Median Arcuate Ligament Syndrome

[BennyB]

Hi all,

I need some help from the more medically minded folk on DB or those that are pretty handy at research (i'm looking at you Trux!).

I've had a lot of abdominal pain in the last 3 weeks and after a series of misdiagnosis's, almost having my Gall Bladder removed, an ultrasound yesterday and today a CT scan revealed that the likely culprit is Median Arcuate Ligament Syndrome [ame=http://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome]Median arcuate ligament syndrome - Wikipedia, the free encyclopedia[/ame]. This involves the Median Arcuate Ligament (which is attached to the base of the diaphragm) compressing the celiac artery which is the first branch off the Aorta supplying blood into the abdominal area, which causes abdominal pain. This compression is particularly noticeable on the CT scan when I was exhaling as the diaphragm is pushed upwards.

My doctor, the two radiologists and my mum are all convinced that freedive training has played some sort of role in this condition occurring, in that extensive diaphragm training may potentially bring it on. It's been a few months since any serious diving and i've only done a handful of 20-30m dives in the last 3 months since then.

Does anyone have any knowledge of this condition? Specifically, have any freedivers ever had it? The doctors (and me) are pretty interested to know if freediving would set it off. Has anyone been treated for it and had any further diving implications?

Would appreciate any light the DB community can offer. So far it looks quite treatable with simple keyhole surgery.

Cheers,
Ben

 

[podge]

Benny I know bugger all about the medical world but I wish you a speedy recovery form yer ills mate.

 

[Rik]

To my knowledge of the literature, this has not been previously described within freedivers. It is possible that it is unrelated, but median arcuate ligament syndrome is also easy to be overlooked. To make it more difficult, the ligament can be there without causing symptoms, making it only an positive find if the complaints can be directly linked to the existence of the radiographic proof of compression syndrome.

You might ask the physician if it is possible to do several breath-hold exercises and see how your diaphragm relates to the ligament. I don't know which hospital you are attending, but I do know that the physicans at the Concord Repatriation General Hospital have some experience in performing radiological research on freediving. Dr. Peters of thoracic medicine was involved in two recent breath-hold diving studies related to glossopharyngeal insufflation (packing).

 

[trux]

Hi Benny. Sorry to hear about your troubles. Frankly told it is the first time I hear about the syndrome, but what I understood after looking at some articles, I do not think it can be created by the diving (or a diaphragmatic exercise) alone. I understood that first of all there needs to be a predisposition - the position of the ligament vs. position of the aorta branching. Some sources tell 10-20% people may have this predisposition. Once the predisposition is there, the diaphragmatic exercise and the strengthening of the ligament can indeed aggravate the syndrome. That's my understanding of it, but I am no expert, so do not take my words for given.

When looking it up, I did not find any documents associated with diving, freediving, breath-hold, or even yogic exercises (and I looked for non-English articles too). However, there were several references of athletes who were able to return to competitive sport after the operation.

Wishing you good luck and quick recovery in case you decide for the operation

 

[BennyB]

Thanks for your input and your kind wishes guys.

Rik I think they've done all the testing they need to now - during the CT scan they took images on full inspiration and full exhalation however they were nowhere near full inhale or full exhale. I live in Brisbane nowdays so getting down to Concord Hospital (Sydney) isn't really an option. I know of the people you're talking about though, I was one of the participants in their Glossopharyngeal insufflation studies back in 2004/2005 - interesting stuff.

PM me your email address and i'll send you the pic of the CT scan showing both inhalation and exhalation, it's quite interesting. My GP also suggested that researchers might want to do further checks on me because it is quite rare - hopefully this isn't some sort of evidence suggesting that freediving is bad for you! In any case i'm glad there doesn't appear to be any published link between freediving and MALS.

Cheers,
Ben

 

[Rik]

Dear Benny

Well, like Trux suggested, there should be a lot more people with MALS if there would be an direct relationship. Freediving is certainly not a cause. In theory it could have an influence, but we will need a lot of freedivers with MALS to statistically proof that.

What might be interesting for the researchers is to combine both CT's to find any differences. There is a chance they are not compatible, due the used technique or the used window size, but it could be an idea for the physican who would like to write about it.

Please let us know if you decide for the operations and how your recovery will be.

 

[Donna]

Hang on, haven't you been growing that furry thing on your face for the last few weeks......could that be more than just a coincidence

Of course I'm joking....sorry to hear of your troubles, wishing you a speedy recovery x