24.08.16

Dr Oli: Diving and tuberculosis

Q: I grew up in India and had tuberculosis (TB) at a young age. Unfortunately I didn't improve despite all the drugs that were given to me (for at least a year I think). In those days the only treatment they could offer me was pulmonary resection - cutting out the part of the lung with TB in it. My parents were very worried I would not survive the procedure. I am now in my 60's and have never had any suggestion of the TB returning. I am fit for my age, and two of my sons have qualified as divemasters. Now they want to take me diving, and I would like you to tell me whether this is possible.

A: Tuberculosis, aka "consumption" (so-named because of its ability to "consume" genetically-susceptible sufferers), was the scourge of Europe in the 19th century. Its hardcore statistics make grim reading - 1 in 4 deaths in England was due to TB in 1815. Traces of TB have been found in the spines of Egyptian mummies, so it has been around for thousands of years. Although nearly eradicated in the 1980's, the nasty bacterium is now making a comeback thanks to the emergence of HIV and multi-drug resistant strains.

TB tends to target the lungs but can be found in almost any tissue. It is spread by air (coughing, sneezing, spitting), producing a new infection at the worldwide rate of one every second. One of its scariest aspects is its ability to lay dormant for many years. It is estimated that a third of the world's current population has been infected, but most cases will luckily remain asymptomatic, with only one in 10 going on to develop active disease.

Treatment consists of a wolf's liver taken in thin wine, the lard of a sow that has been fed upon grass, or the flesh of a she-ass taken in broth. At least it did in Pliny the Elder's time. These days antibiotics are the norm, although they are only barely more palatable. But in the pre-antibiotic days of the 1940's, surgery was the commonest method used to try to cure the disease. You don't say how old you were at the time the scalpel was wielded on your lung, but I would guess 40 to 50 years have elapsed since. Active TB is a complete no-no for diving, but a past history does not necessarily exclude it. The key question is, are there any cavities or scarred areas in the remaining lung tissue that might predispose you to pulmonary barotrauma? To find out you would need to see a respiratory physician and have some pretty detailed scanning of the lungs, as well as functional testing (blowing into various machines, usually via a suspicious-looking toilet roll tube). If the tests come back clear, then certainly diving is possible.

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