swims. There may also be a genetic
component to IPE. In other words,
some individuals may have the
potential to develop IPE under
certain conditions, yet others may
never develop IPE even under the
same stress. Though there may be a
genetic predisposition, I have seen
and treated cases of IPE and then
returned the diver to full duty with
no recurrence. The diver went on
to complete identical dive profiles,
wearing the same thermal protection
and breathing the same regulator, but
never again developed IPE. Of course,
it may be that the circumstances of
the subsequent dives never matched
identically the IPE trigger (or triggers)
of the culprit dive.
Under what circumstances can
someone who experienced IPE
return to diving?
Bove:
One common problem is
excess hydration coupled with rapid
onset of heavy swimming exercise
on the surface. In triathletes who
develop IPE, excess hydration and
rapid onset of extreme exercise
while immersed should be avoided.
Military divers are instructed to
avoid overhydration before high-
energy swimming. Divers are
advised to ensure normal regulator
function and not to use regulators
that allow breathing resistance to
be increased. The majority of divers
can return to diving with proper
precautions and confirmation their
cardiac evaluation is normal.
Ebersole:
Unfortunately, very little
is known about the likelihood of
recurrent IPE once a diver has had
an episode. After an episode of IPE,
there is often spontaneous recovery
once the diver leaves the water. If
not, it tends to respond to standard
therapy for pulmonary edema, such
as diuretics. Whether or not a diver
should return to diving after an
episode of IPE should be determined
on a case-by-case basis. The decision
should be based on the physical
condition of the diver, a history
of hypertension or cardiovascular
disease and the type of diving being
considered. Obviously, shallow warm-
water diving in a young, healthy diver
who suffered a mild case of IPE is less
concerning than a middle-aged diver
with multiple medical problems who
wants to return to cold-water diving
after a severe episode of IPE that
required hospitalization.
Witucki:
An otherwise healthy
person who has experienced a single,
isolated episode of IPE may return
to diving once all symptoms have
resolved. This person should be
counseled that futures dives should
be aborted if they again develop
signs of IPE. Again, I have treated
many cases and subsequently
returned these divers to full duty
without recurrence. A person who
has known or potential cardiac
disease (hypertension, advanced
age, diabetes) and develops IPE is a
different matter. These people should
have further cardiac evaluation
prior to diving to make sure they
do not have heart valve problems
or underlying blockages in their
48
|
FALL 2011
RESEARCH, EDUCATION & MEDICINE
ONE THIRD Vertical Final.indd 1
9/6/11 12:26 PM
46-49_Expert_Opinions.indd 48
9/30/11