Pleural Space Hell

The tragedy of life doesn’t lie in not reaching your goal. The tragedy lies in having no goals to reach. -Benjamin Mays

It has been over a week since I last freedived.

Not being able to do the sport I’ve been addicted to for years and being restricted to rest, rest and, well, more rest, and not doing any exercise and (as Dr. Sadek puts it) “activities where you inhale and do not exhale immediately” is torture, to say the least.

It’s been a mental game every single day to fight the thought of ‘being lazy’ and not just train anyway, or go to the gym, or go for a run, do a home workout video, yoga, something, anything. Shifting my mindset was one of the hardest things I have ever had to do. Think about what you love to do. Now think about stopping it completely.

Why do you ask? Very good question – and thus, I begin my story of what I am calling my “Plueral Space Hell”.

How it All Began…

I’ve been training in freediving intensively since arriving back in Dahab in December. My focus has been mostly on constant weight and static apnea with a bit of training in free-immersion to prepare for the RedCcup competition at the end of May.

Training during the winter in Dahab has been a bit of a battle, dealing with chilly water temperatures (20 degrees celsius), early contractions, illnesses, among other things. But my depths and breath-hold times were improving, slowly and surely, and so I was grateful.

Summer arrived around mid-April and brought with it warmth, sunshine and happiness. I was fit, had a sun-kissed freckled glow, was enjoying teaching and was feeling inspired and motivated in my training. Life was good and with good people all around.

The Dive

The morning of May 5th was business as usual. I met up with Flo, at 6:45 am for static apnea training at Lighthouse and afterward headed to the Blue Hole with Nick for freediving.

Nick set the bottom plate to -50 meters (yes, we were actually using a bottom plate made out of a plastic paper towel dispenser, and with proper tags haha). My warm-up dives were super, and I was ready as ever for my ‘deep dive’ (‘deep dive’ in quotes because 50 meters isn’t considered so deep in the modern world of freediving where the women are diving over 100 meters!). I hadn’t done free-immersion in a while, so my plan was to go to whatever depth I felt comfortable, but max -50 meters (FYI that’s 164 feet), and maybe, hopefully, come back with a tag.

So down I went… The dive itself was relatively easy; equalization was smooth, there were some light contractions but at some point they faded away, my thoughts disappeared as I free-falled down to the ball, and even grabbed a tag! I came up relaxed and easy, with plenty of air to spare, arriving at the surface happy and fresh.

I finished off the session with two sprint dives to 30-35 meters to work on my speed and freefall technique and then took the rest of the day off, a job well done.

The Next Morning

The following morning I woke-up excited for another day of free-immersion training. But I noticed pain on the left side of my chest and rib cage, front and back. As I went about my morning the pain went from not-so-bad to bad to worse.

I finally came to the realization that I’m not going to be able to dive today. So instead, I spent the day resting and having quality cuddle time with Peanut, my cat, hoping that I’d feel better in a couple of hours.

But no such luck.

It was impossible to lay on my side, so I slept (or tried to) on my back (with Peanut on top of me) waking to increasing pain every couple hours. By evening, I was in agony. To the point that I could not get out of bed. Pain coated my entire thoracic cage, front and back, covering each rib and clinging to every crevice of my back, shoulders and neck. I couldn’t move, couldn’t think, couldn’t breathe, couldn’t exist, without ever-present pain.

Here is a list of the symptoms I was experiencing:

Symptoms

• Shallow and painful breathing
• Chest and back pain
• Hot / cold flashes
• Loss of appetite
• Dizziness

(Thus – my pleural space hell.)

Poor Nick to see me in such a state, he checked on me every 10-15 minutes, graciously delivering dishes of my favorite foods which piled-up on the bedside table uneaten for hours upon hours.

The Injection Doctor

Eventually it became unbearable. I felt like I was drowning beneath the pain, suffocating because I could barely breathe. I asked Nick to call Dr Sadek to see if he could do a house visit. And 15 minutes later ‘The Injection Doctor’ arrived.

Dr. Sadek examined me while I informed him of my symptoms and frustrations. He noticed right away that I had a fever and “some kind of infection in the chest”. But he needed me to go for chest x-rays in order to know exactly what it was.

Before leaving, Dr. Sadek handed me two sheets of tablets, and (to no surprise!) injected me with a massive needle full of some kind of miraculous drug. Within minutes, 80% of my pain, along with my fever, was gone.

I could finally move a bit, and eat, and breathe somewhat normally. It was an incredible moment, I will tell you that!

X-Rays

Later that evening I went to Dr Sadek’s clinic for x-rays. The dripping wet black plastic sheet was held up to a dim light and showed the right lung completely normal, white lines (showing the ribs) with black spaces between (showing the air inside the lung). The curved line of the diaphragm could also be seen quite clearly.

The left lung, however, was a different story. The black areas were, well, they were not so black, they were more whitish and cloudier, and the line of the diaphragm was not apparent at all. Dr Sadek diagnosed it as a pleural effusion.

A pleural effusion is a condition when the pleural space (the area between the wall of the lungs and the chest cavity) is filled with excess fluid. My friend, Marlis, describes the pleural space as so; “Imagine the lungs are contained in a bag, in another bag and between those bags, there is a fluid that allows the lungs to glide with respect to the thoracic cage”.

In short, the problem with my lungs was that I had TOO MUCH fluid (and most likely infection and/or inflammation) in this pleural space between the lung and the chest cavity. This was causing the lung to pull away slightly from the chest cavity.

And this is why the left lung on the x-ray appeared more white rather than black on the x-ray, because we were seeing the excess fluid in the pleural space rather than the air in the lungs.

Now What?

Dr Sadek said that if I continued freediving there is a risk that the pleural space could fill with more fluid, causing the lung pull away more from the chest cavity. This could result in a collapsed lung and, well at that point… It was the first time the truth looked me in the face with a smug smirk. It was also the first time I wondered what my life would look like without being able to freedive, like at all whatsoever. (ok maybe I’m being over-dramatic)

The Million Dollar Question

I wanted to throw a tantrum, kick my legs, punch teddy bears and scream at the world: why did this happen? How? Was it from freediving? Or something else?

Dr. Sadek said that it was likely due to inflammation, infection or underlying health issues in the body in combination with ‘deep’ freediving. (I told him that 50 meters was not that deep.)

To sum things up for you:

• I’m sad
• I’m angry
• I’m upset with myself
• I’m ticked-off
• I’m exhausted
• Often I’m depressed with the situation
• I’m angry
• I’m human

Hell hath no fury like an angry woman, right?

Mostly I’m angry at myself for not taking better care of myself. I should’ve sorted out my health, should’ve eaten healthier, trained less, rested more.

Time to Be Reactive

Yes, I admit I wasn’t proactive in the beginning, and now I had to be reactive.

Reactive Changes:

• Rest
  • No freediving training (for a minimum of two months.)
  • No static apnea training, as the increased pressure in the lungs will only worsen the condition.
• Treat the effusion
  • Go on a course of Ciprofar 500 mg antibiotics to prevent/treat infection in the pleural space (2 per day for 5 days)
  • X-rays after one week to see if there is any noticeable improvement
• Treat the cause
  • Get a proper medical check-up with a good internist complete blood tests including liver and thyroids tests, also minerals (as recommended by Marlis)

Be Proactive!

While I spend my time being reactive, being proactive would have been a better strategy. I recommend this for other freedivers, so you do not end up in a hole trying to climb out.

Blood Test

If you’re freediving regularly to depths, say more than -40 meters, I’d recommend you get a full blood analysis. Even if you feel there is absolutely nothing wrong with your health, freediving to these depths require you to have healthy circulating, oxygenated blood. So if you do not do the testing, you will never know for sure if you’re in proper health for freediving.

It’s easy to get a blood test done, just make an appointment at a nearby lab and request a full a blood analysis. Then afterward you have an appointment with a doctor to discuss / interpret the results AND do the necessary research online.

A week before my “pleural space hell”, I had blood tests done. I noticed abnormalities but I ignored them, thinking it was probably nothing. My blood tests showed low counts of;

• Hgb (Hemoglobin),
• RBCs (Red Blood Cells)
• Hct (Hematocrit)

From what I’ve researched, this basically means that I am anemic. Anemia is when your body doesn’t have enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells that binds to oxygen. If you have too few red blood cells and/or the hemoglobin count is low, then the cells in the body are not getting enough oxygen. A person with anemia, will often be fatigued because the organs are not getting what the need to function properly (hence my usual afternoon siestas after freediving)

Blood, low in oxygen obviously isn’t good, especially for freediving. I should’ve started taking iron tablets a long time ago, and who knows, that could’ve helped prevent the effusion among other health issues in the process.

If any of your blood tests are abnormal, I highly recommend to refrain from freediving until you sort it out and until the values within normal range.

If you feel chest pain do not dive

Maybe this is common sense but it wasn’t for me. If you have any type of chest pain or rib pain, even if you didn’t experience a squeeze or injury, do yourself a favor and refrain from freediving and breath-holding activities. It could very well be a pleural effusion like mine, and if you continue training, it will likely get worse and become reoccurring.

I’ve had this same chest pain four times in the past two years (although not as severe as this time) and continued to train because I thought it was just “muscular pain” (as misdiagnosed by a different doctor). Now I realize that it wasn’t muscular pain, which explains A) why it took so long every time for the pain to go away and B) why it keeps reoccurring, because it never actually completely healed!

Also I should add that pleural effusions can lead to lung scarring, pneumothorax (collapsed lung), empyema (a collection of pus in the pleural space) and sepsis (blood infection which can lead to death). It isn’t something you want to mess around with!

Don’t Overtrain

If you are overtraining, you probably already know it. I’d recommend you to stop. Deep diving (or in my case not-so-deep-diving) takes a heavy toll on the body, so without sufficient rest between you increase your chances of an accident or injury. Try your best to make a schedule where you have rest days in-between your deep diving days.

Also, it’s probably best to avoid doing deep dives after a static apnea training. The body and mind are tired! That day I did the 50 meter dive, I was super tired after my the static training. It was certainly unwise for me to do both trainings on the same morning without enough rest between.

Concluding Thoughts

• I hope to turn my health around in the next 2-3 months so that I can resume training, but it could take longer.
• I also hope this post helps someone else one day.
• My advice to you is to be proactive; do the lab tests, listen to your body and be smart about your training schedule. More is not always better!

An excellent video about pleural effusions: