AD 2017 Q4

RESEARCH, EDUCATION & MEDICINE
FROM THE MEDICAL LINE
Diving After
Bariatric Surgery
DAN MEDICAL INFORMATION
SPECIALISTS AND RESEARCHERS
ANSWER YOUR QUESTIONS
ABOUT DIVE MEDICINE.
SHUTTERSTOCK.COM
Q:
I’m an instructor, and I have a student
who completed his pool sessions, but he
had gastric bypass surgery before he could
do his open-water dives. Before I allow him to
continue with his training, I’m asking him to get
an updated medical form signed by his doctor and
to contact DAN® for advice. What does DAN think
about diving after this kind of surgery?
A:
Please note that DAN is not in a position to
either approve or disapprove of an individual
diving. We share medical information and
resources to allow you and your physician to make an
informed decision regarding diving.
There are a few factors to consider with regard to
bariatric surgery. The first is the recovery time from
the surgery. It is important that surgical wounds
have closed and
healed before
the patient dives
to ensure there’s
not an elevated
risk of infection.
Depending
on the type of
surgery that was
performed, air
is sometimes
introduced into
the abdominal
cavity. The body
requires time
to reabsorb
this air. Air pockets are of concern given their
ability to compress and expand as ambient pressure
changes. Similarly, there is air within the
gastrointestinal tract that may contract and expand
as the depth changes. Therefore it is important to
allow the surgical sites inside the abdomen to heal to
avoid creating a leak.
Another consideration is the delayed complications
and/or known side effects of the surgery. These factors
depend on the particular surgery that was performed.
Some bariatric surgeries put an individual at increased
risk for intestinal blockage, gastroesophageal reflux
disease (GERD) or malabsorption.
Next, consider the physical demands of scuba diving.
Weight-loss surgery and the resulting drastic change in
body mass that may occur afterward can involve loss
of muscle mass and general deconditioning. As scuba
diving is physically demanding, it is important that an
individual can perform vigorous physical activity.
Finally, many patients who undergo bariatric surgery
have other medical problems that are associated with
obesity (such as diabetes, heart disease and high
blood pressure). These issues should be addressed
and stabilized prior to returning to diving. A common
expected recovery time is 6-12 months.
As you suggested, it would be worthwhile for a
physician trained in dive medicine to evaluate your student
and clear him for diving. He will require clearance for full,
unrestricted activity — including lifting heavy weights
such as dive gear, unrestricted mobility and tolerance for
vigorous exercise such as extended swimming. We can
search the DAN referral database for a doctor trained in
dive medicine close to the student’s location.
— Mala Trivedi, M.D.
Q:
I did some wreck diving this summer and
got a minor abrasion on my knuckles while
digging for artifacts. It was so superficial
that I continued diving and didn’t give it much
thought. Several weeks later, however, it doesn’t
seem to be getting any better. It is red and bumpy
and occasionally has some crust on it, although it
doesn’t hurt. Antibiotic ointment has not helped, so
I plan to see a doctor about it. Are there any marinespecific
pathogens I should ask the doctor about?
A:
While some infections might be more
frequently associated with aquatic
environments, there are no marine-specific
pathogens, at least not to humans.
Based on your brief description, this may be an
infection by an opportunistic pathogen known
as Mycobacterium marinum. This organism is
responsible for a condition known as aquarium
granuloma. These wounds typically look like what
you described: red and bumpy nodules no larger than
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