Find here your most Frequently Asked Questions.

Q: I want to dive with Blue Water Diving Center, do I need to produce a medical certificate to dive?

Our answer: If you are in good health, the medical attest is not mandatory. You will be asked to fill in a medical questionnaire on your medical history. Depending on your answers, a medical certificate could be necessary.

The fact that you are asked a medical certificate for diving does not barr you from diving, it just means that your health situation of the moment needs to have the approval of a medical doctor.

For Dive courses and young divers a medical certificate is compulsory as per the 2012 MSDA Safety Norms.

 

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Heart Problems and Diving

Q: I have medically controlled blood hypertension, can I dive with Blue Water Diving Center?

Our answer: Yes, it is possible in some cases to dive with us. However you must produce a valid medical certificate from a specialist doctor allowing you to dive. Warning! Some medications can be formal contra-indication to diving! (Partly Substracted from DAN medical magazine reports)

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Q: I had a heart valve replacement when I was young. Can I learn to scuba dive?

 

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Q: I have a heart murmur, but I would like to learn to dive. I'm in good health. Am I at higher risk?

Our answer: A heart murmur is an extra sound that can be heard during chest examination with a stethoscope. The opening and closing of the heart valves produce expected and predictable sounds in individuals with normal heartbeats. Murmurs represent extra sounds caused by turbulent or abnormal flow of blood past a heart valve, in the heart itself or in great vessels (i.e., aorta, pulmonary arteries).

Some murmurs occur strictly from increased flow. For example, pregnant women often have a functional murmur due to a greater blood volume and hyperdynamic metabolism; these are benign. Other murmurs are due to damaged heart valves and represent significant pathology. Damaged valves may either restrict blood flow (stenotic lesions) or allow blood to flow back into the chamber of the heart from which it had just exited (regurgitant lesions). Heart valves can be damaged due to infection, trauma, heart muscle damage (myocardial infarction), or an individual may be born with a structurally abnormal heart valve.

Fitness and Diving Issue

Stenotic lesions, such as aortic and mitral stenosis, restrict efficient blood flow and may have serious consequences during exercise. Significant aortic stenosis places an individual at greater risk for sudden cardiac death while exercising; it is a contraindication for diving. Mitral stenosis also limits the response to exercise and, over a period of time, can result in congestive heart failure.

Regurgitant lesions pose somewhat less of a risk during diving. Over a period of years, the heart will be taxed by the extra work necessary to pump blood, and heart failure may be the long-term result. Divers with these types of heart valve problems may safely participate in diving if they have no symptoms and have normal left ventricular structure and function, as evidenced by an echocardiogram. (Partly Substracted from DAN medical magazine reports)

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Q: I have recently had a defibrillator implanted by my doctor. After I recover, what are my chances of going back to diving? I am told that it works as a pacemaker too.

Our answer: These implantable devices have been found to benefit patients at a high risk of ventricular tachycardia, ventricular fibrillation, or other rhythm defects that can lead to sudden cardiac arrest. The pacemaker feature will increase the heart rate of the patient if it slows to an inefficient rate.

With or without the pacemaker feature, these internal devices are used to treat potentially life-threatening rhythms. It is the opinion of diving medicine professionals that due to this potential life threat, individuals with these implanted devices are disqualified from diving.

These devices are intended to prevent sudden cardiac arrest, but the heart itself may be in generally poor health which is not compatible with safe diving. As relaxing as diving is there is still an increased work-load placed on the heart. The heart needs to be able to respond effectively to any increased exercise demand, especially in an emergency situation. A heart that is prone to life-threatening rhythms has most likely sustained injury from coronary artery disease or other conditions that affect the muscle tissue of the heart, or its electrical pathways. Any exercise restrictions from the diver’s cardiologist would be a good indicator that diving would hardly be in their best interest.

To date, limited testing has been performed on implantable defibrillators regarding the effects of increased ambient pressure. There is an air space in the device and only limited testing is reported to 40fsw. This is not considered to be an adequate testing-depth for recreational diving. There is no data available to determine what (if any) effect increased ambient pressure may have on the function of the device – especially in terms of repeat exposures. (Partly Substracted from DAN medical magazine reports)

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Q: My doctor has started me on Warfarin (Coumadin). How will this affect my diving?

Q: I recently went on a dive trip to the Indian Ocean and was almost denied diving because I had a heart attack four years ago. They were not going to let me dive even though I was a DAN Member, and they wouldn't call DAN to find out if it was OK to dive.
I am in very good physical health and have made 10 to 15 dives per year since my heart attack. How can we better inform some dive resorts about letting people with certain medical issues dive?.

Our answer: There is no single solution for this situation. Fitness and diving issues are difficult for both the diver with a health concern and the resort or dive operator sponsoring the dives. Individuals respond differently to the same disease, and not all divers may have the same physical capabilities after a heart attack (myocardial infarction, or MI).

So, who can dive? Who can't? First, the situation you faced occurs more often than many divers believe. As divers grow older, they may acquire medical conditions or illnesses. Your case involved cardiovascular disease, which is common among older divers. Unless divers are committed to a regular fitness program and periodic medical exams, they may not even be aware that they have a potentially serious cardiovascular problem.

The first sign or symptom of cardiovascular disease can be chest pain - or your first heart attack. DAN diving fatality statistics reveal many cases of sudden death due to cardiovascular disease with no prior history of it. In that regard, a fit diver who has recovered fully after an MI may have less risk while diving than many active older divers.

Usually the diver's personal physician will decide if the diver is capable of full activity without restrictions, including scuba, after a heart attack. A discussion of the issue can be found in Diving Medicine, third edition, edited by Alfred Bove, M.D.

If the diver meets fitness requirements, the physician can recommend diving. However, there is no guarantee that a cardiovascular event will not occur while diving. The resort operator cannot be made responsible for deciding who can and cannot dive when there is a medical issue like cardiovascular disease in question.

Even if DAN is called, our physician would have no knowledge of the health history of the diver. If you know who you are going to dive with on a trip, notify the shop ahead of time to prevent any misunderstanding. If you have health issues, have your physician give you written documentation that you have met appropriate health requirements for diving. (Partly Substracted from DAN medical magazine reports)

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Cholesterol Medications & Diving

Q: I'm a scuba instructor for several certifying agencies. In the last few years I've noticed more open-water and advanced students taking medication to lower their cholesterol. Are these medications safe to take when scuba diving? Is there anything else I should be concerned about?

Our answer: At this time, there is no known interaction between the effects of cholesterol-lowering (hypolipidaemic) agents and diving. But this is not the complete answer. Some cholesterol-lowering medications can cause side effects which might impair diving performance; others may cause symptoms similar to decompression illness, such as dizziness, fatigue, paraesthesia (a burning, tickling or tingling sensation), peripheral neuritis (inflammation of a nerve), and muscle and joint pain.

Patients who take these medications regularly are usually aware of such side effects and, in the event of a dive accident, should be specifically asked about them. Another important issue for individuals taking hypolipidaemic medication is cardiovascular fitness. High cholesterol is one of several well-known risk factors for cardiovascular disease. Other risk factors include diabetes, hypertension, cigarette smoking, being overweight, a family history of heart disease before the age of 55, and simply being male (cardiovascular disease is more common in males). Any individual taking cholesterol-lowering medication should therefore receive the OK from his personal physician that he is physically fit and capable of sustaining exercise levels which are likely to be experienced while diving. (Partly Substracted from DAN medical magazine reports)

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Asthma and Diving

Asthma is a chronic disorder of the lungs in which there is a tendency for the muscles surrounding the bronchi (breathing tubes) to contract excessively. This causes a narrowing, or bronchoconstriction, with a resulting increase in breathing resistance, particularly during exhalation, which may manifest as wheezing, chest “tightness”, coughing or breathlessness. Learn about the effects of asthma and diving including the effects of asthma medication and diving, and how to determine if you’re fit to dive with asthma. This article is a stepping stone to help asthmatic divers try and manage this chronic disorder.

Many factors may trigger an episode of asthma or bronchial constriction including exposure to allergens, noxious fumes, cold air, exercise or respiratory infections such as “colds” or flu. The increase in breathing resistance due to narrowing of the airways may be aggravated by the collection of mucus within the airways. As far as diving is concerned, there are basically three issues that make scuba diving risky for asthmatics: (1) increased breathing resistance with build-upof carbon dioxide, (2) increased risk for lung overpressure injuries,and (3) effects of the medication on diving.

Increased breathing resistance

As soon as the human body is immersed in water, there is an increased resistance tobreathing due to the mechanical and antigravity effects of being in water. In addition, there may be greater oxygen consumption and carbon dioxide production due to exercise as this requires a greater exchange of air and more breathing effort. There is also the effect of depth on gas density: with greater density of gas comes a further increase in breathing resistance. In an individual with breathing difficulties due to asthma, these additional demands on the body may be sufficient to lead to a critical build-up of carbon dioxide with panic or loss of consciousness.

Lung overpressure injuries

Narrowing of the airways and mucus production impairs the ability to exhale easily. As a result, air trapping may occur during ascent, particularly in an emergency ascent due to panic or breathlessness. This predisposes the diver to pulmonary barotrauma leading to
pneumothorax, pneumomediastinum and/or cerebral arterial gas embolism.
Effects of the medication on diving The “reliever” pumps can lead to a tremor and anxiety, which may predispose to loss of dexterity and diving accidents. A further theoretical concern is that some of the medications also lead to dilation of the blood vessels in the lungs, which may cause a loss of effectiveness in filtering out small bubbles commonly formed during decompression. This increases the risk of paradoxical embolism (i.e. gas embolism not caused by pulmonary barotrauma). The risk is obviously difficult to quantify or prove.

Determining fitness to dive in diverswith asthma
To avoid risks related to impaired breathing and pulmonary overpressure, divers with asthma must have unimpaired lung functions that remain stable during the normal exposures related to diving. Divers who experience persistent or regular asthma attacks in response to exercise, cold or “stress” are discouraged to dive. Diving should obviously be avoided during and up to48 hours after an asthma attack or any upper respiratory tract infection causing pulmonary symptoms (i.e. coughing or wheezing). Previously the only asthmatics that were considered fit for recreational diving were those whose symptoms were completely controlled on inhaled cortisone. The use of a short-acting bronchodilator, also called “rescue” or “reliever” medication (e.g.Ventolin ® or Venteze ®) was not considered appropriate as its effects were unpredictable and short-lived. With more modern long acting bronchodilators (e.g. Serevent ®) or combinationbronchodilator/cortisone combinations (e.g. Seretide ®) – also called “‘controller medication” – some divers are now permitted to dive if their symptoms are controlled completely and their lung function remains stable and unimpaired.
However, the asthma should be stable for at least three months after starting the medication.

The following would indicate the need for reassessment of medical fitness to divedive: (1) any deterioration in pulmonary function, wheezing or regular early morning coughing; (2) any intercurrent asthma attack or need for “rescue” or “reliever” medication in addition to the long acting medication; and (3) any significant chest infection (i.e. symptoms lasting more than a week).

Asthma is known for its tendency to wax and wane. Symptoms appear with a chest cold and remain for several weeks thereafter. Autumn and spring may bring exposure to allergens that provoke attacks. As a result, fitness to dive cannot be assumed and it must be assessed consciously by the diver prior to each dive. Diving is not recommended unless the diver is completely free of respiratory symptoms before each dive. Indeed, most diving medical experts agree that asthmatics should not dive within 48 hours of using “rescue” or “reliever” medication and experiencing complete relief of symptoms.
If an asthmatic has an attack, spirometry (a common pulmonary function test measuring lung function) should be done to assess the severity and need for treatment. The individual should not dive until the airway function returns to normal. Mild to moderate asthmatics with normal screening spirometry can be considered candidates for diving if their exhaled volume ofair in one second (i.e. FEV1) is at least 75% of the full volume of exhaled gas (i.e. FVC). The risk of diving is probably acceptable if the diving candidate, with a history of asthma, shows no deterioration in lung function after strenuous exercise. However, divers must be made aware that they are facing an increased risk of an adverse event related to diving and no diver with asthma should be diving without restrictions. The minimum restrictions needed for diving are: (1) the diver should follow a personal testing protocol and (2) diving should be adapted to account for possible problems.

Personal testing protocol:
The first step is to ensure that your asthma is well controlled. This is done in collaboration with your treating physician. The control required for diving means that you should never, or very rarely, wheeze if on “controlling” medication or have to use your “reliever” medication.
The severity of attacks is also an important factor and persons who have needed hospitalisation for their asthma within the past five years should not dive. If the asthma is well controlled, the diver should be seen by a doctor specifically trained in diving medicine. The objective is to assess the lung function values and to determine whether enough reserve capacity exists. Many divers may then need to see a specialist pulmonologist for further evaluation.
After being cleared by the diving doctor, the diver should buy him or herself a peak flow meter (available at large pharmacies). Follow the instructions carefully to ensure that you perform the measurements correctly. The diver needs to perform a number of measurements per day for a period of at least two weeks. These measurements can be used to determine the “normal” peak flow values for the person. The person then performs a peak flow the day before diving and on the day of the dive. If the peak flow has decreased by more than 10% of the normal maximum value, the person should not dive until 48 hours after returning to normal. Example: The value of the early morning peak flow of the diver was 650 ml. A 10% drop in the value would mean that a value of less than 585 ml (650 ml – 65 ml) on the day of diving indicates that it is probably not safe for that person to dive. (Partly Substracted from DAN medical magazine reports)

 

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Ear Problems and Diving

Of all the potential problems that affect divers, ear and sinus problems are not only the most common, but also most likely to keep divers out of the water – for many the grimmest prognosis of all... This article offers an overview on the most common diving maladies related to the ears and offers some practical advice on how to prevent and manage problems if they occur.

Diving-related problems of the ear fall into two categories: (1) exposure to water and (2) exposure to pressure.

Water affects the quality of hearing and our ability to localise sound. Immersion also exposes the external ear to water with the risk of maceration (water-logging of the skin) infection.

Cold water exposure may cause dizziness due to stimulation of the inner ear. Over time, chronic exposure to cold water (i.e. less than 20˚C) That we shall discuss here!

Pressure, on the other hand, may result in trauma called barotrauma, ear squeeze (during descent) or reverse blocks (during ascent). It may also lead to the absorption of inert gas (i.e. nitrogen) with a potential risk of developing decompression sickness. Dizziness, or more specifically vertigo (i.e. a false sense of spinning) may occur during descent due to rupture of the ear drum with the entry of cold water into the middle ear, nitrogen narcosis, pressure on the ear drum being transferred to the inner ear (i.e. alternobaric vertigo), or high pressure nervous syndrome when divers dive deeper than approximately 150 m.

We could developp many chapters in relation with ear problems. Just to give some fast advices we are going to list the different equalizing manoeuvres et some preventions.

The first step is always prevention: Never dive with infected or tramatised ears!

Prevention for water exposition and infections: Before the dive in tropical waters, put some almond oil drops into the outer ear ducts. It will protech the skin and soften the ear drum.

After diving: rince ears with fresh and clean water and it most important if the water is polluted, use antiseptic or soap or gel. Remove water from ears after rincing. It is also gfood to put some drop of drying liquid that can be found at Chemists.

CAUTION, Never Ever put any solution or medicine in the ears if you suspect a rupture of the ear drum. Seek medical advice immediately!

There are many techniques for equalising the middle ear to ambient pressure. Only the most common and useful ones have been listed to provide divers with a number of options, as some people may respond better to one particular technique than to others. They include:

• Swallowing or yawning

• Voluntary Eustachian tube opening (beance tubaire voluntaire - BTV)

• Valsalva

• Toynbee

• Frenzel

• Twitching techniques

Swallowing and yawning:These are the natural ways in which the middle ear is equilibrated. Middle ear infections in  childhood are largely the result of failure of these normal mechanisms. Even in sleep, equalising occurs approximately every five minutes through swallowing, while it occurs every minute while awake.

BTV: Some individuals have the knack of opening their Eustachian tubes voluntarily by a kind of twitch in the throat or an invisible yawn.

Many professional divers eventually master this technique.

Valsalva: Perhaps the most popular equalising method is the technique described by Antonio Maria Valsalva in 1704. It involves blowing against a pinched, blocked nose so that air is forced up the Eustachian tubes, thereby equalising the middle ear. It can unfortunately be performed too forcefully, leading to inner ear problems. Therefore, the safest recommendation to divers is to blow harder than it would take to inflate a large balloon and to never perform an uninterrupted attempt of more than five seconds.

Toynbee: Joseph Toynbee described a technique of pinching the nose and swallowing simultaneously. The action of the soft palate and adjacent muscles then opens the Eustachian tube while a pressure wave in the nasopharynx moves air in and out of the middle ear. As a result, this is a very sensitive test for Eustachian tube dysfunction as only small pressures are involved.

Frenzel: A German flight surgeon, Herman Frenzel, described a technique for the benefit of Stuka pilots in WWII. It involves moving the tongue backwards quickly against the soft palate, thereby creating a pressure wave as well as positioning the muscles for easy equalisation. The technique is even better when combined with pinching of the nose. The best way to teach this technique is to have the subject say “kick” in the back of the throat while pinching the nose. It is a very gentle and therefore a very safe technique. People who struggle with the Valsalva technique often find that this technique works for them.

Twitching: This is a good technique to get people started who are unfamiliar with equalising. While pinching the nose, the subject swiftly turns the head to the side. The ear facing forward generally equalises. The technique canbe repeated for the other ear.

Head tilting: This technique corrects a synchronous equalising. Many divers find that one ear is more difficult to equalise than the other. The head is tilted sideways from the neck (so as to point the “bad ear” upwards) while keeping the shoulders horizontal. This stretches the folds around the Eustachian and straightens it, making equalising easier.

Edmonds: This technique exploits the effect of jutting the jaw forward. Again, this manoeuvre tends to open the Eustachian tube, and should be combined with other conventional equalising techniques.

Lowry: Another combination technique described by Christopher Lowry may be useful to improve equalising in general. It involves pinching the nose and blowing against a blocked nose while swallowing simultaneously. Although this is impractical to do with a regulator in place, it can assist with the discovery and improvement of equalising techniques.

Otovent®: A product distributed by Invotec International (http://www.invotec.net/otovent.html). The Otovent has been promoted for the prevention and treatment of otitis by treating negative ear pressure caused by Eustachian tube  dysfunction. This device, made up of a nozzle and a balloon, is very useful to train novice divers about the correct amount of pressure required to equalise. It also verifies effective attempts at auto inflation. Regular practice with the Otovent® may improve the ability to equalise.

In addition to equalising techniques, several known factors may compromise Eustachian tube function and should be  avoided or treated. Many people display a low-grade allergy towards dairy products. Avoidance of all dairy products two days prior to diving often provides significant relief. Some people have very sensitive nasal linings. These are the people who, for instance, tend to sneeze when their feet are in contact with a cold surface. Preventative use of nasal decongestants with diving may be appropriate for this group of individuals. Physical obstructions are not uncommon in the nose and may include fleshy outgrowths called polyps or a skew nasal septum. Corrective surgery is a legitimate and effective remedy for these conditions. Inflammation of the nasal passages also clearly compromises the ability to equalise.

Smoking and head colds prevent effective drainage of mucus from the sinuses and may predispose to ear and sinus barotrauma. It should also be remembered that the ears are really a “safety net” for the lungs: Blockage of the nasal passages and ears is not an isolated phenomenon. Frequently there is some blockage and inflammation in the airways of the lungs as well. However, whereas blockage of the ears will only result in pain during diving, blockage of the airways may present fatal complications.

Finally, chronic use of nasal decongestants may result in the rebound congestion that will make equalising problems worse. The two most commonly prescribed medications for equalising problems or middle ear barotrauma are pseudoephedrine tablets and oxymetazoline nasal spray. Both are chemical relatives of adrenaline (epinephrine) and narrow blood vessels to reduce engorgement. The use of decongestants for the purpose of diving can only be justified if it is intended to improve an existing ability to equalise, not to make it possible, and even then it should be taken with caution and for no more than five days.

Prolonged use causes rhinitis medicamentosa, a chronic stuffy, running nose that is unresponsive to decongestion. Finally, divers should know how to preserve and protect their ears. Upon discovering any equalising problem or ear pain, further descent should be stopped immediately. The diver should then ascend 3 to 6 fsw (1 to 2 MSW) to reverse the locked-blocked situation. Various techniques for ear equalising may then be attempted, bearing in mind that the ear should never be forced, and no attempt at blowing should exceed five seconds. If all these measures fail, the dive should be ended.

(Partly Substracted from DAN medical magazine reports)

 

"Active ear equalising is not a natural activity for humans."

 

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PREGNANCY AND DIVING

Q: I am a qualified diver and pregnant, Can I dive with Blue Water Diving Center?

Our Answers: We strongly warn women not to venture into SCUBA diving if pregnant! No one knows what could be the consequences of saturation and decompression sickness on a foetus. Giving life is one of the most wonderful and noble action of the universe, all care should be taken for the safe arrival of the baby.

 

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Special Requests

Q: I have done many introductory dives and some dives exceeding 20 meters in depth, I am comfortable underwater, can I join your divers on recreational dives?

Our Answer: You can indeed join our dive centre to dive. You shall be allowed to dive as per your qualification or level. If you do not hold a divers certification card, you shall then be allowed to dive to depth not exceeding 6 metres accompanied by a personal  dive leader. If you wish to venture to higher depth, we shall be happy to train you to the first level in divers qualification in a few days and you shall be authorized to join all our recreational dives here and everywhere throughout the world!

 

 Q: I hold a first level in diving certification and made over hundred dives, some of them deep! Can I join on your deep dives?

Our Answer: You can join us on dive as per your actual qualification. It is not very hard to join in a course for deep dives. We can train you within a few days to reach the required level. contact our instructors  for information on our contact web page.

 

Q: I hold a PADI Rescue Divers card, can I dive on your dive sites at 40 meters?

Our Answer: Yes it is possible if you also hold the PADI deep Diver certification, or else you are only allowed to 30 meters as per PADI regulations and you are not allow to enter decompression dives.

You can chose to join in a 2 day course for PADI deep diver certification or make a cross over to CMAS 2 star certification that allows you to dive down to 40 meters and controlled decompression dives.

 

Q: Is it possible to get a equivalent CMAS certification for PADI certification holders?

Our Answer: Yes and No! As per the PADI-CMAS 1998 Agreement , there is no systematic equivalence between the 2 organization. Both organization signed an agreement allowing their divers to join in a full course of the other organization thus recognizing the existing level as equivalent. For more information, Go to: Convention CMAS-PADI

 

Q: I am being imposed a Refresher dive, should I really do it?

Our Answer: Refresher dive is requested to all divers regardless of their qualifications, if they did not dive for the last 12 months or more. This dive is very important so as to familiarize with the water environment, with the equipment and with oneself. It is important to rehearse all exercises and diving signals, the equipment such as tank and wet suit can change having consequences on the divers' buoyancy. The ears need to adapt themselves easily at shallow depth. all these including psychological stress are important reasons why refresher dives are imposed on easy shallow, nice and very rich dive sites.

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 Q: Do you organize trips with Whales Sperm whales?

Our answer: Yes, we do organize day trips for whales and Sperm whales watching. Just register at the diving center and ask for more information on our contact page. Everyone must read, sign, adhere and respect the whale watching chart of good conduct.

 

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 Q: I am qualified CMAS level 1 diver or PADI OWD, I wish to dive with the sharks at the shark dive site, Is this possible?

Our Answer: Yes It is possible to dive with sharks on dive sites where the depth does not exceed the limits for your level and that water exits are easy. It is obvious that these dives are not open to beginners or newly licensed divers. We can take divers with at least 30 logged dives.

 

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 Q: I have lost my certification card, is it still possible to dive at your dive center?

Our answer: Yes this can be possible if we can retrace  your card on the internet. For this you must submit the following personal information:  Surname, name and middle name initials, Date of birth. Normally with these information we may retrace your certification. if not enough we may also need the instructor name and/or number and place where you had you certification done.

 

Q: I cannot find information on your dive rates on your website, can you help??

Our Answer: Yes we can! If you are using a smartphones or a tablets to search for information on our website, you may have problem to find the sub-menus scrolling down. Then click on the main menu and you have the possibility to select the required page - e.g: Dive rates , PADI courses rates, CMAS courses rates etc...