Rheumatoid Arthritis

[xenophanes]

I am going to get back into diving after a long absence because it will provide physical challenges for me since I am limited by Rheumatoid Arthritis.

My question is about the meds I am taking for it and other things.

I take Arava (20mg daily), Methotrexate (15mg weekly), Relafen (1250mg daily) and occasionally Prednisone (up to 10mg daily and tapering back down for a few days, then no Pred for a few months) for the RA. Diovan for moderate hypertension and Claritin for hay fever and cat allergies.

I have not spoken to my doctor about diving yet, but am curious if there are any specific problems with the meds or the disease itself that will preclude me from getting back into diving.

Thanks.

 

[John Reinertson]

The medications you list are primarily ones that affect the immune response, not levels of concentration.

There are no studies that I know of specifically addressing your question.

Medical knowledge would suggest an increased susceptibility to respiratory or skin infection, so diving in beautiful, clear, unpolluted waters would be best.

Cold aggravates Rheumatoid arthritis for most people, so warm water and a good exposure suit would be wise.

The RA will limit exertional maximums somewhat, so low-risk planning with avoidance of stressful and physically challenging environments would be worthwhile.

The only precautions I would suggest specific to your medications are 1. Get a lung function test prior to trips..
Fibrosis of the lungs can happen with methotrexate or with rheumatoid arthritis. and could limit respiratory capacity underwater or increase likelihood of bubbling.

2. Wear a medicalert bracelet with details, including prednisone usage. People that use prednisone with some frequency can develop atrophy of the adrenals and may need special precautions with acute illnesses or major body stresses. It sounds like your doc is working hard to avoid this with the regimen he's using, but you don't want to be somewhere unconscious and have the treating doc have no idea of the potential for problems.

Dive conservatively. The limitations of your RA may each be minor, but they add up to a somewhat higher risk than the average diver. Counter that with a more conservative profile and you'll probably be able to balance the risk somewhat.

I would suggest Hepatitis A and B vaccinations, and try to pick areas with little or no malaria. Either malaria or Hepatitis A can be more serious in those with a suppressed/altered immune response.

Sounds like we're coming down to a recommendation for Caymans or Bonaire or something along that line..

Hmmmm.. You don't need a personal physician to accompany you, do you??

Kidding aside, Check with your doctor, and consider checking with an infectious disease specialist regarding risks at your destination.

Dive carefully, if you do decide to go and your doctor clears you.




2.

 

[xenophanes]

Thanks, Doc, for the detailed review. I am going to be sure to mention the points you brought up when I next visit my family doctor.

As to the lung function, I had one in June and was well inside the box for my age group. I swim 500 yards freestyle three times a week for my exercise regimen and my wind is not a bother, just the pain from the RA.

After my wife and I get going with diving, we plan to visit John Pennekamp Park in Florida, and our open dives for the certification will be out of Morehead City here in North Carolina, so the water temps should not be too bad.

My open water dives those many years ago were in March in a spring fed lake in Idaho. The water temperature was 38 degrees and we all wore two wet suits. I remember my mouthpiece kept falling out of my mouth because my lips were numb. I guess dives like that are out of the picture, right?

Thanks for the advice and support. It means a lot.

Terry

 

[John Reinertson]

Hope my suggestions are helpful.

I certified a loooong time ago, in 48 degree water, with a single wet suit and no hood, and viz of two ft. (BRRR)(instruction was more macho in 1974)

I have never dived Iowa water since.
Bonaire is my personal favorite, but Pennekamp is way cool.

Have a good time.
John