AD 2017 Q3

RESEARCH, EDUCATION & MEDICINE
RESEARCHER PROFILE
Dr. Moon’s driving professional interest is the treatment
and characterization of DCS. He is an anesthesiologist
and a pulmonologist, and both fields have been very
relevant to his work in dive medicine.
There was a lot of deep-diving research going on in
the 1980s in Germany, France, Japan and Norway, and
most of the people running these experiments also had
someone become manic during a dive.
You were one of the first researchers to identify
a relationship between PFO and DCS. There has
been significant research on PFO closure since you
made that discovery. Is there still work to be done
on that front?
We discovered the link between PFO and DCS in the
mid-1980s. The National Oceanic and Atmospheric
Administration (NOAA) sponsored research that
allowed us to bring back patients we had treated who
were previously paraplegic because of DCS. This gave
us insight into the effects of PFOs and demonstrated
the substantial capabilities of hyperbaric oxygen
therapy. These patients who had originally come to us
with severe DCS and partial or complete paralysis were
walking and functional.
As an aside, we learned a lot about managing spinal
DCS from the initial treatment of these patients.
Because they could not move their legs, their risk
of pulmonary embolism was significantly increased.
It wasn’t clear that traditional prophylactics would
adequately attenuate the risk of pulmonary embolism,
and we discovered that we had to scan the legs for
clots to manage that risk.
It is fairly well established that a PFO is related to
serious and repeated DCS. I think it is a closed issue
at this point. In some individuals, closing a significant
PFO will decrease the risk of DCS. Approximately
one-third of people who get DCS, however, will have
serious symptoms regardless of whether they have
a PFO — the main risk factor for DCS is still the
exposure (i.e., depth and time). The discussion that
culminated in DAN’s 2015 Patent Foramen Ovale and
Fitness to Dive Consensus Workshop answered most
of our questions on the topic.
You have done a great deal of research on IPE,
particularly in divers and other athletes. What
prompted this work, and what have you found?
IPE first became a concern when it appeared in
otherwise healthy Navy SEALs who had undergone
rigorous physical exams and were in excellent shape.
Several SEALs had problems with IPE while swimming
in California’s cold San Diego Bay during training,
and we worked with the Navy to research the risk
factors and possible treatments. This was particularly
COURTESY RICHARD MOON
64 | SUMMER 2017