Crazy question about SCUBA diving and MS...

[Susanne285]

I'm hoping to book a sunny vacation to Cuba. Ideally to a location where I can do lots of SCUBA diving.

Here's the question... I just want to be safe. Is there any reason why a person with MS cannot SCUBA dive? I was only diagnosed in August 2010, so I'm still new to all of this. I have an appointment with my neurologist before leaving for vacation, but I'd like to book it before that appointment.

Thanks, Susanne

[Bubba]

Hmmmm.... Excellent question!

[growing2boys]

The idea of scuba is that you obtain a normal oxygen supply while diving. Do you have physical limitations? That should be your only concern (although I am not an expert)

I was a diver for 15 years. I've had to stop because the gear is too heavy & I am too weak/unbalanced to ambulate the boat safely or get out of the water. I also have a tremor & I am slow with reactions.

You need to consider the worse case scenarios. Can you retrieve your mask or regulator quickly if it is kicked off (I've been faced kicked many times by inexperienced divers) Are you taking meds that will effect your level of alertness? Can you tread water for the minimum of an hour if you are lost from your boat on drift dives? (this happens rarely, but it's happened to me several times & it's terrifying on the best of times) Keep in mind you of course have your vest that will help, but you should be a strong swimmer. Is your vision clear?

If you are in good physical shape- get out there & dive. Travel as much as you can. Do all the things you may not be able to do later NOW!!!

[1978leandro]

growing2boys

Great Answer!!!

I am diver too, and you motivated me to not stop diving.

Thank you

Leandro

[trisca]

I've just done a bunch of research on this because I'm thinking about scuba for my upcoming trip. Apparently there's no reason no to (provided you are physically able to) but some places don't like taking people with MS because the symptoms of ms are similar to the bends and having ms makes diagnosing the bends difficult. At least that's what I've learned on the internet.

[Susanne285]

Well, I've continued to dive. I did two dives in Cuba last week with no problems, other than being kicked by the amateur divers!

Happy diving!

[rudolf]

Hi, I am a (Dutch) neurologist and today a patient asked me precisely this question. There is actually no literature on the subject except for one case: Aviat Space Environ Med. 2003 Feb;74(2):184-6. Multiple sclerosis presenting as neurological decompression sickness in a U.S. navy diver.
Jan MH. This person had manifestations of MS after diving. Therefore, it is possible that diving itself could elicit the symptoms. But what is the mechanism and what does this mean to people who have MS and want to dive? Well, nitrogen, the gas of decompression sickness, might be at work here. because of the high partial pressure of nitrogen during diving, nitrogen might dissolve in the plaque and cause or exacerbate neurological dysfunction. Is there any proof for this assumption? No, there isn't. On the other hand, and extending this line of reasoning, a rule of thumb might be derived:
1. it is probably not advisable to make decompression dives if active disease is present (Gd+MRI plaques or/and symptoms of MS), dives up to 10 m depth are probably save, but the exact risk remains uncertain.
2. it is probably save to dive if one does not have active disease (see below the advise of the British society),
3. the exact save interval is unclear (the period between the last manifestation and the dive), but according to the British, a year is a save period (but quite long).
4. if the disease is inactive and the patient does not have serious handicaps, impeding his/hers ability to dive, there is no additional danger.
5. location of the lesion is probably important: a high cervical spinal cord lesion as in my patient is an additional risk, because dysfunction at this level could result in tetraparesis or paraparesis.

It would be interesting to hear from other patients and care-takers.

Yours sincerely,

Rudolf


Multiple Sclerosis
The symptoms and signs of multiple sclerosis (MS) and optic neuritis are very similar to neurological decompression sickness and arterial gas embolism. Any neurological symptom arising within 24 hours of surfacing from a dive must be considered dysbaric in origin and the only method of establishing the diagnosis is by assessing the response to therapeutic recompression. Instances have occurred where new neurological symptoms have arisen following dives in individuals who have had suspected or confirmed multiple sclerosis. These have proved very difficult management problems for the attending diving physicians. However, the medical committee recognises that up to one-third of patients do not develop progressive disability and remain relatively unimpaired many years after the onset of the illness. The committee therefore considers that a prospective diver who has experienced the symptoms and/or signs of MS should wait for a period of at least one year before taking up scuba-diving. During that year, no further symptoms or signs of MS should become evident and there should be no further clinical deterioration in the patient.
If a diver with MS experiences further episodes of MS (in or out of the water) then he/she must cease diving for a period of one year during which time there should be no further signs or symptoms of MS and his/her clinical condition should not deteriorate further.
Consideration of individual cases may be undertaken by the medical committee. The position with isolated optic neuritis remains unclear, but a recent episode of isolated optic neuritis would also disqualify for a period of one year.
References:
Elliott DH, Moon RE. Manifestations of the decompression disorders. In: Bennett PB, Elliott DH eds. The physiology and medicine of diving. 4th ed. WB Saunders Co. Ltd. London 1993 p500.

[cheerleader]

I'd refer you to the research of Dr. Philip B. James, University of Dundee Medical School--who began looking at the similarities in decompression sickness during deep dives and neurological illness, specifically MS. He noted spinal degeneration in commercial divers, and suggests HBOT treatments. http://www.thelancet.com/journals/lance ... 1/fulltext
He's published much on the subject for the past 30 years.

Studies of bubbles formed on decompression in diving have demonstrated the importance of pulmonary filtration in the protection of the nervous system and that filtration is size dependant, as small bubbles may escape entrapment. Fluid and even small solid emboli, arresting in or passing through the cerebral circulation, do not cause infarction, but disturb the blood-brain barrier inducing what has been termed the 'perivenous syndrome'. The nutrition of areas of the white matter of both the cerebral medulla and the spinal cord depends on long draining veins which have been shown to have surrounding capillary free zones. Because of the high oxygen extraction in the microcirculation of the gray matter of the central nervous system, the venous blood has low oxygen content. When this is reduced further by embolic events, tissue oxygenation may fall to critically low levels, leading to blood-brain barrier dysfunction, inflammation, demyelination and eventually, axonal damage.

http://www.ncbi.nlm.nih.gov/pubmed/17439700

here is more of his published research--
http://www.ncbi.nlm.nih.gov/pubmed?term ... d=17439700

cheer

[centenarian100]

Wow Rudolf. Great post. Thank you for the info!

[centenarian100]

I am diver too, and you motivated me to not stop diving.

Way to go

[cleareaching]

I've just concluded a round with doctors on this same topic. I've always wanted to dive, but when I was very young I didn't have the money, then I got married and became a mum and I've just waited for my son to grow up and take him go diving together. In the meantime, I was diagnosed with MS (four and a half years ago, one episode, symptom-free ever since) but this summer, that my son was old enough to go diving, I took him and myself to a scuba diving school where I had to fill in this form and there is this question about neurological problems - I'm an honest person, so I explained my condition and they asked me for a doctor's certification to let me dive.

So I went to my neurologist first. He sent me for another round of MRIs etc. but the truth is he didn't have any clue whatsoever. He only said that he was afraid of underwater pressures.

Then I found out there was this medical center exclusively for divers with doctors specialising in HBO (hyperbaric oxygen) and diving. So I went there and I saw this doctor who is also head of the naval hospital's diving department. What he told me was that it is dangerous for me to go diving and he explained: MS causes these demyelinating foci (which in reality are inflammations) here and there in the brain and grey matter. What the organism does wherever there is inflammation is to send more oxygen at the point, because that's what it does to help it heal. This translates into more blood flowing to the area.

However, when diving, the veins that bring the blood to the area carry not only oxygen but nitrogen as well. And there is a strong possibility that this nitrogen, which arrives at increased numbers at the points of inflammation in the brain and the grey matter, will activate symptoms.

So, scuba diving is not advisable for people with MS who want to learn how to dive, because they run higher risk than any person without MS. If someone used to be a diver, however, and would like to continue, there is always the NitroX method, that causes lower nitrogen concentration in the body during diving. That's what the doctor said to me just yesterday and I wanted to share this with you. I hope you'll excuse my slips in English, as I'm not a native speaker.

I won't get at all into how I felt when the doctor offered me his hand and told me "I'm sorry"...

[cleareaching]

And a clarification: it's not nitrogen that can ignite symptoms, it's that nitrogen bubbles reduce the oxygen content of the blood arriving at the areas with inflammation or may altogether block the flow of blood in the micro-veins of the grey matter or the brain.

[NHE]

However, when diving, the veins that bring the blood to the area carry not only oxygen but nitrogen as well. And there is a strong possibility that this nitrogen, which arrives at increased numbers at the points of inflammation in the brain and the grey matter, will activate symptoms.

I'm not a scuba diver so I might be missing something in this doctor's explanation. However, 78% of the air we normally breathe is nitrogen and we already have nitrogen in our blood before we go under water. The problem divers face, e.g., the bends, is when they surface too quickly and the nitrogen dissolved in the blood comes out of solution and forms little bubbles which can block blood flow.

[cleareaching]

So, you're saying, one will only have a problem when going up too quickly? I frankly don't know, I'm trying to figure things out...

The doctor mentioned the decompression table and said that it is generally understood that this table is accurate by 98%, which sounds logical because it can't be that the same table is valid for someone who's 6 feet tall and beefy and someone who's only 5 feet tall and skinny, or for a granny and a teenager at the same time. So there's a 2% chance that something with the decompression process will go wrong, even if you do it "by the book" (or "the table" in our case). We, I mean people with MS, are more likely to be in this 2% given our condition, that's what I gathered from what he said.

He also said that a diver going up is like a fizzy drink, his body full of bubbles everywhere, and one needs to open the lid and let the bubbles out gradually. However, as the flow of blood in areas with inflammation is larger and, hence, there are more bubbles in these areas, the likelihood of bubbles blocking the blood flow in people with inflammations (like with MS) is stronger. And concluded: why run the risk? Look, if I were on my own, I would most probably give it a try with Nitrox, but I have two kids and I'm really thoughtful...

[lyndacarol]

I've just concluded a round with doctors on this same topic. I've always wanted to dive, but when I was very young I didn't have the money, then I got married and became a mum and I've just waited for my son to grow up and take him go diving together. In the meantime, I was diagnosed with MS (four and a half years ago, one episode, symptom-free ever since) but this summer, that my son was old enough to go diving, I took him and myself to a scuba diving school where I had to fill in this form and there is this question about neurological problems - I'm an honest person, so I explained my condition and they asked me for a doctor's certification to let me dive.

So I went to my neurologist first. He sent me for another round of MRIs etc. but the truth is he didn't have any clue whatsoever. He only said that he was afraid of underwater pressures.

Then I found out there was this medical center exclusively for divers with doctors specialising in HBO (hyperbaric oxygen) and diving. So I went there and I saw this doctor who is also head of the naval hospital's diving department. What he told me was that it is dangerous for me to go diving and he explained: MS causes these demyelinating foci (which in reality are inflammations) here and there in the brain and grey matter. What the organism does wherever there is inflammation is to send more oxygen at the point, because that's what it does to help it heal. This translates into more blood flowing to the area.

However, when diving, the veins that bring the blood to the area carry not only oxygen but nitrogen as well. And there is a strong possibility that this nitrogen, which arrives at increased numbers at the points of inflammation in the brain and the grey matter, will activate symptoms.

So, scuba diving is not advisable for people with MS who want to learn how to dive, because they run higher risk than any person without MS. If someone used to be a diver, however, and would like to continue, there is always the NitroX method, that causes lower nitrogen concentration in the body during diving. That's what the doctor said to me just yesterday and I wanted to share this with you. I hope you'll excuse my slips in English, as I'm not a native speaker.

I won't get at all into how I felt when the doctor offered me his hand and told me "I'm sorry"...

Welcome to ThisIsMS, cleareaching.

Let me get this straight: you had ONE episode 4 1/2 years ago and you have been symptom-free ever since. Can you be sure that you were not misdiagnosed 4 1/2 years ago?

Since the cause of MS is unknown and the precise mechanism is not known, it seems to me that you might not have had MS at all or that your body could have healed itself.

I assume that you have read the post by rudolf (a neurologist), dated April 6, 2013, found on this very page of this thread. I think it answers many of your questions. I hope others who scuba dive will add their thoughts. I understand that, as the mother of two children, you are cautious; but this shared experience (scuba diving school) with your son could be an important memory in the making.