>One of the interesting "facts" currently in print in the technical diving
>community is that the use of pseudoephedrine predisposes one to oxygen
>toxicity and "panic attacks".  This is based on a nitrox diving fatality
>that is suspected to be oxygen toxicity related (partner did not see the
>victim convulse, victim was seen taking SudaFed pre-dive), and the basic
>math based on the NOAA limits showed the victim to be within the recommends
>time limits.  Ipso facto, the culprit had to be something other than the
>NOAA guidelines (and ignoring the data from Donald showing extremely wide
>variability in exposure to exposure limits in the same diver, let alone
>between divers).  Suddenly, reports of "near misses" with divers taking
>pseudoephedrine jumped from the woodwork, and a new urban myth is born.
>
>Obviously, the fact that pseudoephedrine is one of the few drugs allowed by
>the US Navy in active divers (and I think in the military aviation field)
>is not germaine to the new world of technical diving... 
>


This business with sudafed has taken on a life of it's own with 
speculation and a bit of recrimination and fingerpointing on everyone's 
part. I didn't really know "what was what" medically as it pertained to 
diving (and repeatedly confessed as much to this list) but I did want to 
"keep peace in the family". So, I called the folks that *SHOULD* know...I 
CALLED HOME today! 

I called the Naval Aerospace Operational Medical Institute (NAOMI 
formally NAMI) and asked what the straight poop was on decongestant meds 
and diving (at least as practiced by Navy divers). Keep in mind that 
undersea medical officers are monitoring these guys the same way that 
flight surgeons like me watch over the airdales so hopefully nobody does 
anything "stupid"...injudicious? The problem remains with civilian divers 
that folks are free to do whatever they want as far as self-medicating is 
concerned so that sudafed is being taken by Navy divers *under different 
clinical circumstances* than the rest of us. 

Their answer: SUDAFED (if NOT taken in conjunction with a head 
cold...NOBODY DIVES WITH A COLD!!!) IS APPROVED FOR USE WHILE DIVING ON A 
PERIODIC BASIS. That means that if a diver uses (needs) it *chronically* 
to clear, he gets an ENT work-up, but *occasional* use is OK. I 
specifically asked about depth, decom and gas mix limitations and was 
told there were none.

AFRIN IS OUT!! There are rebound phenomena which makes this a bad drug to 
take when diving. The rebound occures when you keep blocking histamine 
production which is a normal part of the inflammatory reaction of the 
body...annoying but normal. The body in a sense attempts to set the 
"histamine rheostat higher to get the desired effects (which you are 
blocking). When the stuff does wear off, you're left with even higher 
histamine levels....the "rebound". It's annoying on dryland, at depth 
your a set-up for a squeeze.

There is some work being done by the Navy to test some new decongestants 
for diving (Cleratin and Noviscan (spellings probably wrong) but THESE 
ARE EXPERIMENTAL AND NOT YET APPROVED FOR DIVING!

I do not yet have the hard copy of the Navy references but they promised 
to fax them to me. Let me reiterate...this is NOT carte blanche to use 
sudafed. Occasional use is OK but if you need to use it chronically you 
should be seen by your doctor (hopefully versed in diving medicine). (the 
difference between "chronic" and "occasional" may be a fine one for folks 
with seasonal hay fever...see your doctor to be safe)

Sorry for the oral free-flow, but I figured that folks out there would 
like to get the Navy's info on this as soon as possible since the 
question keeps coming up.

I suppose under these circumstances I'll have to get official and state 
that I am NOT acting as an official spokesman for the Navy nor is this 
message to be construde as an official Navy statement of policy, just one 
diver trying to get the best available info out to his diving buds.

Take care,

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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