Here's a list compiled over the years of commonly asked questions. The list was created by DAN MDs and represent specific, evidence-based recommendations our member should take into consideration.
- Sun exposure or mechanical trauma from the mask and/or regulator may worsen the wound, creating a larger scab and lengthening the healing process.
- If the sore is bleeding, oozing or otherwise open, the risk of infection by pathogens in the water is significant. Cold sores can become complicated by bacterial infections, so it is important to wash them thoroughly with soap and water and keep them as clean and as dry as possible.
- If a mask skirt will be placed over the sore in a way that rubs or irritates it, then diving should be postponed. The same is true of the regulator; if holding it would cause irritation, then diving would not be recommended.
- Dive buddies should review procedures for buddy breathing in an out-of-air situation in light of the fact that cold sores are contagious. If gear is rented, ensure proper decontamination procedures are followed. Although it's unlikely, there is always a chance that resuscitation may be needed. Thus, precautions should be taken to prevent disease transmission. This is normally not an issue because barrier devices are readily available in most first aid kits.
- Treatments such as penciclovir (Denavir) and docosanol (Abreva) can soften the skin and promote healing. Topical numbing agents such as phenol and menthol may be used for comfort. See your doctor and begin using an over-the-counter product at the first sign of a cold sore; beginning antiviral therapy within the first 48 hours can speed recovery. We recommend you to go back to diving once the treatments are over, there are no more signs and symptoms related to the cold sore and there is total recovery of the ideal psycho-physical conditions.
Moreover, the Metotrexate intake could put your student at a further risk for its side effects which includes lung tocixity and myelotoxicity. Hence you need to have your student’s fit to dive necessarily verified by a specialist in diving and hyperbaric medicine.
This where you would find the majority of latex, but this is not an entry-level issue. There are pieces of accessory equipment that are made of latex, but there are many alternatives that are made of other materials. You have a great deal of control with latex exposure with your own equipment. However, when you are diving from a resort, especially a dive boat, incidental encounters with latex are certainly possible. The severity of your allergic reactions needs to be considered as the best indicator of whether diving would be an appropriate pursuit. Please feel free to contact our medical division if you have any further questions. Also your local dive shops are a good resource for discussing specific equipment issues.
No one knows to what extent these bubbles could form in younger divers.
Theoretically, these bubbles may obstruct blood flow in nutrient vessels to the epiphyseal plates, also called growth plates.
This process may cause focal areas of avascular necrosis or angular deformity to the developing weight bearing long bones, particularly the femoral head, distal femur, and proximal tibia. Young divers should stay within the guidelines of the junior divers program.
This will limit their exposure to nitrogen, by restricting depth, time and number of dives as well as allowing for maximum surface intervals to promote nitrogen off gassing.
Although the concern is theoretical, conservative dive practices are recommended for junior divers.
If you get sick while traveling, a local physician is your best resource; he or she will be aware of the common pathogens that cause problems in the area you are visiting.
When traveling, your best defenses against illness are handwashing, careful sourcing of water and food, getting relevant travel immunizations and taking appropriate precautions in areas where mosquitoes and other living organisms can transmit infectious diseases to humans. Talk to your doctor or visit a travel medicine clinic if you will be going to a region in which medical care is lacking.
The doctor can advise you about any medications you should take with you and when to use them.
Some physicians believe diving is an unnecessary risk for their patients who are taking anticoagulants and will advise against diving, but DAN is unaware of any data indicating that sport divers face an increased risk of complications.
Some physicians trained in dive medicine may be willing to endorse recreational diving for these patients provided:
- The underlying disorder or need for anticoagulants does not put the patient at increased risk of an accident, illness or injury while diving
- The patient understands the risks and modifies his or her dive practices to reduce the risk of ear, sinus and lung barotrauma as well as physical injury. This includes avoiding forceful equalization — equalization must come easily for these people
- The patient dives conservatively, planning short, shallow profiles to reduce the risk of decompression illness, which can involve bleeding in the inner ear or spinal cord
- The patient avoids diving in circumstances in which access to appropriate medical care is limited
- DAN medics are available for consultation with you or your doctor; don’t hesitate to give us a call
The underlying problem is constriction of the blood vessels in response to cold, stress or some other phenomenon supplying these areas.
Symptoms are often mild.
Raynaud's phenomenon may occur as an isolated problem, but it is more often associated with autoimmune and connective tissue disorders such as scleroderma, rheumatoid arthritis and lupus. Raynaud's Syndrome poses a threat to a diver who is so severely affected that he/she may lose function or dexterity in the hands and fingers during the dive. If coldness is a trigger that causes symptoms in the individual, immersion in cold water will likely do the same.
These individuals should avoid diving in water cold enough to elicit symptoms in an ungloved hand.
The pain may be sufficiently significant that, for all practical purposes, the diver will not be able to use his/her hands. Less severely affected individuals may be able to function adequately in the water. Calcium channel blockers may be prescribed for individuals with severe symptoms; lightheadedness when going from a sitting or supine position to standing may be a significant side effect.
- Most strokes occur in older people. The stroke itself identifies the person as one who has advanced arterial disease, thus a higher expectation of further stroke or heart attack.
- The extent of disability caused by the stroke (e.g., paralysis, vision loss) may determine fitness to dive.
- Vigorous exercise, lifting heavy weights and using the Valsalva method for ear-clearing when diving all increase arterial pressure in the head and may increase the likelihood of a recurrent hemorrhage.
- While diving in itself entails exposure to elevated partial pressures and elevated hydrostatic pressure, it does not cause stroke.
- There is certainly increased risk in diving for someone who has experienced a stroke. Exceptional circumstances may exist, such as cerebral hemorrhage in a young person in whom the faulty artery has been repaired with little persisting damage.
This type of recovery may permit a return to diving, with small risk. Each instance, however, requires a case-by-case decision, made with the advice of the treating physician, family and diving partners. Consulting a neurologist familiar with diving medicine is also advisable.
- There is a similar concern for significant residual symptoms, as with post brain tumor surgery.
I do not think major problems are to be expected, but believe that limiting the depth and dive times are wise decisions.
In addition, concerning the type of dives that you will be able to perform from now on, you will surely have to avoid strong currents and cold water dives, and should limit yourself to purely recreational diving, which means a maximum depth of 30 m, and No-Deco.
The - actual and common - possibility that inert gas bubbles could form inside the implants, does not appear of considerable importance, since this phenomenon would remain limited to the inside of the implant, and therefore without causing any damage.
This applies both to implants made only of silicone, and to saline implants.
There is no information of statistic or scientific interest regarding soft tissue fillers, or injectable implants, even if theoretically, there could be the risk of a localized production of bubbles at a different rate from surrounding tissues.
However, considering that the filler is injected into the tissue and is free to move in the surrounding areas, it is possible that a gas exchange will take place, but with a non significant risk of damage.
The silicone-saline-filled type showed the greatest volume change.
Bubble formation in implants led to a small volume increase, which is not likely to damage the implants or surrounding tissue. If gas bubbles do form in the implant, they resolve over time.
Once sufficient time has passed after surgery, when the diver has resumed normal activities and there is no danger of infection, she may begin scuba diving.
Breast implants do not pose a problem to diving from the standpoint of gas absorption or changes in size and are not a contraindication for participation in recreational scuba diving. Avoid buoyancy compensators with constrictive chest straps, which can put undue pressure on the seams and contribute to risk of rupture.
Therefore, we have no data on coincident osteoporosis and osteonecrosis in women at risk (or men for that matter).
The pathophysiologic mechanisms leading to osteoporosis and osteonecrosis are different.
Osteoporosis results from decreases in osteoblast activity and relative increase of osteoclast activity, resulting in bone resorption and demineralization.
The infarction of the microcirculation of bone is the triggering mechanism for osteonecrosis. Women are at increased risk for osteoporosis given that their overall lifetime peak bone mass is lower than men and that the loss of estrogen during menopause, greatly accelerates the rate of bone demineralization.
All we can say at this point is that women should dive as conservatively as possible, thereby trying to minimize their risks of osteonecrosis, so as not to impose this bone damaging disease on top of their already increased risk of fracture due to Type I estrogen dependent osteoporosis.
The most prudent is to leave 24 hours before flying or going to high altitude, but the minimum guidelines established by DAN and the Undersea and Hyperbaric Medical Society for flying/altitude (Sheffield and Vann 2004) are:
- A single dive within the no-decompression limits: 12 hours
- Repetitive dives or multiple days of diving: 18 hours
- Decompression dives (planned or unplanned): substantially greater than 18 hours
This means that, with 2-3 dives a day you would be required to wait at least 18 hours.
Since this seems impossible to do, you are strongly advised to either restrict your diving to a single dive daily, to permit yourself an adequate surface interval, or change accommodation.
If they are large then it would be best to go to a doctor to remove them as otherwise they will cause a foreign body granuloma which, although not a problem of health concern, may leave a noticeable ‘bump’ in the skin.
It is quite common for the itching and discomfort to last for a few days, in spite of the cure. If it is too annoying, you could ask your doctor to prescribe a cortisone-based ointment with a higher concentration, and for the itchiness, you might consider (obviously only on prescription) an anesthetic cream for local use (xylocaine or lidocaine based).
Without a good seal and a means to occlude the diver’s nostrils, any attempts to ventilate will be unsuccessful. Even if the mouthpiece can be successfully placed in the diver’s mouth there is a risk of it pushing the relaxed tongue to the back of the throat and blocking the airway.
If the regulator mouthpiece remained or was placed in the diver’s mouth without blocking the airway, the next challenge would be administering air.
Purge buttons do not have any true regulatory capability. They effectively override the second stage’s function of stepping down gas from intermediate pressure to ambient pressure and thereby deliver intermediate-pressure gas directly from the first stage.
Delivering breathing gas to the lungs at too high a pressure may overinflate them, potentially leading to serious injury.
If the diver’s airway is not maintained in an open position, the breathing gas delivered by the purge button could be forced into the stomach, causing gastric distention.
This places the diver at risk for regurgitation, which can further compromise the airway and lead to aspiration.
Delivering rescue breaths using a pocket mask or similar method provides tactile feedback via changes in pressure required to ventilate the lungs; supplying rescue breaths with the purge valve eliminates this important feedback. Using a regulator’s purge valve also precludes the option of supplementing the gas with 100 percent oxygen.
Rescue methods that are currently taught by dive-training agencies are the result of years of practical experience.
Purge valves were never designed to function as rescue equipment. When ventilating an injured diver, rely on established methods
- significantly decrease inert gas bubbles detected by a Doppler scan after a dive
- reduce tension of inert gas in ‘fast’ tissues, which is an important fact to correlate with gas exchange happening in the spinal chord.
Authors of scientific publications regarding this topic concluded that a deep stop can decrease the likelihood of suffering from decompression sickness.
Theoretically, your partner may be more susceptible to decompression illness, and therefore, we advise you to reduce any risks by taking appropriate precautionary measures with regard to dive profiles.
The following are the characteristics of dive profiles with the lowest production of bubbles:
- do not plan dives with compulsory decompression stops
- avoid, as much as possible, repetitive dives, or if you wish to dive repetitively, make sure your surface intervals are long enough (not less than 3 hours, and best if longer)
- limit your bottom time to no more than 70% of the No-Deco time indicated by your computer upon reaching maximum depth, or as suggested by your dive tables
- perform your dive by reaching maximum depth right at the start and then “ascending”, and avoid staying at shallow depths and then going deeper again
- if your dive computer allows advanced settings, set the GF Low to less than 30 and the GF High to 70
- if possible, use enriched air mixes and set your computer or use dive tables as if you were diving on air
It is the opinion of diving medicine professionals that due to this potential life threat, individuals with these implanted devices are disqualified from diving.
These devices are intended to prevent sudden cardiac arrest, but the heart itself may be in generally poor health which is not compatible with safe diving. As relaxing as diving is there is still an increased work-load placed on the heart.
The heart needs to be able to respond effectively to any increased exercise demand, especially in an emergency situation.
A heart that is prone to life-threatening rhythms has most likely sustained injury from coronary artery disease or other conditions that affect the muscle tissue of the heart, or its electrical pathways. Any exercise restrictions from the diver’s cardiologist would be a good indicator that diving would hardly be in their best interest.
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