Deco dives while on meds

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lakepride, that is some medical profile, there was a vid posted of how diving helped the spine or back of people in wheelshairs, so I am sure diving is a very good treatment for you, and in know way can it be as painful as what it is on land.

Duke said he needs raw data (we don't give extra-conservative advice to save stupid people from themselves) that would be you as I see it in dukes eyes, which is against TOS. On the other hand Duke dive medicine can Pay you $10,000 a dive and get the raw data needed.

Never the less Doc And jimmy have a great deal of actual experience of the diving part and that is what you need.

Lakepride here is an actual dive doctor that has been diving for decades Doc's Diving Medicine Home Page email him and ask him how can I dive, what would be the way for me to perform a deep dive.

This guy is just the greatest diving doc there is.
 
Duke said he needs raw data (we don't give extra-conservative advice to save stupid people from themselves) that would be you as I see it in dukes eyes, which is against TOS.

I think you misinterpreted my statement. I was replying to one of Jimmy's posts and in no way referring to the OP.

Best,
DDM
 
Well I guess, it just looked that way with all ya had to say, for me its hard to agree with any one, although I had meds that made me feel anxiety and excited when at 160 to 260', I just quit taking meds all together as diving is way more important than what should be good for me.
 
I'm all for divers being personally responsible for themselves, and we do our best to educate them when we evaluate them so that they can make informed decisions. I don't really want to open the PFO can, so to speak, but an example is this: if we treat a diver for sudden-onset severe neurological and/or inner ear DCS and discover a PFO, we will advise that diver to stop diving and tell him/her exactly why. We will also advise the diver that if he/she chooses to continue diving, to use nitrox, preferably on air tables, and dive very conservatively. This, I think, is a good example of giving divers the facts and then letting them decide for themselves.

Best regards,
DDM

DDM
I think what I underlined is exactly the point and I am very happy you said this. So what are the facts? Can anyone answer these simple questions to help him evaluate the risk? What is the percentage of seizures in the normal diver at a 1.6 ppo2 or cns tox <100%? How much does it go up when said diver has had a prior head injury? How much does it increase when said diver is on ultram? What is Lakerpride's risk of seizure diving at a 1.6 ppo2?

The last relevant question is what is the survival rate of a seizure at depth?

The facts are that we do not know what his risk is for a seizure is. We all agree that his risk is increased. Beyond that is a guess, even if a highly educated guess of highly trained people. It is also safe to say (as you pointed out) the survival of a seizure is very very low without a helmet/full face mask and a lot of luck.

Telling him NO, is not educating him and letting him decide. We can not and should not make decisions for other people.

Jimmy
 
Tramadol is a known street abused drug, which means it has a central effect on mentation. I would not take it before diving if I were you.

Can I ask you how many times a day you take the 800mg of ibuprofen and how long you're taking this?
 
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DDM
I think what I underlined is exactly the point and I am very happy you said this. So what are the facts? Can anyone answer these simple questions to help him evaluate the risk? What is the percentage of seizures in the normal diver at a 1.6 ppo2 or cns tox <100%? How much does it go up when said diver has had a prior head injury? How much does it increase when said diver is on ultram? What is Lakerpride's risk of seizure diving at a 1.6 ppo2?

The last relevant question is what is the survival rate of a seizure at depth?

The facts are that we do not know what his risk is for a seizure is. We all agree that his risk is increased. Beyond that is a guess, even if a highly educated guess of highly trained people. It is also safe to say (as you pointed out) the survival of a seizure is very very low without a helmet/full face mask and a lot of luck.

Telling him NO, is not educating him and letting him decide. We can not and should not make decisions for other people.

Jimmy

Jimmy,

Your last question is probably the most important one because the survival rate for recreational divers who seize underwater is essentially zero. Of course seizure is not the only symptom of CNS oxygen toxicity, but it's very frequently the first to appear. As you pointed out, a full face mask can help eliminate the possibility of losing the gas supply, but those are awkward to use in technical diving unless you're on a rebreather or have a fancy gas-switching manifold.

The questions about probability of seizure are difficult to answer. The risk varies among divers, and changes from day to day in individuals. Work level and blood CO2 level are known risk factors and, of course, can vary from dive to dive. Immersion is a risk factor in and of itself. Most of the human experimentation was done in the 1930s and 1940s by the the British and U.S. Navies and was published by Dr. Kenneth Donald in 1992 in a book called Oxygen and the Diver. Vann et al summarized this work in the report on the 2008 technical diving conference (reference: Vann RD, Mitchell SJ, Denoble PJ, Anthony TG, eds. Technical Diving Conference Proceedings. Durham, NC: Divers Alert Network; 2009; 394 pages.) It's available on the Rubicon website here. Page 53 of this publication has a graph that contains some figures, but again keep in mind that these can vary widely. In short, statistical modeling shows a risk of CNS oxygen toxicity of about 1% after about 30 minutes on 1.6 ATA, and about 2% after about 45 minutes.

One of the end results of the early work on CNS O2 toxicity was the promulgation of the U.S. Navy's operational limits on closed-circuit oxygen rebreather diving. Chapter 19 of the U.S. Navy Diving Manual, available for download here, has the details, but essentially, 100% O2 CCR divers are limited to a transit depth of 20 FSW, or about 1.6 ATA, with limited excursions below 20 FSW permissible. The manual also states,

"Although the limits described in this section have been thoroughly tested and are safe for the vast majority of individuals, occasional episodes of CNS oxygen toxicity may occur. This is the basis for requiring buddy lines on closed-circuit oxygen diving operations."

Keep in mind that the guys using 100% O2 CCRs in the Navy are not quite as susceptible to hypercapnia and are much more exercise tolerant than most of us.

How much more at risk of O2 toxicity is a diver who uses tramadol? I don't know. It's never been studied, and nowadays institutional review boards frown on making test subjects have seizures unless they're four-legged and like cheese. Hopefully though, after all this writing, I've done better than simply tell LakerPride, "NO". Throughout my ramblings I think I've provided a pretty good rationale, which is exactly what we'd do for any diver seen in clinic here. I hope he digests all this then goes and educates himself even further. VooDoo, bless his little pea-picking heart, provided a great resource in Dr. Kay.

Diving involves a lot of risk mitigation, and when things like medications put a diver at increased risk for adverse events, we try to make sure that divers understand those risks completely. Risk mitigation equals survival. That's why guys like Ed Viesturs can keep going up and down Everest, and folks like the WKPP can keep plunging in and out of dark scary holes and come back and tell us all about it.

Best regards,
DDM
 
Tramadol is a known street abused drug, which means it has a central effect on mentation.I would not take it before diving if I were you.

Hi Hatul,

I believe that your assertion is incorrect & misleading. Just because a drug is abused on the street doesn't automatically mean that it acts on the central nervous system. Peripherally acting erectile dysfunction agents such as Levitra, Cialis & Viagra are abused on the street, as are various steroids. What is the actual point you are trying to make with this statement?

Moreover, other opioids (e.g., Vicodan, Percocet/Percodan, methadone, OxyContin, Talwin, Toradol), as well as many other centrally acting drugs such as ADHD stimulant agents (e.g., Strattera, Ritalin, Concerta), anti-emetics (e.g., Benadryl, Dramamine), antihistamines/decongestants containing pseudoephedrine (e.g., various Sudafed products, Coricidin HBP) and skeletal muscle relaxants (e.g., Soma) also are abused on the street. Should these also not be taken by any diver under any conditions whilst diving?

Regards,

DocVikingo
 
DDM,
That is an excellent post that educates as best as possible and lets them decide. :yelclap: I commend you for doing the work and effort to create the post you did. In medicine it is easier to give an answer, much harder (but important) to educate someone to come to the same conclusions. Bravo!!

We can not forget get that in any decision like this, it is about risk v benefit. While we can lecture on the risk, it is up to him to decide the benefit. MANY people feel the risk of tech diving or the vast majority of hobbies out weight to benefits. I know a few divers that have had major accidents and were told by all rational people that they should never dive again. They still do. Why? Because people underestimate their own perceived benefit from diving. I believe there are quite a few people who would rather die diving than not dive at all. I have no problems with this. If a person realistically understands the risks (as best as possible) and the consequences of their actions, I support any choices they make.

Should we not allow base jumping? What about motorcycles? Smoking? Fatty foods? Guns?

I do not see the consequences of my actions as being that bad. I do not have children or people who are dependent on me. If I die, I die with my eyes wide open doing something I felt was worth the risk. I have also educated those that love me on this reality. They will blame no else if anything happens to me.

I am sorry to bring this up but I have just been doing a lot of reading on the subject lately. When you read about David Shaw, many people think he was crazy and had a death wish. Others hear his story and say he died living his life the way he felt he needed to to enjoy it. I believe I remember his wife making a statement along the lines of "If he was not doing these things, he would not have been him." Throughout ones life, your values and priorities are in a constant flux. Children, age, passions, and commitments change.

I can even begin to pretend I know ANYTHING about lakers life and his motivations and thus can not tell him if he should dive or not. I can do my best to educated him to the risks and then let him decide.

OK, I am done rambling.

Jimmy

---------- Post added April 13th, 2012 at 09:33 AM ----------

Hi Hatul,

I believe that your assertion is incorrect & misleading. Just because a drug is abused on the street doesn't automatically mean that it acts on the central nervous system. Peripherally acting erectile dysfunction agents such as Levitra, Cialis & Viagra are abused on the street, as are various steroids. What is the actual point you are trying to make with this statement?

Moreover, other opioids (e.g., Vicodan, Percocet/Percodan, methadone, OxyContin, Talwin, Toradol), as well as many other centrally acting drugs such as ADHD stimulant agents (e.g., Strattera, Ritalin, Concerta), anti-emetics (e.g., Benadryl, Dramamine), antihistamines/decongestants containing pseudoephedrine (e.g., various Sudafed products, Coricidin HBP) and skeletal muscle relaxants (e.g., Soma) also are abused on the street. Should these also not be taken by any diver under any conditions whilst diving?

Regards,

DocVikingo

I will admit that I have a standing policy that no one I dive with is allowed to take Levitra, cialis or viagra before a dive. It might RAISE issues during a dive I am not ready to deal with with. :rofl3:

Jimmy
 
Jimmy,

Thanks for the kind words, and thanks for being such a strong advocate.

Best,
DDM
 
Hi Hatul,

I believe that your assertion is incorrect & misleading. Just because a drug is abused on the street doesn't automatically mean that it acts on the central nervous system. Peripherally acting erectile dysfunction agents such as Levitra, Cialis & Viagra are abused on the street, as are various steroids. What is the actual point you are trying to make with this statement?

Moreover, other opioids (e.g., Vicodan, Percocet/Percodan, methadone, OxyContin, Talwin, Toradol), as well as many other centrally acting drugs such as ADHD stimulant agents (e.g., Strattera, Ritalin, Concerta), anti-emetics (e.g., Benadryl, Dramamine), antihistamines/decongestants containing pseudoephedrine (e.g., various Sudafed products, Coricidin HBP) and skeletal muscle relaxants (e.g., Soma) also are abused on the street. Should these also not be taken by any diver under any conditions whilst diving?

Regards,

DocVikingo

You're right that Viagra is sold on the street for other uses, but in the case of tramadol it's street use is for its mind altering effects. Of the drugs you list I would not dive on any of the opioids: tramadol, Talwin, oxycodone, hydrocodone and methadone. Among other effects there's likely a synergistic increased effect of nitrogen narcosis when taking CNS depressant drugs, the effects on seizure threshold have been mentioned, and just the effects on mentation and ability to deal with problems quickly. He's better off to replace the tramadol with plain Tylenol before diving.

The one exception may be the person who is on a long-acting opioid, has been on this for a long time for chronic pain, and has developed a tolerance to its side effects.
 
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