A great summary from the production and testing side of the house! But it 
does lead me to a question for the diving community...

I've been surprised at the number of comments and questions regarding the 
use of decongestants in general and sudafed in particular (questions 
about side-effects, synergistic effects with O2 toxicity, effects at 
depth and the like). Now my experience and formal training is in 
aerospace medicine (and pathology) and how the body works at high 
altitude, partial vacuum, high G's and temperature extreme environments 
(almost the exact opposite to what the diver is undergoing in many 
respects). I've taken it right between the eyes trying to learn those 
differences as I go along! (I still refer folks to DAN and the other real 
pros in hyperbaric medicine. The first principle of medicine is "primum 
non nocere...First do no harm!" An honest "I don't know...I'll look it 
up", is always in order rather than BS'ing your way through. (Want to 
lose trust real quick? Try violating that last rule.) Aviators will 
almost always forgive an admission of ignorance, but if they catch you 
trying to BS them (especially to protect your own tender ego) you've had 
it! They'll never trust you again with personal problems that'll effect 
them in the cockpit...same probably goes for divers. But I digress...

I've heard the expression used (by a real hyperbaric doc) "ear fear" in 
describing divers that really have no problem clearing but are 
apprehensive about their ability to clear. Now I can relate to that 
(especially after slamming myself to the bottom of the pool my first time 
out learning how to vent my BCD and giving myself an ear squeeze!). But, 
it seems that there's a fair number of divers (or divers "with a friend") 
that in spite of the risks use decongestants. What gives? They can't all 
be getting over colds, can they? Do that many divers feel they need that 
something extra to clear?

I really am not looking to tie up this list with survey results, there's 
more important stuff to discuss, but a couple of impressions from the 
more experienced folks might help put the actual usage in perspective for 
me.

Sorry about that jammed "oral" free-flow valve of mine...trying to get it 
fixed!
;-)

Robb Wolov





>  Just a quick note of agreement on Dr.Wolov's comment about medication &
>diving.
>  While I'm not a pharmacologist either,I am in my final year of pharmacy
>school,and he makes valid points.
>  With the possible exception of some narrow-spectrum antibiotics,most drugs
>have other effects on the metabolism besides the main one they were
>prescribed for.Since these work on foreign bodies in the anatomy,& not our
>own phisiology,these are probably the safest candidates for use at depth,but
>then again,If you've got an infection,that in itself is probably enough
>reason not to dive.
>   Drugs that reach the market have undergone extensive testing,but that
>doesnt mean they have been examined under all circumstances.If companies had
>to test every possible scenario of usage,we'd still be packing our cuts with
>mud.
>It's virually impossible to ,for example,  see what effects a particular
>drug has on left-handed plumbers,who hang upside-down on the weekends for 
>kicks.
>  Due to government & commercial involvement,some drugs have undoubtedly
>been tested for their hyperbaric effects;possibly even for their effects in
>a diving situation,but this type of testing is usually of the "Gee,since 96
>divers took azuritine before diving,and more than half of them turned blue &
>died,maybe there's an interaction here" variety.
>   There's also a question of use,overuse,or abuse here.I can't count the
>number of divers I've seen eating Sudafed like candy,under the assumption
>that if one is good,seven is seven times as good.The biggest concern I have
>about medication & diving is more from a dosage standpoint than from an
>unreported reaction.Blood flow & cell membrane composition are probnably the
>major factors involved in drug absorption & excretion,and these could very
>well change depending on saturation,hydration & thermal
>considerations.Imagine if all 600 tiny time pills in you Contac go off at 
>once.
>  Bottom line,unless you really like lettuce,dont volunteer to be a lab 
>rabbit.
>John Dunk

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