Dive medical post Pulmonary Embolism

[roamingchick]

Hi everyone

I was diagnosed with a pulmonary embolism approximately 6 years ago, post international flight. I was told it was only very small and I was put on blood thinners for 3 months. In my post exam I was told I am all clear by my GP, but without any further tests (xray, MRI).

I am 51, very healthy and fit; no smoker, very moderate drinker. I have never felt my lungs to be different post PE.

Have snorkelled a lot and just wanted to do a dive recently, when I remembered that I better get a medical prior to diving.

Has anyone had experience with this?? What does it require for me to get cleared (hopefully without breaking the bank..). I have medical records that can be released to the diving Dr, but need to know which steps to take first…

Thank you for your help.

Regina

 

[Capt Jim Wyatt]

I'd begin by calling DAN. Maybe they can refer you to a hyperbaric physician or at least a doc that understands diving physiology as related to the non-diving related embolism you describe.

Please keep us informed how this progresses for you & Good Luck!!

 

[Duke Dive Medicine]

Hi everyone

I was diagnosed with a pulmonary embolism approximately 6 years ago, post international flight. I was told it was only very small and I was put on blood thinners for 3 months. In my post exam I was told I am all clear by my GP, but without any further tests (xray, MRI).

I am 51, very healthy and fit; no smoker, very moderate drinker. I have never felt my lungs to be different post PE.

Have snorkelled a lot and just wanted to do a dive recently, when I remembered that I better get a medical prior to diving.

Has anyone had experience with this?? What does it require for me to get cleared (hopefully without breaking the bank..). I have medical records that can be released to the diving Dr, but need to know which steps to take first…

Thank you for your help.

Regina

Hi Regina, provided you have no underlying medical issues and are off anticoagulants, given the information you've provided here I can't think of a reason why you wouldn't be able to dive. DAN Asia-Pacific is a resource as @Capt Jim Wyatt said. Here's the South Pacific Undersea Medical Society's list of diving physicians in Australia. A good next step would be to contact a diving physician and schedule an appointment for a fitness-to-dive exam.

Best regards,
DDM

 

[Tippytoes12]

My understanding is that because you had what we call a provoked PE, i.e. there is a reason for it, it was small and you are relatively young and fit, your risk of a recurrence is low. Be sure to get a medical from a diving doctor and consider a second opinion if you get a negative answer from the first doctor.

 

[Angelo Farina]

Same experience.
Back in 2007 I had DVT at right leg during a long flight back from Australia in economic class.
When the thrombosis did reopen the vein, some particle went to my left lung, causing a temporary embolism and a respiratory crisis.
I was placed under heparin for one month, then under Coumadin for 6 months.
At the end, after proper tests (including CT scan, echo color doppler to legs, echo color doppler to heart, several blood tests including genetic tests) I was declared healed, no more anticoagulants, and allowed to dive.
Of course, being in Italy, all treatment, drugs medical tests and examination was entirely free.

 

[agilis]

I had pulmonary emboli in both lobes of both lungs after a botched same day surgery. I was hospitalized for two weeks, on blood thinners for a few months. That was 20 years ago, when I was 60 years old. I've dived scores of times since then, and still do some diving, though not as much as when I was younger. I went on a dive trip that same summer. Pulmonary emboli are transitory, usually of no serious consequence unless they get into your heart, where they can kill you almost instantly. Once they are gone, though, you're pretty much as good as new, and they are gone fairly rapidly, reabsorbed.

Not living in Italy my enormous bills were paid in full by my excellent university health plan.

 

[Duke Dive Medicine]

I had pulmonary emboli in both lobes of both lungs after a botched same day surgery. I was hospitalized for two weeks, on blood thinners for a few months. That was 20 years ago, when I was 60 years old. I've dived scores of times since then, and still do some diving, though not as much as when I was younger. I went on a dive trip that same summer. Pulmonary emboli are transitory, usually of no serious consequence unless they get into your heart, where they can kill you almost instantly. Once they are gone, though, you're pretty much as good as new, and they are gone fairly rapidly, reabsorbed.

Not living in Italy my enormous bills were paid in full by my excellent university health plan.

Just a point of clarification on this. The mechanism of injury in pulmonary embolism is that the clot breaks loose, usually from an extremity, travels through the venous circulation and the right side of the heart, then to the pulmonary arteries. The clot then may obstruct blood flow through part or all of the pulmonary arterial circulation. If the clot is large enough, it can lead to impaired gas exchange. The larger the clot, the more the blockage to the point that the pulmonary arteries can be completely obstructed, which is rapidly fatal, often even with aggressive medical intervention.

Best regards,
DDM

 

[kinoons]

DDM has nailed the overwhelming majority of this thread.

So I’ll just add that I echo his statements. You had a provoked PE, almost certianly due to a DVT in the lower extremity, due to the international flight.

If you are completely recovered (which it sounds like you are) I cannot think of any reason to limit any physical activity, to include diving. So much so that if your doctor has already cleared you to return to physical activity, and you have done so successfully, I wouldn’t give diving a second thought and wouldn’t puruse additional evaluation just to dive.

Usual disclaimer, you are not my patient, post for educational purposes only, see your own doctor, etc…

 

[Capt Jim Wyatt]

You had a provoked PE, almost certianly due to a DVT in the lower extremity, due to the international flight.

What is a DVT & why was it due to an international flight?

 

[kinoons]

What is a DVT & why was it due to an international flight?

DVT is a deep vein thrombosis. It’s a clot in a large, deep (not the superficial ones you can see just below the skin) vein of an extremity. Most often the lower leg is the culprit, although upper extremity DVTs are possible. Upper extremity DVTs are usually associated with vascular access or other upper extremity procedures/surgeries.

DVTs are associated with immobility. International flights, where someone sits in a chair for hours upon hours at a time with minimal movement due to the sardines in a can effect is a good non-surgical example. Bed rest after any surgery can also cause DVTs, and lower extremity surgeries are even greater risks for developing a DVT.

As DDM noted, a clot that forms in the veins of an extremity can break loose, travel through the heart, and get stuck in the arteries of the lungs. These can potentially be fatal.