Air-travel pulmonary embolism and diving

[itziar]

I am a 39 years old, active female, and have never had any major
health complications until now. I have, however, recently come down with a pulmonary embolism caused by blood clots created during a long air trip. My doctor has termed my condition as a "micro-clot" induced pulmonary embolism, since there is no sign of the clot in the X-ray plates, but I have had the accompanying symptoms (pressure on the chest, coughing, erratic and abnormaly high blood pressure). The blood analysis also confirmed the presence of the clot -- but I have forgotten the name of the cell that they found in great concentrations and that confirmed the case. I was, unknown to me, in the risk group for developing this condition as I was using oral contraceptives. My doctors do not believe I am prone to creating clots. I still have to do several tests, including a gamma-gram (?) of my lungs to check the damage. That will come this week. I am back at work now, but cannot do any physical exercise other than walking at the moment. My docs expect me to resume my normal cardio routine in one to two months.

I cannot dive while I am treated with anti-coagulants, and DAN has recommended me to see a diving specialist after the six month period of my medication, when they can take a ventilation perfusion test and assess whether I am at risk of developing air embolisms while diving. I am planning on following all these procedures, and seeking a qualified assessment of whether I will be able to resume diving when I come out of the drugs.

That being said, I was wondering if anybody else in this board has gone through the same condition, or knows of anybody who has gone through the same, and whether there are any "happy" stories out there.

Thanks for reading

Itziar

 

[Saturation]

I am a 39 years old, active female, and have never had any major
health complications until now. I have, however, recently come down with a pulmonary embolism caused by blood clots created during a long air trip. My doctor has termed my condition as a "micro-clot" induced pulmonary embolism, since there is no sign of the clot in the X-ray plates, but I have had the accompanying symptoms (pressure on the chest, coughing, erratic and abnormaly high blood pressure). The blood analysis also confirmed the presence of the clot -- but I have forgotten the name of the cell that they found in great concentrations and that confirmed the case. I was, unknown to me, in the risk group for developing this condition as I was using oral contraceptives. My doctors do not believe I am prone to creating clots. I still have to do several tests, including a gamma-gram (?) of my lungs to check the damage. That will come this week. I am back at work now, but cannot do any physical exercise other than walking at the moment. My docs expect me to resume my normal cardio routine in one to two months.

I cannot dive while I am treated with anti-coagulants, and DAN has recommended me to see a diving specialist after the six month period of my medication, when they can take a ventilation profussion test and assess whether I am at risk of developing air embolisms while diving. I am planning on following all these procedures, and seeking a qualified assessment of whether I will be able to resume diving when I come out of the drugs.

That being said, I was wondering if anybody else in this board has gone through the same condition, or knows of anybody who has gone through the same, and whether there are any "happy" stories out there.

Thanks for reading

Itziar

Sorry to hear of this predicament. Pulmonary embolism is not a common problem despite the issues with long travels and cramped plane seats. There usually is a another issue that makes one at risk for this disease, such as birth control pills, obesity, genetic changes or other diseases that make one prone to this [e.g. lupus, cancers, leukemias etc.,].

The goal of treatment is to prevent another PE with medications, usually coumarin by mouth, then find a reason why a clot happened. Since PE can occur with other diseases, doctors would look for other diseases that need to be treated too.

Once treatment is completed diving is not precluded. Theoretically, circulation is improved with diving, so the likelihood of clotting again is reduced, not increased. The risks otherwise is diving with coumarin, not because the drug causes some problem in the water, but if you are injured it could cause much bleeding. This includes a risk that if one is bent, the tissue around the bubble may bleed and complicate a usually uncomplicated bends. There is also risk is the act of traveling to a diving location or of the PE reoccuring because the original cause was not found and treated. If doctors mention a test to prevent air embolism because of a pulmonary embolism, this is usually looking for a PFO, but its not a major disease to consider. PE do not put one at risk for cerebral air embolism. In diving, lung air embolism is one way we decompress from diving, bubbles are trapped in the lungs [in medicine jargon that is an 'embolism'].

For peace of mind, its best to see a diving medicine physician to review all the event to clear one for diving. However, if one is clear to return to exercises and full physical activity by any physician, one is good to dive.

 

[itziar]

Thanks for your response, Saturation. It is making me feel much more positive about the possibility of a full resolution of my case.

My doctor (a non-diver) was not positive at all that I would ever dive again, but when I questioned her about the reasons why, the response did not make much sense to me. My husband talked to DAN while I was in hospital, and they were not overly positive either, but they said it would all depend on the results of a ventilation-perfusion test after the 6 month treatment with anti-coagulants, and they recommended a diving doctor in Mexico City. Their rational was that the clot might have permanently damaged some alveoli, and in that case, there is a risk for a pulmonary air embolism -- as I understand it, pockets of air passing to the blood flow through ruptured cells, which would be the reverse process of degassing that you mention, right? This makes sense to me: if the air pressure is higher, then the pressure on the cells of the air-sacks is higher, and if there is any weakness in the wall of cells, the risk of rupture is also higher. Sorry if this is a too simplistic reasoning -- I am a physicist. Now, I do not understand how the ventilation-perfusion test will test that (since it is done at ambient pressure), so maybe I am not understanding it properly.

I checked several websites and this ventilation-perfusion test (not profusion, as I mistakenly wrote in my first post, now corrected) is what the docs here call "gamma-gram". I had my first perfusion test done this week (almost 2.5 weeks after the problem started): they injected a radioactive substance in my blood flow, and recorded the glow of my lungs. The result is positive and confirms the diagnosis as a small pulmonary embolism by a blood clot: there is a small region in the upper section of my right lung which shows a slight depression in the brightness levels (at eye-sight, maybe a 1/30th of the area of the right lung, at most). Now, if there are some alveoli damaged, how will this be shown in these kinds of test? The resolution of the maps does not seem to me high enough to check the air-sacks one by one...

DAN did not mention any PFO test to my husband.

Thanks a lot again for the information you’ve sent me.

Cheers,

Itziar

 

[Randy43068]

I wish you well soon! Also I hope you can dive again in the near future.

Randy

Thanks for your response, Saturation. It is making me feel much more positive about the possibility of a full resolution of my case.

My doctor (a non-diver) was not positive at all that I would ever dive again, but when I questioned her about the reasons why, the response did not make much sense to me. My husband talked to DAN while I was in hospital, and they were not overly positive either, but they said it would all depend on the results of a ventilation-perfusion test after the 6 month treatment with anti-coagulants, and they recommended a diving doctor in Mexico City. Their rational was that the clot might have permanently damaged some alveoli, and in that case, there is a risk for a pulmonary air embolism -- as I understand it, pockets of air passing to the blood flow through ruptured cells, which would be the reverse process of degassing that you mention, right? This makes sense to me: if the air pressure is higher, then the pressure on the cells of the air-sacks is higher, and if there is any weakness in the wall of cells, the risk of rupture is also higher. Sorry if this is a too simplistic reasoning -- I am a physicist. Now, I do not understand how the ventilation-perfusion test will test that (since it is done at ambient pressure), so maybe I am not understanding it properly.

I checked several websites and this ventilation-perfusion test (not profusion, as I mistakenly wrote in my first post, now corrected) is what the docs here call "gamma-gram". I had my first perfusion test done this week (almost 2.5 weeks after the problem started): they injected a radioactive substance in my blood flow, and recorded the glow of my lungs. The result is positive and confirms the diagnosis as a small pulmonary embolism by a blood clot: there is a small region in the upper section of my right lung which shows a slight depression in the brightness levels (at eye-sight, maybe a 1/30th of the area of the right lung, at most). Now, if there are some alveoli damaged, how will this be shown in these kinds of test? The resolution of the maps does not seem to me high enough to check the air-sacks one by one...

DAN did not mention any PFO test to my husband.

Thanks a lot again for the information you’ve sent me.

Cheers,

Itziar

 

[Saturation]

Thanks for your response, Saturation. It is making me feel much more positive about the possibility of a full resolution of my case.

My doctor (a non-diver) was not positive at all that I would ever dive again, but when I questioned her about the reasons why, the response did not make much sense to me. My husband talked to DAN while I was in hospital, and they were not overly positive either, but they said it would all depend on the results of a ventilation-perfusion test after the 6 month treatment with anti-coagulants, and they recommended a diving doctor in Mexico City. Their rational was that the clot might have permanently damaged some alveoli, and in that case, there is a risk for a pulmonary air embolism -- as I understand it, pockets of air passing to the blood flow through ruptured cells, which would be the reverse process of degassing that you mention, right? This makes sense to me: if the air pressure is higher, then the pressure on the cells of the air-sacks is higher, and if there is any weakness in the wall of cells, the risk of rupture is also higher. Sorry if this is a too simplistic reasoning -- I am a physicist. Now, I do not understand how the ventilation-perfusion test will test that (since it is done at ambient pressure), so maybe I am not understanding it properly.

I checked several websites and this ventilation-perfusion test (not profusion, as I mistakenly wrote in my first post, now corrected) is what the docs here call "gamma-gram". I had my first perfusion test done this week (almost 2.5 weeks after the problem started): they injected a radioactive substance in my blood flow, and recorded the glow of my lungs. The result is positive and confirms the diagnosis as a small pulmonary embolism by a blood clot: there is a small region in the upper section of my right lung which shows a slight depression in the brightness levels (at eye-sight, maybe a 1/30th of the area of the right lung, at most). Now, if there are some alveoli damaged, how will this be shown in these kinds of test? The resolution of the maps does not seem to me high enough to check the air-sacks one by one...

DAN did not mention any PFO test to my husband.

Thanks a lot again for the information you’ve sent me.

Cheers,

Itziar

I understand. One should still discuss all the issues around the event with the diving doctor since there maybe a number of individualized factors, including one's tolerance for risk, that needs consideration.

The physicians are concerned with a risk of air trapping within scars than may form once healing has completed or, rupture of the 'scars' so air enters circulation? Both are uncommon in healing with PE, even in large life-threatening PEs or a severe variant, pulmonary infarction.

Pulmonary tissue heals well if one has healthy lungs. It receives blood from the airways and the pulmonary artery, so blocking one leaves a backup.

Once the clot is degraded, repaired, absorbed and/or reopened, tissues recover well. If scarring occurs it thickens the vessel wall and may deform the blood vessels morphology but rarely its function. If for some rare situation, the vessel remains occluded, new vessels grow to replace it while the alveoli get secondary circulation via the bronchial arteries. Thus, in most cases, the alveoli are not prone to damage or air trapping after a PE.

If residual damage is of concern, the ventilation-perfusion scan can be repeated in 6 months to see any return to normal of the area of 'mismatch' that is visible on the scan. The VQ scan is a functional scan, meaning it checks how the lung is working. For completion, it can be followed up by a spiral CT or MRI of the chest focusing on the lung field in question for an anatomical scan, to check the appearance, as best possible. All these tests will not guarantee a scar exists that is too small to see by these machines ... as you see how blurry the VQ scan is. However, it may help your local doctor decide as seeing no scars, reduces a perceived risk of considering air trapping even further.

 

[itziar]

Saturation, I cannot thank you enough. That is the most informative explanation I have received so far. It makes me feel I am better prepared to face the interview and tests with the diving specialist in a few months. I am aware that the outcome of the tests might tell me otherwise, but I feel much much more optimistic about a happy resolution of my condition now. I will focus on positive thoughts!

Thanks for the good wishes too, Randy!

Itziar

 

[DandyDon]

Always good to follow the physicians suggestions, at least until you can obtain a more qualified one. Some doctors know little about diving, or maybe even the symptom, and their advice may be overly cautious.

Good luck with the follow ups...

 

[SubMariner]

I cannot dive while I am treated with anti-coagulants, and DAN has recommended me to see a diving specialist after the six month period of my medication, when they can take a ventilation perfusion test and assess whether I am at risk of developing air embolisms while diving. I am planning on following all these procedures, and seeking a qualified assessment of whether I will be able to resume diving when I come out of the drugs.

That being said, I was wondering if anybody else in this board has gone through the same condition, or knows of anybody who has gone through the same, and whether there are any "happy" stories out there.

First & foremost, glad you are recovering from your PE, Itziar. And yes, there IS a dive life afterwards. It just may take a while.

My husband suffered dual PEs (what they call a "saddle embolism") in both lungs as well as a DVT back in April following some elective surgery. He spent 8 days in the hospital and has been on coumiden ever since. His pulmonary specialist has him scheduled for some specific follow-up tests this month which should indicate when he can stop the blood thinners.

Meanwhile, after consulting ScubaDoc's website (http://scuba-doc.com/) we were able to contact a hyperbaric/dive physician in our area, who cleared my hubbie to dive. His only "concern" was that a coral scrape may take longer to stop bleeding due to the medication. (Which, given his excellent buoyancy skills is pretty much a non-issue.)

As for air travel, the pulmonary specialist cleared him to fly a few months post hospitalization after tests indicated that his lungs were clear.

Bonne chance,

 

[itziar]

That's great. I wish your husband a prompt full recovery. Since he is way ahead of me, would you mind when he is done with the tests, telling me if these were again a VQ, or the spiral CT or MRI that Saturation mentioned, or any other? My doctors have mentioned other ventilation-perfusion tests, but I do not know if that's the only test they will pass me through.

Good website this scuba-doc.com.

Thanks, Submariner, and happy reinmersion into diving to your husband too!

Itziar

 

[SubMariner]

That's great. I wish your husband a prompt full recovery. Since he is way ahead of me, would you mind when he is done with the tests, telling me if these were again a VQ, or the spiral CT or MRI that Saturation mentioned, or any other? My doctors have mentioned other ventilation-perfusion tests, but I do not know if that's the only test they will pass me through.

Good website this scuba-doc.com.

Thanks, Submariner, and happy reinmersion into diving to your husband too!

Itziar

Thanks, Itziar!

He's going for a CATscan near the end of the month. It's supposed to show whether or not he still has any blockage in his Pulmonary artery.

Bonne chance,