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Trauma, Surgery and Orthopaedic Probs Which Dive Medical?

Trauma, Surgery and Orthopaedic Probs - Spine

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I was given your contact details by Cate Jago from London Scuba who said that you may be able to provide me with some advice.

I'm hoping to undertake my PADI course and when I printed out the medical form I had to answer "yes" to recurring back problems. I therefore made an appointment to see my Doctor. When I saw him I explained what the form was for, although he didn't really ask me any questions, he signed it. When I saw the receptionist after the appointment to check whether I needed to pay for him to sign my form, she went to check. When she returned she apologised to say that the Doctor didn't realise what he was signing, had scribbled out his signature and that the surgery doesn't do medical examinations for dangerous sports.

Would you be able to advise me on what I should do? Should I be expecting a medical examination before a Doctor signs the form? As my surgery won't be able to help me, where do I go to get my form signed and what should I be saying when I make the appointment to check that they will do this?

I would be grateful for any advice that you can give me.

A - Strewth. The NHS never ceases to amaze me at times. Talk about back tracking. What to do next...it depends very much on the nature of your back trouble. If it's an occasional twinge when you lift the shopping into the car, then you will be fine. But if its spasming with a slipped disc every time you sneeze or cough then there could be issues with diving. Remember, its not really a dangerous sport, scorpion swallowing is, but diving with good training is fairly safe, but you have to be fit. Your back needs to be able to carry the full air tank in, and help an ailing buddy out of the water. If you can do this you will be fine. It has always been my ideal that you should see a dive doc for a dive examination. GP's are allowed to do it but they will charge you and often more than a dive doc does. So pay less and see someone who knows.

Q - I'm currently undergoing treatment for a compressed disc at C6, in the mid-neck, which is causing pain in my hands. After having Physio and traction it is no better and I have been referred to a surgeon who discussed surgery with me, but am currently waiting for further MRI scan results. If I opt for surgery then I may have the choice of fusing the bone or inserting a new disc. As surgery seems almost inevitable I was wondering which of these would cause the least problems while diving? Also how long would it before I would be fit to dive again?

A - Disc, bone. Bone, disc. Hmmm.

I go for bone here. The issue with the disc is that by slipping, it causes the nerves to compress, hence the pain and tingling. A new disc could do this again, I guess. A bone fusion, strengthens the whole area. Nodding might be odd, but all the symptoms should stop. That's my call. But it does also depend on the surgeon's ability and experience. Ask them what they are better at doing. You are allowed to do that, and if they say they've never fused a C6, run a mile and find someone who has.

Q - I have decided to take the plunge and begin to learn diving, I have been once and loved it and decided to begin PADI courses. I had spinal surgery in December 2001. I had scoliosis and have made a 100% recovery and up to full fitness. I have no problems or side effects and I was out of hospital within 6 days!

I am only 17 years old so I have age on my side, like I said I have no problems with it.

I was hoping you could tell me if I would be fine to dive?

A - I think you should be fine. A scoliosis is a curvature of the spine in a left/right direction, or lateral to be a tad medical. This is infact quite common but needs correction or you will get a lot of knock on effects later in life. The good news is that the actual nervous tissue of the spinal cord is not affected, just the bones of the vertebrae. So this can be seen dive medically like any other bony op like a leg or an arm. That is its OK to go once you are better. The only issue is, are you now strong enough to lift a tank onto your back and your buddy out of the water. If its a yes then go for it.

Q - I wonder if you can help me, I have just been told I might have ankylosing spondylitis. I hardly have any problems with it but as I am a diver that is just going on an Advanced Open water diving course should I carry on diving. I am fit and go to the gym regularly (I am very mobile).

A - Yes you should carry on diving and this is no problem to you doing an Advanced OWC. Ankylosing Spondylitis is an arthritic condition characterised by young onset and lower back pain due to inflammation of the joint within the pelvis called the sacroiliac joint. The only problem that may occur at this early stage is difficulty in gearing up in cramped conditions due to any pain and restriction of movement. Later this disease can cause rigidity of the spine so you would find it hard to bend down with your legs straight so if this happened you should make preparations with your kit like getting a BCD integrated weight belt so you don't have to bend over to get the buckle tight and also make sure that any dive boat has an easy means of reboarding after a dive so you don't have to flop into it like a seal.

Q - Hello, just a question on diving medicals. I am currently a PADI scuba diving instructor and will be in need of my first HSE medical, having never had one before. There was just one thing that concerned me before making an appointment with you.

I have a slight curve of the spine- a scoliosis I am told.

I have been diving for many years and am fit and healthy. It has never interfered with any part of my life, and only recently I found out about it. Does this play a part in the medical?

Thanks for your time.

A - A scoliosis is a curvature of the spine in a lateral direction. So if a doctor looks at your spinal vertebrae they will see it bend either to the left or right from the normal direction. You say that it doesn't affect anything you do in day to day life, but when we do an HSE Medical on you we will check for a couple of things. Firstly does it affect your ability to bend over and lift. As an Instructor you may have to deal with an emergency and have to lift someone out of the water. If the scoliosis still means you have full power that will be OK.

Secondly, are there any neurological signs as a consequence of malpositioned vertebrae. We will make sure they are noted at this stage, so that if you ever have a suspected bend, then any loss of sensation or power would be known in advance and not mistaken for DCS.

I have never known a mild scoliotic patient fail an HSE for that reason alone, so I think you should be fine.

Q - I am a PADI Open Water diver I qualified three years ago. I 'm 44 years old and I am thinking of going for the Advance Certificate now that I've been diving a while and have a little more experience (30Dives). I had a central herniated disc S1/L5 and 18 months ago I underwent a Circumferential fusion S1/L5. I had a SPECT Scan in December 99 which indicating that the fusion had successful taken.

With this condition, do you think I can continue to dive?

A - The only real problem you face having had a fusion of these 2 vertebrae in your lower back is to do with tanks and weights. Because your scan shows the 2 bones have successfully joined you shouldn't get any problems with your disc herniating out anymore.

This would have caused problems with diving if left untreated, but that is obviously OK now.

However after any op in that area you may get the odd niggling pain and weakness there. So you need to be sure you can carry your tanks well enough, especially on long walks to a shore entry. I think it would also be wise to carry any weights in your BCD pockets as a traditional weight belt would hang down right over where you had the fusion and may exacerbate any remaining problems.

On a different note, I am glad you are thinking of doing your Advanced Cert.

As a diver myself, it wasn't until I did that course that I really felt comfortable and relaxed underwater which then confers as safer diving.

Q - I wonder if you can help by giving me some advice. I am 24 yrs old. On May 24th I had an accident while jet skiing and I fractured my spine at T12. I had surgery a week later to put a very small fixture in place around T12 and fixing it into T11. I was wearing a support brace for 4 weeks and have since been cleared by my doctor. I no longer need to wear the brace and am having very little pain or discomfort at all now. I have full mobility.
Do you think I would be ok to go diving in August. Actually the end of August. I guess I may have some trouble to walk with the equipment on or maybe to carry the equipment and for this I may need to go into the water and then wear the equipment. But do you foresee any problems related to DCI?

Thank you very much for your help. I appreciate any advice you can offer.

A - It should be fine to dive then if your spinal surgeon has said things are OK.

There would have been an issue if you had damaged your spinal cord, but from the above it seems that the problem was just with the bones of the lower thoracic vertebrae.

It is important that you do have enough strength to assist your buddy if there was a problem, and the same with kit carrying. Make sure you haven't got long walked shore entries. Perhaps diving off a boat where all your kit is put in by the staff before hand is the answer.

As for DCS, there is contradictory evidence when it comes to previous injury attracting a bend to the area in question. In my experience it is not the case as we have treated enough divers with pre-dive traumas, and the hit never seems to be in that place.

So dive on, but you will need a med cert as you have to tick YES to the back surgery question.

Q - I am a 35 year old male Divemaster. My problem is that I have got a problem with my lower back. My Consultant refers to this as worn or degenerative discs. I have been into hospital for facet joint injections into 3 discs, which haven't worked. I don't dive when my symptoms are bad and know my limits. I don't tend to do a lot of deco diving and dive about twice a month. The worry I have got is, will my injury increase the possibility of DCI in my spine or are the discs inert? The pain I suffer is more to do with my sciatic nerve down my right leg rather than in my back itself. Your opinion would be greatly received and thanks for your brilliant column each month.

A - And thanks for your obvious good taste!

The evidence about whether this sort of trauma will increase the chance of a bend there is moot.

In my experience I have seen plenty of divers with disc problems with bends in their elbows or shoulders, and not the previously affected area. Likewise medical data does not support the fact that this will predispose you to a hit if you dive.

So I think that you need not worry on that count. However we all know the strains put on the lower back when we dive.

Humping your kit, weight belts pulling on that part of you, trying to heave yourself onto a RIB. The bottom line is that if you feel your back can support these sort of actions and be strong enough to help a buddy in distress then you will be fine.

It would be worth noting any neurological problems that spin from your sciatic problem. Weakness, numbness and tingling are symptoms of disc pressure on nerve roots. And bends too. You don't want to waste a day in a chamber so get yourself a neuro map done by a dive doc. It'll save a misdiagnosis later.

(other dive medical questions)



   


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