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Diaphragm paralysis

Thread Status: Hello , There was no answer in this thread for more than 60 days.
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Haydn

Well-Known Member
Apr 23, 2004
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I have now had two heart opperations to fix atrial fibrilation. The last one being 9 months ago was totally successful and I have now got a great heart, it feels so obviously better. However, during the operation the surgeon froze the phrenic nerve. This nerve controls the diaphragm, and half my diaphragm was paralysed in full exhale position. This complication was said to take between 6 and 18 months to recover from as the nerve repaired itself during its period of inactivity.

Tests last week have confirmed that my diaphragm is now fully functioning and my surgeon said I could once again breath hold and freedive (after two years). So it was off to my doctor to get my medical signed. Unfortunately, my doctor is not a diving specialist and was not happy to sign my medical for diving, although he encouraged apnea and dynamic training in order to kick start the strengthening and awareness processes prior to getting deep. Depth could start after a period of preparation through training. When I am prepared to dive (and need a signed document to compete) , he will be happy to sign the medical.

The issue he has with signing the medical is quite unique. Because my diaphragm was paralised, it may now be very weak and may not have the strength to withstand pressure at 50m. If there is insufficient strength to hold the breath at that pressure, the result could be an involuntary reflex causing a full exhalation. This of course could be fatal as suddenly, I would become much more negatively bouyant at the same time as dumping the O2. The return trip would be very difficult, especially in an untrained state of ability. Of course, there is nothing to say that any failure of the diaphragm may happen at 25 or 30m.

Secondly, the diaphragm may not be weak depending on my training of it and therefore strengthening it sufficiently. However, in this case, although it might be strong, it nevertheless may have an inherrant weakness if nerve function only repairs to an 80% fix. I would then be diving with a damaged (although working) diaphragm.

His solution, is to test the diaphragm in a hyperbaric chamber, to see if I can hold a breath at 50m conditions. If successful, he would clear me to start constant weight training and I would take the role of a novice freediver and maybe take a year or so to get below 50m. It would be ill advised to go deep straight away.

So, its off to Plymouth on the National Health Service for some unusual tests and in the meantime, I can at least get wet again.
 
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Great news Haydn. Remember it's not the ultimate destination, it's the journey that's important.
 
Sounds like complete rubbish to me. No muscular effort is required of the diaphragm to 'hold the air in' at depth. Or on the surface, for that matter. It's your throat that does that. In fact, if you were able to voluntarily exhale more than a few hundred mls of air at 50m you'd be doing very, very well!

Oh and way to go re having a heart op and getting back into freediving :)
 
1. Air is generally held in by the epiglottis, not the diaphragm

2. Beyond 35m, the negative pressure in the lungs tends to cause an INHALE rather than an exhale

3. Doing an FRC dive, negative pressure at all depths tends to cause an inhale rather than exhale.

Glad to have you back in diving again...
 
Congrats to the return and improved health, Haydn!

Beside to what was told by others above, also the test in the hyperbaric chamber will not prove anything. You would have to hold you breath before they start increasing the pressure and hold it until the full pressure of 6 bars (50m). That could be pretty dangerous, because blood shift would likely not kick in as easily as in water, so the negative pressure could damage your lungs much easier than at real dives. Besides it, when diving, you usually do some warm ups before going to 50m.
 
Others have already commented on the mechanics, so I'll just say that I find your story and getting above such difficulties truly inspiring.

I hope it goes well for you and I'm sure I don't need to remind you to take it easy at first.

To me it would make sense that strengthening the diaphragm would happen by using it. So what I would suggest (obviously not being a doctor, but obviously not every doctor really understanding how bh-diving works) - is loads and loads of very light aerobic exercise (walking, light jogging, swimming)? I mean of course if your heart really is up to it!

Also dry breathing exercises alternating with full inhale/exhale and (at the beginning very very mild and conservative) diaphragm stretches would likely benefit you a lot and build up confidence.
 
I thought as much. When the doc was explaining to me, I thought that a dive just doesnt feel that way and there is no effort at depth in the physical holding of breath. It is just that I expect I am the only freediver ever to have a paralised diaphram. So taking the comments into account, I expect the chamber guys will explain to the doctor that the idea is pointless.

As far as past training is concerned over the last two years. Since the heart problem became serious, I was unable to use a monfin as the effort would simply puff me out with insufficient O2 reaching the brain due to very rapid, irregular and weak heart beat. So I switched to bi fins and just fin kick on the surface for miles, with my raft. I have done no breath holding whatever, as the area of the heart which is stressed by breathold had atypical flutter and the surgeon didnt want me stressing it. Since the last opperation, my heart now delivers great O2, but I still got puffed out simply because the diaphram was rubbish and only allowed passive breathing. In the summer I did do a 10 metre dive and could not gasp in air back on the surface, it was scary getting my breath back with only normal breathing. I have done no diaphram stretching either, as the whole recovery process was natural and I did not want to undo any mending that was going on.

I am really excited about the prospect of freediving again and cant wait to see whether I have found the answer to why I could do 156m dynamic with only a 4:25 static. My thoughts are that as a swimmer I have natural feel for motion through the water and the technique was efficient when the heart beats a little higher, but at tick over or less (during a static), my heart was like a misfiring car engine and gave poor performance. I wonder what it will be like once I have regained my fitness.

Keep the replies coming, so that I can reproduce them for the doctor. Thanks guys.
 
It's great to hear your return to good health and freediving! I'm excited for you.

I agree with the comments above, that at depth you would be very unlikely to let any air out due to your reduced lung volume. Doesn't the diaphram get -for want of a better word- 'sucked in' because of the reduced lung volume anyway?
I'm sure that doing pool practice and slowly incresing your depth in a safe environment would be much more useful than the pressure chamber.

Congrats again!
 
Hi Haydn
How is your diaphragm now? I note this is an old post.
I'm a scuba diver who now has a paralysed right hemi-diaphragm due to phrenic nerve damage - it's been over 2 years and although there has been some improvement it's not significant.
I note your concern was that you would end up with a full lung full of air - it's my understanding that the 'at rest' position of the diaphragm is when it is high, rather than low, so the difficulty would be a lack of lung capacity rather than an uncontrolled excess.
I have also experienced diaphragm failure underwater three times. I wasn't deep either. Prior to the problem I would dive to 50 metres without difficulty. After my phrenic nerve packed in I experienced breathing issues at 6 metres! I came to the surface on the first dive, after acting as back up for my husband who was conducting a lesson. I told him it was really difficult to breath and I'd basically been hanging in there really quite stressed, taking lots of breaths. We decided there was something wrong with my regs so we swopped me onto a spare set. Second dive (about 2 hours later) and I was ok stationary at 5-6 metres but when I finned off to take the students on a bimble at around 8 metres there was no air whatsoever, I was breathing in and out but felt like my tank was empty. Very scary so I binned off the dive. On the surface everyone decided I'd had a panic attack (which was really unhelpful but to be fair by the time I was topside I was panicking). The following week my husband and I decided to go for a dive without students just so he could prove to me that it was a panic attack. We did a slow descent but at 8 metres it happened again I communicated this to my husband and he told me to 'stop and calm down' The communications between us wasted my remaining oxygen and in the end I ignored him and started to ascend, unfortunately ascending did not improve things. I started to fin up but using my legs zapped me of all my energy and I nearly passed out - at around 4 metres I pressed to inflate my jacket and was relieved to find myself on the surface and breathing, even if it was only rubbishy breaths. I had to be 'rescued' and dekitted as I was in such a state with my breathing. Subsequently my diaphragm paralysis was diagnosed (several months later and only after everything else had been ruled out) and my respiratory doctor has explained to me that what I experienced was paradoxical breathing whereby my left diaphragm, in an attempt to compensate for the right diaphragm that is weak, pulls down hard and in doing so actually pulls up the right diaphragm - as a result of which the chest capacity does not alter and no air is dragged in. It is really quite scary when it happens. I've had it happen twice on dry land too - by exercising too much - the recovery is several minutes during which I feel like I'm going to die.
It's now almost 2.5 years since the incident which knackered my right phrenic nerve - I don't know when or if I will ever be able to scuba dive again. For non divers that might not seem important but to me it's a huge part of who I am, my marriage and my friend circle are all around diving. I've been on 3 liveaboards (all booked prior to the damage) and not dived - which was awful, but this summer my friends and husband went without me and that was even worse.
If anyone has any information on how to strengthen a weak diaphragm please let me know. The only options I'm aware of plication (which I don't think I could breath after?) and replacement of the phrenic nerve, which may or may not work and would take around 2 years to kick in effectively - and I don't think the docs will do that anyway because symptomatically there has been some improvement.
Any ideas?
 
Where I've said I wouldn't be able to 'breath' after plication I meant 'dive'. Thanks
 
Where I've said I wouldn't be able to 'breath' after plication I meant 'dive'. Thanks

Great account Peej. I remember coming home from hospital after the operation but before the nerve damage had corrected itself. I went swimming with a friend and we each had a non swimming child with us. They would swim a little and then rest on our backs as we all swam out to a bouy. Somewhere around 400 meters offshore the kids got more tired and we had to swim back in with them. I thought I was going to die as I couldn't breath at all, once swimming with a child on my back was needed. My diaphram has stayed well behaved since the operation many years ago now. I would say recovery was nearly as full as before the paralysis. But I have only freedived a few times since. Kind of switched back to long distance swimming.
 
I realize these posts are several years old but wanted to comment and mention by case. I am a 71 year old retired cardiologist who developed a paralysed right hemidiaphragm 2 years ago. After an extensive workup it was felt to be either viral or idiopathic (meaning no identifiable cause). It has not improved and is not likely to do. My freediving (recreational spearfishing to 40 feet/12 meters) is essentially gone. There are no exercises to improve a paralysed diaphragm but one can try to strengthen the other respiratory muscles thru resistance inhalers. I am still active an able to bicycle at least 60 miles quite vigorously but the multiple problems with diving (prone position, hydrostatic pressure of water, weight belt, wet suit) make freeediving nigh on impossible. I am thinking of going back to scuba (I used to be an instructor) but am put off by the posts of problems there as well. Anyone with any thoughts or experiencer would be appreciated.
 
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