prednisone, ulcerative colitis, young patient

[wrybosome]

Hello medical people-

I have a question regarding diving, ulcerative colitis, and prednisone.

The patient is a 16 yo girl recently diagnosed with ulcerative colitis after her first acute phase last week. She was hospitalized, had a colonoscopy, and was diagnosed with UC this week. Currently she is on po prednisone 40mg/day and po mesalamine 4.8 g/day. The prednisone is to be tapered off over the next 40 days. So far (4 days) she is tolerating it well. Overall she is tremendously improved from a week ago: no bleeding, little pain/discomfort, minimal weight loss during the attack. She is back in school and starting her normal activities now.

We had a dive trip to Largo scheduled for next week before this happened, and our pediatrician and gastroenterologist (both non-divers) had the same reaction to the should she dive question: definitely go on the trip, but it would be more conservative to not dive while she’s on prednisone.

She has been bugging me to get other opinions on this from a doc that dives, and wants me to keep the diving option open so we can see how she feels when we get there. My gut reaction is to just snorkel when we’re down there.

What are your thoughts on UC, diving, and prednisone? And how would I go about finding a diving doc in my area?

Thanks,

Tim

 

[wrybosome]

I had the bright idea of calling DAN. The doc I spoke to there said that easy shallow diving was not an issue if she felt well, and was able to reccomend a diving doc in our area.

 

[jupitermermaid]

You and your daughter have my empathy. I, too, was diagnosed with UC when I was 16. Hopefully, the medication will help keep her in remission and she doesn't have more episodes. I didn't start diving until I was in my 50's, so I can't answer about the prednisone and diving. I had a Brooke ileostomy when I was 24, then converted to a BCIR (internal pouch) about 20 years ago. I dive and have no issues with the pouch. If it's any consolation, my life is much fuller now than it was when I was 16.

Good luck with your daughter and her continuing to be able to dive. Keep us posted on her condition and her diving.

 

[TSandM]

I did some searching, and I could not come up with anything about corticosteroids and diving, other than the brief mention on Fred Bove's site that there probably isn't a big issue with it.

Corticosteroids in high doses have some significant and unpredictable side effects, including major mood swings (inappropriate euphoria or even hallucination in some people), reduced resistance to infection, and poor wound healing. They can also wreak havoc on blood sugar levels, which can easily lead to dehydration.

I don't know how rapid this taper is, and you will obviously have some time to monitor psychological effects of the drug, and blood sugars, too, if you are willing to do it. You do want to be extremely certain that any volume losses associated with the diarrhea and blood loss that led to the diagnosis have been completely corrected before any diving takes place.

In short, I don't think there is any science to say that someone should not dive at all when being treated with corticosteroids. The decision to dive should be based on the status of the disease process being so treated, and some period of time to monitor the patient for major side effects. Anyone diving on this medication should be aware of an increased risk for and severity of any type of skin or soft tissue infection, including otitis externa and infection from any traumatic wound suffered in or out of the water.

 

[wrybosome]

They can also wreak havoc on blood sugar levels, which can easily lead to dehydration.

I don't know how rapid this taper is, and you will obviously have some time to monitor psychological effects of the drug, and blood sugars, too, if you are willing to do it.

The decision to dive should be based on the status of the disease process being so treated, and some period of time to monitor the patient for major side effects. Anyone diving on this medication should be aware of an increased risk for and severity of any type of skin or soft tissue infection, including otitis externa and infection from any traumatic wound suffered in or out of the water.

Thanks for your input. I hadn't thought of monitoring her blood glucose levels. I can pick up one of those test kits at the pharmacy.

Psychologically she seems very much herself but it's early days so far. We're keeping an eye open for that. Talked to her just now, she had some dizziness at school but otherwise is feeling well. Maybe a diabetic test kit will tell us something there if the dizziness recurs.

Overall I think I'll encourage some snorkeling but keep an open mind if she's really feeling and looking well.

Snorkle or dive, I'll make sure we have some ear tincture using that acetic acid/peroxide recipe.


Jupiter Mermaid - Thanks for sharing your story and your good wishes, we're really hoping to never have to go down the surgical route.

 

[Dyver]

Ulcerative Colitis is the pits. I was diagnosed and have been on steroids years before I started diving. I have been fortunate to have my flare ups occur around my dive trips, but I will be diving a month from now in Cozumel and I'm currently recovering from a recent bout. Prednizone causes tissue swelling, and speculate it would effect blood circulation and nitrogen build up in tissues in a different way than if not on pred. I plan on staying shallow and drifting about with my dive buddy as to not exert myself, and to inform my guides of my condition depending on the nature of the dive plans.

I never thought I would do anything exciting with my future after diagnosis, and your daughter will get a needed confidence boost through diving, Tim.

Do keep an eye on her for shivering and joint aches during and between dives. Also check out vitamin D supplements and spending too much time in the sun due to medication reactions. And as always, HYDRATE, Personal experience here, but UC can vary from person to person.

 

[TSandM]

Just to correct a bit . . . Prednisone does not cause tissue swelling. It can cause fluid retention and puffiness. I doubt that would have any significant effect on nitrogen loading or offgassing, except to combat dehydration to some extent.