Dr. Wouldn't Sign Authorization For Diving...

[GeneL74]

Hello All!

I just returned home from my physical, and the Doctor wouldn't sign my authorization form so I could become certified....

A little history.....

I am a 28 year old male, 6' 195lbs, in what I would consider to be excellent physical condition..... Perhaps I could drop 15 pounds, but I still feel that I am in great shape.....

I work a very physically demanding job (steel work, 12hrs a day, 4 days one week, 3 the next) and in my spare time, I cut/split a lot of firewood, ride mountain bikes occasionally, and spend as much time doing activities as I can with my daughter...... I just recently quit smoking, and cannot imagine feeling better then I do right now.....

About 13 years ago (April of 1989) I suffered an accidental gunshot wound to the chest, approx. 1 inch below my left nipple...... To make a long story short, the bullet went throughout me much like a ball does in a pinball machine..... When it was all over, it had grazed my heart, collapsed a lung, and went through my liver......

I was rushed to the ER, done the chest tube thing, and was rushed to surgery after x-rays, and some other tests, shots, and painful activities......

The doctors were able to make all the needed repairs, and after a couple weeks in the hospitol, I was sent home...... Within a couple months, everything was healed, and my doctors give me a full discharge. I was told that I was as good as new (although I now had some really ugly scars) and that I my future activities would not be effected in any way...... I was able to do anything I felt/wanted to do...... No problems....

Fast forward to the present.....

A few weeks ago my family and I went to Florida, and myself, my brother, and his fiancee decided to go do this "discover scuba" course...... We went, and although I suppose I should not have, I stated on the form that I had not had any medical problems in the past that would prevent me from diving..... We went out, spent about 40-45 minutes on our dive (ended up only making it to 31' deep) and had a wonderful time.....

When we got home, my brother and I decided that we would get certified..... This time, I decided to do the smart thing, and go for the physical even though I knew everything would be okay.....


I contacted DAN, and they referred me to a physican who could perform the needed physical.....

I went to my appointment this morning, and everything went fine..... The doctor said everything sounded/looked great, but that he needed to do a chest x-ray, and also perform some breathing tests..... No problem, or so I thought....

After passing me off to a nurse I was x-rayed, and then done about 4-5 different types of breathing activities...... The first breathing activity is the one that I had trouble with..... She told me to take a deep breath, now exhale - more-more-more..... Opps, you breathed in too soon..... Gotta try again..... After about 5 attempts, I was able to make it through the 3 that are required....... I mentioned to her that it seemed like she wanted me to exhale for an awful long time, and she said something about that activity being the most difficult of them all, so I still thought things were going fine.....

When I finally made it back in with the doctor, he told me that the chest x-ray looked fine, other then some lung scarring from my accident, and that that was not a problem...... The problem was with my breathing test.

The doctor concluded that my lung output was significantly abnormal (I am inhaling plenty, but am not exhaling enough). He then questioned me about experiencing shortness of breath during minimal activity (which I don't) and then about my families breathing history (nothing abnormal with any of them that I am aware of... no asthma, nothing) and finally concluded that it was bad enough that he wouldn't sign the papers..... To say I was devastated would be an understatement..... I've never had any breathing problems whatsoever....

Anyway, he give me two Advair Diskus' (fluticasone propionate 250 mcg and salmeterol *50 mcg inhalation powder) to use twice a day and told me to come back in a month for re-evaluation..... He didn't come right out and say it, but I got the impression that the inhaler's may help, but in the end, it's not going to make a difference with the diving aspect of it....

To make a long story short, I have no idea what the problem is, and to be honest, I was pretty frustrated when I was there and didn't ask many questions after he didn't seem to be able to tell me what could cause such a problem..... I kinda wonder now if I could possibly have been doing something wrong during the test..... Who knows?

Like I say, I was flustered, and probably wasn't paying attention as good as I should have been, but I do remember him saying something about 40%. Perhaps I was exhaling 40% less then normal?

I dunno, but I find it very hard to believe that such problems exist, yet I feel so good, and have absolutely no problems whatsoever that I am aware of......

Any ideas? Anything I can do to improve this "problem"? Breathing exercises? Anything?

Thanks in advance, and sorry for being so long winded!

Regards,

Gene

 

[O-ring]

...to get a second opinion...

 

[Ladydiver]

with O-ring. Definitely get a second opinion. My big concern would be that you don't feel you questions about what may be causing the problem, were answered sufficiently. I don't think I would be comfortable with that and I would want to find someone that could/would answer my questions until I was satisfied.

Just my $.02.

 

[tchil01]

I also agree that you should get a second opinon to find out what the doctors concern is and make sure you are ok. However, I wouldn't keep going to doctors until I found one to sign the authorization. I had an aunt who would keep changing doctors until she found one who wouldn't tell her to quit smoking... of course she's been dead for year now.

Ty

 

[chuckrt]

Iunderstand your feelings especially since you are very active and do not feel like you have any problem. However since you have an abnormal Pulmonary Function Test and the MD started you on an inhaler is an indication of problems. These inhalers are the best on the market for decreasing inflamation and rastoring an increase in your testing but they may not be approved for diving.

I would seek an opinion from a Pulmonologist again, get referal from DAN. The PFT in a MD's office might not be the best for you where in the specialist office the equip. and usually the person giving the test is better suited for definitive diagnosis.

I am a licensed Reg. Respiratory Therapist and think you need to get another opinion and find out exactly what your problem is. Also tell the MD about your meds and find out if they want you to stop taking them a few days prior to your test.

chuckrt

 

[John Reinertson]

The doc is right in not allowing dive training for a person with significantly abnormal lung function. I would not certify you with abnormal results, either. BUT...

A couple thoughts:

It is very possible to get an abnormal lung function test on someone with normal lungs. We have a similar machine in our office. When the patient does the maneuver correctly and the machine is working correctly, it is quite accurate.

These readings are very dependent on the patient doing the breathing test correctly, however. It is easy to get a falsely abnormal test. Also, machines are machines, and nothing in life is 100% reliable or foolproof.

Therefore, we have an abnormal result that may represent disease and may represent artifact.

Repeated testing of some sort is in order, and it sounds like your doc has that in mind after a trial of inhaled steroid/salmeterol.

This is a rational approach. Getting a second opinion is also a rational approach. Either approach will likely yield more information and help you further along toward a decision.

What we have here is incomplete/insufficient information. Keep digging, and good luck.

John

 

[mtdivegirl]

I had a physical a year ago and randomly asked my doctor if she thought I would be okay to dive and she said she saw no problems (i have had kidney problems and a somewhat smallish battle with cancer). I figure she is my doc and has been for 5 years she knows my problems. So when I decided this year to go for my OW I was shocked to find out that no medical form was required to be signed. PADI was just requiring my honest answers to their questions and they were all "No."
On an aside, I have trouble breathing only out of my mouth..typically i breathe both out of my nose and mouth which makes it difficult for me to breathe out over an extended period of time. Would I have failed a test like this? Would I be allowed to plug my nose so I could control my breath through my mouth?

 

[DivingDoc]

I agree with Dr. Reinertson. If pulmonary function tests are abnormal -- especially if any value is 40% -- a person should not be certified to dive.

Since your doctor put you on Advair, it probably means that your spirometry/flow-volume loop showed what is called an "obstructive" pattern. This could be from a false test (since you could not perform the maneuvern properly) or due to asthma or due to some chronic obstructive pulmonary disease from your previous smoking. I doubt it's from the previous bullet wound, but it's possible.

I should think it would be best to recheck your pulmonary function ON the Advair, since protocols I've seen require you to have normal spirometry both before and after exercise ON regular controller medicines, such as Advair.

See the following YMCA "Y SCUBA" protocol:

http://www.ymcascuba.org/ymcascub/asthmatc.html

Hope this helps,
ET
:doctor:

 

[art.chick]

Gene,
On a few occasions in my life, I walked into a Dr.'s office expecting to get an old prescription filled or a form completed, & was instead given the news that there was some issue that would have to be resolved before (s)he could comply with my request (ie: lowering my cholesterol, healing some infection, etc.)

At the time, I was quite miffed. I had made a trip to his office on my short schedule & needed to get this business taken care of, and now he is telling me I have to change my life for a period & come back, & even then there were no promises!

But by following the instructions, taking the prescriptions for the unexpected problem, and returning later, I did find my health improved. If you have a serious contrindication, it may still be healable, but being realistic about its existance is the start of a healing miracle. If worse comes to worst, try freediving; it has some risks, but you will find your limits soon enough. Best of luck!