Diving and Raynaud Syndroma

[mboh]

I'm a Diver and a Doctor (physician) from Réunion island.
I wanted to ask if anyone knew something about Diving and Raynaud syndroma (in french) It's System disease (connectivitis ?) with white fingers under cold athmosphère.

Could we have complication with diving on a young women ? Without any sign when diving.

Do you know of any problems with "vasodilatateurs" phamacologic effects on vascular system ?

Thank you for your response.

I'm French, excuse my bad english !

 

[scubadoc]

Hello Doctor:

Answers to questions are for information only, do not imply diagnosis or treatment and should always be used in conjunction with advice from one's personal physician.

Raynaud's phenomenon is sporadic attacks of blood vessel spasms resulting in interruption of blood flow to the fingers, toes, ears, and nose. It is caused by exposure to the cold or strong emotions and is secondary to some
other medical conditions. Most dives are in water colder than body temperature and will eventually cause one to have problems with this condition.

Strong emotion or exposure to the cold causes the fingers, toes, ears or nose to become white, due to a lack of blood flow in the area. They then turn blue, which is a result of tiny blood vessels dilating to allow more blood to remain in the tissues. When the flow of blood returns, the area becomes red and then later returns to normal color. There may be associated tingling, swelling, and painful
throbbing. The attacks may last from minutes to hours. For this reason, there are diving physicians who feel that you should not dive with this condition as it might worsen and cause confusion with symptoms of a decompression accident.

If the condition progresses, blood flow to the area could become permanently decreased causing the fingers to become thin and tapered, with smooth, shiny skin and slow growing nails. If an artery becomes blocked completely, gangrene or ulceration of the skin may occur.

The use of vasodilators in diving should be used with care due to the possibility of syncope. Any loss of consciousness underwater is most ofdten associated with drowning, unless the diver has a full face mask. In addition, immersion causes hemodynamic changes that might be worsened by these drugs.


Best regards for safe diving!
Ern Campbell, MD
Diving Medicine Online
http://www.scuba-doc.com

 

[John Reinertson]

I've heard of no research surrounding this problem and diving, and it sounds like Dr Campbell hasn't either. If Dr Campbell hasn't heard of any research, it probably doesn't exist.

As with any chronic medical condition in diving, we need to list risks and ameliorating factors, and present the risks to the patient and the buddy.

Raynaud's, at least in a US population, can be triggered by stress, cold, vibration, or immune response.
It can also come for no apparent reason.
Raynaud's varies greatly with each individual in my experience. I have had little luck personally with vasodilators in my patients and would suggest caution due to risks of syncope. I agree completely with Dr Campbell.

If I had a patient with Intermittent or mild Raynaud's syndrome, triggered by severe cold or vibration or stress, and the dives were warm water with little stress, I would not criticize a patient that chose to try diving with Raynaud's. They should alert their buddy and probably the divemaster, as any of us should with medical conditions.

If the Raynaud's were part of Systemic Lupus or other autoimmune disorder, I would carefully assess risk of vasospasm elsewhere. One of the possible consequences of systemic lupus erythematosis is cerebral inflammation with vasospasm.

Oxygen is an intense vasoconstrictor in a hyperoxic state and could trigger cerebral vasospasm. There are theoretical reasons to expect that this could occur, and impaired brain circulation at depth is not good. There are, of course, no research data that I know of either way.

I would avoid Sudafed or large amounts of Caffeine as these can aggravate spasm. Most definitely, a patient with Raynaud's should stop all tobacco use, as this is a potent vasoconstrictor and triggers unfavorable reactions elsewhere.

It sounds like, from your description, the patient already dives and has no symptoms when diving.
If The patient dives without symptoms and there is no systemic illness associated with the Raynaud's, I would be comfortable diving with this person as his or her buddy. I would be honest as a physician and say we don't know if there is any increased risk.
I would not be comfortable diving with a buddy with active Systemic Lupus and Raynaud's.

Are there any diving Rheumatologists out there with additional experience or information??

Dive safe and warm
John Reinertson

Please give more information if I have misinterpreted your description.