Asthma question

[GoBlue!]

Kay-

Sounds like you have exceptionally-controlled asthma, if you hardly ever use a bronchodilator & have been off meds for years. Practicing internet-medicine is never wise, so the disclaimer that you would be best off contacting DAN & discussing your case must be given. However, if you were my patient, I'd suggest getting a set of PFTs and give you warnings about when to dive & not to dive, and give you the all clear if all turns out as expected. I wouldn't put a restriction on depth, as it has already been pointed out that the greatest change in lung volume (and therefore risk of barotrauma) occurs near the surface than at depth.

Of course, that's his opinion (I happen to agree; my opinion is you should be able to dive if you want, after all it's your a--. )

It's not only your backside, it's also your buddy's. I believe that there are certain medical contraindications to diving.

I just don't want to make a bad judgement call on this and have to answer for it later (not in the professional sense, but in a personal sense- if something happened to him, I would never forgive myself).

Exactly why I don't treat or give extensive advice to friends & family. Best advice you can give is "talk to a dive physician or DAN."

Now, if we're playing hypothetical games with your friend....

If you have a 23 y/o male patient... who is technically a diagnosed asthmatic, but only in that he blew at 28% change on pre-/post-bronchodilator changes ...

I disagree. I would not have diagnosed him as an asthmatic. One of the key criteria for diagnosis is a history of symptoms consistent with airflow obstruction. If he is truly completely asymptomatic, the response to bronchodilators would get my attention, but I would not diagnose him with asthma from that alone. (By the way, a >=12% increase in FEV1 to bronchodilators is indicative of airway responsiveness, not 25-30%. Perhaps you're thinking of the 20% decrement in FEV1 that's generally considered a positive test in response to methacholine, histamine, exercise, etc.).

More important, what was his actual & predicted FEV1/FVC ratio?

Jim

(This is to be used for educational purposes only; it does not imply a doctor-patient relationship & should not be considered as such. Only your personal healthcare provider should be making decisions with you regarding your health.)

 

[medic_diver45]

I was saying "technically diagnosed asthmatic" just because it is in his records as being "asthma" per the FP doc....the pulmonologist said he didn't think he was asthmatic. I guess I shouldn't have brought it up then....nevermind

I don't have his results in front of me. I can call him and have him email them to me again (he got a copy of them) and then I can tell you the FEV1/FVC ratio. He had e-mailed me the results but I deleted them after I posted the initial posting on here.

As for the mistake on criteria for a positive test, you're right, I mixed up the criteria- I've been out of the PFT lab (I haven't worked in one since I got done with my clinicals for school) for almost two years and I just haven't had to remember that information for working in the ICU and on the floors (I carry a card with me that has all the information on it when I am at work so if I get asked (which I never have) then I can reference that).

 

[GoBlue!]

I was saying "technically diagnosed asthmatic" just because it is in his records as being "asthma" per the FP doc....the pulmonologist said he didn't think he was asthmatic. I guess I shouldn't have brought it up then....nevermind

No problem. I simply made the point because there are likely many people out there with the "asthma" label, who truly aren't asthmatic. Unfortunately, there are many who do have asthma that don't even know it, and aren't being treated. (And remember, just because someone carries a diagnosis in a chart, doesn't mean they actually have that diagnosis! ).

I've been out of the PFT lab...for almost two years....

So you must remember how effort-dependent most PFT results are. I meant to make the point in the last post, but one of the first things I'd do with your friend (if I had any clinical suspicion of asthma after speaking with him) is repeat the PFTs. Perhaps if he had never done PFTs before, his pre-bronchodilator values were a bit of an underestimate, and once he got the hang of the test his post-bronchodilator values were "improved."

You raised an interesting, controversial point re: provocation testing. I haven't looked into where DAN stands on the issue, but the literature is certainly not persuasive. Some small studies suggest that diving itself (or hyperbaric chamber rides) increase airway reactivity in atopic (but asymptomatic) individuals. One could argue that if diving does indeed have this effect, any additional trigger to airway responsiveness may predispose to barotrauma/DCI. This has not, to my knowledge, been demonstrated in any convincing way to date. Perhaps some of the dive medicine gurus that are lurking could comment.

Jim

 

[Laurence Stein DDS]

Steve,

I have watched this thread and the one on O2 administration through a demand valve. You seem to want to stick to good science and proper procedure. Then you talk out of the other side of your....mouth.

Let's make this easy. YOU'RE the DOCTOR and this patient is your....SON. Ya...you wouldn't want to hurt him. What do you tell him?

1) "my opinion is you should be able to dive if you want, after all it's your a--.", as you stated in this thread to Kay.

2) You have some questionable results on your pulmonary testing and have had an inhaler prescribed by another doctor. I'm gonna ignore that bit of science and tell you to go ahead and dive because you probably won't have a problem and if you do, will pose absolutely NO risk to others diving with you in the event of a rescue.

3) Do the professional thing and err on the side of safety. Do no harm. Make a decision based on accepted medical practices and protocol.

Medical decisions are not democratic. Everyone is not equal and does not deserve the benefit of sympathy that their condition is limiting...even if everyone, including the doctor, would love for this person to have no limitations. Asthma or any other medical problem that might limit or prevent participation is not a reason to "break the rules" because a person should be able to participate if they want cause it's their a**...or they are your friend.

I have participated in two underwater rescues in my life. One nearly killed me. It haunts me to this day. I am willing to try to help a fellow diver in trouble even at the risk to myself BUT don't stack the deck againt me or any other diver because someone decides to dive knowing that they are at greater risk for having a life threatening problem at depth.

If a person wants to dive with asthma or epilepsy or serious cardio-pulmonary problems wants to participate...fine...but you damned well better let me know in advance so I can decide whether to dive at the same time and possibly risk my life in the event that you have a serious, health related problem at depth. That diver's decision is not made in a vacuum. Their decision to dive despite any risk to themselves should never be assumed to only affect themselves.

I certainly don't need you, a self professed health care professional, giving advice you are not licensed to dispense and if followed would certainly be below any semblance of "do no harm". You are not an MD making the recommendation and you opinion is just as "lay" as mine would be. So why would you second guess your friend's condition and why on earth would you tell the diver starting this thread that she ought to be able to dive if she wants?

I suppose that after all your rescues, you would still tell motorcyclists that it's OK to particpate without a helmet....damn the fact that many of these people, when severely injured take up huge amounts of our medical resources and may not have the means to pay the huge medical bills created by their arrogance. That cost gets shifted to the public. Their community suffers and their families suffer because they thought that they should be able to ride without anyone telling them that they must use a helmet.

All the letters and certifications following your name do no make you the final expert any more than the DDS after my name makes me the right "Doctor" expert. BTW, the answer to your question about the 23 y/o male is non sequeter and none of our business. A thousand different readers could have a thousand different answers and NOT ONE would be appropriate to give to that patient. We are not HIS doctor and most of us are not physicians. He has not been examined by anyone here qualified to make such a decision and as such, rendering a definitive opinion under such circumstances would be unethical and illegal....only insurance companies seem to be able to get away with that....but that's another story.

You didn't violate HIPAA rules because you never identified the patient. But if you did, simply stating that you had his permission to divulge identifiers is a HIPAA violation. That information requires written consent in most cases and I don't see a signature here. Perhaps HIPAA was mentioned to make you more credible?

All the names and numbers of medical tests and results you are spitting out are only serving to help you to appear to be more expert than you are. This forum is not to second guess real experts who are actually responsible for their final decisions. Creating doubt in or questioning other's decisions is not your responsibility or your specialty. So, back off.

Man, I've been holding this in for days now!

With all due respect,

Laurence Stein, DDS

 

[Laurence Stein DDS]

My apologies Kay,

The last few responses have essentially hijacked your thread and your questions.

I think that Drew's responses were thoughtful and reasonable.

Recommendations regarding diving and asthma are changing. Under the right conditions you can successfully and safely dive but you must first check with the appropriate pulmonologist...one experienced with scuba diving .

No, your lungs won't explode from diving deeper. Yes, you could be at increased risk for pulmonary embolism but this is not related to increased depth. Again, the MD evaluating this can help.

We are rooting for you to have a happy, healthy outcome to your dive experience.

Laurence Stein, DDS

 

[Kay]

Thank you all ever so much for all this useful information. I really, really appreciate it. I did feel better reading it. I already had a PFT recently and it was normal. And, my doctor did give me warnings about diving with a cold, and to do the peak flow meter before diving, etc. I'm sensible, I will do as she instructed.

On that note, I am totally thrilled to say that I successfully completed my very first ocean dive yesterday. I did not have any breathing issues at all--in fact, the breathing was perfect. We dove for 1/2 hour, maximum depth was 13 feet, and it was everything I hoped for--despite being in New England, that is. The water was a balmy 52 degrees and the temperature did not affect my breathing. [I was pretty cold by the end.]

Now that I have completed my first dive [second and third are scheduled for Saturday and Sunday] I should probably ask you how to treat "OCD" [obsessive diving dilemma] because I think I've got it. Please tell me that the preferred treatment protocol involves intensive diving vacations at regular intervals. I can barely wait to get down south to Florida or the Caribbean....

 

[GoBlue!]

Congrats, Kay! Good for you for discussing things with your physician. Have a great time diving!

Jim

 

[Kay]

Thanks, Jim, I'm sure that I will. I am going both Saturday and Sunday, as long as the hurricane doesn't intrude. The water was a startling 52 degrees yesterday. Ouch. Someone told me to bring very warm water and pour a couple of gallons down my wetsuit before getting into the water. Hope that works! I'll let you know.

 

[Laurence Stein DDS]

Thanks, Jim, I'm sure that I will. I am going both Saturday and Sunday, as long as the hurricane doesn't intrude. The water was a startling 52 degrees yesterday. Ouch. Someone told me to bring very warm water and pour a couple of gallons down my wetsuit before getting into the water. Hope that works! I'll let you know.

52 degrees! Are you kidding me???!

Kay, you're gonna love the Caribbean and Florida. Right now the water temp is 87 degrees....really.

Glad you enjoyed your dives.

Regards,

Larry Stein

 

[Kay]

Really, Larry, it was 52. I was once a student at the University of Miami, so I am painfully aware of what I'm missing. My parents live in Bonita Springs in the winter, though, so I go to Florida every year. It keeps me sane during all those cold, dark nights.

I was in Belize in June/July, but not certified to dive. I snorkeled until I resembled a raisin. It was heaven. Next time, I will be hovering near the bottom watching the world drift by.