Asthmatic looking to scuba dive - had a dive physical today...

[purbeast]

Well thanks for the replies guys.

2 Big 2 Fail, you are kind of correct in that I have already made up my mind and will probably do it. I am more just asking on here if people have experiences with people whom may have gone through something I did or has asthma with similar conditions such as mine. Trust me, as an asthmatic, I know that no 2 people have it the same.

Well on a good note just now, the doctor I saw yesterday for the physical JUST called me a second ago. He told me that he had called one of the doctors he knows pretty well from the DAN network and spoke to him about my condition. He actually told me that when I get back if I dive and really enjoy it, that he would like me to possibly talk to my doctor about increasing my current doseage of advair (currently in the middle tier of 3 tiers), just to clear out my smaller lung functionality a little bit, and that if he saw some improvement in my PFT results, that he would clear me medically.

And another thing he asked me is if I had gotten over a cold a few days before the PFT I took. Well on December 23rd, I came down with a pretty nasty head cold/flu like symptoms. That literally lasted about a week, and I could still feel it a tad around new years. I took the PFT on January 4th. So I told him this as well and he really thinks that I will be okay and that he was just being extremely precautious with his decision.

So with my current health and after talking to him again today, I feel pretty confident that I will not have any additional risks due to my asthma

 

[2 Big 2 Fail]

You may get a lot from the last few posts (page 3) of the asthma thread over in Disabilities.
http://www.scubaboard.com/forums/divers-disabilities/345002-diving-asthma-3.html

 

[mrjoshw]

Great to hear man! I hope you enjoy it. Let us know how the trip goes.

 

[DevonDiver]

He told me that on the waiver, if I really want to do it, to just say I don't have asthma.

That's an incredibly irresponsible and unprofessional thing for him to advise.

He's not willing to risk a legal liability in signing you off to dive? - but is willing to place a dive operator into a position of huge liability by advising you to lie on your medical declaration form. (yes...it is a legal declaration).

Hmmm....

Be aware that there are legality issues involved in the waiver. If you had a problem due to an undeclared medical condition, it might involve the dive instructor/operator taking considerable personal risk and expenses to rescue and evacuate you. They'd be able to sue over that.

Secondly, be aware that deliberately mis-leading a dive operator on the medical declaration form would undoubtably invalidate any insurance you had. Chamber treatment can costs hundreds of thousands of dollars. You'd need that chamber treatment for a lung over-expansion injury.

Lastly, the doctor over-simplified the issue and significance of the 'burst lung'. Trapped air in the lungs can lead to 1 or more, different lung over-expansion injuries. These are often fatal and you wouldn't need a fast ascent to get these, if your lungs trapped a pocket of air.

Lung over-expansion injuries account for many diving fatalities every year. Unlike a 'burst lung' suffered on dry land, a scuba diver is at much greater risk, because any air that enters their body will continue to expand as they ascend (Boyle's Law). These lung over-expansion injuries are:

AIR GAS EMBOLISM (AGE) This is the most serious type of lung over-pressurization injury. This result occurs when the air enters the blood stream from a rupture of the alveoli into the pulmonary capillaries, causing an air embolism or arterial gas embolism. Think of this as a blood embolism, but replace it with air. It acts the same way.
An embolism is any foreign object that enters the bloodstream that blocks its flow. An air embolism is the same but now it is an air bubble that blocks the flow of blood. So as you ascend the once small bubbles become larger and larger due to the expanding nature of the ascent. This is a bubble on the arterial side of the circulation.


Air enters the bloodstream in the lungs flows through the pulmonary vein into the heart, to the left side of the heart into the aorta and then the arterial system. This air bubble can lodge almost anywhere in the circulatory system - can cause severe damage by blocking blood flow to the tissue. The first main branch off the aorta is the carotids. The carotids supply the majority of blood to the brain. If bubbles travel into the carotids, which is likely, they will go to the brain and cause cerebral air embolism. The bubbles deny the brain of oxygenated blood, which causes a stroke. The symptoms include dizziness, confusion, shock, personality changes, unconsciousness, and death. The effects of cerebral air embolism and other lung injuries tend to be rapid and dramatic. DCS tends to be delayed. If the bubbles were to miss the carotids, and block the coronary arteries, the result would be a heart attack.


MEDIASTINAL EMPHYSEMA
Mediastinal means center of the chest. This is sometimes called pneumomediastinum, is far less serious that air gas embolism and pneumothorax This condition, air accumulating in the mediastinum presses on the heart and major blood vessels interfering with circulation. A victim may feel faint and short of breath due to impaired circulation.



SUBCUTANEOUS EMPHYSEMA
This occurs frequently with mediastinal emphysema as air seek its way from the mediastinum, and following the path of least resistance, into the soft tissues at the base of the neck. Air accumulates under the skin in this area. This causes the victim to feel a fullness in the neck and to experience a voice change. The skin may crackle if touched.



PNEUMOTHORAX
If the over pressurized lung tears at it surface, the expanding air leaks between the lungs and the pleural lining (chest wall), causing the lung to collapse, either partially or entirely. This collapsed lung is called a pneumothorax. This is not nearly as life threatening as an AGE because the victim, in most cases, still has a working lung to breathe from. This collapse lung causes severe chest pain, and may cause the victim to cough up blood. There is another form of this condition called spontaneous pneumothorax. This occurs with out the expansion of the lungs but through a weakness in the lung itself. This causes a sudden tearing and collapse of the lung. This condition is uncommon, but can be more serious than the standard pneumothorax. especially if it happens underwater. This type can be aggravated on ascent, when the air pressing on the collapsed lung expands, increasing the pressure of the injured lung.Since spontaneous pneumothorax tends to recur, it inhibits further diving till surgery is performed to correct the problem. Since out a physician who specializes in pulmonary dive medicine.

My advice - go and see a specialist diving doctor for a second (6th?) opinion.

If a doctor isn't willing to risk the liability of signing you off as fit to dive, then how can they advise you that the risks are minimal?? It's worth risking your life, but not their reputation?? Can't you see that is fishy?

 

[k ellis]

I know of people who had asthma when they were children and they have outgrown it. One person I know had Asthma attacks every time you looked at him but has not had an Asthma attack in 25 years or better.

Asthma is a serious problem but not one that cant be overcome. I do strongly agree though to make sure you get a doctors clearance.

Your doctor probably did not want to clear you though because as he stated it could come back on him if in the rare event something did happen they would say he was the one who gave the ok.

As to telling no on the medical questionaire its been a topic of sometimes extremely heated debate on here with some people flat out getting P***** at the thought of someone doing it. Others say nothing is wrong with it. The only advise I can really give you is to decide this on your own but think it over long and hard as Scuba is extremely safe in most cases but unlike football and other sports a simple uh oh can turn dangerous if you panick and over act such as shooting to the surface or other type incidents.

None the less we are all glad you are eager to join the sport we all love so much and wish you the best on what ever you decide!

 

[DevonDiver]

As to telling no on the survey its been a topic of sometimes extremely heated debate....

What is to debate? Are there other interpretations of this declaration?

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition.

Or is the debate about whether honesty and ethics should be allowed to get in the way of what someone wants to do?

If I discovered that a student had lied on the declaration form, they would be immediately removed from the course, until they got medical clearance. If they didn't get medical clearance, then they would not get a refund.

I detest liars.

 

[k ellis]

What is to debate? Are there other interpretations of this declaration?



Or is the debate about whether honesty and ethics should be allowed to get in the way of what someone wants to do?

If I discovered that a student had lied on the declaration form, they would be immediately removed from the course, until they got medical clearance. If they didn't get medical clearance, then they would not get a refund.

I detest liars.

Devon sorry I had a typo. I meant medical questionaire. I could not agree more but for obvious reasons I dont support or denounce any decisions one makes. I do encourage everyone though to do whats right and be honest.

I detest liars too. I can see why many people do lie on these things and I am not supporting any of them or otherwise but here are a few reasons.....

Some people lie on them when they forget to bring medical release from home and are on vacation. They know and have already spoken to their doctors and have been cleared. However being told to see a doctor on the island and wait out several days of valuable vacation time leads many people to lie on them.

On the class room session its not likely they have already spoken to a doc if its open water but they feel that their condition is not serious enough to denounce them from diving. Is this right or wrong? If its wrong the answer would be quiet obvious. If its right then its up to the person and the dive center to work out and not for me to answer.

Some people lie on them because they are ashamed of their medical history too. They perhaps have a condition they dont want people to know about. Again its not up to me to say right or wrong on this one.

Dive Centers only have the rights you mentioned above to a person who lies on the questionaire. And as I have debated with people on this in the past it does put the dive center in an unfair position to not be honest because you have placed a person in a moraly sensative position even if hes 100 percent in the right. To put a person in the position of watching a person have a serious medical condition turn bad underwater and in essence watch him die is not fair to the instructor or facility.

Anyway I apologize that I placed Survey in place of Questionaire. It was a brain fart and as for the rest of my rant I hope it makes sence.

 

[DevonDiver]

On the class room session its not likely they have already spoken to a doc if its open water but they feel that their condition is not serious enough to denounce them from diving. Is this right or wrong? If its wrong the answer would be quiet obvious. If its right then its up to the person and the dive center to work out and not for me to answer.

That's all about dive operation logistics. Every dive centre I've worked at had formed a close working relationship with a knowledgeble local doctor. The doctors were educated about the risks involved in diving. Typically, it takes the student 30-60 minutes to pop over to the Doc and get their consultation.

It's also about getting the paperwork done properly. I don't sign up a student onto a course, or recieve money, until they've completed the medical declaration and been pronounced fit to dive. Every centre I've worked at does the medical declaration at the 'point of sale', not in the classroom.

I also make sure that I am very clear to the potential student about the need for honesty on the medical declaration. This is what I was taught on my IDC, and what I adhere to now. I've seen too many instructors 'fudge' the declaration, because they wanted the 'sale'.... that is contrary to agency standards and opens a huge risk of litigation if something went wrong.

"The instructor told me it wasn't important".
"The instructor told me I would probably be OK, so I could tick 'no'"

Fast-lane to legal issues...

 

[k ellis]

This is true. I have seen all of the declarations done at point of sale myself. And you are correct about the legalities. For the very reason you mentioned I never give advice on such sensitive issues myself one way or the other. If I say go ahead and mark no it will be ok then it comes back to bite me. If I say answer honestly and for what ever reason some dive op has a poorly worded medical questionaire (Just saying the what if here) and it so happens to be something that goes awray and they say he said it was ok then its my butt again.

In the modern day I can say one thing I have learned from being in law enforcement is never answer advice but instead tell the person to seek the advice directly from an authority in the field of which they are asking.....

 

[DevonDiver]

In the modern day I can say one thing I have learned from being in law enforcement is never answer advice but instead tell the person to seek the advice directly from an authority in the field of which they are asking.....

Yep...and when that authority refuses to put their name on paper to clear you as safe.... then you need to understand that it is because they aren't willing to take a personal (legal) risk based upon the chances of you getting hurt... That says a lot!