Would you let my wife dive?

[tomfcrist]

I'm on the same page with you Jim. My daughter has had TC, IS and absence seizures pretty much daily since she was 6wks old. Definitely not something someone would want to have happen underwater.

I find it interesting that you mentioned the respiratory distress, as that is quite common. I am sure a FFM would solve the drowning issue, but there are a lot of variables involved with the ascent. I'm pretty confident that I could keep my wits about me and not bring up the person seizing until all is said and done, but I'm also sure that a dive buddy that hasn't seen anything like that before would have a hard time doing so. Additionally, what if the seizure is prolonged(longer than a few minutes) or that person goes into status? That would be a bad scenario. God help them if they are already low on air when the episode starts.

Freewillie,

I think the question is based from a DM, Instructor or shop liability standpoint rather than a medical clearance perspective. Any doc can sign a form, but is that doc qualified to make the decision. I don't know about other agencies, but with NAUI, the decision is ultimately at the level of the dive pro. FWIW, even in the event the worlds top neurologist cleared her to dive, I would still refuse to either train this lady, dive with her, or let her a trip that I am sponsoring/attending. It's not worth the liability in my eyes.

 

[Wookie]

Epilepsy/Seizures and Diving | DIVER magazine

This opinion says she should be ok. The risk is that she will die if she has a seizure underwater. Do you like her?

 

[freewillie]

I'm on the same page with you Jim. My daughter has had TC, IS and absence seizures pretty much daily since she was 6wks old. Definitely not something someone would want to have happen underwater.

I find it interesting that you mentioned the respiratory distress, as that is quite common. I am sure a FFM would solve the drowning issue, but there are a lot of variables involved with the ascent. I'm pretty confident that I could keep my wits about me and not bring up the person seizing until all is said and done, but I'm also sure that a dive buddy that hasn't seen anything like that before would have a hard time doing so. Additionally, what if the seizure is prolonged(longer than a few minutes) or that person goes into status? That would be a bad scenario. God help them if they are already low on air when the episode starts

I'm not trying to argue that the OP's wife should dive. I'm just offering a different perspective. One, as you and your daughter are well aware you have to live your lives with the specter of potentially suffering a seizure in any of you life's activities. That includes any activity on dry land as well. As in my previous post how do you handle the risk of driving? If you have a seizure on the freeway that usually has a bad outcome as well. And as for status epilepticus, that can carry a very high death rate on land with access to emergency rooms as well. I've seen patient present and then die because the doctors can't get the seizure under control. It just so happens that if you seize under water it almost for sure means you will drown. But, devil's advocate is that there is no guarantee you will survive on land either.

I have always said that you can't go through life in bubble wrap. We have risks that we all are willing to take, or, are not willing to take. Some of my friends look at me like a daredevil because I dive. They look at me like I'm the stupidest parent in the world for letting my kid dive too. Now, I love to dive and I have spent hours practicing and hours taking extra training. This in theory should reduce my risk. It does not however eliminate my risk. It is a risky sport. I'[m not such a daredevil however that I want to sky dive. For some reason that terrifies me and under no circumstances ever will I willingly attempt to jump out of plane even with a parachute.

As for the OP it is a decision that he and his wife have to make. I understand fully your position and Jim's position. Fact is if I was not a diver I probably would be telling patients no to diving as well. But after several years you realize that you can only control for so much. Medicine is practically speaking about reducing risk with the realization that there will always be a certain amount of risk regardless of what we do. For anyone it is all about informed consent. You lay out the risks and then let the person taking those risks accept the risk of the activity or then avoid the risk and avoid the activity completely.

 

[100days-a-year]

My brother had seizures during the onset of puberty,could not get a drivers license or play sports until he was seizure free a year and off meds.That was 30+ years ago.He is 49 now,certified and has around 100 dives,mostly a tropical vacation diver.

I don't let many people dive on most meds as there is little science(tons of pontification)on the the effects of depth on them.That being said I know quite a few drinkers,potheads and folks on prescribed meds who dive on them .... but not on my boat.

 

[tomfcrist]

I get it freewillie, but it's not just their decision. As a dive pro, if she were to come to me as a charter customer carrying a full cave and hypoxic trimix card, I could(and would) be completely within my right to tell her that she will not be diving with my operation.

That's all i was trying to convey. Just as you can choose to either sign the medical waiver or refuse to touch it with a 10ft pole.

I think we are on the same page.

 

[boulderjohn]

ScubaBoard is blessed to have a number of highly qualified physician divers on staff, but if the thread is not placed in the Diving Medicine forum, they may miss it. I will move the thread there.

 

[drrich2]

Times are I wish there was a good way to put a number on the risk involved; like one chance in how many thousands of serious risk of injury or death.

It would be interesting to know how the actual risk of this woman doing regular recreational diving would stack up against the risk of a person without such a past doing deep technical dives on a rebreather, or cave diving.

So much focus seems to be on the hypothetically increased risk this woman faces compared to people without that medical history, doing recreational diving. My point is, do we turn a blind eye to people doing perhaps riskier diving than that, simply because we've decided that those causes of added risk are acceptable and hers is not?

Richard.

 

[tomfcrist]

It would be interesting to know how the actual risk of this woman doing regular recreational diving would stack up against the risk of a person without such a past doing deep technical dives on a rebreather, or cave diving.

Have you ever done a risk assessment matrix?

There are 3 main components. Is there a risk of mishap? What is the probability? What is the severity?

I like the thought process of what you wrote above. In order to properly asses it, either real world data or best guess estimates would have to be made concerning the probability of serious mishap in either risk group. Where there are many tech rebreather folks that have had failures, what percentage of those failures resulted in a mishap? Similarly how many people have had seizures underwater? How many of those resulted in a mishap?
What were the severities of those mishaps?
Sight unseen I would classify the epileptic as having a smaller probability of a mishap in general, but the severity would be extreme the majority of the time(death). Mishaps on a rebreather at tech depths do happen more often I would guess, however the severity side of the scale varies greatly depending on the failure.

Is that a reasonable guess? Maybe, maybe not...I don't have data to support it nor debunk it, but it makes logical sense to me.

 

[drrich2]

Tom:

And using that approach, a FFM could mitigate some of that risk, further changing the equation. Jim Lapenta pointed out that while a FFM might reduce immediate drowning risk, it's harder to gauge whether disrupted breathing might put the diver at risk for over-expansion injury on ascent (assuming that an epileptic might close their airway so gas couldn't flow out as it expanded). But at least part of the risk would be reduced.

I would like to know what type of seizure was had, at approximately what age, whether there were any known precipitating conditions (e.g.: fever, infection, medication or drug exposure, recent head injury), etc...

If the OP takes an interest in FFM's, be mindful they are a bit more complicated to work with. My wife has an old AGA Interspiro, and a buddy of mine has also used it. From their experience & observation with that specific model:

1.) It's strapped thoroughly on the head. Getting it off could be a bit involved.

2.) You can't donate an octopus readily to my wife unless she takes it off.

3.) At the surface, there's a knob/valve/what'cha'ma'call'it she turns to let her breathe ambient air, yet must turn off to submerge. You could take an unconscious person to the surface, forget to open it, and have them run out of gas & suffocate.

4.) It doesn't fog.

5.) It generally doesn't require purging.

6.) It's a bit harder to equalize; there's a plate of some sort pushed up to the nose, I think.

7.) You can breathe through your nose!

8.) They seem to go through their gas (e.g.: air, nitrox) a bit faster vs. standard scuba mask.

9.) The 2nd stage is integrated with it, so we needed to use a 1st stage from another regulator with it.

There are other brands & models of FFM, and at least one of the Kirby Morgans lets you detach the 2nd stage and accept a buddy's without taking the whole thing off, if I recall correctly. FFMs tend to be rather expensive. Some have the option to add wireless communication modules, but that adds its own complexities.

Richard.

 

[tomfcrist]

Completely on board with the FFM thoughts. The problem with epilepsy is that you just never know when a seizure is going to hit. You could be seizure free for 35 years and suddenly have 20 a day. Its crazy.

All I'm saying is that with the data we currently have available, and the current recommendations of the leaders in dive medicine, I think that a dive pro would be assuming undue risk of liability to do anything outside of current medical consensus. It's just a lawsuit waiting to happen, with no defense that will stand up in court.