Pleurodesis and free diving? (experience? medical advice?)

[sepiafan]

It's peoples (al)most feared PITA again: Spontaneous pneumothorax
But I will not ask, whether I can SCUBA with one, but have a rather urgent question regarding free diving:
As part of the treatment, a pleurodesis has been sugested (with obvious advantages on land and in case of SCUBA), but free diving really digs flexible lungs. "fused to the ribcache" does not quite match "moves easily", does it?
Any insights on this would be very welcomed, especially since I am supposed to decide within the next few hours, whether it will be part of tomorrows op or not.


fine print
- while I am an above average free diver, I do neither participate in competitions nor changing weight. So I stay out of depths where lung compressability becomes an issue.
- I did however enjoy underwater rugby in the past, so a lung managing rapid dive-resurfacing cycles in short time would be very welcomed. It was deffinetly nice to have one.
- yeah, I know irreversible decisions should not be left to the internet. But while my clinic does provide a high class lung surgeon, it does lack both dive docs and internet on weekends. So I did manage to mail a couple of professionals this morning, but with spamfilters, lots-to-dos, "you want my answer? make an appointment"s and of course general "I stopped reading after SP, you are never going near the ocean again"s, I do not expect a lot of helpful answers in the next few hours, while some forums are really great to gather lots of experience reports within a very short time.
- "you are never going near the ocean again". If I can't go, I will have to swim. Staying dry is certainly not an option after two decades of SCUBA and another half of apnoe and snorkeling. Especially as the spontaneousness was probably aided by a hart bump to the back. Only question is: Have I decide between apnoe ("flexibity!") and SCUBA ("0 space in chest!") or is this one single direction?
- Despite above said I will not be near water any time soon and have thorough exams before going deeper than my own height. I might value diving more than my life, but my girlfriend's nerves rank even higher ;-)
- One helpful proffesional insight just came in: "wales and elephants don't have a pleura either and dive just fine". So I am pretty pro-pleurodesis now, but as this wall of text has already been typed, I will ask for experience none the less. I will need it anyway when I have to decide about picking up acitivty next year.

 

[Kharon]

It's peoples (al)most feared PITA again: Spontaneous pneumothorax
But I will not ask, whether I can SCUBA with one, but have a rather urgent question regarding free diving:
As part of the treatment, a pleurodesis has been sugested (with obvious advantages on land and in case of SCUBA), but free diving really digs flexible lungs. "fused to the ribcache" does not quite match "moves easily", does it?
Any insights on this would be very welcomed, especially since I am supposed to decide within the next few hours, whether it will be part of tomorrows op or not.

When I was in undergraduate school I had 3 Spontaneous pneumothorax episodes. The third occured while they were treating the second, in the hospital. They dusted my lungs with something to scar the surface and prevent future episodes - Talc pleurodesis. I have continued to snorkel/freedive and scuba dive with no problems encountered.

I wouldn't worry at all about freediving because your lungs hold surface pressure air. I wouldn't consider scuba till after pleurodesis and enough time to be sure it's not going to recur. At depth, air that leaks into your pleural cavity outside the lungs has no way to escape and will expand on ascent. I would guess that would be very deadly.

Also, you lungs have to move freely after pleurodesis. Otherwise you couldn't inhale or exhale. I'd get the procedure.

 

[sepiafan]

Yep, pneumothorax at depth can be very deadly - "pressure at depth" * "percentage of pneumothorax compared to maximum air intake". So if your lung collapsed to 50% before ascend, than you better where not lower than 10 m because otherwise the air trapped around your lung will not fit into one half of your chest anymore, but excert pressure on the heart and eventually kink a blood vessel, interrupting blood flow in the whole body.
That's an issue I have to think long and hard about in one years time, as it will definetly be a risk to the untreated other half of my lung (though pending further diagnosis hopefully not a greater risk than it was for the last 20 years or for everyone else). This definetly not a risk with freediving as you cannot get more than one lung full of air into your chest and will notice any lung ruptures fast enough anyway to not unfold (infold?) them fully while still submerged. However freediving puts a lot more stress on the lung and a pleurodesed lung might be more stressed by this, as one expert now confirmed to me. He also pointed out that airbubbles can become trapped in pleurodesic tissue, contraindicating any kind of submerged acitivity.

This sucks. Whish there was any way back to just my go'ole natural lungs. I quite liked them for almost 34 years and now they suggest changing everything around :-(
But you diving for years in all kind of ways with complete pleurodesis makes me kinda hopeful again. (They don't use talc anymore btw, only problematic areas get a local pleurodesis by laser scaring nowadays. everything gets better if you add lasers.)

 

[Duke Dive Medicine]

Sepiafan,

Did they recommend pleurodesis on both lungs or just one?

Best regards,
DDM

 

[sepiafan]

Hi DDM,
so far not treatment has been proposed for the other side. The operation was planned (btw now cancelled due to unsure patient ;-)) to make use of the already placed chest tube and it's opening. I guess they might have talked about a second op after performing the first, but so far they haven't. As might be indicated by my questions, "talking to patients" is a very rare speciality among the surgeons here. I definitly will push the topic when there are results from a first thoracoscopy, as it is very unlikely that the other lung is perfectly fine if the first is in dire need of changes.

On a related note I have no assembled answers from three more experts (ranging from chief surgeons who are qualified as dive medics on the side to DAN's van Laak himself) who all agreeded to some risks asscociated with pleurodesis (and in one case even with the resection itself), but who completely disagree about the relevances. Answers range from "no diving with pleurodesis at all" to "yeah, does stress lung a little bit, but damages due to this are very unlikely and it does a great job in preventing problems with the predamaged/resected areas". I'll go on collecting further opinions and hope that some of the experts will agree to direct exchange among themselves with me sitting on the sideline.

 

[Kharon]

... as it is very unlikely that the other lung is perfectly fine if the first is in dire need of changes.

Is that your assumption or advice from the doctor? My three spont's were all in the same lung. Never had a problem with the other (anecdotal, I know - that's why curious if the Dr told you).

Also curious about which lung it is. My doctor had a hypothesis that it was more often the right lung due to greater volume (heart reduces volume in left lung) and therefore greater exposure to insult

 

[sepiafan]

that's my assumption, but also does seem to be the general reasoning I found online by doctors. If your spontaneous pneumothorax is not caused externally, there is likely to be a general condition and why should that one stop in one lung?
I am also curious though, whether this logic applies to the higher risk of having a second pneumothorax after the first as well. Most people appear to have all SPs on the same side and at least in short terms this seems perfectly logical to me: Bullae have ultra thin walls and as such should stretch a lot easier than the rest of the lung. So I would expect the space left behind by a popped bullae (pneu #1) to be filled not by a slight stretch of the whol lung, but by a big stretch of other bullae around (unless these are resected. or all popped) thus making pneu #2 almost a guarantee on the same side, while the just-as-unhealthy tissue in the other lung (or in the lungs of the many people which never get #1 due to good luck) just continues to work as in decades before.
Well, I am definitly not complaining if I only need one surgery in the future. Chest tubes suck in more than one way.

Regarding curiosity: Yep, it was my right side. But I have found reports of left sides as well and as most spontaneous pneus seem to be caused by bullae at the upper lung tip, I do not think that less lung further down below would change a lot. At least the total length/height of the lungs and therefore stretch tension is the same on both sides naturally. (In my case however a broken claviula 20 years ago left me with a shorter right shoulder, causing me to pull that side up a bit more for symmetrical posture)