Asthma/depression - BUT I WANT TO DIVE

[freewillie]

If I ever find myself in Florida and we have the chance I'd love to have drink (or several!) with you. I love chatting in general and can go on about medicine and supplements. It's actually a big reason why I get behind on physicals when patients and I start discussing vitamins and supplements.

Asthma is an interesting condition. It spans a wide range of severity from very mild to life threatening and severe. But, the hallmark is that it has underlying inflammation of the pulmonary airways that triggers bronchospasm. More simply, irritation(inflammation) of the airways causes the muscles to cramp (bronchospasm). It is also a condition characterized by periods of remission punctuated by exacerbations. What differs from mild to severe is how easy it it triggered and how easy it is treated.

The mildest form is exercise induced. It is only induced by strenuous physical activity. For the most part simple beta agonist is all that is required. Next is mild intermittent. Patients have few and infrequent attacks. Next, mild persistent. Attacks on occasion but more frequent than mild intermittent. All these require simple beta agonist/albuterol only as needed to inhaled steroids until symptoms resolve. Mthen you may not have symptoms for,weeks to months if not years.

But moderate to severe need inhaled steroids on more or less chronic basis. If a patient uses an albuterol inhaler even once a day but as often as three times a week they do require Advair style medications daily. Period. That is simply standard of care.

For the mildest forms you can get away with NielMed rinse for sinus. Herbal remedies for whatever. Doesn't matter in the long run. Exercise induced asthma falls into this category.

But, more severe forms of asthma is inherently more dangerous. That means medically it can be life threatening if not treated properly. That's why I'm taking the time for education. All types of asthma are not equal. Just because one person has mild exercise induced asthma does not mean you can treat all forms of asthma the same. What is okay for one patient may be inadequate and malpractice for another. Same name, different standards. It's like trying to say house cats as pets are the sames as adult lions because they are both cats.

The cause of the inflammation is simply asthma itself. That's just the nature of the condition. but, any good allergist or pulmonologist needs to also address the triggers that trigger attacks. Heartburn, gastric reflux, post nasal drip, allergies to name a few. And with allergies Niel Med sinus rinse is great for those patients who it works well for. My dive instructor swears by it.

But it's like sunburns. Some are mild and the skin just gets little red with minimal pain. Some are severe with skin that blisters and peels. The OP Cogaritis has described aspects of his asthma that are different than mild exercise induced asthma. Quite simply and to be blunt, it's not the same.

---------- Post added March 27th, 2014 at 11:13 PM ----------

PS. I've met more than a few collegues I'd describe as a horse's rear end too.

 

[TSandM]

Freewillie has done an excellent job of reviewing the pertinent information.

Asthma in divers is considered dangerous because of the possibility of air trapping during a dive, causing air embolism (often fatal) or pneumothorax (also possibly fatal). It used to be that no asthmatics were ever cleared to dive; that has been relaxed, but the criteria are still fairly strict in that only patients who are primarily asymptomatic and do not need routine medications are considered for clearance.

At the very least, the OP should undergo a set of formal pulmonary function studies, which will delineate the degree of his asthma. If, as his history suggests, his pulmonary function without medication is abnormal, it is unlikely that any physician will clear him to dive.

 

[chillyinCanada]

For some reason, I don't believe it is only OP's asthma that keeps physicians from clearing him to dive.

That aside, my 'intermittent mild' cleared up once Barrett's was diagnosed and treatment for same began to work. Question then becomes was it ever asthma at all.

 

[danvolker]

If I ever find myself in Florida and we have the chance I'd love to have drink (or several!) with you. I love chatting in general and can go on about medicine and supplements. It's actually a big reason why I get behind on physicals when patients and I start discussing vitamins and supplements.

If you ever do take a trip to Florida, please do let me know and plan to do some dives with us!!!
We also have some pretty cool places on the water for Drinks and Stories

 

[TSandM]

Oh, and I forgot to mention that both Dan and chilly are quite right in one thing -- asthma-type symptoms CAN be secondary to another primary problem, such as persistent post-nasal drip or reflux. Remove the stimulus and the bronchospasm goes away, too. But I am sad to say that the majority of asthma is intrinsic asthma, arising from an inflammatory process in the lungs, and if persistent, requires appropriate anti-inflammatory treatment.

 

[danvolker]

Oh, and I forgot to mention that both Dan and chilly are quite right in one thing -- asthma-type symptoms CAN be secondary to another primary problem, such as persistent post-nasal drip or reflux. Remove the stimulus and the bronchospasm goes away, too. But I am sad to say that the majority of asthma is intrinsic asthma, arising from an inflammatory process in the lungs, and if persistent, requires appropriate anti-inflammatory treatment.

I used to get head aches, and then a smart Doctor friend of mine suggested I stand far enough away from Sandra that she could not smack me on the head so often. This ended up being more effective than aspirin

 

[Tigerman]

I used to get head aches, and then a smart Doctor friend of mine suggested I stand far enough away from Sandra that she could not smack me on the head so often. This ended up being more effective than aspirin

Also very effective with such female-induced migraines is to just avoid talking to them (women) if there is any sign of grumpiness...

Sent from my GT-I9300 using Tapatalk

 

[Duke Dive Medicine]

Hi Dustin,

If an individual has asthma that is well-controlled with medication and has normal pulmonary function testing before and after provocative testing (exercising while breathing dry air), then we will typically clear him or her for recreational diving.

Re the Zoloft: interactions between medications and pressure or high concentrations of oxygen are poorly studied. Medications that can affect mentation or lower the seizure threshold are generally contraindicated in diving. Zoloft has seizure as a listed side effect and so likely lowers the seizure threshold. Generally, though, if someone is stable on the medication and isn't experiencing any serious side effects he or she is ok for recreational diving provided he or she obtains clearance from a qualified physician. Also, out of an abundance of caution, we advise people taking this medication to avoid breathing gas underwater that has a higher concentration of oxygen (nitrox or high-O2 decompression mixes), since high levels of oxygen can lead to seizures as well. DocVikingo is more qualified than I am to speak to psychoactive medications; Doc, if you have anything to add or correct please do.

The ADCI (Association of Diving Contractors International) has a set of consensus standards that include conditions that are disqualifying for commercial diving. Two of those are "significant obstructive or restrictive lung disease" and "chronic conditions requiring continuous control by medication".

Unfortunately if appears that, from the information you've provided, you would probably be excluded from commercial diving. That doesn't mean you can't be cleared for recreational diving, though. Scottsdale Healthcare hospital has a hyperbaric facility with medical staff who can examine divers. If you're looking for clearance to dive that would be a great place to start.

Hope this helps!

Best regards,
DDM

 

[Taliena]

Technical diving is a recreational way of diving. But it is more demanding than sportsdiving. I like technical diving, sportsdiving is not my way to relax. Of course I do shallow dives, but I prefer technical diving, caves and deep wrecks with decogases for accelerated deco.
Why not do this? and find a normal job to earn money for a really nice hobby?

 

[cogaritis]

Hey everyone,

I couldn't find my thread and then saw that someone moved it - and appropriately so, so thank you.

I noticed a few homeopathic things on here, and I take them into consideration, but I've had asthma my entire life and the only thing that has worked is western medicine, though I don't mind exploring other options.

See, everyone says "these effects are not studied." Okay, fine. Use me as the guinea pig! I'll test it for you! Zoloft isn't an issue - I can discontinue that medicine if it meant I could be eligible for commercial diving, but it ain't gonna happen so no point in doing that.

I actually contacted the Australian Navy to see if I could join. Under their revised guidelines, I could be eligible to join their defence program, but of course I would still be ineligible for diving or special forces. HOWEVER - if the U.S. DoD would allow me, I'd already be in. I can't even get a desk job because asthma is a straight disqualifier. Australia has realized how dumb this is and is making exceptions for servicemen who don't have particularly demanding fields (i.e. a nuclear/mechanical/chemical engineer). I also contacted the Royal Navy (UK). We'll see what they have to say. (A few hundred years ago, would I be considered a traitor? Damn redcoats. lol)

I'm going to pursue diving as a hobby. I'd love to learn technical diving - one of my hobbies is metal detecting and I'd love to use that underwater. I'd love to inspect wrecks.

Thanks again for all the responses, whether to me or not. I found them all helpful.

Now, does anyone know what field I could get in where I could work on Navy ships - like building them, repairs, all that kind of stuff? Or where I could learn about the engines they use and if there is even a demand for people who can work on these engines? I know welding is one area, but maybe there are others.

---------- Post added April 2nd, 2014 at 06:52 AM ----------

The mildest form is exercise induced.

That's what I have, or at least the major trigger.

But moderate to severe need inhaled steroids on more or less chronic basis. If a patient uses an albuterol inhaler even once a day but as often as three times a week they do require Advair style medications daily. Period. That is simply standard of care.

Was taking albuterol inhaler twice a day, at least. Since Advair, haven't touched it. It's still at 114 puffs left.

But it's like sunburns. Some are mild and the skin just gets little red with minimal pain. Some are severe with skin that blisters and peels. The OP Cogaritis has described aspects of his asthma that are different than mild exercise induced asthma. Quite simply and to be blunt, it's not the same.

Which is interesting... But I get the analogy. My cousin gets blisters and, just, eww, and I just turn brown and peel a few days later, like a lizard.