Marfan and diving
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chuckrt
Contributor
This could be a Big problem for them, sorry couldn't resist. I no they are more suspect for pneumo's but if they are past their mid 20's without having one maybe a physician could clear them. Another question regarding their joints, if they are slightly enlarged in thier knees elbows etc. is there any chance for trapped air in them?
Hopefully one of the medical regulators will have info on this.
chuckrt
Hopefully one of the medical regulators will have info on this.
chuckrt
The Iceni
Medical Moderator
Hi seabass,
I am not a regulator but can confirm that you need to consult a physician with intimate knowledge of Marfan's syndrome.
It is not an illness, like asthma, but a syndrome the features of which include tall stature, joint hypermobility and when severe the increased risks of pneumothorax and aortic aneurysm. (All tall, fit young men are at an increased risk of spontaneous pneumothorax, by the way.)
Clearly those only mildly affected will be perfectly fit to dive, those with the more severe features will not.
The hypermobility does not, to the best of my knowledge, increase the risks of joint DCI.
Not much help I know.
I am not a regulator but can confirm that you need to consult a physician with intimate knowledge of Marfan's syndrome.
It is not an illness, like asthma, but a syndrome the features of which include tall stature, joint hypermobility and when severe the increased risks of pneumothorax and aortic aneurysm. (All tall, fit young men are at an increased risk of spontaneous pneumothorax, by the way.)
Clearly those only mildly affected will be perfectly fit to dive, those with the more severe features will not.
The hypermobility does not, to the best of my knowledge, increase the risks of joint DCI.
Not much help I know.
The problem is that finding a doctor who actually has experience with Marfan's is probably rare. And one that knows anything or has experience with diving is going to be even rarer.
Would it be better to go to a doctor that specializes in marfans or a doctor that specializes in diving?
Would it be better to go to a doctor that specializes in marfans or a doctor that specializes in diving?
The Iceni
Medical Moderator
Marfan's syndrome is characterised by a weakness of collagen elastic connective tissue. This may lead to the artery walls becomiming weaker than normal and bulge out, much like the inner tube pushing through a large pucture of a bicycle tyre.
If I may plagiarise the US National Marfan Foundation.
In my personal opinion it would seem sensible, therefore, to consult a cardiologist and arrange an annual cardiac echo to detect the early and asymptomatic onset of such problems.
Many British cardiologists also have an interest in diving medicine in any case.
Here is a web page on this subject: http://scuba-doc.com/mrfnsynd.html .
There are 11 references listed as well as a discussion of the possibilities of diving with the condition.
scubadoc
There are 11 references listed as well as a discussion of the possibilities of diving with the condition.
scubadoc
I have already done a lot of research and have seen that site before. Of course what they are saying makes sense, however there is no evidence. The articles aren't really research articles, they are simply case studies of individuals (anecdotal). I was hoping that someone might know of a reference to something more substantial or knew of a physician that had seen more than a few marfans patients who were able to dive. In this case the individual has never had spontaneous pneumothorax but has had trauma pneumothorax as a result of a car accident. Echocardiograms are done every 6 months, as heart surgery was performed to strengthen the aorta in the early twenties. The marfans case is mild, but I am not sure what criteria a physician would be able to apply to determine that diving would be safe.
The Iceni
Medical Moderator
Sadly the evidence is there - that sufferers of Marfan's Syndrome are obviously at a greater risk of pulmonary barotrauma. It seems unlikely therefore, in these litiginous times, that you could ever find one, unfortunately.
:doctor:
John Reinertson
Guest
I fully sympathize with your wish for a study with multiple patients/divers.
To do this, we would first have to get a hundred or so patients with Marfan's, all of similar severity, and have them do a number of dives.
To be meaningful, they would either have to do a LOT of dives. (To prove safety comparable to a healthy Non-Marfan's diver, it would take in the range of a hundred thousand or more dives to get proof.)
Alternatively, they would have to do dives until a statistically significant number had serious mishaps (to prove conclusively it is unsafe.)
Neither study is entirely practical, or likely to get funded.
The data we have, and the knowledge of the condition that we have, would suggest a major increase in risk compared to run-of-the-mill healthy divers. If you want to read through the thread earlier on epilepsy and diving, it is possible to dive with a high-risk condition, but a prudent and considerate person would realize that the risk is not theirs alone, but includes the risk to everyone that might become involved in a rescue or recovery effort.
Only you can decide whether or not to dive. I only ask that you avoid taking risks that might endanger others.
If it was your life's greatest passion to take a leisurely dive off Salt Pier in Bonaire, and the conditions were calm, and your health were at its best, and you chose to take the risk, I can't step into your shoes or brain and tell you no.
I can tell you that rescue attempts risk lives of rescuers, and those left behind after a fatal accident wonder why you didn't care enough for them to want to be careful and stay alive for them.
Whatever you choose, choose thoughtfully, not just for yourself, but for all affected by your choices.
John
To do this, we would first have to get a hundred or so patients with Marfan's, all of similar severity, and have them do a number of dives.
To be meaningful, they would either have to do a LOT of dives. (To prove safety comparable to a healthy Non-Marfan's diver, it would take in the range of a hundred thousand or more dives to get proof.)
Alternatively, they would have to do dives until a statistically significant number had serious mishaps (to prove conclusively it is unsafe.)
Neither study is entirely practical, or likely to get funded.
The data we have, and the knowledge of the condition that we have, would suggest a major increase in risk compared to run-of-the-mill healthy divers. If you want to read through the thread earlier on epilepsy and diving, it is possible to dive with a high-risk condition, but a prudent and considerate person would realize that the risk is not theirs alone, but includes the risk to everyone that might become involved in a rescue or recovery effort.
Only you can decide whether or not to dive. I only ask that you avoid taking risks that might endanger others.
If it was your life's greatest passion to take a leisurely dive off Salt Pier in Bonaire, and the conditions were calm, and your health were at its best, and you chose to take the risk, I can't step into your shoes or brain and tell you no.
I can tell you that rescue attempts risk lives of rescuers, and those left behind after a fatal accident wonder why you didn't care enough for them to want to be careful and stay alive for them.
Whatever you choose, choose thoughtfully, not just for yourself, but for all affected by your choices.
John
The Iceni
Medical Moderator
One reason I am not at all happy with the BSAC's self certification system.
While I am sure Seabass will be sensible and consider the other people in his life I fear there are many who will, and have, ignored such sensible advice.
Kind Regards,
While I am sure Seabass will be sensible and consider the other people in his life I fear there are many who will, and have, ignored such sensible advice.
Kind Regards,
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