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Diving prior to kidney transplant

Discussion in 'Diving Medicine' started by farsidefan1, Apr 15, 2015.

  1. farsidefan1

    farsidefan1 Loggerhead Turtle Rest in Peace

    # of Dives: 200 - 499
    Location: Salt Lake Valley, Utah USA
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    The bad news:my kidneys are a bit of a mess. The good news is my wife wants to keep me around and she is what is affectionately called a "universal donor". I have some major clients that have been wanting to dive with me for several years and we finally got it together this yr. We are scheduled for Little Cayman Island Beach Resort the second week of May. Obviously my condition hadn't deteriorated to nearly this level when we made the plans.

    I was doing fairly well till my second knee replacement surgery at which time one of my primary indicators which had been hovering around 20 (My kidney doc had said - prior to the knee surgery- that no way was I getting a kidney transplant when that number was above 19). Well post surgery the number fell to 11. It has since rebounded to 14. We have heard that they can wait till you hit 7 prior to dialysis.

    Now I am training my daughter to take over my business (financial adviser) and had planned on training her over the next 5 yrs or so. She is a chemist but I lured her away to keep the business in the family. It is a very successful practice.

    One final note. I am not going to do long term dialysis. I have spoken to some doing it and I am not willing to spend 3-4 hours a day 3 times week hooked to a monster and feeling like crap during the process. I might do it for a short time but my daughter is going to need to learn fast. Realistically there should be no need for dialysis with the donor situation lined up.

    Is there any data about diving for those with severe kidney problems? My kidney doc is not aware of any. I will meet with him the week before I go. I would like to point out any relevant information to him now so he can read up on it and give me good advice.

    Anyone got anything? I clearly am looking for this information for entertainment value only with no thought that I will depend on the internet for medical advice. I know that advice on the net is not quite worth what you pay for it and no one offering information or advice could possibly be held responsible for any outcomes, good or bad, by anyone, ever. etc etc etc.

    Thanks in advance. I've been away a long time. Diving has become a once a yr. event. Sigh. I have become a vacation diver. The good news is I completed my bucket list in October:D. Got to see the northern lights ( I had to go north of Fairbanks but hey, I saw and photographed them). I completed my diving bucket list with Palau some time ago so if it's my time I'm perfectly ok with it. In fact with the joint pain I've enjoyed the last few yrs I'm looking forward to it. Greetings to all my friends I have not spoken to for all too long.
     
  2. Spg01

    Spg01 Solo Diver

    # of Dives: 200 - 499
    Location: Orange County, Ca
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    Not that I know of. Way back I lost one kidney to cancer and just recently I had 20% of my remaining kidney removed because of cancer. My nephrologist did not think I should dive any more so I ended up getting a list of dive medicine doctors in my area from DAN and went to one. In my case it was determined that I could dive and they would just monitor me to see if anything changes. If something changes we will reevaluate then.

    The dive medicine Dr. said there was no real data that diving would harm me any more than exercising. My nephrologist was worried about blood pressure changes while diving. But there is always a chance, so I would have to determine if I would want to take the risk. I have only been diving 3 or 4 times so far.

    My kidney function had returned to pre surgery levels before I started diving again. I agree that dialysis does not sound like a good time and I am glad that I dodged that bullet for now.

    So talk to DAN about doctors in your area.
     
    farsidefan1 likes this.
  3. TSandM

    TSandM Missed and loved by many. Rest in Peace ScubaBoard Supporter

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    There is actually quite a bit of difference between have reduced, but fully functional renal mass, and being in renal failure. And the medical considerations vary with the type of renal failure, too.

    One of the first things that worries me about diving with dialysis-level renal dysfunction is volume status. If your kidneys are not clearing the volume you take in, you could be volume overloaded, and at higher risk for something like immersion pulmonary edema. If your urine output is still normal, but the quality of the urine is not, this may not be an issue.

    The second thing that concerns me is potassium. Potassium is almost entirely excreted through the kidneys, and rising potassium levels are common in people with renal failure. High potassium raises the risk for abnormal heart rhythms, and the heart is rendered more irritable when there is adrenaline in the system, as there is with high exertion or any apprehension or anxiety. I don't have any statistics to quote you on whether it's safe for somebody with a potassium of 5.5 to run, bike, or dive. It's just something I would worry about. If your potassium is still running in the normal range, this is not an issue.

    The third and fourth issues with renal failure, which are acidosis and uremia, probably aren't significant issues for anyone who is feeling well enough to dive.

    At any rate, I hope you are able to make your dives, and that your transplant operations goes smoothly and without complications.
     
    farsidefan1 likes this.
  4. Duke Dive Medicine

    Duke Dive Medicine ScubaBoard Supporter Staff Member ScubaBoard Supporter

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    I would have the same concerns as TSandM. If your kidneys can't compensate for the fluid volume redistribution that occurs during immersion (think immersion diuresis), your heart could be forced to pump against increased pressure, which could aggravate any pre-existing heart problems, even if they're subclinical at the moment. The high potassium level that she wrote about could further contribute to the risk of an adverse cardiac event. Of course that is worst-case, and your condition may be compatible with diving. I would recommend you go see Dr. Weaver in the hyperbaric unit at Intermountain Health Care: Hyperbaric Chamber - Intermountain Medical Center - Serving the community of Salt Lake City, Utah

    Best regards,
    DDM
     
    farsidefan1 likes this.
  5. farsidefan1

    farsidefan1 Loggerhead Turtle Rest in Peace

    # of Dives: 200 - 499
    Location: Salt Lake Valley, Utah USA
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    Excellent information. Thank you very much for responding. My potassium levels are good as of now. GFR or whatever it is has now recovered back to 18 (as of yesterdays test) which was a surprise although I'm still trending at loss of 5 per year.

    I was at an all day meeting today and just found out that I will likely be insulin dependent after a transplant. I guess tons of steroids are the order of the day right after surgery. Now I have to rethink the whole transplant idea. )I need to speak to some insulin dependent patients to determine if I want that lifestyle.

    I am going on the dive trip. I may limit my self to 2 dives a day rather than the 3 offered and I'll stay shallow. I will meet with Dr. Weaver as soon as he can get me in.

    Thanks again.
     
  6. TSandM

    TSandM Missed and loved by many. Rest in Peace ScubaBoard Supporter

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    Believe me, you will be MUCH better off with insulin than dialysis. The quality of life of dialysis patients is not that great, and they remain at significant risk of cardiac events, infection, grafts clotting . . . A few sticks a day of insulin is WAY WAY preferable. And the steroids are tapered after the initial period, so people who have their transplants long-term generally get down to very modest doses.
     
  7. farsidefan1

    farsidefan1 Loggerhead Turtle Rest in Peace

    # of Dives: 200 - 499
    Location: Salt Lake Valley, Utah USA
    1,293
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    Thanks, The choice won't be insulin or dialysis. It is between insulin and letting nature run it's course. Dialysis is not on the table. I'm not going there. That decision has been made. My kidneys are probably good for another 2 yrs. By then my daughter will be able to take over the business.

    My wife did point out something that I missed (I stopped listening after hearing about the insulin dependence) . She pointed out that the progesterone will eliminate the joint pain I've been living with for the last several yrs (both knees replaced). The doc said no more worries about gout but I didn't process that it was a permanent fix.

    So it wasn't all bad news. Trade off the pain with the bother of insulin. I just need to speak to some people that are insulin dependent and find out if it will hinder my ability to travel (which is a primary goal of retirement). Perhaps I'll just have to give up travel to 3rd world countries. Anyway I'm not as depressed as I was with the initial news. It just totally blindsided me. I had not heard word one about the insulin dependence till this afternoon.
     
  8. TSandM

    TSandM Missed and loved by many. Rest in Peace ScubaBoard Supporter

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    As I said, the degree of insulin dependence (and perhaps insulin dependence at all) may diminish with time, and decreased steroid dose.

    It really is not that big a thing to be insulin dependent. Insulin is widely available, and people get very good at monitoring their blood sugar and adjusting the dose as needed. And if you are type II and simply going over the edge to insulin, you don't have to worry about being extremely brittle, either, or about DKA.
     
  9. farsidefan1

    farsidefan1 Loggerhead Turtle Rest in Peace

    # of Dives: 200 - 499
    Location: Salt Lake Valley, Utah USA
    1,293
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    Thanks, I got to speak to another transplant recipient. She was only insulin dependent for a few months till they got her meds balanced. That's both good and bad news. After thinking about it I had decided that I was perfectly happy to trade my joint pain (fixed by steroids) for insulin dependence. Now I see that I may not remain on the steroids. Either way I have decided to go through with the transplant and just accept the outcome.

    I appreciate the insights and advice. TSand, you are always thoughtful and helpful. DDM, You are great to provide me with a local contact. Thanks to you as well.

    Spg01, Thanks for sharing your special insights and experiences. I wish you the very best.
     
    Spg01 likes this.
  10. DocVikingo

    DocVikingo Senior Member

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    Hi farsidefan1,

    GFR is the acronym for glomerular filtration rate. At ~20% GFR, evaluation for kidney replacement is typically commenced. At ~15% GFR, the eligible candidate typically will be entered onto a replacement waiting list.

    As regards any expectation that progesterone will eliminate chronic pain secondary to knee replacement, while this hormone indeed is a potent anti-inflammatory, its effect on the amelioration of joint pain is a somewhat complicated business and it may be prudent to take a wait and see attitude.

    Best of luck,

    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.
     

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