Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
Q - Hi, I'm a 32 year old male in need of a spot of advice on my suitability to take up diving. About 15 years ago, I had disks removed from both my breasts. No serious complications other than a slight haematoma. Can you foresee any issues regarding taking up diving?
A - As opposed to Madonna (who should have her breasts removed from her discs, or CDs, in fact both), it’s funny for us blokes, we do have a bit of regular breast tissue there. Come the hormonal swings of adolescence, it can get a bit bigger giving a teen-moob sort of look. Terrible if you have it – no toplessness on the beach and your mates all sniggering at the school pool. So they can be removed and the sufferers can then point and laugh fifty years later at other men’s full-on beer and dope fuelled 36 DDs. Oh yes, it’s a medical fact that marijuana gives men gynaecomastia. Hence the bra sales in Kingston and Peter Tosh concerts. So the disks are gone and you can go topless with impunity when the sun is out at your local. Good news, this is a minor op, not involving cutting deeper than under the skin (i.e. missing the lungs) and heals easily. In fact, you don’t even need to see a doctor for a diving medical after this, simply email via London Diving Chamber and we will post out the fit to dive cert.
Q - Hi, I wonder if you can help. I had an emergency appendectomy on 4th January. Due to the infection, they had to remove it via a central vertical laparotomy incision. I didn't have any post op complications or infections and the wound has healed nicely. I have now returned to the gym and I'm also swimming again. I feel absolutely fine and have no restrictions. I was thinking of having a week's diving in Egypt before returning to work - this would mean exactly two months following surgery.
Is this a reasonable time post op to return to diving or am I being too optimistic?
A - Hang on here… just working the timings again. You’ve had your guts ripped out. Big incision etc. two months off work for that and before you go back you want a weeks diving. I hate to sound like Scroogissimo here, but… shouldn’t you just go back to work if you are up to it? They’ve been without you for two months and you are darn lucky not to get P45’ed in this recessionary time for so much absence. But hey… you might be in a McJob and not really needed, in which case you are fine to dive. If you are swimming and gymming then you can be finning too. [Amazing ‘terminal word alliteration’ Doc. Ed... Thanks dude. Doc]
Q - Hello, I had an emergency operation on 11/11/09 for a testicular torsion. Both testicles are now stitched in place and the wound is still weeping a little and a little painful. However, what I would like to know is when can I go diving again? Or, how long I should leave it before trying to dive again?
A - When they’re not weeping. When the dry suit squeeze doesn’t make you blow out your reg. When the rented wetsuit two sizes too small doesn’t do the above. When your testicles and you are in cerebral harmony. When you can indulge in the sin of Onanism without calling 999 afterwards. …6 weeks.
Q - My partner snapped his Achilles Tendon four weeks ago and had surgery to fix it. He has had his foot in a hard cast ever since and went back yesterday to get it repositioned. The doctor says that he has to wear the cast for another six weeks. We are booked to go on a four day liveaboard in six weeks. Will he be able to dive or is it a bad idea?
A - I’ve gotta say a big old ‘YES’ here. So you can dance you’re jig of joy around the room and laugh at your partner ‘cos he can’t do that at the moment. Unless he wants to look stupid. The cast is coming off in six weeks. You are diving in six weeks. Awesome timing. When the cast is off – all should be fine. The only issue will be a little bit of weakness in the ankle and calf muscles. What’s good for weak stuff there? Finning and flippering, that’s what. So diving is not only a ‘yes’, but mandatory citizen. The only cock up I can see on the horizon is as follows: His appointment for the cast removal is cancelled; all the doctors have Pig Flu; the hospital burns down; so he gets bumped and ends up flying with the cast on. DVT leads to PE (pulmonary embolism), leads to a body bag on arrival. But don’t call me pessimistic.
Q - I recently had an abscess on my back which required lancing. This was then followed by a course of packing with a wick and daily dressings from the nurse at my surgery. It is healing well and getting smaller but it is still likely to be an open 'hole' (albeit quite small) when I go for a two week diving holiday next week. I plan to keep a dressing on it but would like to know what effect salt water and pressure is likely to have on it. I am open water qualified so will be diving to 18 metres.
A - The pressure of diving is unlikely to cause any problem, but an open wound like this has the potential to become infected in tropical waters (although the water is salty, it contains a lot of marine bugs). So keep it covered if you can, and you'll have to keep a close eye on it for signs of infection developing. Clean it with fresh water and an iodine-based antiseptic, and if it gets painful, red, or starts weeping, then you'll need to start antibiotic medication sooner rather than later - best to take something with you if you can.
Q - I have a suspect mole on my upper central chest which I have arranged to have removed. They will also be performing a biopsy (spudgun stylee) on my arm on another suspect area of skin. This was scheduled for next week, with the stitches out 10 days later. So I booked a diving holiday in Egypt with some friends, going out a week after the stitch removal, thinking this was perfect timing to get good recuperation etc. Unfortunately the hospital called me yesterday and said they had to cancel. Long story short, I managed to get them to reschedule for the week after next, so this is slightly less time for healing than I would like. I spoke with my local Dive Shop manager and he expressed some doubts around whether it is safe for me to dive in this impending condition (worries around the wound bursting open at depth).
So that is the background…. I have a few questions which I will lay out below and hopefully you can help me to understand more about this. I particularly need to know if the risks are actual DANGERS or just risk of personal pain! I can't stress enough how much I have been looking forward to this holiday (it will be my first week off this year!), but I don't know for sure that my stitches would be out before flying to Egypt.
Is it dangerous to dive with a stitched wound (even if near the stitch removal date)?
If I have just had stitches removed is it safe to dive?
Is there anything I can do to promote faster healing?
If diving is not out of the question, are there any particular dressings/ointments/patches (or other steps) that I can use while diving?
Would risks (and pain) be reduced/mitigated if I stick to shallower dives?
I hope that at least some diving will not be out of the question and if it is only a matter of personal pain then that is something I can decide on while I'm there. I am very grateful for any advice or help you can offer!
A - By another staggering (and this time quite unbelievable) coincidence, I actually found my old spud gun at home recently, complete with a shrivelled nubbin of potato hanging forlornly from its muzzle. Cue flashbacks to the playground and making Sanchia Osborne cry with it after she pulled my hair… these days the joys of firing starchy projectiles at people would no doubt be roundly condemned for encouraging a life of crime. I suppose the potatoes are happier though.
Er, anyway, normally mole removal is safe, uncomplicated surgery so you won't have many stitches. Healing rates depend on the site and the individual, but central or upper chest wounds are reasonably quick (ballpark figure 7-10 days). So with any luck the stitches will be out before you go. Once they're out then the wound edges should be bound together tight enough to hold.
If the stitches are still in, then there are potential risks with infection in tropical water, which can cause the wound to dehisce (burst open). Some divers put Tegaderm or other adhesive dressings over the wound but they can't be guaranteed waterproof. If diving is “unavoidable” then all you can do is rinse the wound with fresh water and clean it with iodine or a similar antiseptic after the dive.
Speeding up healing - the holy grail of many forms of medicine! Unfortunately this particular prize is still being sought. A healthy diet is about all the scientific community has come up with so far. Any strain on the wound is more likely to cause it to burst though, so keep the dives shallow and non-strenuous if possible; no chest expanding exercises or pulling on the stuck anchor.
Hope that answers your queries.
Q - I would like to go diving in the coming August as part of my summer holiday. Unfortunately I was diagnosed with a low grade glioma (brain tumour) last year having had a seizure whilst asleep. I have since had the tumour removed and have not had any more seizures. I have checked with my consultant to see if I can dive and he doesn't see any reason why not?
I sent a mail to the diving club at the resort I will be staying in and they said I need to get confirmation from a diving doctor. So I'm asking whether you would be happy to give me the all-clear to dive? Will I need a physical assessment?
A - Firstly a random tangent on glue-sniffing (all will become clear). The pronouncements of the oracle at Delphi, which had profound influence on much of ancient Greek life, were not so much prophetic visions as the ramblings of minds made euphoric by glue. This bombshell was suggested by geologists recently when they discovered that the original site of the Delphic temple sits above 2 fault lines, through which high levels of methane, ethane and ethylene suffused. Whether this led to the coining of “glia” as the Greek word for “glue” I don’t know. Glia these days refers to support cells in the brain and spinal cord, the “glue of the nervous system”, which provide nutrition and insulation for nerves, and remove dead ones after a big night out. A glioma is a tumour of these cells, which can be very slow-growing, or quite aggressive. Symptoms of a glioma depend on where the tumour is: in the brain they cause headaches, seizures and vomiting; in the optic nerves, visual loss; in the spinal cord, pain, weakness, or numbness in the extremities. Treatment is often a combination of surgery, radio- and chemotherapy.
So to the question: fit to dive? The brain is enclosed in a decent hard case, so pressure will not normally affect the structures inside. Surgical approaches to tumour removal can have diving implications though. Boring through the skull will render that area more susceptible to external pressure and possibly infection. The eye-watering nasal approach to some pituitary gliomas can impair sinus function and increase future barotrauma risk. Sometimes the treatments can result in loss of neurological function, so you would need to be assessed in person for this. If your single seizure was due to the glioma which has now been dealt with, then you are at no further risk of another. Provided you are not taking anticonvulsants and all else is well, I suspect you’ll be found fit to dive.
Q - I recently had a Hartman's resection to remove 50cm of damaged colon(due to colitis or diverticulitis) following a fistula between bowel and bladder.
This has left me with a stoma bag(hopefully for only 4-6 months), after which a reversal will be carried out.
I wonder if you could let me know whether you see any problems with scuba diving with a stoma bag and after a major operation.
A - I don’t see any real issues with the bag. This sits across the piece of bowel that has been extended to come out of your abdominal wall. They do this to give the lower bowel a rest before the rejoin. The bag has a super sticky ring that goes around the fleshy stoma and obviously collects the intestinal mulch coming out. So as long as putting on and removing a wetsuit won’t tear it off. Or it doesn’t come loose inside a dry suit leaving you with one hell of a clean up job, then that should be fine. Stay away from windy foods, you know the sort, as theoretically if wind is produced at depth in the bag, it will expand on ascent. And I don’t want to be flippant but a stool filled plastic bag bursting on the deck of a live aboard would have the same consequences as that scene in Trainspotting.
Give it at least 8 weeks post op before diving again.
Q - I have been given you e-mail address in order I can seek advice following a
I am a 37 year old female. On 30th January I underwent a laparoscopy/laser
surgery to remove endometriosis. The procedure was done under general
anaesthetic and required an overnight stay in hospital.
I am going to Taba, Egypt in May.
Having got my PADI open water license in the summer I would obviously like
to enjoy some more diving whilst away.
My question is can I do this safely? My consultant initially advised me to
take it easy, nothing strenuous for a couple of months, but friends say I am
ok to dive as long as the wounds have healed and I feel ok.
I would really appreciate you advice as to whether I can do a couple of
short shallow dives or whether I should just relax and enjoy the sunshine.
A - Yup go for it. After a simple laparoscopy, i.e. tube through your tummy button to introduce the laser that does the zapping, all you have to worry about is healing of the abdominal wound. As they let you lift after a few weeks, then a 10 litre tank and a few kilos will be OK for you. Dive on in Taba my love and stare across to Jordan from your hotel room, and be jealous of all those flying back from Aqaba airport. The most civilized in Arabia, and no bleedin’ queues.
Q - I had a face lift and eyes done on the 13th March, I am looking to go to the
USA to do my divemaster and instructor courses. When will it be safe for me to dive please?
A - GO.
Right now. Go girl. Unless you are a bloke, in which case, shame on you, nothing wrong with that gritty Eastwood look of a gnarled face.
I am not super au fait with all forms of cosmetic surgery, but I assume they cut some skin off your forehead, and yanked it all up. Then replaced your eyes. Like in Terminator. All I would say is, that if it’s all healed you are ok to dive, but for others out there, the only thing to watch is a mask squeeze, especially after collagen injections. If you get enough negative pressure in your mask on descent, I reckon it could pull bits out of shape, making your beautiful youthful features resemble most of my previous girlfriends.
So a loose mask, and lets say 4 to 6 weeks post op for all you Ipanema Beach bunnies out there.
Q - I underwent a laparoscopy examination on Saturday 12th November, under
general anaesthetic, for investigative purposes only. During this, I
had my abdominal region pumped with Carbon dioxide, as is normal in these
procedures. I was told that it would take a few days for the CO2 to work
it's way out of my body. The specialist did not seem concerned that I am
flying to Barbados 5 days after the operation for
a diving holiday. However, I have since heard that it can take up to 3
for all traces to leave my body and so am concerned about diving. I would
like some advice as to whether I should dive or not. I will have the
of some shallow (6m) and some deeper (25m) dives, starting from 6 days
after the operation.
A - Insufflation, that’s what they call it. A lovely word indeed. When there’s trouble in the tum, and the surgeons need to take a look, they have to blow up the abdomen with this gas. That’s so that when the pointy steel visual thing goes in through the umbilicus, they all get a clear view.
Your doctor is right, the CO2 does clear fairly quickly, being resorbed by the tissues, so flying is fine. You should not expand like that baddie in the Bond movie whom explodes comically over the alligator pool. But I do have a reservation with diving so soon. 5 days after an op like this that involves a G.A., with the abdominal wall pierced too is too soon. Normally 2-3 weeks would be OK, but not 5 days.
I suggest taking it easy, and if you must dive, keep it shallow, 10 metre max, and only a couple at the most. No heavy lifting either, and that includes your kit. With easy exits too. Come to think of it, just chill and drink rum.
Q - My Husband is a very keen diver but in Feb this year he was diagnosed with
cancer of the pancreas and bile duct. On 16th March he had a Whipple's Procedure
( removing half stomach, half pancreas, bile duct and his duodenum). He made
a very quick recovery and was released from hospital after only 15 days ,he
has just finished his 6 month course of chemotherapy and has been given the
all clear . We are planning a holiday soon and he is wondering can he dive?
A - This is an incredible recovery. Stats show 80% of folk with this diagnosis kark it. So well done him.
Diving depends on 2 factors. Which chemo he had, and what effects that has left on him. And how strong he now feels. Man enough to lug those tanks and weak buddies.
If the diving doc feels that there has been no collateral damage from the chemo, and he passes any fitness tests, then he could well be back in the water soon.
Cal this a wake up message to get out and enjoy life to the full. In the words of the pianist from “Spinal Tap”...” Have a good time- all the time.”
Q - I had a femoral nail (pin) inserted into my right leg back in 2002 and wish to have it removed as its causing some discomfort. My question is do I have to stop diving for a while after the pin is removed? If so how long should I allow?
Hope you can help please.
A - I assume this was for a fracture, not cos you thought body piercing was a tad passé, and wanted to go one further. "Nipple or Prince Albert, sir", "neither mate, I'll have the femoral nail thanks". That'll give a certain Paul Toomer something to aim for.
I suggest you give it 2-3 months post removal before diving. It all depends on recovery, and whether your femur is stable. If it is, go for it, but if there is any infection or wobbliness then you have to wait for as long as you are physically strong enough.
Q - I want to do PADI open water certificate. In the operation in Feb 1997, the tumour had invaded the diaphragm and wall of the inferior vena cava. Both patched with Dacron. I am now fully fit and have no health problems. Does this count as blood vessel surgery on the medical questionnaire, and can I go ahead with the PADI certificate?
A - It does and you do need a medical. I am not sure what sort of tumour it was but it does sound nasty. However if you have been lucky and it's all out now then there's hope.
Dacron is used to patch up vessel walls after surgery. It is not compressible at depth and so should not be an issue. But the patched up hole in the diaphragm needs further exploring.
If it moves fine and does not restrict breathing then all is OK. To assess this you will need spirometry. Get this done at your local dive doctor.
Q - I'm due to go in hospital in a couple of weeks for an operation to remove a "small cluster" of varicose veins from the side of my left testicle. How long after the op would it be sensible to dive again as I would love to use the time off work to further explore the beautiful island of Malta where I recently achieved my advanced open water certification?
A - Alright fellas, enough sniggering, it could happen to any of us. To use the correct medical terminology, it' called a varicocele. And indeed those little veins inside the scrotum, around the testicle can become enlarged and engorge with static blood. Just like in the legs. The only problem here is that they can increase the tessy temp. That can lead to sterility, and we know where that leads. Yup, asking your buddy to fertilise your missus. "Sorry mate, you can borrow my spare fin straps, but it stops there", he will say. But I digress, give it 4 weeks to be sure all the bruising has healed, and if there is still any remaining tenderness, prevent pain from a suit squeeze, with a cricket box.
Q - I appreciate if you may advise me on a diving medical question, or provide me with additional guidance.
About 2 months ago I underwent an operation to correct hydrocoele and to remove varicocele around my testis. I intent to go SCUBA diving in one month, and doing the Advanced PADI course which I believe requires depth of 30 meters.
Is it possible to establish if there are any dangers associated with my operation and Diving. Currently I do suffer from some pain in the area.
A - I bet you are all dying to know what these are! And if you are a ballsy bloke your gonna wince. So look away.
A hydrocoele is a collection of fluid around your tessy. It causes said organ to lie in a giant pool of straw coloured sticky stuff, rather like a prune floating in a sac of golden syrup. Normally you stick a needle into this big old bag and suck out the liquid. Just make sure the doc doesn't miss and put it into your nad.
A varicocele is infact varicose veins around your tessies. You know you have one if the ladies complain of feeling worms around your nuts when your first date gets to the hotter phase. There's only one thing to do here. Op and snip the little vessels out. You've got to do this as they can raise the temperature of your plum and cause your sperm to die in a hot sweat, rendering you infertile.
Can you dive? Very much so. Give it 4 weeks post op as they may still be painful, and we all know what a dry suit squeeze can do for the pitch of a divers voice. But once healed, dive on, and never tell anyone what you had.
Q - I will soon be having surgery on the misaligned 5th metatarsals of eachfoot. This involves cutting, re-shaping and pinning them. Apparently I'll be walking around ok in 2 weeks, and back to running in 4-6 weeks. Once I'm capable I'd like to go off, get some sun and continue diving. Would you suggest any time limit after the op before diving?
A - You can see why orthopaedic surgeons are thought of as carpenters by some in the medical world.
Well after this bit of re-modelling your only real concern is finning.
There will be swelling, there will be pain.
But at 6 weeks, if your surgeon feels you can run, then you should be able to fin. Before you do, make sure that your fins still fit properly as you will then have a different shaped feet. They will probably be narrower. So check before you dive and wear a thicker neoprene boot or sock if you don't want to splash out on a new set of flippers, as they are called, by tabloid travel writers.
Q - I have just been diagnosed with a ganglion on my wrist ( a small lump the size of a one penny piece). It appears that I may have to wait some time for an operation. Is this going to affect my diving at all? I have a holiday booked in the Red Sea at Easter and am concerned if the pressures of diving will be detrimental to it, either before or after the operation.
A - You have absolutely no problem here. A ganglion is a small cystic swelling that occurs in relation to a joint or the sheath that surrounds a tendon. They always seem to occur around the back of the hand or the wrist. They are filled with a jelly like substance that is similar to the liquid that lubricates our joints, called synovial fluid and so the theory is that they arise from a tear in the tissue that surrounds a joint which is supported by the fact that they can arise after trauma to an area.
They are mostly painless but can cause aching in a joint, so I would suggest that you make a good mental note of this and are aware of where the ache is before you dive, as you don't want to end up on a 5 hour recompression in a chamber after a dive as the joint pain has been mistaken for a bend.
There will be no detrimental pressure effects to it when you dive, so don't worry on that count.
A ganglion can be treated by syringing out the fluid but this is only temporary as they always seem to recur. The best thing is to have the fluid and the wall of the ganglion excised surgically. Sadly this is low priority in our Health Service and you can often wait for over a year but once it is done it should never come back.
Like after all operations you should wait until the wound has healed properly before diving again but this will be quick after your operation as it is done through a very small incision with only a stitch or two which come out after a week. So leave it 2 weeks to be safe and I hope you can get the op done this side of the next World Cup.
Q - In April of 2002 and I a grade 3 shoulder separation and it was operated on.
They drilled holes in my collar bone and used something like tape to wrap it around my scapula to hold it in place. They had to harvest ligaments. My question is would my shoulder be able to stand the water pressures of scuba diving on a March break. I've been twice before and loved it. I was told to ask a hyperbarics doctor but my search came up empty. If you know the answer or if you know where I could find the answer I would really appreciate it.
A - You've come to the right place.
When you dive, pressure only affects and compresses air spaces. Middle ears, sinuses, those sort of things.
Because shoulders are made of bone, muscle and tendons, the pressure effects will be fine.
My only concern is with what function you are left with after the op. You must be able to move your arm easily, especially if it is your left. Wrist dumps on a drysuit, inflator hoses on a BCD all need good free left arm movement. If the surgery has limited this then you may need to revue your gear. Only you know this and only physiotherapy can help.