Getting certified with a pacemaker

[herman]

A friend of mine is going through a similar issue now. Here is a little more info you may find helpful. He was being told his depth limit with his pacemaker was 50 ft but could get no good reasons as to why. I got him in contact with a local cardiologist who also is a dive instructor and was motivated to dig a little deeper into the issue rather than just accept the generic response for the manufacturer. As it turns out the mechanical limit on his pacemaker is actually 165 ft and not 50 ft as he was first told. The 50 ft limit is one placed on the pacemaker IF a certain feature of the pacemaker is turned on; otherwise the limit is 165 ft. Trouble is, the manufacturer just gives out the 50 ft limit as their general response unless they are pressed for info from someone who understands the issues. Luckily for him he does not have the feature turned on ( I do not know what it is) so he has been cleared to130 ft ( 130 max for no other reason than a 35ft safety margin on the PM) No way am I giving medical advice or suggesting you ignore the doctor but thought you may be able to use this information.

 

[StevenN]

I know that you do not want to hear this,but, from a liability and moral standpoint your LDS should never have started to teach her to dive if the cardiologist placed a limitation on her being fit to dive.Sounds like they took an easy opportunity to make some $ bat your expense.
Does not matter if pacemaker is rated to 500' if the Dr placed any statement on the medical form other than "I find this individual fit to dive" then we would have turned her down..Sorry..

I have to agree on this one. Diving is not an absolute necessity and while I think it would be great if your child could do it I think a more well thought out approach to the risk/reward factor might be in order here.

 

[tc]

My 13 yr old daughter has a pacemaker. Her cardiologist has cleared her to dive up to the manufacturer's recommended limit of 50'. Our local dive shop had no problem with the class after getting the cardiologist's letter.

Now I'm in Bonaire with a referral letter and the hotel dive shop will not complete the check out dives. They insist that the cardiologist's letter is not good enough and that we need a letter from a hyperbaric physician. We are going to try and get an appointment with one of the local hyperbaric physicians, but I anticipate him saying that the cardiologist is more qualified to make this call.

Has anyone else run into this issue and if so, how did you resolve it?

I know that you do not want to hear this,but, from a liability and moral standpoint your LDS should never have started to teach her to dive if the cardiologist placed a limitation on her being fit to dive.Sounds like they took an easy opportunity to make some $ bat your expense.
Does not matter if pacemaker is rated to 500' if the Dr placed any statement on the medical form other than "I find this individual fit to dive" then we would have turned her down..Sorry..

Update: Yesterday (Monday) was a holiday on the island and everything was closed. I called DAN and the medic (not MD) I spoke to agreed with me that the hyperbaric physician would say that the cardiologist is the person to make the call. Of course the cardiologist has signed the letter saying "I find no medical condition that I consider incompatible with diving." The cardiologist did put a note referencing the pacemaker manufacturer's (Medtronic) letter saying the device should operate normally up to 49.5 fsw.

The dive operations manager here still refuses to complete her checkout dives until the hyperbaric physician on the island reviews her case. We have an appointment with him at 4:00 pm this afternoon. Hopefully, he will agree with DAN and my daughter will be able to complete her training dives tomorrow.

It would appear from these statements that the only limitation placed on her was due to the depth rating of the device rather than a medical issue. With the cardiologist having given a medical clearance I don't see the shop as having done anything wrong there.

 

[Cave Diver]

It would appear from these statements that the only limitation placed on her was due to the depth rating of the device rather than a medical issue. With the cardiologist having given a medical clearance I don't see the shop as having done anything wrong there.

And I don't see putting a depth limit as anything different than those placed on younger children/jr. divers.

 

[gasdiver]

Update: The electricity has been real spotty on the island this week. It has gone out for hours at the time the last few days, so I've been unable to get on the net.

Well, we took my daughter to see the hyperbaric physician on Tuesday afternoon late. The first thing he said was "I'm not a cardiologist". He took one glance at the letter I had from the cardiologist and the device manufacturer and said my daughter was clear to dive. So he signed another letter and put his stamp on it.

I took this back to the dive shop and they accepted it. My daughter completed 3 of the 4 checkout dives yesterday and will finish the 4th one today.

I am still not happy with the dive shop for screwing up our vacation, we lost 3 out of 6 days of diving, but they have offered to refund any boat dives we paid for but don't end up making. Hopefully, this issue will be behind us now and my daughter can enjoy a lifetime of safe diving.

 

[Jim Lapenta]

You could have avoided all of this by planning further in advance and completed her cert at home. This is one reason why I don't like the whole process of issuing referrals. But at the same time if I do have to issue one I will personally locate an instructor for the student or if they choose one I will call him/her and verify that they will accept the student. Then discuss how the dives will be conducted and any concerns that may affect the process. I tell my students that up front and if they have an issue with me discussing say a medical problem with the referral shop or instructor that I will not issue the referral. On vacation you cannot always count on new divers being clear on everything. There may also be language or standards issues that they would not be aware of and able to discuss. As the referring instructor I can make clear and hopefully resolve any issues before they even take place. I'm surprised that her referring instructor did not offer to do this for you. It might have saved you alot of time and effort. I cannot fault the shop for their policy, the issue is with you not verifying it before you even got there. Once again a reason why I say that dive planning begins when you decide to dive, not when you get to the site.

 

[wedivebc]

Update: The electricity has been real spotty on the island this week. It has gone out for hours at the time the last few days, so I've been unable to get on the net.

Well, we took my daughter to see the hyperbaric physician on Tuesday afternoon late. The first thing he said was "I'm not a cardiologist". He took one glance at the letter I had from the cardiologist and the device manufacturer and said my daughter was clear to dive. So he signed another letter and put his stamp on it.

I took this back to the dive shop and they accepted it. My daughter completed 3 of the 4 checkout dives yesterday and will finish the 4th one today.

I am still not happy with the dive shop for screwing up our vacation, we lost 3 out of 6 days of diving, but they have offered to refund any boat dives we paid for but don't end up making. Hopefully, this issue will be behind us now and my daughter can enjoy a lifetime of safe diving.

I am sorry you were cheated out of a couple of days of diving but I applaud the shop for erring on the side of caution and not placing $$ ahead of safety as so many do.
I wish your daughter the best and as Jim mentioned above a little pre-planning might go a long way in the future.
Enjoy the rest of your vacation.

 

[knowone]

Really interesting information. Thanks. Never really thought about it. I'll be reading some more. Congtratulations on the family not keeping your daughter wrapped in cotton wool. Be really interesting to hear from her about the, dive shop scewed up vacation. Perhaps you could spend your refund money on pertinent literature and give it to the one who most needs the information. I think I once read somewhere, "number of dives does not a person make."

 

[Jim Lapenta]

Once again the shop did not screw up the vacation. They followed the shop policy. Their perogative. If anyone screwed up it was those who assumed that everything was good to go without actually checking. Dive planning is the responsibility of the divers. In this case they did not do their job as thoroughly as they could have. They assumed everything would be ok. First very big mistake.

 

[Dr. Doug Ebersole]

I'm a cardiologist and a dive shop owner/instructor.

One of the major issues with diving with a pacemaker is not the pacemaker itself, but the medical condition that led to the need for the pacemaker, especially in a child. The major issue here would be if your daughter is "pacemaker dependent" or if it is in place simply as a "back-up" which on routine pacemaker clinic follow-up shows it actually being used very infrequently. A large number of cardiologists would have quite a bit of trepidation "clearing" someone to dive who was pacemaker dependent.

As far as the pacemaker itself, most have been tested to around 100 fsw and performed flawlessly. This could be checked by her cardiologist contacting the device manufacturer. There are some features, however, which can be problematic like some of the rate-responsiveness programs as an example.

So, this is a complex issue and one that needs to be looked at on a case-by-case basis. Meaning no disrespect to anyone here, it's never a good idea to listen to anecdotes like "I dive with one and have never had a problem..." or "I have a friend who......".

The other thing to be aware of is that even the best of electrophysiologists (cardiologists specializing in abnormal rhythms), most of the time have absolutely no knowledge of diving medicine. It is simply not a part of medical school/internal medicine residency/cardiology fellowship training. Therefore, it's always a good idea to contact DAN so they can put you in contact with a cardiologist knowledgeable in cardiology AND diving medicine.

Just my 2 cents.

Doug