Pulmonary Barotrauma with Short Interval Shallow Freedives

[Blueringocto_73]

Just the routine stethoscope when my lungs were checked. If I don't feel a marked improvement after donning the wetsuit and ruling out the cold. I will do as you suggest and get a "real" heart checkup. Almost 2 years ago an infection of my left big toe from diving almost took my life.

I had a small blister on the big toe that got sewer water in it while diving Monterey. It gave me a life threatening Streptococcus B infection. The surgeon wanted to remove that toe but I would not give consent. So the surgeon remove a small piece of bone.

It healed and Penicillin took out the pathogen. I went on to dive extensively in Puerto Galera afterwards. Including some deep dives. However getting back to the subject. Yes that pathogen could find it's way back. And a thorough checkup may be in order as you say.

When did you last have your heart checked? I ask because of something that I read earlier that said a sign of heart problems is a cough that produces pink froth.

 

[chillyinCanada]

My other earlier thought with my vast medical knowledge gleaned from my degree from the web, was that you may have torn something.

 

[Blueringocto_73]

Torn as in alveoli or the outer lung? And how well do the alveoli respond to injuries of this sort. I could expect a bout of pneumonia I suppose but don't have that currently. It's one big mystery to solve.

My other earlier thought with my vast medical knowledge gleaned from my degree from the web, was that you may have torn something.

 

[chillyinCanada]

I wasn't really sure znd had originally decided to say nothing since I so obviously know nothing. It was the completely coincidental reading of the article that spoke of coughing frothy pink foam that had me comment at all.

But now that you question heart or lung, I wonder if you ever experience indigestion/heartburn? Maybe it's from your tummy and neither lungs nor heart?

 

[Blueringocto_73]

Well you hit on my first self diagnosis. The first time it happened it was mild. I thought I had indigestion from something I ate that didn't like me to be inverted as I descended. I think I ruled that out. We'll see.

Frankly I would love for that to be the case. Who wants to hang up their fins. I just need to know if this injury will resolve and allow me to continue both apnea and scuba. I'm going to try the wetsuit the next time though.

I wasn't really sure znd had originally decided to say nothing since I so obviously know nothing. It was the completely coincidental reading of the article that spoke of coughing frothy pink foam that had me comment at all.

But now that you question heart or lung, I wonder if you ever experience indigestion/heartburn? Maybe it's from your tummy and neither lungs nor heart?

 

[Duke Dive Medicine]

So lung squeeze (PBT) is not an uncommon event with deep freedives. However I personally didn't realize that it could occur with shallow dives. So in my case while making laps around a cold swimming pool (59F) and diving to 12ft./4meters with each lap I experienced it.

After about 1/3 kilometer I was getting a raspy sound on exhalation with shortness of breath (more than I would expect normally). Exiting the pool area I was coughing up copious amount of thick clear liquid. Making it to the bathroom the liquid had a yellow color and after more coughing it was pink froth. There was a burning feeling in my chest.

2 hours post and there really isn't that much there now. When I saw the pink froth it prompted me to research the phenomenon online. Now I know it can be extremely serious leading to death, but usually resolves. So I am a bit more at ease.

I took a very warm shower afterwards and the warmth running down my back produced some relief. I will be seeing my primary care physician in a couple of days who is not a dive medicine professional.

Pulmonary barotrauma can happen a couple of ways. Pulmonary barotrauma of descent happens in free divers when the lungs are compressed on descent to a point beyond their residual volume, which is the volume that remains after a complete exhalation. In the average human, this would happen at roughly 130 feet of sea water. So, unless you expelled all of the air you possibly could before you dove to 12 feet, you almost certainly did not have pulmonary barotrauma of descent. Pulmonary barotrauma of ascent happens in compressed gas divers who ascend with the airway partly or completely closed off. The classic scenario is a panic ascent from depth, but it can also happen under other circumstances.

I would tend to agree with the other posters in that you likely suffered an event of immersion pulmonary edema aka swimming-induced pulmonary edema. Cold water and heavy exercise can contribute to it. In triathletes and combat swimmers, it's almost always "pure" IPE, that is, there isn't a cardiogenic origin. In us mortals, it can have a cardiac component to it. I'm glad you're getting worked up for it. If a cardiac cause is ruled out, we might be interested in speaking with you about our research.

Best regards,
DDM

 

[Blueringocto_73]

Thank you for the detailed information. I will now regard this as IPE. So I'll give a bit more detail. An estimate of the quantity of material that exited my lungs. About 1/2 cup of clear thick mucus. Followed by a tablespoon of yellow clear mucus. Followed by 1/2 teaspoon of pink mucus. There were no red streaks or visible red blood.

I'm curious whether IPE can occur spontaneously with cold water shallow dives such as I was doing. With heightened blood volume in the core along with over hydration being the trigger for the event. Late last year I was swimming this routine without an IPE event.

And a question. Generally is IPE something that resolves if not triggered by the heart? I'll know a bit more after my limited test with the 7 mil wetsuit this evening. I'm not going to do enough to fully trigger what happened earlier. I will see what happens for a threshold level of exertion and immersion duration. I will also be talking to the staff of my dive shop tomorrow.

Pulmonary barotrauma can happen a couple of ways. Pulmonary barotrauma of descent happens in free divers when the lungs are compressed on descent to a point beyond their residual volume, which is the volume that remains after a complete exhalation. In the average human, this would happen at roughly 130 feet of sea water. So, unless you expelled all of the air you possibly could before you dove to 12 feet, you almost certainly did not have pulmonary barotrauma of descent. Pulmonary barotrauma of ascent happens in compressed gas divers who ascend with the airway partly or completely closed off. The classic scenario is a panic ascent from depth, but it can also happen under other circumstances.

I would tend to agree with the other posters in that you likely suffered an event of immersion pulmonary edema aka swimming-induced pulmonary edema. Cold water and heavy exercise can contribute to it. In triathletes and combat swimmers, it's almost always "pure" IPE, that is, there isn't a cardiogenic origin. In us mortals, it can have a cardiac component to it. I'm glad you're getting worked up for it. If a cardiac cause is ruled out, we might be interested in speaking with you about our research.

Best regards,
DDM

 

[Blueringocto_73]

Finished the swimming/diving test with 7 mil wetsuit. Went about 1/4 kilometer and only 3 times to 4 meters deep. (took a bit of effort to get down without weights) Stamina was good and absolutely no hint of any liquid in the lungs or raspyness. One hour post and a general feeling of well being/runners high.

So from a layman's perspective I'll be continuing with both apnea and scuba as before. However with a new respect for what cold water could do to adversely effect health. So making this plain to anyone reading this. If you swim in cold water(59 F) and dive to at least 4 meters repetitively in extreme circumstances your lungs will leak liquid from the alveoli and fill the lungs. And if you continue long enough you will drown in your own fluids.

A better title for this thread might be "SIPE induced by Repetitive Shallow Cold Water Freediving". Surface interval is probably not a factor. Blood volume in the core is most likely what triggered IPE in my case. However I will let the professionals weigh in.

 

[Duke Dive Medicine]

Thank you for the detailed information. I will now regard this as IPE. So I'll give a bit more detail. An estimate of the quantity of material that exited my lungs. About 1/2 cup of clear thick mucus. Followed by a tablespoon of yellow clear mucus. Followed by 1/2 teaspoon of pink mucus. There were no red streaks or visible red blood.

I'm curious whether IPE can occur spontaneously with cold water shallow dives such as I was doing. With heightened blood volume in the core along with over hydration being the trigger for the event. Late last year I was swimming this routine without an IPE event.

And a question. Generally is IPE something that resolves if not triggered by the heart? I'll know a bit more after my limited test with the 7 mil wetsuit this evening. I'm not going to do enough to fully trigger what happened earlier. I will see what happens for a threshold level of exertion and immersion duration. I will also be talking to the staff of my dive shop tomorrow.

Finished the swimming/diving test with 7 mil wetsuit. Went about 1/4 kilometer and only 3 times to 4 meters deep. (took a bit of effort to get down without weights) Stamina was good and absolutely no hint of any liquid in the lungs or raspyness. One hour post and a general feeling of well being/runners high.

So from a layman's perspective I'll be continuing with both apnea and scuba as before. However with a new respect for what cold water could do to adversely effect health. So making this plain to anyone reading this. If you swim in cold water(59 F) and dive to at least 4 meters repetitively in extreme circumstances your lungs will leak liquid from the alveoli and fill the lungs. And if you continue long enough you will drown in your own fluids.

A better title for this thread might be "SIPE induced by Repetitive Shallow Cold Water Freediving". Surface interval is probably not a factor. Blood volume in the core is most likely what triggered IPE in my case. However I will let the professionals weigh in.

For clarity, the free diving may not have contributed to your event if it was indeed IPE/SIPE. The immersion alone is enough, though there have been reports of unilateral IPE in someone doing the side stroke so it's not altogether impossible. When the body is immersed, the effect of gravity on body fluid is negated and a significant fluid shift happens - there's an auto-transfusion of somewhere around half a liter of blood into the vessels in the torso, including the pulmonary arteries. In some individuals, for reasons that are still under investigation, the pulmonary arteries do not dilate to compensate for the increased amount of fluid in them. This results in pulmonary artery hypertension (PAH) and can subsequently lead to pulmonary edema. Cold water exacerbates this process because there's additional shunting from the extremities to the core. Exercise also exacerbates it by increasing cardiac output and blood flow through the pulmonary arteries.

The left side of the heart receives blood from the lungs via the pulmonary veins and pumps it to the body. If the left heart's pumping ability is decreased, blood can back up in the lungs and lead to pulmonary edema. An individual who is already susceptible to IPE/SIPE and also has decreased pumping ability in the left heart is especially vulnerable.

The genesis of IPE/SIPE differs depending on the individual. In triathletes and combat swimmers (e.g. SEALs), their enormous cardiac output during exercise is more contributory. One thing that's really interesting is that IPE/SIPE has not been reported in athletes who only do competitive swimming, only in those who engage in a variety of vigorous exercise. This is thought to be related to cardiac remodeling. In others who suffer IPE/SIPE, there may be more of a cardiac origin. In either case, if the individual exits the water, the symptoms tend to resolve fairly quickly. However, if the individual ignores them, the condition can be fatal.

Best regards,
DDM

 

[Blueringocto_73]

Yes very interesting what has taken place. It's the sum of all the negative factors that create the anomaly. Good to know that other than the cardiac issues IPE/SIPE resolves itself. There's no "bursting" of the alveoli, just a leakage. Allowing for the condition to correct itself.

On a side note, I was an engineer for Intel corp. and had extensive troubleshooting experience. The human body can be analyzed like semiconductor equipment. Just that it's the most complex machine there is to analyze. I won't say that I have successfully analyzed my injury. However based on what you have provided I have some idea of what's going on.

Thank You once again

For clarity, the free diving may not have contributed to your event if it was indeed IPE/SIPE. The immersion alone is enough, though there have been reports of unilateral IPE in someone doing the side stroke so it's not altogether impossible. When the body is immersed, the effect of gravity on body fluid is negated and a significant fluid shift happens - there's an auto-transfusion of somewhere around half a liter of blood into the vessels in the torso, including the pulmonary arteries. In some individuals, for reasons that are still under investigation, the pulmonary arteries do not dilate to compensate for the increased amount of fluid in them. This results in pulmonary artery hypertension (PAH) and can subsequently lead to pulmonary edema. Cold water exacerbates this process because there's additional shunting from the extremities to the core. Exercise also exacerbates it by increasing cardiac output and blood flow through the pulmonary arteries.

The left side of the heart receives blood from the lungs via the pulmonary veins and pumps it to the body. If the left heart's pumping ability is decreased, blood can back up in the lungs and lead to pulmonary edema. An individual who is already susceptible to IPE/SIPE and also has decreased pumping ability in the left heart is especially vulnerable.

The genesis of IPE/SIPE differs depending on the individual. In triathletes and combat swimmers (e.g. SEALs), their enormous cardiac output during exercise is more contributory. One thing that's really interesting is that IPE/SIPE has not been reported in athletes who only do competitive swimming, only in those who engage in a variety of vigorous exercise. This is thought to be related to cardiac remodeling. In others who suffer IPE/SIPE, there may be more of a cardiac origin. In either case, if the individual exits the water, the symptoms tend to resolve fairly quickly. However, if the individual ignores them, the condition can be fatal.

Best regards,
DDM