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Diseases / Viruses - Contagious

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 have been told that people who have had Malaria will always get an ear infection when diving and for some reason it can be dangerous? Can you advise whether the risk is any different compared to the normal risk or is it an old wives tale?

A - Old wives get a hard deal don’t they? I’m sure many are supremely intelligent, but their presumed lack of sophistication is what has lent their name to false urban legends. There are plenty of myths circulating in the diving world, but this is the first time I’ve heard this one. Needless to say it’s as false as the “knuckle cracking causes arthritis” or “a stye means you have been reading pornographic material” type rumours. Malaria has absolutely no connection with ear infections, and you are at no greater risk diving having had malaria, as long as you are fully recovered.

What of other diving myths then? One favourite of mine is the “you lose most of your heat from your head” one. This might be true if your head was a vast spherical dome (no jokes about mine please) but any exposed part of the body loses heat in proportion to its surface area. The rate of heat loss is the same whether it’s the head, hand, foot or any other appendage. You do not lose heat any faster through the scalp. Interestingly, hair on your head or face makes absolutely no difference either. And as we all know, bald is beautiful.

Another classic: gender does not affect buoyancy. Some think that the additional breast tissue and fat that women carry make them more positively buoyant – not so. The centre of gravity depends on the distribution of fat, more so than the amount of it. Most men carry fat on their upper bodies, with relatively longer and leaner legs; the female of the species has a more even deposition of fat on both lower and upper bodies, and hence tends to be more streamlined. One fascinating study in competitive swimmers revealed that males have a lower power output than females due to their less hydrodynamic buoyancy distribution. So, in a nutshell, skinny legs increase drag.

And one that caused us some chamber-based headaches: a hot shower after a cold dive is NOT recommended! For some reason this seems to have become a bit twisted, and an instructor actively encouraging a hot shower may have contributed to a case of DCI we treated recently. There are 2 reasons for this. Firstly, exposure of peripheral blood vessels to heat causes them to dilate, which actually lowers the body’s core temperature. A hot drink down your neck is a far better idea. Secondly, hot water immersion can stimulate bubble formation, probably due to the speed of the temperature increase. Unlikely on its own to cause DCI, but it may just tip someone over the edge into symptoms. Better to wrap up in a blanket (or friendly dive buddy) and warm up slowly.

Anyone got any other old wives tales they wish to query or debunk in these hallowed pages?

Q - I have glandular fever - which is very bizarre as I'm about 35 years too old for it, and haven't been snogging any 17 year olds since I was 17...

Nevertheless, I do have it, and do feel rough in the mornings, and get tired. I am working - and manage to get to the City and work (reasonably long days) - but don't do much else - come home and collapse in the evenings/ weekends. I have stopped running, and doing swimming training - although I do swim a bit in a pool. I have pulled out of a triathlon in two weeks.

I am due to go diving in the southern red sea, on a liveaboard , at the end of December. The travel company have requested payment. My doctor said that there is still plenty of time for me to get better - but I couldn't go in my present state. What's your view? Should I cancel now? Can I expect to get better in time? To what extent would glandular fever be a bar to diving (I am sure I could still cope in a crisis, but over exhaustion might have a knock on effect. However, sitting on deck would be quite relaxing too - and more relaxing than commuting etc…

A - Poor you. Glandular fever [GF], or Infectious Mononucleosis, to give it its boring name, can be gotten at any age. The virus can get you when you are feeling low, and make you feel lower still. I think the key thing here, as recovery goes, is to have goals to aim for and work up to them slowly. In rare circumstances GF can lead to ME like problems, where constant inability to achieve normal activities, sets you back physically and mentally. Depression sets in, physical exertion gets harder, and before you know it you’re off work for a year, and Esther Rantzen has to take you to swim with a dolphin “to get you better”.

So book the dive holiday. Work your physical activity up to the point where you will be strong enough for the diving by then. And when there take it easy and only take on the easy stuff to start. GF is no bar to diving, but the inability to do even the lightest of activities would be, so plan your recovery from now with that in mind.

Q - As Training Officer for a BSAC Branch, we teach and practice 'full on 100% contact' mouth to nose A.V. in water, obviously not inflating the casualty's lungs. I am wondering what the medical consequences are with respect to infectious diseases? i.e. hepatitis, cold sores etc! Are we risking anyones health and what are the legal implications?

A - When you use the term "full on" in reference to any physical contact it makes me wanna move to St Albans and join your club!

The cases of viral transmission, e.g. HIV or any of the Hepatitis viruses after mouth to mouth or to nose contact are enormously rare. What would be needed is blood to blood contact from each participant, and for long enough to make viral transmission a possibility.

To tell the truth the only case I saw was on cable TV, one of those Springer type shows. "I got AIDS from kissing" strap-lined below 2 of the ugliest people ever to appear on telly. They both had bleeding gums during snogging, and were both stupid enough not to realise how repellant the other one was and to stop.

Their best efforts to remove themselves from the gene pool was sadly not rewarded as their later mutant progeny sat by their sides.

Mouth to nose should be fine. You really should practise it well as you would have to do it if the situation arose. The Paramedics use those mouth guards not so much for viral reasons but rather for blow back of vomit in an unconscious patient.

So no worries there and keep it full on up there in Herts.

Q - I am going diving in the Andaman Islands off India, but have heard stories about street beggars having leprosy. Is it possible to catch this disease easily from them if they were to touch me or is it quite safe really?

A - Your fears, you will be glad to hear, are not well founded. Leprosy, or to give it it's other name of Hansen's Disease, named after it's discoverer, is in fact not transmitted by direct contact with the skin of a sufferer.
Current figures show that this disease afflicts over 15 million people world-wide. These cases are found around Africa and India mainly, and are seen in the poorer sector of the population.

Leprosy is caused by bacteria which live in the lining of the nose and also in the nerves of sufferers, and it is because of the latter that the affects of the disease are seen. Because the nerves that supply the feeling of sensation to various parts of the body get inflamed during the infective process then they cease to function properly. This then results in what we call painless injury. People with this problem can easily cut themselves, or pick up objects that are far too hot, and even break bones without realising, and because of this deformities arise all too easily. The skin depigmentation seen in this disease is due to scalding or also sometimes as the bacteria can also cause inflammation in the skin. The sad thing about leprosy is that it is easy to diagnose and also very easy to treat in the early stages with simple antibiotic treatment, but the problem goes unchecked in the developing world due to lack of resources and also the persons fear of the stigma of the disease.

The way that it is spread is via respiratory droplets full of bacteria being sneezed and then inhaled by the recipient. Early symptoms are non- itching rash or blood stained nasal discharge, and if you are diagnosed at this stage then a course of dapsone will cure it. But this really is a hard disease to catch and you wouldn't get it from just passing contact but by sharing a room with a sufferer for quite some time and it is definitely not passed on by touching a person with it.

Interestingly the leprosy bacteria is only able to infect humans and one other animal species, the 9-banded armadillo, which of course is now blamed for the spread of disease in parts of the Americas.

The other myth to dispel here is that parts of limbs do not fall off in this illness, so don't worry, it is a hard disease to get and an easy one to get rid of.

(other dive medical questions)



   


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