Wednesday, April 05, 2006

Last Ten Posts on Scuba Clinic



1 Scuba Clinic / Gastrointestinal problems / Hiatal Hernia on: Today at 10:52:06 AM
Started by Ern Campbell | Last post by Ern Campbell
Posts retrieved from cache

I was looking at contraindicated conditions and noticed that Hiatal Hernia is listed as one of those condiditons. This is kind of surprising because I have had a sliding hiatil hernia for years and have been diving with no problems. I know that there is an exception for every rule but how many of these "contraindicated" medical conditions are supported by actual doc**ented studies and how many guinea pigs did they use before labling a condition "contraindicated"? This is an issue for me me because if I want to pursue further recreational dive training I need a note from my doc because I am over 40 and there is training I want to do. So is it o.k. to dive or do I have to hang up my tanks. Please let me know. Thanks.

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scubadoc
Site Admin

Posted: Wed May 04, 2005 3:48 pm Post subject: Hiatal hernia disqualifying?

Hello JohnB:

The answer to your question is that 'not all hiatal hernias are disqualifying'. If there is significant gastroesophageal reflux, then there is the risk of aspiration of gastric contents on ascent due to the effect of Boyle's Law and the 'weightlessness' underwater with loss of the normal mechanisms protecting us from reflux.

Paraesophageal or sliding hiatal hernias are contraindications for diving but the most frequently seen hiatal hernias are usually minimally asymptomatic sliding hernias are not disqualifying.

If there is any air trapping in the part of the stomach above the diaphragm, it must be remembered that swallowed air at depth expands four to five times upon ascent to sea level.

So, whether or not you can continue diving depends to a great extent on whether or not you are symptomatic, whether or not you can belch and rid your self of air and how your physician feels about your specific condition.

Hope this is helpful!
_________________
scubadoc
Diving Medicine Online
http://scuba-doc.com/

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Guest

Posted: Wed May 04, 2005 4:02 pm Post subject: AN IDEA

I do suffer from GERD but don't dive when symptomatic. I was wondering and I just realized this is something that I forgot mention is I do plan my dives to allow for a slower than normal assent and if I experience any discomfort I slow down until I belch or pass gas. So then another idea might be instead of contraindicating diving modify the parameters of the dive profile for persons with certain conditions.
And thank you for your prompt reply.

2 Scuba Clinic / Gastrointestinal problems / Carbonated beverages and diving? on: Today at 10:43:49 AM

Posts retrieved from cache

Contribution of Carbonated Beverages to DCI

diverdoug
Guest

Posted: Mon Jul 26, 2004 12:48 pm Post subject: Contribution of Carbonated Beverages to DCI

hello forum,

QUESTION #1: How many times, and in what publications, has there been a warning that the consumption of carbonated beverages before diving will trigger DCI? (say within 24 hours before a dive) And I'm not inferring the diuretic contribution of caffeine to dehydration here. I am instead referring to the propensity for CO2 to form bubbles upon decompression. I know of only one source. It was a PADI basic certification dive manual vintage 1986. I can't quote you the author and page numbers at this time, though.

It was stated in Buhlman's book on decompression that CO2 is forty times more soluble in olive oil, than is N2. (by either molar or weight) Olive oil is supposed to closely approximate human fat. The ingested CO2 will dissolve under pressure, into the stomach or small intestine, I suppose. The circulatory system is supposed to reject excess cellular CO2 into the lungs, when it is above a certain partial pressure. But can it reject the CO2 from a 12oz can of carbonated beverage, when it is dissolved into the stomach/small intestine?

QUESTION #2: Can the ingestion of carbonated beverages prior (within 24 hours) to hyperbaric treatment (HBOT), in a chamber, be dangerous to the patients and to the staff?

thanks forum, Doug Kemp.

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scubadoc
Site Admin


Posted: Mon Jul 26, 2004 4:16 pm Post subject: Carbonated beverages, DCI?
Hello Doug:

We had a similar question a couple of years ago - which I answered in my March 31, 2002 Divemed newsletter. http://www.scuba-doc.com/mar3102.pdf

Here is what was said:

Diving after drinking carbonated beverages?
I hear a rumor that carbonated beverages are a contributing factor to DCI. In fact I think that I confirmed this rumor in the PADI basic diving manual. Is this true? If so, what would be the underlying mechanisms?
Answer:
It is doubtful that carbonated beverages would increase the gas load to a sufficient level to increase the chance of gas bubble growth in a decompression situation. The lungs would excrete whatever was to enter the venous system.
Carbon dioxide would dissolve into the the fluids in the stomach, and could ultimately be absorbed into the bloodstream. The chemistry would suggest that the CO2 would react with H2O and would be carried into the
bloodstream as a HCO3- bicarbonate ion, but some would remain as CO2. Most CO2 produced by metabolism is carried this way to the lung. There, the equilibrium is upset as the CO2 dissolves across the cell membranes and into the lung airway. This drives the reaction of HCO3- + H+ --> CO2 + H2O and the CO2 continues to be eliminated.

The same thing would apply in a dry chamber dive as in a wet dive. Carbonated beverages that contain caffeine are diuretic and thus may increase the risk of DCI.

Hope this helps!

scubadoc

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casahilo
Guest

Posted: Sun Aug 01, 2004 11:19 am

I seem to remember in my hyperbaric training, we were told to have pt.s avoid soda before treatment because gas expansion occurs within the intestines on ascent, and may result in vomiting, flatus, abdominal discomfort and colicky pains. Rarely severe.
The only danger I see to hyberbaric staff might be flatus in a multiplace chamber.
Del

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scubadoc
Site Admin

Posted: Wed Aug 11, 2004 3:02 pm Post subject: Swallowed gas

Good point!

Carbonated beverages are taken in at ambient pressures - gas escapes as CO2 in the GI tract. Most is absorbed, some lingers as CO2 in the stomach.

The diver descends - the gas gets smaller and probably is added to by the diver swallowing air during equalizing maneuvers.

It is further compressed as the diver descends. On ascent, what gas is not absorbed enlarges.

If there is significant quantity still left in the stomach - then there will be pain, discomfort and belching. It is the diver who cannot belch [as in people who have hiatus hernia repair] who will be at significant risk for rupture of the stomach.

Gas in the GI tract is discussed on our web site at http://www.scuba-doc.com/flatus.htm .

scubadoc




3 Scuba Clinic / Dive Training, Gear and Technical Problems / Re: Stomach gas while diving on: April 04, 2006, 08:07:01 PM
Started by Mantaman | Last post by docvikingo
Hi Mantaman,

The hypothesis that this gentleman is unwittingly swallowing air is a good place to start. It is consistent with his symptoms and air swallowing is not uncommon in new divers. A student with this issue should inform the instructor so that they may take steps to correct the behavior.

Given such a complaint, it also would be prudent to eat a small, bland meal prior to but not in very close proximity to scuba. Avoid drinking too much liquid with this meal.

If the student takes medication to control acid reflux, e.g., Tagamet, Zantac, he should maintain his regular regimen while diving. If he does not, he may wish to consider such a drug. Also, taking a plain antacid tablet or two just prior to a dive may prove helpful

Finally, belching and passing gas freely can bring remarkable relief and should be encouraged.

If the problem continues despite reasonable measures, medical evaluation should be undertaken.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

Regards,

DocVikingo

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5 Scuba Clinic / Dive Training, Gear and Technical Problems / Stomach gas while diving on: April 04, 2006, 01:36:31 PM
Started by Mantaman | Last post by Mantaman
I have had a query from a workmate who is keen to begin diving, and wishes to resume an interrupted course in a few weeks time. He was compelled to abort a shallow try/training dive owing to gathering gas pressure in his stomach which he claims grew sufficient to seriously inhibit his breathing, this while at a constant depth. He cites a meal prior to the dive, and a history of gas problems, but I suspect that he was also unwittingly swallowing air as his symptoms seemed acute. Obviously his awareness of various factors affecting him such as regulator performance, stress, etc, are beyond his horizon at this stage. The problem was resolved naturally after the dive, and he felt fine, but is now anxious that he will suffer the problem again. He is considering the usual pharmaceutical solutions. Any advice from other sufferers?



6 Scuba Clinic / Medical and Surgical Problems and the diver / MOVED: Tooth Implant and Diving. on: April 04, 2006, 10:34:20 AM
Started by docvikingo | Last post by docvikingo
This topic has been moved to the Dental Problems forum.

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7 Scuba Clinic / Dental Problems / Excess salivation in a new diver on: April 04, 2006, 10:22:34 AM
Started by Ern Campbell | Last post by Ern Campbell
This query was sent to us by email and is posted here for comment by others who may have had similar experiences.

The last time I was diving- this past weekend, I experienced an excess salivation in 3 out of 5 dives that was so much I felt like it was choking me. I would spit it into regulator, but it was quite unpleasant. What makes this happen and how can it be prevented. Could it be that this mouthpiece was too big? I should tell you I am pretty new to diving and this was the certification dive.

Hello diver:

I haven't run into this question before but suspect that it is due to stimulation of the salivary glands from action of the regulator mouthpiece. You may be correct that the mouthpiece is ill fitting or that the simple presence of the object in the mouth is stimulating you to salivate.

Suggestions include wearing the mouthpiece around the house in order to get used to the feeling or to get a mouthpiece that can be heat molded to fit your bite better.

I plan to send your question to one of my dental diving consultants for another opinion.

Best regards:

Ern Campbell, MD

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8 Scuba Clinic / Dental Problems / Re: Tooth Implant and Diving. on: April 04, 2006, 07:53:00 AM
Started by newdiver48 | Last post by docvikingo
Hi Scotty,

I have provided you with a copy of Dr. Stein's "Alert Diver" (Mar/Apr '05) article entitled, "Dental Implants & Diving." Based on that, I'd guess the bone grafting will put you off the second stage mouthpiece for at least a couple of months, perhaps more.

But, you need an expert opinion so I'm going to contact Dr. Stein and ask him to respond to your inquiry.

Stay tuned.

DocVikingo

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9 Scuba Clinic / Dental Problems / Tooth Implant and Diving. on: April 04, 2006, 06:40:54 AM
Started by newdiver48 | Last post by newdiver48
I'm going to have my lower back molar taken out and and they are going to do a bone graph and they told me this would have to heal for 4 months before the new crown or tooth goes on. Question, How will this affect my diving? Will I be able to Dive, etc... would appreicate any info you guys can share...thanks Scott P.S. This is suppose to take place June 1 and the only dives for the first couple of months would be at the ga aquarium in 33' of water at the deepest. Then in August, we are going to Hawaii, will I be able to do this? thanks

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10 Scuba Clinic / Dive Training, Gear and Technical Problems / Re: For Dive Instructors: Student Lying on Medical Forms on: April 03, 2006, 06:48:43 PM
Started by Ern Campbell | Last post by mddolson
I am a retired instructor and do not have to deal with this issue anymore.
However, student safety and my liability are the primary concerns.

I would forbid any further water sessions until a doctor (diving doctor) signed a fit-to dive medical declaration.

Mike Dolson
NAUI 4780/PADI 202288 (Retired)
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Many Thanks to Patty Dilworth for the great photos of nudibranchs.