Q: I’ve been stationed out in Vietnam with work for a year, and while here I’ve been enjoying all the natural pursuits the country has to offer – among them, diving in inland lakes as well as off the coast, caving, longboating up the river, etc. Recently I had what I thought was just a cold/cough, with the usual symptoms of fever, shivers, muscle pains and a sore throat. It went after four or five days, but someone mentioned a condition called Weil’s disease, and that it was common here and I might have picked it up from the water? Is this possible and what should I do to find out if I’ve got it?

A: There are very few notable Adolfs in history: Adolf Fick, who invented the contact lens in 1888; and, er, the other one. Oh, and Adolf Weil, a German physician who first described ‘an acute infectious disease with enlargement of spleen, jaundice and nephritis’ in 1886. Initially therefore called ‘infectious jaundice’, this bacterial illness, now known as leptospirosis, is usually acquired via water contaminated with animal urine coming into contact with eyes or unhealed breaks in the skin.

Surfers, rowers, farmers and sewage workers are examples of your at-risk groups; leptospirosis has even been seen in golfers who have become infected while retrieving balls from stagnant pools. Thankfully it’s rare, as it’s a pig to diagnose (much like decompression illness, in this respect). Symptoms vary from none at all to almost anything, but typically an initial flu-like illness resolves before a second phase of meningitis, liver damage and renal failure kicks in. Diagnosis is via blood tests and cultures but can be hit and miss unless there is access to a lab with sophisticated equipment. High doses of antibiotics are required to deal with the bacteria, but handily doxycycline is a good prophylactic (in addition to its similar function as an antimalarial). As usual, the golden rule is to try to stop yourself getting it in the first place, so avoid any rat-infested swimming pools if you can.

Q: I am a 32-year-old novice diver but my club has asked me to get in touch as I have been suffering with panic attacks since a work-related incident last year. I start hyperventilating and get palpitations, which last a few minutes, although I’m getting better at controlling them with breathing exercises (the old paper bag trick works!). I’m supposed to be going on a dive trip soon with my boyfriend who is a diving instructor, but I’m worried about what might happen if I get a panic attack underwater. Can you enlighten me – is it safe?

A: I don’t think there’s a diver among us who, if they’re honest, hasn’t felt that rising sense of anxiety and the accompanying adrenaline surge from time to time. What matters is how one deals with it, and recognition is key, to prevent a full-on panic attack (which, to answer your query, is inherently unsafe in the water). I think you need to ensure your boyfriend keeps a very close eye on you so that he can assist as soon as you start to feel anxious. Clearly you need to tackle the root cause of the panic attacks, but what do you do if one does occur underwater?

Hyperventilation blows off carbon dioxide, and makes the blood less acidic and more alkaline. These conditions cause calcium in the blood to bind to a protein called albumin, lowering the free calcium level and causing ‘tetany’ – where muscles start spasming involuntarily. Not surprisingly, this causes further panic, more rapid breathing, and a vicious circle develops. The brown paper bag trick works by making you rebreathe your exhaled air, which is high in carbon dioxide, so raising the calcium level and restoring normal muscle function. Sadly, there’s no waterproof equivalent as yet, so a diver has to be able to slow their breathing and keep the panic at bay while making a controlled ascent to the surface. A bit of honest self-assessment is required, and any uncertainty over your ability to cope with panic underwater would necessitate a delay to diving until the issue is resolved.

Do you have a question for Dr Firth? Email: [email protected] com and we’ll pass it on.

Main image credit: Jeremy Bishop

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