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on 6/10/00 7:50 AM, Christian Gerzner at christiang@pi*.co*.au* wrote:
> PS Thanks JoeL, you read what I was *trying* to say correctly. :-)
Christian,
I think you have it generally right. One other diver mentioned taking
aspirin and ibuprofen predive as a prophylactic and that's been widely done
for many years. I take half an aspirin on the morning of a dive also
although I've never heard of ibuprofen being used in the same way. The last
theory that I heard was that aspirin, as a blood thinner and anticoagulant
is commonly used and has been studied to prevent the reoccurrence of heart
attack. It's also used during a heart attack. Aspirin, in part, acts on the
platelets, it prevents platelets from making a compound called thromboxane
A2, without which they can't stick together and easily form clots.
The problem is that there are side effects, although for most people they
aren't a problem:
liver or kidney disease
peptic ulcer
other gastrointestinal disease or bleeding
other bleeding problems
allergy to aspirin
use of alcohol
Well, that last one might be a problem for some instructors. <g>
There may be a more recent study, and "extreme" divers may have some
evidence that I'm not aware of, but I'm not aware of any study or specific
scientific discovery that proves aspirin's beneficial effects for diving
except the notion that thinned blood that doesn't coagulate easily may help
to reduce the risk of DCS. I'd be interested in seeing any study or research
in this area.
I've read of ibuprofen being used as a prophylactic for Cystic Fibrosis and
Menstrual Cramps, but never as an anticoagulant or that it has any use in
the prevention of DCS or any sort of barotrauma. What it does primarily do
is reduce swelling, ibuprofen is able to block the production of chemicals
called prostaglandins that cause inflammation. Inflammatory conditions,
such as tendinitis, bursitis and the kind of arthritis where fluid and
swelling occur in the joints, respond better to ibuprofen. As an analgesic,
aspirin, acetaminophen and ibuprofen all work in varying doses.
This brings me to the problems. In one study, data presented found an
association between ibuprofen's use during chickenpox and necrotizing
fasciitis (NF), but stopped short of saying the drug caused the infection.
Rather, researchers said, the drug may mask the symptoms signaling the onset
of NF. It is possible that because of its reputation, ibuprofen was given
to sicker children with fever. By lowering fever and reducing inflammation,
ibuprofen masked the beginning of the secondary symptoms, and appropriate
treatment was delayed.
This is the concern with any drug that relieves aches and pain: it could
mask more serious symptoms and delay treatment. Scott mentions the use of
ibuprofen AND aspirin as part of his "daily dive rituals." I'm not doubting
its efficacy here, I would like to see how they have come to the conclusion
that the benefits justify the risks.
Using both drugs in tandem, with many of the risks overlapping, internal
bleeding, liver damage & etc. seems even more of an overall concern, but I'd
like to stress that I don't doubt that he has evolved a regimen that works
for the type of diving that he does, I'd just like to see how they came to
the conclusion that this routine was beneficial overall.
Was this just divers not liking the aches and pains and finding that
Ibuprofen worked to relieve them? In the case of aspirin, was it the notion
that has been in the tech diving community for years that aspirin is a DCS
prophylactic (despite the lack of any study or direct evidence that it's
actually effective) and they take it "just in case" it works? Or do they
have actual clinical proof that either of these drugs have a direct,
beneficial effect for technical/gas divers that overweighs the potential
risks?
Finally, anyone taking aspirin, even low doses (the current recommendation
to receive its full anti-coagulant effect is about 1/4 of a normal aspirin
tab or a baby aspirin) is at risk of bleeding. Any trauma that results in
bleeding might be uncontrolled if the diver is using aspirin. In fact,
people who take aspirin to prevent secondary heart attack have to let their
doctors know before any medical procedure, even dentistry.
This is an interesting subject, one that I've followed somewhat, but not
doing the long-duration gas dives that some of you are doing weekly, I may
not be aware of studies and proof that you've found. I'd be interested in
seeing the latest information in this area.
Later,
JoeL
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