Sarcoidosis and diving

[stiebs]

Well that CT scan was done, and although my lungs look mostly clear, there is still some evidence of sarcoidosis in my lymph nodes, and I'm back up to 10mg of predisolone after dropping to 5mg for a short while.

Doc ideally wants to see another CT in about 10 weeks, but is concerned about overdoing CTs - that would be three in the space of 6 months. So looks like it'll be just a chest xray and blood tests. Best outcome for me so far would be a clear X-Ray in 10 weeks, drop off the drugs for a few more weeks, and then another CT after being drug free. Only when that's clear will it be time for a lung function test and (hopefully) the all clear to dive again.

 

[stiebs]

Just catching up on some other threads, I saw in the UTD Decompression thread (UTD Decompression profile study results published) something that caught my eye, but rather than tag onto that thread, I was hoping that I could drag @Dr Simon Mitchell or @lowflyer across here, as they seem to know something of the topic

I'm no decompression expert - I know just enough to dive plus a bit more to satisfy my curiosity, and I'm no immune system expert - I know just enough from my sarcoidosis plus a bit more to satisfy my curiosity.

I was not aware of any prior knowledge, study or hypothesis that bubbles could have an effect on immune system inflammatory response, and reading those statement in the thread above as rekindled my curiousity as to whether my diving may have not necessarily caused my sarcoidosis, but possibly been a contributing factor for it becoming symptomatic?

 

[lowflyer]

I'm not a tech diver, so my interest in that thread was simply to see what "inflammatory markers" the study referred to because there are some that are truly reflective of inflammation and others that are just peripheral to tissue injury, etc. I know something about sarcoidosis but will not speculate about your situation since it is a varied disease, and I don't know you. Whether diving was an aggravating factor no one can say, IMO. I'm pretty sure it was not a cause. I wish you luck and am sorry I can't give you a more definitive answer.

 

[Duke Dive Medicine]

Stiebs, Dr. Mitchell can speak to this specifically, but the inflammatory markers they found were indicative of a local inflammatory response caused by vascular damage from venous bubbles. This process is a known component of the pathophysiology of decompression sickness. I'm not aware of anything that links diving and sarcoidosis but it's an interesting question. In theory, asymptomatic venous bubbles that lodge in the pulmonary capillaries would also elicit a local inflammatory response but how that could be linked to the inflammatory component of sarcoidosis is
a question for a rheumatologist or pulmonologist. I'll check with one of our attendings.

Best regards,
DDM

 

[stiebs]

Whether diving was an aggravating factor no one can say, IMO. I'm pretty sure it was not a cause. I wish you luck and am sorry I can't give you a more definitive answer.

Thanks for dropping by @lowflyer. Even with my limited medical expertise, I can fairly confidently say that it is highly unlikely for diving to cause sarcoidosis. But since it is claimed in some places (of uncited or arguably unreliable sources) that up to 30% of sarcoidosis cases are asymtomatic, I am simply wondering if I was one of those, and if so did diving aggravate it causing it to become symptomatic.

I have all but dismissed the symptoms coming so soon after a return to diving as coincidental rather than causal. However if there is the potential of causal factor in it, that will most certainly weigh on my mind on each and every dive after I'm (hopefully) cleared at some point in the future. I guess if my CT and PFT come up good after I've been off the pred, then I show symptoms soon after diving again, I'll have my answer

Sarcoidosis still seems to be a relatively mysterious, and as mentioned, varied condition. And I've only found one source reference (http://hyperbaricinformation.com/HB...-Med-1999-70-594-7-Tetzlaff-Hyperbaric-ch.pdf) that ties diving to sarcoidosis. All others seem to cite this case.

I'm not aware of anything that links diving and sarcoidosis but it's an interesting question. In theory, asymptomatic venous bubbles that lodge in the pulmonary capillaries would also elicit a local inflammatory response but how that could be linked to the inflammatory component of sarcoidosis is a question for a rheumatologist or pulmonologist. I'll check with one of our attendings.

Hmm, that doesn't really match my case, being that my initial symptoms were arthritic (ankles) and erythema nodosum on my lower legs - far from a local response to pulmonary capillaries!

 

[Duke Dive Medicine]

.... and, got a very quick response from Dr. Piantadosi, the head of our lab and interim chief of pulmonology at Duke. He doesn't know of a link between the two either, and he's one of the few people in the world who could answer that question.

Best regards,
DDM

 

[stiebs]

Thanks for your quick response DDM. What a wonderful asset SB and its members are to the worldwide diving community. I feel priveleged to receive such quick and personal response from the most knowledgable people in the world in this field.

 

[Duke Dive Medicine]

Glad to help, that's why we're here! SB is indeed a fantastic resource. I've gotten lots of good information from SMEs here.

Best regards,
DDM

 

[lowflyer]

There is a wide range of autoimmune diseases. For some of them we recognize certain triggers. For most we have no idea what exacerbates them or sometimes even spontaneously makes them better without treatment. Often times a person will develop symptoms of "Disease X" for which we don't know the cause. Then the patient thinks back and remembers some traumatic mental or physical event and thinks that is the cause, when statistically that is highly unlikely.
In your case no one will be able to say with certainty whether diving and nitrogen bubbles were the trigger for your exacerbation of sarcoidosis, unfortunately. Possibly your idea of self experimentation will suggest an answer, and if you get to that point of diving again, and the Sarcoid flares, it should be written up in a dive medicine source as at least as an interesting case. Again, good luck and report back.

I'm editing this to suggest that in addition to seeing the pulmonologist you consult with a rheumatologist or immunologist, if not already doing so.

 

[stiebs]

I'm editing this to suggest that in addition to seeing the pulmonologist you consult with a rheumatologist or immunologist, if not already doing so.

Yes, currently under the care of a rheumatologist