Returning to diving after a hiatus and cardiac procedure.

[MudBug]

I’ve posted about this topic in the introduction section but will now post my situation in more detail in the diving medicine section for better exposure.

Background: I am a retired 60 year old male that was an active diver in my late ‘20s-mid’30s. I am 6’1”. In October 2019 I weighed 228. As of January 19th I now weigh 207 with a goal of 195.

I nearly stopped diving entirely while I raised a family, going diving once every five years or so as the opportunity presented itself. Did not have any issues with gearing up and diving at these times and performed as well as others with a better focus on safety then most. I want to resume diving again and my son is now considering becoming certified himself. I am certified basic and the SLAM (Scuba Life saving and Accident Managment).

The meds I take daily are:
1) 20 mg Atorvastatin. My HDL/LDL levels are fine
2) 500 mg Metformin. Taken prophylactic as when tested I was on the low caution level A1C.
3) Lisinopril 10 mg and Amlodipine 10mg for BP control. Typical for me is 136/74 on meds.
4) Levothyroxine 0.100mg. Had half my thyroid removed.
5) 81 mg Aspirin

I use a CPAP machine when I sleep.
Reading this sounds terrible to me but in all honesty I feel fine.

My doctor asked that I have a cardiac CT done to establish a base line. The score came back pretty bad at 1534. At 300 they recommend you see a cardiologist.

I have never had a heart attack and when I swim laps I feel fine. I recently spent two days doing a controlled burn at a ranch is some pretty hilly country. Despite having to bust through brush and set undergrowth on fire all day (and eating my share of smoke) I never felt any real fatigue or tightness in my chest.

This week I go in for an echo-cardiogram, heart cath and likely a balloon or stent procedure.

I intend to take a refresher course or may do the beginners course with my son just for the shared time together.

My root question is as follows:

What are the goalposts that I can share with my cardiologist to determine if it is relatively safe for me to resume diving activities?

 

[Duke Dive Medicine]

I’ve posted about this topic in the introduction section but will now post my situation in more detail in the diving medicine section for better exposure.

Background: I am a retired 60 year old male that was an active diver in my late ‘20s-mid’30s. I am 6’1”. In October 2019 I weighed 228. As of January 19th I now weigh 207 with a goal of 195.

I nearly stopped diving entirely while I raised a family, going diving once every five years or so as the opportunity presented itself. Did not have any issues with gearing up and diving at these times and performed as well as others with a better focus on safety then most. I want to resume diving again and my son is now considering becoming certified himself. I am certified basic and the SLAM (Scuba Life saving and Accident Managment).

The meds I take daily are:
1) 20 mg Atorvastatin. My HDL/LDL levels are fine
2) 500 mg Metformin. Taken prophylactic as when tested I was on the low caution level A1C.
3) Lisinopril 10 mg and Amlodipine 10mg for BP control. Typical for me is 136/74 on meds.
4) Levothyroxine 0.100mg. Had half my thyroid removed.
5) 81 mg Aspirin

I use a CPAP machine when I sleep.
Reading this sounds terrible to me but in all honesty I feel fine.

My doctor asked that I have a cardiac CT done to establish a base line. The score came back pretty bad at 1534. At 300 they recommend you see a cardiologist.

I have never had a heart attack and when I swim laps I feel fine. I recently spent two days doing a controlled burn at a ranch is some pretty hilly country. Despite having to bust through brush and set undergrowth on fire all day (and eating my share of smoke) I never felt any real fatigue or tightness in my chest.

This week I go in for an echo-cardiogram, heart cath and likely a balloon or stent procedure.

I intend to take a refresher course or may do the beginners course with my son just for the shared time together.

My root question is as follows:

What are the goalposts that I can share with my cardiologist to determine if it is relatively safe for me to resume diving activities?

Hi @MudBug ,

The below linked paper by the late Dr. Fred Bove and @Dr Simon Mitchell provides some guidance on assessment of your cardiovascular fitness to dive. The good news is that you're asymptomatic of cardiovascular disease.

Medical Screening of Recreational Divers for Cardiovascular Disease: Consensus Discussion at the Divers Alert Network Recreational Diving Fatalities Workshop.

Best regards,
DDM

 

[markmud]

Hi Mudbug,

Disclaimer: I am not a doctor or other medical professional.

My wife and I have some of your issues, and we also have other medical issues that we don't share with you. I am 60 and she is 67. She takes some of the meds that you take.

We dive just fine. We focus on taking care of ourselves u/w and don't ever think that we are going to save the world or others underwater. Younger divers and divers with more training can do that. The best thing we can do for the diving community at large is dive well, be physically fit, and enjoy the u/w world. We thumb dives that are outside the envelope for our age group, physical condition, and experience level. We don't plan on being the "rescued".

Duke Dive Medicine has answered questions that we have asked--they are an excellent resource. Other MDs and medical professionals on Scubaboard are very helpful as they have a doctor's perspective on DCI/DCS issues. You have come to the right place (Scubaboard).

To answer your specific question, I will say get a doctor that understands that good recreational diving does not have to be stressful or a workout. Our goal is to be comfortable u/w and use as little energy as possible to allow us to enjoy the dive for a longer duration. If you are relaxed and breathing normally, you use less gas and can dive longer. Some of my wife's doctors consider diving to be strenuous exercise, which it should not be. Choose your doctors wisely.

We hope to meet you on a reef someday!

Also, check-out the Scubaboard Surge and Invasion trips. They are excellent. Plenty of old folks just like us diving on those trips (young people also dive Surges and Invasions). Fun and happy people.

Good luck reengaging in our wonderful avocation!

cheers,
m

 

[MudBug]

My thanks to Duke Diving Medicine and MarkMud for their replies. Nice to get feed back from the professionals and the layman as well.

 

[MudBug]

Reading through the PDF linked by DDM it mentions a questionnaire that was being developed and questions that were added or deleted.
Was a consensus reached on the questionnaire and if so is a PDF of this document available?
From what I have read in the provided PDF it seems likely I can resume diving after I recuperate from the procedures.

 

[Dr Simon Mitchell]

From what I have read in the provided PDF it seems likely I can resume diving after I recuperate from the procedures.

Hello Mud Bug,

Yes, that is a succinct summary of what you read, with the extra caveat that the procedures are successful in fixing any significant problems. You need to be able to achieve the functional capacity required of diving (discussed in that paper I wrote with Fred) without inducing myocardial ischemia. A coronary angiogram with stenting of significant lesions should achieve that, but you will need to have a discussion with your interventional cardiologist afterwards to get a sense of how significant your coronary disease is, and how successful the intervention was in ameliorating it. If they put stents in you will probably be put on a potent antiplatelet agent for a period. There is controversy about diving whilst taking these drugs, but I am ambivalent about it - especially for shallow conservative diving. It will be critically important to continue to manage your risk factors going forward (basically good compliance with your hypoglycaemic and hypotensive drugs, and your cholesterol-lowering statin. You should also comply with any recommended regular follow up.

Finally, no matter what you have done or how successful it is, nobody can ever give you a guarantee that you won't suffer some sort of cardiac event whilst diving. It follows that you must assume responsibility for any decision to dive as an informed risk acceptor (just like all of us really).

Good luck!!

Simon M

PS The medical screening questionnaire for recreational diving has just been revised by a committee convened by PADI and will be released soon. It would be of little value to you though, in the sense that it is a screening questionnaire and you are already effectively screened with appropriate investigations / interventions underway.

 

[MudBug]

Hello Dr. Simon Mitchell,

I sincerely thank you and am very grateful for your time and effort. I will share all of this with my cardiologist. I will tailor my dive profiles to factor in all you have been so kind to share with me and the input of my doctor. The last thing I want is to be diving with my son and have him witness his me having a diving emergency.

With respect,

Mudbug..

 

[MudBug]

UPDATE:
On January 21, 2020, I went in for an angiogram procedure. A 3 X 20 stent was placed in my LAD due to 90% blockage. There is some amount of blockage on the other two but not enough to warrant stents. If they had been it would have become a triple by-pass.
Recovery was uneventful.

I gave my cardiologist print outs from the sources provided by Dr. Mitchell for him to review. He told me the former president of the local cardiologist's association had been a diver and had given many lectures he had attended on the subject.

I have lost a total of 25 lbs and have adopted a fish and chicken Mediterranean diet on my doctor's advice. No sacrifice there but my wife is not terrible fond of fish.

I had my post op follow up with my doctor yesterday and flooded him with questions. He said there was no damage to my heart muscle. My statin meds have been increased as it may help the reduce some of the blockage over time. He said my heart pumping function was fine, it was moving blood very well. My aortaic blood pressure checked out ok as well.

I asked him about returning to diving and he said he saw no reason I should not do so.

I have 36 sessions of cardiac rehab to go through. Two of the therapists are divers as well. I have shared the information from Dr. Mitchell with them as well and they are incorporating it into my profile.

My son is planning on taking a novice class and I may retake it as well to take the class with him. Or may not, he may not want to hang with Dad...it will be his call. If I don't do the class with him I will take a refresher class.

Again, I thank all you have posted for their input.

Bubbles up!!

 

[Dr Simon Mitchell]

I gave my cardiologist print outs from the sources provided by Dr. Mitchell for him to review. He told me the former president of the local cardiologist's association had been a diver and had given many lectures he had attended on the subject.

Yes, Fred Bove was the President of the American College of Cardiology. Sadly he died recently. I felt very privileged to collaborate with him on that paper.

On your other points, it sounds as though everything is trending in the right direction. It just remains to ensure that your functional capacity is adequate for diving, and your cardiac rehab team will help with that.

Simon M

 

[MudBug]

I shared with the RN's at the cardio rehab center the documents provided by Dr. Mitchell. They told me what my goalposts were, namely 6METs for 30 minuets. During the three sessions I had worked out at 4.3METs with no indication of any issues. On my fourth session I asked that I be permitted to bump up to 6MET's. They conferred and agreed to allow it but only if I were to back off at any sign of stress. I agreed to this reasonable request. They set the treadmill up for the goal and off I went. The RN came over and told me the calculations were based on me not holding on to the handrails of the tread mill so I let loose. I felt fine through out the session but I really need to get a better music library for working out...what I had was too sedate.

At the end of the session I had maintained a 6.3METS for right at 30 minutes with no stress perceived on my part and the EKG showing no issues.

I am now down to 200 pounds. I have been watching calories and fat intake, the diet coaches have informed me I need to increase my protein intake even if it means taking in more calories.

I have now enrolled in a refresher class at the same dive shop I begin at 34 years ago. The owner/DM was the nephew of the original owner and was one of the instructors in my beginners class. I have completed the online part of the class and will do my pool dive in early March, no open water dive required.

I want to thank all of you for your input, direction and words of encouragement.