Hi SD fans, and welcome back to the channel. As you know, we have been working with the team at
Divers Alert Network for several years now, and over the coming months, I aim to share some of
their knowledge and expertise when it comes to medical ailments and conditions and scuba diving.
In this video, I will be looking at medications and fitness to dive – DAN say their medical staff
often receive questions on whether it’s safe to dive while taking a particular medication,
and even though there is not a straightforward answer to this question,
here we’ll provide some useful indications.
DAN (as any other medical organisation) does not keep a repository of data on how
medications are affected by the diving environment. No formal research trials
about the influence of drugs on human divers in an underwater environment can be conducted,
out of ethical concerns. Anecdotal reports of dive accidents are of limited value in assessing
if it is safe to dive while taking a particular drug. Several physical and physiological factors
are always involved, so it is extremely difficult to isolate a single variable.
However, by considering elements such as the medical condition being treated, the physical
demands on divers while underwater, and known facts about a drug from clinical trials conducted
on land, sound advices can be provided about the suitability of diving while taking medications.
General considerations Most divers asking DAN advices
about medications and diving are concerned about new side-effects occurring at depth.
It is possible that certain drugs might potentiate or be potentiated by the narcotic
effect of nitrogen. A diver should consider this possibility if planning to dive deeper than 24m
while taking a drug that warns against drinking alcohol or operating heavy machinery. Aside
from this theoretical concern, most drugs are not suspected to incur specific biological hazards due
to immersion, pressure or breathing-gas mixture. It is understandable for divers to be apprehensive
about new side-effects occurring during a dive, but the more important issue to medical
professionals is whether the underlying medical condition might make diving less safe. The injury
or illness being treated is much more likely than the medication to exclude someone from diving.
Reduced physical fitness is not uncommon among people treated for medical conditions. Although
diving itself is a relaxing activity for most recreational divers, lifting and wearing heavy
equipment as well as entering and exiting the water can cause fatigue. Divers should always
have sufficient physical capability to fight currents, perform a long surface swim or help
a buddy in case of emergency. They should not be at increased risk of barotrauma due to congestion,
and they should not have symptoms such as numbness, tingling or pain that might be
confused with decompression sickness after a dive. Furthermore, it is important to consider whether
a diver has experienced any side effects from a medication, how long he or she has been taking it
and what other drugs the diver is taking. Before diving while taking a particular drug, the person
should have experience with it on land. For most prescription medications, 30 days is recommended
to ensure the dosage is correct and reveal any side-effects the diver is likely to experience.
At least one doctor should be aware of all medications an individual is taking
to minimize the risk of drug interactions. A diver who experiences any side effects that
could cause distraction or decreased awareness underwater should not dive.
These are general considerations, but there are also some specific questions and points
for discussion relevant to particular types of medications, which should be addressed during
the physician’s evaluation, as well as in the diver’s self-assessment, so let’s take a look.
Orthopedic pain medications and muscle relaxants • Could pain or impaired mobility cause
distraction or physical limitation during a dive? • Might heavy dive gear exacerbate an injury?
• Could side-effects of prescription-strength pain relievers diminish a diver’s alertness
or awareness? • Might soreness,
numbness or tingling be confused with DCS after a dive?
Neurologic drugs • Are the diver’s
physical capabilities diminished? • Has the diver ever experienced a seizure?
• Could any drugs the diver is taking cause side-effects that might be confused with DCS?
Psychiatric medications • Might symptoms or a drug’s
side-effects impair judgment, behavior, awareness or ability to handle stress?
• Is the patient’s condition managed successfully or in remission?
Gastrointestinal drugs • Is the patient at risk for gas
trapping that could cause barotrauma on ascent? • Is the diver dehydrated due to vomiting
or diarrhea?
Cardiovascular drugs • Does the patient have the cardiovascular
health and exercise capacity to safely dive? • Is a stress electrocardiogram (EKG)
needed to confirm good cardiac fitness?
Respiratory medications, including inhaled corticosteroids
• Is there any reason to suspect air trapping or impaired ability to breathe while diving?
• People with asthma should undergo an exercise challenge test, which consists
of pulmonary function testing before and after exercise in a clinical setting.
Decongestants, antihistamines and intranasal steroids
• Is the diver congested (and therefore at increased risk of barotrauma)?
• Has he or she been congested recently? • If the medication wears off at depth,
will it cause a problem? • How might the potential sedative
effect of antihistamines affect the diver? Hormones, insulin and medications
used to treat diabetes • Are the patient’s hormone
levels stable and close to normal? • Is the diabetic diver at risk
for hypoglycemia with exercise? • Divers with diabetes must have
good health and fitness and be experienced managing blood glucose levels while exercising.
Antibiotics • Does the
patient have an illness or infection that might be complicated by diving?
Chemotherapy drugs • Is the person physically fit to dive?
• Lung cancer warrants particular consideration. • Medical ports are generally not a problem,
but they should be padded well.
These points should be considered in the context of both the symptoms of the medical condition
and the side-effects of any drugs used to treat it. The focus should
be on whether any of these factors might lead to impairment of a diver’s physical capabilities,
awareness, reaction time or judgment. This list is by no means exhaustive, but it highlights some
of the concerns that accompany certain medical conditions and the drugs used to treat them.
Any medical condition or medication should prompt a diver to seek a physician’s approval prior to
diving. Got a medical query? As always, DAN is available to discuss the relevant concerns of
injuries, illnesses and the medications used to treat them. Leave your question below,
and remember, if you enjoyed this video, be sure to subscribe to our YouTube Channel,
and check out our playlist for more inspirational and educational content.
As always, stay safe – and if you are going diving soon, enjoy!