www.alertdiver.com
|
47
MEET the experts
Emmanuel Gempp, M.D.,
is a diving medical officer in the French Armed Forces
Health Service and a certified mine clearance diver in the French Navy. He is a senior con-
sultant in the department of diving and hyperbaric medicine, Sainte Anne’s Military Teaching
Hospital, Toulon, France. Gempp is also an emergency medicine consultant and the author of
numerous papers on dive medicine.
Mahito Kawashima, M.D., Ph.D.,
is executive director of Kawashima
Orthopedic Hospital in Oita, Japan. He is also vice executive director of the Japanese Society of
Hyperbaric and Diving Medicine and a clinical professor at Tokyo Medical and Dental University
and Oita University School of Medicine. Kawashima is widely regarded as an expert on dysbaric
osteonecrosis (DON) and decompression sickness. He received the 2002 Charles W. Shilling
Award and the 2012 Oceaneering International Award, both given by the Undersea and Hyper-
baric Medical Society.
Akin Savas Toklu, M.D.,
is the head of the department of underwater and hyper-
baric medicine at the Istanbul Faculty of Medicine, Istanbul University, in Turkey. He is a diving
and hyperbaric medicine specialist, a professor of diving and hyperbaric medicine at the Uni-
versity of Istanbul and a member of the European Diving Technology Committee. Toklu is a dive
instructor and a medical consultant for a variety of underwater operations, including excavation,
pipeline installation, salvage operation and archeological projects.
Kawashima:
Yes. X-rays of shoulders, knees and hips were effective in catching
divers at risk. Today, an MRI at the site of previous bends may be a better choice
since X-ray photos can miss signs of DON in asymptomatic patients.
Toklu:
An X-ray was routinely used to screen divers for DON in the past, but it
is currently not recommended because of the hazardous effects of radiation. An
MRI of long bones is more sensitive and allows early diagnosis of DON without
radiation. It may be used in technical divers, who might undergo it if they ever
have signs of DCS or report omitted decompression or any discomfort or pain
in their shoulders or hips.
What protective measures other than safe decompression protocols might
technical divers consider?
Toklu:
A physical examination and blood tests may be recommended to
screen out known risk factors for aseptic bone necrosis. Smoking is strongly
discouraged because it predisposes to both diving- and nondiving-related
diseases. It should be kept in mind that alcohol intake is also provocative
for osteonecrosis. Divers should ensure adequate fluid intake to prevent
hemoconcentration, which may predispose to DON.
Gempp:
Lifestyle and dietary measures along with predive and postdive
hydration may reduce the deleterious effects of venous stasis (slow blood flow)
in the medullary cavities of bones following decompression. Some researchers
propose that slower rates of compression might lower the incidence of DON.
One recent work suggested anticoagulation therapy might reduce the risk
of DON, but many side effects, particularly bleeding, outweigh the potential
benefit, and thus it is not recommended.
Kawashima:
The most important thing is to avoid repetitive diving and long
bottom times.
AD