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Respiratory Problems - Infections

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 - I grew up in India and had tuberculosis (TB) at a young age. Unfortunately I didn't improve despite all the drugs that were given to me (for at least a year I think). In those days the only treatment they could offer me was pulmonary resection - cutting out the part of the lung with TB in it. My parents were very worried I would not survive the procedure. I am now in my 60's and have never had any suggestion of the TB returning. I am fit for my age, and 2 of my sons have qualified as divemasters. Now they want to take me diving, and I would like you to tell me whether this is possible. (is vital capacity the sum of BOTH lungs?)

A - Tuberculosis, aka “consumption” (so-named because of its ability to “consume” genetically-susceptible sufferers), was the scourge of Europe in the 19th century. Its hardcore statistics make grim reading. 1 in 4 deaths in England was due to TB in 1815. Traces of TB have been found in the spines of Egyptian mummies, so it has been around for thousands of years. Although nearly eradicated in the 1980’s, the nasty bacterium is now making a comeback thanks to the emergence of HIV and multi-drug resistant strains.

TB tends to target the lungs but can be found in almost any tissue. It is spread by air (coughing, sneezing, spitting), producing a new infection at the worldwide rate of one every second. One of its scariest aspects is its ability to lay dormant for many years. It is estimated that a third of the world’s current population has been infected, but most cases will luckily remain asymptomatic, with only one in 10 going on to develop active disease.

Treatment consists of a wolf's liver taken in thin wine, the lard of a sow that has been fed upon grass, or the flesh of a she-ass taken in broth. At least it did in Pliny the Elder’s time. These days antibiotics are the norm, although they are only barely more palatable. But in the pre-antibiotic days of the 1940’s, surgery was the commonest method used to try to cure the disease. You don’t say how old you were at the time the scalpel was wielded on your lung, but I would guess 40 to 50 years have elapsed since. Active TB is a complete no-no for diving, but a past history does not necessarily exclude it. The key question is, are there any cavities or scarred areas in the remaining lung tissue that might predispose you to pulmonary barotrauma? To find out you would need to see a respiratory physician and have some pretty detailed scanning of the lungs, as well as functional testing (blowing into various machines, usually via a suspicious-looking toilet roll tube). If the tests come back clear, then certainly diving is possible.

Q - I would appreciate your advice re an injury I have sustained. After having a cold and cough for approximately a month, I developed a pain to the right side of my ribcage. I visited my GP, when the pain failed to subside after about a week. At this time I was informed that I had cracked one of my ribs and it may take 4-6 weeks to heal itself. This was about 5 weeks ago. The pain has generally gone, but I get discomfort on sneezing, etc. and after vigorous exercise. I am a keen sports diver and concerned as to effects of diving on this injury. Is there a recommended time I should refrain from diving? (I am 31 years old and have no other illnesses or injuries and take no medication.) Thanks in anticipation of your advice.

A - I think that you have waited long enough to get back in the water. If you suffer a rib fracture for whatever reason then it will be pretty much healed in 6 weeks.

The thing to watch out for is the pain and the way it may limit your ability to inhale.

If you find that on inspiration when the chest expands that it catches, and makes you cough, then this is a problem underwater. On top of this is the effect of an inflated BCD pushing onto the painful area. This may compound the problem. So my tip is to put on your BCD at home, orally inflate it and try to breathe in as deeply as you can. If there is no pain and you can inhale fully then you should be fine to dive.

A point though from what your doc told you. There are other reasons for late presentation localised chest pain if you start with a simple cough. Rib fracture is rare, but there could be a chance that you have a pneumonia or pleurisy. This is where the outer lining of the lungs get infected and can cause a similar sort of pain. I think that if you are still getting pain now a chest X-ray would be useful as you shouldn't dive with the latter two.

Q - I am planning to start diving next week but my concern is the illness that I had 9 months ago. It was tuberculosis, and it was in my lungs ...I wonder if I could dive. Treatment completed 3 months ago and I don't use anymore medication...another thing that I would like to ask you is that I have Hepatitis B and I receive treatment for that which is the drug called NIMUVADINE(100MG).
Could you contact my diving centre which is called Triton Diving in Islington, London and my self to advise me on these matters..?

A - Let me be the first to break the bad news. Sorry it's no diving for you.

It's not the Hepatitis B though. Divers are not a squeamish lot. The prospect of doing CPR and mouth to mouth on a Hep B positive buddy is not an issue, with protective mouth guards that are used nowadays. And any liver enzyme derangement will not affect diving.

The issue lies with the TB.

Lung TB is not a fatal thing like in the old days of seaside sanatoriums. But it does cause terrible cavitating lesions in the lungs when it is pulmonary or lung TB. So when you dive, the air would enter the lung under pressure of depth. Air trapping would be the inevitable result as it would not be exhaled. On ascent [you can't stay down there forever remember] the air would expand and. badoom, air bubbles into your lung circulation, left heart and of into your brain and spine.

Sorry to paint such a bad picture but you need to realise how dangerous it would be to dive.

I am glad though that Triton Diving had the foresight to get you to mail me first, they obviously seem to know what they are doing.

(other dive medical questions)



   


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