DAN Medical Q&A

From the DAN Medical Line

DAN medical specialists and researchers answer your dive medicine questions

Marfan syndrome Q: I have Marfan syndrome and would like information from someone who specialises in diving and its associated risks. My cardiologist has recommended against diving, but people with Marfan syndrome usually have limited physical activity, so I was not surprised. I have been treated my whole life and maintain a very active lifestyle, including swimming, water polo, basketball, and marathon running, against all recommendations. What are the risks for someone with Marfan diving, and is there anything I can do to mitigate them?

A: Marfan syndrome has an extensive spectrum of presentation from mild to severe and requires your physician team’s assessment. Many factors may have influenced your cardiologist’s recommendation against diving despite the active physical activities that you describe. Physicians will carefully separate the list of appropriate activities. Diving affects various body systems, so the extra stress on systems that Marfan syndrome affects is an important consideration. The following are a few specific conditions to consider: • Dilation and dissection of the aorta: Fluid changes that occur while diving may stress the aorta. • Cardiac valvular conditions, cardiomyopathy, and dysrhythmias: These potential problems are often more significant if they occur underwater. • Pneumothorax: Marfan syndrome can have a higher association with pneumothorax. There can be a risk of spontaneous pneumothorax (collapsed lung) with little or no inciting event. Although problematic on land, it is lifethreatening while diving. Pulmonary barotrauma can cause a collapse of anyone’s lung. Upon ascent, trapped air expands and may cause a collapsed lung to develop into a tension pneumothorax, a medical emergency in which air cannot escape the pleural space around the affected lung, increasing the risk of a pulmonary overinflation syndrome such as arterial gas embolism. • Scoliosis: Spine curvature has been associated with Marfan syndrome. Depending on the severity, scoliosis may cause a reduced exercise tolerance, making routine dive activities such as carrying gear, climbing a boat ladder, or swimming against a current more difficult. • Spinal dura: There may be changes to the spine’s dura that can result in pain and headache. These changes may have a confounding impact on the diagnosis of spinal decompression illness (DCI). • Thermal regulation: Wearing thermal protection can delay the core temperature drop from immersion in water, but you will eventually cool, and self-regulation may be difficult.

You should review temperature regulation with your physician. Medications and your baseline wellness are also worth reviewing. Some medications may have adverse reactions that may be a contraindication to diving. Your daily wellness is a necessary consideration, as are any regularly occurring pain or deficits that may make diagnosing DCI difficult. It’s essential to have an open discussion with your treating physician and follow their recommendations. World.DAN.org

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10 WAYS TO MAKE A DIFFERENCE TO OUR OCEANS

Protecting our oceans is imperative as divers and

ocean lovers. We need our oceans to be preserved for generations to come. There are many ways you can help out and be involved this year, from simply spreading your love of the aquatic world by introducing your friends and family to your favourite diving activities to going out into your community and taking action. Check Out SSI’s Top Ways to Make a difference:

1. Write to Your Leaders

One of the most direct and impactful things you can do to help our oceans is to send a letter to your nation’s leaders calling attention to the state of the ocean. You can research who your local representatives are yourself or use precreated letters from organizations.

2. Plan an Event

Hosting an event allows you to not only give your friends, family, and community members something to do to help our oceans, but it also draws attention to the challenges our aquatic resources face and ways we can help. • If you live near an ocean or large body of water, consider hosting an underwater and/or beach clean-up. • If you are stuck inland, you can still host a clean-up at a local park or national forest.

3. Speak Up and Speak Out

Social media has become the cornerstone of our daily lives in many ways. Why not use your social media accounts as a platform for calling attention to ocean conservation and encouraging change?

4. Join the SSI Blue Oceans Community

Blue Oceans, powered by SSI, is a free programme that helps divers and SSI Training Centres further ocean conservation and make a lasting difference.

SSI’s Blue Oceans initiative provides the perfect starting point for divers, dive centres, and even non-divers to learn about and incorporate ocean conservation in their daily lives.

5. Reduce Your Plastic Use

Single-use plastic is one of the worst contributors to plastic trash on our planet today. The quickest way to greatly reduce your plastic waste is to replace as many of the single-use plastic items you use in your daily life.

By being plastic-minded, you can have a significant positive impact on the world’s oceans. Switch out these single-use plastics: Straws, grocery bags, water bottles, and toothbrushes.

6. Use Reef Safe Sunscreen

Reef Safe sunscreen may be a new concept within the last decade, but it is catching on quickly within the oceanminded community and is helping to protect coral reefs.

Typically, most sunscreens use oxybenzone and octinoxate as their UV-blocking agent. These chemicals can cause coral bleaching and are unhealthy for marine life.

Reef-safe or reef-friendly sunscreens are usually zincbased and do not harm corals, so make sure you stock up on these sunscreens before heading to the tropics.

7. Take an SSI Environmental Specialty Programme

SSI currently offers six informative Ecology Specialty programmes to help you become an ocean ecology and conservation expert. These programmes are the perfect way to enhance your dive experience by learning about different marine life, how ocean ecosystems function, and how to dive safely with sharks, rays, and more!

8. Be Water-Wise

Planet Earth already contains all the water it will ever have, so we must treat it carefully. No new water is or can be created. Here is how to reduce your water use: • Turn off the water when it is not in use. • Take shorter showers. • Install high-efficiency (water-saving) faucets in your house. • Place water buckets in your garden to collect rainwater for your plants.

How to increase water quality by watching what you put into it: • Use non-toxic cleaning products, low-phosphate detergents, and biodegradable soap, shampoo, and conditioner. • Use natural, non-toxic fertilizer in your garden. • Check your car regularly for leaks. • Use non-toxic car cleaning soap when washing your car.

9. Eat Sustainably

By eating sustainably caught seafood and responsibly grown meat, you can help to protect our oceans and landbased environments. You will be limiting what we are taking out of the ocean and reducing the land needed to produce food products. It’s as simple and effective as that.

10. Become an Eco-Diver

An eco-diver is anyone interested in taking extra steps to protect our oceans and other aquatic resources with lifestyle choices that help protect the environment. Ensuring that this planet will be filled with healthy dive sites for years to come depends on the actions we take as divers now. n