Question about a new Med???

[tyki]

Well, hubby and I are getting close. We finished our confined water dives tonight. However, a check up with the family doc today ended up with hubby on a new prescription. Hubby is 5'6 and about 275 pounds. Since all the tests the doc ran came up normal, the doc prescribed Meridia for weight loss.

Question is....is there any reason that taking this med would cause a problem with diving? Cholesterol and blood pressure are normal, just carrying more weight than the doc is happy with.

I sure hope this won't postpone our Open Water dives in 2 weeks.

tyki
excited about the next time she gets to get wet

 

[scubadoc]

Hello:

Meridia or Sibutramine is a weight loss drug regulated as Class IV. It blocks serotonin and norepinephrine and has a fairly vigorous pressor effect (blood pressure elevation) in some people. In addition, as with most medications it has a long litany of side effects that can happen to some people - some of which can be adverse to a diver at depth or mimic signs and symptoms of a decompression accident. These include: agitation, amblyopia, angina, anxiety, arthralgia, asthenia, back pain, bleeding, cough, depression, dizziness, drowsiness, dysgeusia, dyspnea, ecchymosis, edema, emotional lability, fever, headache, hypertension, laryngitis, muscle cramps, myalgia, mydriasis, otalgia, palpitations, paresthesias, peripheral edema, pruritus, rhinitis, seizures, sinus tachycardia, sinusitis.

Possibly more important to your husband's safety than the medication is diving with his height and weight. In some areas of the world where medical fitness is more stringently regulated than the US, a high BMI (body mass index) would deter him from diving. In fact this medication should be prescribed only to individuals with a BMI of 30 kg/m2 or above without complicating factors, such as diabetes mellitus, dyslipidemia or hypertension. The BMI is important to divers due to the fact that people with high BMI are more prone to coronary artery disease and an untoward coronary event while diving. Your husband's BMI is 44.4, which is quite high.

You and your husband need to know that there is an increased risk for him diving with his weight problem as well as from the possible side effects of the medication. The possible ill-effects of nitrogen added to the drug is not known.

Diving is a wonderful sport but it would be better to wait until he loses down to a comfortable level - at least below 30kg/m2.

Figure your BMI by going to this web site:
http://www.nhlbisupport.com/bmi/bmicalc.htm

 

[tyki]

Thanks for the feedback. It sounds like we need to sit down and have a serious talk tonight about hubby's diving. I don't want to discourage him, or make him feel like he's being punished for the weight. But I also don't want to spend my 25th wedding anniversary with a marble marker. I will sit down with him tonight and show him what you had to say and talk to him, perhaps getting the certification can be an incentive to keep him on the weight loss program.

Anyone know where I can get lessons in building sand castles? ;-0 (sniffle)

tyki

 

[Dr Deco]

Dear tyki ( - and hubby):

Weight is a real problem for many people as is high blood pressure. I was a very thin individual when younger and I lived in the cool north. When I moved to Texas, the humidity was high in summer and my joints began to give me problems when I jogged. My weight went from 190 to 240 with a height of 5’10”. This is too much, and now I walk almost every day for three purposes.

• Weight control
  Blood pressure reduction
  Anti depression.

It is successful if carried through with persistence. I do find that I need to walk 5 to 7 miles a day, but I do this with my little radio and find the music and outdoors quite enjoyable. This is coupled with a diet that is more “portion control” than anything else. :doctor:

Now for the bad news (it gets worse ?). From the standpoint of decompression, when one dives, nitrogen dissolves in all tissues of the body in proportion to the gas solubility and the blood flow to the tissue. As far as joint-pain DCS is concerned (“the bends”), this arises primarily in tissues that contain water. However, nitrogen is very soluble in adipose (fat) tissue and, in overweight people, the fraction of this tissue in the body is high. In some cases, nitrogen loads can rise in adipose tissue and bubble formation can be extensive. While one would not develop pain DCS from this, these gas bubbles would be dumped into the venous system where they are carried to the heart and lungs. If the gas bubble loads to these organs is high, the lung capillaries become block, blood pressures rise in the pulmonary artery, and bubbles can pass through the lung vasculature (or a PFO, patent foramen ovale in the heart) and embolize the brain. [red]We end up with a vein-to-artery "stoke" and neurological DCS. [/red]
Attempts should be made to reduce weight – even if one were not a diver. I know personally that this is easier said than done.:devilish:

Dr Deco

 

[tyki]

It isn't that we don't want to hear about ways to help lose the weight, just that he has a lot of irons in that fire at the moment. This latest diet will help me shed a few pounds as well as we watch even closer what we eat around here. (My BMI is around 27.4)

Hubby has tried in the past to lose the weight with only very moderate success. The bulk of the weight gain started 15 years ago when he gave up smoking and got out of the service. Then the snoring started....which grew and grew. He joked about the snoring while I complained. Until last fall when I recorded his snoring, and made him hold his breath during the times the recording wasn't picking up the snoring. I explained to him that when he isn't snoring at night, he wasn't breathing, I was convinced that he had sleep apnea. That finally convinced him to get a physical and look into getting a sleep test done.

In spite of thie elevated weight, his cholesterol count is in the good range, blood pressure normal, no diabetes, no thyroid, EKG normal. Then he went for the sleep test. Sleep apnea big time, over 98 apnea episodes an hour while sleeping. So now we have an air mask that he wears to bed. The sleep doc says that once he catches up on the sleep he has been missing out on for all these years, he should start to see a dramatic weight loss, just through sheer metabolism shift and increased energy. Family doc says other than the weight his health is excellent and just wants to help the weight loss along by using Meridia and diet control.

Hubby bowls, plays softball, plays indoor soccer, and is active with a Boy Scout troop. So it isn't like he became a total couch potato. The swimming to get ready for class was fit in around all the other sports activities he was already involved in.

It's just really hard to turn down his enthusiasm for diving at the moment. Any ideas on how to get him to cool his jets?

 

[John Reinertson]

As one whose BMI is higher than ideal and age (52) is a risk factor, I can tell you that the above mentioned DCS risk associated with high body fat is real. To a large extent, this can be modified by diving more conservatively.

I often point out that diving is somewhat like snow skiing.. It is possible to do it on the bunny slope or the black diamond runs.. At any given skill or fitness level, the risk of a "black diamond" or expert dive is probably higher than that of a very cautious shallow dive. There is always some element of risk, but it can be lessened with caution.
There is no way to accurately quantify the additional risk from weight without careful eval and medical judgment.

I personally dive quite cautious profiles and accept that level of risk... at least until I get my weight down where it should be.

Dive safe, John

 

[tyki]

have become the name of the game for us. Hubby opted to hold off on starting the Meridia until we got back from Florida. And conservative and cautious is the only way to describe how our first OW dives went.

Now that we are home, I feel that I was the "dumber" of the two of us. Our OW class consisted of the instructor and 3 students (hubby and I, and a fellow who was getting re-certified). Monday the wet suit was constricting and I was toughing my way through a bought of nausea and I got it in my head that anyplace was better than that rocking boat when dive time came. (My first ever bout of motion sickness, I hadn't fed the fish yet but was struggling with the feelings of nausea). The excitement of the first dive, the nervousness, and the quick shot of cold water made it so I felt like I couldn't catch my breath. I had the BCD slightly overinflated, which was making breathing tougher. I released some of the air from the BCD and was able to catch my breath and calm down. I made the decent and got below the churning seas, my heart was racing but I was determined that I could do it, so I followed the other student down. In the meantime, the instructor was working with hubby, who was having trouble with his mask flooding and his weights slipping, when it came time for hubby to decend, he just couldn't convince himself to deflate the BCD and he aborted the dive (it just didn't feel right to him). Hubby called his dive, and I probably should have called mine as well, but I was being stubborn and wanted to get away from the rolling of the boat.

I made a short dive, but was overbreathing. Taking in more air than I was exhaling. Even with the BCD totally deflated, and wearing 16 pounds of weights, I was still positively bouyant at 28'. I floated toward the surface after about 10 minutes of being down and was losing sight of the instructor and the other student. Rather than try to swim down and try to find them, I noted that I was right next to the boat and decided it was time to get out of the water. The instructor and other student were back on the surface by the time I got to the ladder. I got out of the water, but was definitely done for the day.

Dive day one was a bust for us. I fed the fishes on the way back to the marina and felt miserable. Hubby was shaking his head and beating himself up about panicking in the water. We both went home questioning if we really wanted to do this or not. We were wiped out and miserable. Crashed into bed around 830 Monday night.

Tuesday morning we talked the over the events of the previous day. Evaluating what we had done, what we could do differently, and whether or not we even wanted to continue.
For whatever reason, Tuesday clicked for us and we were able to complete 2 successful training dives at 31'. Wow did we see some neat fishes and coral.

We were unable to extend our stay in Florida and have had to return to the cold without completing the certification. But we came home with a positive attitude about our diving experience and are looking forward to more diving in the future. Now to get busy with the diet and weight loss program which will make the diving more enjoyable for hubby.

All in all, I think this is a great 25th anniversary gift we are giving to each other. We have accepted that it isn't going to happen overnight and we are just destined to do it one step at a time, one dive at a time.

tyki
looking forward to her next swim with the fishes

 

[John Reinertson]

Great attitude and good sense. Anxiety is usually part of training. It's important to learn from it and it sounds like you have..
When anxiety rears its head again, you'll be able to stop, think, and take appropriate action.

Good experience, even if unpleasant in some respects.

Dive again soon,
John