Wednesday, June 21, 2006

Message from Fred Bove

This blog is available for discussions of diving medicine and medical issues related to diving. Information about diving medicine is also available at www.scubamed.com

20 Comments:

Blogger Fred Bove, MD, PhD said...

Beta blodker medication and diving

I often hear from divers that they should give up diving if they must take a beta blocker. These drugs block the effects of adrenalin, and are used for hypertension, coronary disease, for benign tremors, and for treatment of heart failure. Individuals with coronary disease or heart failure need a careful evaluation by their cardiologist before participating in any sports, but even some of these patients can dive under very limited conditions. If you are healthy and take a beta blocker for hypertension or for a tremor, there is no need to give up diving.

Fred Bove

6:22 PM  
Blogger Fred Bove, MD, PhD said...

There is a continuing misconception abour Patent Foramen Ovale (PFO) and diving. Some physicians think any PFO is a contraindication to diving, yet the incidence of decompression injury in divers with a PFO is extremely small (ranges between 1 in 2000 dives to about 1 in 5000 dives). Because decompression sickness symptoms can be quite varied, almost any symptom that is reported is being related to a PFO. Since 25-30% of all people have a PFO, there is a good chance that a PFO will be found as an incidental finding in a significant number of divers with vague symptoms not related to decompression at all. Don't give up diving because you have a PFO.

12:41 PM  
Blogger sleepyras said...

Do you know if there is any evidence to suggest that divers with a history of childhood asthma would benefit from a prophylactic rescue inhaler (ie albuterol)? I had asthma severely as a child but no longer even use a rescue inhaler. The asthmatic tendency is still there and I am wary to stay away from triggers (mainly livestock) but even still the last several "attacks" I had over the last few years were mild and didn't require anything more than waiting it out and removing myself from the trigger. It has been several years since I even used an inhaler and I don't take any preventative medication.
I plan to become certified this summer as a diver and am curious to know if I should use a rescue inhaler before dives or if the increase in heart rate from albuterol (causing an increase in O2 requirement?) may not be worth the unlikely chance of a severe asthma attack. Or would prophylaxis with a rescue inhaler make any difference at all for the dive anyway? Could the use of a rescue inhaler make the likelihood of complications underwater greater?
Thanks for your time.
Kelly RN

1:28 AM  
Blogger Fred Bove, MD, PhD said...

Many divers with occasional asthma attacks use Albuterol before diving. In some cases, it is a pre-dive routine. Albuterol used about an hour before diving will not affect diving, and will provide adequate airway relaxation that diving can be done safely.

9:16 PM  
Blogger Fred Bove, MD, PhD said...

DIVING AFTER A STENT IMPLANT

Do you have a coronary stent? if so, be assured that other divers have been diving after receiving a stent. You need to be free from angina, have good exercise tolerance with no evidence of impaired blood flow to the heart. This is usually determined by a stress test. Also note that if you have a drug eluting stent (DES), you need to take Plavix® for at least a year, and we generally recommend even longer periods to be sure no blood clots form inside the stent. If you have a bare metal stent, you should take Plavix® for at least 3 months, and again, we usuallly recommend a longer period. Ask your cardiologist which kind of stent you have- a drug eluting (DES) or bare metal (BMS).

6:53 PM  
Blogger muleskinner said...

This is non-cardio related but I could use some help. I am an FP whose wife is a Dive Master and works yearly in Indonesia for 3 months. We have found that most of the non native divers who dive daily get non healing skin ulcers. Some but not all these start from a slight skin defect such as a bug bite or scrape. They are not inflammed or painful like an infection but act like inpetigo in that they tend to spread outward. They seem to only respond to long periods of being out of the water. I have tried topical and systemic antibiotics and steroids...neither made a big difference. Any thoughts?

9:05 PM  
Blogger Smiles said...

I am looking for more information on diving with ear issues… I have had two stapedectomy surgeries and have never been diving. I’m planning a honey moon in Mexico and would like to go diving at least once in my life time. When asking the doctor whom preformed the surgery his nurse responded with a “No, not recommended period” with no exclamation on what could / not happen. I don’t take well with “no” with out a valid exclamation or argument on why. …One was preformed in 1990 and the other in 2000, does this matter? I have had issues with my ears my whole life and can pressurize them and for the most part drain them on command using my jaw. If I were to do this would there be a recommended depth limit? Should I even try this at all? I do fly and travel a lot with no problem does this make a difference?

10:44 AM  
Blogger JudyP said...

Plavix & Diving:

Is it safe to dive while on plavix (75 mg) if I recently passed my stress test at 15 mets, have clear arteries, no stent, am in good shape, 40 years old and am a rescue diver? I can't wait to get back!!!

7:59 AM  
Blogger Student Doc said...

Dr. Bove - I have read your recommendations on Asthma and Diving. I wish there was more clear information like yours, because I have found so much contradiction.

I have asthma and want to get SCUBA certified this summer. My asthma is well controlled with Advair, I use Albuterol prior to exercise simply because I always have. My Pulmonary Function tests are higher than average, but decrease with Methacholine testing.

Is this Methacholine test a contraindication to diving? I am sensitive to chemicals, so it isn't surprising to me that this decreased my PFTs.

I was hospitalized at age 13, but other than that have had no other serious problems with my asthma.

I am 24 and in relatively good shape. My weight/BMI is normal and everything.

I'm just nervous and trying to get opinions! Please reply if you can.

3:05 PM  
Blogger Sigurd Haveland said...

hello,
I used to be a commercial diver and diver medic. I am now an EMT working for an Emergency Medical Service and following a degree in paramedic science. As part of my degree course work I have been asked to prepare a presentation in diving medicine. I would like to ask the experts if they could help me on directing me on what would be the best topics to cover. For example include some diving physics and then link it up to the physiological challenges and possible pathophysiology. Any help will be great.
Thank you
Sigurd

12:52 PM  
Blogger Sigurd Haveland said...

hello,
I used to be a commercial diver and diver medic. I am now an EMT working for an Emergency Medical Service and following a degree in paramedic science. As part of my degree course work I have been asked to prepare a presentation in diving medicine. I would like to ask the experts if they could help me on directing me on what would be the best topics to cover. For example include some diving physics and then link it up to the physiological challenges and possible pathophysiology. Any help will be great.
Thank you
Sigurd

12:53 PM  
Blogger IMoussa said...

Dear Dr. Bove,
PFOs in divers

This is a great website to learn Diving Medicine.

I do have one comment with respect to the website content regarding the relationship between PFOs and DCI. The current content simplifies the message to "if you're a diver and have a PFO don't worry about it!".

What has not been given sufficient attention is that not all PFOs are alike. Patients with large PFOs and right to left shunt at rest are in fact at higher risk for DCI than those with small PFOs or no PFOs. (Cartoni D et al. Am J Cardiol 2004;94:270–273)

Divers should know the naunces of this topic and should be advised to discuss their particular case with their physician.

8:46 AM  
Blogger Cassandra P. said...

This comment has been removed by the author.

3:10 PM  
Blogger Cassandra P. said...

Dear Dr.Bove,I have looked through your site but have not seen anything regarding restrictive lung problems.I have these problems and this summer as things were not so bad finally began diving. My doc gave me a health certificate but told me to be very careful.Anyway, I was amazed that I breathed much better underwater at a depth of about 13-15 meters. In shallower water it was not great but the lower I got, the better I could breathe.The air just seemed to go in on its own and for the rest of each day that I was diving I was not plagued by the fatigue which I normally have and had more strength, this effect would pass however by evening. I talked about this to my pulmonologist but she said that there is really nothing she knows of that could mimic such a thing as mechanical ventilation would not create those conditions (every year I get a work-up to see if it would be time for mechanical ventilation at night, it's not time yet). It would be so wonderful to breathe like this all of the time but I cannot of course live underwater, any suggestions? I have MS by the way and that seems to have caused this lung restriction. The pulmonologist also says that so few people with these issues actually try diving that she does not have feedback regarding these experiences. Thank you for any advice, Cassandra P.

3:16 PM  
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