BPPV new diver

[Zef]

I took meclazine prophylactically to prevent motion sickness during rough seas while stationed on an FFG. It caused a quite the feeling of fatigue and drowziness. Luckily the ship would reduce to only essential watch-standers during rough seas and most others were then expected to be in their rack. It was never the pitch or the roll that got to me, it was the yaw that would kill me...the meclazine sure helped me sleep through most of it....never vomited, just hated feeling nauseuous and found that feeling more crippling than vomiting itself.

That said, as a DM, given my experience with meclazine, I don't think I would want to bear responsibility for someone underwater breathing compressed air who might be taking that drug, or someone who is not taking meclazine but has the potential to have an episode of severe uncontrolled disorientation.

I am not saying someone with this type of underlying medical condtion shouldn't be allowed to experience diving, I am just saying I don't want that person diving with me, in a personal or a professional capacity. There used to be a lot of things that would medically disqualify someone from diving; it seems over the years that many of those disqualifying factors are no longer disqualifying...I am not certain if that is because those issues are not a concern or if doctors don't want to be the one to say "no, you can't do this type of activity given your condition". It also seems to me that an aspect left out of the equation of "should one dive with x medical condition" is the impact on the dive partner(s) should a person suffer an episode of whatever condition they have while under the water....could they effect a rescue or could the stess of a non-normal/non-routine situation spur an "episode" that might incapacitate them when you need them the most.

@tridacna , ultimately its your choice, and I imagine the very nature of/reason for your question has you already leaning in a particular direction. Just remember...the person your question is about can't drown or suffer dci/dcs if they don't enter the water.

-Z

Edit: Oh yeah, forgot to mention that I too didn't do a fellowship in otolaryngology...but I did once stay at a Holiday Inn Express.

 

[doctormike]

Where’s @doctormike ?

LOL. Haven't been as active here lately. Always feel free to text, etc...

 

[doctormike]

Where did you do your fellowship in otolaryngology?

No need to be snarky. You don't need to be an otolaryngologist to know that the gravity and inertial effects acting on the inner ear are unchanged by submersion in water.

 

[doctormike]

I've had infrequent BPPV for 15 years, never while diving and not severe. I went to physical therapy with an ear/balance provider and learned how to self treat when an episode occurs using the Epley maneuver. Medication doesn't get rid of it, and by the time the meds start to work, the episode would be over because it only lasts a couple of minutes. I'm not a doctor, just speaking from experience. I'm interested to hear what our dive docs have to say.

I'm a pediatric ENT doc, so I don't deal with patients like this in my practice, but I think that this sums things up pretty well, actually. Transient BPPV is not uncommon (my wife has the same thing), and unless you have chronic symptoms, you aren't going to be on meds all the time, so not really an option.

It's also important to have an accurate diagnosis. Lots of things cause vertigo, and BPPV is really a diagnosis of exclusion. So it's worth having vestibular testing if this hasn't been done.

I know that the standard recommendation is not to dive with BPPV. If the vertigo is significant and frequent, scuba diving is not the best choice of a new hobby to start.

That having been said, there is a bell curve for everything, and the history of rare brief episodes of mild vertigo wouldn't always preclude dive training in a mature individual who can deal with this remote potential at depth. Usually people with actual BPPV learn which orientations trigger episodes, and doing the Eply maneuver at home and/or vestibular rehab can make future episodes less likely (but not impossible).

Many of us dive with chronic conditions that can flare up - some are contraindications to diving (e.g. most seizure disorders), some are not. It is not possible to completely eliminate the risk of a sudden onset of a medical condition at depth, but that's a tradeoff that the diver has to make. This is true for all of us, especially as we age. And of course, @tridacna, you would need to feel comfortable training them, after having this discussion.

If someone like this were to dive, they would need to be able to deal with this remote possibility as they would with any other dive emergency. They would have to stabilize themselves in the water, breath calmly, and wait for the episode to pass. Things like solo diving or black water diving wouldn't be a good idea.

 

[uncfnp]

So not an ENT or otolaryngologist here but my understanding is that true episodes of BPPV are Positional (head and the P in BPPV) and of brief duration. If this is true in her case maybe spend a bit of time with her in the pool to see if diving (posture not pressure) triggers her vertigo and of course discuss beforehand what to do if it occurs.

 

[tridacna]

Her first episode resulted in a trip to the ER. Diagnosis by an ENT at Rutgers who specializes in BPPV. He has signed off on her medical so I'm doing it. Taking a DM who is a MD along for the ride to keep an eye on her.

 

[doctormike]

Her first episode resulted in a trip to the ER. Diagnosis by an ENT at Rutgers who specializes in BPPV. He has signed off on her medical so I'm doing it. Taking a DM who is a MD along for the ride to keep an eye on her.

LOL. If your DM can do an underwater Eply maneuver, and if you can video it, we can publish it...

 

[tridacna]

LOL. If your DM can do an underwater Eply maneuver, and if you can video it, we can publish it...

LOL. He's a pediatric cardiologist and had no idea what BPPV was before this morning! Not going to be doing any EPLYs UW I'm afraid...you volunteering?

 

[doctormike]

LOL. He's a pediatric cardiologist and had no idea what BPPV was before this morning! Not going to be doing any EPLYs UW I'm afraid...you volunteering?

I'll volunteer to do the video if I get my name on the paper.

And actually, underwater would be a very easy place to do an Eply maneuver...

 

[doctormike]