Diving With Disabilities

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A Real Diving Challenge

This page is written and maintained by
Ernest S Campbell, MD, FACS

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Have you ever been on a night dive and had your lights go out? Or, imagine yourself doing a shore dive and you find that someone has tied your feet together; just imagine the difficulty of dragging yourself in and out of the water.

These are just two of the challenges that face disabled people who want to experience the serenity and beauty of scuba diving: the blind person is forever in pitch darkness, the paraplegic faces this wall every day.

In spite of these seemingly insurmountable obstacles, there are many disabled who are participating in scuba diving programs especially designed to assist them to experience our sport safely.

Below are listed various services and contacts for disabled persons who wish to learn more about diving:

Articles

• Dive Training for the Disabled: What is it Worth? Diver Magazine, August 1997


• "Soaring Below", by Vicki Stiefel.

'Alert Diver', March/April 1996; a publication of
DAN (Divers Alert Network)

• "Diving With Care",

Training and Medical Aspects of Diving With Disabilities,
Kimberly P. Walker, NREMT-P, DAN Training
Alert Diver, March-April 1996, p. 40.

• Scuba Diving With Disabilities Robinson, Jill. & A. Dale Fox:

(Champagne, Illinois: Leisure Press, a Division of Human
Kinetics Publishers, Inc. Box 5076 Champagne, Il 61820. 1987)
"A valuable supplement to any diving manual or class. For the disabled diver or the instructor who wants to teach disabled divers, the book is must reading."

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Associations and Clubs and Training

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Amazing Seals

amazingseals.com

St. Paul/ Minneapolis Minnesota

Masha Bowen coordinator

divingunderground@hotmail.com

(651)263-9707
We have recently started this exiting new program and working with local rehabilitation centers providing scuba experience for disabled divers. We have PADI and HSA certified instructors.

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Disabled Diver training in the San Diego area.

John Ellerbrock
PADI Master Instructor
Pinnacle Divers

PinnacleDiver@home.com
619.997.DIVE (3483)

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Eels on Wheels Adaptive Scuba Club
Aron Waisman,
12338 Limerick Ave,
Austin, Texas, 78758
(512) 873-9121
awaisman@austin.rr.com
http://www.Eels.org

Article "Challenges of Diving With Disabilities", by Tammie Shelton
http://scuba-doc.com/DivingDisabilities.pdf

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National Instructors Association for Divers with Disabilities (NIADD), Dorothy Shrout, P.O. Box 112223, Campbell; CA 95011-2223; (408) 379-6536, (408) 244- 8652 fax
NIADD, San Jose, CA. Contact Frank Degnan at Any Water Sports, (408)244-4433. Frank and Dorothy Shrout organize this.

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Handicapped Scuba Association, Jim Gatacre, 1104 El Prado, San Clemente, CA 92672-4637, (714) 498-6128, HSA@HSASCUBA.COM

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Houston Disabled Scuba Divers Association, 403 East Nasa Road 1, Suite 325, Webster TX 77598-5314, (713) 477-5556, swa@neosoft.com

Southern Wheelchair Adventurers Association of Galveston-Houston, 403 East Nasa Road 1, Suite 325, Webster TX 77598-5314, (713) 477-5556, (Lytle Seibert); swa@neosoft.com,

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Canadian Scuba Diving Clubs for Divers with Disabilities

• Club Challenge, 3108 Woodland Park Drive, Burlington, Ontario L7N 1L2 Canada; (905) 634-8234 (Joan Muir; Burlington), (905) 844-4160 (Annis Dixon; Oakville), (519) 658-5838 (Margaret Sanderson; Kitchener), (416) 485-7355 (Jerry Ford; Toronto)


• Pacific Northwest Scuba Challenge Association, 14286 72nd Avenue, Surrey, British ColumbIa V3W 2R1 Canada; (604) 525-7149 (Ron Stead)


• Persephone Scuba Diving Club, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec H4B 1R6 Canada; Louis Jankowski, Ph.D., (514) 848-3320 (office), (514) 630-1429 (home)

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Diving With Disabilities
Bruce Van Hoorn
14960 Penitencia Creek Road
San Jose, CA 95132
(408)258-9789

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Dis-A-Dive
Bart Schassoort
3530 Warrensville Center Road
Suite 200
Shaker Heights, OH 44122
(216)241-3483

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Open Waters, Paul A. Rollins, Project Coordinator, or Steven Tremblay, Project Director, c/o Alpha One, 127 Main St., South Portland, ME 04106-2622; (800) 640- 7200 (voice or TTY) or (207) 767-2189 (voice or TTY), (207) 799-0355 fax, open_waters@alpha-one.org , http://www.alpha-one.org

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The Australian Underwater Federation has published a booklet on teaching disabled divers. It can be obtained from theAUF Office,
PO BOX 1006,
Civic Square, ACT, 2608, Australia.

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IAHD, is a non-profit organization for disabled divers.
www.iahd.org and www.iahd-americas.org

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Norges handikapfellesskap in Norway,
Dive Training for the disabled.
www.handikap.no
e-mail:tomm.fredriksen@handikap.no

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Undercurrent Online Update for Subscribers

Undercurrent -- Consumer Reporting for
the Scuba Diving Community since 1975
www.undercurrent.org

Dive News

June 3, 2009

You have received this message because you are a current paid subscriber to the print edition of Undercurrent (with subscriber number ,or are a current Online Member (username = ecscubadoc , expiring 2012-12-31 ). Removal instructions are below.

Read or download the current issue*

Check Out Our New Blogs and Forum: We've started running blogs on our website, with updates coming regularly. You can read original pieces by the likes of Burt Jones and Maurine Shimlock, Bret Gilliam, John Bantin, Doc Vikingo and even me, Ben Davison. Or go to our now-public online forum, post your questions, advise others, run your own commentary. Take advantage of the Undercurrent community at Undercurrent .

Belize Island Beachfront Acreage Available: As Undercurrent has often reported, diving off Saint George's Caye is as good as it gets in Belize. Protected by the Barrier Reef, the nearby reefs are in fine shape with little diving pressure, though it's only a 20- minute boat ride from Belize City. Fred Good, who built the venerable Saint George's Lodge (one of our favorites) in 1977 and sold it in 2004, called to tell us he is selling a large beachfront parcel on St. George's. It's about three acres with 900 feet of beach frontage. It could accommodate a dive resort, up to three family compounds, or be subdivided into 12 building lots, and Fred is willing to actively consult or project-manage because he has already "been there" and "done that." There's a photo of the land above. For more photos and details, click on www.belizebeachfrontproperty.com

Stop Shark Finning in Palau: Diving the famed Blue Corner won't be the same if Palau's politicians approve Senate Bill SB8-44 to permit commercial fishing for sharks and shark finning. A follow-up punch is SB8-50, which would encourage commercial fisheries in Palau's waters by granting them a five-year tax exemption. This would gut the 2004 legislation that banned shark fishing by foreign fisheries, one of the most ironclad laws in the Asia-Pacific area. To stop this nonsense, sign the petition sponsored by SharkSavers.org to keep the bills from becoming law:
http://www.sharksavers.org/get-involved/sign-these-petitions/542-petition-to-palau-stop-senate-bill-8-44-on-shark-fishing.html .

Take a Great Trip on Fiji's Nai'a and Support the Coral Reef Alliance: Join CORAL to celebrate its 15th anniversary by taking a dive trip from November 21 to 28 aboard the Nai'a, the 120-foot luxury liveaboard sailing vessel that Undercurrent readers love. You'll visit spectacular sites near Lomaiviti, Bligh Water and the Namena Marine Reserve. CORAL senior program staff will interpret what's happening underwater and discuss reef ecology and Fijian culture. You'll visit a village where CORAL is working with the community to preserve its reefs. Experience some of the world's best diving while supporting the people who depend on reefs for daily survival. Visit http://www.coral.org/dive_trip to learn more or reserve your spot now - the folks at CORAL tell us the trip is filling quickly.

Divers, Pick Paper Over Plastic: Undercurrent subscriber Hilton Fitt-Peaster (Boulder, CO) told us about a slideshow done by the Pocono Record showing how plastic bags make their way to the ocean and seriously harm - and kill - marine life on the reefs we dive.
(http://www.poconorecord.com/apps/pbcs.dll/article?AID=/20080506/MULTIMEDIA02/80505016)

Are You Unsatisfied with an Equipment Warranty?: We want to know if divers are satisfied with their regulator or computer warranties. Ever have a problem and need to get it resolved under the warranty? Have you had a problem with an item purchased from an Internet seller? Did it or the manufacturer honor the warranty? Has your dive shop handled a warranty problem for you? Let me know your experience, good or bad, by e-mailing your story to me at EditorBenD@undercurrent.org.

Basic Underwater Photography: If you're just getting started or want a refresher course, for $5 you can download this just-published manual by writer and photographer Paul J. Mila. It's got everything you need to get good images by using just your camera's automatic settings. Get details and order the book at www.paulmila.com.

Malaysia Search Called Off for American Diver: Malaysian officials have called off the search for Kenneth Wayne, who disappeared at sea on May 24, because weather conditions were too dangerous for the rescue divers. Wayne, 62, was sailing his 65-foot yacht Sampai Jumpa when it collided with another vessel 31 miles off Kuantan. Wayne, another diver and the three-man Thai crew had to jump into the sea after being rammed by the other boat, which kept on going. The other four were rescued a few hours later by a fishing boat but officials believe Wayne is trapped in the boat, lying some 130 feet deep in the sea.

Florida's Newest Artificial Reef Is Ready For Diving: After a decade of planning and an $8.6 million price tag, the General Hoyt S. Vandenberg was finally sunk on May 27 and is now a public dive site. Forty-four explosive charges sent the 524-foot-long boat 140 feet to the bottom, seven miles south of Key West. The Vandenberg was used to transport WWII troops, bring refugees to freedom, and as a setting for the sci-fi movie Virus. The topmost portion of this former Air Force missile tracker is at 40 feet, making it accessible to divers of all levels. Minutes after it sank, a sea turtle, a pod of dolphins, barracudas and a hogfish checked out the ship. Contact any Key West dive shop for details.

New Flights to Bonaire: American Airlines canceled its weekly flight to Bonaire last month, but Insel Air has stepped in with a weekly Saturday nonstop from and to Miami, starting July 4. Check flight times and prices at www.fly-inselair.com .

Lembeh Straits: Been diving there recently? What did you think of the fish life, especially on muck dives? Was it up to your expectations? Let me know by e-mailing your comments to EditorBenD@undercurrent.org.

Coming Up in Undercurrent: Diving in Puerto Rico and on the Solomon Islands' Bilikiki: are they worth the trips . . . . . should you sauna before a dive? . . . where Hawaii's fish have gone - it's not just the fishermen taking them . . . how and where you can recycle used scuba gear . . . learn to master diving from a kayak . . . why what you eat affects how you dive . . . the best website for determining the dangers of certain overseas dive sites . . . and much more.

Ben Davison, editor/publisher
Contact Ben

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Secrets of the Deep

Here is an interesting article in the New York Magazine about diving along the waterfront of New York City. The entire article can be seen at http://nymag.com/news/features/56609/

What lies beneath the surface of New York Harbor? For starters, a 350-foot steamship, 1,600 bars of silver, a freight train, and four-foot-long cement-eating worms.

• By Christopher Bonanos
• Published May 10, 2009

Commercial diver Lenny Speregen and NYPD detective John Drzal. Illustrations by Mark Nerys (Photo: Matt Hoyle)

The steady transformation of New York’s waterfront from wasteland to playground means more of us are spending time along the city’s edge. That can lead a person to wonder: What, exactly, is down there? Until recently, we had patchy knowledge of what lies beneath the surface of one of the world’s busiest harbors. What we did know came largely from random anecdotes, and depth soundings done the way Henry Hudson did them—by rope and lead sinker. This first GPS-era picture comes from the team at Columbia University’s Lamont-Doherty Earth Observatory, who have methodically swept the lower Hudson with state-of-the-art sonar. LDEO’s Dr. Frank Nitsche stitched together their data, along with several other researchers’ work, into this elegant color-keyed map, which we’ve supplemented by talking with sea captains, historians, and the divers pictured above. There’s a whole other city down there. Here and on the following pages is your guide.

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DAN Names New Head of Medical Department

Dr. Nicholas Bird Joins DAN Staff as New Head of Medicine Department

Anyone who has called the DAN® 24-Hour Diving Emergency Hotline or used the non-emergency Medical Information Line knows the outstanding caliber of those who comprise DAN’s medical department. That legacy now continues with the addition of Dr. Nicholas Bird, DAN’s incoming vice president of medical services.

Dr. Bird joins the DAN staff in June. He comes to DAN from the Dixie Regional Medical Center in St. George, Utah, where he currently serves as the medical director of hyperbaric medicine. His acceptance of his new position at DAN follows an intensive and exhaustive months-long search by the organization to find the right candidate for the job.

“We knew the incoming VP would have some large shoes to fill,” said Dan Orr, president and CEO of DAN. “Our retiring VP of Medical Services, Joel Dovenbarger, has served this organization for almost all of its 30 years, and his contributions to its success cannot be measured. We knew it would take a special person to succeed him, and Dr. Nick Bird is that person. He’s a highly qualified and capable physician with extensive experience in hyperbaric medicine. He’s a great fit for our culture and the needs of our medical department, and he’s an active diver who understands and enthusiastically supports our mission and philosophy. We couldn’t have asked for more.”

Dr. Bird’s qualifications include a medical degree from the Royal College of Surgeons in Ireland and the completion of his family medicine residency at the University of Washington at Vancouver, as well as a fellowship in diving and hyperbaric medicine at the University of California at San Diego. He is board certified in Family Practice and Undersea and Hyperbaric Medicine. He served in the U.S. Air Force as a Flight Surgeon and was honorably discharged with the rank of Major, but not before serving as the final Commander of the Base Hospital in Jordan during Operation Iraqi Freedom.

In addition to extensive credentials, Dr. Bird’s character was also highly admired and praised by the candidate selection committee. Said Dr. Brett Hart, a member of DAN’s Board of Directors and the selection committee: “[Our] decision to support Dr. Bird's selection as DAN's new Vice President of Medical Services came down to three things: honor, courage and commitment. Beyond being a capable physician, he consistently demonstrated the moral character necessary to 'do the right thing' in terms of supporting DAN and its mission."

Added Dick Clarke, president of National Baromedical Services and another member of the selection committee: “Dr. Nick Bird brings to DAN solid medical credentials, excellent interpersonal skills and great enthusiasm. DAN's membership will be that much better off as a result of Dr. Bird's close coordination of emergency evacuation and related medical care with all those who work globally on behalf of the injured diver.”

Although the start of Dr. Bird’s tenure at DAN is still a few weeks away, his enthusiasm for his new position is unmistakable. “DAN [is] integral to the diving community,” he said. “As a resource for information, a lifeline for injured divers, a conduit for research and a pioneer of safety training, DAN has distinguished itself as an industry leader.

“I am honored to have been chosen as the new VP of Medical Services and look forward to advancing DAN’s mission of dive safety. As a hyperbaric physician, I am especially interested in DAN’s goal both to establish and enhance the quality and integrity of medical care for divers in remote areas. I have joined DAN at an exciting time in the organization’s development and look forward to rolling up my sleeves and diving in.”

Dr. Bird’s addition to the DAN staff is certainly one reason it is an exciting time at DAN, and we hope you’ll join us in welcoming him both to DAN and the dive industry.

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Undersea and Hyperbaric Medicine Board Review Course

The University of Pennsylvania School of Medicine (jointly sponsored by DAN) is conducting a Undersea and Hyperbaric Medicine Board Review Course in Philadelphia, PA on 8/21-8/23/2009.

Presented by the Institute for Environmental Medicine/Division of Hyperbaric Medicine, this conference is designed to prepare physicians eligible to take the ABPM of ABEM subspecialty exam in Undersea and Hyperbaric Medicine. Upon completion of the program, learners should be able to:

- Describe the physics of, and human physiological responses to, immersion and high-pressure environments
- Describe the pathophysiology and treatment of medical conditions resulting from diving accidents and injuries associated with changes in pressure
- Understand and describe the medical assessment of fitness for diving process
- Discuss the mechanisms of action, complications, and contraindications of hyperbaric oxygen therapy
- Describe the pathophysiology and treatment of medical conditions in which hyperbaric oxygen therapy is indicated
- Effectively use this overview to prepare for the subspecialty board examination in Undersea and Hyperbaric Medicine

To download a course brochure and registration form, please visit:
http://www.diversalertnetwork.org/Events/Event.aspx?EventID=704

Yours in diving safety,

DAN Medical Services

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To Pee or Not To Pee?

Here is an article that I wrote some years ago for Scuba Diving Magazine.


By Ernest S Campbell, MD

What Makes Divers Want to Pee While Diving?

When diving, I suddenly get the urge to pee, even though I voided only minutes before. Why do I need to pee so soon?
via e-mail

This physiological phenomenon is known as immersion diuresis, a fancy term for your body's response to feeling under pressure. Blood is shifted to your body's core, and the hypothalamus gland thinks this means your total fluid volume is too high and instructs your kidneys to make urine. What can you do to avoid immersion diuresis?

Avoid diuretics like caffeine before you dive.

Intentionally dehydrating yourself might seem like a good idea, but dehydration increases fatigue and predisposes you to decompression sickness.

Try to stay warm. A side effect of your body's response to cold is the production of urine. Wearing a hooded vest under your wetsuit may save you from having to empty your bladder when you least want to. On the boat, stay out of the wind, bundle up and wear a hat.

Be healthy, sober and rested. A variety of over-the-counter and prescription drugs can interfere with your body's heat conservation mechanisms, typically by preventing the constriction of blood vessels near the skin. Antihistamines are particularly suspect. Alcohol is worse.

Although adipose tissue insulates well, allowing fat people to tolerate cold water immersion longer than lean people, it's better to be physically fit.

The Science of Warming Your Wetsuit

You try to hold it in, but can't. Desperate, you pee in your wetsuit. You hope no one will notice. But what can you do? Drink less water?

No, drink more.

The Dehydration Factor

Deliberately dehydrating yourself, in the hope you can hold it until the surface interval, just makes the embarrassment problem worse.

Because of immersion diuresis and your involuntary reaction to cold, chances are you'll have to pee anyway.

Dehydration makes the result stronger in odor and color.

The Embarrassment Factor

There is a well-worn joke that divers belong to two schools regarding peeing in their wetsuit: Those who do and those who lie about it. If you do have to pee in your wetsuit, know this:

If you're well-hydrated, your urine will be nearly clear and odorless. Almost like water. So who's to know?

There's no health risk to peeing in your wetsuit. Most people don't realize that urine is sterile, unless you already have an infection of the urinary tract. The worst you have to fear is a case of diaper rash if the urine stays against your skin several hours, and this too is less of a problem when your urine is diluted. Solution: Open your wetsuit under water and rinse it between dives.

The Warmth Factor

True or false? Urinating in a wetsuit is a quick way to warm up. False, and here's why: You may feel warm initially, but it will actually lower your body's warmth. And, if you're wearing a tight-fitting wetsuit that doesn't flush easily, a semi-dry or dry suit, then this warming-up technique loses a lot of its appeal.

What To Do with a Wetsuit that Stinks

It couldn't be helped. You felt the urge to pee during a dive, and so you did. Now you're afraid your wetsuit will stink. What should you do?

Give it a hot rinse. This is the most important part of regular stink prevention. Walk right past the rinse tank where other divers are busy dunking their suits in the filth rinsed off other gear, and go back to your room at the resort or home and rinse it in hot, fresh water. The easiest way to do this is to take your suit in the shower with you. Hot water is better than lukewarm water for breaking down salts from the ocean and from your body.

Hang it. After rinsing, hang your suit to dry on a wide wooden or plastic hanger, preferably one made for wetsuits. Use a wide hanger to keep the front and back of the suit apart so it can dry more quickly.

Soap it. Every once in a while give your suit a soapy bath. Scrub it well inside and out. Use a sponge on the slick neoprene and a soft-bristled brush on any nylon linings. Just about any kind of soap will work to kill the odor, but some are better than others. The best soaps for the job are commercially available "wetsuit shampoos" (check your local dive store) or a gentle baby shampoo. Next best are regular bath soaps and shampoos. Dish and laundry soaps are too harsh to use regularly on your wetsuit, but will do the job in a pinch. Never have your suit dry cleaned.

Deodorize it. If your suit still reeks, you might want to deodorize it. "Sink the Stink" (www.flinet.com/gulfstream/sts.html) is an all-natural deodorizer made specifically for de-stinking wetsuits.

Diving With Cirrhosis and Ascites

Cirrhosis and Ascites

Here's a query from a scuba instructor:

57 year old male, history of alcoholism & suffering cirrohsis of the liver. Very large, distended belly ( has the largest "outie" belly button you've ever seen! ), but otherwise not obese. Passed the N.A.U.I. pool test better than most of his classmates. Claims his drinking days are past & has non-diving physician, unrestricted approval to participate. No other medical contraindications noted on the standard N.A.U.I. medical questionaire. He is an educated man ( prof. engineer ) with previous sport diving experience years ago... What is your advice?

Answer:
It is highly likely that your diver has ascites (large quantities of free fluid in his abdomen surrounding his organs). In addition to his umbilical hernia (which can rupture easily under these circumstances) which has occurred in response to the excess pressure of the fluid - it is also highly likely that he has esophageal varices or dilated blood vessels in the lower end of his gullet.

Due to the effects of immersion on the blood supply of the body, during a dive blood is shunted from the periphery into the blood vessels of the gastrointestinal tract, liver and spleen. This would cause dilation and possible rupture of the esophageal varices with massive hemorrhage. Add to this the acid reflux changes that occur about the cardia (lower end of the gullet and upper stomach) due to the action of Boyle's law during ascent and we have a set up for rupture of not only the varices but the stomach.

This not just a theoretical possibility but has been reported.

Massive variceal bleeding caused by scuba diving.
Am J Gastroenterol. 2000 Dec;95(12):3677-8.
Nguyen MH, Ernsting KS, Proctor DD.
http://snipurl.com/3s76

Finally, cirrhosis of the liver to the extent that it causes ascites can have significant mental effects of obtundation of the intellect. Hepatic encephalopathy can cause apathy, confusion, disorientation, drowsiness and slurred speech. This alone would be dangerous enough to disallow diving.

Because of what I consider significant risk, I would not certify this person as fit to dive.