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October 2009    Download the Entire Issue (PDF) Available to the Public Vol. 24, No. 10   RSS Feed for Undercurrent Issues
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Why Divers Fail to Disclose Medical Conditions

there’s not much trust in the system

from the October, 2009 issue of Undercurrent   Subscribe Now

Not long ago, we asked our subscribers via email if they were truthful on their medical forms when they go diving. A preponderance of the respondents said no, many emphatically. What struck us was the range of conditions divers refused to disclose and how they justify their secrecy. In many cases, the reasons seem quite valid, as you shall see.

I can think of another sport where each time a participant goes out with a paid operator, he is required to list his medical history and disclose his medications. And where a check in the wrong box will disqualify you -- at least until you track down a physician who will approve your participation. One can take vigorous hikes with a travel group, go mountain biking or do some serious kayaking without having to tell the trip organizer your medical history. Accidents off in the wilderness can mean distant rescue and trip disruption for all participants, just as it might in diving. Maybe it’s because diving is conducted underwater that it merits such close scrutiny by operators – and insurers.

What became clear in reading our respondents’ comments was that not only did many of the divers believe their medical information and their willingness to participate based on their medical history was their own busi- ness, they also didn’t want to be knocked out of the box because of arbitrary decisions made by schoolboy divemasters halfway around the world, with no way to appeal. After all, every medical condition has enormous shades of gray. A bout of depression ten years ago doesn’t seem to have much impact on whether you should go diving today. But because you have no clue what the divemaster will say or do, it’s best to stay mum, so our readers say.

Particularly our aging readers. The people who spend money for serious dive travel are the 50-plus crowd, and as they age they manage their changing bodies with drugs to lower blood pressure and cholesterol, and to keep away the hot flashes. But to many dive operators, such drugs are a sign these folks shouldn’t go near the water. For example, B.D. from Shelby Township, MI (I’ll just use initials here to keep divers anonymous to dive operators) says, “My wife has used a mild and common medication to control her high blood pressure for many years. On a dive trip to Cozumel, she filled out Aqua Safari’s waiver and was told she couldn’t dive because she was under medication. We were shocked as this had never happened before. We walked down the street to Dive Paradise and filled out their medical history checking the ‘NO’ box next to ‘Are you taking any medications?’We went on to dive our normal three dives per day, plus a few night dives that week.”

A.A. from Campbell, CA, says, “The last time I filled out a form, I listed Lipitor as a medication and it was a huge hassle. On this Caribbean island, I had to find a doctor, have a $150 medical exam and bring it back to the dive shop. I have no heart or any physical problems, just lowering cholesterol levels, but once you mark the sheet, the problems begin. I will never mark the medication section again.”

P.G. from Haiku, HI, was at Club Med Turks and Caicos several years ago and disclosed she took estrogen hormone replacement therapy. “I was not able to dive till I was cleared by their doctor. The girl I was diving with was on thyroid medication and had a letter of clearance to dive from her Canadian doctor but they refused to allow her to dive at all because it was not a French doctor. So I disclose nothing that I don’t have to. When it comes to the medical questions I lie.”

But one has to concede that there are cases where an operator requires an exam and that might not be such a bad idea, especially if you’re up there in age. N.M. from Palo Alto, CA, was getting a Nitrox certificate and was given the medical history form. “One line was ‘Do you take any prescription medications?’ I am 81 years old so of course I do. I had to receive an MD’s release, which involved seeing a cardiologist and a pulmonary specialist, and getting an exercise EKG, a CT scan and a lung capacity test. Having passed all that, I am not sure what I will reply for the next dive operation.” But, at age 81 it probably probably wasn’t a bad idea to get all this checked out.

And consider the case of XX from Collinsville, IL, who is age 62, 5’9” and 285 pounds, and taking diabetic and blood pressure medications. “It takes 14 pounds of lead, (sans wetsuit) to get me down. After three days of two-tank dives and a night dive, I’m tired. But after 20 years of diving I feel I have a better idea of what I can do and can’t do. I’m not a cowboy, I don’t push any limits, but I can glide around with my camera watching the fish go by.” Since so many diving deaths involve obese divers under stress with heart ailments, let’s hope he gets his regular cardio exams.

When telling the truth is a problem

If you are honest about your medical history, the only way a dive shop may let you dive is if you get approval from a local doctor. Not as easy as it sounds, as many doctors are booked up in advance and don’t have the free time to see you right away. It can be worse in overseas dive destinations and who knows what kind of doc you’ll end up with. Furthermore, it could shave days off your dive schedule while you seek out and wait for an appointment.

“In Jamaica, I was required to have a physician authorize me to dive when I reported that I had back surgery in 1995,” says M.W. from Williamsport, PA. “This requirement was placed on any person who acknowledged any medical condition. A nurse told me it would take several days to find a physician who would see me, obviously at my own expense. And local doctors are reluctant to sign off on waivers because they perceive it as an assumption of liability. Luckily, I was able to phone my home physician and get authorization faxed to me.”

P.P. from Bethpage, NY, gives a good reason why you shouldn’t trust what a dive operation’s reservations staff says, and you should get the facts straight from the operator who will be giving you the waiver, especially for a trip in another country. “I am a type 1 diabetic and I wear an insulin pump. I had booked a liveaboard in Australia, sending an e-mail that I was diabetic, and got a response back that if my doctor released me, they were fine with it. A couple of months prior to the trip, I figured I’d better double-check with the boat. I was told I would have to be approved by an Australian doctor. I e-mailed the South Pacific Underwater Medicine Society with my medical history and diving history, explaining how often I checked my blood sugar when diving. No one replied back, just one board member who simply said, ‘Cancel your trip.’ So unless Australia changes its mind about diabetic divers, I will never get to experience the Great Barrier Reef.”

Come prepared

Savvy dive travelers may not always care to volunteer information, nonetheless they come prepared with notes from their doctors.

H S from Whitefield, NH, says, “I had heart surgery in 1999 to repair a leaking mitral valve, which has been functioning normally since then, and I have annual checkups. Still, I am frequently questioned about whether I am fit to dive by dive ops with no medical background. I now carry a note from my cardiologist, a diver too, stating that I am fit to dive and my past surgery poses no problems.”

D.C. from Boston says she gets a signed PADI medical form from her doctor during annual checkups and keeps a couple of the signed copies in her dive log in the event that she is challenged.

O.H. from Great Falls, VA, says, “I’m 63 and in excellent health, according to my doctor. But if I put Lipitor on the medical form, the dive shop thinks ‘heart condition’ and wants to either deny me or restrict my diving In one situation when the dive operator wasn’t going to let me dive, I had to get my doctor on the phone, which wasn’t easy. Now I carry a letter from my doctor that lists all the meds I take and that none are contraindicative for diving. It also states when my most recent physical was and nothing was found that poses a risk to my diving.”

If I disclosed my cancer
and the meds I take, I
doubt any dive operation
would allow me to suit-up

When you’re not prepared…..

As B. K. from San Diego, CA, got older, her blood pressure became higher than normal. “My doctor, an avid diver, put me on a medication that returned it to normal and assured me I was fit for diving. A few years ago, I checked a box on the dive form indicating my high blood pressure medication and assured the dive operation my blood pressure was fine. I was banned from diving until I tracked down a local doctor, whom I paid to write a note saying I was OK. Now I check forms saying I take no medication and have never had any health problems I believe I am responsible for my own health and safety.”

Yes, there is that risk that when you check a box, you’ll be barred from diving, as G. N. from Dallas worries about. “I don’t tell the dive operators I’m on blood pressure medication because I fear they won’t let me dive if I’m honest. On the other hand, I’m anxious about nondisclosure only because I worry that maybe I’m not really supposed to be diving even though my blood pressure is controlled by the medication.”

But GN, why not have a conversation with your doctor and even with DAN doctors to get the scoop on your medication? By itself, medication for high blood pressure is not a disqualifier.

Divers with serious diseases should do their homework

Several divers with serious diseases told us quite candidly how they manage their disease and continue to dive, even though they still don’t disclose to the dive operators R J from Philadelphia says, “I have multiple sclerosis and must dive with EAN32 as a back gas and EAN80 in a stage to be used at 20 feet and up. Also, I must take longer deco stops, at least five minutes Without these precautions, I am very likely to get neurological DCI I am medically cleared for diving by the head of Dive Medicine at a university here and have written documentation but do not show it to the shops. Can you imagine their reaction if I told them all this?”

“I’ve had type 1 diabetes for 20 years and have been a diver for 19,” says C A from Austin, TX. “I treat diving like a serious sport and make sure my sugars are in a good range before I dive. I am physically fit and exercise five times a week. I always bring glucose tablets in a dry bag and carry sealed glucose gel in my BCD pocket that can be administered in the water…and I’ve never had to use it. I was so happy when Divers Alert Network came out with new guidelines for diving with diabetes. I copied several pages and took them to my doctor. Although he was skeptical, he signed a waiver letter to let me dive. I still don’t mention to the dive ops that I’m diabetic but I dive with a buddy who is aware of my situation. ” (DAN recommends that diabetic patients take blood glucose readings an hour, 30 minutes, and immediately prior to “splashing,” or starting their dive. Dr. Michael Madsen, a fellow in undersea and hyperbaric medicine at the University of Pennsylvania, says that blood glucose should be kept “a bit above normal” at 150 mg/dL since the diver will be using more energy than normal. “When diving, we like to keep diabetics a little bit sweet,” he said, adding that the dive should be cancelled if blood glucose tops 300 mg/dl. [ABC NEWS])

“I had a heart attack, over four stents, and I’ve had neck and lower back surgery and surgery on both shoulders,” says B.S from Danville, C.A. “My cardiologist sees no problem with my diving as long as I can handle the exertion, so I exercise regularly at a gym. But if the prior medical conditions are mentioned, it only complicates things for the dive operator and its insurance. I don’t tell them anything. They already have me sign a release that absolves them from any liability short of shooting me, so why do they need to know what medications I may be taking? I’m a grown man, I know the risks and I’m prepared to deal with them, I don’t need babysitting and I especially don’t need some silly dive shop rules to keep me from diving after I’ve already paid for it.”

However, there are a few readers, while in the minority, who are honest and up front with dive shops about their conditions and are not penalized for it. “I tell them about my multiple sclerosis, which is currently in remission and for which I have a neurologist’s written okay to dive,” says S E from Portland, OR. “My medication needs to be kept cool, so I need to use the operator’s refrigerator for my syringes This way, it’s clear what all them drugs are for. If I do experience some decompression-related issues, the symptoms can overlap or mimic MS symptoms This information could help the dive staff with diagnosis and treatment decisions. My experience: No problems with dive operators yet.”

S.M. from Westford, MA, carries a note from his physician as well as the PADI medical form signed by his physician, which helps him in keeping honest – to a point.” If I think about what I would do if I did not get permission to dive, the truth is I would then probably lie on the waiver. The problem with this, of course, is that I put myself and others diving with me at risk I certainly should not do this but my passion for diving would probably prevail over common sense.”

We all know how much we love to dive and how we will fight to not give it up. Here’s one last comment from a diver who is fighting that fight.

“I have rare and incurable carcinoid cancer. My blood sugar, blood pressure, and even my breathing can change rapidly if I am not properly medicated. I am careful about my medication, so I have not even come close to experiencing such problems underwater. If I disclosed my condition, and the meds I take, I doubt any dive operation would allow me to suit up. I rarely go below 60 feet, and stay away from super-strenuous dives, to lower the likelihood that I will overtax myself. In the course of my close to 300 dives (all while I have had cancer), I have been able to help other divers in trouble under water, and have coped with a few catastrophic gear failures of my own I realize that I would not only be risking my own life if my illness impaired me while diving. This has not even come close to happening. I hope that I will have the sense (and the sense of self-preservation) to stop diving when my disease impairs my functioning on dry land. My wife is my dive buddy, and if I can’t see it for myself, I trust in her to tell me when that day has come. In the meantime, I want the freedom to decide for myself, rather than be excluded by a medical mind set that is sometimes based on conjecture rather than fact; remember when asthma was an absolute bar on diving?”

Conclusion:

We’re amazed to see how many divers dive with serious medical conditions. I’m not here to disapprove or condone, only to report In the next issue, Doc Vikingo will give us the medical perspective and we hope to have an training agency perspective as well.

– Ben Davison

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