Has anyone been diving after a collapsed lung?
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diveflick
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Three weeks ago my wife and i were diving in Belize. we were doing a surface interval on a small island when another dive boat roared up with an emergency. they had a snorkel guide who dove 20ft or so down and came up unresponsive. my wife is an MD so she and another doctor worked on the young man. sadly he died. the other md commented to my wife that he may have had a spontaneous pneumothorax as he was 20 something, tall and skinny etc...which is classic of the type of person who has these things.
when we got home my wife did more research on this as she recalled that I had had a spontaneous pneumothorax 25 years ago. needless to say we were both shocked to see that all this time i have been diving and should not have. I am now 45 and take very good care of myself. 5 years and close to 100 dives all over the world (Bora Bora, Cabo, Cozumel, Honduras, Belize, Bahamas, etc...). many of the dives were considered deep and nothing happened thank God. Our whole family dives now so this is like a huge part of our lives being pulled away as we dive with all four of our kids. I am crushed and have not told my kids yet.
i dont think anyone will ever clear me in this era of litigation, but I am going to seek a CT with a pulmonologist to see if there are any or many blebs present. if there are i am for sure done. if there are not though I have to decvide if I roll the dice. I did read somewhere that the most risk is during ascent and so going very slow is absolutely a must.
when we got home my wife did more research on this as she recalled that I had had a spontaneous pneumothorax 25 years ago. needless to say we were both shocked to see that all this time i have been diving and should not have. I am now 45 and take very good care of myself. 5 years and close to 100 dives all over the world (Bora Bora, Cabo, Cozumel, Honduras, Belize, Bahamas, etc...). many of the dives were considered deep and nothing happened thank God. Our whole family dives now so this is like a huge part of our lives being pulled away as we dive with all four of our kids. I am crushed and have not told my kids yet.
i dont think anyone will ever clear me in this era of litigation, but I am going to seek a CT with a pulmonologist to see if there are any or many blebs present. if there are i am for sure done. if there are not though I have to decvide if I roll the dice. I did read somewhere that the most risk is during ascent and so going very slow is absolutely a must.
diveflick, your story is a beautiful illustration of the problems with medical "clearance" to dive.
What we know: The recurrence rate for spontaneous pneumothorax is high, and can approach 50%. The potential risk of a pneumothorax in the water is enormous.
What we don't know: What YOUR personal risk of recurrence is. Some people never recur. Others have multiple recurrences and end up requiring a surgical procedure to keep the lung up. We also have no way at all to predict whether, if you do recur, you will do it during a dive, and if so, whether you will be sufficiently asymptomatic to persist in the dive until the pneumothorax is large and potentially lethal on ascent.
We are physicians; we don't like lethal risks, even if they are small. We REALLY don't like malpractice suits that occur as a result of having authorized someone to undertake even a small risk of a lethal event. There is an entire, enormous literature on how to avoid the 2% of chest pain patients discharged from emergency rooms, who will subsequently prove to have had a heart attack, and may have complications.
Each diver, though, has the right to assess risk for himself, assuming he has in hand the available valid information on his particular condition. Weighed into the equation have to be what is known, what is not known, how important diving is to the individual, and what the consequences to his family are should he expire while diving. In your case, you have an advantage -- you have years and years of data about safe dives. A high resolution CT will give you more data. But you are the ONLY person who can make the decision about how much risk you feel comfortable assuming.
I cave dive. Therefore, by definition, I'm willing to assume risk well beyond that taken by people doing only uncomplication, shallow reef dives. So I empathize with you.
What we know: The recurrence rate for spontaneous pneumothorax is high, and can approach 50%. The potential risk of a pneumothorax in the water is enormous.
What we don't know: What YOUR personal risk of recurrence is. Some people never recur. Others have multiple recurrences and end up requiring a surgical procedure to keep the lung up. We also have no way at all to predict whether, if you do recur, you will do it during a dive, and if so, whether you will be sufficiently asymptomatic to persist in the dive until the pneumothorax is large and potentially lethal on ascent.
We are physicians; we don't like lethal risks, even if they are small. We REALLY don't like malpractice suits that occur as a result of having authorized someone to undertake even a small risk of a lethal event. There is an entire, enormous literature on how to avoid the 2% of chest pain patients discharged from emergency rooms, who will subsequently prove to have had a heart attack, and may have complications.
Each diver, though, has the right to assess risk for himself, assuming he has in hand the available valid information on his particular condition. Weighed into the equation have to be what is known, what is not known, how important diving is to the individual, and what the consequences to his family are should he expire while diving. In your case, you have an advantage -- you have years and years of data about safe dives. A high resolution CT will give you more data. But you are the ONLY person who can make the decision about how much risk you feel comfortable assuming.
I cave dive. Therefore, by definition, I'm willing to assume risk well beyond that taken by people doing only uncomplication, shallow reef dives. So I empathize with you.
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No medical opinion on this can be 100%, it is question of the level of risk. Diving after suffering a pneumothorax was listed on the AAUS Medical Questionaire as an absolute contraindication to diving, but now in under the heading: Conditions Which May Disqualify Candidates From Diving since there no longer is an "Absolute Contraindication" section. Maybe its easy for me to say, since I do not face the problem, but I would choose not to dive.
OP
Ok, time for a follow-up.
First, thanks for everyone's replies.
Second, I just had my "image-enhanced ct scan" with results showing I'm cleared to dive by my local radiologist. They also provided me with a dvd-rom of the ct scan files. I'm tempted to copy the disc and send it to a radiologist with a scuba background. Not that I don't trust my central Illinois radiologist, but...
There is still this little kernal of knowledge in the back of my brain running the "what-if" possibilities. But for me this isn't suppose to be a weekend sport or holiday getaway experience. If it was, I'd take up snow-skiing or 4-wheelin or whatever. I was making plans to get my OWSI cert and begin "the next chapter." I think I'm willing to take the known risk. I think I'd rather die from a diving accident in SouthEast Asia than a cycling accident in Central Illinois.
Thanks again, everyone.
First, thanks for everyone's replies.
Second, I just had my "image-enhanced ct scan" with results showing I'm cleared to dive by my local radiologist. They also provided me with a dvd-rom of the ct scan files. I'm tempted to copy the disc and send it to a radiologist with a scuba background. Not that I don't trust my central Illinois radiologist, but...
There is still this little kernal of knowledge in the back of my brain running the "what-if" possibilities. But for me this isn't suppose to be a weekend sport or holiday getaway experience. If it was, I'd take up snow-skiing or 4-wheelin or whatever. I was making plans to get my OWSI cert and begin "the next chapter." I think I'm willing to take the known risk. I think I'd rather die from a diving accident in SouthEast Asia than a cycling accident in Central Illinois.
Thanks again, everyone.
Henry,
If you'd like a hyperbaric physician who evaluates divers to put eyes on your file, there are a few who are relatively close to Champaign. The closest is at Methodist Hospital of Clarian Health in Indianapolis. In the Chicago area, there are Ingalls Memorial Hospital in Harvey and Swedish Covenant Hospital in the city. In St. Louis, there is St. Luke's Hospital. We can provide contact info for one or more of these if you need it.
In general, people who have made a full, uncomplicated recovery from a traumatic pneumothorax are ok to dive, but we would encourage you to have a board-certified hyperbaric physician evaluate you. If that doesn't work for you, then you can have your radiologist contact us at the Duke Hyperbaric Center and we'll put him/her in touch with one of our attending physicians.
Duke Dive Medicine. Doctors for Divers, Climbers and Explorers
"I think I'm willing to take the known risk. I think I'd rather die from a diving accident in SouthEast Asia than a cycling accident in Central Illinois."
A final word on risk: having analyzed a few diving fatalities, my guess is that most victims, if they could speak, would not be saying, "By golly, that was worth it!"
Good luck, and enjoy a slice of Papa Del's for those of us back east who can't get good pan pizza!
If you'd like a hyperbaric physician who evaluates divers to put eyes on your file, there are a few who are relatively close to Champaign. The closest is at Methodist Hospital of Clarian Health in Indianapolis. In the Chicago area, there are Ingalls Memorial Hospital in Harvey and Swedish Covenant Hospital in the city. In St. Louis, there is St. Luke's Hospital. We can provide contact info for one or more of these if you need it.
In general, people who have made a full, uncomplicated recovery from a traumatic pneumothorax are ok to dive, but we would encourage you to have a board-certified hyperbaric physician evaluate you. If that doesn't work for you, then you can have your radiologist contact us at the Duke Hyperbaric Center and we'll put him/her in touch with one of our attending physicians.
Duke Dive Medicine. Doctors for Divers, Climbers and Explorers
"I think I'm willing to take the known risk. I think I'd rather die from a diving accident in SouthEast Asia than a cycling accident in Central Illinois."
A final word on risk: having analyzed a few diving fatalities, my guess is that most victims, if they could speak, would not be saying, "By golly, that was worth it!"
Good luck, and enjoy a slice of Papa Del's for those of us back east who can't get good pan pizza!
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Pneumothorax (and for that matter any thoracotomy) was a contraindication to diving (at least in the science community) when I was actively involved in making such decisions as a DSO. Our medical advisor (boarded hyperbaricist) once suggested to me that a repaired pneumothora, even a spontaneous one, was stronger and less likely to cause future problems. What is your thinking on both a repaired pneumothorax or a diver with a history of some other thoracotomy?
It would depend a lot on the individual. We normally would look at the etiology, order radiographic studies if there aren't any recent ones, and advise accordingly. I found scant literature on the subject but Elliott and Denison published a good case history in SPUMS in 2001 and covered the pros and cons pretty well. You've likely already seen it but it's linked here. http://archive.rubicon-foundation.org/dspace/bitstream/123456789/7736/1/SPUMS_V31N3_8.pdf
Bennett and Elliott cover spontaneous pneumo but not thoracotomy per se.
Bennett and Elliott cover spontaneous pneumo but not thoracotomy per se.
Cruisin Home
Contributor
You are somewhat in luck in that I invented multi-slice CT scanning and also had a broken rib and pneumthorax in my teens (late 70's) playing football. I was also a commercial shellfish scubadiver during high school and college and completed over a couple thousand dives since the injury. Injury was in late fall and i didnt dive again til April. Didnt have the benefit of CT to give me info to help make that decision.
Couple points:
1) There are no guarantees in life everything is a risk, i.e. driving cars is the greatest risk you take on a daily basis.
2) medical profession is ultra conservative particularly in the litigous USA. There almost has to be clinical trials that are double blinded with placebos to get a "definite" thumbs up.
3) A lot of people have surgery and get "air" inside them that is likely to be reabsorbed over time. I see it every day in neurosurgical cases. As a believer in the medical imaging that I helped create; I would trust a CT to show me a) bone healed, b) air gone, and maybe c) nothing strange re the injured site. My educated guess is it takes 6 months to reach that condition wheteher it were thoracic or neurological sequalae.
4) sit on the bench for the winter (****, Illinois is cold man), spring time get a CT scan, summer start some dives under close supervision, very shallow at first (remember the biggest pressure change differentially speaking is in the first 10 feet!)
5) only you can decide this thus you cant hang the risk on anyone else but yourself. I took the risk and I have been fine. You could take the risk and encounter an issue. Be prepared.
Always willing to look at your scans but don't expect me to tell you their is no risk, just not gonna happen.
Couple points:
1) There are no guarantees in life everything is a risk, i.e. driving cars is the greatest risk you take on a daily basis.
2) medical profession is ultra conservative particularly in the litigous USA. There almost has to be clinical trials that are double blinded with placebos to get a "definite" thumbs up.
3) A lot of people have surgery and get "air" inside them that is likely to be reabsorbed over time. I see it every day in neurosurgical cases. As a believer in the medical imaging that I helped create; I would trust a CT to show me a) bone healed, b) air gone, and maybe c) nothing strange re the injured site. My educated guess is it takes 6 months to reach that condition wheteher it were thoracic or neurological sequalae.
4) sit on the bench for the winter (****, Illinois is cold man), spring time get a CT scan, summer start some dives under close supervision, very shallow at first (remember the biggest pressure change differentially speaking is in the first 10 feet!)
5) only you can decide this thus you cant hang the risk on anyone else but yourself. I took the risk and I have been fine. You could take the risk and encounter an issue. Be prepared.
Always willing to look at your scans but don't expect me to tell you their is no risk, just not gonna happen.
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