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| Originally Posted by Daz217 As i say obviously everyone is entitled to an opinion but how can professionals in Diving Medicine vary so vastly in advice on the same subject. You would have thought the answer would be the SAME from every Doctor. |
Hi
You raise a very interesting question which could be debated forever!
Medicine is often not as scientific as many would think. We try to develop guidelines and protocols based on research evidence but often the research is just not there to guide us. We may then rely on analysing case histories and this can be very helpful but also can muddy the waters.
Diving medicine is also often not precise and often the research is just not there to guide us. So guidelines are developed based on what we know and understand about the physiology of diving and examples of people diving with a particular problem.
In the case you raise there simply is not the research evidence to guide us on what the risk level is. After fundoplication many people find they have trouble belching for a while but often this recovers in time to some extent. Now a doctor has to make an assessment of what the potential risks are and when it is safe to resume diving if ever. In the absence of good research evidence their advice will be affected by their own individual experiences and that of colleagues they have spoken to. Therefore you could easily get opposing opinions. However if the doctor is doing his job correctly he will explain how he has come to his conclusion so compare these two responses.
1) "There is a theoretical risk of gastric rupture after the sort of surgery you have had because it interferes with your ability to bring up wind. However I have never heard of any reports of gastric rupture in divers after this sort of surgery. As you can belch reasonably well albeit differently to before your surgery I think it would be safe for you to dive but you should do lots of shallow build up dives and see how you go and let me know".
2) "There is a theoretical risk of gastric rupture after the sort of surgery you have had because it interferes with your ability to bring up wind. Although I have never heard of any reports of gastric rupture in divers after this sort of surgery I am aware of someone who did have considerable difficulty during a dive and I think was very lucky not to have a gastric rupture. Despite the fact that you can belch reasonably well, it is different to how you belched before your surgery and I think it would not be safe for you to dive".
There are lots of instances of differences of opinion between doctors on advice for divers.
We do try very hard to be as consistent as possible though. I think sometimes it is down to a difference in the acceptability of a certain level of risk. I might find a level of risk OK which someone else does not. What is important is to try and share the debate about that level of risk with the person as best we can.