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.
hspace=5 A nurse holds a defibrillator. In the case of a heart attack the jolt of electricity settles the heart down into its normal rhythm, but it is also used to treat irregular or fastheartbeats.
I have paroxysmal atrial fibrillation (AF). I have woken in the early hours to feel my heart fluttering four times this year, despite taking Sotalol hydrochloride. Three times I have been cardioverted (electric shock) and once needed a digoxin drip. I am otherwise in good health and tests for heart damage are negative. I am 49 and have been diving since 1993. I have never felt my heart go out of rhythm before, during or after diving, but is it safe for me to carry on diving while on Sotalol

Abnormal heart rhythms need to be assessed carefully to form an opinion on fitness to dive. Information required would include all investigations done, any heart abnormalities found and, more importantly, the degree of disability that they cause when they come on, such as shortness of breath or dizziness.
Should problems occur under water, it would leave a diver incapacitated and unable to help him or herself or others. Also, Sotalol is a beta-blocker, which is not recommended when diving because of its possible effects on the lungs.
Provided all criteria are met, sometimes restricted permission to dive is given. Restrictions would include no-stop diving, depth (to allow easy access to surface) and staying with experienced buddies.
You need to be assessed carefully by a medical referee or other doctor experienced in diving medicine.

Diving between dental visits
I am set to have a capped tooth removed, and will have a temporary denture. Three months later a hole will be drilled into the bone and an implant inserted. Six months after this, the new tooth goes in. During this time can I continue diving Is there a chance of a trapped air space

Dentures should be worn by divers only if they are well secured. After all, they do hold your regulator second stage in place! I suspect that there is very little risk of trapped air here, but it is wise to mention to the dentist that you dive and that any air spaces should be carefully packed or removed. This is also true when divers go to have fillings.
There are issues around the denture and the change in bite, however. Loose teeth / dentures have the potential to be inhaled, particularly if broken in panic situations. As with all dentures, if they dont fit securely, remove them for diving. The change in bite may make holding the mouthpiece more difficult, and it is worth practising before going into open water.

Lithium aftermath
If a sport diver with 11 years experience was put on a long-term course of lithium after a brief (2-3 weeks) hospitalisation eight years ago, and has been stable since, could he still get certified fit to dive, to do a few leisure dives a year in warm water at depths of 8 -16m

There are several issues here. Lithium is usually given for the control of manic depressives, a condition which in its own right makes diving unwise.
Second, lithium has a probable increased risk of toxicity in divers because of the dehydrating effects of diving and intra-/extra-cellular shift of ions at depth. On the information given, I would not have thought certification as fit to dive possible.

The trouble with tobacco
I am male of 50. I was diagnosed with asthma when I was four and take Ventolin for it. In the past year a hospital consultant indicated that I do not have asthma, but do have chronic lung disease due to smoking, which I gave up three months ago. For this I take four puffs of Atrovent and four of Seretide a day. Can I learn to dive

The simple answer is no, you cannot dive. You probably did have asthma as a child, but years of this and smoking has caused permanent damage to your lungs. When the lungs are damaged like this, there is a great risk of air trapping, which can lead to a pneumothorax (burst lung), and CAGE (air getting into the brain, causing a stroke-like effect).
Im afraid you will have to look for another sport to take up.
As an aside, for other divers who smoke, there does appear to be increased risk of decompression illness which is possibly related to minor, early damage caused by smoking. As always the advice is - stop smoking.

How safe are antihistamines
I have quite a severe reaction to mosquito bites. Can I take antihistamines when diving Can you recommend any

Few drugs have been tested under pressure, but widespread use of the newer non-sedating antihistamines and the lack of any link between them and any diving incident make cautious use probably acceptable.
Older sedating antihistamines such as piriton should not be used. There are several over-the-counter preparations, with little to choose between them.

hspace=5 Depressing news
I take fluoxetine in the morning for depression, which I am sorting out with a counsellor. I also have trouble sleeping, so I take temazepam at night. Am I fit to dive

Neither temazepam nor fluoxetine is compatible with diving. You should not be diving until both the depression is sorted out and you are off medication.
Two problems relate to the condition - first, depressed divers are less able, more prone to panic and thus more at risk. Second, the temazepam is sedating you, with hangover effects in the day - possibly made worse by increased pressure.
Fluoxetine, on which we have little data, is probably OK but the UK Sport Diving Medical Committee still advises against diving on the medication. I would regard you as not fit to dive.

Family planning
My husband and I hope to start a family, but should I stop diving while we try to conceive I realise that I should do so if I become pregnant, but is there any risk to a foetus in the two weeks or so before a period is missed and a test done Reading suggests that problems are likely to occur only after the placenta forms, which I understand does not happen for at least a couple of weeks after conception.

There is limited data available, because who would take the risk Some animal trials have seen bubbles pass across the placenta, so it has been presumed that the baby would be at increased risk and diving should be avoided.
The early stages of pregnancy are more difficult. With one in six pregnancies failing in less than 12 weeks anyway, who is to know whether diving increased the risk
A DDRC study showed no apparent increased risk of miscarriage in women who dived in early pregnancy. I have come across many women who found themselves pregnant after diving and had normal babies.
I suspect that the risk will be small, but it is not known. You must decide.

Bodybuilders beware
Ive started to take some bodybuilding supplements called norateen heavyweight II which, as I understand it, are testosterone and growth-hormone boosters. Will this affect my diving

I had not heard of this substance, so researched it on the Internet. It is claimed to be naturally occurring but to increase testosterone and growth hormone to unbelievable levels. It was also implicated in a rugby player being banned after drugs testing. If the claims are true, side-effects could include severe mood disturbances and aggressive outbursts at least.
Straightforward vitamin supplements and high-protein drinks are OK but anything else should be avoided. Some illegal drugs used in bodybuilding can cause severe mental disturbances, liver, kidney and heart damage, impotence and other serious side-effects. These are not compatible with diving and should be regarded as potentially harmful drugs.
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