Pneumothorax (collapsed lung) & diving

Sarastro

LE
Kit Reviewer
Feck I had forgoten about this stuf, Your missing "spontaneous pneumothorax

During COVID I had what was clearly a COVID prompted single pneumothorax (collapsed lung). The standard medical advice is that there are three types of pneumothorax: puncture (e.g. from a bullet); disease-induced; and spontaneous. Once healed and after a rest period (~12 months) puncture pneumothorax is not a bar to diving, but spontaneous is a lifetime bar. Disease-induced, however, is a "depends on the disease" case (which I understand from the one useful doctor I've talked to is a function of whether the disease acts on existing weaknesses in the lung, or creates those weaknesses.
The question is whether it is actually correctly categorised as "Spontaneous" or "Disease-induced spontaneous" (which is not necessarily spontaneous). "Disease-induced Spontaneous" is a pre-defined list of conditions for which, in early 2020, COVID was obviously not yet on the list, so it got marked as "Spontaneous".

Alternatively I have a bet to see how many times I can get the word "spontaneous" into a single thread before anyone notices.
 

jinxy

LE
The question is whether it is actually correctly categorised as "Spontaneous" or "Disease-induced spontaneous" (which is not necessarily spontaneous). "Disease-induced Spontaneous" is a pre-defined list of conditions for which, in early 2020, COVID was obviously not yet on the list, so it got marked as "Spontaneous".

Alternatively I have a bet to see how many times I can get the word "spontaneous" into a single thread before anyone notices.
It's been along time since I dived. Three causes of fuecked lung. Spontaneous, Interstitual and lung bursting.
 
I had a pneumothorax from swine flu, and was permanently barred from military diving.

After about a decade, I asked again, and the advice I got was “you haven’t had one since, you should be good to go”. However, the consultant was clear that other consultants’ opinions may vary (but he cleared my med cat).
 

jinxy

LE
I had a pneumothorax from swine flu, and was permanently barred from military diving.

After about a decade, I asked again, and the advice I got was “you haven’t had one since, you should be good to go”. However, the consultant was clear that other consultants’ opinions may vary (but he cleared my med cat).
Docs can be a little contrairy. I had a mastoid op as a kid. One said you will fail the medical to get in the army. The other wisperd "what day is it" I answered correctly
 

The_Duke

LE
Moderator
Yep, thus the research. But unfortunately the advice to date I've had is "you've had condition B which we have no studies on, so here is the advice for condition A". Which doesn't inspire confidence either way, nor make a solid recommendation for any insurer. Clearly to an extent this is unavoidable with any new condition, just casting a net for any new information I've missed.

A private dive / respiratory medical seems like the best way forward.

On a separate note, perhaps I've just missed this insurance requirement. Thinking about it my diving in the last ten years has been in the Middle East, Africa or Asia, where I imagine they are less regulated than Europe or the US.
It isn't a requirement but a consideration.

A generic travel insurance policy will often include diving as a standard or by "tick to accept". This comes usually on the basis of "within PADI guidelines" or similar. If you do anything out of that and it goes wrong, you may have problems.

Divers doing anything outside of PADI Open Water may consider a more specialised product to get no-quibble access to hyperbaric chambers.

To give a rough indications, aeromed within Europe starts at around £10k and goes up very rapidly, long haul at £100k or more. Those figure will also be well out of date as I have not been closely involved with aeromed insurance for around a decade.

Dead is dead, but stuck in a distant hospital burning bills in the region of $2k per day - before aeromed - gets expensive fast.
 
Aware that this violates Newton's First Law of not asking for medical advice on the internet, but I thought given the various jobs and expertise here there might be an outside chance that someone could point me to some better professional resources than Google.

During COVID I had what was clearly a COVID prompted single pneumothorax (collapsed lung). The standard medical advice is that there are three types of pneumothorax: puncture (e.g. from a bullet); disease-induced; and spontaneous. Once healed and after a rest period (~12 months) puncture pneumothorax is not a bar to diving, but spontaneous is a lifetime bar. Disease-induced, however, is a "depends on the disease" case (which I understand from the one useful doctor I've talked to is a function of whether the disease acts on existing weaknesses in the lung, or creates those weaknesses.

Because I had COVID in March 2020 and the NHS triage system was flawed at best, it went undiagnosed for 5 weeks.* The eventual diagnosis treated it as a spontaneous pneumothorax, while acknowledging that it was caused by COVID. Because COVID was new, there is no option or research on the "disease-induced" elements of it, and so it's still unclear (I've asked doctors who are mostly unhelpful) whether COVID pneumothorax is a diving bar or not.

Two questions. First, although I can do my own Googling, has anyone had or heard of information or experiences relating to this and diving? Long shot I know. Second, since the problems with pneumothorax and diving relate to oxygen equalisation, free diving is still theoretically in - does anyone have any knowledge of or links to free diving resources which explain the differences in pressure / physics between free and air-breathing diving?

Again, fully aware this is a long shot, but military diving quals tend to be more comprehensive in the theory education part, and if you don't ask etc.

* Which, given subsequent figures for COVID pneumothorax of a 66% mortality rate with 100% requiring ventilation, and I achieved a 0% mortality rate with 0% ventilation, I'm going to categorise as getting COVID "like a boss", albeit a somewhat weakened boss who had to pause for a couple of minutes after every third step up the stairs.
Bahrain 64 I did a lot of diving, and the chest pain I had turned out just that, I spent 3 months in Muharraq RAF hospital and was sent back to his Jufair to finish of my tour,
then:
in well ages ago, I got it again, but worse and got sent to Bristol His where they cut me open and sewed up sma lesions in my left lung, three months away from the secret spy base,
since then no problems , but the surgeon on a check up said 'you will always know I have been in there,'
 

EddieVDog

War Hero
Spontaneous pneumothorax is indicative of a weakness in the lung structure which may or may not predispose the sufferer to further incidences.
To answer your question regarding the differences between free and sub aqua diving. In free diving, the participant takes a breath at normal atmospheric pressure (1 bar /14.7psi) upon descending the volume of gas decreases in accordance with Boyle's Law. When the diver ascend, the gas will expand, but never to more than the orignal volume, therefore theoretically, a reoccurrence of a pneumothorax will be unikely as there will be no overpressurisation of the lungs.
In sub aqua diving, the diver is constantly breathing gas at the ambent pressure. Given the average lung capacity of about 5 litres, a lungful of air breathed at 10m (2 bar absolute) would expand to twice the volume upon ascent to the surface if the diver held their breath. An overpressure of as little as 70mm Hg is sufficient to cause a pulmonary barotrauma, this equates to just under 1m of water, that's an idea of how delicate lung tissue is and why, if you've had a spontaneous pneumothorax, you really ought to heed Docs advice
 
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