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appeared in DIVER September 2005 |
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Dr Ian Sibley-Calder has been a GP since 1988, is a medical referee for the UK Sports Diving Committee and is involved with hyperbaric medicine and commercial diving activities. He is a BSAC Advanced Diver and Club Instructor.
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Jaw joints can be seriously affected by biting down too hard on a second-stage mouthpiece |
Every time I dive, whether in warm water, cold or the pool, I suffer from what seems like dislocation of my jaw. My right jaw joint becomes painful while diving and stiffens up, making holding the regulator mouthpiece uncomfortable. When I move my jaw left and right or open and close it, it cracks loudly and feels almost dislocated. The longer I dive, the longer it takes to recover, sometimes hours. I have such restricted movement after coming up that I can't eat, and can drink only through a straw because I can't open my mouth. If I force it open, it is extremely painful and cracks loudly. What could be causing it and what can I do that may help?
Nicky
You have a condition called temporomandibular joint dysfunction - a problem with the jaw joint.
This is a complex joint that can get inflamed and can then cause spasm in the masseter muscle (the biting muscle), which leads to the problem of not being able to open your mouth.
You may well be biting down hard onto your mouthpiece quite unconsciously, which would aggravate the problem.
Look carefully at your mouthpiece. This often holds the mouth open just a little bit too much, which can lead to stress on the jaw joint.
Consider investing in an orthodontic tailor-made mouthpiece - expensive, but it would be worth it.
I become terribly anxious when in tropical waters, and especially when in the middle of the ocean (irrational/ rational fear of sharks). Would it be safe to use something along the lines of Rescue Remedy (Herbal) beta blockers to stop the anxiety without side-effects, and allow me to dive in warmer waters? I am fine in Scottish waters, but wish to see more life.
Gills
No-one should have to take any anxiety-reducing mediation to go diving. The sport requires calm nerves, decision-making skills under stress and the ability to try not to panic and think and act decisively in emergencies.
If a person cannot cope with these anxieties and stresses, he or she should not be diving.
Training, good buddies and information can all help in this respect but medication is not the answer and should not be used.
I have recently undergone emergency surgery in the form of an ileostomy. I have suffered from Crohn's disease for about 10 years, during which time I have dived extensively. Apart from the odd flare-up I have had no real problems diving with this condition. Diving with a stoma, if indeed that is advisable, will present me with new challenges - barotrauma of colostomy bag and other nightmare scenarios spring vividly to mind. Is there any reason why I should not enjoy the sport we all love so much? Where are all the Òstoma diversÓ? Is there a special stoma diving society? I am surely not alone.
Mick
I have mentioned problems associated with inflammatory bowel problems in previous columns and Mick illustrated one of the treatments in having part of the affected bowel removed.
I have known several divers who have dived for many years with active stomas very successfully. The problems can all be overcome with a little thought.
Stomas on the right side of the abdomen tend to produce very liquid matter frequently, but those on the left are very solid and often only once or twice a day. So dealing with this is a very personal thing.
Barotrauma can be avoided by using bags that allow flatus to escape, and thought has to be given to equipment such as weightbelts and tight suits. Day trips can be a problem if there is nowhere to change the bag.
I don't know of any stoma diving society but following this letter I am sure successful stoma divers will be happy to give you advice on how they cope.
I have been deaf in my left ear since I was an infant, due, doctors believe, to mumps. I have had many tests including MRI (last one five years ago) and it is due to a malfunction in my cochlea that cannot be corrected. Will this be an issue if I want to become an instructor? I never experience any medical symptoms when diving and have no problems equalising.
Graham
The nerve deafness in the one ear does not represent any problem with diving or instructing. There is one point to be made, however: diving can involve trauma to the ears, and it is not unknown for divers to lose hearing secondary to barotrauma or DCI.
Most divers start off with two chances, so that if they lose hearing in one ear they still have one good ear. You would not have this luxury, and if you had a problem in your good ear you could be rendered totally deaf.
Instructors often have to chase students with poor buoyancy control, making the risk greater.
You need to think carefully about how much risk you are willing to take while diving.
I recently suffered a cerebral embolus after a dive to 33m for 27 minutes. I had temporary paralysis and loss of vision, which came back soon after being put on oxygen. I did 7.5 hours' recompression, with three further two-hour retreats. Apart from having a leg that feels as if it's wired up back to front (cold feels hot and hot feels cold) I am completely recovered, and the question of diving again has entered my head.
Rachel
You require a proper assessment by a doctor interested in diving to assess not only your current injuries but also any precipitating factors, and whether you need to be tested for a PFO (hole in the heart).
You say you are completely recovered but still have problems with the temperature sensation in your leg. This implies to me that you have had significant damage to your neurological system that may have largely sorted itself sorted out but with residual damage.
This has to be taken into account and requires counselling as to future risks and what measures could be taken to reduce them should further diving be allowed.
My husband, who is 55, had a small infero apical infarct in May. He has been diving for four years. He has had an angiogram, which showed only minimal damage. He is eager to continue diving and has recently had an ECG stress test, which was OK, but he does have an irregular heart rate, for which a beta blocker has been prescribed. He is on Clopidogril (75mg), Carvedilol (6.25mg), Bendroflurazide (2.5mg), Simvastatin (20mg), Lisinopril (20mg) and Omeprazol (10mg). Will he be able to dive again?
Isabel
Diving following a heart attack requires individual assessment by a diving doctor who understands the risks and how to assess them.
The diver must have made a full uncomplicated recovery with minimal heart damage, have good heart function and be able to achieve at least stage 3 on the exercise ECG.
Complications such as irregular heartbeats and beta blockers make diving less likely.
It is thought that a number of divers die each year as a result of heart attacks. Those who have already had one are at greater risk of a second and need full assessment.
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