Actually, I DID experience one of those infrequent episodes of "orthostatic hypotension", if that's what it was, while wearing the Holter. The reviewing cardiologist did not notice anything unusual while reviewing the complete trace. Also, FWIW, since all this testing and medicating has been underway, the frequency of these episodes has dropped to basically zero, and I can't remember when the last one occurred. It's certainly been many, many months now.
It's now been over a year since the TIA episode, and the end game is under way. All the medical tests have been completed, and I am waiting for a final consult with the dive physician to review all the findings. To summarize, 57 year old male had a very mild TIA two minutes after surfacing from a simple dive with moderate head and neck contortions "de-gearing" in moderate waves. Symptoms gone in hours, absolutely no residual effects. MRI showed 2 small infarcts, in the LH Occipital and Parietal lobes. Tests including a 24Hr Holter, TTE and TEE showed no heart abnormalities at all. Carotid Doppler showed tortuosity but satisfactory flow on the RH, moderate blockage on the LH. A second Doppler two months ago showed little change. This area of my neck is co-incidentally damaged, stiff, scarred and often sore from radiation many years ago. Co-incidental to this testing was the discovery of a small clot in the SVC, which was successfully cleared by Coumadin. The consensus among the treating specialists is that this was probably unrelated to the dive incident, and probably some form of UEDVT which I suspect I inflicted on myself not long after the dive TIA. Blood testing shows no predisposition to clotting and all other routine blood tests are actually quite good for my advanced years. Cholesterol and BG are good, and my BP is absolutely quite normal
The current thinking, both from the treating dive physician and a dive cardiologist he has been talking to, points to the neck as the most likely source/cause of the blockage. I am waiting for a follow-on meeting with the neurologist to review the follow-on Doppler, but so far he has not indicated that he is concerned enough to have prescribed any treatment or restricted my activities. I plan to ask him for his thoughts on a referral to the Vascular team for follow-up.
My question is this: If I make the leap of faith, and accept that the neck was the source of my TIA, what is it about diving relative to other physical activities that puts me at increased risk, when I am not under any other physical restrictions at all. The only medications I have been given from all this is extra Chrestor and low dose ASA. I have not been told to limit physical activities, restrict head and neck movements, etc.
I seem to have three options. Give up diving forever, which would gut me (but it's only a discretionary, recreational activity, after all), dive normally with no restrictions, or dive with limitations on depth, physical exertion, head and neck movement etc. The last option is perfectly satisfactory, as I had been planning to scale back a bit anyway, and take up sidemount as way to limit the load I had carry.
Thoughts and comments would be appreciated. Thanks in advance.
