Can I Dive With a Cold?

The dive manuals and your instructor say no, but the dive doc says ... maybe. When your vacation is on the line, here's a commonsense guide to making your own decision.

- By Samuel Shelanski, M.D.

Decongestants | Antihistamines | Analgesics

Sick Diver's Checklist: Should I Dive? | What's the Difference Between a Cold & a Flu?

You booked the trip three months ago, paid off the plane tickets and prepped your gear. But just days before departure, you start sniffling, coughing and now your throat is scratchier than an Al Jolson record.

We all know that diving with a stopped-up head is dangerous, but does a simple cold or touch of the flu mean your vacation is over before it begins? Maybe not.

Question: Why can't I dive when I'm sick?

Answer: When your head is congested, you may have difficulty clearing your ears and sinuses while descending. Even worse, you're at high risk of a reverse squeeze. If you've never experienced the pain of expanding air trapped in your sinuses as you ascend, trust those of us who have. It's miserable.

When you can't equalize, whether going up or down, it's easy to rupture an eardrum, or cause other serious damage to your ears. In addition, the injury to the mucosal lining of your sinus passages can cause significant bleeding.

When a cold or flu has settled into your chest, there are several ways it can interfere with diving. Breathing cold, dry compressed air can cause irritation and coughing fits, which in turn increases your chance of losing your reg, inhaling water and generally having a bad time. The added stress can lead to a higher chance of panic, rapid ascents and life-threatening arterial gas embolism (AGE). AGE can also occur if air gets trapped behind mucous "plugs" in your lungs.

The fever that can accompany colds and flu revs up your body's metabolism, causing you to burn through air more quickly, and it causes many people to feel disoriented--not what you want when diving.

The bottom line: Never dive if you aren't physically or mentally ready.

Question: So a runny nose means my vacation is canceled?

Answer: Not necessarily. If your head and chest are clear and you don't feel sickly, then it's probably safe to dive. If an illness has run its course or been tamed by proper medication, it's probably fine to dive with a bit of a runny nose, as long as you can equalize with ease. Likewise, a minor scratchy throat should not rule out a well-deserved dive.

On the other hand, if all you want to do is curl up in a corner and whimper, then that's about all you should do. Don't push yourself. By diving when you aren't up to it, you will--at best--make yourself and those around you miserable, and the worst case scenario is pretty awful. The nausea, vomiting and aches of the flu will feel 100 times worse when you are cold, wet and sucking diesel fumes in four-foot seas.

If you don't feel well, order room service, watch HBO or lounge by the pool and have the grace to suffer with dignity. Better to postpone a trip, get a refund or eat the cost of a dive than put your safety, and the safety of other divers, at risk.

Question: So if I think I can get through a dive, that's good enough?

Answer: Ask a physician, nurse or divemaster if you should dive while in less than perfect health, and the automatic answer will be "No." This is the safe answer that eliminates all risk, but ignores the reality that divers don't want to forfeit their precious vacation time because of a sniffle.

The key here is using common sense. Use the checklist to evaluate your symptoms, and if there's any doubt about your fitness to dive, take the day off.

If you do choose to dive while sick, understand that you are taking a risk and that the responsibility for the decision rests solely with you. Equally importantly, your buddy must also realize and accept the situation. Agree that the dive ends immediately if either of you feels uncomfortable with the situation. Rehearse the "abort dive" signal and respond to it immediately--no questions, no guilt.

Question: You mentioned medications. Which ones are safe to take while diving?

Answer: Many healthy divers already use over-the-counter cold and allergy medications to help clear their ears while diving. While there has been little research on the effects of pressure on these medications, the evidence so far indicates that many work well without side effects.

Most cold preparations contain one or all of the following ingredients that may help you beat back the sniffles and get on with diving.

(Top)

Decongestants

Decongestants shrink inflamed membranes that line the nose and sinuses, opening these passages so that air can pass more easily. The most popular brand name decongestant is Sudafed (pseudoephedrine), and it's found in many popular cold remedies. Phenylpropanolamine is another decongestant commonly found in over-the-counter cold and sinus combinations. While both are generally regarded as safe to take while diving, these drugs make some people feel very antsy, or like their heart is racing. If you've never taken one of these medications before, try it on land first. Under water is no place to discover you have adverse reactions.

• Long-lasting formulas. Whether you use a decongestant in pill form, or as a nasal spray like Afrin (oxymetazoline) or Neo-Synephrine (phenylephrine), make sure that you use a long-acting version of the medication. Using a 12-hour tablet or spray will minimize the chance of a medicine wearing off halfway through your second tank. And as always, pay attention to the drug manufacturer's limits on duration of use. The nasal sprays in particular can have a nasty rebound effect when used too long.

(Top)

Antihistamines

Antihistamines are commonly used to combat allergies and viral infections. They clear sinus congestion, runny noses and ease itching eyes by limiting the action of histamines--chemicals released by the body in response to infection--which cause swelling of the mucous membranes in the nose, sinuses and lungs.

• Non-drowsy formulas. Unfortunately, many of these medicines tend to make people drowsy and are thought to make divers more susceptible to nitrogen narcosis. An example is Benadryl. Divers should look for non-drowsy over-the-counter formulations or ask their physicians to write a prescription for one of the many newer non-drowsy antihistamines available.
• Two to avoid. Avoid the earlier drugs of this class, like Seldane (terfenedine) and Hismanal (astemizole)--they tend to react badly with other medications. Newer drugs such as Claritin (loratadine) and Zyrtec (cetirizine) do not, and are regarded as safe to take while diving.

(Top)

Analgesics

Just a fancy word for pain relievers, this class includes Tylenol (acetominophen), Advil or Motrin (ibuprofen), and plain old aspirin. In addition to easing aches and pains, they also knock down fevers.

• A few words about labels. If you're shopping for a cold remedy overseas, read the labels carefully. It's important to stick to brand names and straightforward formularies.
• A few words for pharmacists. Asking the island pharmacist for the strongest thing he's got may get you a medication that contains the sedative codeine--the last thing you want to take before a dive. Know exactly what you're taking before you enter the water, and understand how it affects you.

Question: What can I do to cure my cold--fast--and get on with diving?

Answer: There are many who swear by zinc lozenges, vitamin C and echinacea to get them through illnesses. While none of these has been proven to work in proper clinical tests, none appears to do any harm. Nor do any of these remedies have any side effects that should cause problems for a diver. So if you think any of these herbs or vitamins helps, take it.

One of the most important things you can do to help yourself is to stay well-hydrated with clean water, juices and non-caffeinated beverages. Not only will this help your body fight off the cold and flu, but you'll be in top form to hit the water when the fever stops and your head clears.

(Top)

Sick Diver's Checklist: Should I Dive?

Unless you can answer "yes" to all of these questions, you should stay on the beach. Sure, missing a dive hurts--but not as bad as a reverse squeeze, ruptured eardrum or arterial gas embolism. No dive is worth your health, your safety or your life.

1. Close each nostril in turn. Can you breathe easily through both sides of your nose?

2. Have you gone at least two hours without having to blow your nose to clear it?

3. Can you equalize your ears with minimal effort on land?

4. Has it been at least a day since you have had fever, chills or sweats?

5. If someone asked you to play tennis, go for a cycle or run, or even just a brisk walk to the top of a hill, would you feel up to it physically?

6. Have you gone at least two hours without coughing?

7. If you are taking medicine, will it last until at least two hours after the dive is scheduled to end?

(Top)

Ask the Dive Doc

Question: What's the difference between a cold and the flu?
Answer: From the sufferer's point of view, not much. Both are caused by viruses (meaning antibiotics won't help, so don't ask for them) and they both make you feel lousy. There are distinct differences, however.

• Colds are caused by a family of viruses called rhinoviruses (rhino = nose). These viruses infect the mucous membranes of the upper respiratory tract-- nose, sinuses and throat. The result is the classic "head cold."
• The flu is a seasonal illness prevalent from December through March. Caused by the influenza family of viruses, it affects the lungs, resulting in coughing, difficulty breathing, fever, body aches and general misery.

Flu shots taken before the season can help bolster natural immunity to specific influenza strains, but do nothing to "cure" the flu or a cold once you have it. Only your body can do that. In fact, the best thing "cold and flu" medications can do is make the symptoms easier to live with.