Earlier this year I was on Neurontin, also for post surgery back pain. My experience with it was that the side effects were more than just drowsiness...I also experienced confusion and clumsiness, inability to remember some words, and a general "fuzziness". I would not dive while taking neurontin.
Diving on Morphine. Please read!
- Thread starter Justarius
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beche de mer
Contributor
Neurontin can causes drowsiness, dizziness and unsteadiness of gait. The product information states that a person taking this medication should not drive or operate machinery unless they are sure they are not experiencing these side-effects.
Morphine, as has been said, can cause drowsiness, depression of respiration and impairment of judgement. However, people become used to the effects of morphine very quickly, so it is possible to be taking quite large doses and feel entirely normal.
From what you say, you are not experiencing any significant side effects topside. However this does not necessarily mean that you are not going to experience them at depth.
I think it is highly unlikely that you would find a doctor who is prepared to certify you as fit to dive while taking these medications.
Similarly, I think it is unlikely that you would find a dive operator who would be prepared to let you dive while taking them.
So the options are either not to dive, or to conceal the fact that you are taking these medications, and to take things extremely cautiously. If you are an extremely experienced diver and making these dives means the world to you, you might consider taking the chance. However, I gather from your post that you gained your certification not all that long ago and may not have a great number of dives under your belt.
All things considered, I would advise strongly against diving.
Remember, you would not just be putting yourself at risk. There's also your buddy to consider. What's more, if anything went wrong, you could be creating a world of hurt for the dive operator.
Sorry Justarius, but that's the way I see it, and that's how I would advise you if I were your diving doc.
Morphine, as has been said, can cause drowsiness, depression of respiration and impairment of judgement. However, people become used to the effects of morphine very quickly, so it is possible to be taking quite large doses and feel entirely normal.
From what you say, you are not experiencing any significant side effects topside. However this does not necessarily mean that you are not going to experience them at depth.
I think it is highly unlikely that you would find a doctor who is prepared to certify you as fit to dive while taking these medications.
Similarly, I think it is unlikely that you would find a dive operator who would be prepared to let you dive while taking them.
So the options are either not to dive, or to conceal the fact that you are taking these medications, and to take things extremely cautiously. If you are an extremely experienced diver and making these dives means the world to you, you might consider taking the chance. However, I gather from your post that you gained your certification not all that long ago and may not have a great number of dives under your belt.
All things considered, I would advise strongly against diving.
Remember, you would not just be putting yourself at risk. There's also your buddy to consider. What's more, if anything went wrong, you could be creating a world of hurt for the dive operator.
Sorry Justarius, but that's the way I see it, and that's how I would advise you if I were your diving doc.
Unfortunately, most MDs, (including myself, and I would guess many diving medical experts) are poorly trained regarding narcotics and chronic pain. My $.02 is to try to get both a diving specialist and pain management specialist together on this.
As some have pointed out, people develop tolerance to the side effects (other than constipation) of narcotics, and can function quite normally (unless they stop and go into withdrawal). William Halstead, one of the foremost surgeons of his time (late 1800's and early 1900's), pioneered many surgical techniques, set up the training program at Johns Hopkins, etc., etc., while a lifelong user of morphine (fortunately he apparently kicked alcohol and cocaine early on). I know some divers and docs on chronic narcotics for chronic pain, and I'd rather dive with/ be cared for by them than a lot who are drug-free.
As pointed out, Neurontin causes a lot of drowsiness, but most people develop tolerance to that as well.
Pipedope makes a good point about diagnostic difficulties re DCS and someone with preexisting neurologic deficits, but that's true for anyone with prior back surgeries, etc., regardless of meds. Whether the scar tissue predisposes to DCS is another issue not well understood.
Good luck
As some have pointed out, people develop tolerance to the side effects (other than constipation) of narcotics, and can function quite normally (unless they stop and go into withdrawal). William Halstead, one of the foremost surgeons of his time (late 1800's and early 1900's), pioneered many surgical techniques, set up the training program at Johns Hopkins, etc., etc., while a lifelong user of morphine (fortunately he apparently kicked alcohol and cocaine early on). I know some divers and docs on chronic narcotics for chronic pain, and I'd rather dive with/ be cared for by them than a lot who are drug-free.
As pointed out, Neurontin causes a lot of drowsiness, but most people develop tolerance to that as well.
Pipedope makes a good point about diagnostic difficulties re DCS and someone with preexisting neurologic deficits, but that's true for anyone with prior back surgeries, etc., regardless of meds. Whether the scar tissue predisposes to DCS is another issue not well understood.
Good luck
Bob3
Contributor
I'm on fentanyl (30x to 80x stronger than morphine) & diving on it doesn't pose any significant problems in/of itself.
The other little glitches, like displaying many of the same symptoms as DCS when you're in "normal mode" is something to watch out for.
The other little glitches, like displaying many of the same symptoms as DCS when you're in "normal mode" is something to watch out for.
beche de mer
Contributor
That's interesting Bob3. Would that be Duragesic? I'd be interested to know whether you have been certified OK to dive by a dive examiner, fully conversant with the facts.
Weight for weight, Fentanyl is much more potent than morphine, but the doses are correspondingly smaller. An average dose is about 100 micrograms per hour, whereas an average dose of morpine might be about 10 milligrams every 4 hours. A milligram is a thousand micrograms.
The mode of delivery is a factor also. Fentanyl used for chronic pain is usually delivered by absorption through the skin. Morphine is given either by injection or orally, which would make the bio-availability somewhat greater.
But yes, Fentanyl is a very potent narcotic. Remember the recent hostage situation in a Moscow theatre by Chechnian rebels? The security forces knocked out the rebels by introducing Fentanyl via the air-conditioning. Unfortunately many of the hostages died from respiratory depression or inhaling vomit.
You have a "normal mode"?
The best I can come up with is "emulate normal".
The best I can come up with is "emulate normal".
Hey everyone, sorry this reply is long overdue but I just wanted to thank everyone for responding. Wow... I really was not expecting so many replies. This forum is amazing!
I can tell just from the response to my post what a great community this is and I think that is also indicative of the Scuba community in general.
I intend to write back more fully and comment on some of your points but I've been strapped for time.
After taking into consideration what you have all written and consulting further with a doctor here and a drug expert, I've decided for now to take a scuba review here and then do a shallow dive in Grand Cayman or Cozumel. Something like Stingray City where the depth is similar to snorkeling. I hear there is amazing diving in both these places at, say, less than 30 feet. Anyone have any advice on the best way to find a dive with these parameters? If I can't find something like that I'll just snorkel and forego diving for now.
Then in the summer I'm going to dive with some friends who are dive masters and know my situation and can keep a close eye while we try progressively deeper and longer dives. Given my top-side tolerance of the drugs (no side effects at all) the general consensus is things will be fine but I should take it slow.
Thanks again everyone, I really appreciated the show of support from a few of you in particular. I'll write more soon.
Anthony
I can tell just from the response to my post what a great community this is and I think that is also indicative of the Scuba community in general.
I intend to write back more fully and comment on some of your points but I've been strapped for time.
After taking into consideration what you have all written and consulting further with a doctor here and a drug expert, I've decided for now to take a scuba review here and then do a shallow dive in Grand Cayman or Cozumel. Something like Stingray City where the depth is similar to snorkeling. I hear there is amazing diving in both these places at, say, less than 30 feet. Anyone have any advice on the best way to find a dive with these parameters? If I can't find something like that I'll just snorkel and forego diving for now.
Then in the summer I'm going to dive with some friends who are dive masters and know my situation and can keep a close eye while we try progressively deeper and longer dives. Given my top-side tolerance of the drugs (no side effects at all) the general consensus is things will be fine but I should take it slow.
Thanks again everyone, I really appreciated the show of support from a few of you in particular. I'll write more soon.
Anthony
IBKuz
Registered
Justarius,
Not sure that I can help you with the morphine question but though I could talk a little about back pain. I myself have had back problems most of my life (L5 region), nothing as severe as yourself but a problem none the less. Three years ago I came to a crisis point and needed to do something as my pain was starting to affect my quality of life. At this time I looked into various pain killers and how I could help my back. I started a program of stretching exercises and Chiropractic treatments. I had had treatments earlier in my life and medical doctors felt that my present condition would not be benifitted by surgery. At the same time I did some research and found a non-perscription supplement called MSM.
This substance is used in controlling cronic pain and specifically in the use for severe arthritis, with varring degrees of success. I have also recommended this to other friends and colleagues for there back problems and they have also had good results. Unfortunetly, like most drugs that are not pattenable there are no major studies to determine the specific triggers that make this substance work. This being said the substance has a toxicity level simular to water and has been used for many years with no recorded problems (please note, as with most suplements, I do not have rigorous scientific data on this statement). My main interest in using MSM was the concern from long term usage of painkillers as there are lots of studies outlining the detrimental affects of various painkillers. To date, my reasearch found that there has been no known problems with the use of MSM over long periods of time.
This substance will not remove your severe pain but I found it did give me relief from the day-to-day aches that I would normally feel. This allowed me to reduce some of the depression and got me exercising again. The exercising being the best action I have found to date for reviving/improving my back condition.
If you wish to find out more about MSM just type it into the "google" search engine and you will find quite a bit of info, unfortunetly a lot will be advertising. You can also visit your local healthfood store and ask (there are some books on the market) and most Naturopath and Holistic doctors should also know about this supplement (even your regular doctor might know something).
Now for the disclaimer, I am not a doctor and it should be noted that this info is for information purposes only. Like all medicines and supplements, you must reseach them yourself to decide if they are right for you. I would also like to note that there have been other beneficial attributes for MSM that also make this a good supplement for back pain as it is believed that it also helps in the reduction of inflamation and has been known to reduce scar tissue. If you would like to know more please PM me and I will help as best I can, good luck.
Ian
Not sure that I can help you with the morphine question but though I could talk a little about back pain. I myself have had back problems most of my life (L5 region), nothing as severe as yourself but a problem none the less. Three years ago I came to a crisis point and needed to do something as my pain was starting to affect my quality of life. At this time I looked into various pain killers and how I could help my back. I started a program of stretching exercises and Chiropractic treatments. I had had treatments earlier in my life and medical doctors felt that my present condition would not be benifitted by surgery. At the same time I did some research and found a non-perscription supplement called MSM.
This substance is used in controlling cronic pain and specifically in the use for severe arthritis, with varring degrees of success. I have also recommended this to other friends and colleagues for there back problems and they have also had good results. Unfortunetly, like most drugs that are not pattenable there are no major studies to determine the specific triggers that make this substance work. This being said the substance has a toxicity level simular to water and has been used for many years with no recorded problems (please note, as with most suplements, I do not have rigorous scientific data on this statement). My main interest in using MSM was the concern from long term usage of painkillers as there are lots of studies outlining the detrimental affects of various painkillers. To date, my reasearch found that there has been no known problems with the use of MSM over long periods of time.
This substance will not remove your severe pain but I found it did give me relief from the day-to-day aches that I would normally feel. This allowed me to reduce some of the depression and got me exercising again. The exercising being the best action I have found to date for reviving/improving my back condition.
If you wish to find out more about MSM just type it into the "google" search engine and you will find quite a bit of info, unfortunetly a lot will be advertising. You can also visit your local healthfood store and ask (there are some books on the market) and most Naturopath and Holistic doctors should also know about this supplement (even your regular doctor might know something).
Now for the disclaimer, I am not a doctor and it should be noted that this info is for information purposes only. Like all medicines and supplements, you must reseach them yourself to decide if they are right for you. I would also like to note that there have been other beneficial attributes for MSM that also make this a good supplement for back pain as it is believed that it also helps in the reduction of inflamation and has been known to reduce scar tissue. If you would like to know more please PM me and I will help as best I can, good luck.
Ian
Bob3
Contributor
Yep, brand name is Duragesic. I get all my meds from the VA (Veteran's Administration) so have had the opportunity to not only get DRs familiar with hyperbaric aspects of medications, but I also get to play an active role in selection of the meds. I only use meds that will not prohibit me from diving.
The object of a pain medication is not to eliminate the pain (that'd be great, eh?) but to "knock the edge off", enabling me to stay more active, which helps considerably more than any of the pain meds on their own.
I had a chunk of L5 knocked off when I busted my pelvis, & some nasties in C-6&7 which causes all sorts of mischief, including many of the symptoms of a DCS hit.
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