New diver with a DVT

[Infntrymn13]

Hello all, I am a soon to be medically retired army vet. I just took discover scuba and as I knew i would I fell in love with diving, just from an hour in the pool! I am amped to get my certification, but I have a DVT. I was diagnosed june of last year. The DR says i will probably be on Coumadin for life. So far the only answer i can get, i got from DAN on the danger of coumadin causing a bleed. Does anyone know someone that has a DVt and dives. i am curious as to if there are any other dangers outside of bleeding that i should be aware of before I really get going with my certification. I am not sure if deep dives are off limits to me or if there is a depth i should avoid going past in general. I currently live in FT. Benning Ga so dive Dr.s are hard to come by here, lol. so any advice or information would be really appreciated! Learning the hard way on this one would be a bad idea i am sure, lol. Thank in advance!
I should note, i am genetically predisposed to clots, my INR is generally in range(2.2 last check), the clot is the result of an ankle surgery to repair damge done in Afghanistan and my last duplex showed the clot to be stable. Vascular surgeon advised no vena cava filter, but coumadin for life to prevent future clots. Protiens S and C were low( i believe low) but that could be from the coumadin.

 

[pasley]

I AM NOT A DOCTOR and I CAN NOT ADVISE YOU ON MEDICAL ISSUES

You have already talked to Divers Alert Network aka DAN. They are widely considered the definitive experts on all thing relative to diving and medicine. You could take a road trip to DAN to see a physician and let them get a look at things. Duke University in Raleigh NC is only a few hours up the road from you. There could be a difference in their advice after they exam you versus just discussing it over the phone.

I don't know what DAN told you (would like to hear) but I am guessing it was something like:
1. Risk of accumulation of nitrogen or bubble formation at the clot site and in the scar tissues.
2. Pressure increases could cause the clot to shift
3. Possible increase risk for bleeding at sites of pressure differentials (lungs, sinus etc) which would increase with depth.
4. Potential to bleed if you receive an injury such as a cut, scrape, or puncture from something in the ocean.

Be certain to discuss this issue with your dive instructor as well.

Last thoughts:
1. Diving is an adaptive sport. We are operating in an environment that is foreign to us and places demands upon the body we do not normally experience. We wear life support equipment to operate in the water and there are rules the must be followed. Penalties here range from paralysis to death.
2. If you are diving Against Medical Advice (AMA) you are placing not only your life, but that of your dive partner(s) at risk. (If something happens to you at depth, they have to do the rescue and increase their risk of injury). Read "Diver Down" for numerous examples of this.
3. Always advise your dive buddy of any medical condition before the dive. You conditions affect their life too and they have a right to know.
4. If DAN said don't dive, don't dive. If DAN said it was OK, then see your local physician, have them talk to DAN, get your medical clearance and learn to dive.

Final Thought - Vet to Vet - Thank you for your service, welcome home Soldier. If you have not yet done so join IAVA.org

 

[bleeb]

You may also want to have a browse through the Dive Medicine forum, or it's parent, Marine Science and Physiology. Different aspects of this issue seem to get discussed every few months.

You may also want to PM (Private Message) a Moderator and ask them to move this thread to Dive Medicine (preferred over starting a new one), where one of the doctors or other medical types who frequent SB are more likely to see it. You may have better luck picking a Moderator who's actually online at the time, identifiable with a blue

in the left hand column.

 

[Infntrymn13]

DAN did not go into the kind of detail you just did, which by the way is very helpful! Here is the sum of what they said-"A diver who has been prescribed an anticoagulant, e.g., Coumadin® or Warfarin®, should be warned of the potential for bleeding: excessive bleeding can occur from even a seemingly benign ear or sinus barotrauma. There is a potential risk that, if decompression illness occurs, it may then cause significant bleeding in the brain or spinal cord. The diver must be able to equalize without difficulty. Also dive physicians would recommend conservative dive profiles to help further reduce the risk of DCI." Thank you for your thoughts though and the recomendation on joining up.
Vet to Vet- Thank you for paving the way!

 

[John C. Ratliff]

I am not a doctor, and cannot diagnose. However, if it were me, I would get a second opinion as to how long this deep vein thrombosis (DVT) will likely last. I think it is entirely possible that this condition will go away after a few years. There are a lot of risks of things happening it the water which could break it loose. I would not dive with this diagnosis until I'm pretty sure that there is no further danger from it. DVT is not something to fiddle around with--it can kill. This is aside from the medication you are taking.

The danger, which you asked about above, is that the thrombosis (blood clot) breaks loose, and goes through the major veins to the lungs, heart, and/or brain. There it will cause major damage, or possibly death.

Also, another vet-to-vet, thanks for everything you did for us while in the service.

SeaRat

 

[Bubbletrubble]

@Infntrymn13:

pasley did a nice job of reviewing the complications of taking anticoagulant meds. He and John C. Ratliff also mentioned one of the major concerns regarding the clot itself -- the possibility of it moving/shifting.

To ensure that you are truly informed of the potential consequences of diving with DVT, please be aware of the symptoms associated with pulmonary embolism (PE): unexplained shortness of breath, chest pain (usually worse with deep breath or when coughing), feeling lightheaded/dizzy/faint, coughing up blood, sense of anxiety/nervousness. PE is the primary complication associated with deep vein thrombosis. It is a serious, potentially life-threatening condition for which medical treatment exists.

Good luck and thanks for your service.

 

[TSandM]

Thrombus in situ "organizes", or becomes fibrous and adherent. That is the reason why people who DON'T have a genetic problem with thrombosis can be taken off Coumadin after about six months -- the risks of the clot breaking off or moving are minimal by that time.

If you do have a protein S or C deficiency, you do need to be on lifetime anticoagulation. Coumadin, when in the therapeutic range, will increase the length of time that any wound or injury bleeds, so you will get bigger bruises, easier nosebleeds, and more chance of subconjunctival hematomas from poorly equalized masks. In the event of a significant DCI problem, it may well be aggravated by the Coumadin -- this is real, and has to be part of the risk assessment that you make in diving. On the other hand, few recreational profiles run the risk of major DCI events, if proper ascent technique is observed. The other impacts of Coumadin are annoying but minor, if the INR is in the therapeutic range. But therein lies the rub . . . Coumadin is one of the most difficult medications in the pharmacy to manage. Its metabolism is affected by almost everything else you might take, especially, for example, antibiotics. It is also affected by your diet to such a degree that even people who have been on a stable dose for years can get way out of range, one way or the other, with brief dietary changes.

I don't think Coumadin is a contraindication to diving (nor does DAN). But a person on lifetime Coumadin who intends to dive regularly really needs to learn to be very meticulous and observant about their Coumadin management, and certainly, before any major diving trip, a very recent INR would be called for.