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Respiratory Problems - Pneumothorax (Spontaneous)

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hello, I'm interested in giving diving a go, but I have a history of spontaneous pneumothorax. A friend of a friend who is a diving instructor said you might be able to advise me. I first had a pneumothorax in 1994 at the age of 18 on my right lung. I had a chest drain put in for that at Maidstone hospital. A few months later my left lung collapsed and I had surgery for that at Guy's hospital in January 1995 (thoroscopy and then pleurodesis). I had no more trouble with my left lung, although my right lung would occasionally suffer small relapses until I got to about 23 years old (1999) - these reccurences were never large enough to require treatment though, and resolved themselves.

As I say, I'm interested in trying scuba diving but I understand that with my medical history I might not be suitable. I feel completely confident in myself that my lungs are fine now, but I was hoping you could advise me on the best way to be certain that I would suffer no ill effects from scuba diving.

A - Iíve got a bad feeling here. You have never dived, and there are loads of things you could do otherwise. And having a pneumothorax underwater could be fatal. I just donít think you should risk it. Sure you could get CT scans, MRIís and see the worlds best lung Professor, and get passed with a lot of finger crossing. But mate, if if if, so to speak. Go spelunking or canyoning or whatever. A burst lung there, and you can easily survive. But just donít risk messing with the physiological laws of expanding gases in confined places, i.e your thorax on ascent.

Q - My name is Melany and I've recently moved to Dahab to work and to learn how to dive but unfortunately due to an incident that happened more than 21 years ago, I've been advised that I can never take up diving. What happened was I suffered a collapsed lung on the right side, just the top part of it went, I had X-rays, was given a course of tablets to take (can't remember what they were) that went away but some weeks later I had the same problem with my left lung, what it was due too I was never told, again I took tablets and this problem has never re-occurred nor have I ever suffered any discomfort. I don't smoke and rarely drink alcohol. I live a healthy, clean life-style and would very much like to exhaust every channel of hope before I give up my dream of being able to dive. I won't attempt it has the advise I've received from the club I work for ( dive urge ) are very professional in their approach to my problem and I intend to see a doctor again when I'm back in the UK in April but would very much appreciate any advice you can give me on this.

A - There is a school of thought, not supported by many dive docs, but still expounded at conferences we go to, that a past history of collapsed lung [pneumothorax] is not really a bar to diving in the future. I prefer a more logical approach, and that is as follows. The causes are little blebs or pouches on the lung surface. If they burst, air gets out, and the outside pressure collapses the lung. They often repeat themselves soon after, but then never occur again. It it were to happen underwater, then it could be fatal, so you must make 110% sure that there are no blebs left. This can be done by an operation to stick the lungs to the chest wall. However before you leap into this, there are tests to se if your blebs have gone. A certain sort of CT scan can show the lung structure and resolve the issue for you. So I suggest you arrange for one of these on your UK return. If all is well then you could be allowed to dive. But if there are still abnormalities, and you are commited to Dahab, then you had better go buy a windsurfer.

Q - Many years ago, I had on 2 separate occasions a Spontaneous Pneumothorax. If memory serves correctly it was on the same side. That is the left side. I do recall that the doctors told me that this is a common occurrence amongst young tall, thin men. I am not that tall (5'10"), I am now older and heavier (31 next week and just under 11 stone). My last 'attack' was in early 1994. As it has been 7 years since I was last affected by this, is it sufficient time to assume that I am now safe to start scuba diving?
Do I need to have any specific tests done?
Will I need a proper medical certificate?

I am going on holiday in July to the Maldives and I think that this would be a wasted opportunity not to have an introduction to scuba in such lush tropical waters, as Scuba is something I have always longed to do.

I appreciate any help and advice that you could offer me in this respect. Many thanks.

A - To answer both your questions in turn. Yes and yes.

A pneumothorax is when you burst the outer lining of your lung. What then happens is that the air you breathe in instead of being exhaled normally can escape out of the newly blown hole into the chest cavity. The more air that escapes, the more this air can then crush down on the lung as it is all enclosed, so eventually collapsing down the lung. So imagine a situation where air under pressure in inhaled when you dive, a pneumothorax occurs and then as you ascend this air expands.
You would be breathless in seconds and in some cases the venous blood flow back to your heart can be cut off too. Nothing in to the heart, nothing out and then death is the sad eventuality.
So you can see the risks of diving if there is any chance of this happening again.

The stats on pneumothorax is that it can occur for no reason in young tall fit men and can reoccur again soon after the first event. However if a period of 4 to 5 years goes by without a recurrence then it is unlikely to come again.

The key fact as a diving doctor is what are the risks of a repeat episode and will that happen when you are diving.

We assess this by both waiting a number of years after the first event and also having a special scan of the lungs to see whether there are any abnormalities that will cause another pneumothorax. This is called a CT scan.

If it is at least 5 years post initial pneumothorax and your CT is normal as well as lung function studies then you should be fine to dive.

This though throws up an interesting issue that I have come across many times with divers in your situation. Because diving is a recreation the good old NHS will not do your CT for free as it is deemed non-essential to your continued wellbeing. This means that you have to fork up for a private CT which comes in at about £300 to £400 before you can dive. I personally think that this is a mad situation as you have been honest about your problem and you now have to foot the bill through no fault of your own. If you had been a smoker and suffered lung problems then all CT scans would be free. Write to your MP on that one.

To your second question, you will need to be signed off by your local diving doctor after seeing the CT results before you can learn to dive.

There are other causes of pneumothorax that can mean a quicker return to diving but we will look at those next month.

(other dive medical questions)



   


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