Smoking and Trimix

[My_Name's_Bruce]

Hi Dr. Deco

I am trying to quit smoking tobacco and have started the drug Chantix. I honestly believe smoking will kill me. Not in the sense that smoking is bad for you and you can get lung cancer in the long run. ( not saying smoking is not bad to your health ) But can smoking cause my immediate death? I believe it can and looking for solid facts to strengthen my resolve to quit smoking.

This is my theory and a some what simple one. First I have been diving on air to about 150 to 160 feet and decoing on nitrox 32 for about 6 months. Second I am planing to start diving deeper on trimix and decoing on 50% 80% and 100% o2.

My fears are that decreased lung function due to smoking and cause me to pass out while diving deep on trimix and heliair because of the lower % of o2. Also pulmonary oxygen toxicity scares me because smoking and breathing high levels on o2 on deco might burn my lungs out.

Other than simple common sense advice that smoking is bad for you and you should quit, can you tell me of the real dangers I am facing?

Thank you.
Cary

 

[DevonDiver]

I have been diving on air to about 150 to 160 feet and decoing on nitrox 32 for about 6 months.

That's a looonnng hang! :shocked2:

 

[My_Name's_Bruce]

That's a good one. Gave me a good chuckle. Good to see people still have a friendly sense of humor.

 

[TSandM]

Bruce, I don't think there are any compelling data to support the idea that smoking and staged decompression diving using trimix will be a lethal combination.

It is definitely true that active smokers, and in particular long-term active smokers, will pretty much all show abnormalities on detailed pulmonary function testing. But for people who feel well enough to dive, those abnormalities are subtle and generally don't interfere with day to day function. There may be some small decrease in the efficiency of ventilation (generally diffusion abnormalities don't show up until you have pretty severe lung disease) but, given that decompression modeling is an extremely imprecise thing, those minor differences are probably not going to be noticeable in practice.

Where smoking could significantly impact you is in total exercise tolerance, should you be caught in a situation where fitness is really critical. And of course, there is the ticking bomb of arterial disease, and heart attacks DO kill divers. Many people have sudden death as their first notice that they have coronary artery disease -- that's pretty much unrecoverable, if it occurs at depth.

 

[Dr Deco]

Hello Bruce:

As TS and M has said, there is little reason to believe that smoking is hindering your decompression. Divers in Europe are notorious for smoking and diving. That is, not smoking while in the water, but actually smoking when in the deco chamber [professional divers, that is].

Decompression tables are designed to cover virtually all divers and are not “fine tuned” for any one diver. Small differences will not be noticed – especially since physical activity is not considered. This later activity will create the infamous micronuclei. Dr Deco :doctor:

 

[smellzlikefish]

Hi Bruce-

I think some have missed the point. If you want someone to confirm that smoking might kill you instantly so that you have a better reason to justify quitting, I'd be happy to provide that. It can kill you instantly, and you can quote me on that!

First off, it contributes to heart disease. The heart is one of those organs that can seem fine for a long time, then decide one day to suddenly give out. If it gives out on land, you have a chance at treatment, but if it gives out 180 feet down with an hour of decompression owed, you're probably screwed.

Second, I imagine the damage it does to your lungs could contribute to lung expansion injury as the scar tissue could conceivably block off certain air escape pathways.

And even if these reasons are a stretch of the imagination, go ahead and believe it anyway. Quitting smoking is probably the most important action for you to take right now and you should use any reason you can to stick to it. I used diving as an excuse top quit smoking years ago. You can, too.

 

[My_Name's_Bruce]

TS and M, Dr. Deco, and SmellzLikeFish.

Thanks for the reply's. I never considered a Heart attack under water. I will admit that because of smoking and a sedentary life style I am so far out of shape any heavy work load I get out of breath easily, and my heart seems to pound. A heart attack could very well be around the corner, and as one can well imagine, would be the end at depth. Especially since I am doing mostly cave diving.

One positive note is I thought I would have to postpone trimix for about a year or so while my lungs recovered from the smoking. It is good to know that since I am quitting now, I can go ahead with trimix and I don't have to wait.

 

[DocVikingo]

Hi Cary,

I am trying to quit smoking tobacco and have started the drug Chantix.

In January '08, Pfizer Inc., the manufacturer of Chantix/Champix (varenicline) began to strengthen it warnings about possible adervse psychiatric reaction to the drug. The latest package insert contains the following warning----> Safety Update to CHANTIX (varenicline) Package Insert Information: a letter from Pfizer . It would prudent to read this carefully.

In studies, the most common side effects for people who took the drug were nausea, changes in dreaming, constipation, gas and/or vomiting. Nausea was the most common side effect in about 30% of patients, but generally it was mild to moderate and for most people, but not all, it went away.

If the user has been taking the drug for an adequate period to assess for potentially worrisome side effects and has developed none, then it likely should be safe to dive while on the medication.

My fears are that decreased lung function due to smoking and cause me to pass out while diving deep on trimix and heliair because of the lower % of o2. Also pulmonary oxygen toxicity scares me because smoking and breathing high levels on o2 on deco might burn my lungs out.

You might find the following article from the Sep '10 issue of Undercurrent to be informative:

The Risks of Oxygen at Increased Depth: Undercurrent 09/2010


While not directly related to your inquiry, you also might find the following research to be of interest:

"J Appl Physiol. 2010 Sep 2. [Epub ahead of print]

High incidence of venous and arterial gas emboli at rest after trimix diving without protocol violations.

Ljubkovic M, Marinovic J, Obad A, Breskovic T, Gaustad SE, Dujic Z.

1University of Split School of Medicine.

Abstract

SCUBA diving is associated with generation of gas emboli due to gas release from the supersaturated tissues during decompression. Gas emboli arise mostly on the venous side of circulation and they are usually eliminated as they pass through the lung vessels. Arterialization of venous gas emboli (VGE) is seldom reported and it is potentially related to neurological damage and development of decompression sickness. The goal of the current study was to evaluate the generation of VGE in a group of divers using a mixture of compressed oxygen, helium and nitrogen (trimix) and to probe for their potential appearance in arterial circulation. Seven experienced male divers performed three dives in consecutive days according to trimix diving and decompression protocols generated by V-planner, a software program based on the Varying Permeability Model. The occurrence of VGE was monitored ultrasonographically for up to 90 minutes after surfacing and the images were graded on a scale from 0 to 5. The performed diving activities resulted in a substantial amount of VGE detected in the right cardiac chambers and their frequent passage to the arterial side: in 9 out of 21 total dives (42%) and in 5 out of 7 divers (71%). Concomitant measurement of mean pulmonary artery pressure revealed a nearly twofold augmentation, from 13.6+/-2.8, 19.2+/-9.2 and 14.7+/-3.3 mmHg assessed before the first, second and the third dive, respectively, to 26.1+/-5.4, 27.5+/-7.3 and 27.4+/-5.9 mmHg detected after surfacing. No acute decompression-related disorders were identified. The observed high gas bubble loads and repeated microemboli in systemic circulation raise questions about the possibility of long-term adverse effects and warrant further investigation.”

Regards,

DocVikingo

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.