Question about dive fitness...

[Easdem]

A bit of background story. I started to get more serious about my diving, signed up for some advanced certifications, hope to make it to DM by the end of the season. My gear is getting serviced as we speak, I am so ready to jump in the water...

I quit smoking, been running 2 miles four or five times a week for about 4 weeks now. About that same time I started having some chest pain… Got a little concerned and went to my GP… He prescribed some Zantac twice a day (possible GERD, also could be the culprit in some post nasal drip I have had lately)...The discomfort never really went away, so as any internet savvy dude, I started checking my symptoms on Google… Lots of bad stuff came up, got nervous and went to an Urgent Care center near my work where they did a full work-up (PFT's, Chest X Ray, EKG, Blood work).

Everything except the X Ray came back clean. I called my father, a Radiologist, and he said he would call the Radiologist who was going to read my film.

After speaking with my dad, he told me they consulted on the phone as the film was read. The infiltrate was only visible in one of the views and he was not 100% certain it was there but to make sure to follow up with another set of x-rays in a few weeks. Pops thinks that the rad read it "hard" because the patient is the son of a Radiologist.

I plan on seeing a pulmonologist next week, just to be sure, but I do have a class that starts Saturday, missing it would throw all sorts of things off as far a time frames are concerned.

with this scenario is the risk of Pulmonary Barotraumas (I assume that would be worst case) low enough to do the class this weekend?

 

[TSandM]

Can you get a hard copy and run it by your father?

Nobody can advise you on the internet, but I can tell you we used to have a radiologist at my hospital who routinely overread infiltrates -- we called them by the radiologist's name because it was so predictable. "Was the x-ray normal?" "No, it had a xxxxx infiltrate on it . . . "

 

[Easdem]

I guess I can send him the films... I cant get an appt with the Pulm Doc until next week anyway...

 

[DocVikingo]

Hi Easdem,

There are many causes of pulmonary infiltrates, both infectious and noninfectious. Some of them are of great concern, while others are much more minor. BTW, such findings can be seen in individuals with GERD.

Based on the descriptions thus far, it is possible that unusual conservatism was taken in reading the chest x-ray and having your dad offer an opinion seems appropriate.

I would point out that the matter of the "chest tightness/pain" is not further specified nor has any comment been made on whether it has resolved or not. A normal EKG is good, but depending upon your age (also not specified) an exercise stress test might be wise.

Normal PFTs also are good. The risk of pulmonary barotrauma likely won't be increased by the presence of very slight, uncomplicated pulmonary infiltrates as these will not restrict the flow of air into and out of the lungs and are fluid rather than gaseous in nature and therefore not subject to Boyle's law. However, it is theoretically possible that the risk of immersion pulmonary edema (IPE) (http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=82) could be elevated.

The prudent diver may want to wait until this situation gets fully sorted out before resuming SCUBA.

Please let us know how everything turns out.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[cutlass]

I also think there's not enough info to help you understand what might be going on. Certainly, the questions about the film should be resolved. But just some general thoughts:

The complaint is chest pain (without mention of breathlessness). Presumably, a cardiac cause has not been identified. IMO, "infiltrates" alone don't account for the complaint because there's no innervation in the lungs below the main bronchi. OTOH, irritation/inflammation of the trachea/bronchi can give chest pain, usually at the same level as the irritation. The lungs' outer covering (parietal pleura) is pain-sensitive and connects to the nerve bundles beneath the ribs (intercostal nerves) and the phrenic nerve (primarily diaphragm movement, also branching to the heart, with terminals in the upper cervical vertebrae C3,4,5). You mentioned a new regime of running which may be assumed to be pushing your rate and depth of breathing efforts. Pain which varies with chest wall movement suggests looking at the ribcage. Pleural pain often finds some relief by "splinting"; i.e. holding the painful side as still as possible. Then changes in diaphragm tone may affect the lower esophaegeal sphincter, resulting in some reflux. Pain to the shoulders or upper back could be referred pain from organs lying near the diaphragm.

 

[Easdem]

Thanks for your responses...


To add a little more info. I am 30 years old, 5"11 200lbs. The chest pain, which I could pinpoint, was directly behind the sternum. At first I felt it on the left side, then it moved right. It was a dull,constant, burny sensation along with some tightness, even when it was at the highest levels, it would go away during my workouts, and come back a few minutes after I was done. That fact, coupled with my age, no family history of heart disease (on either side) and a clean EKG, the doc ruled cardio problems out. The chest pain has subsided to almost nill at this point, all that remains is at scratchy throat irritation and tightness, like usually comes along with post nasal drip.

I do have some upper back soreness, I attribute that to the increased workout routines though…..

 

[Easdem]

So I got the films to my father....

He says that the are negative for any infiltrates, all clear in that front... All he saw was evidence of smoking in the bronchi...

good to go now??

 

[cutlass]

Of course, nobody on this side of the screen can advise go/no-go. We can only comment on what what's been reported here. The two main issues -- chest pain and equivocal film readings -- seem to have been addressed. The chest pain seems less likely to be a result of cardiac issues; reflux being the other possibility for which treatment was prescribed. Questions about the infiltrates seem to have been settled. But now you mention

...All he saw was evidence of smoking in the bronchi...

Was this only some thickening of the bronchial walls? In terms of diving, flags would be raised for patterns of darkness in the lung fields as these may indicate air-trapping and alveolar problems; e.g. emphysema.

 

[Jim Lapenta]

Not a doc but as someone who quit smoking 10 years ago after over 20 years of doing it I recall I still seemed to be hacking up crap and have some discomfort for a couple months. Again not a doc but I have heard the same complaint from other former smokers when they started exercising and maybe using parts of their lungs that had not been working for a long time.

 

[Easdem]

Actually he only mentioned the thickening of the bronchial wall.... No blebs, plugs or anything else, and I asked...