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Update on IPE research at Duke

Discussion in 'Diving Medicine' started by Duke Dive Medicine, Jul 12, 2019.

  1. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

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    A ScubaBoard Staff Message...

    ScubaBoard's prohibition against multiple identical threads in different forums has been waived due to the public service value and time sensitive nature of this thread.

    Hello all,

    I wanted to provide an update on some of the Swimming Induced / Immersion Pulmonary Oedema (SIPE / IPE) research being conducted at the Duke Center for Hyperbaric Medicine and Environmental Physiology.

    Dr. Moon is moving into the next step of his research with the goal of developing a treatment and possibly even prophylaxis for SIPE / IPE. He is looking for study subjects ages 18-45 who have had at least one incident in the past and have no underlying cardiac disease. I'm linking an article below with his contact information.

    Sildenafil: The pulmonary oedema wonder drug? - Research Outreach

    Please don't hesitate to reach out via PM if you have any questions. I'll be posting this thread in multiple forums on SB and social media.

    Best regards,
    DDM
     
  2. Pao

    Pao Manta Ray

    # of Dives: 200 - 499
    Location: Manila, Philippines
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    Viagra for IPE? The missus might be suspicious of what she sees in the dive kit. :-D
     
  3. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

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    Annd, cue the Viagra jokes. Rest assured that we have never heard any of them before and will laugh heartily at each new one :wink:
     
    judyo1, Griffo, Andrew Dawson and 9 others like this.
  4. Germie

    Germie Cave Instructor

    # of Dives: 1,000 - 2,499
    Location: Netherlands
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    Ok, take Viagra before diving :D

    More serious: I have seen 2 divers with IPE. Both survived. Never was a cause found, both are healthy. 1 case was my direct buddy, the other was more from aside. One has done over 1000 dives since then and no problems again. The other I don't know, I know he did some dives a few days after it happened, without problems, but I don't know if he is still diving. It is same as wit dcs, it happens or it happens not. You cannot say this is the one and only reason. Most times there is no reason. It is just a sportinjury. Would viagra help to prevent in these cases? You never know. You would only know if every diver will take it before diving. The person who is still diving without problems is not taking anything. Is just healthy and the same as any other diver. Would you advice to take viagra to such persons? I am a person who is against taking things without a reason. In this case I would say take nothing, in my eyes there is no reason. But if you had 2 times IPE, then taking viagra is better than quit diving.
    Maybe it helpst to prevent dcs also. LOL
    But such research is important because divers don't accept the 'advice': 'maybe it is better to quit diving'. And yes, the divers are right in this, no dive no life. If viagra works, the next question will be: went to start using it? After 1 case, after more cases?

    But what does the WADA say about Viagra? :wink:
     
    caydiver likes this.
  5. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

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    @Germie ,

    IPE is an interesting phenomenon. Dr. Moon is looking for people like the divers you mention who have had "pure" IPE, that is, there's no underlying cardiac problem or other health issue. His research has demonstrated that individuals who have suffered IPE in the past have consistently elevated pulmonary artery pressures with immersed exercise. Cold water increases this susceptibility. It's important to note that anyone who has suffered IPE in the past is considered to be susceptible to it. Both divers you mention could be stricken again, and the fact that they survived one episode is not necessarily an indicator that they will survive another. Water temperature, hydration level, and exercise level are all known factors.

    Effects of head and body cooling on hemodynamics during immersed prone exercise at 1 ATA. - PubMed - NCBI
    Immersion pulmonary edema and comorbidities: case series and updated review. - PubMed - NCBI
    Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. - PubMed - NCBI
    Environmental Physiology and Diving Medicine

    Importantly, the fourth article mentions the theoretical increase in risk for CNS oxygen toxicity with the use of sildenafil.

    Best regards,
    DDM
     
    Esprise Me likes this.
  6. Germie

    Germie Cave Instructor

    # of Dives: 1,000 - 2,499
    Location: Netherlands
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    I really dont believe that you are more susceptible after a first episode. Maybe some, but not all and I dont believe extra checks are needed when such a thing happens. The person I have contact with sometimes dove just a day later again, and never had anything again. So a lot is still unknown by everybody, including doctors. But it is interesting to follow studies. And remember: if people decide to follow their own advice instead of others advice, they still help with improving things. The biggest issue is that some doctors dont like discussions. But if they are willing to listen to people who decide different, advices can be changed. I think this is part of the difficult way to find people to tell about dcs, ipe, etc

    I will sent you a pm about what I have seen.
     
  7. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

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    I'll look for the PM. Meanwhile, I'd direct you to the research, it pretty much speaks for itself. Re doctors not liking discussions, for the record, Dr. Moon is one of the most erudite people you'll ever run into. He'll also be the first to tell you that anecdotal cases like the ones you're citing are the lowest level of evidence. I would not base any conclusions about IPE on the two cases you've encountered, and I'd reiterate that both of them are now considered susceptible. What they choose to do with that information (provided it reaches them) is entirely up to them.

    Best regards,
    DDM
     
    Pao likes this.
  8. Germie

    Germie Cave Instructor

    # of Dives: 1,000 - 2,499
    Location: Netherlands
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    It was not me, but buddies :wink: I hope never ever to get any illnesses. I have sent you a pm.
     
    Duke Dive Medicine likes this.
  9. Esprise Me

    Esprise Me Kelp forest dweller ScubaBoard Supporter

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    Is Viagra still hideously expensive? I remember hearing something like $10/pill when it first came out; not sure if that was ever true or still is. I wonder if insurance would cover it for this purpose. That's getting a little ahead of things, I know, but just wondering how practical a solution it would be if the research shows it's effective.
     
  10. mcpowell

    mcpowell Barracuda

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    Perhaps this comment would be better in its own thread...but...Ever taken Viagra? Everyone I know who has taken it, has mentioned that it gives them a flushed feeling in their face, and more sinus congestion than they had before. Seems to me that it could cause some ear and sinus squeezes that may not have happened otherwise. So could taking viagra for IPE lead to other injuries?
     
    caydiver and Duke Dive Medicine like this.

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