RETURN TO DIVING AFTER PNEUMOTHORAX (lung overexpansion)

[NEDU]

Nothing like an internet forum to get people talking in absolute terms about things you can almost never know absolutely. You can have an overexpansion injury and not know it. It may or may not be associated with underlying disease. You can pop normal lung tissue while weight lifting. You can have an overexpansion that pops a pre-existing bleb, causing you to think it was "traumatic" while you still are at risk for future "spontaneous" injury. Oh and by the way, CT can miss all of these things. The point is that you can never be certain of things that occur less than 100% of the time. Diving is an inherently risky activity and medicine has no answers when it comes to how much is too much. Every person has to decide 1) whether they have accumulated enough information, 2) how much risk they can live with and 3) how much risk they should subject those around them to. Navy and commercial standards are for employers who are responsible for the health of their employees. They define how much risk the company is willing to assume, but can't tell you what level of risk you are willing to assume. Get the best medical information you can from providers who know the science, and who know you best. Then decide what you can live with.

LCDR Robert W. Perkins, MD, MPH
Head, Biomedical Research
Navy Experimental Diving Unit

 

[davesdiving]

I have got to know. Did you ever get back into diving? I just had my first SP and canÃÕ seem to find anyone who has the experience to really say anything other than dive at your own risk which something everyone does anyway

Your experience would be greatly appreciated.

-David

 

[scubaholt]

Dave, sorry to hear about your SP. To answer your question, yes i'm back in the water again. Been diving since Aug08 but only after getting cleared by a very experienced doc. The pneumo that I had was from a lung overexpansion-basically a breathhold injury.
What would I do if I was in your shoes? Join DAN. They helped me out and I wasn't a member at the time. Get a doctor from DANs list and go. Do as much research on the subject as possible. The knowledge will help you make a better decision.

I won't give ya any medical advice because i'm not qualified. I went through several doc's before I found one that agreed to do all the tests that I needed to make a decision. And no I would'nt be diving if the docs advised not to.

PM me and I'll gladly help you as much as I can. I appologise for not getting back to you sooner, I work offshore flying ROVs and sometimes dont get to the internet for long periods.

 

[Chastened]

You can have an overexpansion injury and not know it. It may or may not be associated with underlying disease. You can pop normal lung tissue while weight lifting. You can have an overexpansion that pops a pre-existing bleb, causing you to think it was "traumatic" while you still are at risk for future "spontaneous" injury. Oh and by the way, CT can miss all of these things. The point is that you can never be certain of things that occur less than 100% of the time. Diving is an inherently risky activity and medicine has no answers when it comes to how much is too much.
LCDR Robert W. Perkins, MD, MPH
Head, Biomedical Research
Navy Experimental Diving Unit

Doc is right. I had an overexpansion (due to rising with full lungs and closed throat). Stupid, but there it is. i immmediately felt chest pain, but thought i'd just overinflated momentarily, not done any permanent injury. Later. the chest tightness got worse after flying the next day with increased feeling of tightness in chest and localized feelings of pressure inside my rib cage, tiredness and shallow breathing due to pain with even a moderate depth breath. The x-ray and CT showed nothing (although they were looking for an embolism). Oddly, going under in a hyperbaric chamber somewhat relieved the symptoms somewhat permanently and the feeling of localized pain temprorarily. The localized pressure pain came back upon resurfacing in a more generic way -- larger chest area, but less acute. Am utterly convinced i had air escape into the area between the ribcage and lungs or the sac around the heart (was hooked up a lot for couple days and heart rate had dropped to low-mid 40s). Doc said she suspected same thing, but there was only my symptoms and event to point to it, since x-ray and CT did not confirm.

Actually, was put into the HBC for possible bends since was down too long and some other joint issues arose concurrently, but they were unrelated (i have arthritis). Typically, i guess you don't get the HBC for the lung overexpansion, but it seemed to have a small effect on chest symptoms, although that could be predominently the pure oxygen.

In short, i definitely had a problem, but it was unobservable to the equipment. Now am unsure how to guage when to go back diving. Since no problem showed, no test can show it corrected. Can only go with gut when i feel i'm completely healed.