Chest Pain in Older Diver

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John BantinMy mother always insisted that we children waited an hour before swimming after eating in case we got the cramp. As a diver, I often ate a hearty meal immediately before diving without, I believed, ill effect. Cramp, though uncomfortable, doesn’t cause a diver to drown.

During my long career as a diving journalist, I was ever aware of my health and on the watch for any signs of ill effects from breathing compressed gases underwater, such as nerve damage or bone necrosis. Every year, I’d enjoy the same medical check-up that any commercial diver was required to undertake in the U.K. and passed each time with flying colors.

By the time I was 66 years old, I started to get occasional pains in the chest. It is a dangerous age for men, but these thorough annual health checks indicated I had admirably low blood pressure, a low heart rate at rest, and a quick recovery time after heavy exercise.

Hypochondria is an underestimated illness! The mind can play tricks and I started to suffer from various other symptoms, including losing my voice for three months, and on a separate occasion, going stone-deaf for four weeks. In neither case was any medical cause discovered, even after thorough investigations with brain scans and a camera down into my voice box. (These came at no cost, thanks to the fantastic British National Health Service.) I decided I didn’t want to find myself ill when the other side of the world from my home, and took belated retirement. Eighteen months of boredom then resulted in me taking a full-time job, the first I’d ever taken in a 50-year-long career of being self-employed.

However, the pains in the chest did not subside. I started to realize that they were a form of indigestion, because they were related very much to whatever I had recently eaten. I gave up beer and coffee and avoided spicy foods because they resulted in misery later. I have had a history of suffering from acid reflux and have lived on 20mg Omeprazole (an acid-pump inhibitor) for the last 10 years. These chest pains saw me visiting my doctor and requesting he increase my daily dose. (In the U.K., prescribed medication is free to the elderly.) Instead he suggested I have a gastroscopy, in case the pain in my esophagus was caused by something more sinister. The results were telling.

I’d done a lot of deep diving when I was young but reflected that, back at the turn of the millennium. I had been diving at Bikini Atoll when I’d first suffered unusual, if less than serious, symptoms. The dives were deep; always in excess of 180 feet, and during ascents from the first dive of the day, I would involuntarily regurgitate my breakfast. There was no violent vomiting or retching, which could have been very dangerous and led in a worst-case scenario to drowning. It was as if I had simply gently exhaled the contents of my stomach into the water.  I have noticed this on ascents from several deeper dives since.

Now I step into the world of theory. It is a well-proven fact that many people who breathe through their mouths also involuntarily inhale air into their stomachs. Naturally, with a regulator in your mouth, one inhales through the mouth, and I believe that I might well be one of those who is a  gas swallower. Of course, this air enters the stomach at ambient pressure and during an ascent will expand and makes its way out, usually by way of the mouth by belching.

Probably, the air ingested at, say, 180 feet at Bikini Atoll was mixing with the contents of my stomach and forcing that out with it. No harm done, one might think, and I’ve done many thousands of dives since that time, but then I started getting these intense chest pains.

The results of the gastroscopy revealed that I now suffer from a large sliding hiatus hernia. Luckily it turned out to be nothing more serious! This is a result of part of the stomach wall being pushed up into the esophagus through the hiatus, which in turn allows stomach acid to reflux past the diaphragm, hence the pain.

What caused this hernia? Could it be the result of inhaled gas that has entered the stomach expanding during repeated ascents and, blocked by the recently-eaten stomach contents, done the damage by pushing the stomach wall against the hiatus in the diaphragm?

Evidently, the symptoms become worse if you are horizontal, as any good diver would be. I’m told that hiatus hernias are common among the overweight and elderly. Built like a racing snake, I can now confess only to the latter.

As my fellow divers get older, I have witnessed several cases of people suffering chest pains after diving. These have always been treated as possible decompression illness and oxygen administered – quite rightly so. In each case, they have recovered in short order, but I wonder now if they are suffering these pains from the same cause as I am. It may be too late for me, but I suggest that you avoid eating large meals before diving in case you too are a gas swallower. It might also result in a hiatus hernia later in life!

If you suffer from chest pain, consult a physician.

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8 comments for “Chest Pain in Older Diver

  1. Larry Clinton
    September 2, 2015 at 12:14 am

    I’ve long felt that diving Nitrox helped with acid reflux systems, and wonder if John might have had a similar experience.

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  2. John Bantin
    September 2, 2015 at 6:30 am

    Larry, as an early adopter of Nitrox and a great believer in it, I have used it not only for leisure dives but for accelerated decompression times after deeper diving. Alas, it has not proved to be the magic bullet! I just wish I hadn’t so often been so greedy at breakfast!

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  3. Rick Hillier
    September 2, 2015 at 2:28 pm

    I have a sliding hiatus hernia as well. I have been taking Prevacid (or the generic equivalent) for years now and the symptoms, with the exception of the odd occurrence once in a blue moon, have gone away completely.

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  4. Dick Jacoby
    September 2, 2015 at 4:23 pm

    I’m a nose-breather.
    Haven’t deep dived in decades.
    Heart doc thoroughly “stinted” me a three years ago.
    I’m 85.
    I’m going to Raja Ampat again this November.
    So there, too.

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  5. September 3, 2015 at 11:19 pm

    I thin the root of John’s problem is the cosmetic surgery he recently had inspired by Bruce Jenner’s trans-gender operation. John basically had a tit job and now is endowed like Dolly Parton. While he has achieved modest success as a brass pole dancer in a sleazy London Club, I seriously doubt if the effort was worth the expense. C’mon… hanging a set of 46Ds on a skinny guy like John is a bit of overkill. He’ll likely also experience lower back pain as well. And I’d counsel holding off on the Botox lip work until the earlier work on his nose stabilizes. But he does bear a striking resemblance to a fetching platypus that is quit cute. This obsession with older gentlemen and needless cosmetic enhancements is a bit delusional so some psychological counseling should be undertaken as soon as possible.

    I’d be willing to donate some primo testosterone if it would aid his recovery.

    Pray for John and his quick recovery. And I suggest that he start drinking heavily…

    Vaya con dios, maricon grande!

    Su amigo,

    El Grande

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  6. John Bantin
    September 4, 2015 at 6:38 am

    El Grande (you probably know who he is) has always been very careful about what he eats.

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  7. David Vickery
    September 11, 2015 at 10:15 am

    Interesting. My wife of Lo These Many Years has chest pain as well, a high stress job, and over 800 dives. She recently had every cardio test known to Western Man and passed them all with flying colors. Her cardiologist told her to lose 5 pounds. She lost 15. The pain diminished but persisted. In addition she could no longer tolerate spicy food. Long story short, she has a hiatal (as it is known in the Colonies) hernia.

    We have a dive trip planned for December and another in April. We dive in the mornings and skip breakfast. Now that we are fore warned by this information, we will be cognizant of any symptoms, and if anything develops, let you know.

    Pass the salsa, will you, honey?

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  8. John Snow
    September 29, 2015 at 2:03 pm

    You might want to think twice about taking a PPI for life as there is more and more research that these drugs lower your total body magnesium, particularly in the older person, which can have some serious consequences. Out of the PPIs Losec (omeprazole) and Tecta (pantoprazole) according to the FDA data are a few of the worst PPIs while Nexium caused the least lowering of Mg.

    Low Mg can result is muscle cramps, poor glycemic control, hypertension, heart arrythmias, osteopenia/porosis, idiopathic pancreatitits, insomnia, and declines in aerobic performance plus a host of other problems.

    PPIs also lower your vitamin B12 absorption and can put you at increased risk for C. dificil diarrhea.

    If reflux symptoms can be controlled with good old ranitidine (Zantac) one is far better off with this oldie but goodie anti-reflux drug rather than long-term PPI use as Zantac does not lower magnesium.

    The mechanism is not known yet but it appears that the PPI as a drug class inhibits Mg absorption from the gut so taking extra Mg may not correct the problem until the PPI is stopped.

    Determining if one is low on Mg is problematic because serum Mg is not reflective of total body stores unless very low. Still not perfect but more indicative of low total body Mg (stored in bone and muscle) is red blood cell Mg so ask for that test plus the serum Mg.

    Don’t believe this then look at the FDA black box warning on any PPI these days or search on Pubmed.com under magnesium deficiency or Mg and PPI. Here’s a link to get you started!

    http://physrev.physiology.org/content/95/1/1
    http://www.ncbi.nlm.nih.gov/pubmed/24901943
    http://www.ncbi.nlm.nih.gov/pubmed/26130997
    http://www.ncbi.nlm.nih.gov/pubmed/25138239

    If you’re found to have low Mg the best one to take is magnesium glycinate.

    Cheers,
    John

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