sinus infection & confined water dives
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I don't have any medical background, but I am a fellow sufferer of occaisional sinus maladies. If you truly have a sinus infection, your best bet would be to try to get some antibiotics. Normally you would see results in 2-3 days, and so you should be okay with 9 days before your class. Some physicians want you to have the condition for 10 days before prescribing an antibiotic, but I circumvent this when its clear its not going to resolve on its own. If you have a brown/green/dark yellow discharge this is one indication of a bacterial infection. The fact that you would only be going down 10 ft is not going to preclude problems with airspaces in your sinuses, based on my own experience. Be aware of what a reverse block is with your eustachian tubes, as it is not enuf that you can get down, you also have to get back up from a dive. I take sudafed before any dive. Best to dive with no medication at all, but for me the only other choice is not diving. Certainly try any medication on dry ground before using it diving and see how it affects you personally. Be aware that pressure will also affect how a medication affects you. I have noticed that pressure and some antibiotics don't mix that well (increased susceptibiity to narcosis).
Soggy
Contributor
I had a cold during one of my pool sessions...It involved excruciating pain that felt like it was in my tooth...I spent the session in the shallow end which felt fine. Below 5 ft or so was impossible. You'll probably be able to do the session, but maybe not in the deep end.
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I follow the dive medicine literature fairly closely, and am aware of no research indicating increased susceptibility to narcosis related to antibiotic use. Can you enlighten me?
Best regards.
DocVikingo
Best regards.
DocVikingo
Hi Doc Vikingo:
I should have been more specific in my comment. It wasn't necessarily meant to be general for all antibiotics. My comment was more along the lines of, antibiotics, like all drugs can have side effects. Some side effects my not interact well with increased partial pressures of nitrogen. Consider me as one data point -- I did a relatively deep dive while I was taking Cipro to 80 ft on nitrox 32, I felt fairly strong effects of nitrogen narcosis, which I have never before felt at this depth. Cipro is a heavy duty antibiotic and diving with Cipro was probably a poor choice for me since I do imbibe in caffeine, although I try to limit my intake while diving. Cipro slows the metabolism of caffeine (and also theopylline), resulting in nervousness and CNS stimulation. The former side effect may bode poorly for narcosis and the latter one is counterindicated for elevated oxygen partial pressures.
I will defer to your knowledge on this but it seemed that the DAN Europe faq was good for antibiotics in general:
ANTIBIOTICS AND DIVING
Question:
Is it allowed to dive after antibiotic treatment for an external otitis treated with Augmentan for 8 days?
The physician cleared the diver for resuming diving two weeks after healing, but an experienced instructor said that there is added risk
in diving after antibiotic therapy, due to the changes of the blood, and that diving shouldnot be resumed for at least two months.
Answer:
Thank you for your interesting question, which is actually not at all uncommon and gives us the opportunity to clear a frequently
misunderstood matter.
Besides certain special conditions, where the antibiotic itself may have caused adverse reactions, it is not generally the antibiotic
treatment, but the condition for which it is prescribed and administered, to be the potential cause to disqualify an individual from
diving, either temporarily or permanently. Even in the case of an adverse effect of prolonged duration, it will be the adverse effect itslef
and not the antibiotic substance, per se, to be considered as the disqualifying factor.
The hematological and other physiological changes that a normal antibiotic therapy can generate do not generally affect normal
physiological function to any significant level, especially if the treatment is carefully prescribed and medically monitored. When the
convalescence period prescribed by the treating physician has passed and a complete resolution of the condition for which the antibiotic
treatment was prescribed has been obtained, there is no reason to refrain from any activity because of a presumed long term adverse
effect of the pharmacological treatment, not detectable with clinical assessment, laboratory or functional tests, unless there are other
contraindications, and if the general fitness of the individual has returned to levels which are considered compatibel with the activity to
be performed.
I should have been more specific in my comment. It wasn't necessarily meant to be general for all antibiotics. My comment was more along the lines of, antibiotics, like all drugs can have side effects. Some side effects my not interact well with increased partial pressures of nitrogen. Consider me as one data point -- I did a relatively deep dive while I was taking Cipro to 80 ft on nitrox 32, I felt fairly strong effects of nitrogen narcosis, which I have never before felt at this depth. Cipro is a heavy duty antibiotic and diving with Cipro was probably a poor choice for me since I do imbibe in caffeine, although I try to limit my intake while diving. Cipro slows the metabolism of caffeine (and also theopylline), resulting in nervousness and CNS stimulation. The former side effect may bode poorly for narcosis and the latter one is counterindicated for elevated oxygen partial pressures.
I will defer to your knowledge on this but it seemed that the DAN Europe faq was good for antibiotics in general:
ANTIBIOTICS AND DIVING
Question:
Is it allowed to dive after antibiotic treatment for an external otitis treated with Augmentan for 8 days?
The physician cleared the diver for resuming diving two weeks after healing, but an experienced instructor said that there is added risk
in diving after antibiotic therapy, due to the changes of the blood, and that diving shouldnot be resumed for at least two months.
Answer:
Thank you for your interesting question, which is actually not at all uncommon and gives us the opportunity to clear a frequently
misunderstood matter.
Besides certain special conditions, where the antibiotic itself may have caused adverse reactions, it is not generally the antibiotic
treatment, but the condition for which it is prescribed and administered, to be the potential cause to disqualify an individual from
diving, either temporarily or permanently. Even in the case of an adverse effect of prolonged duration, it will be the adverse effect itslef
and not the antibiotic substance, per se, to be considered as the disqualifying factor.
The hematological and other physiological changes that a normal antibiotic therapy can generate do not generally affect normal
physiological function to any significant level, especially if the treatment is carefully prescribed and medically monitored. When the
convalescence period prescribed by the treating physician has passed and a complete resolution of the condition for which the antibiotic
treatment was prescribed has been obtained, there is no reason to refrain from any activity because of a presumed long term adverse
effect of the pharmacological treatment, not detectable with clinical assessment, laboratory or functional tests, unless there are other
contraindications, and if the general fitness of the individual has returned to levels which are considered compatibel with the activity to
be performed.
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Thank you for answering my inquiry.
While I do appreciate your sharing of your dive experience while on Cipro, I'm afraid that I see it as a less than meaningful data point. Leaving aside that it's a single dive by a single person under a singular set of conditions, it's entirely anecdotal self-report.
Again, I know of no scientific findings indicating increased susceptibility to narcosis solely related to antibiotic use.
To the extent that Cipro may increase the serum half-life of caffeine, this, in and of itself, does not cause nervousness & CNS stimulation. The Cipro is not directly potentiating the effects of caffeine, but simply prolonging them somewhat. Given that modest amounts of caffeine are imbibed at modest intervals, I can see no reason for the serum level of caffeine to reach a worrisome area. And, in any event, this state of affairs is not the fault of the antibiotic; it's the untoward result of taking two drugs, one of which is not necessary to the health & welfare of the individual.
Even accepting the argument that this slowing of the metabolism of caffeine does result in CNS stimulation, it nonetheless cannot be supportably stated that this side effect may bode poorly for narcosis, or that it is counterindicated for elevated oxygen partial pressures. I know of no published evidence to support either of these assertions. However, I will grant that there is a theoretical reason, to my knowledge unexamined to date, that CNS stimulation in the face of exposure to elevated oxygen partial pressures might not be prudent.
Perhaps you have some formal studies to prove me wrong. It's awfully hard to keep on up everything these days.
In the meantime, I do accept the DAN Europe FAQ that:
"Besides certain special conditions, where the antibiotic itself may have caused adverse reactions, it is not generally the antibiotic treatment, but the condition for which it is prescribed and administered, to be the potential cause to disqualify an individual from diving, either temporarily or permanently. Even in the case of an adverse effect of prolonged duration, it will be the adverse effect itself and not the antibiotic substance, per se, to be considered as the disqualifying factor."
Best regards.
DocVikingo
While I do appreciate your sharing of your dive experience while on Cipro, I'm afraid that I see it as a less than meaningful data point. Leaving aside that it's a single dive by a single person under a singular set of conditions, it's entirely anecdotal self-report.
Again, I know of no scientific findings indicating increased susceptibility to narcosis solely related to antibiotic use.
To the extent that Cipro may increase the serum half-life of caffeine, this, in and of itself, does not cause nervousness & CNS stimulation. The Cipro is not directly potentiating the effects of caffeine, but simply prolonging them somewhat. Given that modest amounts of caffeine are imbibed at modest intervals, I can see no reason for the serum level of caffeine to reach a worrisome area. And, in any event, this state of affairs is not the fault of the antibiotic; it's the untoward result of taking two drugs, one of which is not necessary to the health & welfare of the individual.
Even accepting the argument that this slowing of the metabolism of caffeine does result in CNS stimulation, it nonetheless cannot be supportably stated that this side effect may bode poorly for narcosis, or that it is counterindicated for elevated oxygen partial pressures. I know of no published evidence to support either of these assertions. However, I will grant that there is a theoretical reason, to my knowledge unexamined to date, that CNS stimulation in the face of exposure to elevated oxygen partial pressures might not be prudent.
Perhaps you have some formal studies to prove me wrong. It's awfully hard to keep on up everything these days.
In the meantime, I do accept the DAN Europe FAQ that:
"Besides certain special conditions, where the antibiotic itself may have caused adverse reactions, it is not generally the antibiotic treatment, but the condition for which it is prescribed and administered, to be the potential cause to disqualify an individual from diving, either temporarily or permanently. Even in the case of an adverse effect of prolonged duration, it will be the adverse effect itself and not the antibiotic substance, per se, to be considered as the disqualifying factor."
Best regards.
DocVikingo
BillP
Senior Member
Like DocV, I'm unaware of any information that would indicate that taking antibiotics in and of itself increases the risk of narcosis. I agree with the DAN Europe assertion that barring an adverse reaction to the antibiotic (like an allergic reaction independent of diving) any risk in diving comes from the illness for which the antibiotics are taken, not the antibiotics themselves. It seems that DAN Europe is also correct that this concept is often misunderstood.
I suppose it's possible that a diver who already feels out of sorts from too much caffeine could be sensitive to noticing certain untoward effects of narcosis. But then any concern about that effect should prompt a warning about taking too much caffeine and diving, or about combining excessive caffeine use with Cipro use- not a warning that antibiotics increase the effects of narcosis.
Caffeine does indeed stimulate the central nervous system (CNS), and if you think about it you might become concerned about an increased risk of CNS oxygen toxicity. But the only study that I'm aware of that looks at caffeine and CNS oxygen toxicity shows that it reduces the effect of CNS oxygen toxicity (in rats, at least.) See:
http://www.ncbi.nlm.nih.gov:80/entr...eve&db=PubMed&list_uids=8574677&dopt=Abstract
Howdy wanda:
Many people dive with slightly stuffy noses without ill effects, but it's not really advisable, even in shallow water. A barotrauma injury can occur in as little as 2.6 feet of water.
HTH,
Bill
The above information is intended for discussion purposes only and is not meant as specific medical advice for any individual.
Hi DocVikingo:
I agee it's nice to know and report the results from studies, but in my book if a finding comes out of a published study it isn't infallible. Personally, before I would accept something published as "true" I would have to study the methodo logy used in a published study myself (even in a refereed journal), and then wait for other independent studies to validate the first study. I made clear that my comments about my experience were anecdotal and would hope people would consider them accord i ng to whatever their personal criteria are for assimilating such information -- certainly within that spectrum is to disregard them, which is fine. Most of this board is anecdotal as near as I can tell. I still find it useful.
I think its important not t o put antibiotics on a different plane compared to other drugs. As a class, antibiotics are extremely heterogenous in their composition. Consistent with this, the way in which they attack bacteria differs greatly as well. Here are three classes of anti bio tics for example: beta-lactams (eg penicillin), macrolides (eg erythromycin), fluoroquinolones (eg ciprofloxacin, levofloxacin). They inhibit cell wall biosynthesis (serine acylation), protein synthesis (by binding to the ribosome 50S subunit) and dna rep lication (binding to topoisomerases), respectively. Their chemical structures are also very different: beta-lactam, macrocyclic ether, and polyaromatic. Side effects from antibiotics are all over the map, and include in some cases drowsiness. Drowsin ess i s in my limited exposure to dive medicine is what gets pinpointed most often as enhancing the effects of narcosis, especially in combination with seasickness preventatives. I would suggest this is one area where antibiotics could easily increase sus ceptibility to nitrogen narcosis. Where we may differ is that I don't require a published study to make the connection for my personal use. For sure making a connection like this is informal, but I would do it because in my mind it seems reasonable and pr udent. I understand that it couldn't be officially condoned and passed on as knowledge. I look at it this way: in the absence of firm knowledge to the contrary, I attach a certain probability to something being true based on inference, and minimize percei ved ri sk accordingly.
Cipro is a potent inhibitor of Cytochrome P450 1A2. This enzyme is responsible for metabolism of caffeine. It's clear to me anyway that Cipro is going to _increase_ the serum concentration over what it is in its absence, not just i ts half-life. The kinetics involved are the rate of absorbtion from the gut and the rate of metabolism in the liver. Both of these processes take some amount of time. In the absence of cipro there will be a ramping up of caffeine serum concentrations until some maximum is reached, and all the while backgroud metabolism of caffeine. This background metabolism of caffeine before it reaches its serum concentration maximum is necessarily greater in the absence of the P450 inhibitor cipro. It follows that the maximum serum concentration of caffeine will be less in the absence of cipro, and the maximum caffeine serum concentration will be greater in its presence. As for whether a small amount of caffeine will get you in to trouble with cipro, this really depend s on how strong of an inhibitor it is of the P450 enzyme, and indications are that it is pretty strong. I think its important to keep in mind that when denying the body the ability to clear something, what would otherwise be a small amount of something ca n lead to trouble. In the case of theopylline and cipro, deaths have been implicated to result from the combination, but absolute causality has not been determined since theophylline alone _can_ have the same effects observed, at least in prinicple.
Ther e are a host of side effects for Fluroquinolones that are not consistent with safe diving. From the NIH website:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202656.html#SXX20
Fluoroquinolones may also cause some people to become dizzy, lightheaded, drows y, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that can be dangerous if you are dizzy or are not alert.
For cipro in particular side effects can incl ude: upset stomach, diarrhea, vomiting, stomach pain, headache, restlessness, nervousness, difficulty falling or staying asleep, anxiety, nightmares.
Clearly side effects are person dependent and studies don't help that much when you are not a part of the study.
Regards,
Zorax
I agee it's nice to know and report the results from studies, but in my book if a finding comes out of a published study it isn't infallible. Personally, before I would accept something published as "true" I would have to study the methodo logy used in a published study myself (even in a refereed journal), and then wait for other independent studies to validate the first study. I made clear that my comments about my experience were anecdotal and would hope people would consider them accord i ng to whatever their personal criteria are for assimilating such information -- certainly within that spectrum is to disregard them, which is fine. Most of this board is anecdotal as near as I can tell. I still find it useful.
I think its important not t o put antibiotics on a different plane compared to other drugs. As a class, antibiotics are extremely heterogenous in their composition. Consistent with this, the way in which they attack bacteria differs greatly as well. Here are three classes of anti bio tics for example: beta-lactams (eg penicillin), macrolides (eg erythromycin), fluoroquinolones (eg ciprofloxacin, levofloxacin). They inhibit cell wall biosynthesis (serine acylation), protein synthesis (by binding to the ribosome 50S subunit) and dna rep lication (binding to topoisomerases), respectively. Their chemical structures are also very different: beta-lactam, macrocyclic ether, and polyaromatic. Side effects from antibiotics are all over the map, and include in some cases drowsiness. Drowsin ess i s in my limited exposure to dive medicine is what gets pinpointed most often as enhancing the effects of narcosis, especially in combination with seasickness preventatives. I would suggest this is one area where antibiotics could easily increase sus ceptibility to nitrogen narcosis. Where we may differ is that I don't require a published study to make the connection for my personal use. For sure making a connection like this is informal, but I would do it because in my mind it seems reasonable and pr udent. I understand that it couldn't be officially condoned and passed on as knowledge. I look at it this way: in the absence of firm knowledge to the contrary, I attach a certain probability to something being true based on inference, and minimize percei ved ri sk accordingly.
Cipro is a potent inhibitor of Cytochrome P450 1A2. This enzyme is responsible for metabolism of caffeine. It's clear to me anyway that Cipro is going to _increase_ the serum concentration over what it is in its absence, not just i ts half-life. The kinetics involved are the rate of absorbtion from the gut and the rate of metabolism in the liver. Both of these processes take some amount of time. In the absence of cipro there will be a ramping up of caffeine serum concentrations until some maximum is reached, and all the while backgroud metabolism of caffeine. This background metabolism of caffeine before it reaches its serum concentration maximum is necessarily greater in the absence of the P450 inhibitor cipro. It follows that the maximum serum concentration of caffeine will be less in the absence of cipro, and the maximum caffeine serum concentration will be greater in its presence. As for whether a small amount of caffeine will get you in to trouble with cipro, this really depend s on how strong of an inhibitor it is of the P450 enzyme, and indications are that it is pretty strong. I think its important to keep in mind that when denying the body the ability to clear something, what would otherwise be a small amount of something ca n lead to trouble. In the case of theopylline and cipro, deaths have been implicated to result from the combination, but absolute causality has not been determined since theophylline alone _can_ have the same effects observed, at least in prinicple.
Ther e are a host of side effects for Fluroquinolones that are not consistent with safe diving. From the NIH website:
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202656.html#SXX20
Fluoroquinolones may also cause some people to become dizzy, lightheaded, drows y, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that can be dangerous if you are dizzy or are not alert.
For cipro in particular side effects can incl ude: upset stomach, diarrhea, vomiting, stomach pain, headache, restlessness, nervousness, difficulty falling or staying asleep, anxiety, nightmares.
Clearly side effects are person dependent and studies don't help that much when you are not a part of the study.
Regards,
Zorax
BillP
Senior Member
Howdy zorax:
Thanks for trying to further clarify and qualify your initial statement that:
If I may intrude again, I still think that further clarification is in order.
If I understand you right, and you are now trying to say that any medication can have untoward side effects, and if you happen to be unfortunate enough to develop one (or more) of those side effects it can interfere with diving, then I'd certainly have to agree with you. But since you have picked out several side effects of Cipro in particular as they relate to narcosis, I think it only right to mention the statistical chance of developing those side effects to help put the "risk" into perspective.
Drowsiness (the side effect you seemed to associate most with increased risk of narcosis) <1%
Upset stomach (a cause of narcosis?)- 5.2%
Diarrhea (narcosis again?)- 2.3%
Vomiting (another narcosis risk factor?)- 2%
stomach pain- 1.7%
headache- 1.2%
restlessness- 1.1%
nervousness <1%
difficulty falling or staying asleep <1%
anxiety <1%
nightmares <1%
The above untoward effects can indeed occur (some probably about as often as with placebo), and if someone were unlucky enough to develop one (or some) of those uncommon side effects it might very well affect their response to narcosis. (For example, if you happen to be among the less than 1% of people who get drowsy on Cipro, then taking Cipro could affect your diving.) Good point.
But then, what if you don't develop one of those unusual untoward side effects? If you are still trying to say the the simple act of taking antibiotics in the absence of any untoward reactions to the medication increases a diver's susceptibility to narcosis and therefore antibiotics should be avoided by divers in general when diving (as your original post seemed to imply), then your position requires support beyond your single anecdotal experience. (And your position contradicts the DAN Europe source that you quoted to support your position.)
If you personally would like to avoid mixing Cipro and diving in the future because of your one experience, then that's certainly your business. But if you wish to suggest that other Scubaboard readers should avoid antiboitics when diving in order to reduce the risk of narcosis, then I think you need to come up with more relevant information than you've provided so far.
Just my 2¢,
Bill
Thanks for trying to further clarify and qualify your initial statement that:
If I may intrude again, I still think that further clarification is in order.
If I understand you right, and you are now trying to say that any medication can have untoward side effects, and if you happen to be unfortunate enough to develop one (or more) of those side effects it can interfere with diving, then I'd certainly have to agree with you. But since you have picked out several side effects of Cipro in particular as they relate to narcosis, I think it only right to mention the statistical chance of developing those side effects to help put the "risk" into perspective.
Drowsiness (the side effect you seemed to associate most with increased risk of narcosis) <1%
Upset stomach (a cause of narcosis?)- 5.2%
Diarrhea (narcosis again?)- 2.3%
Vomiting (another narcosis risk factor?)- 2%
stomach pain- 1.7%
headache- 1.2%
restlessness- 1.1%
nervousness <1%
difficulty falling or staying asleep <1%
anxiety <1%
nightmares <1%
The above untoward effects can indeed occur (some probably about as often as with placebo), and if someone were unlucky enough to develop one (or some) of those uncommon side effects it might very well affect their response to narcosis. (For example, if you happen to be among the less than 1% of people who get drowsy on Cipro, then taking Cipro could affect your diving.) Good point.
But then, what if you don't develop one of those unusual untoward side effects? If you are still trying to say the the simple act of taking antibiotics in the absence of any untoward reactions to the medication increases a diver's susceptibility to narcosis and therefore antibiotics should be avoided by divers in general when diving (as your original post seemed to imply), then your position requires support beyond your single anecdotal experience. (And your position contradicts the DAN Europe source that you quoted to support your position.)
If you personally would like to avoid mixing Cipro and diving in the future because of your one experience, then that's certainly your business. But if you wish to suggest that other Scubaboard readers should avoid antiboitics when diving in order to reduce the risk of narcosis, then I think you need to come up with more relevant information than you've provided so far.
Just my 2¢,
Bill
Hi Bill:
Yes, I am saying that. I was saying that before too. In particular I said in my first message:
If you think a 1% risk is small and uncommon, then you are welcome to that opinion. I don't really believe its that small. It means if 100 people take the drug that one person is going to have that side effect.
It would be better to move away from cipro, and talk about antibiotics in general. Cipro only came up because I had a bad interaction with it. This is not the only antibiotic people take. I am not the only person that has ever had a bad reaction to an antibiotic.
I never said that or implied the above. What I said is quoted above in this message and was in effect to just try the medication on dry ground to see how it affects you personally. The implication was clearly to see if you suffer any side effects that are inconsistent with safe diving.
I hope you read my last post. I think I have made some valid points.
My original comments were benign and don't suggest that anyone do anything that isn't common sense. You guys didn't like the comment of an antibiotic causing narcosis in my original post. I was invited to come up with any reason that any antibiotic might cause narcosis, and I did.
I stand by my original anecdotal comments about my own experience. I told people to check out medications on dry ground before they take them when diving. I didn't say don't dive with antibiotics. I think most people on this board know how to digest information as useful or not.
Zorax
Yes, I am saying that. I was saying that before too. In particular I said in my first message:
If you think a 1% risk is small and uncommon, then you are welcome to that opinion. I don't really believe its that small. It means if 100 people take the drug that one person is going to have that side effect.
It would be better to move away from cipro, and talk about antibiotics in general. Cipro only came up because I had a bad interaction with it. This is not the only antibiotic people take. I am not the only person that has ever had a bad reaction to an antibiotic.
I never said that or implied the above. What I said is quoted above in this message and was in effect to just try the medication on dry ground to see how it affects you personally. The implication was clearly to see if you suffer any side effects that are inconsistent with safe diving.
I hope you read my last post. I think I have made some valid points.
My original comments were benign and don't suggest that anyone do anything that isn't common sense. You guys didn't like the comment of an antibiotic causing narcosis in my original post. I was invited to come up with any reason that any antibiotic might cause narcosis, and I did.
I stand by my original anecdotal comments about my own experience. I told people to check out medications on dry ground before they take them when diving. I didn't say don't dive with antibiotics. I think most people on this board know how to digest information as useful or not.
Zorax
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