Diving without part of a lung

[ElizaDoolittle]

Original post below (I didn't want to delete it all in case it's not good manners, but following LI-er's advice, I'm sticking to the facts:

61-year-old man had part of one lung removed owing to complications after pneumonia thirteen years ago. Do you think he can dive?

(Sorry, but, I know, I have a tendency to ramble.)



I've been off the forum, but not off diving, for a long time now, but I've returned here to ask for advice. I'm going to ask a medical question, and I'm aware that only a doctor, and one who knows about diving, can give a definite answer, but I'd like to have your opinions first. They will either lead to discarding my idea, or provide me with questions I may want the doctor to clarify.

At the ripe old age of 59, I've fallen in love with a spring chicken of 61, a widower (well, actually, I fell in love when I was 57). He's got two sons, one an adult, and another who's ten years old (his wife died in childbirth). We're at that point where I'm head over heels in love with him, and he clearly likes me, too, though I'm pretty sure the thought of a romantic relationship hasn't crossed his mind. Yet. I'm working on that, of course.

We have discovered we both like scuba diving, but from the beginning, he told me he cannot do it any more because of health issues. For some time, I thought he was referring to a herniated disc he's got. But I've recently found out that the pneumonia he had thirteen years ago, which I knew had been serious (he was on sick leave for over ten months), was even worse than I thought, resulting in his losing part of one lung (I have the impression he still has got most of that lung). Now I'm sure that's what he refers to when he says he cannot dive any more.

I'd like to know, do you really think it's so? I don't want to encourage him if it's hopeless, as that would hurt him (he clearly misses diving), but if there's a possibility he may take it up again, I'd love to ask him to try. Is there any contraindication, considering he didn't lose the lung because of a chronic condition, and that it happened so long ago that he must have adjusted completely to his present situation?

Thanks beforehand!

 

[Allen-1]

@duke dive medicine

 

[CRT2]

Pulmonary Considerations In Diving - DeeperBlue.com

DAN VP and Medical Director Dr. Moon explains lung diseases that must be considered for dives.

www.deeperblue.com

From Dr. Moon,
After lung surgery (for example, lobectomy or pneumonectomy, removal of a portion of the lung or the entire lung, respectively) there may be some reduction in maximum breathing capacity, which could impair a diver’s ability to tolerate exertion underwater.

 

[uncfnp]

 

[kinoons]

I would argue that several years later if his cardiovascular and respiratory health are good enough to allow for a fairly normal lifestyle then diving is possibly an acceptable risk.

If he can walk a golf course with no problems, if he can go up and down stairs with no problems, if he can go shopping and carry the groceries into the home with no issues this would reassure me that the risk of diving may be acceptable from a pulmonary and cardiovascular standpoint.

I would hazard my own WAG that there are adult life long smokers who have far more pulmonary damage and restrictions who continue to dive and apparently do so safely when compared to a patient who had a severe lung infection and lost part of the affected lung.

If he fatigues easily, becomes short of breath easily, has chest pain when exerting himself, or has issues with lightheadedness, dizziness, or palpitations when exerting himself, then the risks associated with diving will increase.

In any case we are almost certainly getting into an area of medicine with virtually no randomized evidence to strongly support any opinion.

Ultimately this will boil down to what is an acceptable risk to your friend. The risk may be no greater than the average diver or perhaps slightly more but in a person’s opinion still acceptable. OTOH if he still isn’t “fully” recovered that risk may be much greater and therefor unacceptable. Only he can make that decision.

Usual disclaimer - for conversational/edicational/debate purposes only. I’m not your primary clinician and this post is not intended to establish a patient/provider relationship. Please see your own clinician for advice specific to you.

 

[Khoujo1]

I am a Pulmonologist and diver, so I hope I can give some insight to this issue. Full disclosure: I do not claim to be a dive medicine physician. I’ll leave that to the Duke Dive Medicine crew.

The question I would ask is what type of surgery, specifically, your friend had. It is rare to remove part of a lung for pneumonia. The more common scenario is that a patient with pneumonia has the infection spread to the fluid surrounding the lung, called an empyema, that requires surgery to drain. If this is indeed the case most patients recover with little to no decrement to lung function.

The other issue is whether he has any large air spaces in the lung due to the pneumonia. Patients can have injury that then leave residual cavitary areas that theoretically could rupture and cause an underwater emergency.

I would think that relatively shallow (40-60 ft) recreational diving with careful attention to slow ascents from depth should be safe unless there has been extensive surgery/damage to his lung.

If he’s still hesitant, there’s always snorkeling! Good luck and be safe!

 

[Capt Jim Wyatt]

You will not get a definitive answer here. He must be seen by a Dr who is a diver who knows about this field of medicine. Maybe a hyperbaric doc would be a good place to start.

I hope @duke dive medicine will jump in here and give you some guidance as to a starting place.

PLEASE keep us posted.

 

[FishWatcher747]

You will not get a definitive answer here. He must be seen by a Dr who is a diver who knows about this field of medicine.

This is only partially correct. He will not get a definitive answer from a dive medicine pulmonologist either. As noted above there are no randomized studies in this area of dive medicine to give a definitive answer.

 

[Capt Jim Wyatt]

He will not get a definitive answer from a dive medicine pulmonologist either.

I agree. I do *think* he can get a very well-educated opinion with a fairly high degree of accuracy. But I am not a doc so my opinion is probably as useless as tits on a rooster.

 

[ElizaDoolittle]

(...)

If he can walk a golf course with no problems, if he can go up and down stairs with no problems, if he can go shopping and carry the groceries into the home with no issues this would reassure me that the risk of diving may be acceptable from a pulmonary and cardiovascular standpoint.

(...)

If he fatigues easily, becomes short of breath easily, has chest pain when exerting himself, or has issues with lightheadedness, dizziness, or palpitations when exerting himself, then the risks associated with diving will increase.

He can certainly do the things in bold (I have no idea about the golf course). He leads a healthy lifestyle, and doesn't smoke. And I've never seen him get dizzy, or short of breath, though it's true I've never seen him exerting himself too much (at the most, a short trot when about to miss the train). Actually, I would have never known he had had part of a lung removed if he hadn't told me himself.

The question I would ask is what type of surgery, specifically, your friend had. It is rare to remove part of a lung for pneumonia. The more common scenario is that a patient with pneumonia has the infection spread to the fluid surrounding the lung, called an empyema, that requires surgery to drain. If this is indeed the case most patients recover with little to no decrement to lung function.

The other issue is whether he has any large air spaces in the lung due to the pneumonia. Patients can have injury that then leave residual cavitary areas that theoretically could rupture and cause an underwater emergency.

He explained it to me, but I can't remember the terms he used. What I understood is that it was a complicated pneumonia which caused something like a big ball of pus next to the lung, which kept on growing. I've been reading about the empyema you mention, and it sounds as if it could be the same thing, doesn't it? But he said that along with draining all that pus, they had to remove some part of the lung, too. He told me the pus was drained through a hole in one side of his back, between two ribs, and I assumed the piece of lung had come that way, too, though I may be wrong.

Thanks a lot for taking the time to give your opinions. From what you say, I see diving is not an absolute no-no regardless of everything else. Of course, many things have to be considered (like those mentioned here, scar tissue around the lung and the existence of air cavities in it), and a talk with a knowledgeable doctor is mandatory, but if everybody had agreeded that it was crazy, I wouldn't even have thought of suggesting it.