Pernicious anemia

[proulxbert]

I love diving. I am a dive master and have over 150 dives since learning to dive 4 years ago. I dive mostly in the great lakes but try to take 1-2 warm weather trips to Florida, costa rica, Cozumel, etc. To escape the cold!

I was recently diagnosed with pernicious anemia. I am wondering how that would affect my diving. I get b-12 shots every three weeks and feel a thousand times better with renewed energy. But, as this is an autoimmuned disease that affects the oxygen levels of blood I wonder how this affects my diving. My doctor, a non-diver, was not confident with his answer.

Any thoughts from the doctor/divers out there?

Thanks,

 

[terrylowe]

The low oxygen can be caused by low red blood cell counts (anemia) due to B12 malnutrition. Pernicious anemia that is severe enough to cause low oxygen is very rare. Correct the anemia with lifelong b12 and you won't have any restrictions. Your doctor was right.

Question for you though. Did the low B12 cause you to have any numbness in your hands or feet? If so, this could cause more of an issue for you during a dive.

 

[TSandM]

As said, pernicious anemia caught early and properly treated should not impact your diving.

 

[bleeb]

Not a medic here, but out of curiosity, have you found, or if you'd rather not go into too much detail about yourself, have you heard if this can have any effect on exercise tolerance, cardio capacity, endurance, or cold tolerance?

 

[proulxbert]

No tingling or numbness. My problem was fatigue, with shortness of breath when I exercised or exerted myself and pretty bad forgetfulness. I Went to the dr for complete physical. Found low b-12.he then ordered a complete blood count and shillings (? Spelling) test done. Diagnosed with pernicious anemia. Feel great since starting b-12. I have my husband do shots at home now. Quick and easy every 3 weeks. Diving better sat rate too. Thanks for your comments.

 

[Duke Dive Medicine]

proulxbert,
Concur with Terry and TSandM, with a couple of follow-up questions. Do you have any significant medical history besides the pernicous anemia? Also, you mentioned feeling much better with the B-12 shots; has your activity tolerance gotten to the point where you can engage in the type of physical activity that diving involves? Just reading your post above.... what does "diving better sat rate" mean?

 

[bleeb]

proulxbert,
Concur with Terry and TSandM, with a couple of follow-up questions. Do you have any significant medical history besides the pernicous anemia? Also, you mentioned feeling much better with the B-12 shots; has your activity tolerance gotten to the point where you can engage in the type of physical activity that diving involves? Just reading your post above.... what does "diving better sat rate" mean?

Again out of curiosity (and maybe helpful additional guidance for the OP), I've seen exercise tolerance of 13 METs or equivalents mentioned as a target for divers to be able to handle urgent strenuous situations, especially when discussing those recovering from heart or similar circulatory problems. For the medical types out there, do you think such a guideline would be an appropriate target here, particularly for a cold water diver?

 

[DocVikingo]

Hi proulxbert,

Agree with prior posters that caught prior to any lasting damage to the nervous or other organ system and appropriately treated (e.g., hemoglobin level and RBC maintained within normal limits), PA should not adversely impact SCUBA.

You ask about the 13 mets recommendation. While this stage of exercise stress testing is primarily directed at divers with cardiac/cardiovascular issues, the diver with PA who can sustain this level of exertion very likely has fully adequate oxygen-carrying capacity.

RE "shillings (? Spelling)". A Shilling test is a 24-hour urine assessment done to evaluate whether vitamin B12 is being absorbed by the body.

BTW, I assume by "Diving better sat rate too" you actually mean better surface air consumption (SAC) rate.

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.

 

[Duke Dive Medicine]

Again out of curiosity (and maybe helpful additional guidance for the OP), I've seen exercise tolerance of 13 METs or equivalents mentioned as a target for divers to be able to handle urgent strenuous situations, especially when discussing those recovering from heart or similar circulatory problems. For the medical types out there, do you think such a guideline would be an appropriate target here, particularly for a cold water diver?

Bleeb,
That 13 MET figure comes, at least in part, from a recommendation by Dr. Alfred Bove, who's a renowned diving physician and cardiologist. Not everyone agrees with that figure, though. It's considered to be unrealistically high by some sources:

Pollock NW. Aerobic fitness and underwater diving. Diving and Hyperbaric Medicine. 2007; 37: 118-24.

also:
Rubicon Research Repository: Item 123456789/9176

At any rate, when the 13 MET figure is used, it's used as a target for divers recovering from a cardiac event. As such, it's based on exercise tolerance from a cardiac standpoint and not from an anemia standpoint, so to speak. A better measure of function for the op might be a red cell count that's within normal limits and the ability to exercise to the level that she'll need to perform the dives she plans to do. If we made everybody exercise to 13 METs, we'd lose a pretty big chunk of the recreational diving population.

BTW, I assume by "Diving better sat rate too" you actually mean better surface air consumption (SAC) rate.

Hi Doc,
Your guess is probably better than mine. I thought she might have meant "sed rate" as in ESR.

For proulxbert: can you clarify?

Thanks,
DDM

 

[DocVikingo]

bleeb -- That 13 MET figure comes, at least in part, from a recommendation by Dr. Alfred Bove, who's a renowned diving physician and cardiologist. Not everyone agrees with that figure - it's considered to be unrealistically high by some sources:....DDM

Hey DDM and bleeb,

The following from intervetional cardiologist Dr. Doug Ebersole, who occasionally visits the board (aka debersole), greatly clarifies the issue for me and appears much more sensible:

"The "13 met" rule came from Dr. Fred Bove, a very well respected cardiologist and expert on diving medicine. It is based on exercise physiology. Actually, I discussed this at length with Fred last April at the DAN Fatality Conference in Durham as I also had spent years recommending patients be able to go to 13 mets before returning to diving.

Here is where that recommendation and now the lower number came from. As treadmill testing is usually done by incrementally increasing the workload, we strive for a maximum exercise tolerance. The bottom line without going into the physiology is that if you can hit 13 mets on a treadmill (12 min on a standard Bruce protocol) as a maximum, that would suggest you could SUSTAIN an effort of around 6.5 mets for a prolonged period of time (say 20 min) which is what it would require for you to, say, swim against a significant current in the event you were downcurrent of the boat, etc. Another way to assess this rather than formal exercise testing would be to say that if a patient after stents or bypass surgery can walk 2 miles in 24 min (12 min miles) they are okay to return to diving as this is also a workload of around 6.0 - 6.5 mets. So they are really saying the same thing -- a MAXIMAL effort of 13 mets or a SUSTAINED effort of 6.5 mets to return to diving."

Regards,

DocV