DIVE DOCTOR: Medical Q&A
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.