RETURN TO DIVING AFTER PNEUMOTHORAX (lung overexpansion)

[scubaholt]

Gave Myself A Pneumothorax On Aug2007 Just Shy Of My 4000th Logged Dive.
It Happened On The 1st Of 2 Dives. Both Were 90 Ft And Extremely Strenuous, Grabbing Lobsters. Didnt Notice Any Symptoms Until After Working Out(weight Lifting) The Following Day. Started Feeling Unusally Low On Energy And Slightly "heavy Chested" About 24 Hrs After My Last Dive. Spoke To A Dan Medic, Went Over Both Dive Profiles, And Correctly Diagnosed The Pneumothorax. Ended Up In Icu For 3 Days-chest Tube And Air Around Heart And Neck. Rh Lung Was Approxamently 70% Collapsed. Luckily It Wasnt A Tension Pneumo!
Both X-rays And A Spiral Ct Scan Were Done In The Hospital Which Showed A 4mm Tear In The Upper Rh Lung. The Scans Showed No Other Lung Abnormalities-weak Spots-disease Ect.
I Was Cleared To Dive After 3 Months By The Pulmonary Surgeon Who Treated Me, At My Own Risk Of Course!
So Here Comes The Question/dilemma!
I've Done Tons Of Research On The Subject, Went To A Second Md W/navy Dive Medical Experience And Got The Same ''at Your Own Risk Response''.
Its Been 8 Months Since The Injury Occured, I've Been Cleared To Dive Again However...i'd Have A Better Piece Of Mind If I Could Get A Second Spiral Ct Scan And Have Both Docs Review It Before Getting Wet To Rule Out Any Potential Air Trapping Etc. Problem Is Neither Doc Thinks Its Worth It! Think Im Being To Careful?
Im 42 Years Old Very Fit With No History Of Any Lung Problems/disease, Non Smoker Etc. I'd Appreciate Any Info/thoughts/experience On The Subject. Thanks

 

[jcscuba]

Gave Myself A Pneumothorax On Aug2007 Just Shy Of My 4000th Logged Dive.
It Happened On The 1st Of 2 Dives. Both Were 90 Ft And Extremely Strenuous, Grabbing Lobsters. Didnt Notice Any Symptoms Until After Working Out(weight Lifting) The Following Day. Started Feeling Unusally Low On Energy And Slightly "heavy Chested" About 24 Hrs After My Last Dive. Spoke To A Dan Medic, Went Over Both Dive Profiles, And Correctly Diagnosed The Pneumothorax. Ended Up In Icu For 3 Days-chest Tube And Air Around Heart And Neck. Rh Lung Was Approxamently 70% Collapsed. Luckily It Wasnt A Tension Pneumo!
Both X-rays And A Spiral Ct Scan Were Done In The Hospital Which Showed A 4mm Tear In The Upper Rh Lung. The Scans Showed No Other Lung Abnormalities-weak Spots-disease Ect.
I Was Cleared To Dive After 3 Months By The Pulmonary Surgeon Who Treated Me, At My Own Risk Of Course!
So Here Comes The Question/dilemma!
I've Done Tons Of Research On The Subject, Went To A Second Md W/navy Dive Medical Experience And Got The Same ''at Your Own Risk Response''.
Its Been 8 Months Since The Injury Occured, I've Been Cleared To Dive Again However...i'd Have A Better Piece Of Mind If I Could Get A Second Spiral Ct Scan And Have Both Docs Review It Before Getting Wet To Rule Out Any Potential Air Trapping Etc. Problem Is Neither Doc Thinks Its Worth It! Think Im Being To Careful?
Im 42 Years Old Very Fit With No History Of Any Lung Problems/disease, Non Smoker Etc. I'd Appreciate Any Info/thoughts/experience On The Subject. Thanks

It sounds like you have done your homework well. You don't mention the incidence of potential recurrence, I'm guessing from the above description that you has a spontaneous pneumothorax. Here is the incidence from WebMD of reoccurrence.

What are the chances that a pneumothorax will return?
If you have had one pneumothorax, you have an increased risk for another. Nearly all recurrences happen within 2 years of the first pneumothorax. If you smoke, quitting smoking can reduce your risk of another pneumothorax.

Spontaneous pneumothorax returns in about 20% to 30% of people who don't have lung disease. People with lung disease have a 40% to 50% chance of having another pneumothorax.1
Go on WebMD use the topic spontaneous pneumothorax, at the bottom of the article (the overview) the last paragraph will take you to the article from which this information comes.
I guess this is all about personal choice, if you have been bent more than once would you keep diving? If you had seizure disorder would you keep diving. Hope this helps and whatever you decide that you are safe and enjoy a very long life, J.C.

 

[ClayJar]

You don't mention the incidence of potential recurrence, I'm guessing from the above description that you has a spontaneous pneumothorax.

If it was pneumothorax due to lung overexpansion, it was by definition *not* spontaneous. From what I've read, only *spontaneous* pneumothorax is an absolute contraindication to diving (as it could recur, well, spontaneously).

 

[TSandM]

That really is the big question. In general, traumatic pneumothorax, once healed, is not considered a contraindication to return to diving. Spontaneous pneumothorax is considered by many to be an absolute contraindication, and certainly the minimum I'd want for myself is a CT showing absolutely no blebs or fibrosis, and even then I'd have to accept that I was taking a small but unknown lethal risk by diving.

Your case is muddy, because the cause of the pneumo is not known. I think I would want a second scan, simply because the first one was likely done with the lung partially collapsed, and might hide some blebs due to that. If the first one was done with the chest tube in place and the lung fully inflated, that would be more convincing that the underlying lung was normal.

 

[jcscuba]

Gave Myself A Pneumothorax On Aug2007 Just Shy Of My 4000th Logged Dive.
It Happened On The 1st Of 2 Dives. Both Were 90 Ft And Extremely Strenuous, Grabbing Lobsters. Didnt Notice Any Symptoms Until After Working Out(weight Lifting) The Following Day. Started Feeling Unusally Low On Energy And Slightly "heavy Chested" About 24 Hrs After My Last Dive. Spoke To A Dan Medic, Went Over Both Dive Profiles, And Correctly Diagnosed The Pneumothorax. Ended Up In Icu For 3 Days-chest Tube And Air Around Heart And Neck. Rh Lung Was Approxamently 70% Collapsed. Luckily It Wasnt A Tension Pneumo!
Both X-rays And A Spiral Ct Scan Were Done In The Hospital Which Showed A 4mm Tear In The Upper Rh Lung. The Scans Showed No Other Lung Abnormalities-weak Spots-disease Ect.
I Was Cleared To Dive After 3 Months By The Pulmonary Surgeon Who Treated Me, At My Own Risk Of Course!
So Here Comes The Question/dilemma!
I've Done Tons Of Research On The Subject, Went To A Second Md W/navy Dive Medical Experience And Got The Same ''at Your Own Risk Response''.
Its Been 8 Months Since The Injury Occured, I've Been Cleared To Dive Again However...i'd Have A Better Piece Of Mind If I Could Get A Second Spiral Ct Scan And Have Both Docs Review It Before Getting Wet To Rule Out Any Potential Air Trapping Etc. Problem Is Neither Doc Thinks Its Worth It! Think Im Being To Careful?
Im 42 Years Old Very Fit With No History Of Any Lung Problems/disease, Non Smoker Etc. I'd Appreciate Any Info/thoughts/experience On The Subject. Thanks

If it was pneumothorax due to lung overexpansion, it was by definition *not* spontaneous. From what I've read, only *spontaneous* pneumothorax is an absolute contraindication to diving (as it could recur, well, spontaneously).

It sounds like a spontaneous pneumothorax from the way your articulately described it, What does the Dive Doc tell you? Bet he cant. As mentioned a spontaneous pneumothorax is a contraindication to taking dive lessons. Tough one with 4000 dives, it's obviously your thing. I personally know pulmonary physicians who will argue both ways as a contraindication for this as well as "asthma" 31 years in medical research. J.C.

 

[scubaholt]

The Problem Is That I Cant Put My Finger On The Exact Moment The Pneumo Occured-i Really Didnt Feel A Thing! The First Dive Was So Strenuous That My Ascent & Saftey Stop Were Made With Me Totally Out Of Breath, A Really Dumb Thing To Do. The Time Between Max Inhalation And A Couple Of Foot Ascent -then Exhallation, Could Easily Rupture A Lung Espcially The Last 15 Feet. The Second Dive Was The Same As The First- Never Dove That Hard Before. Therefore The Grey Area! The Only Symptom On The Boat Was A Little More Fatigue Than Usual, On 38% Shouldnt Have Been Tired.
As In Most Accidents There Was Multiple Factors-extremely Strenuous Dives, 70 Hr Work Week, Lack Of Sleep -it All Adds Up! I Think For My Own Piece Of Mind I'll Get A Second Ct Scan And Have As Many Doc's As Possible Check It Out.the First Scan Was Done To Affirm That The Lung Was Totally Reinflated...but Still Any Possible Air Trapping/blebs/fibrosis Etc. Not Looking For The ''golden Egg'' Just The Best Info For A Decision On My Part-lots At Stake Here! Thanks!

 

[Scubakevdm]

Isn't it more probable that you got it from weight lifting, not the diving?

 

[GrimSleeper]

Only you can 'know' how you feel, but if a pulmonary surgeon and a medic with Navy experience both think you're fit to dive and are prepared to say that they don't think that diagnosis requires a second scan, I'd reckon you've got all the medical clearance you're going to get.

It's scary going back into the water after a pneumothorax, I know. It happened to a very good friend of mine while she was instructing, and was then compounded when she refused to admit that the chest pain might be a problem... until she had to be physically helped out of the water one day a week or so later. It took a lot of nerve for her to get wet again, but - it might help to know in your case - has gone on in the four years since it happened to become a mixed gas diver and complete 350-foot-plus dives without ill effect. (Although the medical she had to take before being allowed to start a trimix course was, rightly, pretty gruelling!).

It doesn't make any rational sense, since the pressure change is proportionally greatest in the last few metres of a dive, but what worked for her initially was doing a string of really shallow dives to get back into it, the rationale being that, because it didn't feel like 'big' diving, she was more relaxed about what she was doing.

Talking of relaxing, skubakevdm might well have a point. After two strenuous dives like you describe, I'd be spending the rest of the day lazing!

Best of luck with making your decision.

 

[Al Mialkovsky]

If it was pneumothorax due to lung overexpansion, it was by definition *not* spontaneous. From what I've read, only *spontaneous* pneumothorax is an absolute contraindication to diving (as it could recur, well, spontaneously).

This is my understanding also.

 

[jcscuba]

This is my understanding also.

I note a number of answers that keep suggesting this is not a spontaneous pneumothorax. Nothing the diver describes would indicate that it was caused by diving absolutely as and over expansion injury. When one is unlucky enough to have a pneumothorax, they know it, when and where. It sounds like he may have had it happen while lifting weights. That's when he noticed the symptoms the following day. Could this be a coincidence? Agree, get all the medical opinions from dive knowledgeable pulmonary doctors.