I am 54 years old, have been diving for just over 10 years and have been a DAN member for 9 years. I have always enjoyed good health (I am an AVIS donor), and I try to keep fit with moderate but constant physical activity. I suffered a deep vein thrombosis in my right leg, complicated by a pulmonary embolism, without any premonitory signs. I was rushed to hospital, where I underwent a series of tests that confirmed the nature of the condition. I remained in hospital for a few days and was then discharged, at the same time starting anticoagulant therapy, which was reconfirmed throughout the year, and I am now also wearing elastic stockings. On subsequent checks (ECODOPPLER and CT scan), the thrombus in the vein has dissolved, as has the embolus in the lung, and the venous vessel has recovered its functionality. During my hospitalisation, I was screened for thrombophilia on a genetic level, which revealed a mutation in the MTHFR gene (C677T variant), as well as other parameters such as coagulation factor VIII, LAC and ENA screening, which were above the normal range. According to my family doctor, I have had that mutation since birth, from what I understand it is quite common, but that alone does not justify the fact that I am predisposed to thrombosis. I recently re-did my blood tests, and they were normal, since my homocysteine was within limits, my factor VIII was within limits, and my LAC is over the limit, but by a very small margin. I did not repeat the ENA because the family doctor did not consider it appropriate. Basically, it is impossible to explain what triggered the thrombosis, also considering the fact that there have never been similar cases in the family. It certainly was not the scuba diving, since the last one was about two months before and although it was deep (about 38.00 metres), it had been carried out calmly, respecting procedures, the stops indicated by the computer and disposing of the accumulated DECO, without any embolic phenomena in the following hours. In view of the fact that the doctors at the hospital had told me categorically that I would not be able to dive any more, I am asking you: In light of the investigations that have been carried out, do you think that the situation has normalised and that I can resume diving, perhaps even with appropriate precautions? Even if I have to continue anticoagulant therapy for life, as many people claim, could this adversely affect diving? Could a period of incorrect lifestyle, in terms of bad eating habits or incorrect leg posture, which slows down blood circulation, be the cause of the illness? It is clear that if I start diving again, I will do so gradually, as is only right.
ANSWER FROM DAN EXPERTS
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column el_class=”page-text”][vc_column_text]As previously announced, we confirm that a homozygous mutation in the MTHFR (methylenetetrahydrofolate reductase) enzyme, variant C677T, is relevant. This congenital mutation must be considered as a factor of possible increased susceptibility to decompression sickness, which must therefore be prevented by including, in due course, the choice of safe dive profiles both from the point of view of decompression stress (dives without the obligation to deco, no more than two dives a day, depths within 25 metres, bottom times within 75% of the maximum allowed, possible use of Nitrox with calculated dive times for compressed air), and of the production of circulating gas bubbles. It is also essential to act with pharmacotherapy and by implementing lifestyle modifications; surely it can only be to one’s advantage to have resumed exercise. Clearly, as long as thrombotic pathologies of this kind and entity are active, diving is absolutely not recommended. From the moment the pulmonary pathology is cured with full restoration of normal lung function even under exertion conditions, the peripheral venous pathology is either totally resolved (clinical evidence of recanalisation of the vessel(s)) or completely stabilised with restoration of venous return efficiency, and it would also be desirable to have terminated anti-coagulant therapy, with a return to normal coagulative parameters (a condition that is already in place at the moment), the resumption of diving can be considered, naturally through a complete and thorough fitness assessment by a diving and hyperbaric medical specialist. Considering the attainment of the normal range of coagulation parameters, if he should continue to take anticoagulant therapy for life, we do not see this as an absolute contraindication to the resumption of diving; nevertheless, it is important to take into consideration the possible haemorrhagic risk, which could aggravate any possible dysbaric damage (barotraumatic as well as decompressive). Finally, we feel it is necessary to inform you that the homozygous mutation of the MTHFR enzyme exposes you to a susceptibility to oxidative insult, significantly exposing you to a condition of low-grade inflammation, especially in the intestines. This can be reflected in the onset of the so-called metabolic syndrome (overweight, hyperglycaemia, hypercholesterolemia, high blood pressure).
This means that incorrect eating habits, prolonged drug intake and prolonged stress can trigger inflammatory phenomena and generate, for example, a thrombotic response. In this context, it is essential to adopt an appropriate lifestyle in order to reduce oxidative stress and, if necessary (always under specialist medical guidance) take specific measures to this end. We remain at your disposal for any further clarification.[/vc_column_text][/vc_column][/vc_row]
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