Newly diagnosed and heading for a dive trip soon, need advice

[KathyV]

My husband was recently diagnosed with rheumatoid arthritis, so far the symptoms are mild but he has been taking methotrexate and folic acid for a couple of months. I know that these treatments are immuno-suppressive and that he is more susceptible to cold sores and shingles and other infections and that exposure to strong sunlight can bring on herpes and shingles and other infections. He has always been prone to ear infections on dive trips and he has broken out in a sun rash a few times in the past.

We are leaving soon on a 2 week tropical vacation including a week on a livaboard. I plan to buy sunscreen and encourage him to use it but we are there to have fun so we want to spend time diving and enjoying the beautiful, sunny climate. We don't know what the future will hold and if we will be able to take dive trips in the future so we want this one to be a great trip. He is in his early 60s and in generally good health otherwise. Am I over-reacting or what precautions should we take to prevent/treat possilbe infections? He's under a doctor's care but I would really appreciate some knowledgeble advice from a diver's perspective. Thank you!

 

[DocVikingo]

Hi Kathy,

I can appreciate how distressing this must be for both of you.

Oral herpes simplex infections certainly can more easily gain a foothold in an individual prescribed a immunosuppressive agent (e.g., methotrexate), and ultraviolet ray exposure indeed can exacerbate the condition.

The new profile test that begins with a "V" that you refer to is the Vectra DA test (Vectra DA test results - Vectra DA - The Vectra DA Test) and there is no reason be overly concerned with the numbers yielded by this measure provided that serum RA is negative and symptoms remain mild & well-controlled by meds. It is positive that an anti-viral agent has been effective in helping to resolve the herpes labialis outbreak, and probably a good thing that the of dosage methotrexate has been at least temporarily reduced.

The likelihood that sun exposure would precipitate an episode of shingles (herpes varicella-zoster) in an individual with no history of an outbreak is less than in a person who has a history of prior attacks. But, while wanting to enjoy the sun & sea certainly is understandable, it would be unwise to do so under these circumstances, especially by an individual with a reported history of sun rash. The prudent course of action would be to use at least an SPF 50 sunblock applied copiously & frequently, wear protective clothing & remain out the sun to the maximum extent possible.

As for the proneness to ear infections you mention, I suggest reading this Alert Diver article of mine --> http://www.awoosh.com/DocVikingo/Pre...immers_Ear.htm

Regarding obtaining anti-microbial agents pre-trip for use in case of infection, one problem is that they have to effectively target the offending microorganism, and lay individuals may be unable to make educated guesses about this. And the wrong anti-microbial can sometimes make matters even worse. Still, it should do no harm to discuss your concerns with you husband's PCP.

Do have a splendid time.

Cheers,

Doc V

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.