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<font size=3>Refer him to Ernie Campbell scubadoc@scuba-doc.com, <br>
but see
<a href="http://www.scuba-doc.com/antcoag.htm" eudora="autourl">
http://www.scuba-doc.com/antcoag.htm</a> - <br><br>
or, better yet, call the DAN medical information line - they will
give you a free consult: +1-919-684-2948 (Duke University Diver's Alert
Network) <br><br>
</font><font size=2><b>Most authorities (Bove, Davis, DAN, etc.) agree
that diving with coumadin</b> <b>is either a relative
contra-indication or absolute contraindication to diving.<br><br>
The diagnosis of DVT does not in itself constitute a diving danger
(except</b> <b>maybe for the constrictions of gear and wet
suits)---but the bleeding hazards are several. Divers are certainly prone
to barotrauma of the air containing portions of the body (middle ears,
sinuses, lungs, gut) and relatively slight barotrauma can cause
significant bleeding even in the normal diver. Coumadin would certainly
aggravate this occurrence.<br><br>
</b></font><font size=3>I would argue a bit with Ern here (about it being
"relative") in that (1) dehydration is the biggest risk factor
for decompression illness/injury AND is common in diving - so risk of
recurrent DVT as well (2) ability to control diet is very limited on most
dive boats (3) wet suits are indeed tight and there are pressure
differentials across the entire body depending on the position (head up
or head down) at depth - no work I know of regarding this potential issue
in light of history of DVT and (4) many dive sites a LONG way from
medical care (and boat operators often do NOT want to deviate because of
the other guests unless they think you are dying). <br><br>
Even mask squeeze (bleeding into sinuses and eye vessels) which is very
minor for someone not on anticoagulants, could be a huge deal 6 hours
from medical evaluation/attention on Plavix, much less LMWH or
Coumadin.<br><br>
If he was further out from the DVT (and known to be very stable on
Coumadin dose), if it turns out he is a certified Master Scuba Diver,
Dive Master, or Instructor, if he is going somewhere with Western level
medical care (Grand Cayman, Australia, Key West, Key Largo, NOT
Sharm, Dahab, Roatan, Brac or Little Cayman), then I would agree RELATIVE
contraindication - but more likely absolute.<br><br>
Some combination of DAN (fairly conservative) and Ern Campbell (bit more
realistic/liberal) are probably as good advice as you will get. <br><br>
Lorick<br><br>
<br>
At 03:19 PM 2/6/2008, Joe Nemeth wrote:<br><br>
<blockquote type=cite class=cite cite="">-Recent Dx of DVT...on
A/C...<br><br>
</font></blockquote>
<x-sigsep><p></x-sigsep>
<font face="Lucida Handwriting" size=3><b><i>Lorick<br><br>
</i></b></font><div align="center"><font size=1>Lorick Fox, MPAS,
PA-C<br>
SEAVIN/Peace Vector IV<br>
Gianaclis Egyptian Airbase<br>
Gianaclis, Egypt<br>
(cell) +20-18-230-4448<br>
(landline) +20-45-240-9450<br>
<a href="http://www.lorick.org/" eudora="autourl">www.lorick.org<br>
</a></font></div>
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