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Drugs and Diving - Anti-Inflammatories

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hi... I was diagnosed with multiple sclerosis (MS) in 2000 and whilst I have the odd niggle, relapses are happening at about 3 - 4 year intervals. These are not major as such and thus far I have always recovered pretty much 100% with rest. So far, I know when I am overdoing things and heading for a problem, which when I back off and rest, usually averts any major or long lasting.

I qualified OW in October, and to be honest, as I wasn't taking any medication (never have before) I didn't actually think about a dive medical as I have been fit and well, doing a full time active job etc. However, over Christmas, I have had some problems with my right arm (usual place it affects) with the pins and needles, numbness, nerve pain etc., waking me at night and some loss of grip to the right hand.

It has settled fairly well now but I am still taking the diclofenac sodium 3 times a day, the tramadol only when the pain wakes me at night as these space me out too much. I would never consider diving if I didn't feel 100% okay on the day but will I be okay to dive whilst taking diclofenac? My husband has just presented me with the flight tickets etc., for a diving trip to Dahab this Thursday!

A - A nice surprise to be sure. I can reassure you on that point immediately – there are no problems taking diclofenac on a dive.

MS though is worth a bit of didactic discussion though. It's a neurological illness involving the central nervous system (brain, spinal cord and optic nerves). The CNS nerve fibres are surrounded by an insulating fatty sheath composed of myelin, which aids in the transmission of electrical impulses. In MS, myelin is lost and replaced by areas of scarring, termed sclerosis – often in multiple disparate areas, hence the disease's name. As a result, conduction in the nerves is disrupted, giving rise to a broad range of symptoms – cognitive impairment (memory difficulties, attention and concentration deficits), sensory manifestations (pins and needles, numbness), bowel or bladder disturbances, and visual problems to name the more common. Anyone with a passing knowledge of DCI will perhaps recognise all of these as possible symptoms, and historically this has been a major issue – diagnostic confusion between MS and DCI. Although a delay is possible, precautions such as keeping an up to date record of a MS diver's neurological deficits should allow a clued-up doc to distinguish the two. There's no evidence that diving has any detrimental effect on the disease process, but sometimes MS relapses can be triggered by over-exertion or extremes of temperature. These factors should be borne in mind when considering dive trips and evaluating conditions on the day.

Some drugs used to treat MS and its symptoms might also have an impact on in-water safety, so best discuss any new medications with a dive doc before jetting off. Have a great trip.

Q - Hello there. I would be grateful for any information you could give me about the effects and recommendations of diving on the drug Naproxen. I take two 250mg tablets daily and have done so for a couple of years. I very rarely take any other medication other than Naproxen and beer. I have dived on this medication without any problems but it has been on my mind so I thought I should check with an expert.

A - OK, hands up anyone who wouldn’t value a doctor who can get away with prescribing beer as a medication. Mothers used to be offered a choice of a bottle of Guinness or Mackesons every day that they were in the maternity wards in the late 1950’s, paid for by the NHS, and in return “Guinness is good for you” was their advertising slogan for years. Sadly it’s not being funded by the NHS anymore. Naproxen, on the other hand, is. It’s a variant on the anti-inflammatory theme, particularly good for mild pains, stiffness in the joints and for menstrual cramps or painful periods. It’s probably not a good idea to take the two together - beer and anti-inflammatories are a perfect recipe for creating stomach ulcers, or at least some good-going gut erosions. The good news is that if you have no side effects then naproxen (and all other anti-inflammatories) are safe to dive with. The bad is that beer isn’t – apart from the obligatory post-dive cold ones, obviously.

(other dive medical questions)


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