Bubbletrubble
Contributor
FYI... Excerpt from Bove and Davis' Diving Medicine 4th Edition (p. 479; Ch. 24 - Pulmonary Disorders):
Can only dive 50ft, is it worth it?
- Thread starter Nick Briseno
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Otolaryngologist here, not a thoracic surgeon or a pulmonologist - and this is certainly a pretty hot thread! My 2 PSI...
1) Don't see how titanium ribs would be relevant to this situation, but I don't know much about them. If they are supporting the chest wall at the surface, and if there is continuous breathing (equalization of trans-thoracic pressure) at depth, that wouldn't seem to be the issue.
2) In case people missed it, "tracheotomy" was a spell check error (I only mention it because a few other posts have after the correction). The operation was a thoracotomy. Matt Johnston was the only person that I ever heard of diving with a tracheotomy.
3) Pulmonary barotrauma happens when an air filled space can't match ambient pressure fast enough to keep a pressure differential from building up. The most familiar way that this can happen to a diver is if by holding your breath on ascent (intrathoracic air expands but doesn't vent through the larynx). Another way that this can happen is if you have a poorly ventilated space in the lung due to trauma (surgical or otherwise), or from infection (this was apparently a problem in the days that tuberculosis was more common and not treatable). There are also congenital underventilated spaces in the lung (pulmonary blebs) which might first show up as a spontaneous pneumothorax in a child.
An air space in the lung that was completely sealed off (say, after surgery) would eventually just collapse and scar in, but a space that has a poor, tenuous partial connection to the airway might put one at risk of pulmonary barotrauma, just like a poorly ventilated middle ear space can result in ear barotrauma. This is because air can get in during descent but can't escape fast enough during ascent to prevent an expansion injury. This could also happen if there was collapse of one of the small airways with a ball-valve effect, which can let air in during inhalation, but trap it during exhalation.
4) There may also be a potential for a vascular issue here as well. If there is an abnormal arteriovenous connection following trauma, it could put the diver at risk for a cerebral gas embolism.
5) I never like to cast doubt on a doctor that I don't know, but that 50 feet figure sounds totally arbitrary and not based on any sort of dive physiology. Either the pulmonary air space is ventilated or it is not. If it isn't, 50 feet would certainly be enough to cause barotrauma. If it is, then I can't imagine what would be special about that depth.
5) Yup, there's a lot of cool stuff above 50 feet!
6) Call DAN. They are great. They will help. Non-emergency medical information line: 919-684-2948
1) Don't see how titanium ribs would be relevant to this situation, but I don't know much about them. If they are supporting the chest wall at the surface, and if there is continuous breathing (equalization of trans-thoracic pressure) at depth, that wouldn't seem to be the issue.
2) In case people missed it, "tracheotomy" was a spell check error (I only mention it because a few other posts have after the correction). The operation was a thoracotomy. Matt Johnston was the only person that I ever heard of diving with a tracheotomy.
3) Pulmonary barotrauma happens when an air filled space can't match ambient pressure fast enough to keep a pressure differential from building up. The most familiar way that this can happen to a diver is if by holding your breath on ascent (intrathoracic air expands but doesn't vent through the larynx). Another way that this can happen is if you have a poorly ventilated space in the lung due to trauma (surgical or otherwise), or from infection (this was apparently a problem in the days that tuberculosis was more common and not treatable). There are also congenital underventilated spaces in the lung (pulmonary blebs) which might first show up as a spontaneous pneumothorax in a child.
An air space in the lung that was completely sealed off (say, after surgery) would eventually just collapse and scar in, but a space that has a poor, tenuous partial connection to the airway might put one at risk of pulmonary barotrauma, just like a poorly ventilated middle ear space can result in ear barotrauma. This is because air can get in during descent but can't escape fast enough during ascent to prevent an expansion injury. This could also happen if there was collapse of one of the small airways with a ball-valve effect, which can let air in during inhalation, but trap it during exhalation.
4) There may also be a potential for a vascular issue here as well. If there is an abnormal arteriovenous connection following trauma, it could put the diver at risk for a cerebral gas embolism.
5) I never like to cast doubt on a doctor that I don't know, but that 50 feet figure sounds totally arbitrary and not based on any sort of dive physiology. Either the pulmonary air space is ventilated or it is not. If it isn't, 50 feet would certainly be enough to cause barotrauma. If it is, then I can't imagine what would be special about that depth.
5) Yup, there's a lot of cool stuff above 50 feet!
6) Call DAN. They are great. They will help. Non-emergency medical information line: 919-684-2948
Bob DBF, my understanding regarding the reason tissues take on nitrogen as depth increases has to do with the increased amount of inert nitrogen in compressed air, with the molecular density of nitrogen (and O2) increasing as the degree of compression increases. O2 is immediately used by the body, but the inert nitrogen molecules are absorbed and retained by tissue. It's not pressure forcing tissue absorbtion, it's molecular density, the same phenomenon that will eventually cause O2 to become toxic at a certain molecular concentration point.
That's why enriched nitrox becomes toxic sooner than straight atmospheric 21% 02 air, and why helium is used in trimix, and why its possible (and necessary) to have percentages of O2 much lower than the 21%atmospheric levels of O2 at extreme depth. Pressure on the gases is what creates the denser molecular concentration, which results in greater exposure to and absorbtion of the gasses. Pressure on the breathing organism's tissues has nothing to do with it.
That's why enriched nitrox becomes toxic sooner than straight atmospheric 21% 02 air, and why helium is used in trimix, and why its possible (and necessary) to have percentages of O2 much lower than the 21%atmospheric levels of O2 at extreme depth. Pressure on the gases is what creates the denser molecular concentration, which results in greater exposure to and absorbtion of the gasses. Pressure on the breathing organism's tissues has nothing to do with it.
DAN can recommend doctors in your area that understand medical issue relationships to SCUBA.
Aqua-Andy
Contributor
As other people have said, yes it is worth it. I don't buy what your doctor is saying because there should be no pressure, but don't take my word for it. Look on the bright side most of the marine life can bee seen between the surface and 50 feet any way, plus that means no tech diving so you will save a TON of money.
Have FUN at Mardi Gras.
Careful tossing those beads. ( It can be a contact Sport! )
Let us know what DAN says.
If you get an OK to dive, I'm sure you will be able to find an instructor. You should inform them of your condition.
Careful tossing those beads. ( It can be a contact Sport! )
Let us know what DAN says.
If you get an OK to dive, I'm sure you will be able to find an instructor. You should inform them of your condition.
Absolutely worth it. In fact, I'd day that if I were told I needed to make all of my dives below 50' I'd hang it up.
However, what's this about ribcage pressure? Other than failing to breathe reasonably while ascending or descending your pressures are in harmony and as you go deeper the fluctuations as a percent are less. Skin/free diving is a whole other kettle of fish.
Pete
However, what's this about ribcage pressure? Other than failing to breathe reasonably while ascending or descending your pressures are in harmony and as you go deeper the fluctuations as a percent are less. Skin/free diving is a whole other kettle of fish.
Pete
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Nick,
Follow Doctor(Mike)'s orders.
Follow Doctor(Mike)'s orders.
"6) Call DAN. They are great. They will help. Non-emergency medical information line: 919-684-2948"
I hope scuba will work out for you, but if it doesn't, snorkeling also takes you to a wondrous world. Kudos to you for overcoming such serious trauma. Best wishes for continued good health and adventure!
**************************
Thanks for finally posting the phone number, Mike. I kept wishing someone would, as I was reading the thread.
I hope scuba will work out for you, but if it doesn't, snorkeling also takes you to a wondrous world. Kudos to you for overcoming such serious trauma. Best wishes for continued good health and adventure!
**************************
Thanks for finally posting the phone number, Mike. I kept wishing someone would, as I was reading the thread.
Eric Sedletzky
Contributor
Even if I was limited to diving no more than 10 feet it would be worth it.
I could be happy diving no deeper than 50 feet for the rest of my life.
I've gone deep, done tech diving, been there done that. Where I dive, going deep there is nothing but barren bottom, cold, and dark.
A lot of people get caught up by challenging the deep numbers on their depth gauges as a means in itself. I'm way past it, I dive in 30 to 50 feet of water and love to poke around rocks and look at stuff. Just being underwater and seeing the beauty and the sun rays shining down through the water, that's the real joy to me.
I could care less about the depth numbers. The smaller the number means the more time I get to stay under and look at stuff.
I could be happy diving no deeper than 50 feet for the rest of my life.
I've gone deep, done tech diving, been there done that. Where I dive, going deep there is nothing but barren bottom, cold, and dark.
A lot of people get caught up by challenging the deep numbers on their depth gauges as a means in itself. I'm way past it, I dive in 30 to 50 feet of water and love to poke around rocks and look at stuff. Just being underwater and seeing the beauty and the sun rays shining down through the water, that's the real joy to me.
I could care less about the depth numbers. The smaller the number means the more time I get to stay under and look at stuff.
What the doctor could be concerned with would actually relate to the surrounding water pressure exerting force on the body rather than breathing air in at depth. This force will put pressure on the new ribs. Now, being that they are titanium I wouldn't think that wouldn't be a major consideration but perhaps where they are joined would be the issue. No idea, not a doctor. Get multiple opinions but then make up your own mind as to how far you want to push it. One doc could say you are good to 100 the one you saw already says 50 and another could say 65. This is no different that the old computer debate. One computer says you're good at the depth for another 5 minutes while your backup (running a different algorithm) says you're in DECO. Which one is more precise, are you actually in DECO or not? Same applies for how deep, you won't know until you do it and if at any point there is something not right, abort the dive and make sure you remember the depth you were at and then go from there.
Get another opinion? Sure, why not. Call DAN? Same answer. Start slowly and work your way down to deeper depths and see how it goes. Only you can determine your own conservatism and how far you want to go. As you do more dives you may find yourself going deeper and deeper with no problems but be sure to check in every once and a while to make certain that damage isn't being done that you may not be able to feel. Last thing you want is more surgery cause you buggered something up and decided to overdo it. If you pursue this you're going to become your own testing ground and based on past results (much the same way dive tables were first created) you will know how far you can go.
Good Luck! :cool2:
Get another opinion? Sure, why not. Call DAN? Same answer. Start slowly and work your way down to deeper depths and see how it goes. Only you can determine your own conservatism and how far you want to go. As you do more dives you may find yourself going deeper and deeper with no problems but be sure to check in every once and a while to make certain that damage isn't being done that you may not be able to feel. Last thing you want is more surgery cause you buggered something up and decided to overdo it. If you pursue this you're going to become your own testing ground and based on past results (much the same way dive tables were first created) you will know how far you can go.
Good Luck! :cool2:
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