Posts Tagged ‘medications’

The weather for this week is pretty stable; lows 80-81, highs 91-92, 20% chance of rain every day, wind east to southeast at 10-15 knots.  No kidding.  The next seven days will be like the movie “Groundhog Day” as far as the weather is concerned.  For us, a 20% chance of rain is more descriptive if you look at from a 80% chance of sunshine.  In yesterday’s Wunderblog, Dr. Jeff Masters reported, “The Atlantic is quiet, with no tropical cyclones predicted over the next seven days by the reliable computer models”.

Everything is going well with the programs and participants.  We received truck loads of new sand for the volleyball court yesterday.  So we put some of the participants to work shoveling sand.  One of our staff members whacked his own big toe with a shovel.  It wasn’t as bad as it sounds, but it could have been.  We probably could have made a game out of “find the bloody toe in the sand” but I don’t know what would have been an appropriate prize.

Yesterday was Nancy Wells’ last day (for a while) of working the check-in desk.  She did a great job of subbing for Dr. Ellen.  I hope Nancy’s real work didn’t suffer too much.  Thanks for your help Nancy!

A quickie reminder: medications used to treat ADD, ADHD, OCD, and depression are NOT particularly compatible with scuba diving.  While there is no ban on such drugs within the BSA Scuba Policy, please discuss this at length with your doctor before deciding to mix these drugs with scuba diving.  Some people may be disqualified from scuba diving at the Florida Sea Base depending on the medications used.  These drugs can be dangerous under the increased pressures of scuba diving.  My suggestion is you look up the medication on the internet.  I like www.nlm.nih.gov because it is not owned by a pharmaceutical company.  Look carefully at the side effects.  Now think back to what you learned about nitrogen and pressure in your Open Water Diver certification course.  [For the non-divers, what we learned was that nitrogen, an inert gas that makes up about 79% of the gas we breath, poses no threat to us at sea level.  However, as divers descend, the pressure causes the nitrogen to have a greater effect on the brain.  The deeper you go, the greater the effect.  For most people, at depths near 100′ nitrogen causes a feeling of euphoria or intoxication.  This can lead to poor decision making.  Even oxygen, the single most important gas to our existence, becomes toxic  under increased pressure and can (a does) cause convulsions and death.]  Now back to the side effects.  Although you may not experience any of the listed side effects of your medications at sea level (like suicidal tendencies), those side effects may be twice as strong at 33 feet, three times as strong at 66 feet and 4 times as strong at 99 feet of sea water.  I have personally been on a dive with a former staff member who was on antidepressants who usually experienced no side effects of his medication, but on this particular dive he became suicidal and tried to drown himself.  Fortunately he survived.  NONE of these medications are tested for safety or effectiveness under increased pressure.  No one, including your MD, can say what response your mind will have to these drugs underwater.  There is absolutely no scientific evidence that they are safe underwater.  Psychotropic drugs are of greatest concern.  And if you have made 100 dives while using the medication and have not had any problems, remember my divemaster dive buddy who could say the exact same thing until the day the medicine caused him to try to kill himself during a scuba dive.  Diving is safe.  Diving is fun.  But diving can be VERY unforgiving.  Drowning is a horrible way to die.

I will conclude with that jolly note.  I hope you have a safe day.  I am going to send 125 to 150 participants out scuba diving today.  I worry about each and every one of them.  Our “acceptable loss ratio” is ZERO.  No one dies.  No one gets hurt.  Everyone goes home safe.  Everyone has a great time.  150 divers a day, averaging 2 dives per diver per day, for 100 straight days during the summer session.  30,000 dives in three months.  30,000 chances for someone’s child to be hurt on my watch.  30,000 reasons why I cannot allow incompetence from the scuba staff.  ONE of the reasons I don’t always sleep well.

Capt. Steve Willis
Aboard S/V Escape

Some of my readers are going to be unhappy with this article.  But issues like this is why I started this blog.  Getting this posted on the official Florida Sea Base website would be, well, let’s call it, “unlikely”.  But it is an important issue and should be shared with our participants.  I have discussed this at length with the Florida Sea Base Health Advisor.  It is disappointing that many doctors will unknowingly approve persons for scuba diving without having an adequate understanding of hyperbaric effects of various medical conditions and medications.

Almost every year we find ourselves facing new medical issues and scuba diving.  For 2011 the issues are hemophiliacs and persons using blood thinners.  (I have combined these two issues because they are so closely related.)  Most MDs should recognize that these conditions are not compatible with scuba diving.  However, we have had several medical forms signed-off by doctors clearing hemophiliacs and participants using blood thinners for scuba diving.  The Florida Sea Base Health Advisor (an MD with a sub-specialty in hyperbaric medicine) will deny such requests.  Here is just some of the data available that supports the idea that people should not scuba dive while taking blood thinners.

From PubMed Health:

“PubMed Health is a consumer health Web site produced by the National Center for Biotechnology Information (NCBI), a division of the National Library of Medicine (NLM) at the National Institutes of Health (NIH). PubMed Health provides up-to-date information on diseases, conditions, injuries, drugs, supplements, treatment options, and healthy living, with a special focus on comparative effectiveness research from institutions around the world.”

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000634/

“Warning …

“Warfarin may cause severe bleeding that can be life-threatening and even cause death.

“Warfarin prevents blood from clotting so it may take longer than usual for you to stop bleeding if you are cut or injured. Avoid activities or sports that have a high risk of causing injury.”

What side effects can this medication cause?

Warfarin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • gas
  • change in the way things taste
  • tiredness
  • pale skin
  • loss of hair
  • feeling cold or having chills

If you experience any of the following symptoms, or those listed in the IMPORTANT WARNING section, call your doctor immediately:

  • hives
  • rash
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, or eyes
  • hoarseness
  • chest pain or pressure
  • swelling of the hands, feet, ankles, or lower legs
  • fever
  • infection
  • nausea
  • vomiting
  • diarrhea
  • loss of appetite
  • pain in the upper right part of the stomach
  • yellowing of the skin or eyes
  • flu-like symptoms
  • joint or muscle pain
  • difficultly in moving any part of your body
  • feelings of numbness, tingling, pricking, burning, or creeping on the skin
  • painful erection of the penis that lasts for hours
  • ***BOLDED SYMPTOMS ARE ALSO SYMPTOMS OF DECOMPRESSION ILLNESS***sw

The following brand names are from RxNorm, a standardized nomenclature for clinical drugs produced by the National Library of Medicine:

Brand names

  • Coumadin
  • Jantoven
  • Marfarin”

From Divers Alert Network:

http://www.dan.org/medical/articles/article.asp?articleid=79

Anticoagulants

A diver who has been prescribed an anticoagulant, e.g., Coumadin® or Warfarin®, should be warned of the potential for bleeding: excessive bleeding can occur from even a seemingly benign ear or sinus barotrauma. There is a potential risk that, if decompression illness occurs, it may then cause significant bleeding in the brain or spinal cord.

From Assessment of Diving Medical Fitness for Scuba Divers and Instructors, by Peter B. Bennett, Frans J. Cronje, Ernest S. Campbell

PAGE 99 BLEEDING DISORDERS

“Other causes of bleeding disorders include: … Medicines, such as aspirin, heparin, Warfarin, and drugs used to break up blood clots.”

“Risks to divers include barotrauma damage to air filled spaces such as the sinuses, ears, or lungs from the bleeding that can occur in these organs, and the decrease in oxygen carrying capacity of the bleeder with anemia.  These individuals should be advised not to dive.”

Since symptoms for hemophilia is very similar to those listed above, the rational is the same.  In the old days most of the training agencies were more direct.  Bennett, et. al., hit the nail on the head.  “These individuals should be advised not to dive”.

Coumadin, Jantoven, Marfarin, Warfarin, and all other brand names of blood thinners have not been tested for safety under increased hyperbaric pressure (as in scuba diving).  While a person may experience no side effects at sea level, side effects may be magnified by the increased pressures of diving.  Several of these side effects mimic decompression illness and can exacerbate treatment.  Bruising injuries (such as getting smacked by the boarding ladder) are common on dive boats.  Sinus squeezes and ear barotraumas are frequent in scuba diving, especially for new divers and persons who dive infrequently.  These conditions can be a serious risk for hemophiliacs and persons on blood thinners.  Barotrauma to the lungs, spinal cord or brain could be fatal to anyone, but again, the danger is significantly higher for persons with bleeding disorders.

If you are using a prescription blood thinner, that medication has been deemed medically necessary by your doctor and you should NOT discontinue your medicine in order to participate in recreational scuba diving.  If you are on a preventative regime of low dose aspirin, you should ask you doctor if it is “medically necessary” or if it would be okay to suspend the aspirin therapy during diving.  Remember that it may take 72 hours or longer to flush the aspirin from your system.

As far back as I can remember, hemophilia and the use of blood thinners have been contraindicates for scuba diving.  This is NOT new.  What is new is the number of doctors who seem to be unaware of the issues and who approve persons for diving when they are at such an increased risk of injury.

Capt. Steve
Aboard S/V Escape

27Jun

It’s Over

in Staff  •  3 comments

Today was a great day at the Florida Sea Base, unless you were in the office.  Thank goodness it’s over.  Here’s how it went.

Before breakfast one of the staff members came into the office and presented with a possible concussion including severe pain at the site of an earlier blow to the head and exceptional drowsiness.  The staff member will receive medical care.  Also before breakfast Capt. Carl Olshenske who drives BSA Explorer for the scuba program reported that he had a youth participant on his boat this week who was having behavioral problems.  After breakfast I had the young man and one of his adult leaders in my office to get the young man’s attention and assure that he acted in a safe and reasonable manner on the boat.  (The captain reported this afternoon that the youth performed much better.)

Shortly thereafter I discovered that Florida Sea Base incident reports were not being completed to reflect these and other issues.  That will be addressed at Monday’s 07:30 staff meeting morning.

Before lunch it was brought to my attention that Davis Tours had not shown up to take a departing crew to the airport.  The crew was in jeapordy of missing thier flight from Fort Lauderdale.  I tried multiple times to call Davis Tours and their emergency phone number to no avail.  We are very short handed on Sundays at the Florida Sea Base.  Capt. Alex Bergstedt volunteered to drive them to the airport.  They barely made it and we never heard from Davis Tours.  I don’t mean to give Davis Tours a black eye.  I am only reporting fact.  For the 10 years that I have worked at the Florida Sea Base they have had an exemplary record.  However, something has happened and they have had major scheduling issues recently.  Our Director of Program, Rob Kolb, will be addressing our concerns with Mr. Davis on Monday.

Immediately before lunch I saw Capt. Dutch VanderLann hobbling across the yard.  He has re-injured his left knee.  He is a trooper and will gut it out.

Check-in begins at 13:00 daily.  Sundays are big scuba crew arrival days.  One of the crews had an adult leader who had refused to submit his medical prior to arrival as required.  So Ellen, the Office Manager, was reviewing the medical he brought with him.  It was on the wrong form and we couldn’t accept it.  So he called backed home and had the appropriate form faxed to us.  The form showed that he is asthmatic and taking three medicications for asthma.  This disqualified him for the Florida Sea Base scuba program.  He was allowed to stay with his crew and he can snorkel, but he cannot scuba dive.  Somehow this gentleman feels that his failure to submit the medical when required (01 March 2010) so we could try to resolve his issue is not the problem.  I am the problem.  I am very sorry for the situation but mostly I am disappointed that this gentleman failed to follow procedure and we were deprived of the opportunity to address his issue.

Then we had a youth check in who was taking some medications that required counseling of him, his adult leaders and divemaster.  He will likely do fine.

Then another crew arrived that had a bad experience with Davis Tours.  They were aggitated but Ellen (and an air conditioned office) helped the leader calm down.

After dinner, Commissioner Matt McClure had a severe alergic reaction to some aloe vera that was being applied to his sunburn.  After two showers and 50mg of Benefryl he decided to go to the ER for a cortisone injection.  Before he left, Divemaster Scott Costa slipped and twisted his knee and decided to accompany Matt to the ER.  By the time they got to the ER, Matt was feeling better and did not see a doctor.  Scott has a sprain or torn ligament and will miss at least a week of work.

Now the latest on T/S Alex.  The official forecast still shows T/S Alex will curve into Mexico below the Texas border.

Tropical Storm Alex - Weather Underground

However, one of the more reliable computer models (GFS) still suggests the possibility of landfall south of Galveston, Texas.  This is a good example of how crazy life can be when a hurricane is forecasted to approach within a thousand miles of the Florida Sea Base.  The forecasted trajectory changes frequently and radically at times.

T/S Alex Computer Models - Weather Underground

It’s past my bedtime.  I will post sometime tomorrow.

Capt. Steve
Aboard S/V Escape