for only about 5% of affected individuals. About 15% of people with Parkinson’s disease have a first-degree relative with the disease, so genetics has to play a factor. Some environmental factors (insecticides, pesticides, herbicides, heavy metals) seem to increase the risk of developing Parkinson’s disease but the evidence is quite weak.
The symptoms of Parkinson’s disease are highly varied but commonly include tremor. The tremor is usually in a hand or limb, may include a back-and-forth rubbing of the thumb and forefinger (pill-rolling), and usually occurs at rest. Movement is typically slowed, steps become shorter, and doing things takes longer. Muscles may become stiff and sore. The sufferer may start to stoop and balance frequently becomes poor. Unconscious movements like smiling, blinking, swinging arms when walking may disappear. Speaking may become slurred, soft, hesitant, quick or monotone. Writing may become difficult to do and the sufferer may write very small characters.
In addition, people with Parkinson’s disease often have cognitive problems, including slowed thought, difficulty solving problems, depression, emotional changes, and sometimes outright dementia. They also frequently have severe trouble sleeping, bladder control issues, constipation, reduced blood pressure, loss of smell, pain, and sexual dysfunction. Separate from the trouble sleeping, fatigue is often a severe problem and simple getting out of bed in the morning can be a real challenge.
Tere is no evidence that diving makes the symptoms worse or affects the disease process
There is no specific test to diagnose Parkinson’s disease. The diagnosis is based on history, signs and symptoms, neurological and physical examination. Early in the disease the signs and symptoms are often too mild to make the diagnosis but over time they tend to become worse and the diagnosis becomes clear. Blood tests and imaging studies are used to rule out other diseases. An improvement in the signs and symptoms after starting treatment with carbidopa- levodopa helps confirm the diagnosis.
Treatment
Treatment of Parkinson’s disease does not affect progression of the disease, but it can dramatically reduce the signs and symptoms for many years. The most common and effective treatment for Parkinson’s disease is levodopa-carbidopa. Dopamine cannot be given directly as it does not cross the blood-brain barrier. Levodopa crosses into the brain where it is converted to dopamine. Carbidopa reduces the conversion of levodopa to dopamine before it crosses into the brain, which reduces the common side-effects (nausea) and increases the effectiveness of the levodopa. This drug combination is often quite short acting and many people find that they get much better control if they take small dosages frequently throughout the day. The drug tends to lose effectiveness after several years and taking too much can cause involuntary movements (dyskinesia). Duopa was approved in the United States in 2015 and is a gel form of levodopa-carbidopa that is continuously infused into the gut via a feeding tube so that a constant
level of the drugs is maintained in the blood.
Dopamine agonists are drugs that act like dopamine (pramipexole, ropinirole, rotigotine, apomorphine). They are not as effective as levodopa but they last longer. Unfortunately, they also have more side-effects including hallucinations, sleepiness and compulsive behaviours like gambling, hypersexuality, and eating.
Deep brain stimulation is a surgical procedure where electrodes are planted into a specific part of the brain and a generator is implanted into the upper part of the chest. The electrical signals often help control some of the symptoms in severe Parkinson’s disease. Unfortunately, all of these treatments seem to affect mostly the motor symptoms and have very little effect on the cognitive problems.
Lifestyle changes are very important in someone with Parkinson’s disease. A balanced diet, regular aerobic exercise as well as stretching and resistance training, massage, Tai chi, acupuncture, yoga, meditation, etc. all may help with some of the symptoms.
There is very little ‘good’ evidence that you can do anything to reduce the risk of developing Parkinson’s disease. However, there is some evidence that caffeine, green tea and regular aerobic exercise may reduce the risk. Apart from Parkinson’s disease, there is good evidence that regular aerobic exercise (30-45 minutes daily) reduces the cognitive decline of aging. Prognosis in someone with Parkinson’s disease is quite variable. Untreated individuals usually lose independent function about 8 years after diagnosis and are bedridden by 10 years. However, with treatment many individuals are still quite functional 15 to 20 years after diagnosis. Decline in motor function seems to be more severe in people who develop the disease at a younger age while cognitive problems are greater in older people. Having Parkinson’s disease increases your risk of dying sooner.
Parkinson’s and Diving
So, can you dive if you have Parkinson’s disease? The answer is sure, sometimes, maybe.
There is no evidence that diving makes the symptoms worse or affects the disease process. A few people have noticed some symptoms seem to be better while diving but this is not common. There is also no good evidence that hyperbaric oxygen has a significant effect.
The question of whether you can dive with Parkinson’s disease has to be answered from three perspectives. First, are your motor symptoms compatible with diving? Early in the disease your symptoms are usually mild enough that diving is not a problem. Later in the disease your symptoms will become bad enough that you will not be able to reliably take care of yourself or your buddy in an emergency. At this point in the disease process I believe you could still be ‘taken’ diving by a couple of competent buddies who would be responsible for themselves, and you. Clearly, as your motor symptoms progress, you will have to reduce the challenge or difficulty of your dives and eventually stop diving.
The motor symptoms of Parkinson’s disease are often very responsive to medications, particularly early in the disease process, but now you have to consider the second question. Are the drugs you are taking and the side effects you are experiencing compatible with diving?
Many of the medications used to treat Parkinson’s disease have CNS side effects and these side effects may increase the risk while diving. If your side effects are minimal, diving may be OK. At the same time, it is quite likely that the narcosis caused by breathing air under pressure (nitrogen narcosis) could make the side effects of the medications worse, or the drugs may make the narcosis worse. Therefore, be aware of this potential problem and stay shallow or be on the lookout for problems if you go deeper. Finally, whether you can safely dive after you have been diagnosed with Parkinson’s disease has to be evaluated from the perspective of your cognitive effects. These are not well treated with medications and may prevent you diving safely. If you have been told it is not safe for you to drive a car, it is highly likely that it is also not safe for you to dive. Depending on the effects, it may still be OK for you to be ‘taken’ diving. Parkinson’s disease is a relatively common, progressive, neurological disease. Motor symptoms can often be fairly well controlled for years with medications. The cognitive symptoms are not so easily treated. The motor symptoms, cognitive symptoms and effects/side-effects of the drugs taken have to be considered before taking up or continuing to dive.
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