Not long ago, we asked our subscribers via email if
they were truthful on their medical forms when they go
diving. A preponderance of the respondents said no,
many emphatically. What struck us was the range of conditions
divers refused to disclose and how they justify their
secrecy. In many cases, the reasons seem quite valid, as
you shall see.
I can think of another sport where each time a participant
goes out with a paid operator, he is required to
list his medical history and disclose his medications. And
where a check in the wrong box will disqualify you -- at
least until you track down a physician who will approve your participation. One can take vigorous hikes with a
travel group, go mountain biking or do some serious kayaking
without having to tell the trip organizer your medical
history. Accidents off in the wilderness can mean distant
rescue and trip disruption for all participants, just as it
might in diving. Maybe it’s because diving is conducted
underwater that it merits such close scrutiny by operators
– and insurers.
What became clear in reading our respondents’ comments
was that not only did many of the divers believe
their medical information and their willingness to participate
based on their medical history was their own busi- ness, they also didn’t want to be knocked out of the box
because of arbitrary decisions made by schoolboy divemasters
halfway around the world, with no way to appeal.
After all, every medical condition has enormous shades
of gray. A bout of depression ten years ago doesn’t seem
to have much impact on whether you should go diving
today. But because you have no clue what the divemaster
will say or do, it’s best to stay mum, so our readers say.
Particularly our aging readers. The people who spend
money for serious dive travel are the 50-plus crowd, and
as they age they manage their changing bodies with drugs
to lower blood pressure and cholesterol, and to keep away
the hot flashes. But to many dive operators, such drugs
are a sign these folks shouldn’t go near the water. For
example, B.D. from Shelby Township, MI (I’ll just use
initials here to keep divers anonymous to dive operators)
says, “My wife has used a mild and common medication
to control her high blood pressure for many years.
On a dive trip to Cozumel, she filled out Aqua Safari’s
waiver and was told she couldn’t dive because she was
under medication. We were shocked as this had never
happened before. We walked down the street to Dive
Paradise and filled out their medical history checking the
‘NO’ box next to ‘Are you taking any medications?’We
went on to dive our normal three dives per day, plus a
few night dives that week.”
A.A. from Campbell, CA, says, “The last time I filled
out a form, I listed Lipitor as a medication and it was a
huge hassle. On this Caribbean island, I had to find a doctor,
have a $150 medical exam and bring it back to the
dive shop. I have no heart or any physical problems, just
lowering cholesterol levels, but once you mark the sheet,
the problems begin. I will never mark the medication section
again.”
P.G. from Haiku, HI, was at Club Med Turks and
Caicos several years ago and disclosed she took estrogen
hormone replacement therapy. “I was not able to dive till
I was cleared by their doctor. The girl I was diving with
was on thyroid medication and had a letter of clearance
to dive from her Canadian doctor but they refused to
allow her to dive at all because it was not a French doctor.
So I disclose nothing that I don’t have to. When it comes
to the medical questions I lie.”
But one has to concede that there are cases where an
operator requires an exam and that might not be such a
bad idea, especially if you’re up there in age. N.M. from
Palo Alto, CA, was getting a Nitrox certificate and was
given the medical history form. “One line was ‘Do you
take any prescription medications?’ I am 81 years old so
of course I do. I had to receive an MD’s release, which
involved seeing a cardiologist and a pulmonary specialist,
and getting an exercise EKG, a CT scan and a lung capacity
test. Having passed all that, I am not sure what I will
reply for the next dive operation.” But, at age 81 it probably probably
wasn’t a bad idea to get all this checked out.
And consider the case of XX from Collinsville, IL,
who is age 62, 5’9” and 285 pounds, and taking diabetic
and blood pressure medications. “It takes 14 pounds of
lead, (sans wetsuit) to get me down. After three days of
two-tank dives and a night dive, I’m tired. But after 20
years of diving I feel I have a better idea of what I can do
and can’t do. I’m not a cowboy, I don’t push any limits,
but I can glide around with my camera watching the fish
go by.” Since so many diving deaths involve obese divers
under stress with heart ailments, let’s hope he gets his
regular cardio exams.
When telling the truth is a problem
If you are honest about your medical history, the only
way a dive shop may let you dive is if you get approval
from a local doctor. Not as easy as it sounds, as many doctors
are booked up in advance and don’t have the free
time to see you right away. It can be worse in overseas dive
destinations and who knows what kind of doc you’ll end
up with. Furthermore, it could shave days off your dive
schedule while you seek out and wait for an appointment.
“In Jamaica, I was required to have a physician authorize
me to dive when I reported that I had back surgery
in 1995,” says M.W. from Williamsport, PA. “This requirement
was placed on any person who acknowledged any
medical condition. A nurse told me it would take several
days to find a physician who would see me, obviously at
my own expense. And local doctors are reluctant to sign
off on waivers because they perceive it as an assumption
of liability. Luckily, I was able to phone my home physician
and get authorization faxed to me.”
P.P. from Bethpage, NY, gives a good reason why you
shouldn’t trust what a dive operation’s reservations staff
says, and you should get the facts straight from the operator
who will be giving you the waiver, especially for a trip
in another country. “I am a type 1 diabetic and I wear an
insulin pump. I had booked a liveaboard in Australia,
sending an e-mail that I was diabetic, and got a response
back that if my doctor released me, they were fine with it.
A couple of months prior to the trip, I figured I’d better
double-check with the boat. I was told I would have to be
approved by an Australian doctor. I e-mailed the South
Pacific Underwater Medicine Society with my medical history
and diving history, explaining how often I checked
my blood sugar when diving. No one replied back, just
one board member who simply said, ‘Cancel your trip.’ So
unless Australia changes its mind about diabetic divers, I
will never get to experience the Great Barrier Reef.”
Come prepared
Savvy dive travelers may not always care to volunteer
information, nonetheless they come prepared with notes
from their doctors.
H S from Whitefield, NH, says, “I had heart surgery
in 1999 to repair a leaking mitral valve, which has been
functioning normally since then, and I have annual
checkups. Still, I am frequently questioned about whether
I am fit to dive by dive ops with no medical background.
I now carry a note from my cardiologist, a diver too, stating
that I am fit to dive and my past surgery poses no
problems.”
D.C. from Boston says she gets a signed PADI medical
form from her doctor during annual checkups and keeps
a couple of the signed copies in her dive log in the event
that she is challenged.
O.H. from Great Falls, VA, says, “I’m 63 and in excellent
health, according to my doctor. But if I put Lipitor
on the medical form, the dive shop thinks ‘heart condition’
and wants to either deny me or restrict my diving In
one situation when the dive operator wasn’t going to let
me dive, I had
to get my doctor
on the phone,
which wasn’t
easy. Now I carry
a letter from my
doctor that lists
all the meds I
take and that
none are contraindicative for diving. It also states when
my most recent physical was and nothing was found that
poses a risk to my diving.”
If I disclosed my cancer
and the meds I take, I
doubt any dive operation
would allow me to suit-up |
When you’re not prepared…..
As B. K. from San Diego, CA, got older, her blood pressure
became higher than normal. “My doctor, an avid
diver, put me on a medication that returned it to normal
and assured me I was fit for diving. A few years ago, I
checked a box on the dive form indicating my high blood
pressure medication and assured the dive operation my
blood pressure was fine. I was banned from diving until I
tracked down a local doctor, whom I paid to write a note
saying I was OK. Now I check forms saying I take no medication
and have never had any health problems I believe
I am responsible for my own health and safety.”
Yes, there is that risk that when you check a box,
you’ll be barred from diving, as G. N. from Dallas worries
about. “I don’t tell the dive operators I’m on blood pressure
medication because I fear they won’t let me dive if
I’m honest. On the other hand, I’m anxious about nondisclosure
only because I worry that maybe I’m not really
supposed to be diving even though my blood pressure is
controlled by the medication.”
But GN, why not have a conversation with your doctor
and even with DAN doctors to get the scoop on your
medication? By itself, medication for high blood pressure
is not a disqualifier.
Divers with serious diseases should do
their homework
Several divers with serious diseases told us quite candidly
how they manage their disease and continue to dive,
even though they still don’t disclose to the dive operators
R J from Philadelphia says, “I have multiple sclerosis and
must dive with EAN32 as a back gas and EAN80 in a stage
to be used at 20 feet and up. Also, I must take longer
deco stops, at least five minutes Without these precautions,
I am very likely to get neurological DCI I am medically
cleared for diving by the head of Dive Medicine at
a university here and have written documentation but do
not show it to the shops. Can you imagine their reaction if
I told them all this?”
“I’ve had type 1 diabetes for 20 years and have been
a diver for 19,” says C A from Austin, TX. “I treat diving
like a serious sport and make sure my sugars are in a good
range before I dive. I am physically fit and exercise five
times a week. I always bring glucose tablets in a dry bag
and carry sealed glucose gel in my BCD pocket that can
be administered in the water…and I’ve never had to use
it. I was so happy when Divers Alert Network came out
with new guidelines for diving with diabetes. I copied several
pages and took them to my doctor. Although he was
skeptical, he signed a waiver letter to let me dive. I still
don’t mention to the dive ops that I’m diabetic but I dive
with a buddy who is aware of my situation. ” (DAN recommends
that diabetic patients take blood glucose readings
an hour, 30 minutes, and immediately prior to “splashing,”
or starting their dive. Dr. Michael Madsen, a fellow
in undersea and hyperbaric medicine at the University of
Pennsylvania, says that blood glucose should be kept “a
bit above normal” at 150 mg/dL since the diver will be
using more energy than normal. “When diving, we like to
keep diabetics a little bit sweet,” he said, adding that the
dive should be cancelled if blood glucose tops 300 mg/dl.
[ABC NEWS])
“I had a heart attack, over four stents, and I’ve had
neck and lower back surgery and surgery on both shoulders,”
says B.S from Danville, C.A. “My cardiologist sees
no problem with my diving as long as I can handle the
exertion, so I exercise regularly at a gym. But if the prior
medical conditions are mentioned, it only complicates
things for the dive operator and its insurance. I don’t tell
them anything. They already have me sign a release that
absolves them from any liability short of shooting me, so
why do they need to know what medications I may be taking?
I’m a grown man, I know the risks and I’m prepared
to deal with them, I don’t need babysitting and I especially
don’t need some silly dive shop rules to keep me from
diving after I’ve already paid for it.”
However, there are a few readers, while in the minority,
who are honest and up front with dive shops about
their conditions and are not penalized for it. “I tell them about my multiple sclerosis, which is currently in remission
and for which I have a neurologist’s written okay to
dive,” says S E from Portland, OR. “My medication needs
to be kept cool, so I need to use the operator’s refrigerator
for my syringes This way, it’s clear what all them drugs
are for. If I do experience some decompression-related
issues, the symptoms can overlap or mimic MS symptoms
This information could help the dive staff with diagnosis
and treatment decisions. My experience: No problems
with dive operators yet.”
S.M. from Westford, MA, carries a note from his physician
as well as the PADI medical form signed by his physician,
which helps him in keeping honest – to a point.” If I
think about what I would do if I did not get permission to
dive, the truth is I would then probably lie on the waiver.
The problem with this, of course, is that I put myself and
others diving with me at risk I certainly should not do
this but my passion for diving would probably prevail over
common sense.”
We all know how much we love to dive and how we will
fight to not give it up. Here’s one last comment from a
diver who is fighting that fight.
“I have rare and incurable carcinoid cancer. My blood
sugar, blood pressure, and even my breathing can change
rapidly if I am not properly medicated. I am careful about
my medication, so I have not even come close to experiencing such problems underwater. If I disclosed my
condition, and the meds I take, I doubt any dive operation
would allow me to suit up. I rarely go below 60 feet, and
stay away from super-strenuous dives, to lower the likelihood
that I will overtax myself. In the course of my close
to 300 dives (all while I have had cancer), I have been
able to help other divers in trouble under water, and have
coped with a few catastrophic gear failures of my own I
realize that I would not only be risking my own life if my
illness impaired me while diving. This has not even come
close to happening. I hope that I will have the sense (and
the sense of self-preservation) to stop diving when my disease
impairs my functioning on dry land. My wife is my
dive buddy, and if I can’t see it for myself, I trust in her to
tell me when that day has come. In the meantime, I want
the freedom to decide for myself, rather than be excluded
by a medical mind set that is sometimes based on conjecture
rather than fact; remember when asthma was an absolute
bar on diving?”
Conclusion:
We’re amazed to see how many divers dive with serious
medical conditions. I’m not here to disapprove or condone,
only to report In the next issue, Doc Vikingo will
give us the medical perspective and we hope to have an
training agency perspective as well.
– Ben Davison