Packing: GI causes lung injury in trained breath-hold divers

[Lil Dragonfly]

The real question is, will this lung damage from packing harm one's freediving abilities (either short-term or long-term).

As for health problems that will not hurt her freediving, Lil D doesn't give a rat's ass.

 

[Lil Dragonfly]

Do they do any freediving studies in the USA? Ooh...free money!

 

[B-J]

I agree that they need more subjects. I was the lucky one in the norwegian study that doesn`t seem to "leak" any air. And I`ve done very, very many max packing breathholds. I also do packstretching and often get sore in my throat and chest afterwards. But after two times in the CT-machine in the Norwegian study they didn`t see any bubbles in my chest.

For every time you leak air you will get scartissue on your lungs I presume, and this weakens your lungs. At least in commercial diving a previous pneumothorax usually means you can`t dive for the rest of your life. I was told this was because when you get scartissue on your lungs they are weakened. Can anyone confirm this?

 

[efattah]

Could this air leaking explain some causes of squeeze? After all, packing makes squeeze way more likely.

 

[fpernett]

Could this air leaking explain some causes of squeeze? After all, packing makes squeeze way more likely.

I was thinking the same.

As a lung squeeze is a pulmonary edema associated to immersion, any failure on alveolus-capillar barrier will make alveolus flooding more easy.

I started to have lung squeeze almost at the same time that I started lung packing.

 

[Haydn]

How is Dominique? Thats the real issue. Has he fully recovered?

 

[efattah]

How is Dominique? Thats the real issue. Has he fully recovered?

Dominique Ventzke's accident was in 2005. He recovered in a couple of days, fully. However if he had not been rushed to the emergency, who knows.

In my opinion there is a big difference between mild packing, moderate packing and extreme packing. Today I was diving and I was carefully 'sensing' the area in the middle of my chest. I found that when I passed 35-40 packs, I suddenly felt a strange, subtle feeling in the middle of my chest. I would not notice it, unless I was checking for it. Perhaps this is the 'air escape.' If I packed 30 times I would not get the feeling. 55 packs is my max.

 

[Chrillepille]

I totally agree with Goran. Competitive sports at high levels are usually associated with high risk of injury. It is up to the athlete to figure out how to deal with the risks, how to make it safe. If one way of diving causes injuries, then maybe you have to either need more training to be able to dive that way, or alter the way you dive. Coaches, event organizers, federations and scientists should partake in this evolution as well and discussions here at DB are very helpful.

In my opinion freediving is still very diverse in ways of diving style and physiques of the divers. Thus, the way of handling risk of injuries is probably also very personal.

For those who understand swedish, here is a short documentary about the former swedish dyn-record holder. During an easy warm-up dive he lost all motor control but not the consciousness after about 50 meters. Since it was an easy dive (for a 200+ guy) the security was not rigorous and it took a while until he was noticed and picked up. During that time he was fully conscious but not able to move at the bottom of the pool. Here he talks about his fears of diving after the accident:

Take care!
Christian

 

[stingaree]

But after two times in the CT-machine in the Norwegian study they didn`t see any bubbles in my chest...
For every time you leak air you will get scartissue on your lungs I presume, and this weakens your lungs. At least in commercial diving a previous pneumothorax usually means you can`t dive for the rest of your life. I was told this was because when you get scartissue on your lungs they are weakened. Can anyone confirm this?

Theoretically this should be the case. However, I think the real issue here is that NO DOCTOR IN THE WORLD would ever take the risk of giving O.K. to dive on compressed gasses to a diver with any pneumothorax history just to cover his/her back, regardless of the origin of the accident or likelihood of its reoccurrence. The scar very often doesn't even appear on CT and I also heard a few physicians saying that the scar tissue can make the affected area stronger than prior the incident. At any case, sp. pneumothorax ends any SCUBA diver's career, full stop. It ended mine.

 

[trux]

Another study about packing just popped up on the RSS feed at APNEA.cz, and although it does not speak about lung damage, it can be worth of reading for those interested in this topic:

Lung perfusion and chest wall configuration is alt... [Eur Respir J. 2010] - PubMed result

... Registered CT images determined change in the volume of the thorax. CT and perfusion comparisons were possible in four subjects. Lung perfusion was markedly diminished in areas of expanded lung. 69% of the increase in expired lung volume was via thoracic expansion with a caudal displacement of the diaphragm. One subject who was not proficient at glossopharyngeal insufflation had no change in CT appearance or lung perfusion. We have demonstrated areas of hyperexpanded, under perfused lung created by glossopharyngeal insufflation above TLC.

 

[Spearo_the_Hero]

interesting stuff.....I do prefer packing myself and maintain only light to moderate amount of packing of about 12-15 packs as compared to some other guys here such as the master, Eric F.

It seems to help and I'm sure with regular familiarity the body adapts and strengthens. Ones own body should provide feedback. A few packs can't seem to hurt at all and seem to add a performance advantage to the depth of the dive for deep diving causes lung compressing and packing offsets it by providing the inflation to handle the dive, at least for me. Also I seem to get more relaxed faster probably due to the extra influx of oxygen to the blood and brain.

 

[timm]

Out of interest I was one of the 3 divers where the leak had gone a week later with the TLC hold. I wasnt fully packed, I think I did 10 - 12 packs, which is around 1L, I have done more extreme packing upto 25 - 30 for STA but this was a few years ago. I pack for DYN (15ish) for o2 and buoyancy, STA(for o2 been a while but was doing 20 - 30) and CW (for Eq, am changing/backing off next year and working on technique instead but used to do 20).

On the squeeze front, I have been squeezed in the past, and think this could be related. If you get a tear on the surface while packing, I would assume that is now weaker and more prone to further tear at depth or with over expansion on return.

Unfortunately I really quite enjoy the feeling you get with packing its makes to a rather enjoyable first length or so!

Tim

 

[Rik]

Okay, what do you think of the next article from 1982. It is important to note that the article discusses an autopsy with pictures.

Can pulmonary barotrauma cause cerebral air embolism in a non-diver?

 

[trux]

Another related study, this time studying a long term effect of GI. In the abstract they do not speak about short-term or long-etrm damage mentioned in the above quted studies, but the concluded that GI does not permanently alter pulmonary distensibility or impair ventilatory flows and volumes.

Breath-Hold Diving: Respiratory Function on the Lo... [Med Sci Sports Exerc. 2010] - PubMed result

 

[trux]

Another new study about packing. It's not really about GI induced injuries, but just about packing blackouts, so slightly off-topic. However, since packing blackouts are not something unknown to freedivers, and something that would deserve an independent new thread, I am posting it here:

Glossopharyngeal insufflation induces cardioinhibi... [Clin Auton Res. 2010] - PubMed result

Apnea divers increase intrathoracic pressure voluntarily by taking a deep breath followed by glossopharyngeal insufflation. Because apnea divers sometimes experience hypotension and syncope during the maneuver, they may serve as a model to study the mechanisms of syncope. We recorded changes in hemodynamics and sympathetic vasomotor tone with microneurography during breath holding with glossopharyngeal insufflation. Five men became hypotensive and fainted during breath holding with glossopharyngeal insufflation within the first minute. In four divers, heart rate dropped suddenly to a minimum of 38 ± 4 beats/min. Therefore, cardioinhibitory syncope was more common than low cardiac output syncope.

 

[Rik]

Re: Breath-Hold Diving: Respiratory Function on the Longer Term

I have read the original article, and it has its pro's and con's.

The article discusses the results from an heterogeneous group of divers during a three year follow up, which is pretty long compared with other studies. The lack of a difference suggests that GI doesn't have any positive or negative effects to the lungs over a relative short time. This can be seen as good news in relationship to some of the other articles.

What the article lacks is proof that the GI maneuvers where effectively performed. Previous research has shown that packing doesn't have to add up to the volume of the lungs if the diver doesn't do the maneuver right. Also does the article lack information about the "exposure" of the divers. Someone who uses GI only once a week can not be compared with someone who uses it daily. The third aspect is that lung fibrosis or lung emphysema might only develop after several more years of exposure and that the measurement of lung volume might not be the best method to measure lung damage within freedivers performing GI.

This article can convince me that GI might have less negative side-effects as previously was expected. It however doesn't convince me yet that GI is a safe method to be used frequently in recreational and competitive freediving.