Post dive edema

[craracer]

After doing several days of diving I develop a +1/+2 bilateral distal tibial edema. All of my diving is done in other countries, which requires flights over 4 hours in length.

Diving depths vary from 30-100ft. I have a symptomatic PAC issue, which is well controlled with 75 of Metoprolol. Recent ECHO shows a normal EF and no other anomalies. I'm 41 y/o, in excellent physical condition, and a non-smoker.

I'm just wondering what might be causing the edema. Is it the flying; the diving, a combination of both, or none of the above?

Thank you for your replies.

 

[ScubaDocER]

After doing several days of diving I develop a +1/+2 bilateral distal tibial edema. All of my diving is done in other countries, which requires flights over 4 hours in length.

Diving depths vary from 30-100ft. I have a symptomatic PAC issue, which is well controlled with 75 of Metoprolol. Recent ECHO shows a normal EF and no other anomalies. I'm 41 y/o, in excellent physical condition, and a non-smoker.

I'm just wondering what might be causing the edema. Is it the flying; the diving, a combination of both, or none of the above?

Thank you for your replies.

Dependent edema, which is what I believe you are describing, can arise from many sources. It essentially is a circulation problem. The blood is not circulating around your body fast enough to prevent fluid from leaking out of the blood vessels. This can be caused by heart, liver, kidney disease, medications, or a number of causes. Flying for long periods on a plane can predispose you to developing this edema. It can more commonly cause blood clots in your legs called a DVT. Make sure you walk around on the plane and stretch as often as you can. Sitting with your legs bent or folded can also increase it's likelihood. Since your Echo was normal then the issue is probably not your heart. Discuss the issue with your doctor to make sure there are no kidney or liver issues that need to be addressed.

One other concern. The medication that you use to control your PACs also works to slow down your heart rate and to decrease cardiac contractility, i.e., the pumping force of the heart. This reduced pumping action may be contributing to your edema. In either event, if this is occurring regularly, then I would see your doctor as soon as possible. Discuss the fact that you are scuba diving on beta blockers and having dependent edema and see if he agrees that you are medically fit to continue diving.

 

[TSandM]

As ScubadocER says, edema is very much multifactorial. Causes can include anything that affects the balance between the forces that tend to cause fluid to leak out of blood vessels, and the forces that reclaim it from the tissues. That imbalance can be local (for example, a wetsuit that constricts around the knees, and impedes venous return from the lower leg) or mechanical (eg. the dependency of the legs during long plane flights). It can involve external processes or internal ones (blockage of veins with clot, tumors that block pelvic lymphatics). It can also involve systemic issues, like total body fluid balance. This can be affected, for example, by salt intake; if your diet is significantly saltier when you travel, that can predispose to some edema from fluid retention. Edema is a known, irritating side effect of beta blockers, although why you would not experience it at home but would when you travel is unclear to me (unless there are significant dietary differences). Cardiac dysfunction certainly can lead to edema, but with a normal EF on beta blockers, that's unlikely to be your particular cause.

So I guess the bottom line is that I can't really give you any good answer. There are too many variables. The only one that would really worry me would be the possibility of DVT from plane flights, but if this is a problem that occurs repeatedly and clears up promptly, that's not very likely, either.

 

[craracer]

At my last checkup, a few weeks ago, my kidney function was normal. The edema has been going on long before I started on the beta blocker. It usually resolves within a day of returning home.

I've talked to 2 cardiologists and 3 primaries, all of which have cleared me for diving. I never have any calf pain at the time of the edema.

I'm relatively certain that my salt intake increases when I'm on vacation (all-inclusive food tastes yummy, but I'm sure it's salt-laden).

Thank you for your responses! Looks like it will require some rather in depth and lengthy investigation to come up with a reasonable explanation.