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Gentlemen, obviously aspirin does not address DCS directly, nor
does it have anything to do with the prevention of bubble formation nor
do I believe it was being suggested as such. It was implied by Mr.
Markwell. Grogan suggested to Markwell that aspirin gets to the "root of
the symptoms". It in fact, effects an underlying mechanism in the
etiology of DCS, that being platelet aggregation. Clumping of
platelets, IS an underlying cause of DCS (Taylor et al. 98). It
essentially reduces blood flow, thereby reducing gas perfusion, which
could therefore lead to possible symptomatic DCS upon decompression of
said tissue. Grogans prevention analogy was great. Its use IS
preventive, to avert one very specific source of perfusion limitation,
known to be remarkably important in the pathogenesis of DCS (Popovic et
al 82). Mr. Markwell was looking for definitive proof of this drug to
be a panacea of DCS. It clearly is not.
Being well hydrated can prevent the same, however, an
individual's diet can rapidly change ones blood chemistry by the
minute. Aside from diet, the diver will get dehydrated to some extent
during long hyperbaric exposures breathing dry gases. Therefore,
aspirins main benefit to the diver is to allow improved blood flow and
gas transport by increasing tissue gas perfusion, by preventing the
hyper-aggregability of said platelets, just as being well hydrated
would/could. Is is 100% necessary? Well, thats debatable. Is it
effective for increasing tissue perfusion? Yes. Proven time and time
again.
There is NO evidence to indicate that the effective dose, suggested
by Mr. Hunscuker of 800 mg every 4 hours would be any more effective to
that end than that of 600 mg/day. Lower doses have far less side
effects obviously. Combination of aspirin and ibuprofen as indicted by
Grogan, is definitely NOT necessary. In fact, its doing a disservice.
Aspirin blocks a backup clotting mechanism which depends on the blood
platelets, and leaves little protection against bleeding if used in
combination with other similar drugs. Hunsucker also suggests doses up
to 1.2 grams "used for pain relief in 200mg tablets and prescribed in
800/1200mg strength" which suggests some SERIOUS pain. That type of
pain during diving, would suggest the need for OTHER addressing. With
respect to inflammation, anti-inflammatory drug dose is dependant on
severity of inflammation. More importantly, inflammation from what, and
how severe is the inflammation? Further, ibuprofen has NO, not even
possible, benefits to free radical elimination as suggested. I would
argue that the latter is subjective on the part of Mr. Hunsucker and it
does NOT reflect scientific fact. Unless Mr. Hunsucker has study in
hand to suggest differently, it would appear as subjective guessing at
best, as to his suggested dose time relation / relevance / benefits etc.
to diving.
I am however, interested at the hypothesis behind the particular
exacting doses suggested, if in fact they are based on something other
than conjecture.
--
Randy F. Milak
wendell grogan wrote:
>
> I probably shouldn't revive this subject, but on the other hand, I just
> finished going through 500+ mails and this is one of the few directed to
> me personally.
> I really think (ie. have an opinion, but acknowledge the lack of hard
> evidence) that anti platelet and anti-inflammatory drugs are not going
> to stop bubble formation directly. They MAY help reduce the cascading
> injury by reducing local inflammation, improving both intra and extra
> vascular movement of gasses, and thus reduce ongoing damage. I don't
> think they substitute for recompression treatment in the case of DCS
> symptoms. On the other hand, if you've taken them before a dive and you
> don't have any symptoms after the dive, you didn't have DCS.
>
> Esat Atikkan wrote:
> >
> > Interesting point except what escapes me is how the
> > anti-platelet activity is going to eliminate the
> > putative autochtonous bubble mediated DCS symptomology
> > - as in cord.
> > Safe bubbles
> > Esat Atikkan
> >
> > > In terms of "masking" DCS. No.
> > > These drugs actually get to the root of the
> > > symptoms. They stop DCS
> > > symptoms because they block a key part of the
> > > illness. If you have
> > > symptoms despite taking these drugs, seek treatment.
> > > If you don't have
> > > symptoms, you probably don't have DCS. This is not
> > > like taking morphine
> > > to prevent pain from a stab wound. Its more like
> > > taking quinine to
> > > prevent malaria.
> > > BTW, I'm going diving in the deep blue for a week!
> > > Later guys!
> > > Wendell G
> > >
> > >
> > > > Wendell,
> > > >
> > > > That is what I've suspected. It's been said for
> > > years that aspirin was
> > > > "maybe" an aid--probably a very small one--for the
> > > prevention of DCS. That
> > > > some aggressive divers are taking it and other
> > > such over-the-counter
> > > > medications isn't surprising given the insidious
> > > and unpredictable nature of
> > > > DCS.
> > > >
> > > > The conclusion I read everywhere is that there
> > > isn't enough research,
> > > > there's only a intelligent-guess suspicion that it
> > > works. If it has been
> > > > "long recommended" as SOP for deco diving, who has
> > > recommended it and what
> > > > do they base that recommendation on? I'd still
> > > like to see research that
> > > > definitively says, "aspirin and ibuprofen can
> > > reduce the risk of DCS."
> > > >
> > > > There is research, but within the research I've
> > > seen there are probably as
> > > > many new questions as there are answers. The best
> > > anyone can say is that
> > > > aspirin ought to be beneficial. As to dosage, I
> > > did read in at least one
> > > > diving medicine document that as little as 1/4 of
> > > a normal tablet of aspirin
> > > > will provide the full platelet effect.
> > > >
> > > > Ibuprofen affects platelets too, but in a
> > > different way. Do you think that
> > > > there is any concern at all for divers who are
> > > taking larger doses of
> > > > aspirin and ibuprofen together? I've seen one
> > > person suggest that he takes
> > > > 800 mg predive and an additional 800 mg every four
> > > hours of ibuprofen and an
> > > > unstated amount of aspirin as well.
> > > >
> > > > How big is the bleeding concern for this type of
> > > dosage? And to restate my
> > > > previous concern, is there any concern at all that
> > > dosages like this could
> > > > mask subtle DCS symptoms and thereby delay
> > > treatment?
> > > >
> > > > This isn't a zero-sum game. If it actually works
> > > and its been proven that it
> > > > does then it's a good thing for all deco divers
> > > within the boundaries of
> > > > risk that I suggest.
> > > >
> > > > Thanks,
> > > >
> > > > JoeL
> > >
> > > --
> > > "There are two kinds of people, those who do the
> > > work
> > > and those who take the credit. Try to be in
> > > the
> > > first group; there is less competition
> > > there."
> > > (Indira Gandhi)
> > > --
> > > Send mail for the `techdiver' mailing list to
> > > `techdiver@aquanaut.com'.
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> > `techdiver-request@aquanaut.com'.
> >
> > __________________________________________________
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> > --
--
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