Would you let my wife dive?

[Hickdive]

Only a doctor with specific knowledge of diving can say whether or not she is fit to dive, however as a very rough guide here are the UKSDMC guidelines;

Epilepsy

I appreciate that medical authorities elsewhere in the world may have differing views; for example UKSDMC is relatively relaxed on epilepsy whereas SPUMS regard it as a contraindication.

However, from the fact that she is still on medication then I can't see any diving doctor certifying her as fit.

 

[Doc]

ChiScuba, if that means "Chicago"... here's a good place to go next: Diveheart

 

[sheeper]

I will be more than happy to offer yet another internet medical opinion. On second thought, call DAN. You need real, expert advice on this and not YAIO (yet another internet opinion).

 

[Rich Keller]

This seems to always be a controversial topic in the diving community, however if you were a shop owner or DM would you let my wife dive in this situation?

She has had only one seizure 16 years ago, but is still on medication. Her doctor has signed off for her to be able to dive. We are going on a trip soon and she expressed interest in doing a discovery dive to see if it's something she would be interested in. If you were the shop owner, would you allow her to dive at shallow depths?

Her doctor knows about medicine but may not know about diving and what effect it may have on her condition and medication. I would not take the risk if it were my wife.

 

[Searcaigh]

How good is your insurance policy?

 

[tomfcrist]

My answer would be a swift no. Not because I want to ban her from diving, but because I don't particularly want her seizing underwater. Seen that, got the tshirt, not pretty.

I'm n the same boat as Jim in that my daughter has epilepsy, and am questioning (like turisops) why after 1 seizure she is even on meds. Don't get me wrong, she may have epilepsy and need them, but it seems the doc never allowed her to find out. Technically speaking, she does not have an epileptic condition being that she has only had 1 seizure in her lifetime....that does not mean that she would remain that way if she weaned off her meds.

 

[DivemasterDennis]

I would allow the woman in the question to do a discover scuba in a confined water setting, not open water. Then I would evaluate her, read the doctor's letter, and then encourage here to do a certification course, so that step by step she is more familiar with the water and the stress of diving is minimized, as is the risk of seizure when one is relaxed and comfortable, at least that is true in most cases. The nature of the seizure disorder, the type of medication, and the doctor's familiarity with the impact of diving on her disorder are all variables I would want to know before allowing an open water type dive, even if limited to 8 meters.
DivemasterDennis

 

[tomfcrist]

I would allow the woman in the question to do a discover scuba in a confined water setting, not open water. Then I would evaluate her, read the doctor's letter, and then encourage here to do a certification course, so that step by step she is more familiar with the water and the stress of diving is minimized, as is the risk of seizure when one is relaxed and comfortable, at least that is true in most cases. The nature of the seizure disorder, the type of medication, and the doctor's familiarity with the impact of diving on her disorder are all variables I would want to know before allowing an open water type dive, even if limited to 8 meters.
DivemasterDennis

I respect your angle.

You do understand that if anything happened to her that you would be staring down the barrel of a lawsuit that you will likely not win, right? All you can do is pray that the family doesn't pull the trigger on that.

I am pretty sure that DAN( the medical experts), your agency, and any leadership level training you have ever gotten reflects that seizure disorders(even if controlled by medication) are a direct contraindication to participating in scuba diving.

All that being said, it's your liability and ethics decision, therefore it is your right to accept the risk as long as she has been informed of exactly what can happen if she experiences a seizure underwater. I would personally be more comfortable from a liability standpoint if DAN would flat out come out and say something like "controlled epilepsy is compatable with scuba diving as long as proper risk controls are out in place(FFM, rescue certified buddy, etc.).

 

[Jim Lapenta]

Having witnessed a number of seizures there is no way in hell I would even consider putting her in the water. Regardless of what some doctor says who does not know about diving, cannot for sure say what the effect of pressure will be with the meds she is on, or cannot absolutely guarantee she will not have a seizure brought on by some unknown effect of the pressure on her.

What happens when a person seizes in a number of cases is that they also suffer diminished respiratory activity. Some go into respiratory arrest. My daughter did with most of her bad seizures. When the seizure is over they reflexively inhale. Quite deeply. If this were to happen as someone was trying to bring her up it could easily result in a popped lung. That's if they have not bitten through the reg tabs and instead inhale two full lungs of water. A full face mask does not address the issue of them holding their breath. They are also often catatonic after a seizure and may be confused, become combative, go totally limp, or lapse into another seizure.

It's not worth the risk. I would even be hesitant to put a person with epilepsy on medication in a swimming pool on snorkel gear. But then my level of risk acceptance is based on what is best to keep me from having to deal with a serious injury or death of a student. Not what they might get out of an experience. I train tech divers and work with students who have issues all the time. I'm kinda known for my patience and understanding with students. Those types of problems though are often things I can control through those traits. They don't help me to deal with medical conditions that are clearly contraindicative to diving.

 

[freewillie]

I almost always start my threads with the notion you have posted a medical question in a forum with predominantly non-medical untrained lay people. It to me always seems like asking a group of single college kids parenting advise on babies from a group of people who have no experience in parenting let along long term committed relationships. But I am an actual MD and I always find the responses in these forums interesting to say the least.

The short answer to diving with a seizure disorder is no. It is a relative (almost for sure) contraindication. That being said the factors that may mitigate the circumstances tend to be how well controlled are the seizures. If she has been stable on medication for 16 years and has had only a single seizure then the question becomes does she actually need the medication. The answer to that question is that it really depends on why she had a seizure in the first place.

People can have single seizures due to a known precipitating cause and they would not require long term lifetime therapy. High fevers and alcohol withdrawal for example can cause a seizure, but neither condition warrants long term therapy. So, if there is a cause, if there is no structural brain injury (tumor, mass, bleeding) and if she has been stable then the answer is probably.

Without any recurrent seizures over 16 years she is otherwise well controlled. However, the anti-seizure medications have some degree of lethargy and sedation so that motor impairment issues become the main question. Some experts say yes but with caution, most experts say no.

The "official" DAN position (taken from one of the DAN recommended text books of medicine) is that the patient should have a normal EEG (the test that looks for seizure focus in the brain) and has been seizure free OFF medication for 3 years. And even then it is with the understanding that she is inherently taking on more risk than an average diver and that it inherently carries higher risk of accident.

Now, that being said, the other question I would ask is if her neurologist has cleared her to drive. DMV regulations (at least here in California) require that the patient be seizure free on medication for minimum 12 months after last documented seizure. It is interesting to note they can drive with implied motor impairment potential on seizure medication but if you drive under the influence of alcohol you may be cited for DUI. On the other hand, you can drink and drive as long as your blood alcohol level is below a certain level. So the DMV has accepted a certain position that as long as you are on a drug but below levels that should cause obvious impairment you can drive.

Fact is in everything we do there is a certain risk. Staying with the driving analogy there is a risk of bodily injury and possibly death every time I get behind the wheel. There are conditions I can control such as using alcohol that would significantly increase my risk of an accident. To avoid this I should not drink and drive. There are conditions I can't control like the weather, and to decrease my risk I should drive slower in the rain. But since I don't like riding my bike or walking in the rain I accept the fact that I have a higher risk than when it is not raining. My choice.

You and your wife will have to ask yourselves these particular questions. Is it worth the risk. Now, the LDS will say that as long as a medical doctor has cleared the diver medically they don't have any further obligations from the medical perspective. If I was the certifying MD then I would also cover myself by saying that the patient was medically stable and seizure free for 16 years. Notice I didn't say that they have no risk of having a seizure. I'm simply certifying that they are medically "stable." I would then clearly state in my records that I had a conversation with the diver that they have a higher risk and that unforeseen factors from diving might actually precipitate a seizure in an otherwise stable patient. I would then also document clearly that they understand that having a seizure underwater would almost for sure mean certain death from drowning. And as long as we are throwing out legal disclaimers please not that the purpose of this post is for education and information purposes only. It is not my intention at all and in no uncertain terms am I offering specific medical advise for any situation or patient. Any appearance to do so is purely coincidental.

So, I would not "let" your wife dive. I would educate both you and your wife on the risks and then allow YOU and HER to make that decision to dive or not to dive.

I hope that helps.