Concerned about post surgery diving

[Tfast78]

On February 28th (5 months ago) I had a heart attack. I had 85-90% blockage in my LAD and during the cardiac catheterization they found I had a defect (Pete Maravich syndrome) and that was when the decision was made for the transfer to Ochsner in New Orleans for a double bypass to correct both issues. I am 33 years old and have smoked for almost 13 years. After the surgery I was kept on the breathing machine at 100% oxygen for an additional 18 hours because my lungs would not re-oxygenate. The doctors and surgeons all made it a point to tell me that I have black lungs and had to stop smoking right away. Obviously my lungs did re-oxygenate and things are now back to normal. I was told the blockage was due to very high cholesterol and smoking. I have quit smoking, changed my diet and I'm on cholesterol medication. My doctor and surgeon have both cleared me to dive and I have two dives already.

Even though my doctors said that I have been the exception to every rule as far as recovery times and attitude after surger I am still a bit concerned about the condition of my lungs and diving.

The two dives I made were on regular air in my tanks and were at a depth of 91 feet on the first dive and 74 on the second.

On my way home from the dives I did start to experience some pain when swallowing and when breathing deep. If the symptoms wouldn't have quit completely while I was stuck on the I-10 bridge in Mobile, Al for almost an hour I would have gone to the emergency room to get checked out. I did have 911 dialed on my cell ready to hit send and a note written out in case I had to signal to another vehicle stuck on the bridge with me regarding my recent surgery, dive and symptoms. I was that concerned!

Does any one that has experienced something like this or someone on a professional level have any advice or words of wisdom in this matter?

My cardiologist is one of the best in the tri-state area but doesn't know much about diving.

 

[MMM]

Just a thought...rather than ask advice from unqualified people on the internet, have you checked with DAN? They have physicians who KNOW about diving also.

 

[Duke Dive Medicine]

Good morning Tfast78,

First, congratulations on your lifestyle modifications. Quitting smoking is extraordinarily difficult (harder than quitting crack cocaine, so I've been told), but is one of the best things you could have done for yourself.

Five months is pretty soon to return to diving after bypass surgery. We typically recommend waiting at least one year. Also, your cardiac history is very concerning, especially in someone so young. I'm sure you've been told this already, but your symptom set is typically seen in much older individuals. Putting your congenital defect aside for a moment, this makes me wonder about other underlying conditions, e.g. diabetes, obesity, or peripheral vascular disease; and your family history. Can you elaborate on these? Also, you didn't mention any specific postoperative tests like an exercise stress test. I'm assuming you had this done... may I ask what the results were?

Regarding your post-dive symptoms: pain on swallowing and deep inspiration could mean a number of things. How long after the dive did you notice these symptoms? Did they resolve suddenly or gradually? With what you've said about the condition of your lungs, it's not outside the realm of possibility that you experienced a pulmonary overinflation that resulted in mediastinal emphysema. Have you had any radiologic studies that looked at your lungs to ensure that you don't have any blebs or other anatomic abnormalities that could cause air trapping?

Of course, you may have just swallowed some air on the dive. Is that possible?

Looking forward to your responses.

Best regards,
DDM

p.s. @ MMM: hopefully this fits your criteria for a qualified answer Dr. Doug Ebersole, a diving cardiologist who's doing PFO research with DAN, is a frequent poster in this forum. I've sent him a PM to ask for his input as well.

 

[DocVikingo]

Just a thought...rather than ask advice from unqualified people on the internet, have you checked with DAN? They have physicians who KNOW about diving also.

Hi MMM,

Do you consider the Medical Moderators of this forum among the "unqualified people."

And as for DAN being the be-all-and-end all, please consider this --> The Call DAN reflex--> http://www.scubaboard.com/forums/diving-medicine/390933-dcs-just-plain-exhusted.html#post5989601

Regards,

DocVikingo

---------- Post Merged at 05:49 AM ---------- Previous Post was at 05:28 AM ----------

Hi Tfast78,

Hard to say what caused the "pain when swallowing and when breathing deep" based on the information at hand, but given that the symptoms developed after some period post-dive and then resolved completely over the course of a traffic jam it isn't terribly suggestive of heart-related issues and could be something as simple as GERD.

DDM mentioned the possibility of a lung overinflation injury (e.g., mediastinal emphysema), and that is a possibility, although in that situation onset typically would be expected very soon after the dive & symptoms expected to continue for some period of time.

I eagerly await Dr. Ebersole's reply, whom I assure you is extremely qualified.

Regards,

DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[Dr. Doug Ebersole]

I, too, would like to congratulate you on stopping smoking. It's the best thing you could have ever done for your long-term health. With the caveat that I don't know anything about your other medical conditions and I've never examined you or reviewed any test results ........

As far as you diving after surgery goes, as long as someone has preserved heart muscle function, good exercise tolerance, and no evidence of ischemia (limitation to blood flow to the heart), they can return to diving with coronary artery disease. The timing is based on several things, but mainly making sure everything has healed from the surgery and that exercise tolerance is back to normal. If you fit all of these criteria, I would have no issues with your returning to diving.

As far as your breathing issues after your last dive, I am not sure what those symptoms were. The timing is odd for an overexpansion injury and it doesn't sound at all like a "cardiac" issue. Just to be safe, I would recommend at least a chest x-ray to exclude a pneumothorax or blebs. And with the description of your lungs at the time of your bypass surgery, it might be a good idea to get pulmonary function tests to see exactly how much damage has been done by your prior smoking.

Doug (yet another unqualified person on the internet)

 

[DocVikingo]

Doug (yet another unqualified person on the internet)

Hey Doug,

Good thing MMM's post appeared after Dive Team's GC record or you might have been scrubbed from the gig.

Regards,

Doc

 

[Tfast78]

MMM- I know there are a handful of compotent doctors that regular this site so that's why I opted to post here.

As far as underlying conditions, I would have to image that I was tested for most all of these items while I was in the hospital. I was there for seven days prior to the surgery and they took advantage of that taking test after test. I know I was tested for diabetes and my levels are normal. They had me testing myself for 30 days after the surgery as well and reporting the levels to them weekly. Obesity: I am 5' 11" and weigh 195 with a med/large frame so I don't see that being a factor. Family history: there is none. No one in my family has any history and they got checked out while I was in the hospital. The only thing I did post op was cardiac rehab. I was supposed to do 12 weeks but in my 7th week I ran a 10 minute mile and they told me I could come back if I wanted but I didn't need the rehab any longer. I am a physically active person and endurance hasn't been an issue.

Symptoms after the dives began about an hour and a half after the last dive and lasted about 20-25 minutes. I did swallow some water when my reg and mask was pulled off and out by another diver (idiot) I could have swallowed some air at some point but couldn't tell you for sure one way or the other.. It never crossed my mind that it would be heart related. I was leaning more towards a pulmonary problem.

Blebs: is that something that would be pre existing or occurred during/after the dive? I googled it but don't fully understand. I would think that if it were pre existing it would have been caught in one of the many X-rays that were taken at the hospital.

My main concern is the condition of my lungs so I think I may need to set up an appointment to get a X-ray and pulminary test done to see the condition of my lungs. I would have thought that my cardiologist would not have cleared me to dive if my lungs were not up to par. He did review my file and we talked a little bit before he said I was cleared. This may just be me being a little paranoid due to recent events.

Thanks for the great feedback and positive encouragement regarding quitting smoking and changing my diet.

 

[TSandM]

I'm concerned about your post-op course. It really isn't normal for someone your age to have to stay on a vent for a significant period of time postoperatively, especially from a bypass that was done at least semi-electively. I'm assuming you didn't have massive heart muscle damage from your event, as, if you had, you wouldn't be running 10 minute miles (or any miles, likely!) so that's not a reason for a prolonged course on the ventilator.

It sounds as though you did have some underlying pulmonary abnormalities pre-op. And what is good enough lung function and structure for an uneventful life on land may not be for diving -- for example, the accomplished cave diver who died a couple of years back from a lung overexpansion injury due to a lung tumor he didn't even know he had.

I think formal pulmonary function testing, and possibly a high-resolution chest CT, might be considered for evaluation of your pulmonary fitness to dive, but those decisions should be made by a physician or pulmonologist who is knowledgeable about diving. If you do not know of such a physician, perhaps either Duke Dive Medicine or the good folks at DAN can provide you the name of someone to see.

Whether your post-dive symptoms were pulmonary, cardiac, gastrointestinal or related to your chest wall is not possible for us to diagnose here. But I would say that, for your very first times back in the water after a life-threatening event, your profiles were a little ambitious. Maybe playing it a bit cool until you're more recovered and have had your lungs fully evaluated would be a better strategy.

 

[Duke Dive Medicine]

Symptoms after the dives began about an hour and a half after the last dive and lasted about 20-25 minutes. I did swallow some water when my reg and mask was pulled off and out by another diver (idiot) I could have swallowed some air at some point but couldn't tell you for sure one way or the other.. It never crossed my mind that it would be heart related. I was leaning more towards a pulmonary problem.

Blebs: is that something that would be pre existing or occurred during/after the dive? I googled it but don't fully understand. I would think that if it were pre existing it would have been caught in one of the many X-rays that were taken at the hospital.

My main concern is the condition of my lungs so I think I may need to set up an appointment to get a X-ray and pulminary test done to see the condition of my lungs. I would have thought that my cardiologist would not have cleared me to dive if my lungs were not up to par. He did review my file and we talked a little bit before he said I was cleared. This may just be me being a little paranoid due to recent events.

Thanks for the great feedback and positive encouragement regarding quitting smoking and changing my diet.

Thanks for the additional info. If you're certain of the symptom onset time then, like DocV and Dr. Ebersole already noted, it's pretty unlikely that your symptoms were due to pulmonary overinflation.

Blebs would not result from your dives, they would have already been present. They can be idiopathic but often happen in lungs that are heavily damaged by smoking. As you pointed out, they would likely have been detected during one of your many radiologic studies, but I do think your plan to have additional studies done on your lungs is a very reasonable one.

Best regards,
DDM