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Trauma, Surgery and Orthopaedic Probs Which Dive Medical?

Trauma, Surgery and Orthopaedic Probs - Other

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I was hoping you could give me some advice concerning an operation I am having soon. Due to a twisted testicle I am having an orchidectomy and have been offered a prosthetic testicle replacement. I have concerns whether a silicone or saline implant is suitable and safe for a saturation diving environment. I have read reports on the net that although there are no gas cavities within the implant there is a possibility that pressurised helium can diffuse into the implant causing problems. Any advice you could give me relating to this would be truly gratefully received.

A - OK, first bit of advice Ė never trust anything you read on the net. Abraham Lincoln said that. Or was it Churchill? In any case, a lot more useful than my terrifying auntís advice when she was looking after me as a spotty teenager with zero confidence: ďYou can find sympathy in the dictionary, between shit and syphilis.Ē Back to your two veg. There seems to be relatively little information available on this particular issue in diving. Whether that is simply because itís uncommon, or because divers arenít willing to declare the issue, I donít know. A similar situation exists with breast implants and again I can find few reports on safety whilst diving, but there is very little evidence that it causes problems in practice. Implants these days are generally fluid-filled and essentially incompressible, hence pressure changes should not affect them. I would make the surgeon aware of your job and concerns, but as there are no air cavities in the prosthesis, there is no risk of it imploding or exploding. As you say, there is a theoretical risk that helium can diffuse into the implant, but with the amount of gas loading we are talking about, I imagine the risk of a problem is minimal. Depending on the reason you require an orchidectomy, there might be other issues which have an impact on diving safety, so Iíd always advise a check-up with dive doc before taking the plunge.

Q - Hi doc. This is probably going to be one of the strangest questions you've been asked. It's a bit embarrassing, so sorry about that, but I don't know who else to ask. I won't beat about the bush any longer, so here's my problem. Basically I'm getting an erection every time I dive. I'm in my early 40s and although diving is exciting, it never used to produce a reaction quite like this! I had a penis fracture after a motorbike crash some years ago and I've got a prosthetic device fitted. Is it possible that the diving is setting it off? Luckily it's not painful but it's a bit awkward having to deflate myself after every dive - there's not much privacy on the back of a boat! Cheers for any help you can offerÖ

A - Iím sure all the male readers of our esteemed organ can empathise with this poor soulís predicament. I know I do. It turns out that amongst several other bumps and scrapes this unfortunate gentleman had after his motorbike crash, he sustained that most feared of all male injuries, the penis fracture. For those not anatomically inclined, let me reassure you: there is no penis bone. But there is a surprising amount of blood stored in there, and blunt trauma to the erect penis can rupture the soft tissues inside. This generally causes a popping or cracking sound, significant pain, and immediate flaccidity. And a lot of unsightly bruising around the now limp member. Unsurprisingly this is a medical emergency but in this poor chapís case, surgical repair was ineffective. He went on to have an inflatable fluid-filled prosthesis fitted. Now these are fascinating devices, operated by an inflate/deflate button that commonly resides in the scrotum. After a brief but memorable email exchange, we worked out that the button was inadvertently getting lodged in the inflate position by a combination of external water pressure and a rather tight dry suit. Youíll be glad to know that following some judicious tailoring adjustments to said dry suit, the number of unintended erections has dropped markedly. And yes, that was DEFINITELY the strangest question Iíve yet been asked. Anyone care to top it?

Q - I have been away sailing for the past five days and have developed a perianal haematoma and am concerned on whether this will affect either flying or diving. I am taking suppositories to reduce the swelling and it occasionally bleeds. I am not sure how long it will take to clear up naturally (hopefully) but we are flying to Egypt on Friday for a week of diving.

Could you clarify whether I should be worried about this or even worse if it restricts my flying or diving. If you need me to come in to the practice then please let me know and I can do that.

A - Peri = around. Anal = pertaining to the arse. Haematoma = big bruising. Sailing for five days = lots of other sailors.

So we wonít say anything about the cause. As this is a problem of the soft tissue and no air spaces are involved there isnít an issue with diving. Flying can be painful unless you are in a super soft club class recliner. Take a donut cushion for comfort. There could be a problem if you are changing in and out of damp swimmies and tight wetsuits all day, so it might be an idea to get on top of it. To reduce the swelling around your jacksy, try a decent steroid cream three times a day. Thatís about all you can do Ė apart from not ever sailing again.

Q - I am hoping that you can help me.
I was shot 6 months ago trying to avert an armed robbery and was told by the specialist at the time that it would be sensible to go for a medical before I dive again. The bullet went into my back near the shoulder blade and came out the front above my left nipple. It hit my ribs but did not break them. The lung was not punctured but there was some bruising to it. A pleural rub resulted from the injury. I have attached some pics for your interest.
Please can you advise me on what tests I would need to do to be allowed to dive again. Thank you for your help.

A - You might go down in history as one of the most fortunate men alive. From the look of the entry and exit wounds itís unbelievable that the bullet only bruised your lung Ė an inch in any direction and it could have penetrated your heart, punctured the lung, and generally left you in a far more mashed up state. A set of chest X rays to exclude a pneumothorax (collapsed lung) and any retained foreign material would have been done at the time. The functional integrity of the lung tissue could be assessed by normal spirometry, and if in doubt a CT scan to look for any areas of scarring that might predispose to pulmonary barotrauma. But provided the emergency staff are sure that there is no damage to heart and lungs then off you go unrestricted back to the pleasures of the deep. Whatever your lucky charm is, start bottling it and selling it now!

(other dive medical questions)


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