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Subject: Re: DAN Article
Date: Wed, 21 Feb 96 09:21:52 -0000
From: Robert Wolov <wolov@hi*.co*>
To: <techdiver@terra.net>
>>>"The Diver: A recently certified 25-year-old woman had just returned
>>>from her first weekend dive vatcation in Mexico. She takes mild 
>>>medication for anxiety and smokes a pack of cigarettes daily. She's 
>>>in good physical shape but isn't involved in a regular exercise 
>>>program."
>>

I'm not hip enough yet to the subtleties of diving medicine to comment 
meaningfully (I wear wings not dolphins), but in the aviation community 
as a flight surgeon (where I can comment), we've measured the effects of 
just *ONE* cigarette as being 
the equivalent of an ascent to 10,000 feet in reduction of O2 pick-up. 
NATOPS (Naval Aviation 
Training and Ops standards) require O2 masks in tactical aircraft at this 
altitude!

Simple guy that I am, I figure that if smoking cuts down your O2 
absorption at sea level, it *CAN'T* be any better for you at depth! (and 
may be even worse). The "anxiety" meds alluded to could refer to almost
anything. For various reasons, the metabolism of some drugs at depth (and 
at altitude) can 
get real tricky and unpredicable.

While I'm coming to understand that tourist based diving is a big 
business (hence a motive to down play its hazards) there is such a thing 
as being too chavalier about the medical status and conditioning from a 
safety standpoint.

While I just joined DAN a couple of days ago as a personal show of 
support to my newfound community (I've not seen the Alert journal yet and 
have not read this comment in it's entirety) I hope that this is not 
typical of the general hyperbaric and dive medical community (and just an 
unfortunate choice of words).

The juxtapositioning of "cigarette smoking" and any activity as 
intimately intertwined with breathing physiology as diving, is an 
oxymoron.

I really should just keep my mouth shut read a few issues before 
commenting further. But, "good shape" is a relative term and should be 
used guardingly when refering to a smoking diver with obviously reduced 
lung reserves. It's a no-brainer...you smoke...you have reduced lung 
reserves (the pulmonary docs have decades of plesmographic readings to 
prove it. (not to mention the carbon monoxide that irreversibly ties up 
the hemoglobin and further reduces the O2 carrying capacity.

As physicians (formally trained as diving medical officers or not) we 
have to set good examples for our patients (or my new diving friends in 
this case). I'm sure DAN was not condoning smoking and diving (but it 
does show you have to be careful in your choice of words!) 

Sorry, I'm preaching to the choir....will someone help me down now from 
this 
box?

Robb Wolov 


CDR Robert B. Wolov, MC, (FS), USNR
Department of Orthopedic Pathology
Armed Forces Institute of Pathology
Washington, DC 20306-6000

wolov@hi*.co* (preferred)
wolov@em*.af*.os*.mi*

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