Cotopaxi High Altitude Course

These are photos from Mountain & Marine Medicine's High Altitude Medicine Course in Ecuador last month. We had a group of 19 participants who took part in lectures at the UTE university in Quito before leaving for Tambopaxi refuge in the Cotopaxi National Park. We enjoyed lectures and skills labs at Tambopaxi and then hiked up to the Jose Rivas Refuge on the Cotopaxi volcano. These photos are from the climb on Cotopaxi. 40% of our group made it to the top, 19,300 feet! I turned around at 18,500, so none of these photos show the summit. Check back in a few days for a group photo and summit pictures. Most of us exceeded our climbing goals and achieved our highest altitude ever. But the meeting was really about a fantastic education experience in a stunning setting. We met good friends, learned a great deal about altitude medicine, and look forward to our next experience!

Check out our travels and lectures:
http://www.mountainandmarinemedicine.com/HighAlt.html

Our meeting in Kailua Kona also promises to be an exceptional course, with a unique approach to medical education and terrific guest speakers.
http://www.mountainandmarinemedicine.com/Kona2006.html

email us at: mail@MMMedicine.com

Patent Foramen Ovale & Diving

Pictured here is a rash suffered by a professional diver after a typical day of diving. The profile was well within no-deco limits and his dive computer showed that his nitrogen tissue saturation was not substantial. This diver suffered vertigo and dizziness along with the rash, making it a type II decompression sickness (DCS) event. This episode is an illustration of undeserved bends. The diver did everything right, yet suffered severe symptoms of DCS, requiring treatment in the chamber above.

What causes undeserved bends? Occasionally dehydration, illness, or abnormal complement immune function may contribute. However, the cardiac abnormality known as a patent foramen ovale can predispose to DCS in some divers.

Patent Foramen Ovale is an opening between the left and right atria in the heart, allowing blood to bypass the lungs. Divers often develop bubbles in veins, a common occurance (30-100% in some series). Most of the time these bubbles are harmless and are filtered out by the lungs. A patent foramen ovale allows these bubbles to pass by the lungs and go into the brain, where they can cause stroke-like symptoms. In fact, the onset of DCS in divers with a patent foramen ovale can occur rapidly. This can look like a arterial gas embolus, which generally occur when divers hold their breath during a rapid ascent. In PFO however, the diver may have just finished an uneventful dive with no warning from their dive table or computer - hence the term undeserved bends.

So this sounds scary and unavoidable. Scarier still if you consider that about 30% of the population has a PFO! And it seems to be even more prevalent in divers than in the general population. Even doing a valsalva maneuver may open up a closed PFO. Some depressing studies have illustrated a correlation between PFO and brain injury in recreational divers.

But don't quit diving yet. PFOs, while common, rarely cause DCS. And those brain injury studies are fraught with methodologic problems - so far.

We will discuss these issues in great detail this August in Kailua Kona. This information should be of great interest to anybody who dives. In particular, frequent divers, deep divers, and professional divers should know about this research.

Aloha,

Joe Alcock MD
www.MMMedicine.com
mail@MMMedicine.com
http://www.mountainandmarinemedicine.com/Kona2006.html

Hyperbaric Medicine Updates

During our upcoming Marine & Diving Medicine Course, Aug 22-26th, 2006, we will be discussing the latest in hyperbaric oxygen therapy for diving injuries.

If you are a medical provider on a dive trip, you may be called upon to help make a decision about evacuating an diver to a chamber. How will you make that call?

If you are in Cozumel, Mexico, as pictured here, or Honolulu, you are lucky because a hyperbaric chamber and dive physician is nearby. Often, though, a chamber will not be readily available. Kona Hawaii lacks a chamber.

As a medical provider on a diving trip you will be confronted with divers who may minimize or deny their symptoms, captains who have a financial interest in continuing a dive trip, and obstacles to safe evacuation, like unpressurized aircraft.

We will discuss indications for hyperbaric oxygenation in a future post.

Remember, the number for DAN, Divers Alert Network, is 1-919-684-8111. Remember to call local EMS first! A DAN diving physician can offer advise for diving accidents, medical evacuations, and whether hyperbaric oxygen is appropriate.

We strongly recommend DAN travel insurance for participants, a good deal, particularly if you go on several dive trips per year.

Aloha,

Joe Alcock MD
www.MMMedicine.com
www.mountainandmarinemedicine.com/Kona2006.html

Pre-conference Shore Dive

The faculty of Mountain and Marine Medicine are planning a shore dive at Pu'uhonua o Honaunau on August 20th before our Marine and Diving Medicine course begins in Kailua Kona Hawaii. This will be a good opportunity to get acquainted with some of the best diving the Kona coast has to offer. It is a truly special place with frequent visits of Honu or Green Turtles. Green turtles are an endangered species but thankfully common in Hawaii.

You are welcome to dive with us - send us an email at:
mail@mountainandmarinemedicine.com

Above is one of my photos of a green turtle at this dive site.

Joe Alcock MD
www.MMMedicine.com

Mountain & Marine Medicine warns: Don't let this happen to you!

We will cover dangerous marine vertebrates, like this needlefish, which caused the loss of an eye, but not death, in this Japanese victim. See another account of needlefish, or Aha, injury in Hawaii: Aha Injury
And check out this link on Needlefish from the Hawai'i lifeguard site: Aloha

Its is best to protect yourself from the knowledge that will come from our Marine and Diving Course this August.
Visit our Kailua-Kona Course.

Be safe!

Joe Alcock MD
Co-director Mountain and Marine Medicine, LLC
www.MMMedicine.com

Preparing for Marine & Diving Medicine Course

Mountain & Marine Medicine's faculty are getting ready for our CME course in Kailua Kona this August 22-26, 2006 by preparing lectures AND dusting off our dive gear!

We recommend that participants get their regulators and B/C's checked out at a local dive shop. For us, that means stopping by the Scuba Company in Albuquerque NM.


http://www.scubaadventures.com/

Remember, dive gear is your life support system underwater! Do make sure that it is in good working order.

For more information about Marine and Diving Medicine, visit:
http://www.mountainandmarinemedicine.com/Kona2006.html

Mahalo,

Joe Alcock MD
Co-director Mountain and Marine Medicine
www.MMMedicine.com

Dive Medicine in Kailua Kona HI, August 22-26th

Happy 4th of July! From Mountain & Marine Medicine, LLC



Here are some recent photos from Mountain & Marine Medicine's preparation trip to Kona to get ready for our event in August.

We have assembled a great group of participants and faculty for this year's Marine and Diving Medicine Course. This interactive CME conference will be bigger and better than last year! Members of the diving community in Kailua Kona are welcome to join us for an engaging discussion of real life diving accidents and problems encountered by Hawaii swimmers and divers!

Be sure to check out:
http://www.mountainandmarinemedicine.com/Kona2006.html

Live aloha!

Joe Alcock MD
Co-director Mountain & Marine Medicine, LLC
www.MMMedicine.com