Diving with lung condition
hspace=5 My husband was diagnosed with cryptogenic fibrosing alveolitis, but eight months later his lung-function tests show that, thanks to various medications, he seems to back almost to full health. Is a return to diving possible - even if limited to shallow depths (12-15m) around the UK
Evelyn


The exact cause of cryptogenic or idiopathic fibrosing alveolitis is not known (hence the term idiopathic). It was once thought that inflammation within the alveoli (the gas exchange area of the lung) was the main cause, and that this led to scarring
and fibrosis. However, treatments that help to reduce inflammation are not always effective, so the role of inflammation has recently been called into question.
The current thinking is that somehow the cells lining the alveoli are damaged in some way, and then try to heal themselves. But this healing process gets out of control, causing thickening and damage to the alveoli walls and fibrosis (scarring) of the alveoli and lung tissue.
Thickening and scarring reduces the amount of oxygen that can pass into the blood vessels from affected alveoli so, as the disease progresses, less oxygen than normal is passed into the body when you breathe. Treatments are often steroids, immuno-suppressants and combinations.
The condition can stay quite stationary and cause little problem, or it can progress enough for the person to need supplemental oxygen.
This is a serious condition for a diver to have. The scarring could lead to air-trapping and increased risk of pneumothorax and CAGE, and the drugs used for treatment can also cause problems.
If the condition is extremely mild, stable and off medication, and your husband is fully assessed with spirometry and chest scans, he might be able to dive, but the long-term outlook for diving may not be good. He would need a thorough assessment with
a diving doctor, and would be expected to have regular medicals and follow-ups.

Hole in the heart
My 10-year-old grandson did a try-dive in the swimming pool and loved it, but he has since had surgery to repair a hole in his heart. He now has full health, but will he be able to dive
Alan


This is impossible to answer without all the details. A hole in the heart can mean several different things and can have different consequences depending on where it is, and whether it has caused or been associated with other heart problems.
One of the commonest holes in the heart is that between the two upper chambers (the atria). From a diving point of view this is significant, as it causes a right-to-left shunt, allows bubbles into arterial circulation and can cause an air embolism (the same as a PFO, but worse).
That said, if the hole is repaired, and there is no other damage to the heart, diving would be possible. Your grandson would need to see a diving doctor armed with all available medical and surgical data.
It may be necessary to have a bubble study done to ensure total closure, and that there is no right-to-left shunt that might increase his risk of DCI.

In the know
Last March I had a coronary stent fitted for a blocked artery (not a heart attack, and I have been told that there is no disease to the heart or arteries). I am 53, have been diving for 12 years and had always been relatively fit. I now have to take an aspirin and Simvastatin, as well as Omeprazole for a separate condition, hiatus hernia. Is it OK for me to start diving again

Ironically, you could be regarded as being in a better situation than most 53-year-old men. At least you know what your coronary arteries are like, and have had the defect corrected. Most of us will not know what were doing until something goes wrong.
You will need to have a medical with a diving doc with the results of any investigations and details of the procedure. I would also insist on an echo-cardiogram and a post-stent exercise ECG. If everything is OK, you may well be fit to dive.

Unlikely to happen
I have long-term perforations to both ears - basically holes that will never heal, caused by measles about 40 years ago.
A taster dive in a swimming pool on holiday has given me the urge to do more, but what are the implications if I go ahead
John


You should not dive with perforations. Water would be able to get into the middle ear, and could cause serious infections and hearing damage. Potentially, infection could even spread to the brain.
Even the special masks that cover the ears are not reliable enough for this purpose. The only way you could dive would be through successful closure of the perforations with a graft.

More on scar tissue
I am a Rescue Diver, 46 and in good health. A year ago, I underwent an L5/S1 micro-surgical discectomy operation to correct a prolapsed disc injury. It was a great success and I hope to return to diving shortly, so took great interest in one of your previous responses, Scar Tissue And DCI (May 2008), in particular your comment about being cautious in diving following back surgery. Could you enlarge on this topic, and suggest measures to alleviate any additional risks

It is difficult to enlarge on a topic that is largely theoretical rather than evidence-based, but here goes. All scar tissue tends to have poor blood supply, and to disrupt local tissues and blood vessels as it ages and contracts. The original injury itself can do similar things.
The risk with diving is that this disruption could cause problems with on- and off-gassing, leading to a potential increase in bubble formation. Peripheral injuries are not thought to be a problem, but there is concern regarding spinal surgery due to the increased blood supply, the nerve-rich area and the risk that small disruptions could have major effects and increase the risk of spinal decompression illness.
As far as I know, this risk is not backed by any evidence base. However, I usually recommend adding in extra safety factors.
This would include hydration, physical and mental preparation for diving, extra tolerance added into the dive computer and the use of nitrox on air tables.

HRT and diving
I am 55 years old and have been on hormone replacement therapy (HRT) for 15 years. My doctor has advised me to take aspirin when flying, but do I need to take any special precautions when I go diving
Julie


There is a small increased risk of venous thrombosis and breast cancer for women on HRT, especially as they get older. Dehydration and circulation-restrictive dive suits could also theoretically increase the risk slightly.
The risk with diving is too small to quantify, and I would certainly not recommend any extra precautions. Aspirin is a drug that reduces the stickiness of platelets and helps to reduce the arterial clots, but there is little evidence that it helps to reduce venous clots. Indeed the aviation industry does not now support the use of aspirin in clot-prevention in flying but rather exercises, hydration, compression stocking and, in high-risk passengers, low molecular-weight heparin injections prior to the flight.

hspace=5 Malaria precautions
Im going diving in Kenya, and need advice on which malaria medication to use. I am also diabetic, and take 1500mg Metformin tablets daily.
Mel


There are two issues here: the diabetes and the malarial medication. The diabetes needs to be properly assessed by a diving doctor. The medication you are on does not produce any risk of hypoglycaemic (low blood sugar) events, but diabetes
itself increases the risk of cardiovascular (heart) disease and complications.
This risk needs to be assessed, together with your diabetic control.
As far as the malarial medication is concerned, as long as larium is avoided, other medications seem to be safe for divers. Remember, however, that no medication is 100% effective, and other precautions to prevent being bitten should be taken: long sleeves, avoiding skin exposure at dusk/dawn, mosquito nets and so on.

Chest pains
A year ago, I had pleurisy. I had two chest X-rays and ECGs to make sure that I was clear of the illness. Recently I had another pain attack on the same side, the top right of my chest. I had recently taken Amoxicillin and 500mg of Co-codamol for my illness, but feel Ive not had the correct medication. I have had a little pain since then, and feel wary of returning to diving.

Pleurisy is an inflammation of the lung lining giving rise to a sharp pain that is classically worse when breathing in deeply. The cause is usually infective, either bacterial or viral, but can also be caused by trauma, lung disease or clots on the lung.
Although painful, the condition (provided it is infective) is not usually too serious and responds to antibiotics, painkillers and time. It does not usually leave any significant damage, although I have seen people more susceptible to pains in the area after.
From a diving angle, it would be worth getting some lung function tests and, if you smoke, to stop. If the tests are normal, I would expect you to be fit to dive.