Spinal Cord Lipoma + Deep diving

[Azraelien]

So I have been diving for around 15 years, but only in the last few years have been starting to do some slightly deeper (30m+) dives, as well as moving into tec diving (Intro to cave so far, but looking at normoxic trimix next for some deeper wrecks) - the issue is that I have a congenital spinal defect (Spina Bifida Occulta/Partially excised Spinal Cord Lipoma) and because of my lack of medical knowledge, have no idea about whether increased hyperbaric pressure (5atm+) might have any adverse effects upon my spinal cord - such as the lipoma being at risk of compressing spinal nerves under high pressure or whatever.
Is there any research that has been done in similar areas previously? Would there be any way of safely testing this, perhaps in a hyperbaric chamber dive?

 

[Duke Dive Medicine]

So I have been diving for around 15 years, but only in the last few years have been starting to do some slightly deeper (30m+) dives, as well as moving into tec diving (Intro to cave so far, but looking at normoxic trimix next for some deeper wrecks) - the issue is that I have a congenital spinal defect (Spina Bifida Occulta/Partially excised Spinal Cord Lipoma) and because of my lack of medical knowledge, have no idea about whether increased hyperbaric pressure (5atm+) might have any adverse effects upon my spinal cord - such as the lipoma being at risk of compressing spinal nerves under high pressure or whatever.
Is there any research that has been done in similar areas previously? Would there be any way of safely testing this, perhaps in a hyperbaric chamber dive?

There shouldn't be any issues with compressing the tissues themselves at the depths you're considering. Of greater concern would be whether there is any mechanical impingement on the circulation of your spinal cord, which could lead to impaired off-gassing. What has your surgeon said about activity level?

Best regards,
DDM

 

[Azraelien]

There shouldn't be any issues with compressing the tissues themselves at the depths you're considering. Of greater concern would be whether there is any mechanical impingement on the circulation of your spinal cord, which could lead to impaired off-gassing. What has your surgeon said about activity level?

Best regards,
DDM

Hmmmm not sure - to be honest the surgery was 29 years ago, and I'm not sure if the surgeon is even alive any more. What do you mean by 'activity level'?

 

[Duke Dive Medicine]

Hmmmm not sure - to be honest the surgery was 29 years ago, and I'm not sure if the surgeon is even alive any more. What do you mean by 'activity level'?

Ah, ok then! Maybe I should have asked about the time frame in the first place. Are you currently under a physician's care for this condition? By activity level I mean what type of physical activity you can tolerate - lifting heavy weights while moving, aerobic capacity, that kind of thing.

Best regards,
DDM

 

[Azraelien]

Ah, ok then! Maybe I should have asked about the time frame in the first place. Are you currently under a physician's care for this condition? By activity level I mean what type of physical activity you can tolerate - lifting heavy weights while moving, aerobic capacity, that kind of thing.

Best regards,
DDM

Thank you very much for taking the time to respond to these!

Aha I see - no not currently under any care for it. Physical activity-wise... So I am very active - I used to do cross country running, and have have run 3 marathons, I sail tornado catamarans and I swim around 12km a week, compete at state level in archery, and Cave dive, so leg strength, lifting capacity etc is not really an issue, although I believe the affected nerves are those controlling bladder function (partial incontinence) and perhaps to a degree leg function (I walk and frog kick kinda funny, and have reduced feeling in 2 toes, which I think is connected.)

If there were to be a circulatory issue, would that be something I could offset by just massively increasing conservatism in deco profiles?

 

[Duke Dive Medicine]

Thank you very much for taking the time to respond to these!

Aha I see - no not currently under any care for it. Physical activity-wise... So I am very active - I used to do cross country running, and have have run 3 marathons, I sail tornado catamarans and I swim around 12km a week, compete at state level in archery, and Cave dive, so leg strength, lifting capacity etc is not really an issue, although I believe the affected nerves are those controlling bladder function (partial incontinence) and perhaps to a degree leg function (I walk and frog kick kinda funny, and have reduced feeling in 2 toes, which I think is connected.)

If there were to be a circulatory issue, would that be something I could offset by just massively increasing conservatism in deco profiles?

Thanks for the details!

It's hard to talk about risk mitigation when we don't know for sure what the risks are. The probability of DCS increases with increasing depth and bottom time for any diver. The symptoms you mentioned could be associated with direct impingement on, or decreased circulation to, a nerve, but without current radiographic imaging, including circulatory studies, there's real way to tell. One way of approaching this would be to assume some circulatory compromise in the area for safety's sake. Increasing your conservatism would be a reasonable thing to do in response to that assumption, though I'd leave it up to you to decide how much. Unfortunately, you're a one-person experiment with some significant unknowns. If you're trained in mixed-gas and O2 decompression, using O2 on your shallow stops and increasing your stop time would be one way to do it.

Best regards,
DDM

 

[Azraelien]

Thanks for the details!

It's hard to talk about risk mitigation when we don't know for sure what the risks are. The probability of DCS increases with increasing depth and bottom time for any diver. The symptoms you mentioned could be associated with direct impingement on, or decreased circulation to, a nerve, but without current radiographic imaging, including circulatory studies, there's real way to tell. One way of approaching this would be to assume some circulatory compromise in the area for safety's sake. Increasing your conservatism would be a reasonable thing to do in response to that assumption, though I'd leave it up to you to decide how much. Unfortunately, you're a one-person experiment with some significant unknowns. If you're trained in mixed-gas and O2 decompression, using O2 on your shallow stops and increasing your stop time would be one way to do it.

Best regards,
DDM

Thanks once again for the advice - makes perfect sense.
Yeah I'm not trained yet, but the training route I'm looking at will be normoxic trimix with 100% or 80% o2 for accelerated deco, so I can adjust planning to increase stop time for sure.

What with being a one man experiment, do you think it would be worth finding a doctor who might be interested in doing circulatory studies and perhaps a chamber dive to test things out before doing deeper dives?

 

[Duke Dive Medicine]

What with being a one man experiment, do you think it would be worth finding a doctor who might be interested in doing circulatory studies and perhaps a chamber dive to test things out before doing deeper dives?

I think that would be something to discuss with a neurosurgeon.

Best regards,
DDM