DIVE DOC­TOR: Med­i­cal Q&A

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Q: I’ve been a recre­ational in­struc­tor for 20 odd years but 9 months ago was di­ag­nosed with early Parkinsons at the age of 48. Of course I stopped in­struct­ing as soon as I be­came aware of this, but my symp­toms have re­mained very mild (a slight tremor and some mus­cle stiff­ness, nei­ther of which im­pair me func­tion­ally). My neu­rol­o­gist now wants me to start on Madopar, which he says might be ben­e­fi­cial. Nat­u­rally my ques­tion is what is the ef­fect of Madopar in div­ing? Are there any al­ter­na­tives? I’d rather not take any­thing if it will limit my abil­ity to dive and in­struct. I’m see­ing my neu­rol­o­gist for my an­nual re­view next week so I’d like to be armed with your ad­vice if pos­si­ble. Many thanks.

A: I’m not aware that there is any re­search into Madopar (or any other anti-parkin­so­nian med­i­ca­tion) and div­ing, but all is not nec­es­sar­ily lost. If your symp­toms are func­tion­ally in­signif­i­cant (as you sug­gest), and pro­gres­sion is slow (which it would seem to be), then I don’t think you need to give up div­ing just yet. How­ever, I do have some con­cerns. Cer­tainly if med­i­ca­tion is started, you shouldn’t dive un­til you are well sta­bilised, as side ef­fects can be com­mon and would likely be prob­lem­atic in the wa­ter; dizzi­ness, mus­cle spasms and twitches, po­si­tional faint­ing, poor bal­ance to name a few. It would also be im­por­tant to keep a close eye on dis­ease pro­gres­sion as later, more se­vere symp­toms can in­clude cog­ni­tive dis­tur­bances: slow­ing of re­ac­tion time, im­pair­ment of “pro­ce­dural mem­ory” (so-called “how to” knowl­edge, that used when per­form­ing skills), and de­men­tia, with hal­lu­ci­na­tions, delu­sions and para­noia. Clearly none of this is ideal for div­ing in­struc­tion! Nev­er­the­less, at this time, I would heed your neu­rol­o­gists’ ad­vice – any­thing that might slow dis­ease pro­gres­sion needs se­ri­ous con­sid­er­a­tion.

Q: Hello, could I ask for your ad­vice please. 10 years ago I was di­ag­nosed with nodu­lar scle­ros­ing Hodgkins Lym­phoma, for which I re­ceived 6 cy­cles of chemo­ther­apy. For­tu­nately I re­sponded very well and made a full re­cov­ery. I was dis­charged from fol­low-up 2 years later. I have been made re­dun­dant and want to use this as an op­por­tu­nity to ful­fil a life­long dream to work as a div­ing in­struc­tor abroad. Given that I’ve been ab­so­lutely fine for the last 8 years, would my past his­tory stop me? To re­as­sure you, I am a fit­ness freak, eat well, don’t drink or smoke, and have no other med­i­cal is­sues I can think of.

Dr Oliver Firth has gained con­sid­er­able ex­pe­ri­ence in the field of div­ing and hy­per­baric medicine since join­ing LDC in 2006. He is an Approved Med­i­cal Ex­am­iner of Divers for the UK HSE, and a med­i­cal ref­eree for the UK Sport Div­ing Med­i­cal Com­mit­tee. He is in­volved in the man­age­ment of all types of div­ing-re­lated ill­ness, in­clud­ing re­com­pres­sion treat­ment, as well as pro­vid­ing hy­per­baric oxy­gen ther­apy for non-div­ing con­di­tions. He re­mains a pas­sion­ate diver and has par­tic­i­pated in var­i­ous ex­pe­di­tions and con­ser­va­tion projects through­out the globe.

A: These days a re­port en­ti­tled “On some mor­bid ap­pear­ances of the ab­sorbent glands and spleen” wouldn’t pique the av­er­age reader’s in­ter­est; it didn’t in 1832 ei­ther, when Thomas Hodgkin pre­sented 7 cases of the dis­ease that now bears his moniker. It’s a rel­a­tively rare form of can­cer which de­vel­ops in a type of white blood cell (the lym­pho­cyte). The poor old Ir­ish ac­tor Richard Har­ris fell vic­tim to Hodgkin’s, pre­ma­turely rob­bing the Harry Pot­ter fran­chise of a fan­tas­tic Dum­ble­dore. Typ­i­cal symp­toms in­clude fevers, night sweats, weight loss and en­larged but pain­less lymph nodes in the neck, armpit and groin. If caught early it is most of­ten cur­able, with a cock­tail of chemother­a­peu­tic agents termed ABVD. The B stands for Bleomycin, and this has been as­so­ci­ated with pul­monary fi­bro­sis (lung scar­ring) and in­creased oxy­gen tox­i­c­ity – both of which could ob­vi­ously af­fect div­ing. You would cer­tainly need to be in­ves­ti­gated for (and cleared of ) any lung dam­age, prob­a­bly though imag­ine and pul­monary func­tion tests. How­ever, re­lapse of Hodgkin’s af­ter 8 years is very un­likely; so if your lung func­tion is okay then I can’t think of any other rea­son you shouldn’t ful­fil that long-held dream of yours. For more Q&AS from Dr Oli, check out: www.sport­diver.co.uk/dive­doc­tor.

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