Having a pneumothorax sux!

12 years 8 months ago #9052 by mattd
mattd created the topic: Having a pneumothorax sux!
About six months ago I suffered the unfortunate pleasure of a primary spontaneous pneumothorax of my right lung (not whilst diving), which required surgery to repair. As a 30 year old non-smoking, definitely not tall and skinny male, I consider myself exceptionally unlucky. But, ****e happens.

Now here’s the rub. I am, or was, a keen and active scuba diver and underwater photographer. But having a spontaneous pneumothorax is regarded by diving medicos as an absolute contra-indication to ever diving again. This is because there is an elevated risk of a second event, potentially fatal if it happens while diving.

Whilst I haven’t dived since, I have done quite a bit of free diving (got to get a feed of crays somehow). The lungs are fine. In fact, my CT scans and surgeon saw no evidence of any lung blebs.

Whilst I’m not about to go scuba diving any time soon, for the medicos, is my risk of a pneumothorax whilst diving a just theoretical one? Has any diver ever had a spontaneous pneumothorax during a dive?

When does my risk of a reoccurrence fall away? I would have thought that if I give my lungs a good work-out by breath hold diving regularly for a couple of years, I should have another event if it is going to happen at all.

Finally, is there any depth which I could regard as safe to dive on compressed air? Would a pneumothorax at say 5 meters (1.5 atm) be potentially serious?

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12 years 8 months ago #132816 by dteubner
dteubner replied the topic: Having a pneumothorax sux!
Hi Matt,

The problem with spontaneous pneumothorax and diving is three fold.
1. Changes in pressure accross bits of the lungs make a recurrence of pneumothorax more likely breathing compressed air.
2. Scarring from the previous pneumothorax makes pulmonary barotrauma more likely
3. (most importantly)If a pneumothorax did occur at depth the pressure inside the pneumothorax would be the ambient pressure at whatever the depth was. When you tried to ascend this trapped gas would expand, causing a "tension" pneumothorax which pushes the heart accross to the other side of the chest, kinking the big viens and stopping the return of blood to the heart. This is fatal. 5m is plenty deep enough to cause a big problem.

I doubt that anyone could tell you a real number for the risk but it probably lies in the range of 1 in 100 to 1 in 10,000 per dive.

These risks are real even if no-one can tell you "John Smith died like this".

Ultimately the decision to accept any risk is up to the diver, their buddy and any commercial entity involved. There was a pretty good discussion of these issues here: www.diveoz.com.au/discussion_forums/topi...E=true&TOPIC_ID=8801
(For diabetes read pneumothorax)

Hope this helps.

Dave T

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12 years 8 months ago #132863 by Richard Harris
Richard Harris replied the topic: Having a pneumothorax sux!
G'Day Matt
I think this is a bit of a tricky one. As you obviously are aware, one of the major reasons that people who have suffered spont PTX are advised not to dive, is because of the potential presence of pathology on the other side which might predispose you to the same problem. If there is a bleb (a large sac or cyst of empty lung space not filled with the usual lung tissue) on the other side, this could in theory be a weak point which might rupture as gas expands in it during ascent.

In your case it sounds like you have had this excluded with what is presently considered the gold standard test (a high resolution CT), so we can say with some confidence that the other lung is as safe as someone who has not had your problem.

The already injured lung has presumably been treated with an operation called a VAT pleurodesis. This has effectively sealed the pleural space where a PTX can form so that the risk should be eliminated on this side too. As long as there was no unexpected trauma to the lung during the surgery, or from any subsequent chest drains, I think it may be reasonable to resume diving. The depth is not really an issue....the first 10m are the most dangerous as this is where the greatest proportional change in pressure occurs.

2 questions I would ask my respiratory physician and/or thoracic surgeon:
1) What is the chance of recurrence of the PTX in the operated side?
2) Was there any chance of trauma to the operation side lung?

The final issue is whether the intentional scarring formed between the lung and the chest wall (to stop further PTX) could cause any shearing/tearing forces as the lung expands during ascent. I am not sure these forces would be any worse than those occuring as the lung contracts during a 10m freedive, or during a big yawn, breath or cough.

I am a little out on a limb here suggesting I think you would be OK to dive based on what you have stated, but I think it is worth pursuing a liitle further with the specialists looking after you. Then go and have a chat with the guys at the chamber in Hobart (David Smart).

"Harry"
www.divedoc.net

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12 years 8 months ago #132865 by mattd
mattd replied the topic: Having a pneumothorax sux!
Richard and others, thanks for your reply.

actually, I have pretty much resigned myself to not diving for a very long time, if ever again. I have already talked to my physicial, surgeon and the local hyperbaric specialist whom you mentioned. Besides, breath hold diving is good fun and I can still use my UW photo gear that I paid so much for :)

I posted my original mesage to get a few opinions from Dive Oz medicos on just how much above other divers is my risk of a pneumothorax whilst diving.

FYI, no pleurodesis was performed during my surgery, just a stapling of the leaky lung.

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12 years 8 months ago #132872 by drsnakebelly
drsnakebelly replied the topic: Having a pneumothorax sux!
You might be interested in discussions about pneumothorax on scubadoc's web site on this page:
www.scuba-doc.com/spntpnu.htm

There is also a link on the page that discusses risk factors.
www.scuba-doc.com/risksPBT.html


snakebelly

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12 years 8 months ago #133957 by johnson
johnson replied the topic: Having a pneumothorax sux!
I also had a pneumothorax 15yrs ago but i didn't know which type of pneumothormax was. Up to present, no occur again. I have pass the open water last year and my deapest record is 12m. I want to attend the advance open diving course. Does anyone recommend me go or not? As I knew, advance course need a deap dive test approx. 30m to 50m. Is this depth dangerous to me or the dangerous depth is the first 10m.
I had recovered the pneumothormax over 15yrs. Does it mean I can attend the advance diving course.

looking forward any expert recommendation.


thx

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12 years 7 months ago #134503 by dbryant1
dbryant1 replied the topic: Having a pneumothorax sux!
Matt, I feel your pain buddy, I had the same thing happen to me last year. My thoracic surgeon indidcated with surgery diving was possible again. So I had pleuridisis and a pleurectomy with good results. I have my doubts however and am currently being evaluated by a pulmonologist. He's doing CTs, X-Rays and PTFs on me to evaluate my fitness. If he clears me I'm still going to consult a hyperberic specialist and even then I doubt I will return to diving. Maybe in the future medicine will advance to give me a more definitive answer. Does anyone out there have stats on increased risk? The literature is so general it's hard to get a feel for the general risk increase. Or is it really a case by case basis? Thanks.

Lee

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3 years 7 months ago #299744 by Reece23
Reece23 replied the topic: Having a pneumothorax sux!
Hay guys.
Some how I have the same bad luck that you do Matt. I received the no diving ever news from my specialist yesterday but wasn't able to get a sure answer about weather or not the freediving side of things would be non fatal or not.

My history is this, healthy fit young bloke (I know, I fit the bill) and while riding my push bike last week I suffered a spontaneous pneumothorax and had the drain put in to re-inflate my lung in the hospital. I then had a Follow up X-ray mid week and my lung is at 90%~ volume so I have been told that is fine and the body will absorb the remainder.

So my question is how safe, or what are the risks of freediving. Also skydiving?
Any info would be appreciated!

Thank you In advance
Reece

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3 years 7 months ago #299747 by james
james replied the topic: Having a pneumothorax sux!
Wow holly thread revival!!!

In all seriousness , I see Matt from time to time and now has three kids who are growing up very fast. He has not resumed SUCBA diving, but has continued to snorkel to get his feed of crays from time to time, and does a bloody good job at it.

I am no medical expert but might be worth getting a second opinion re the snorkelling.

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3 years 7 months ago #299749 by Reece23
Reece23 replied the topic: Having a pneumothorax sux!
Haha yer sorry I didn't check the dates for previous posts, but I haven't been able to find any other forums that mention the free diving who seem credible.
Am I likely to draw some attention from a medico on this site? Thanks for the reply too James!

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