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Longer Articles - What Drugs to Take - safe drugs in diving

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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What Drugs to Take

See one, do one, teach one. That's how you learn to be a surgeon. Easy really, but from my experience a far better route to being a good doctor is. read about it, contract it yourself, diagnose it in others. My old pharmacology tutor used to take it to extremes and try every drug before lecturing on it to us. This was in the pre-viagra days, and if he hasn't retired by now then I guess he's done away with his old laser pointer. The point of this though is that one of the most frequently asked questions I get is along the lines of "I'm going on a liveaboard and want to take some medicines for any illness I may get" Well you've got the expert here, but mainly because on my travels over the world I haven't had anything on me and consequently gotten most of the diseases available in the countries visited. I speak from experience dear reader. Malaria in Mali, amoebic dysentery in Egypt and ear infections every time I seem to dive. So from these experiences I came up with a list of the must have medications for every diver to take with them. There is a greater issue here too and that is if you go off on a dive holiday and get sick enough to have to stay topside I don't see the insurance companies paying up. They'll argue that you still have the suntan and were able to snorkel so how come you need reimbursement. So its up to us to make sure we stay as healthy as possible when we dive. Here are my thoughts on what every diver ought to be packing along with their BC and reg on the long flight to the longer liveaboard. The medication I can least do without are antibiotic ear drops. It's something I always seem to get around the fifth day of diving, and that is the beginning of pain in my outer ear canal. This is called "otitis externa" or OE. It is due to all the bugs and plankton floating around the sea that get lodged in your outer ear canal. After a few repetitive dives they eventually cause the skin in the canal to swell up and exude this gunk onto the pillow at night. It won't stop you equalising and so wont stop you diving but it's painful and annoying. The way to stop it is to really clean out your ear canals after each dive with Swimear or one of the other ear astringents, but if you forget to do this OE sets in. My favourite ear drop is a combination of gentisone and hydrocortisone. The first part is a good antibiotic and the second a steroid that helps get rid of the inflammation that causes the pain. Using 2 drops 3 times a day will stop the OE in a couple of days, and often if the water where I'm diving looks a bit polluted then I'll use the drops as a precaution to ward off the ear problem. It's cheap and can be bought at the pharmacy in most Asian countries.

Well from that end of the body to the other. The dreaded diarrohea! It's not just the embarrassment of having this in close confines on a boat but the fact that the volume depletion of fluids in the body can really contribute to a bend. You need blood to carry all that nitrogen back to the lungs from the tissues. That's where it's exhaled, but if your usual volume is lessened as your fluid intake seems to reappear in seconds then forget those tables or computer algorithms. They were designed using fit Naval "volunteers" and not tired dehydrated occasional divers. So how do we stop the dreaded D? Well research now shows us that the main causative organisms of travellers diarrohea can be effectively combated by a single dose of 750mg of ciproxin. This is the antibiotic that was so in demand during the anthrax scares in the US last year and it's just as effective against the runs. We all know the reality of diving and that is very few people will stop doing it if they aren't well, so rather than risk a bend simply take the ciproxin, load up on fluids and dive really conservatively. A good rehydration fluid is flat Coke with some salt in it as it has all the salts and sugars your body has lost. The only element you need to add is potassium, which is found in bananas, so eat those too.

The next addition to a basic medical kit is a decent painkiller. I know you can buy ibuprofen or paracetamol at the pharmacy and these are good for a simple headache or sprain. But what happens when you've dropped 10 kilos of lead on your foot, or as happened to me, a tooth abscess blows up out of nowhere? A couple of tablets of tramadol are worth more than their weight in gold. The whole thing about pain relief is that it's supposed to relieve pain. Ask anyone who is munching through a pack of over the counter tablets if they are working and more often than not they'll say "no". So there's no point in taking them really, but make sure what you do have will work for long enough to get you to a doctor for some treatment. As I mentioned tramadol is effective and strong, but another good one is 30mg of codeine. I know there is addictive potential but what we are talking about here is short term emergency use in remote areas, and you will rue the day you left them at home when your fellow divers try to stifle your screams. However if you are worried about crossing borders with these in your pocket then a good work horse painkiller is Distalgesic. The only issue with this is that the effective equivalent to tramadol is 8 of these tablets in a day. Quite a mouthful.

So, where next in this cornucopia of medication. It's got to be seasickness. This is the bane of many a diver and can hit you out of the blue, even on some of the calmest of days. Some tablets like cinnarizine can be sedating and I can't recommend you dive on them as they can make you woozy underwater, but a good one is Stemetil or prochloperazine. This is used for nausea and vomiting, and can settle you down quickly before you paint the decks with your breakfast. An issue here though is that if you take an oral tablet with a little water when you are chucking up, the likelihood is that you will throw the cure up as well. So come on be brave, take the suppository version, and if you can't bring yourself to do it.that's what a good buddy is for! Having said that, a good preventer of seasickness is ginger. Available in tablets or biscuits. Your call. You may not want to take my next suggestion, but I think a diveboat ought to have it for someone who knows how to use it, well, to use it. Local anaesthetic and a small needle. I used it twice on one dive once. One poor diver got his finger jammed between the hull and a pole on the boat and was screaming in agony until I blocked the nerve in his finger. And after the dive a poor old American lady surfaced with a handful of urchin spines. Only one cure for that and the local helped. Of course not every boat will have a doctor, but if there is one then they will need their tools. It's also great for Stone fish stings, Lionfish as well, and the occasional bad jelly sting. This next one is going to sound really weird but it works. There's a spray you can get for good old fashioned piles. It was designed so you wouldn't get your fingers dirty when trying to treat the little nasties. But its contents are pretty good for a far wider range of conditions. There are two things that make up the contents of what I call "grape spray", one a steroid which is a potent anti-inflammatory, the other a local anaesthetic for local quick pain relief. You can see why it's so good for "Sigmunds" as they're called here in London! I use it for any wetsuit rash, sunburn, irritant skin reaction to underwater beasties like jellies or hydroids and it's really good after fire coral contact. Spray it on 3 to 4 times a day. Bliss.

There's been some research recently that shows that over 70% of people going abroad will get ill. "Ill" can be anything from getting hit by a bus or nitrogen all the way to sunburn, so you can see why it's so important to take some medication to remote locations. But there's one thing more that is so often forgotten at the last moment, and it's not a tablet, it's travel health insurance. We had a US diver in our chamber last week with a bend. Poor guy, he'd forgotten to arrange his insurance and the bill after the treatment almost caused him to visit the Coronary Care Unit. Treatment in a chamber is expensive. You've doctors on standby, technicians in and out of the chamber with you, and a bed in the hospital too. The dollars mount up so never ever forget the insurance. It's not just for the bends but for making sure you have the best treatment available to you wherever you are. It's sad we doctors can't give our time for free but you know we have mortgages too. There are a few more additions to the dive medical kit I could suggest but these would be the icing on the cake. A single course of penicillin for the middle ear infection for one. But this is a lot rarer in divers than seems to be "diagnosed". In the UK, if any diver goes into casualty with ear pain they always seem to end up being told it's a case of Otitis Media or OM for short. Wrong call Emergency Doc, the redness you are seeing is more likely to be a barotrauma from poor equalisation on descent rather than bacteria in the middle ear. However if it does happen and you have pain in the ear with a complete inability to equalise then it probably is OM so take the penicillin asap. Sleepers can have their place too. A good way of kicking your body back to local time after jet lag is to use a sleeper on arrival if it's night but your body says you should be just getting up. I recommend zopiclone as the easiest and safest one. Its non-addictive and gives you 6 hours straight kip after a long flight. Waterproof dressings. Well in my experience they all seem to fall of after the rigours of suiting up, so just make sure any wound doesn't start to go pussy in which case you need to take the penicillin and stop diving. Unless there's a whale shark of course, in which case only death will stop me from getting kitted up. I'm going to finish on a contentious issue. We all know about the dangers of deep vein thrombosis and flying. Well there is a theoretical risk of diving and thrombosis too. This is based on the assumption that there are microbubbles left in the body after any dive. All bubbles can cause increased clotting of the blood by activating the enzyme cascade that causes blood clots in the body. So add a long flight to this and you can see the potential of the problem. The only thing is that it has not been proven yet. So I would say to anyone who is coming home from a lot of dives and the flight is over 6 hours, then do take the aspirin. A dose of 150mg at least should keep you clot free. And if you are high risk, i.e. you've had them before or have a family history of embolic stroke then you must take the tablet. So there you go. My list of goodies in a bag to keep you fit and healthy so your trip of a lifetime doesn't end up with zero divetime.

(other dive medical questions)



   


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