them sign a release form that states, in effect, that I am not
not responsible.

This is one of the draw backs that block diving agencies from allowing anyone, cart blanc to take the training courses they wish to take. If it is medically unsound then the only choice the agency has is to withold training. It is NOT against the law to withold training. It would be against the law to provide training without the proper equipment needed to adequately train an individual. This is true whether it is "Joe Average" diver or an ADA diver.

I'm NOT a lawyer so the specifics escape even me. Perhaps someone in these forums is familiar with these laws.

Larry Stein

[Laurence Stein DDS]

Thought everyone might want to see a brief overview of the ADA.
Enclosed is the web link.

http://janweb.icdi.wvu.edu/kinder/overview.htm

The Americans with Disabilities Act: A Brief Overview
[Home | Documents | Links | Kinder ]

Disclaimer; This is a brief overview which cannot possibly set forth everything about the ADA and which, for purposes of brevity or as part of an effort to state legal concepts simply and in plain English, may describe the law in a manner which is not necessarily precise and/or accurate in every respect.

Signed into law on July 26 1990, the Americans with Disabilities Act is a wide-ranging legislation intended to make American Society more accessible to people with disabilities.

It is divided into five titles:

Employment (Title I) Business must provide reasonable accommodations to protect the rights of individuals with disabilities in all aspects of employment. Possible changes may include restructuring jobs, altering the layout of workstations, or modifying equipment. Employment aspects may include the application process, hiring, wages, benefits, and all other aspects of employment. Medical examinations are highly regulated.
Public Services (Title II) Public services, which include state and local government instrumentalities, the National Railroad Passenger Corporation, and other commuter authorities, cannot deny services to people with disabilities participation in programs or activities which are available to people without disabilities. In addition, public transportation systems, such as public transit buses, must be accessible to individuals with disabilities.
Public Accommodations (Title III) All new construction and modifications must be accessible to individuals with disabilities. For existing facilities, barriers to services must be removed if readily achievable. Public accommodations include facilities such as restaurants, hotels, grocery stores, retail stores, etc., as well as privately owned transportation systems.
Telecommunications (Title IV) Telecommunications companies offering telephone service to the general public must have telephone relay service to individuals who use telecommunication devices for the deaf (TTYs) or similar devices.
Miscellaneous (Title V) Includes a provision prohibiting either (a) coercing or threatening or (b) retaliating against the disabled or those attempting to aid people with disabilities in asserting their rights under the ADA.
The ADA's protection applies primarily, but not exclusively, to "disabled" individuals. An individual is "disabled" if he or she meets at least any one of the following tests:

He or she has a physical or mental impairment that substantially limits one or more of his/her major life activities;
He or she has a record of such an impairment
He or she is regarded as having such an impairment.
Other individuals who are protected in certain circumstances include 1) those, such as parents, who have an association with an individual known to have a disability, and 2) those who are coerced or subjected to retaliation for assisting people with disabilities in asserting their rights under the ADA.

While the employment provisions of the ADA apply to employers of fifteen employees or more, its public accommodations provisions apply to all sizes of business, regardless of number of employees. State and local governments are covered regardless of size.

Dive training seems to fall outside of the specific titles--the disclaimer not withstanding.

Larry Stein

[devilfish]

My, my, arn't we getting a bit hot under the collar. Please read.
We, divers and instructors sometimes get lost in the role of a mother, protector, expert, parent, etc., and voice your opinions why some one is permitted to dive or not. Yet, those with conditions contraindicative to diving are willing to take risks and persist. It is their choice if to take the risk. Of course the concern is if they get in trouble often another diver is in jeopardy. If they want to risk another, well, that is also their choice.
However, everybody has a choice, including me. I do have some idea what are the risks of conitions, but that's not the point. The point is if a diver dies, the lawers for the plaintif are ruthless and I will protect myself by not certifying them. Let's not get too lost in playing a parent, we also have a responsibility to protect ourselves and our families from lawsuits. They want to dive, fine, but I don't want to loose my house because they want to play. Diving is a wonderful sport and activity, just like space travel, but contrary to common belief diving is not for everybody.

[wingflyer152]

Stein,
Is that the "official" words from the ADA or YOUR biased summary of it? Also, for the record I think that a dive shop should not have to carry special dive equipment for epileptics, though if diving was publicly opened to epileptics, renting such equipment would probably be profitable. Diving is an expensive sport, and with a disability, that much more expensive.

Wingflyer

[landlocked]

Originally posted by wingflyer152
Stein,

Exactly who are you to give PROFESSIONAL advice about diving?..... Sorry for the attitude, ..... You saying scuba diving is a right and not a privilege, this is exactly what I am talking about people trying to make diving sound "elite.".... The day you are brought to your knees by something that you cannot control, the day that you wake up and cannot drive, realizing that your life dream of being a pilot that you have attained has been taken from you and you will never get it back, when that day happens to you then, one day you can tell me about what is a privilege and what is a responsibility...... Wingflyer152 Soap box warning!! :tonguewag:
This post has bothered me for serveral days. I think that I might like to address why. First, my qualifications. I am the father of an epileptic daughter, now age 22 and a diabetic son (type 1) now age 18. Of the two illnessess, epilepsy is by far the worst in terms of lifestyle and coping with the illness emotionally. Wingflyer, my heart goes out to you. I am amazed by the way that you have confronted and in a way conquered the problems that life has handed you. Would I take my daughter diving with the accomodations that you mentioned? Yes, but then I am her father, I understand her illness and I don't mind going out on a limb for my child. That is what parents do. With that said, I would have to say that if either of these two children of mine (or any of the other 4 healthy children) displayed as much attitude or self pity has this post indicates, I would have kicked their respective butts! :spank: (Figuratively speaking of course.) It is my opinion, you see, that not only is diving a privilege but life itself is a privilege. I am 49 years old and have yet to meet anyone who has had an easy life. Most people fail to acheive their dreams. Most people are "brought to their knees by something that they cannot control." Often this comes by the decisions of an unfair boss. Sometimes by starting to drink socially with the guys while you are young only to realize 30 years later that you were predisposed to alcoholism. Sometimes a persons entire life becomes a daily struggle to overcome anxieties brought on by early childhood abuse. EVERYONE has their problems. Life is not easy for ANYONE. Not even for dentists.

I appreciate your struggle with certification agencies who appear non-supportive to you. Is that really any different than the struggle that all college students face in dealing with the beauracray of general ed requirements? By all means continue the struggle! Perhaps, a little more wisdom and empathy in dealing with others will allow you to be victorious in greater battles yet to come. Joy in life comes when we learn to be greatfull for the struggles. You definately have your struggles and you are definately being successful in dealing with them. Allow others the right to struggle also. Life is a "privilege." You have the "right" to the struggle.

[Laurence Stein DDS]

I was wondering when you would reply. FYI, the ADA summary is not from me nor is it biased. It appears at the previously enclosed website listed.

I want to thank you for acknowledging my apology for an inappropriate figure of speach. I hope you received my private apology.

Part of one of my replys was the fact that as a professional, I cannot have a patient sign away sign away my liability. This is true for doctors and any other person or business that provides a service which as some form of liablility associated with that service.

You wanting or insisting that PADI, NAUI or other certifying agencies have no right or at least reason to decline training for certain medical conditions is based upon this premise. Any doctor signing off as fit to dive for a person with epilepsy or other contraindicated condition, takes full responsiblity and LIABILITY for that decision.

It might not be fair to you but that's the way the game is played. Failure to do so would result in lawsuits that would put all those with a liability issue at great financial risk. BTW, this is not a matter of CYA. Legal action is a very real prospect in this day and age. There is no instructor, doctor, agency etc., who wants to get tangled in a situation like this.

I would love to tell you that it's ok for you to scuba dive. You certainly may do anything your little heart desires even if it is distructive. Just don't expect that others, no matter how empathetic, will just go along with the idea.

I think the posted messages also point to a pervasive feeling that it wonderful that you have overcome your disability but no one feels what you do is safe and you may even jepordize innocent third parties with your actions.

Go ahead and dive. However, should you have an emergency, and another person is injured or killed in the process, you or your family can certainly expect a lawsuit for a wrongful death. This system works both ways.

Laurence Stein DDS

[wingflyer152]

Stein,

Luckily, to escape the liability section of training and diving for epileptics, most of us epileptic divers have adopted the "no ask no tell" policy. I take my medic alert bracelet off whenever I go into a dive shop, and I choose not to let them no of my disability. I have sucessfully doone it with this post. You all dont know who I am, I will even tell you where I am, I am in Knoxville, TN but there is nothing you can do about it because diving is a big sport here. There are many divers who are also pilots here in the Knoxville area. Would a judge or jury who hears that the death of an epileptic diver was caused by the negligence of a instructor that didnt even know of the disability believe it? NO. I studied criminal justice in college with a few classes with an emphasis on law and this kind of liability. It is absolutely absurd to think that I am putting someone else's life on the line while i am diving......I keep telling you people that I have petit mal seizures not the convulsive kind, just the blacking out kind. I simply black out and sit there.

[devilfish]

Wingflyer152,
You may be correct that by hiding a contraindicative condition for diving, the Instructor and who ever is involved may not be found negligent. However there would be a law suit for sure. Majority of lawsuits are settled out of court and large amount of sums are paid out, regardless. Because it is cheaper to sattle than to defend. Very seldom a scuba lawsuit goes the distance. In that case the insurance company might turn around and find the individual who concealed the condition negligent and sue for damages. There goes the plaintiffs family financial security. In all cases of a diving lawsuit, somebody always gets hurt besides the victim.
I'm not telling what one should do, but these are the facts.

[wingflyer152]

"There goes the plaintiffs family financial security."

all of my family's financial securities are locked up in a family limited partnership which is one of if not the hardest thing on earth to sue into. It is nearly impossible to win a suit trying to take something from a limited partnership as one person named a plaintiff and that person being part of a limited partnership It is all of the financial ownings of a family all put together so if one were to kill somebody drunk driving it would be taking away from the innocent family members. :) One person doesn't really own anything, they put it into the partnership, but they have a vote in any decision made in that partnership in case a sibling tries to swindle him or her. You can't take what someone has because they do not legally own their house, their car, or their business......eat that. ;-0

[Laurence Stein DDS]

wingflyer152--call me Larry...

I really do understand where you're coming from. I realize that you have had people all your life trying to ram their rules and opinions down your throat. These people are not wrong in trying and you are not wrong in feeling frustrated.

I can tell you that as a member of a medical profession, and more generally, any service provider or profession treads on very thin ice when dealing with circumstances like yours.

Devilfish is right--covering up your condition to avoid subjecting others to potential liability poses two problems. First, if there is going to be a law suit by the family, it will happen. If it comes out that you covered up the truth, then the insurance company will come after you and will probably still manage to settle with innocent third parties.

If you're interested, I have witnessed a petit mal seizure during practice. It was quite puzzling--the patient would'nt respond to spoken questions. Their eyes were open but they persisted in repetitive actions--attempting to get out of a chair that was not restricting their movement. The whole thing took about 45 seconds. In that time though, there was no way to communicate with that patient.

The patient had to inform me that he had had a seizure. Retrospectively, I felt rather helpless. A non-responding, seemingly awake patient was puzzling. This patient failed to report their condition on their medical history. I also felt stupid that I hadn't picked up the diagnosis--but it happened too quickly to run all the possiblities through my mind.

Some of the symptoms exhibited by this patient would have also been consistent with a TIA or stroke. I have had a patient experience a stroke at the office--I left the room to polish his denture and when I returned, he was conscious but non-responsive to verbal commands. I had given the patient no medications and it took a few minutes to realize what MAY have happened. 15 minutes later, he was talking to my staff at the desk like nothing happened. 3 hours later he had a full blown stroke. This patient NEVER complained of a blinding headache or lost consciousness.

This is why it is so important for us to have a proper medical history.

Anyway, please just be careful. I know you enjoy diving and hopefully your condition will never result in a serious injury.

Regards

Larry Stein

[Laurence Stein DDS]

wingflyer152

You managed to post 30 seconds before me! (with apologies to all attorneys in this group) Eventhough you are supposedly judgement proof. There is always another loophole that an attorney may exploit.

If your actions resulted in the death of another by an error of omission, it is conceivable that you could be brough up on a misdemenor or felony manslaughter charge. Your assets may be in tact but possibly not your lifestyle.

As always, good talking to you.

Regards,

Larry Stein

PS. I wish that if an attorney on the board is reading, perhaps they could put in their two cents--but no billable hours!

[enquire]

I am a little confused by some of the statmements above.

I have a friend who really wants to dive. She was diagnosed with epilepsy 21 years ago (after 3 seizures within a 12 month period) but has been seizure free without medication for twenty years (with various EEGs, CAT scans etc showing no evidence of any condition) and has dived (not admitting to the history) a few times.

Would DAN and PADI still exclude her?

[wingflyer152]

how about a no ask no tell policy???

[wingflyer152]

Stein,

If my doctors say it is ok for me to drive a car down the interstate at 70 mph, then I think it is safe enough for me to dive.

[enquire]

wingflyer,

The problem with the 'don't ask don't tell' approach is that if she goes diving, having lied on the fom, and something else (unconnected) happens then her Insurance will be invalid and she, and her familly, could be ruined. She doesn't want to risk that.

Apparently she could legally dive in the UK with BSAC. Maybe I should suggest she goes there. Cold though !

enquire

[Northeastwrecks]

Dear Wingflyer:

I found your posts regarding the use of a FLiP (family limited partnership) and your comments that you are hiding your condition most interesting and somewhat disturbing. It suggests that you can do what you want because you believe that you have rendered yourself judgment proof and that lying is acceptable.

I will not comment upon the various ways to penetrate a FLiP or to obtain payment on a judgment against supposedly judgment proof debtors. It is sufficient to say that I have burned through asset protection devices in the past, including FLiPs. Before you go off on that, I do not chase ambulances. I specialize in complex commercial and intellectual property litigation.

However, who cares? What you are saying is that you have minimized the consequences of an accident upon you and your family.

Suppose for a moment that your buddy is in need of assistance and that you have a seizure. The few moments that it takes you to recover could literally be the difference between life and death for your buddy. He/she will be no less dead because you believe that you are judgment proof.

Your buddies have the right to know your situation and to make their own decisions about diving with you. Similarly, your instructors have a right to know that you have a condition that subjects you to increased risk. You do not have the right to risk someone else's life or professional license (PADI suspends the licenses of instructors involved in a diving accident pending an investigation) or to increase their risk level by withholding relevant information.

Your posts indicate that you have informed at least one of your buddies. Do you inform each new buddy and provide them with the opportunity to make an informed choice? If not, you should not be diving with them.

By the way, I am not singling you out for special treatment. I dive in a two buddy pair group of relatively experienced wreck divers. We know each others strengths and weaknesses have been examined by physicians for conditions that might put us at increased risk during more difficult dives. I know my dive buddy's gear as well as I know my own and am prepared to effectuate a rescue if it becomes necessary. Every member of our team is prepared to do the same because we train together and practice our skills regularly.

When we (collectively or singly) dive with a new person, we discuss our experience, equipment, expectations, procedures, buddy techniques and attitudes before we get on the boat. The point is to determine how to conduct the dive and whether it will go off at all.

I would not exclude you as a buddy based on your condition. However, I would want to know that you might have a seizure and what to do about it. Depending on the dive environment, I might change the dive plan or ask a third diver to accompany us as additional redundancy and to assist (either of us) in an emergency. This is no different than the attitude you would get if it turned out that you have some other medical condition that might have an effect upon my risk, or if you lacked decompression or penetration experience.

I might call my dive. I would not, however, stop you from diving.

[AllenG]

NortheastWrecks - Thanks for a well conceived, balanced, and well articulated response to the various overplayed positions that sometimes accompany discussions of diving with certain medical conditions.

(and greetings from around the corner - one of my offices is over on Deerfield Road in Windsor)

[Northeastwrecks]

Dear AllenG:

Thank you and hello from Griffin Road South, Bloomfield.

I'm hoping to hear from Wingflyer as I think that this is an interesting issue that deserves further exploration.

[padiscubapro]

Originally posted by wingflyer152
I have one question for you guys. What if somebody told you you couldn't dive? There are avenues that you people are failing to see that we epileptics have so that we can scuba dive. As a diagnosed epileptic, I was told that I would never fly my airplane or scuba dive again. However, I safely do both. I fly as a private pilot with a Certified Flight Instructor as a safety pilot in the right seat. I scuba dive with an AGA full face mask with an oral nasal cavity in case I have a seizure underwater, I will not lose the second stage and drown like you guys have said. You didnt even explore the possibility of this. You left it out alltogether. I also have underwater communications with my dive buddy, who is knowledgeable of my condition and what to do.
I am sick and tired of you losers trying to make diving sound more serious than it really is. It is not space flight, where you muset be in the best shape of anyone on earth. You people should really have much more of a sane and open mind about diving and things of this nature. Sure, there are concerns for safety, but most of the time, this can be resolved and the person still be able to scuba dive. After all, what right do you or DAN or PADI or anybody have to say that I can not scuba dive? You can say that until you are blue in the face, but until you are faced with a bad health situation that was not your fault and those in better health are denouncing you just to make themselves feel better or to make them selves sound more "elite" as divers, you will never understand our position. Also, nitrogen narcosis is a mild effect and a very mild risk when diving with a buddy in shallow water, all you must do is surface, or ascend for a time, after all people narc for fun!!! This is a prime example of you, DocVikingo trying to make the sport sound more "elite" as I stated before. Dont worry though, you are not alone, you have a lot of company in this sport. We disabled divers have a voice, and I will soon be hosting a URL to acnowledge the efforts of those who have overcome their disability, whatever it may be. Anyone who disagrees or agrees with me, feel free to email me at wingflyer152@aol.com with your concerns.

I have a few questions?? Do you only dive with a buddy or do you occasionally dive with a group..

If you are only with your buddy and no other divers around you are limiting possible interaction with others in the event of an even which would probably be a good thing.

If you are diving with a group do you let everyone know of your condition, if not you are probably endangering your self and anyone else who may try and assist not knowing your condition.

If I saw a diver seizing the first thing that would immediately come to mind is "otox" and get the diver on a lower FO2 mix (I have seen a seizure underwater fortunately the diver survived).. if you are on a full face mask you are now making me decide if pulling that mask off is a good idea or not.. I would probably decide against it and now I would have to get your ass to shallower water ASAP, if you are convulsing you now Risk an embolism. If I was aware of your situation I would probably just make sure you stay in place and have a gas supply, and try and wait it out or slowly bring you to the surface. You diving with this condition doesn't only involve you it involves everyone around you.. I agree you have the right to take the risks but you don't have the right to endanger others, they should be able to decide if they want you diving with them...
As an instructor I couldn't certify you without a medical waiver to cover my ass but if you lied to me about your condition that is unfair to me and any other students... Most if not all training agencies(and their insurance carriers) require INSTRUCTORS and Divemasters to report all accidents and assist if possible.
Think about the impression you would have if I had some students with me and we were on the same boat and My students saw you convulse.. first off I would probably have to leave my students to take care of a life threating event and second these people who are new to a sport may now be turned off for life... because of your actions.

Unless you are alone your actions and choices effect others.... There are always consequences, that many do not think about.. We don't have the right to stop you (when you are diving alone) but, you don't have the right to force your actions on others either... its a catch 22... either inform everyone in that case they may decide they don't want you around, they may accept you with open arms, but its not only your decision..

[Northeastwrecks]

PADIScubapro got it right. Wingflyer152 does not exist in vacuum.

There is a phrase in the common law that goes "Danger invites rescue". It stands for the proposition that, in general and to our credit, people will try to help when another person is injured. It also means that a victim may be held liable for injuries to rescuers.

I invite correction from our medical members (or from anyone else who knows the answer), but is seems to me that the symptoms described (unawareness, lack of response, blank stare) are similar to passive panic.

If I find a diver presenting these symptoms and don't know otherwise, I'll follow doctrine, control the diver, ascend and initiate first aid at the surface. This may not be the best protocol, but its better than nothing, particularly since Wingflyer152 has not responded to requests that he/she explain proper treatment for an in water seizure.

Dr. Stein asked about criminal liability for failure to disclose. Many states have statutes that make it a criminal offense to act in a manner that recklessly disregards another's safety and that causes injury. I am unaware of any cases involving criminal liability for negligent behavior involving scuba diving; however, I am aware of at least one case in which a person was held criminally liable for failing to disclose known hazards (shallow depth) while cliff diving in a quarry. In other words, criminal liability is not out of the realm of possibility.

IMHO, this diver is a ticking time bomb, not because of epilepsy, but because of his apparent disregard for the effect his actions have upon innocent third parties and his belief that he can do whatever he wants because he is judgment proof.

I once again invite Wingflyer152 to respond and comment.

I'm sorry, but I must add this. THE FOREGOING IS MY OPINION. IT IS NOT LEGAL ADVICE. YOU SHOULD CONSULT WITH AN ATTORNEY OF YOUR OWN CHOOSING.
:upset:

[Laurence Stein DDS]

Northeastwrecks

I'm glad to see an attorney's take on this subject. I haven't checked this thread lately...wingflyer hasn't responded much.

As much as I am sympathetic to wingflyer's wishes, I know that particiation in diving is terribly risky for the diver and any buddies--especially if they are not informed.

The response in which wingflyer proclaimed to be judgement proof also made me somewhat angry. This person is actually acting like a spoiled, selfish brat. To heck with others...I WANT TO DIVE!

The response to the synopsis of the ADA was also strange. I was accused of bias. The synopsis stands for itself...the web address was posted and could have been visited if clarification was needed.

Anyway, glad to have you on board. Stay tuned for more action.

Wait, what's that I hear...an AMBULANCE!...you gotta go!

Regards,

Larry Stein

:rolleyes:

[AllenG]

Laurence - Without commenting on the accuracy of respective statements by you or Wingflyer, please understand that misinterpretations of ADA, be they willful, out of ignorance, or out of misinformation from others, are more readily circulated than the actual provisions or regulations. And again without commenting on the positions offered by Wingflyer, individuals with disabilities who (1) fought hard to secure the protections of ADA and (2) have taken the time to carefully understand what the law provides and what it doesn't, are often angered by the degree to which misrepresentations are so freely offered as "absolutely clear facts."

The nuances of ADA are many-fold, from who is protected (e.g., just being "REGARDED as having an impairment . . . that substantially limits one or more major life activities" makes one eligible for ADA protections) to what entities must comply (e.g., the U.S. Senate and House of Representatives must comply; the federal executive branch is exempt).

In the hope of adding some verifiable information to our discourse, please note the ADA expressly provides that a public accommodation may exclude an individual, if that individual poses a direct threat to the health or safety of others that cannot be mitigated by appropriate modifications in the public accommodation's policies or procedures, or by the provision of auxiliary aids. A public accommodation will be permitted to establish objective safety criteria for the operation of its business; however, any safety standard must be based on objective requirements rather than stereotypes or generalizations about the ability of persons with disabilities to participate in an activity.

While the ADA does have provisions requiring auxiliary aids, it does not require the provision of any auxiliary aid that would result in an undue burden or in a fundamental alteration in the nature of the goods or services provided by a public accommodation. It should, nonetheless, be recognized that the public accommodation is not relieved from the duty to furnish an alternative auxiliary aid, if available, that would not result in a fundamental alteration or undue burden. Both of these limitations are derived from existing regulations and caselaw under section 504 of the Rehabilitation Act. Application of such limitations have been determined on a case-by-case basis.

Moving beyond ADA and Wingflyer's comments re judgment-proofing himself, which only seemed to fan the flames of hostility in others: I would suggest that the only real questions to consider (1) what are the diving-related risks associated with manifestations of petit mal (the diagnosis that Wingflyer is reporting to us); (2) what are the diving-related risks associated with the particular symptoms (including frequency and severity)Wingflyer currently presents with; and (3) what obligations does any diver and then Wingflyer in particular have relative to his buddy and to others on the dive re his condition. Please note that "petit mal" covers any awfully big diagnostic territory, is sometimes erroneously used to "soften the blow" of an epilepsy diagnosis, and is often misapplied. More info than Wingflyer opts to provide in this forum would be needed to make an informed statement.

Re a diver with epilepsy (or any other medical condition) engaging in behaviors that are risky to self and risky to others, if you overheard others on a dive boat planning a non-nitrox dive that you knew posed great risk for decompression problems, would you assert a right to stop them from diving because you may be impacted if or when said divers encounter problems? Consider the newbie attempting a particulary difficult open water dive that you sense is beyond his/her capacity (e.g., nasty currents around rocky entrance/egress point) - again, do you assume the right and responsibility to get the person bounced from the dive? If, as some assert, smokers have higher pulmonary risks during diving, compared to non-smokers, do you have the right to require the smoker to "disclose" or to get the smoker bounced?

Please don't assume my questions signify acceptance of Wingflyer's positions. I would simply ask that we consider the logic and consistency of our personal opinions.

And, in closing, a warning:

1. Unlike NortheastWrecks, I am not a lawyer, so my opinions stated above should not be construed as legal advice; and
2. I am not a physician (and don't even play one on TV), so my opinions stated above should not be construed as medical advice.

[Northeastwrecks]

Originally posted by AllenG

Re a diver with epilepsy (or any other medical condition) engaging in behaviors that are risky to self and risky to others, if you overheard others on a dive boat planning a non-nitrox dive that you knew posed great risk for decompression problems, would you assert a right to stop them from diving because you may be impacted if or when said divers encounter problems? Consider the newbie attempting a particulary difficult open water dive that you sense is beyond his/her capacity (e.g., nasty currents around rocky entrance/egress point) - again, do you assume the right and responsibility to get the person bounced from the dive? If, as some assert, smokers have higher pulmonary risks during diving, compared to non-smokers, do you have the right to require the smoker to "disclose" or to get the smoker bounced?

I do not claim a right to stop anyone from diving.

However, I do have a right to refrain from diving with someone who will increase my risk level beyond what I consider to be acceptable limits.

In addition, I would hate to see anyone get hurt.

Thus, in the first case, I might ask the divers how they planned to handle the deco obligation that they are going to incur if they execute their plan. If they had the situation under control, I would shut up. If they truly had no clue, I might consider mentioning this to the divemaster. However, I would not stop them.


In the second case, I would probably do what other people did for me when I was a newbie, i.e., strike up a conversation with the newbie, offer some guidance if asked and answer questions. If asked, or if it looks like the newbie is looking for an invitation, I might offer to buddy.

In the third example, it is not the smoking that is a problem. Rather, it is the symptoms that the diver presents. Thus, I would evaluate the diver the same way that I evaluate any other potential buddy.

My point about disclosure was not that we need to bring our entire medical chart and disclose personal details. In the case of Wingflyer152, however, the symptoms he might present are outside of normal dive rescue training and could, therefore, lead a rescuer to initiate an inappropriate course of action (bringing him to the surface instead of waiting for the seizure to end). Compare this to a smoker who's habit may place them at an increased risk for an event that dive rescuers are trained to handle.

[Laurence Stein DDS]

AllenG-

I thought you provided a very insightful response especially if you are not an attorney.

I had not considered bias regarding the ADA on the particular website I enclosed. It certainly is possible. This site had a synopsis of a long and long winded law. From my limited experience with it, the points made were accurate. That being said, interpretation of this complex law is case by case.

With regards to your statement about a diagnosis of petit mal diagnosis of Wingflyer, I don't believe that they ever gave that diagnosis. I mentioned that I had an experience with a person who suffered a petit mal seizure in dental school (nearly 30 years ago) and they had failed to note that on their medical history.

It is certainly true that petit mal is a diagnosis which helps avoid the stigma associated with epilepsy--where none should exist. Other seizure disorders may be misdiagnosed and placed into that category.

I think this next part is especially interesting in light of this thread. Last week a patient of mine was in with a problem. Her medical history INDICATED past seizures. She has been free of any problems for more than 10 years and off medications. When she came in, she mentioned her child was recuperating from a near drowning. When I asked more, she asked me if I had seen the news several weeks earlier--about a driver and their child who ended up in a lake off a local expressway. I did remember something about it. It turns out this was her and her child!

Here was a person medically cleared to drive and out of the blue, they had a seizure while driving. Two strangers stopped their cars and jumped into the water, rescuing both people. The child is still suffering from some neurologic damage. The doctors do not know if it will be permanent.

This is a true story. Makes you think about Wingflyer's condition, huh?

Regards,


Larry Stein

[AllenG]

This thread seems to have evolved into a discussion between NortheastWrecks, Dr. Stein, and me. Aside from my polemics of disability advocacy (sorry, it's an occupational hazard), the three of us are probably in complete agreement re the real issue of any diver displaying responsibility re safety, to oneself, to one's buddy, and to any others participating in the dive. Wingflyer's deviation into the issues of ADA or being judgment-proof only served to distract from the key point.

Some quick final thoughts:

Dr. Stein - Re bias in the information you cited: The "JAN" web site you noted is part of a federally funded, university-based program that, if anything, is going to be more sympathetic to the interests and rights of individuals with disabilities. You need give no concern to the possibility that, in clipping information from that website, you perpetuated some bias or misinformation!

Re the petit mal diagnosis, Wingflyer implied that he was diagnosed with P.M., however, you may have noted that in his 4/23/02 posting, what he actually said was "I keep telling you people that I have petit mal seizures not the convulsive kind, just the blacking out kind. I simply black out and sit there." Are we talking about a neurologist's diagnosis, Wingflyer's self-labeling, or, for that matter, an accurate labeling at all? Who knows? There are several other disorders with a cardinal feature of "blacking out." And, unfortunately, in the hypothetical situation of diving with Wingflyer under his "no ask, no tell" policy, the most that one has re information in the event of an emergency is, well, nothing. And that can be a formula for disaster, disability or not.

Re the incident of 10 yrs asymptomatic and then a calamitous recurrence: This is not the norm, but it is nontheless noteworthy. However, if I can use your words with only the slightest change of diagnosis, consider the person who had a heart attack long ago, but "has been free of any problems for more than 10 years and off medications . . . . Here was a person medically cleared to drive and out of the blue, she had an attack while driving." So was it irresponsible to clear an asymptomatic cardiac history person for driving? Would you see it as irresponsible to clear heart attack survivors for diving or to mandate disclosure of the individual's medical hx to others on the dive? I would hope that you would sooner promote an individualized assessment of risk to promote an informed decision.

Yes, epilepsy is a little different from cardiovascular diseases, but can we find a balance? I think NortheastWrecks captured that balance when, in response to the three hypothetical situations I described in my earlier posting, he suggested that he would seek more information from a diver in a presumably non-threatening manner, evaluate, offer verbal guidance, position himself/offer to be of assistance, or, in the face of persistent cluelessness, hedge by letting the divemaster know of the potential risk. But a strategy such as that offered by NortheastWrecks is reasonable only if the putative risk diver is comfortable and willing to disclose important information, an action which will only be fostered by other divers, certifying agencies, and health care professionals resisting the reflexive response of banning someone from diving simply on the basis of a diagnosis that typically was made by an independent party with no knowledge of diving.

Thanks for considering my position. And to NortheastWrecks, for your thoughtful analysis and response, the offer of the lunch at the best greasy pizza joint in the north Hartford area (and to Dr. Stein, equally erudite, I also extend the invite if the lure of artery-clogging consumables is sufficient to drag you up from New Jersey to Hartford! It may be a long way, but it's good pizza).

[Laurence Stein DDS]

To both AllenG and Northeastwrecks,

It has truely been a privilige discussing this matter with you both. You have been thoughtful and supported your arguments extremely well--they changed in some fashion how I viewed the case. I have enjoyed the discussion immensely.

I'm sure this statement will get me in trouble but it is something that I have felt from the beginning of the thread. Gender has nothing to do with the content of this discussion but I have gotten the distinct feeling that Wingflyer is, in fact, female. This is not a "dig". Great care was used by this person to avoid any reference to gender. Some of the verbal mannerisms and arguments were more femine in nature. If you re-read the entire thread, you might get the same feeling too.

I find that women are, in general, a more caring and more willing to discuss personal problems. There have been a few clues along the way that just seems to point to a person who is doing all they can to overcome the stigma of a disability but to also prove that a woman can compete in a man's world. If I am incorrect, so be it. If not, then perhaps there is more than one agenda being presented. One stated and one under the table.

To AllenG. Your reference to cardiovascular disease may be correct. However, the point I was trying to make is that Wingflyery has repeatly indicated that he (she) is cleared to fly and drive. I was only trying to draw a parallel to this fact and that s--t happens. Even the doctors are wrong some of the time. An innocent child was affected by those decisions made under the best of circumstances. Wingflyer's reasoning and methods circumvents all of this and "don't ask, don't tell" is the nail in the coffin as far as I am concerned.

AllenG--don't know if I can take you up on a greasy pizza although it sounds great! But on any given weekend I am diving in the Miami area--boat trips and gas are free. Manged to land a 35 pound (50 inches long) Cobia (Ling) today. It nearly killed me. It completely wrapped me up in speargun line. It's one of the strongest fish in the ocean. They are known for breaking angler's legs on a boat and wrecking ice chests. My buddies untangled me and I managed to boat the fish while my buddy kept a close lookout for sharks.

If you are interested, let ME know. We don't use no stinking wetsuits down here!!! Northeastwrecks--consider yourself invited too. Leave the drysuit behind--you'll be laughed off the boat!

Sincerest Regards,

Larry Stein

[Northeastwrecks]

Dear Dr. Stein:

Thanks for the invitation. The same applies to you. If you ever want to experience the thrill of discovering your own hand in 12 inches of vis, come on up.

Dan

[Laurence Stein DDS]

Northeastwrecks,

Down here, when we experience our own hand 12 inches in front of our face, it's because something ate the arm in between!

Keep watching Shark Week on the Discovery Channel in, I believe, August. My friend, and sometimes dive buddy, Kent, is in it. He was bitten last year in the Bahamas by a bull shark. He used to have a calf on both legs. Now...just a calf-and-a-half...er...is that a heifer?

He's an instructor and needless to say it put a crimp in his schedule. He was fortunate to live. His wife kept her fist in the wound for an hour until they got to the hospital on the other side of Nassau. You don't dial 911 there!

The good news is that he is back to diving! He just hears a lot of do-do, do-do, dododododod when he dives now--something with his ears I think!

The footage used in the upcoming documentary was shot in Walker's Cay.

Regards and bon apetite,

Larry Stein

[John Reinertson]

This is an intersting thread and has uncovered multiple concerns.

look back to wingflyer's posting earlier, and notice the adaptations made to wingflyer's illness.

Wingflyer has taken something that is normally contraindicated, and found a way to make the risks manageable.

The full face mask and communications with buddy have solved two problems..
First, Wingflyer will not be likely to convulse and drown. (Not certain to be safe, but much safer than denial)
Second, with buddy having the same gear, you eliminate the random-buddy-feeling-coerced problem.
Just like a blind man climbing Everest, itelligent assessment of the problems and careful planning make something that would be normally a No-No into a definite "Ok, under these circumstances, and with these precautions, I can see it as reasonable."

For that intelligent and reasoned approach, I applaud Wingflyer.

I really have a hard time with the idea of concealing assets to be judgment-proof, or assuming that that makes it all OK.

The only acceptable thing in my (sometimes less than humble) opinion is to mitigate the risk where you can, and remember that while you have the right to take your own risks, you don't necessarily have the right to put me at risk.

All of us, not just those with handicaps, need to remember our neighbors and fellow divers when we dive, and not increase their risks by our own actions.

Dive safe, blow bubbles, and appreciate the privilege this is to see a world seldom seen by others.

John Reinertson

[Northeastwrecks]

AllenG:

I missed your earlier post regarding pizza. Thanks for the invitation. PM me and let's talk (I'd PM you, but my system says that I've turned that function off and I haven't quite figured out how to fix it).

[AllenG]

NortheastWrecks - Apparently I can't even send you a PM until you set your account up to receive such messages. I will be glad to call or email you, but lest I might otherwise make erroneous conjectures re identity, may I assume that you are Daniel E. ?

[Northeastwrecks]

That's right.

[wingflyer152]

For the record I am am male. You were whining to somebody earlier that I accused you of being bias....darn right I did because you were being bias. It is no big deal Stein, we are all bias at one point or another in our lives. What are you gonna do about it now, cry? ;-0 You argue with the perspective that your feces doesnt stink. I am sure a few of you all that were trying to chew on me have some skeletons in your closet. You all just remember next time you get paired up with a buddy that you do not know.....it could be me.



Love,

[wingflyer152]

"Dive Naked" :)

[Lloyd]

Wingflyer,
I would like to reiterate the fact that your buddy is diving with out a buddy. You can not be relied upon to assist him in an emergency. The stress and rapid breathing in assisting a buddy in trouble could trigger an episode in you especially if you have to descend in order to retrive him. Sorry, but life is never fair.
Lloyd

[Laurence Stein DDS]

Dear Mr. Wingflyer,

Why not just agree to disagree. I'm sure you have read the general consensus that your medical condition poses potential problems to others you may dive with. The other general consensus is that we all empthetic to your position and condition. I would have no problem diving with you or anyone with a disablilty.

Many of us who have followed this thread expressed concern about your nonchalant attitude to this condition vis-a-vis its potential to affect others around. Of particular concern is the way you almost flaunted your "judgement proof" status. It came as a very callous remark. Most people do this to protect themselves from financial risk associated with their activities such as work or hobby--especially if there is a potential large sum of money that needs protection.

In my profession, hiding information such as yours would be unethical and I view your personal world view as suspect.

You bet I'm biased. Nobody on earth isn't.

You don't like others telling you what you can and cannot do...but that is not the way the world works. The reality is that it is the attention to such details that prevents doctors, attorneys, and even SCUBA certifying agencies from allowing you to participate in this sport. What you have to do is show those in charge that you have a foolproof way to work around your problem that doesn't put strangers at risk. Right now only your buddy knows your problem and even that person is at some risk.

Just disagreeing,

Larry Stein

[Northeastwrecks]

Dear Wingflyer152:

Thank you for warning us that you might be diving in our area. I'll keep a sharp watch out for divers from Tennesee with pilot's licenses, full face masks and the type of attitude that gets buddies killed. That way, I can find another boat and, preferably, another ocean.

I ran into someone like you this weekend. I am a DM candidate and tagged along during a diver's AOW class (OW had been obtained from another shop). All of the diver's paperwork appeared to be in order, with no disclosed medical conditions.

The instructor and the diver walked to the entry point. I followed behind. As the three of us prepared to swim out, the diver vomited and fell face first into about five feet of water.

My instructor and I got him to the surface and did the usual first aid/rescue stuff. At this point, we had no bloody clue what was wrong with him. All we knew was that we had a semi-conscious diver on the beach.

At this point his wife came running. She informed us that the diver was diabetic.

The short version is that this ()*#()* idiot's blood sugar was way off. I did the one-hundred yard dash to my medical kit (it was closer than the one in the shop's van) and grabbed my deco bottle (50% O2, which I had intended to use for a boat dive on Sunday). We administered glucose, which brought him around, and put him on my O2. Someone else brought the O2 kit, so we switched over.

We checked the diver's disclosure forms. There was no indication of any medical condition. The diver later admitted that he had failed to disclose his condition because he didn't think that it was relevant. Apparently, he also forged his medical certification. His comment was that his medical conditions were his business and that it was the instructor's job to teach him, not to tell him that he couldn't dive.

If this had happened at depth, we would have had a situation in which someone could have been hurt. Moreover, by failing to disclose, the diver complicated his treatment.

The mere fact that this diver is diabetic would not have stopped us from diving with him, so long as he was cleared by a doctor. Now, however, he is banned from the shop until he obtains the required medical certifications AND gives us permission to contact the examining physician for verification.

You, sir, are doing the same thing and are just as irresponsible as this person.

Why do you continue in your mistaken belief that you have the right to put others at risk without even the courtesy of a warning? Exactly who do you think you are?

Your rage at your condition is no basis for putting anyone else at risk.

I write this after having been interviewed by the police (we called EMS) and having been debriefed by several people at my shop. It was not fun to have everything I did questioned. It was even less fun to miss my Sunday dive because this )(*# moron sucked down too much of my deco bottle and I did not have time to refill it (see above for why).

Before you respond with sarcasm and pointless rhetoric, I would request that you actually answer the questions. In the meantime, have you considered SASY? It goes with your maturity level.

[Laurence Stein DDS]

Northeastwrecks,

Your story really was scary! What nobody knows until it happens to them is how YOU feel during and after that situation. While you know you did your best, you still wonder whether you could have done it better and you wonder what would have happened if the victim died.

You might even wake up thinking about it or think of it years from now on another dive. It can haunt you--"been there, done that".

I don't know how Wingflyer will react. Perhaps, rather than a simple, I see your point, you will get more retoric about his own right to self determination or distruction. Heck, he might even start picking on you instead of me...what a relief.

Glad you had a "good" outcome. Regards,

Larry Stein DDS

[Northeastwrecks]

Dear Dr. Stein:

Thanks for the note. The funny thing is that I didn't get particularly upset until after the event was over. Then I sat down and had a nice case of the shakes while waiting to be questioned. I hung out with my wife and spoke with some OW students who had observed the entire incident. They were freaked out.

Two of the students were Massachusetts State Troopers. They told me that I had "done good".

Fortunately, the diver was fine. However, he refused transport and denied that there was a problem. His wife drove him home.

I'm certain that we could have reacted differently and more efficiently. For example, I should have grabbed the O2 kit instead of a deco bottle. However, I'd already taken time to strip my rig, my car was closer and I was jogging in a dry suit in 80 deg. weather. Saving the extra steps seemed like a good idea at the time. I also could have called for help earlier. Instead, I waited about 1 minute to see if he would come around.

That said, if the diver had told us that he was diabetic, I might have stuffed a tube of that glucose stuff in my dry pocket (the same way that I stuff an EpiPen in my pocket when I hike with a friend who is allergic to bees). I would have been sensitized to the symptoms and could have started appropriate treatment sooner.

Overall, the fact that the diver is alive and kicking (and complaining) leads me to believe that, while we might not have been perfect, we were close enough. After all, this guy walked out under his own power.

My point is simple. Poo-Poo occurs. Plan for it. Don't risk others live's so that you can have fun. Don't assume that nothing bad will happen or that your actions don't effect those around you. It will, they do, and others will need to clean up your mess.

I hope that Wingflyer responds. I am truly curious to hear his reaction.

[AllenG]

NE Wrecks -

Since the rescued party apparently didn't see fit to recognize your efforts, let me offer a tip of the hat to you for your handling of the emergency. Per my earlier offer of greasy pizza, I just e-mailed you a phone number to reach me at work, so give me a call so I can congratulate you in person.

Unfortunate as the incident is, it makes the point all too well re diving with medical conditions. I too would be interested in hearing a reasoned response from Wingflyer (but not his usual rhetoric) re your most recent experience.

The incident does highlight one issue for me: Imagine, for the sake of discussion, that the diver had properly secured medical certification and clearance to dive. Now, take the situation away from an OW instruction setting and move it into a vacation setting where only your buddy knows you and your medical condition: Should the diver be obligated to inform all others present that "hey, I have this medical condition which ordinarily I wouldn't even disclose to some personal friends, but which I am nonetheless now telling everyone because it could impact my health and safety during the dive" or something like that? Those of us who persist in this thread would likely say "yes indeed. No harm will necessarily come of it, and perhaps some good will come of it." Sounds about right so far, no?

So now let's extrapolate: let's say this individual with diabetes was participating in some other activity, not diving, and as he prepared to begin the activity, he "vomited and fell face first" on to the floor. From the Department of Slippery Slopes, if this activity is called, say, "work," is it okay to require that the individual disclose his medical condition to everyone in the workplace ("ah, excuse me, you don't know me, but I'm Marty Munchausen, down in bookkeeping, and I just wanted to let you know that I have diabetes, so if you see me start vomiting and fall, remember that it's just that I'm too flippin irresponsible to take care of my own diabetes." "Oh, well thanks for sharing that precious insight with me. I'll be sure to carry some glucose with me . . . "). This person is with his/her co-workers much longer than the assembly of dive students and the probability of having diabetes-related complications or symptoms in the presence of co-workers is probably much greater. Should the employee be required to make this disclosure? I'm not the lawyer here, but I believe there is a law that speaks to this matter, no?

Obviously, there are different parameters and risks associated with diving compared to employment, but I believe that a skilled barrister will appreciate the potential for unlawful exclusion or restraint of trade from an activity solely on the basis of a diagnosis. Why, a number of years ago when PADI refused to certify me for instructor on the basis of a diagnosis, attorney friends (and I'm sure some wit on the board is going to say that the notion of an "attorney friend" is an oxymoron) were anxious to litigate on my behalf! So, ignoring Wingflyer's willful pursuit of irresponsibility, how do we set reasonable parameters to facilitate productive disclosure? Expect the diver to tell the DM? Well, in most group dive settings, the de facto UW role of the DM is little more than setting the direction because divers invariably demand that they are granted the flexibility to go where they want, therefore the DM doesn't actually monitor the individual divers. It is more likely that another diver (and not necesssarily even the person's buddy) will be the first to encounter the diver in peril.

And because the DM has no way of determining if the diver's medical condition is currently as good as it was when the MD gave medical clearance, his/her natural inclination is going to be "sorry, I don't have enough current, verifiable information to enable an informed decision re whether to allow you to dive and, because I do not wish to assume undue or unnecessary risk, I prefer that you not dive on my boat . . . . " Think it wouldn't happen like this? Take the incident back to employment and consider Ms. Bea Stove-Burton, who has a history of back problems which today does not impact a physical capacity-related BFOQ and who requests no accommodations to perform any essential job duty. A prospective employer turns her down because "there was a risk that she might re-injure herself." Sound like a recent ADA case? So what's best way to promote disclosure?

As always, many questions and, unless we are dealing with flagrant irresponsibility to self or others (aka, your student with diabetes, Wingflyer's don't ask/don't tell strategy), so few answers.

As always, a pleasure beating this issue to death!

[Laurence Stein DDS]

Northeastwrecks,

I know exactly what you mean. I've been DM certified for years. I don't wish to teach or safety dive. It was just something I wanted to do. There wasn't a Masterdiver rating then so since I didn't want to teach, DM was the highest rating for me. While I dive a lot I don't practice rescue skills but some are ingained.

My most memorable incident involved an out of air situation in 80 ft of water. The victim "appropriated" my main reg. Thank goodness I suspected it would happen. We made it up including a safety stop. The victim ended up in ICU with water in his lungs.

It was only after the dive that I got the adrenalin shakes. The more I thought about it the more I would shake. We both could have died!

Congratulations on doing the Right Thing. Wasn't it you who said:

"Danger invites rescue". It stands for the proposition that, in general and to our credit, people will try to help when another person is injured. It also means that a victim may be held liable for injuries to rescuers.

No truer words have been spoken.

BTW would you all call me Larry. That Dr. stuff is only when I'm answering tooth questions.

Regards,

Larry Stein

[DarkAussie]

Hi,

I am very new to this stuff so I don't know whether this will go to the forum or not. I have been diving for 27 years (20 of them as a passionate cave diver). 6 months ago I had an episode on a significant cave dive, 400 mts from the enterance. My initial reaction at the time was O2 tox so I switched gas several times but no relief. The sensation lasted about a minute (it was the most frightening experience of my life) then reoccured 3 more times during my exit. I some how made it to the surface and chose not to dive for the rest of the weekend.

Then started the barrage of doctors (Hyperbaric, ENT, cardiologists and neurologists). Turns out I have Terminal Lobe Epilepsy (TLE), simple partial seizures - seemingly confirmed by lesions of the Hippocampus (MRI scan) and a mildly abnornal EEG. I am being treated with Tegretol and so far so good.

I was searching the Internet for some reference material as all the medical references I have are dated in the 80's and 90's and came across your forum.

Let's just say that diving (and particularly cave diving) has been my life since I was 15 years old. I am Tech instructor, senior cave diving instructor, 1000 cave dives, blah, blah blah. I also have a family and I don't believe in any form of life after death, so I don't expect to see them again after this life.

To say the news of TLE is hard to swallow is an understatement. I keep asking all the questions - why me, I don't drink or smoke and keep myself fit. Although devistating, the choice for me seems simple - hang up the fins and jump reels. I have a greater responsibility to my family and my diving buddies than my own personal gratification. There is not much you can do with the hand you are dealt - and trying to cheat (death) is not an option for me.

So to the guy who lies and goes diving with epilepsy - you are not too smart. Just because you can close your eyes and walk across a busy street doesn't make it safe. You will get hit eventually and your family WILL GET HURT.

BTW, I don't consider myself to be disabled just unlucky.

Dark Aussie

[Laurence Stein DDS]

Dear DarkAussie,

Sorry to hear about your experience. I've recently had one too--initially thought to be DCS type II. Now it looks like its
probably not. But for the first two months I did 4 chamber dives, been check by eye docs, nerve docs,
MRI's, blood tests--the whole nine yards.

If, in fact it were DCS II, my dive days are over. I too have a family. Unfortunately, if you read the entire thread, there was a, very opinionated diver with a huge chip on his shoulder trying to prove that a disability does not have to hold you back from any endevour you wish.

A wonderful philosophy but not realistic in the real world. Consequences get in the way. You could continue to dive but it is your family that may pay the price. I feel for you--I have been diving since 9 years old and really don't have anothe hobby I enjoy as much.

Unfortunately, you probably don't have any choice (as much as our other epileptic diver would differ). And goodness forbid if YOU DON'T DIE. You will be a burden to your family and on the health system paid for by the taxes of others.

As much as I admired his zest for life, his attitude could get me or others killed so he better dive alone or with his soon to be dead buddy.

So, you got equipment you want to sell????--That's the first thing my friends asked me.

Regards and good luck

Larry Stein

[AllenG]

Dr. Stein -

I was saddened to read that you are dealing with medical complications of your own. I would imagine that dealing with all the diagnostic uncertainties has been as frustrating, if not painful, as the symptoms themselves. From your humorous close ("got equipment you want to sell?"), I can hope that things are looking up for you. And having shared this thread with you, I also hope that things don't progress such that you do have to make a decision that, from an intellectual and rational perspective level is both easy and obvious, but from an emotional level is nothing short of painful.

As opportunity and your spirits may allow, let us know how you are doing.

Allen

[Laurence Stein DDS]

Thanks, AllenG,

I have to tell you that everyone I knew was worried about what happened. I got a phone call from Scubadoc. He referred me to a friend of his, Dr. Frank Butler, an ophthalmalogist and ex SEAL--He didn't know me from Adam but provide a "sounding board". and finally, I spoke to the nice folks at DAN. The chamber down here is really quite nice--Had to watch Black Hawk Down three times and I refused to watch Das Boot.

Every single test was negative. No stroke, no aneurysm, no diabetes, no seizure disorder. MRI's were equally negative. The good news is that I do not have MS, Alzheimer's, diabetes, myasthenia gravis, hyperthyroidism, acoustic neuroma. I just got "cockeyes"--double vision which lasted about two weeks. Fortunately, I could converge my eyes and while sometimes difficult, I was able to work. Occasionally at the end of the day, the eyes would give out and I would call it a day early

All deficits are gone completely. My timeline for the "accident" was at nearly 48 hours. But, I did dive and it stuck in the back of my mind that this could be dive related.

My chamber dives started at the 72 hour mark after initial neuro and eye exams. I had to do 2, USN/AF table 6 dives and then followed with two more 2 hour dives over 4 days.

While there was some resolution after the first chamber dive, it quickly dissappeared.

I visited an NeuroOphthalmalogist and he was quick to point out that since I dive nearly every week, winter and summer, I'm never more than 6 days from a dive. This episode occurred at nearly the midpoint.

I'm serious about Nitrox certification. The less N2 I can collect the more helpful it may be.

Am I in denial--don't think so. I've spent some long days thinking about the "accident" and it just doesn't make sense that the cause was a dive. One of the eyedocs still has concerns but the others don't seem to believe there is a connection.

Your concern is truly appreciated. I think I'll be back diving next weekend.

Regards,

Larry Stein

[AllenG]

Sounds like you've been poked and prodded up one side and down the other! Nice to hear that they ruled out the biggies (aneurysm, MS, MG, diabetes, tumors). The worsening as the day progressed has that MS or MG sound and those are 2 nasty diseases!

Although somewhat-spontaneous remission is not necessarily uncommon, your good news may suggest something non-systemic. Did they consider environmental or other types of exposures (e.g., botulism, trichlorethylene)?

Diagnostic considerations aside, I am simply pleased to hear that things have been going better for you and hope that it will stay that way!!

Allen

[Laurence Stein DDS]

AllenG

The quick resolution probably has nothing to do with spontaneous remission.

The best any doctor has come up is with an eschemic episode. It so happens, that I take a migraine medication which might have this side effect. I did have a "CO2" headache following the dive and I took the medication on the following day. As they say, "Third day's the charm!"

My money's on this but there is no way to prove it. Oh well, if it's anything else, I'm screwed! So I'm thinking positive. Check out the photo on my personal info page--got that cobia the day of the dive--damned near killed me--spun me around about 40 times like a top.

The dive was to 130 feet but I was down only half my allowable time--got the fish and went up--I was ready to go home--I got what I came for, no sense in killing anything else.

Even did a safety stop. We spotted a bull shark circling the wreck before ascending. It made for an interesting ascent.

Regards,

Larry Stein

BTW, any of you single? I have a friend, attorney, DM, beautiful, works at the Court of Appeals and she arranges dive trips to really far away places in her spare time. Hey, if you can't attract them with lobster, there is always the gorgeous attorney trick.

[wingflyer152]

I respect your decision to quit diving for the simple fact that you have a familyof procreation (I am a sociology major). It sucks getting the bad bad news, doesnt it? My deepest sympathies are with you and your family. But guess what, I am still alive and kicking, and I have taken every effort to put the odds on my side. Diving is at all times risky. The key to successfull dives is minimizing risk. The factors I am utilizing to minimize risk are the cold hard facts from my doctor that chances are about 60% that I would never have another seizure doubled with my diving with my brother, a knowledgeable dive buddy with years of emergency medical experience, taking my medicine on time every time to prevent seizures, wearing a full face mask with underwater communications, and the simple fact that I spend maybe one quarter of .0000000000000000000000000000001% of my life physically scuba diving even though I do dive often. Now, can you actually say that that is as in your own words "not very smart"? The name of my game is the same as yours and every other diver in the water. MINIMIZING RISK! Though in this case, I seem to have a slightly higher risk than most people. I am not the only one lying about my condition, I can just about assure you that on just about any dive you go on there are probably people there that havent had there equipment inspected within the last 12 months, there are probably people there with heart conditions that they are not telling about, probably people with epilepsy, and people that for some reason or another could not pass a physical examination for one reason or another, the list goes on and on and on. BTW my family is supporting me in my decision to continue diving, and I have told them that if something should happen to me dont blame anyone but me, I knew the risks and I took them. After all, is life really worth living if you have to live in a room with padded walls in a straight jacket 24/7 just because I have a disability? No, I refuse to let my family pamper me. I do all the things I did before I had my first seizure, but what do I do now when I do them??? TRY TO MINIMIZE RISK !!!!! That seems like a VERY SMART thing to do to me because minimizing risk is the primary focus in every thing I do.

[Laurence Stein DDS]

wingflyer152,

We haven't agreed on much regarding your epilepsy but I have to admit I admire your philosophy and zest for life.

Something we CAN agree on...I had to service my gear the other day. Instead of regular service, I've had my gear O2 cleaned and the tanks readied for Nitrox. Unfortunately, Scubapro managed to send the wrong parts so it became necessary for me to borrow gear from my dive buddy. As soon as I put it on things weren't right. Harder to breathe, corrosion on metal parts...so I asked him when he had it serviced and he said two years ago...it's his son's gear and not used much.

Your statement that there are unknown divers out there with undisclosed medical conditions and poorly serviced gear is so true. Trust no one but yourself. Even you "buddy" can be a liability. My buddy is a great diver, strong as an ox, a supurb boatsman and a royal pain in the butt. His achilles heal is that he is a know it all--yet he knows nothing. He can't do a quick repair on his gear on the boat. If an O ring blows on the boat there is an 80% chance it was his tank or DIN valve. I am sure that he could pull me out of a dangerous situation and drag me onto the boat. He can outswim us all but he is clueless or in denial about the technicalities of the equipment he uses. I'm the repair guy on the boat. Another diver on the boat is good with the motors

I chewed his butt out. Disuse is as damaging if not more so than heavy use. At least the parts stay lubricated in used equipment. I had to shame him into getting his gear serviced and it's under lifetime warrantee for parts. What's the big deal. He has spare gear so he won't be without. This guy will get free parts for life if he services his gear once a year--what's the problem!

I'll bet that you, with your extra special requirements for facemasks, communications, etc have it checked twice a year--perhaps more for the electronics. I do because I do up to 100 dives a year. My bag has two sets of gear. All are within 6 months of service at any time.

Your statement about minimizing risk is true. This sport is not 100% safe but you sure don't want to participate if it's 75% safe either.

I went back to the LDS last week and borrowed back my unserviced gear. It was in better shape than my buddies and I knew where everything was. Now it's fixed so I get to rely on properly operating equipment. I'm still waiting on two regs but I have two servicable one ready now.

Good luck to you. If we ever meet, all I ask is that you let me know how to help in the event I am needed.

Regards,

Larry Stein

[wingflyer152]

Yes it is true that I have all of my gear serviced on a basis of at least once a year. In my book that is the only way to be.

[scubaperro]

if you have siezures, isnt wearing a helmet straped to your head safe enough

[DocVikingo]

Hi Scubaperro,

if you have siezures, isnt wearing a helmet straped to your head safe enough

In a word, "No." Seizures can involve confusion, disorientation and loss of consciouness, leaving the diver out of control. This could result in sinking to extreme depths, ascending to the surface too rapidly, being struck by a passing craft and other dangerous situations.

Additionally, the last post in the thread to which you have just responded is dated Aug of '02.

Given that it is now over 4 1/2 years old, you may wish to PM or email the original participants.

Regards,

DocVikingo

[DandyDon]

I noticed this archived thread come up today, and wondered if scubaperro had found it thru a Search, wondered if s/he may have a personal concern here? If so, you might open a new thread in this forum and present it...??

[DocVikingo]

Not sure what's up, Don, but the seriously dated thread issue can be seen with scubaperro's post in the other epilepsy and diving thread a few lines down the page.

Regards,

DocVikingo

[DandyDon]

Not sure what's up, Don, but the seriously dated thread issue can be seen with scubaperro's post in the other epilepsy and diving thread a few lines down the page.

Regards,

DocVikingo
Missed that, thanks. :blush:

I see now that he has posted on maybe 5 threads about his seizures.