Question Prior Injuries and Diving (Wounds, Stroke, DCS)

[uncfnp]

Trace. Unlike mathematics where 1+1=2 there are rarely easy, concrete answers to questions about the human body or anyone’s specific response to stressors.

You are asking for hard data and research that likely does not exist. The best the most knowledgable professional is likely to give you are the odds of certain events and the risk that an activity incurs. And then only if they have all the facts of your case and the environment you plan to return too.

You seem to be focused on the scar tissue but it would seem the greater risk is whatever caused the original injury. Is it likely to recur? I doubt anyone with a medical license will be willing to put that at risk to give you an all clear. But of course you don’t need that to dive. You are a dive professional well versed in deco theory and the inherent risks of diving. You have to decided if the risk out weighs the benefit. Can your life be fulling without deco dives, without recreational dives?

This is your decision. The best anyone can do is give a bit of guidance to help you find the answer that is right for you. Would it help to make a trip to Duke and talk to one of their dive professionals?

 

[jadairiii]

...I'm trying to find answers beyond the RSTC, ADCI, US Navy and whatever else you can Google. I know there has to be someone out there willing to talk science.

The first person on my list would be Dr. David Doolette, WKPP diver and spoke at one of the TekDiveUSA conference when it was in Miami. If nothing else may have a referral to a doctor that knows how to swim.

 

[boulderjohn]

I would like to echo what uncfnp wrote in post #51. We just don't know enough about the mechanism of DCS in general and your injury/recovery in particular to make a call for you.

From what you wrote, your DCS cannot be explained by any of your dive behavior. The same is true of mine--I absolutely should not have gotten bent when I did. In my case, the delay in my treatment was my own fault--I just couldn't believe I could have gotten bent that day. Perhaps it was something along the lines of bubbles that would normally gradually dissipate getting into the wrong place at the wrong time. I don't know enough to hazard a guess.

As I indicated in another post, as my age advances, I have to gather as much information as I can and make a call. Whatever I choose, it will be my call.

 

[rjack321]

This is your decision. The best anyone can do is give a bit of guidance to help you find the answer that is right for you.

While I went against conventional medical advice at the time, dove after spinal surgery, and it worked out well enough for me... Be very very wary of anecdotes like mine. You are not likely to find anyone to talk about how they disregarded medical advice, continued to dive, and had serious issues.

 

[Kimberlyharrell11]

Part of my future plans. I have an MRI with contrast tomorrow.

So far. Most hyperbarics are wound care now. They don't really know much more than a scuba instructor knows whose read any DAN literature. Their passion isn't diving, therefore they don't pour over diving medicine literature like a hyperbaric doc would who does rebreather diving. I'm trying to find answers beyond the RSTC, ADCI, US Navy and whatever else you can Google. I know there has to be someone out there willing to talk science.

Almost 14 years ago, I developed a really awful floater in my eye. All the doctors I saw said I had to live with except for one of the world's best who developed more than 57 surgical instruments. "Want me to get rid of that for you?" I did. He did. Now, vitrectomies and laser surgery to remove floaters are easy to find. 15 to 20 years ago, not so much. I'm sure someone out there has the best info available for me to decide whether to just freedive or to return to cave diving.

I was also diagnosed with floaters in my eyes two years ago. It had a significant impact on my diving. So, my doc advised me to undergo laser surgery because it is a painless and effective procedure. I was terrified of the surgery, but after researching the condition, I discovered that proper treatment must be performed at the right time or it will result in vision loss. So I agreed to the surgery, and everything went well. The surgery was a huge success.

 

[annasea]

I was also diagnosed with floaters in my eyes two years ago. It had a significant impact on my diving. So, my doc advised me to undergo laser surgery because it is a painless and effective procedure. I was terrified of the surgery, but after researching the condition, I discovered that proper treatment must be performed at the right time or it will result in vision loss. So I agreed to the surgery, and everything went well. The surgery was a huge success.

How bad were your floaters? Not during diving, but in daily life?

I've had floaters for years; most times they're not a problem. A few months ago, I took myself to the ER on the wknd b/c I was getting streaking in my right eye. I followed up w/ my eye doctor afterwards and his thought was to monitor the situation, as sometimes this particular matter (sorry, can't recall the official term) will resolve itself on its own. Unless I all of a sudden develop an explosion of floaters in my eye, for example, it's not a problem and requires no intervention, as nothing can be successfully done at this point anyway.

Your link appears to only cover standard laser surgery, e.g., nearsightedness. I'm surprised a seemingly mainstream place like that would have been able to assist with floaters.

 

[Trace Malinowski]

How bad were your floaters? Not during diving, but in daily life?

I've had floaters for years; most times they're not a problem. A few months ago, I took myself to the ER on the wknd b/c I was getting streaking in my right eye. I followed up w/ my eye doctor afterwards and his thought was to monitor the situation, as sometimes this particular matter (sorry, can't recall the official term) will resolve itself on its own. Unless I all of a sudden develop an explosion of floaters in my eye, for example, it's not a problem and requires no intervention, as nothing can be successfully done at this point anyway.

Your link appears to only cover standard laser surgery, e.g., nearsightedness. I'm surprised a seemingly mainstream place like that would have been able to assist with floaters.

If floaters are a "quality of life issue" and annoy you, many doctors are willing to perform surgery to remove them.

Because floaters are benign and are not a risk to vision, patients are often told to live with them. Such doctors are ignorant of the psychological impact that floaters can have on a patient. They just tell people that floaters are a normal part of aging as the gel-like vitreous begins to liquify and pieces or strands of collagen fibers break away and form clumps which cast shadows on the retina. Floaters can be an indication of a detached retina so doctors will just tell you that if you notice a sudden increase in floaters or see flashes to seek medical help right away. That's the old school approach and if you live in a country with socialized health care, such as Canada and the UK, it can be more difficult to find a doctor who is willing to perform floater surgery.

One strategy that can be used to help you not notice floaters is to wear sunglasses, especially those with a a dark category 4 lens for mountain climbing. I developed floaters in college. I used to wear shades and freediving facemasks that were "sunglassed" to reduce how much I noticed floaters.

When I reached age 40, I developed a large floater in my left eye. Doctors told me I had to live with it. I couldn't. It was like having macular degeneration by blocking my central vision. I did research online and found a floater sufferers support board that gave the names of doctors willing to do surgery. I saw a doctor in NJ about laser vitreolysis and a doctor in NYC about a "floater only vitrectomy" or FOV. I opted for the vitrectomy because the surgeon was considered one of the best in the world and had designed more than 50 surgical instruments in the field of ophthalmology.

He did vitrectomy surgery on the left eye. It looks terrifying if you watch YouTube videos, but you are sedated and don't feel anything. It was an amazing success. Not even a speck of a floater remained. I had a small floater in my right eye, but because floaters would only increase with aging, I had surgery on my right eye a year later. That also was a complete success.

If you have a vitrectomy, you'll most likely get a cataract within five or so years. I developed cataracts about 5 or 6 years afterward. I opted for the Rx intraocular lenses (IOLs). The results were 20/10 right eye and 20/15 left eye. Better than 2020!

Some vitreous that had been left behind from my first surgery detached in my left eye and I had a third vitrectomy to remove that. Again successful.

A couple years after that, I developed the common posterior capsular opacification as epithelial cells grow on the capsule where the IOL is placed. I had YAG surgery to restore clear vision. It took three treatments to clean up some strands that were acting like floaters. That was nothing though. YAG surgery is just looking at three red dots and hearing clicks as the doctor plays Asteroids.

It sounds like a lot, but it's worth it. Some doctors will do everything at once. They'll do a clear lens exchange to insert IOLS, open the capsular bag so you won't get a PCO, use dye to make sure they remove all the vitreous they can, and you'll emerge floater free without the need for glasses and contacts.

After enduring all the fears that go with surgery, I just prayed to God that I'd get to keep my amazing vision. Getting a DCS hit to the brain to cause double vision was decidedly unfair.

 

[annasea]

If floaters are a "quality of life issue" and annoy you, many doctors are willing to perform surgery to remove them.

Because floaters are benign and are not a risk to vision, patients are often told to live with them. Such doctors are ignorant of the psychological impact that floaters can have on a patient. They just tell people that floaters are a normal part of aging as the gel-like vitreous begins to liquify and pieces or strands of collagen fibers break away and form clumps which cast shadows on the retina. Floaters can be an indication of a detached retina so doctors will just tell you that if you notice a sudden increase in floaters or see flashes to seek medical help right away. That's the old school approach and if you live in a country with socialized health care, such as Canada and the UK, it can be more difficult to find a doctor who is willing to perform floater surgery.

One strategy that can be used to help you not notice floaters is to wear sunglasses, especially those with a a dark category 4 lens for mountain climbing. I developed floaters in college. I used to wear shades and freediving facemasks that were "sunglassed" to reduce how much I noticed floaters.

When I reached age 40, I developed a large floater in my left eye. Doctors told me I had to live with it. I couldn't. It was like having macular degeneration by blocking my central vision. I did research online and found a floater sufferers support board that gave the names of doctors willing to do surgery. I saw a doctor in NJ about laser vitreolysis and a doctor in NYC about a "floater only vitrectomy" or FOV. I opted for the vitrectomy because the surgeon was considered one of the best in the world and had designed more than 50 surgical instruments in the field of ophthalmology.

He did vitrectomy surgery on the left eye. It looks terrifying if you watch YouTube videos, but you are sedated and don't feel anything. It was an amazing success. Not even a speck of a floater remained. I had a small floater in my right eye, but because floaters would only increase with aging, I had surgery on my right eye a year later. That also was a complete success.

If you have a vitrectomy, you'll most likely get a cataract within five or so years. I developed cataracts about 5 or 6 years afterward. I opted for the Rx intraocular lenses (IOLs). The results were 20/10 right eye and 20/15 left eye. Better than 2020!

Some vitreous that had been left behind from my first surgery detached in my left eye and I had a third vitrectomy to remove that. Again successful.

A couple years after that, I developed the common posterior capsular opacification as epithelial cells grow on the capsule where the IOL is placed. I had YAG surgery to restore clear vision. It took three treatments to clean up some strands that were acting like floaters. That was nothing though. YAG surgery is just looking at three red dots and hearing clicks as the doctor plays Asteroids.

It sounds like a lot, but it's worth it. Some doctors will do everything at once. They'll do a clear lens exchange to insert IOLS, open the capsular bag so you won't get a PCO, use dye to make sure they remove all the vitreous they can, and you'll emerge floater free without the need for glasses and contacts.

After enduring all the fears that go with surgery, I just prayed to God that I'd get to keep my amazing vision. Getting a DCS hit to the brain to cause double vision was decidedly unfair.

Hah! I won't even do laser surgery for vision correction... partly too much $$ invested in unique eye frames... but also concerned about ghosting, halo-ing, whatever it is that can potentially go wrong.

I'm fortunate in that my floaters are tolerable. I can even deal w/ that flashing in the corner of the right eye since I quickly learned to adjust to it. Now I rarely see it.

Of much greater concern is the retina detaching b/c I've got an 'issue,' can't recall the terminology... maybe a small tear? in the right eye.

Good to know that your cataracts surgery improved your vision! I've read of this for some people, but when I asked my dad about his, he had no change to his prescription. I was diagnosed with the start of cataracts a few years ago, while still in my 40s, FFS, so reckon surgery is a given at some point.

 

[Duke Dive Medicine]

Why is it that you can be cleared to dive if you have received permanent injuries to the neurological system such as to the brain, brainstem or cranial nerves from explosions, concussions, foreign bodies (i.e., shrapnel), and strokes, but a person is medically disqualified from diving if the damage resulted from decompression sickness? Wouldn't any damage, scarring, etc., be similar regardless of cause and cause a reduction of off-gassing efficiency in affected tissues in a similar fashion?

We have "wounded warriors" and stroke survivors learning to dive or returning to diving, but why isn't someone with permanent injuries from DCS allowed to dive as long as they can physically meet the demands of the sport? For example, if you have lost the use of an eye, lost hearing in one ear, or you are left with a slight limp, but can pass a rigorous fitness test such as being able to compete as a professional triathlete or be a professional ocean lifeguard, then why can't you return to diving?

Trace, a bit late to the game here, but current thinking in fitness to dive is less proscriptive and more descriptive, i.e. what CAN you do given your personal situation, rather than a blanket recommendation not to dive. I'm not familiar with your case aside from hearsay, but as others have stated, the thing that would make a practitioner think twice about clearance to dive would be the potential for serious disability should DCS occur again. Happy to discuss particulars offline via PM if you would like.

Best regards,
DDM