Pneumothorax questions

[bk94 0]

Hi all,

Im currently in the hospital with a small pneumothorax (and some clinically cracked ribs) that we think was the result of a hard fall onto the chest. I'd be interested in hearing from any other skydivers/doctors of skydivers that have experienced this as we try to sort out what to do. I'm not asking for medical advice but simply trying to see what resources/experiences might be out there as we make this decision. My doctors are great but they haven't found much (if any) published data on pneumothorax issues (particularly trauma not spontaneous) with skydivers. They've contacted a flight surgeon who has given some advice relating to spontaneous pneumos and we have other advice relating to trauma pneumos with non-skydivers but apparently I am somewhere in between.

The doctors have said that it is small enough that they would have sent me home to see if it would resolve on its own but that since I'm an active skydiver they reccommended trying to fix it faster. We started with a chest tube which worked until we took it out, then lung partially deflated again. Now we are looking at either doing nothing or moving on to surgery. Skydiving isn't everything...but yet it is! :-) The "go for it" part of me says, let's fix it. The rational part of me says, "Why put your body through that when there are no guarantees and it COULD still heal on its own even if it isn't as fast as I'd like" ;-)

I've PM'd Beachbum and read his threads....anyone else?
Thanks!
Brenda

[dugy 0]

Before did my first jump and found out about the skydiving forums I asked this on the local bike forum and go the following reply.

***hmmm dugy well I have had lets see mmmm 5 on the right lung and 3 on the left and stil jumped out of planes

oh and 2 on the right were punctures not spontaneous


I had a spontaneous one that didn't stay up and I had to spend a week in hospital connected to a suction pump.

[GLIDEANGLE 1]

Thoughts:

1. Don't go to surgery without an INDEPENDENT second opinion.

2. Ask ALL your docs about what your options are regarding the following rather than conventional open surgery:
--video-assisted thoracic surgery (minimally invasive)
--Chemical pleurodesis (If you go this route be damned sure that your doc has planned adequate pain control for you, and that more is available if you need it.)

Good Luck,

Jim McGraw RN

The choices we make have consequences, for us & for others!

[Broke 0]

The sky will wait.

Are you willing to risk your lungs. Take your time and do not jump until you are 100% healed up.

We skydive to experiance life, but you need life for it to be experianced.

Divot your source for all things Hillbilly.
Anvil Brother 84
SCR 14192

[bigorangemd 0]

Need to know what percentage in pneumothorax is. around 20% or less should resolve without doing anything. After it has resolved for a week or so, won't be a risk of redeveloping, however jumping with broken ribs HURTS! Usually takes about 6wks before most people are comfortable enough for opening shock. Good luck.

[dugy 0]

The doc that operated on me said no flying for 3 months.
(And no scuba ever.)

Was a few years before I got into skydiving.

When I went back and asked a few different doc's about skydiving they were all very non-commital in giving an answer.

[gravitysucks 0]

This should be well within the scope and understanding of any competent flight surgeon. I agree with the above statement that it would be quite prudent to get a second opinion before proceeding. Many people have "stable" pneumothoraces and most of the patients I have seen with atraumatic pneumothorax which required surgical repair did not have 100% long term success with this.

Bear in mind that as you ascend in altitude, any preexisting pneumothorax will enlarge. The air pressure in your lungs will decrease as you ascend, causing a relative increase between the pressure in the pleural cavity and the pressure in the lungs and thus the increase in size of the pneumothorax. It may not bother you for a hop and pop, but depending on the size of the pneumo may cause serious problems at full altitude and I'm not sure the effect it would have on a recently repaired pneumothorax. I would plan on tabling my jumping activity for quite some time, if not the rest of the summer.

Disclaimer: I'm not a suregon, flight surgeon, or pulmonologist. Just some food for thought and not to be construed as medical advice. Hope it helps.

[hangdiver 1]

I had a Pneumothorax when I was 21 due to a motoX accident. The bike in front of me crashed I drove right into him and over the bars. That was in the first turn with 23 bikes behind me. I curled up and got run over about six times with a tire burn on my the right side of my back. I got up and finished the race. Dumb! Felt like an elephant was standing on my chest. The doc called everyone on duty that night when I was in ER, to come and look me over. He said they would probably never see a live patient with as much air in their chest cavity and still be alive. I had so much air in my neck it sounded like popper paper. No lung collapsed, spent two days in the hospital on IV antibiotics watching to see if my lung collapsed. Doc said right bronchial tube had postage stamp size tear?? I had no broken ribs. I was released after day two, was told not to do anything strenuous for six months and it should heal. That I did. I pretty much forgot about it after that. I raced motoX after that, hiked my hang glider to the top of 1,200' mountains, 3,000+ skydives, racing cars and mountain biking. I am now 55 with a screwed up back from lifting to much but lungs are fine. Oh and crashed everyone of those I mentioned including a swoop gone bad that I miraculously walked away from, ok, limped.
Good Luck

"Mans got to know his limitations"
Harry Callahan

[bk94 0]

Hi all,

Thanks, thanks, thanks for all the advice. My husband talked the docs into letting me out of the hospital a few nights ago. Another scan today shows a slight improvement in the pneumo so we are hoping that the air there now was caused when they pulled the chest tube and not a continued leak and therefore we are not going to consider surgery at this point. We are going to play the "wait and see" game with another CT scan in about 3 weeks.

Glideangle - three different trauma surgeons throughout my stay had three different opinions on course of treatment and they were all with the same group. It was making it really hard to know what to do.

Bigorangemd: Don't know the size for sure but everyone keeps calling it "small".

Gravitysucks: One of the docs did call an Air Force flight surgeon friend who said that they typically call for a 6-month stand down. Apparently, most of the military research is based on spontaneous pneumos not traumatic pneumos. The docs say trauma pneumos are "different". One study (which is also the most recent study they could find) shows commercial air travel to be likely safe 14 days after resolution of a traumatic pneumo. They figure that a safe time for me might be somewhere in between.

One doctor has said that he thinks it might be safer for me to be in an unpressurized cabin under 15K than an airliner cabin due to the rate at which they sometimes pressurize/depressurize the cabins? I'm a little skeptical about that. Sounds like those of you who have waited 3-6 months have been OK. Has anyone jumped sooner than 3 months after complete resolution as shown on an Xray or CT scan?

I appreciate the opinions and thoughts. My husband and I are sure learning a lot about lungs!
B

[momofamaniac 0]

My son, who was 16 at the time, had a Spontaneous Pneumothorax on July 28, 2006 - took him to the ER and was told he had "a collapsed lung and that a chest catheter was required, then laproscopic surgery to repair the left lung...chest catheter was inserted, I could hear my son screaming from the waiting room; two days later the surgery was done, my son left the hospital and returned to DR every week for a chest x-ray; after four weeks we were told he was healing fine and did not need to be seen for eight weeks - my son is into high risk sports such as snowboarding, down hill bike racing, and sky diving, he was told he could do everything but the sky diving until the eight week visit. Well, on the day after the four week visit he was playing frisbee and felt something wrong, next day he tells me his lung is collapsed, we go to the ER and sure enough the lung is collapsed again, again a chest catheter is inserted, this time under "twilight sedation" and unbelievably enough he is sent home, with chest catheter, and told to return in a week. We contact the best DR's in NYC and ask for the best lung doc - we are referred to a surgeon in Poughkeepsie, NY and go and see him the day before we are to return to the original DR. What we are told is devastating...the chest catheter has caused a lung infection and is removed ASAP - my son is hospitalized and we are possibly looking at major surgery and a pleuridisis (which is the adhering of the lung to the chest wall - extremely painful. My son sits in the hospital for days (meanwhile missing his senior year of high school and his 17 Birthday) result is first doctor punctured his lung with BOTH CHEST CATHETERS AND CAUSED MAJOR COLLAPSE only a small fist of a lung was operating on the left lung and a large proteinaceous peel had formed due to infection on his lung - six hours of surgery later he survived. My son spent 26 days in the hospital on Epidural Fentanyl. It was truly horrific, after leaving the hospital he could not return to school until late January (he was hospitalized Sept. 5th, and was only able to snowboard in March. His surgeon told him he was good to go, because he believed it was truly a spontaneous pnuemothorax gone horribly wrong. (Hospital records prove that the two chest caths. punctured the lung). Unfortunately in January of 2008 my son told me his right lung the "good lung" was collapsed - off to the ER truly expecting anything but a collapse I am proven wrong and sure enough the right lung is at a 15% collapse with two "blebs" on the apex and the diaphragm...hospitalized for four days, CT-Scan first day, chest x-rays every day, CT-scan last day and he his released...NO CHEST CATHETER...NO LAPROSCOPIC SURGERY...NO MAJOR SURGERY...March of 2008 - collapse has healed, "blebs" are same, and we are told by the surgeon from Vassar that the original surgery and chest catheters were "harmful and wrong". We are also told that my son has a congenital condition were he will have to worry about his right lung collapsing for the rest of his life but most significantly a possibility in the next 10 years (18-28 years-of-age). So just this week my son wanted to jump, I of course said NO NO NO - his surgeon, who I have the greatest respect for said in sic "Go ahead and jump, have fun, and don't forget you have an appointment in September"
Sorry my story was so long but if anyone that has experienced a Pneumo and would like to speak to me or my son please don't hesitate to contact me at [email protected], also if you are currently looking at surgery or have been told you need a chest tube PLEASE GET A SECOND OPINION BEFORE YOU CONSIDER ANY PROCEDURE!!!!!!!!!!! My son wishes we had and I will never forgive myself for not doing so! Sorry again for such a long story I only hope we helped someone. Thanks!

[ladydyver 0]

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Need to know what percentage in pneumothorax is. around 20% or less should resolve without doing anything. After it has resolved for a week or so, won't be a risk of redeveloping, however jumping with broken ribs HURTS! Usually takes about 6wks before most people are comfortable enough for opening shock. Good luck.

You make some great points doc! I haven't jumped with broken ribs but have taken care of enough people to know how miserable they are.....and can't even imagine trying to jump due to the opening shock issue. And you want to make sure that you are healed.....it makes me wonder if you could be at risk for the possibility of fracturing the area again if you go back too early.

DPH # 2
"I am not sure what you are suppose to do with that, but I don't think it is suppose to flop around like that." ~Skootz~
I have a strong regard for the rules.......doc!

[bk94 0]

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it makes me wonder if you could be at risk for the possibility of fracturing the area again if you go back too early.

That's a really good question - I asked the doctors but didn't get a clear answer. I also asked if being too active before the edges of the bones had healed would put me at risk of re-injuring the lung. The answer I got was that it was theoretically possible but they had never seen that happen.

I got a clean scan on the lung last week. I may try some hop and pops in two weeks (they say safe to go to 8K 14 days after resolution - that weekend will be 17 days since the clear scan and just over 6 weeks from the initial injury) and plan to wait until at least the first week of August before trying a jump from full altitude.That will put me at a full 8 weeks from initial injury and one month after a good scan. I saved some pain pills for the first weekend back. Does anyone want updates on that? This is all probably too much information but since there doesn't seem to be much data on trauma pneumos and altitude, Im willing to share my experiences....

[JohnRich 4]

What's a "pneumothorax"? Some kind of insect?

[bk94 0]

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What's a "pneumothorax"? Some kind of insect?