scar tissue

[Kaffphine]

Just over two weeks ago I had minor surgery. Now DAN's standard recommendation is 6wks on the basis of scar tissue healing completely. At a follow-up appoiment today my surgeon told me "no restrictions, if it hurts slow down" and "you can dive, but don't be stupid" (he does not dive). The surgery was lower back, I'm not on anything right now, and the stiches are out. But with it being lower back I'm ah.... curious as to how a bouncing tank is going to feel (since that's what alerted me to the problem). The other thing is kicking for 40-50 mins, I intend to do some drysuit snorkeling this weekend, see how that goes.

So with the surgeon giving free linceces on activity, how sinigant is the risk of DCS in scar tissue not totally healed?

 

[o2 clean]

If I were you I would hold off on diving until you are completely back to normal. Diving is a fun experience, and in the back of your mind you're going to feel uncomfortable and not enjoy it so much.

Diving will always be there, so take care of yourself and enjoy them when you back to your ole self again.

 

[scubadoc]

You don't mention the type of lower back surgery that you have experienced. Superficial surgery would not be a problem - laminectomy for herniated disc might be different.

Although just about all text books and diving medicine agencies warn about the 'possible' increased incidence of bubbles in areas of deranged vascularity (read scar tissue), I have been unable to find any articles or research that shows this to be true. The most usual admonition is related to prior spinal cord injury being increased by bleeding secondary to a decompression accident.

The biggest fear that I would have would be the diminution in the neurological overlap of innervation secondary to spinal DCS in a previously scarred and rehabilitated spinal cord. This would be the main reason to limit depth, time at depth and rate of ascent in post surgical patients such as in laminectomy.

Usually there are other more valid reasons to restrict or limit diving in post surgical patients besides the fear of decompression illness in the scar/fracture site. This would include wound disruption, marine infection, inability to self rescue or buddy rescue due to the enforced weakness of convalescence and inability to carry out the multitude of functions required of a safe dive.

scubadoc

 

[John Reinertson]

After two weeks, the scar is about 50% of its ultimate strength. Don't be in a hurry to bash it or abuse it.

The risk of DCS in scar tissue is theoretical but probably real. Basically, DCS occurs in vascular spaces when supersaturation occurs and bubble nuclei form.

If you avoid supersaturation sufficient to induce bubble formation, your risks are minimal of developing DCS in the scar.

You would have to dive relatively close to the NDL's to increase your risk substantially. Since the NDL's have an inherent risk of 2 or 3 hits per 10,000 dives, follow prudent practice and stay away from the NDL's by a reasonable margin.

If this is minor (skin or fat or muscle) surgery, DCS within the scar would not be a huge worry of mine.

If it involved bone and disk and other such structures, I'd dive conservatively but worry much more about gear weight and entry/exit stresses than in-water stresses.

Be sure your doc knows the weight of gear involved and the prospect of slippery decks or unsteady shore entries, etc.

There's nothing like standing on a deck that's pitching and rolling a bit and having your boot slip while you have full wet gear on to give your back a real wake-up call.

If you're not certain he understands the stresses and hazards of diving, DAN is just a phone call away, and they're great folks to deal with.

It's impossible to give any definite advice without full knowledge of your surgery and your medical status otherwise.

Considering wearing a spine pad to keep the tank off your back.

Dive safely,
John

 

[Zept]

A slight diversion, but...

John Reinertson said...
Since the NDL's have an inherent risk of 2 or 3 hits per 10,000 dives...

Do you have a reference for this figure, please? And are you refering to a specific set of tables, or is this the figure that table designers aim for?

Hope your back heals quickly, Kaffphine.

Zept