Pulmonary Oedema incident

[WSOPFAN]

good reading thx......

 

[Tricia]

But no matter what, you've got to get that high blood pressure under control. It may have contributed to this, but even if it didn't, that's not something you can leave unattended. And I'm sure your cardiologist is watching it.

I know it's a hard call on medications and buddies. I myself have an SVT that I take meds for all the time (not just when diving) and I'm cleared by a cardiologist and a specialist dive doctor to dive. On the few occasions when I've mentioned it to an insta-buddy, they get freaked out, so I don't mention it any more. The only exception is when I get buddied up with a doctor and they're fine with it.

Pls update us on the next round of tests. We've all got our fingers and toes crossed for you to get back in the water!

Cheers,
Trish

 

[InTheDrink]

Hey Trish,

Thanks for your post and well wishes. Yeah, I'll be working on the blood pressure and just getting fitter generally. Am finding myself a little at a loss without diving or the prospect of it in the near future so will get myself to the gym more and out on the bike more. So when the time comes I'll be in good shape. If I need to take some meds for the blood pressure so be it, but hoping I can sort it without the need for meds. Feel like I've had enough meds for a lifetime.

Again, thanks for the well wishes. I'll definitely let you know when I plan to get wet again

John

 

[InTheDrink]

InThe Drink

I suffered a case of IPE which I would consider "moderate" in my twenties (now in late 40's). I have never had a relapse. Still to this day I wonder what the cause. I can say that I was deep, suffered from sinus/allergies, and was a cold dive. Luckily noticed problem with breathing and got to surface ok. Felt like I had a chest cold for a few days. At the time I had never heard of IPE and always attributed to my sinus/allergies and possible cold.

Only a few years later I had a 'severe" case of PE at my home, later attributed to exposure to an epoxy that I was working with in my basement shop. My lungs filled up unbelievably fast and very soon I was gasping for air. could barely speak when I called 911. Scary.. Told physcian of my earlier dive experience and that was then I was told about IPE.

Never had problems since but I did have a very successful sinus surgery and treatment for my seasonal allergies.

No cardiac abnormalities of any kind. Was in Triathlete physical shape for both incidents.

My takeaway from my own experience is to be very conscious of my body, my breathing etc. and to abort a dive at the hint of anything wrong. It seems if I read your case right that you were having mild reactions in an earlier dive, maybe an early warning sign.

Should have cardiac checkup, also looking for a congenital abnormality called PFO.

My guess is there are alot more cases of IPE, particularly of the mild or moderate types that are not well reported.

My thought is it could share etiology with High Altitude PE (HAPE).

Hey Cruisin,

Thanks for your post - I somehow missed it. I know that feeling of barely being able to tell the person what's wrong. I made sure when I hit the surface I told Simon ASAP so they'd know at least what my problem was before I went unconscious/couldn't speak. I remember also on the boat, it must have been shortly after being brought on, trying to say 'need ventillator' although not sure anyone knew what I meant. It's not a brilliant experience not being able to breathe. I'm sure I've heard that drowning is quite a pleasant way to die once you let go - I'd beg to differ on this pretty substantially.

Anyhow glad you got through both episodes. And that your surgery was so successful. I agree, I suspect there are a lot more cases of PE than people are aware of. Hopefully people will get more aware of it and we'll learn more about it - and how to prevent it.

Cheers,
John

 

[InTheDrink]

Provisional update


So after a battery of tests over the last few months, including:
Ad-hoc blood pressure tests
24 hour blood pressure test
ECG (funny graph thingy - technical term)
ECG (ultrasound flavour - could see heart, valves flapping open close, hear blood flow)
Stress ECG


My cardiologist has said my heart is fine. Nothing wrong at all as far as he can see. My blood pressure isn't as high as we thought (135/80 IIRC - will need to confirm this). No signs of long term high blood pressure such as enlargement or thickening of the heart.


So he has no good explanation why I had my pulmonary oedema event. I asked whether the beta blocker could have caused or contributed to it but he seemed doubtful in a healthy heart. Of course I can't say whether this is correct or not but this is his opinion.


He's going to confer with some colleagues to work out where we go next. And he's going to send me the test results.


So that's the update for now. It's good news in that I'm in good hale and no heart problems. Of course it does pose the question on what caused my lungs to fill up with fluid.


Provisionally however I am hoping to go back diving soon and am starting to plan a trip, probably for March or April and somewhere warm with good med facilities.


Cheers,
John

 

[TSandM]

In the material I've been reading on this topic, it does not appear that many (if any) of the documented cases of IPE have had any major cardiac dysfunction. There does seem to be some association with hypertension, but the dynamic may be more one of increased resistance to forward flow than inability of the cardiac muscle to maintain normal output in the face of normal vascular tone.

The determinants of flow across blood vessel walls (and it's excessive outflow into the alveoli that causes pulmonary edema) are hydrostatic (pressure inside and pressure outside) and osmotic (concentration of solutes inside versus outside). In addition, intact structures (endothelium) are required. If immersion causes centralization of blood volume (which it does) and that increased volume can't flow forward at a rate sufficient to keep the pulmonary capillary pressure from rising, that could lead to hydrostatic transudation of fluid. If breathing from a regulator requires much inhalational effort (as with a poorly adjusted reg) and causes alveolar pressures to fall below ambient, that can also encourage fluid movement into the alveoli. I can't offhand think of any effect that diving should have on the oncotic pressure, but I don't know if anyone has looked at that. And whether breathing compressed gas can or does do anything to the integrity of alveolar walls or pulmonary capillary endothelium I suspect is also not known.

Duke's studying this, but there is just a lot we don't know about this phenomenon.

 

[Ayisha]

Hey John, that's great that your ECG and Echocardiogram/Doppler and your Stress Echo went well. Even if you don't have the answers you want yet, at least you know you're in pretty good cardiac health. You also know to abort at the first sign of trouble and to avoid over-exerting yourself. Have you checked the DAN seminar on medications and their affects on diving? Some beta blockers seem to have less effect on diving than others...

Thanks for updating us. This continues to be an interesting phenomenon that is unfolding ever so slowly...

 

[Hatul]

In the material I've been reading on this topic, it does not appear that many (if any) of the documented cases of IPE have had any major cardiac dysfunction. There does seem to be some association with hypertension, but the dynamic may be more one of increased resistance to forward flow than inability of the cardiac muscle to maintain normal output in the face of normal vascular tone.

The determinants of flow across blood vessel walls (and it's excessive outflow into the alveoli that causes pulmonary edema) are hydrostatic (pressure inside and pressure outside) and osmotic (concentration of solutes inside versus outside). In addition, intact structures (endothelium) are required. If immersion causes centralization of blood volume (which it does) and that increased volume can't flow forward at a rate sufficient to keep the pulmonary capillary pressure from rising, that could lead to hydrostatic transudation of fluid. If breathing from a regulator requires much inhalational effort (as with a poorly adjusted reg) and causes alveolar pressures to fall below ambient, that can also encourage fluid movement into the alveoli. I can't offhand think of any effect that diving should have on the oncotic pressure, but I don't know if anyone has looked at that. And whether breathing compressed gas can or does do anything to the integrity of alveolar walls or pulmonary capillary endothelium I suspect is also not known.

Duke's studying this, but there is just a lot we don't know about this phenomenon.

I wonder if, aside from the factors you mention, there is an effect of the diving reflex on heart function, acting to like an effective beta blocker. We know that metabolism can slow down under water so free divers have learned to slow their breathing rate and heart rate and drowning victims can survive prolonged cardiac arrest. It's possible the diving reflex is preventing the heart from pumping the extra blood from the pulmonary circulation.

 

[InTheDrink]

In the material I've been reading on this topic, it does not appear that many (if any) of the documented cases of IPE have had any major cardiac dysfunction. There does seem to be some association with hypertension, but the dynamic may be more one of increased resistance to forward flow than inability of the cardiac muscle to maintain normal output in the face of normal vascular tone.

The determinants of flow across blood vessel walls (and it's excessive outflow into the alveoli that causes pulmonary edema) are hydrostatic (pressure inside and pressure outside) and osmotic (concentration of solutes inside versus outside). In addition, intact structures (endothelium) are required. If immersion causes centralization of blood volume (which it does) and that increased volume can't flow forward at a rate sufficient to keep the pulmonary capillary pressure from rising, that could lead to hydrostatic transudation of fluid. If breathing from a regulator requires much inhalational effort (as with a poorly adjusted reg) and causes alveolar pressures to fall below ambient, that can also encourage fluid movement into the alveoli. I can't offhand think of any effect that diving should have on the oncotic pressure, but I don't know if anyone has looked at that. And whether breathing compressed gas can or does do anything to the integrity of alveolar walls or pulmonary capillary endothelium I suspect is also not known.

Duke's studying this, but there is just a lot we don't know about this phenomenon.

First person I contacted about my test results was Eric. He's been really helpful in lots of ways.

I don't think I'll ever find out what caused this event. I'm going to stay away from CCR for the moment, get fitter (am already doing about 60/70 miles a week mountain biking, few hours swimming and 30 mins walking a day - not massive but an improvement), improve diet and reduce alcohol intake. Medications are well and truly ditched.

I don't think there's much more I can do that this (although am looking at FFMs and other equipment that might add additional safety margins). Main thing is I'm determined to get back in the water but will take it slow, very slow. I don't believe I will ever have another episode again. I'll plan for it, but I don't believe I will. I wonder was I diving beyond my capability level? And am so going to take it down lots of notches.

I'll post back in due course. Thanks everyone.

John

 

[InTheDrink]

Hey John, that's great that your ECG and Echocardiogram/Doppler and your Stress Echo went well. Even if you don't have the answers you want yet, at least you know you're in pretty good cardiac health. You also know to abort at the first sign of trouble and to avoid over-exerting yourself. Have you checked the DAN seminar on medications and their affects on diving? Some beta blockers seem to have less effect on diving than others...

Thanks for updating us. This continues to be an interesting phenomenon that is unfolding ever so slowly...

Thanks for your post. I believe that ACE inhibitors are more appropriate for diving but TBH I shouldn't have been taking anything. I regret this.

I didn't catch the DAN seminar - any links handy?

And yes, one of the key things for me now will be being body aware. On both dives I had rattling in chest and unusual coldness. I'll be watching out for anything like these. Plus I'm recalibrating my ambitions. My buddies recently went 100m+ (330ft+). That kind of diving is out for me now. And I'm happy about it. I'll happily hang in the shallows with great light and lovely rays, sharks, coral, fish, macro, muck, pretty much everything I love about diving.

Best,
J