Pulmonary Oedema incident

[wtcreaux]

Also realize that several Over-The-Counter (OTC) medications can increase your blood pressure. The more common ones are decongestants (Pseudoephedrine, Phenylephrine) and some nose sprays (Afrin). This would include any medication with a "D" attached, such as: Claritin-D, Zyrtec-D, Mucinex-D. Also includes the multitude of "Cold & Sinus" preparations, i.e., Tylenol Cold & Sinus, Advil Cold & Sinus, Dayquil, Nyquil, etc. Check the ingredients on the back of the OTC box. It will list the chemicals on the left and the purpose on the right. If the right says "decongestant", caution is in order. I always encourage my patients (history of high blood pressure or not) to monitor their blood pressure daily while taking ANY medication with decongestant.

I am utterly amazed at the number of folks who believe "if a little's good, a LOTS better." There are REASONS why the directions state 1 a day, or twice daily, or use no more than X days. (Multiple patients who take Afrin daily for the past several MONTHS).

 

[InTheDrink]

My goal is indeed to get my BP out of the pre-hypertensive park. I believe I can achieve this with lifestyle changes and quickly. I'm pretty fit but drink too much and smoke. Both are going out the window.

However..................

Let's not get too distracted from the Pulmonary Oedema issue. The doctors have now said that my heart is fine and no sign of any long term high BP. So Cardio is somewhat ruled out at this point (according to docs at least).

What is interesting/concerning is that it appears that the guidance - which used to be if the PE was non cardiogenic then with caveats ok to dive again - is now that recurrence and fatalities are being seen in divers with no cardiac issues. They know this because the people that have died already had been tested for cardiac abnormalities, hypertension, etc. and didn't have them. And then they had a recurrence and in some cases died.

Not sure where this leaves me TBH. I'm still determined to get back to it. But there's still a road to travel including working out the best ways to mitigate against the risk.

I'll post back in a few days when I've had a chance to chew over some of the emails I've received in the last few days.

Cheers,
John

 

[fjpatrum]

Hope you get back to it safely. Thanks for the info RE: cardiac issues.

 

[Jax]

Thanks for sharing so much with us, and for pushing IPE to the fore.

 

[InTheDrink]

Cheers Jax.

It's hard to get the balance. This issue shouldn't be overblown. But for those where it does occur it's a big deal and it's not hard to see how people die and also how people might die and the causes be wrongly diagnosed. Funny, cos that's a big issue for me. Probably male ego. But I'm pretty sure if I had died the reasons would be 'panic then drowning'. Which would have been wrong and a disservice to my memory. How many other memories have be so diserviced? Might sound like a detail but probably not to a grieving wife.

John

 

[Jax]

I agree, John, and as TSandM says, there are a lot of unexplained deaths . . . and how much drowning and IPE look alike.

One person I know who acts as a Rescue Diver for Triathlons says that every event, there are 3 to 6 swimmers that just quit and go to shore. Maybe we ought to have some medical personnel there to see if the swimmers are actually IPE victims?

This has troubled me with respect to the "unexplained" deaths, from the time I first read about the condition. It is my very great fear that drowning and IPE look enough alike on post-mortem for one to be mistaken for the other.

I wonder about WOB on rebreathers -- I know it's higher than on OC, but by how much? You can induce pulmonary edema in normal people, if you make them pull hard enough to breathe for a long enough period of time. I wonder if this is a factor in CCR IPE cases?

 

[Bubbletrubble]

One person I know who acts as a Rescue Diver for Triathlons says that every event, there are 3 to 6 swimmers that just quit and go to shore. Maybe we ought to have some medical personnel there to see if the swimmers are actually IPE victims?

It's far, far, far more likely that those "3 to 6 swimmers that just quit and go to shore" are doing so for reasons other than IPE.

I think a stronger argument can be made in advocating for aerobic fitness, regular medical checkups, CPR training, and rescue training for the general scuba audience.

 

[Jax]

One of the points I find again and again is that these folk are incredibly fit individuals, and so far those that recognize and thumb appropriately are the survivors.

I agree completely on a good 1st Aid / CPR / Ox / rescue training.

 

[Bubbletrubble]

One of the points I find again and again is that these folk are incredibly fit individuals, and so far those that recognize and thumb appropriately are the survivors.

For IPE cases observed in surface swimmers, there may be an element of exercise physiology/adaptation in fit individuals that increases IPE susceptibility.
(Something to keep in mind is that scuba divers are subjected to increased ambient pressure [compared to surface swimmers], so it's possible that development of IPE occurs in a slightly different way.)

On the other hand, the people logging the most time in the water while exercising at the surface are probably folks who are in fairly good shape.
The point I'm trying to make here is that even if there is a correlation between IPE susceptibility and fit individuals, it could just be a coincidence.
FWIW, I don't think our tracking of IPE cases has been very good thus far. We can all probably agree that more data needs to be collected about scuba divers, swimmers, and triathletes in which this condition is occurring.

Pulmonary edema, in general, can have many different causes. Heart and respiratory physiology is involved, but other factors can give rise to fluid accumulation in the lungs. For example, there are certain prescription medications which can induce the condition. It would be important to identify such "explainable" causes in the population of scuba divers with a history of IPE.

If you remove water from the equation, you can find case reports of athletes suffering from pulmonary edema during strenuous exertion (ultramarathoners [McKechnie et al., 1979], ultracyclists [Luks et al., 2007). There have even been reports of people suffering from pulmonary edema due to emotional stress, sexual intercourse, and exertion in a cold environment (Wilmshurst, 2004). Interestingly, there are physiologists on either side of the fence, saying that pulmonary edema can/cannot occur in human athletes performing strenuous exercise at sea-level (Hopkins, 2009; Sheel and McKenzie, 2009).

Here at UCSD (where we have a pretty strong respiratory physiology research effort), Sue Hopkins has done some interesting work on exercise physiology that may be relevant to IPE. You might want to do a Pubmed search for her work. A few years ago, I know that her lab was investigating the mechanism of high altitude pulmonary edema (HAPE), which has been hypothesized to have a similar pathophysiology to IPE. One of my friends did her Ph.D. in that lab, and she was always bugging me to be a subject for one of her studies on altitude sickness. I was never sold on being a guinea pig for a few weeks in the summer at the White Mountain Research Station. Sounded a little isolated to me.

 

[Jax]

One of the points I find again and again is that these folk are incredibly fit individuals, and so far those that recognize and thumb appropriately are the survivors.

I agree completely on a good 1st Aid / CPR / Ox / rescue training.

Sigh. I apologize, as I did not put context with this.

When I first started reading about IPE, there was a lot of cuss and discuss about the age, meds, weight, etc. However, since IPE also happens in very fit people, it means there is a lot more to this affliction.