Pneumothorax and diving

[InTheDrink]

I apologise in advance if this or a similar question has been asked before.

I managed to break 8 (yes 8) ribs and puncture a lung a couple of weeks ago. Spent a week in hospital which really helped.

The pain is now manageable (with meds) but was pretty horrendous to start with (couldn’t walk etc).

Apparently the lung puncture is ‘right in the middle’ - not to big, not to small. So hard to make a call on re diving.

I’m getting my scans sent to another friendly face hospital and to a dive hospital and will have further CT scans to ensure bubble has reduced or gone.

I’m not allowed to fly for 6 weeks which is fine. I’m also taking it really easy for the next few weeks so I don’t stress my body out while still doing very moderate exercise.

However I have a trip booked to Indonesia in September. I have been looking forward to it all year.

Question really is: should I sit this one out and dive another day or just take advice from (generally) very conservative doctors. Obvious they lean towards conservatism/total safety.

Breathing is normal. Pain is manageable and improving daily. No sign of infection etc so I feel I’m mending quickly but don’t want to take a significant risk for myself, buddy, skipper, crew, family etc.

Anyone been down this alley before?

Thanks,
John

 

[Duke Dive Medicine]

I apologise in advance if this or a similar question has been asked before.

I managed to break 8 (yes 8) ribs and puncture a lung a couple of weeks ago. Spent a week in hospital which really helped.

The pain is now manageable (with meds) but was pretty horrendous to start with (couldn’t walk etc).

Apparently the lung puncture is ‘right in the middle’ - not to big, not to small. So hard to make a call on re diving.

I’m getting my scans sent to another friendly face hospital and to a dive hospital and will have further CT scans to ensure bubble has reduced or gone.

I’m not allowed to fly for 6 weeks which is fine. I’m also taking it really easy for the next few weeks so I don’t stress my body out while still doing very moderate exercise.

However I have a trip booked to Indonesia in September. I have been looking forward to it all year.

Question really is: should I sit this one out and dive another day or just take advice from (generally) very conservative doctors. Obvious they lean towards conservatism/total safety.

Breathing is normal. Pain is manageable and improving daily. No sign of infection etc so I feel I’m mending quickly but don’t want to take a significant risk for myself, buddy, skipper, crew, family etc.

Anyone been down this alley before?

Thanks,
John

John, sorry to hear about your injury. Clearance to dive after traumatic pneumothorax is done on a case-by-case basis. You'll need to be examined to make sure that there is no scarring or other change in your lung architecture that could lead to air trapping; this may include radiographic imaging. I'd recommend that you contact the consultants at the London Hyperbaric Medicine Chamber and see if they can get that scheduled for you, along with a fitness to dive exam, before you leave for your trip. Their website is linked below.

London Hyperbaric

Best regards,
DDM

 

[InTheDrink]

Thanks for that - it was essentially my plan. I have a friendly CT scanner in one hospital so going to send initial results to them then get them to do a follow up.

If there’s any doubt then Guy’s hospital (who you refer to) definitely on my list as they’re pretty knowledgeable and gave me the go ahead after my IPE 8 years ago.

Just feel In uncharted land and don’t want to put anyone at risk.

Cheers,
John

 

[InTheDrink]

P.s. love your wording about ‘lung architecture’.

Do you think they’ll settle for ‘Gaudian’?

 

[Duke Dive Medicine]

P.s. love your wording about ‘lung architecture’.

Do you think they’ll settle for ‘Gaudian’?

I think that would be one for the literature ;-)

 

[Akimbo]

You'll need to be examined to make sure that there is no scarring or other change in your lung architecture that could lead to air trapping; this may include radiographic imaging.

Three Questions:

1. What imaging method shows this kind of soft tissue injury the best?
2. Would a pulmonologist be the best specialist to start with if a hyperbaric specialist is unavailable?
3. Does Duke do remote "second opinions" if imaging is provided?

 

[Duke Dive Medicine]

Three Questions:

1. What imaging method shows this kind of soft tissue injury the best?
2. Would a pulmonologist be the best specialist to start with if a hyperbaric specialist is unavailable?
3. Does Duke do remote "second opinions" if imaging is provided?

Hi Akimbo,

1. High resolution spiral CT.
2. A radiologist would interpret the scan. A pulmonologist could make a recommendation but not all pulmonologists are familiar with diving physiology.
3. That would involve both our radiology department and hyperbaric medicine so probably not unless the consult came from a physician.

Best regards,
DDM

 

[Akimbo]

3. That would involve both our radiology department and hyperbaric medicine so probably not unless the consult came from a physician.

It probably wouldn't be too hard for a patient to convince their local physician to send the imaging for a second opinion, especially with the unique stresses related to diving and Duke's credentials. Is this a complicated thing for a doctor to request?

It's not exactly tele-medicine but moving in that direction. This might be a good business for Duke to get into???

 

[Duke Dive Medicine]

It probably wouldn't be too hard for a patient to convince their local physician to send the imaging for a second opinion, especially with the unique stresses related to diving and Duke's credentials. Is this a complicated thing for a doctor to request?

It's not exactly tele-medicine but moving in that direction. This might be a good business for Duke to get into???

There's the raw imaging and then there's the radiologist's interpretation of the imaging. If the raw images were sent, we'd have to get our radiology department involved, which makes things more complex because then we're asking them to perform a service with no reimbursement. If the interpretation was sent, one our physicians may be able to look at it and render an opinion to another provider, then it's up to the provider how to frame that opinion with the patient. That would be on a case-by-case basis though, and without an in-person evaluation with complete history/physical the scope of the opinion would be limited.

 

[InTheDrink]

Hi both,

I’m have a disk made with x-rays and CT scans. My friend is a radiologist and diver. But we’ll need another 1 or 2 scans before I think an assessment can be made. Good to know hi-res spiral CT appropriate type (I don’t understand any of this naturally) but I imagine she will.

Thanks again for both your input.

John