Three Common Swimming and SCUBA Myths in the News Again

On Monday July 7, a news show Troubled Waters featured a story of two scuba divers who floated 19 hours overnight after they and their dive boat did not connect after a dive on the Great Barrier Reef in Australia.

In their television interview, the two divers told various points of the situation. Three of the concerns were common myths often repeated in scuba training.

1. They mentioned they experienced signs of hypothermia. Technically, not any chilling is hypothermia. Being uncomfortably cold does not mean you have hypothermia. Shivering and teeth chattering does not mean you have hypothermia. You can even become incapacitated by cold before becoming hypothermic. In informal conversation, the two terms of hypothermia and chilling are often used interchangeably.

2. The woman of the pair stated she had read in a book, which had a section about progression of hypothermia, that exercise is not good and can be counterproductive. They were worried that body movement would, "send blood to the muscles away from your core, and your organs" and for that reason, make them colder.

I have read the book they mention. It is a book of wonderful stories and great writing, interesting medicine, but the physiology is frequently off. As a physiologist, I notice these things. When I teach medical students in their classes, I often see that they do not want to learn physiology, they only want to learn what medicine to give and where to cut. I tell them that without understanding the reasons for how the body resulted in the situation in the first place, they will only repeat the mistakes of their teachers by giving medicines and cutting.

Back to the shivering divers floating all night, waiting for rescue. It is not always the case that exercise in the cold must only make you colder. Exercise in cold water can generate enough heat to match or surpass the large thermal drain, depending on water temperature, work load, duration of exposure, your body composition, what you are wearing, and other factors. It is true that exercise in cold water increases heat loss, but it is an important point that it does not mean that you will always cool. Whether you stay comfortable or get cold depends how much heat you keep and how much you lose. If you generate more heat than you lose, you will be warmer than when you started. When I worked on cold water immersion for the Navy, we studied body cooling in pilots downed in cold water, and how long they could survive (all volunteers, really they loved my studies). We also studied divers. Some divers sent for underwater missions during the Gulf War were overheating underwater and had to wear ice vests with their scuba gear.

3. The last myth is a popular one. I am a scuba instructor and have heard this one repeated often. The two divers mentioned that the woman of the pair was menstruating and that there were sharks in the water. The woman said, "I'm shark bait is what I'm thinking." Diver researcher Dr. Carl Edmonds found that Australia's shark attack tracking system reported nine times more shark attacks on men, even though there was an even number of male and female swimmers.

Menstrual blood does not attract sharks. Neither does menstrual blood attract grizzly bears during camping trips, cause wine to sour as stated in ancient religious writings, or cause wings to snap off airplanes, as pilots insisted in the 1920's. The term man-eating shark, for now, remains.

I explain these myths and more about swimming and diving physiology, underwater and in heat and cold, in the book Diving Physiology in Plain English.

Labels: cold, myths, scuba, swimming

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Stop Lower Back Pain From Swimming and SCUBA Part II

Yesterday's post explained the most common hidden cause of lower backache after swimming and scuba diving. Swimmers and divers who get this chronic pain are often misdiagnosed with SI (sacroiliac) joint dysfunction, arthritis, disc injury or various "catch-all" terms for back pain with unknown origin. Scans may show damage to the facet joints, which can occur from spinal overarching. Injections and surgeries and various anti-inflammatories are often prescribed. No shots, medicines, or surgeries are needed. You do not need physical therapy or strengthening programs. All you need to do is stop overarching and maintain neutral spine when walking, running, swimming, and diving. It is easy, and is a healthy and normal spine position. You do not tighten any muscles to do it. It is just learning a normal posture.

Check yourself to see if you stand in hyperlordosis:

1. Stand up and look sideways in a mirror. Your belt should be level, as in the left drawing of neutral spine. The side seam in dress or trousers should be vertical from leg to waist, as in left drawing, not tilted forward at the hip (middle drawing).
   
   
2. Back up slowly and gently into a wall. If your backside touches first, it may be an indicator that you lean forward at the hip. If your upper back touches first, it often is a good indicator that you lean the upper body backward (right drawing).
   
   
3. Stand with your back against a wall, with heels, hips, upper back and back of your head touching. There should be a small space between your lower back and the wall, but not a large space. Then raise both arms overhead to touch fingers to the wall behind you to simulate swimming with arms outstretched. See if the lumbar curve increases. You should be able to stand with the back of your head touching the wall without increasing your normal curve, and be able to raise your arms without increasing it.

If you have a large space between lower back and the wall, try this:

1. Press the lower back toward the wall to feel how to decrease the space. There is a short movie of this on Fast Fitness - How to Feel Change to Neutral Spine.
   
2. If you can't figure how to do that, put your hands on your hips, thumbs facing the back, and roll your hip under so that your thumbs come downward in back.
3. Feel the large space between lower back and the wall become a smaller space.

Lower back pain that is caused by hyperlordosis should ease right away. Learn how to easily, gently do this while walking, running, swimming, or whatever you do. This is done without tightening or clenching any muscles.

Keep the good new neutral spine when you walk away from the wall, and all the time. Apply it to when you are swimming and scuba diving.

Muscle Use is Not Automatic
The muscles that hold neutral spine are your abdominal muscles. They do not do this automatically, which is why strengthening programs do little to stop back pain. Someone may have strong abs but stand and swim in arched posture, with continuing lower back pain.

Heavy scuba tanks don't make you arch your back or have bad posture. Not using your ab muscles to counter the pull, and allowing your back to arch is the problem.

When you are standing up wearing tanks, straighten your body against the pull of the load and maintain neutral spine. Do not tighten your abs, just move your pelvis. If you notice yourself arching while wearing tanks, straighten your body as if starting to do a crunch but don't curl forward. Only straighten to neutral spine. Don't tuck so much that you lean back or push your hips forward.

No More Lower Back Pain From Overarching
Transfer this neutral spine skill to your daily life for carrying gear, putting cargo up on racks, heavy packages on counters, and whenever you lift and reach. Use neutral spine when standing, walking, running, reaching overhead, swimming, and scuba diving.

Labels: facet joints, lordosis, lower back, neutral spine, scuba, swimming

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Lower Back Pain From Swimming and SCUBA

Lifting and carrying heavy dive gear with good lifting mechanics is good and functional exercise. With bad lifting habits, it is a common and obvious cause of lower back pain in scuba divers. A second major cause of lower back pain after SCUBA and swimming is often overlooked and can occur after scuba diving and after swimming laps with no gear lifting.

Hyperlordosis
When swimming or finning face down and horizontally through the water, many divers allow their lower back to increase in arch. They look like they are face down in a hammock - shown by the figurine below:


A small inward curve belongs in the lower back. When you allow the normal inward curve, (normal lordosis) to increase, it becomes hyperlordosis or overarching (swayback).

For most people, hyperlordosis is most common when upright, such as standing, walking, and running. Swimmers and divers who allow their back to overarch when swimming face down often notice the pain after swims and dives:


How Hyperlordosis Causes Lower Back Pain
Hyperlordosis pinches the joints of the vertebrae called facets and the surrounding soft tissue. When swimming and diving in hyperlordosis, the fulcrum of the kick becomes the facets instead of the muscles of the abs and hip. When standing upright with a hyperlordotic lower spine instead of neutral spine, the weight of the upper body presses down on the overly pinched-backward lower back. Running in hyperlordosis causes more of the banging and pressing.

People with lower back pain from hyperlordosis usually feel they need to bend over forward, or sit, or raise one leg to relieve it. Often nothing shows up on x-rays and scans. Eventually, hyperlordosis can damage structures enough to show. Until then it just aches a great deal.

The cause of this kind of pain is often unrecognized and people may be told they have a condition called sacroiliac, or SI joint dysfunction, or nonspecific back pain, or other names.

Next - Part II, How to Stop Lower Back Pain From Swimming and SCUBA

Labels: facet joints, lordosis, lower back, neutral spine, scuba, swimming

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Technical Difficulties

Articles intended for yesterday and today could not be posted. Blogger is having technical difficulties. No photos or graphics are uploading to Fitness Fixer. The scheduled posts that describe healthy use of kettlebell weights would not be as fun or understandable without seeing the photos. They will come, hopefully soon. Until then, try this remarkable site www.bonkersinstitute.org.

Bonkers Institute was sent to me by reader Dr. Ern Campbell, a good man, who runs the immense resource of the Scubadoc diving medicine site and forum, scuba-doc.com. I am one of the site's diving medicine advisors.

The Bonkers Institute site, on the surface, seems to be funny stories. Look closely to realize how they intelligently expose critical topics. From their "about" page, they explain that they bring to light "shameless disease mongering and unprecedented pharmaceutical profiteering."

"...Our mission is to expose fraudulent medical pseudoscience wherever it is found… We march into the field of battle armed with a powerful weapon: our sense of humor. Fighting pseudoscience with pseudoscience…"

read on -

Labels: drugs, education, mind, scuba

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Can We Teach Young Doctors to Be Healthy?

We have been traveling for the past 2 months in Asia and are on the way to the chilly Smokey Mountains of Tennessee USA to teach medical students for a week during their rotation elective in Wilderness Medicine. This is the third year I will teach there.

I will teach the entire curriculum of diving medicine and physiology, plus a workshop on why commonly prescribed stretches are not healthful, and what to do instead. Several members of the Knox County Sheriff's Office from Knoxville TN have requested to attend my lectures, and several readers made the effort to find the class information on my web site and make arrangements to travel to the camp to attend.

As a physiologist, I design the techniques that physicians use. I spent many years as a military and university researcher in environmental physiology, which is how the body functions in the heat and cold, at altitude and underwater, breathing different mixtures of gases, doing different forms and intensities of exercise. It's important to understand why things work. If you don't understand, then you can't think for yourself, and all you can do is repeat the mistakes of the generation before you, who also were just repeating what they learned in a book from teachers who just were repeating what they had heard.

This problem occurs with some of the exercises and stretches given as physical therapy. An introduction to the problem is in the post What Does Stretching Do? In the past two years teaching at the camp, we encountered young students who were not interested to change bad stretches, and made a point of showing me after my lectures that they will keep doing their rounded bent forward toe touches, since "everyone knows" that is how it is done. However, Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch.

The problem occurs with nutrition. The medical school food at the wilderness camp is not healthy, and students have defended eating candy and junk food as reasonable, even saying that what they eat is not unhealthful - What Medical Students Told Me About Nutrition and When Did Health Become Thinking Out Of The Box?

The problem can occur with medical treatments that are in the books, even though wrong. In my diving physiology lectures, I try to show that if you understand the physiology, you will know why certain treatments do not work or are not needed. Immersion in water, for example, creates many interesting effects such as distributing blood volume more out of the limbs to the body. This is similar to the effect that occurs in space, described in Collapsing Astronaut Gives Healthy Reminder. Recently, during our travels, Paul wound up in the hospital with a swollen leg. The doctor who was Chief of Medicine of the hospital, announced that the treatment was bed rest. Paul was told he must lie flat in bed for at least three to fours days with the leg elevated to drain the fluid. We understand that bed rest is often listed in books as a treatment for this, but it is wrong. I asked the doctor if going in the water could help. The doctor said that standing in the water meant the leg would be "hanging down" and the leg needed to be elevated to drain. If you understand immersion, then you know why immersion can more effectively treat limb edema and water retention than medicines and lying in bed. Extended bed rest is unhealthy, and reduces muscle and bone health so much that it is used to study the damage to the body from floating around during space travel. We escaped the medical care and went into the water. I will post more on immersion, edema, and health soon.

I will not have Internet access for the next week to read or reply to comments. Enjoy the posts. Start taking and sending in fun photos of your successes using all the fun techniques.

Labels: education, injury, scuba, swimming

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Space Walks

The space shuttle Endeavour landed yesterday at Kennedy Space Center in Florida.

Endeavour's two-week assignment to the International Space Station was shortened for safety arrangements concerning Hurricane Dean.


The Endeavour name uses British spelling because it was named for the HMB Endeavour, a sailing ship commanded by 18th century explorer James Cook. Before launching the space shuttle Endeavour, NASA hung a humorous, quickly replaced "GO Endeavor" banner. The formal name is STS - Space Transportation System. This mission was STS-118.


During STS-118, crewmembers went outside the vehicle for assorted tasks. Going out is called extravehicular activity (EVA). Crew going on EVA wear pressurized suits to protect against radiation, space debris, temperature extremes, and low air pressure. The suits aren't just called suits, they are Extravehicular Mobility Units (EMUs). EVAs get interesting because EMUs are pressurized higher than the near vacuum of space, since space doesn't support human life, but not as much as inside the shuttle. The lower air pressure inside EMUs increases risk for various problems like gas embolism, but chiefly, decompression sickness, also called the bends.

Air pressure around us keeps nitrogen gas dissolved all over in our body all the time. When you go up a mountain, in a high airflight, or on an EVA, there is less surrounding pressure. Nitrogen becomes undissolved. If you reduce pressure slowly enough, nitrogen comes out peaceably and you can breathe it out. If you come up from a scuba dive or jump out for your EVA too fast, nitrogen offgases too fast, making bubbles, which are believed to be the basis of decompression sickness. Beside the role of exercise in countermeasures for space health and after returning, exercise is one of several factors affecting risk of decompression sickness. The post Exercise and Fitness in Decompression Sickness Risk explains.

If you could start an EVA with less nitrogen in your body, you could reduce your risk of decompression sickness. Crew preparing for an EVA do lengthy de-nitrogenation procedures. They breathe oxygen instead of air, and do physical exercise to "wash-out" nitrogen in several stages taking many hours. One goal of aviation scientists is to develop faster protocols for denitrogenation without increasing risk of decompression sickness during EVA.

American and Russian space programs use different denitrogenation protocols and different EVA suits. Russians use EMUs with higher suit pressure. The American suit design uses lower pressure, making it more flexible and maneuverable. The lower pressure suit is considered riskier for decompression sickness, and needs longer prebreathing and denitrogenation exercise. The Russian suit, higher pressure inside, is stiffer, needing more muscle to move. My Russian scientist friends say it is like the AK-47 - tough but good. My American scientist colleagues state that the Russian egress suit is a bull, lacking dexterity. My Russians reply they don't need it, as their vehicles, suits (and cosmonauts) are built strong and austerely, not needing fussy fine-tuning. Da.

My crew surgeon friends from both agencies are all submerged in triplicate paper forms for permissions to send me mission stories and photos to post for you. Nice that everyone can feel universally understood.

Labels: aerospace, altitude, scuba

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Altitude Sickness, Viagra, and Bubbles on Flights

The previous post Altitude Sickness During Flights told how certain symptoms occurring during air travel are from exposure to altitude.

If a craft were not pressurized, cabin pressure would be equivalent to the air pressure outside the aircraft at whatever altitude. At high altitude, there would not be enough air pressure inside for crew to be functional enough to fly. This was one of my areas of study with the Navy. Crew in unpressurized craft wear oxygen-delivery equipment.

Passenger planes are pressurized. The inside is kept at a higher pressure (lower equivalent altitude) than flight altitude (the air outside the plane). The pressure is still not as much as at sea level. Keeping that much interior pressure would create huge fuel costs and extreme metal fatigue on the craft. Regular passenger aircraft keep interior pressure equivalent to mild altitude exposure.

In the last few years, Viagra (sildenafil citrate) has been tested by various groups, including the military, as intervention against altitude sickness. Recently it was also found that the drug reduced symptoms, thought to be jet lag, after flights. My guess is that it was effective for symptoms from flights because of the same properties that may help reduce symptoms, in some, of altitude sickness.

Another component that I discovered many years ago in my work in altitude sickness, was a bubble component - an altogether new dimension to the altitude sickness puzzle. Decompression sickness bubbles can form in the body when coming up after a scuba dive. I found the same kind of bubbles can form in your body when going to elevations encountered in aircraft and mountain travel, with no prior scuba diving. More of this in future posts. Decompression sickness is also an issue when going into space during extra-vehicular activities. Click Space Walks.

Altitude sickness in flight is different from (or in addition to) the motion sickness of flight motion, or being stiff after not moving enough during long flights. The post Exercise and Stretch for Long Travel Sitting covers some exercises and stretches to relieve those problems.

Labels: aerospace, altitude, drugs, injury, scuba

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Respiratory Muscle Training for Swimming, Diving, and Running

The previous post on training breathing muscles -
Respiratory Muscle Training for Better Health and Exercise - covered how breathing exercises have been found to help increase respiratory capacity in people with various diseases, and more recently, to help physical training in athletes. At the diving and hyperbaric conference three weeks ago, I attended sessions on respiratory muscle training for underwater operations. It is a topic of interest for those in charge of combat swimmers.

In one study, Researchers at the State University of Buffalo at New York found that respiratory muscle training improves swimming and respiratory performance at depth. As you go deeper, the work of breathing can increase, even using high performance breathing devices, because of higher gas density and other factors. They tested the effect of resistance respiratory muscle training on respiratory function and swimming endurance in divers at 55 fsw (~16 m). They found that respiratory muscles were less fatigued following training, breathing rate was lower during the swims, and that the training increased the duration they could swim by about 60%. They concluded that respiratory muscle fatigue limits swimming endurance at depth, and the increase in swimming endurance may result from reduced work of breathing or improved respiratory muscle ability.

The second study by the same group looked at the different benefits of training the endurance and strength of the respiratory muscles. Eighteen SCUBA-certified swimmers were randomly assigned to a placebo group who didn't train their breathing muscles, a respiratory endurance training group, or a respiratory strength training group. Each group used a breathing resistance device five days a week for 30 min over four weeks. The endurance trained group decreased heart rate and ventilation during underwater swims. Both the endurance and strength groups improved fin swimming endurance. The placebo group experienced no changes.

The researchers concluded that respiratory muscle training is effective in improving swimming endurance. They told me they found it is also effective for endurance running, but perhaps not as effective. They are working on finding out why. My friends who do long stints in submarines mentioned they like to use respiratory muscle training to help keep them in shape since they can't go out for a run while on sub duty.

The post Do Breathing Exercises Work? shows ways to try breathing training. The book Healthy Martial Arts gives more.

Labels: aerobic, breathing, endurance, hyperbaric, performance enhancing modality, scuba, strength, swimming

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Respiratory Muscle Training for Better Health and Exercise

At the American College of Sports Medicine conference last month, I attended an entire session on effects of training respiratory muscle function. Back when I was in school, we learned that the ability to breathe harder, better, faster, could not be trained with exercise or other modality, that it was fixed from person to person, like eye color, except that it got worse with aging, and that it didn't matter much, since ventilation did not do much to limit exercise potential anyway.

Even though the lungs don't have any muscles of their own, it didn't seem right to me, as the diaphragm and muscles that move the rib cage to voluntarily breath in and out are muscles like any other. What if there are people whose respiratory muscles are not trained to work hard enough and add to the metabolic cost of exercise, increasing fatigue and so, limit exercise? It is also true that many people are not in good enough shape to use more oxygen, so breathe most of the oxygen back out with each breath, even when exercising strenuously. What about someone in great athletic shape who could use that oxygen. Why couldn't they be trained to move more air faster if they needed some?

Exercising the muscles that you use to breath in (inspiratory muscle training) is known to improve the endurance of the respiratory muscles in people with spinal cord injury and cystic fibrosis, and is shown to improve exercise capacity in patients with heart failure. What about for people without these conditions or for athletes?

There is some published literature that does not show improved work capacity (J Sports Sci. 1991 Spring;9(1):43-52.) and some that show high-intensity training increases exercise capacity in people who are healthy (Phys Ther. 2006 Mar;86(3):345-54.).

The diving medicine conference two weeks ago had several studies that showed interesting and promising results with breathing training. Combat swimmers have long used various breathing training to get in shape for swims and other strenuous work. The next post covering respiratory exercises - Respiratory Muscle Training for Swimming, Diving, and Running - tells about it.

Respiratory muscle training in the above studies did not involve popping corks from your lips, as in the accompanying photo. To improve your breathing capacity and do training at home without respiratory training devices, see the post Do Breathing Exercises Work? and the book Healthy Martial Arts.

Labels: aerobic, breathing, circulation, endurance, performance enhancing modality, scuba, strength, swimming

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Exercise and Fitness in Decompression Sickness Risk

In the post Train Exercise is Exercise Training I mentioned the ongoing question in diving physiology research of how exercise can affect the risk of decompression sickness (the bends).

It seems that exercise done during a scuba dive at the bottom increases the amount of nitrogen gas you absorb from the air you breathe from your tanks. This makes more gas which could contribute to decompression sickness on the way up. Mild exercise on a "decompression hang" (waiting at specific shallower depths for a few minutes on the way up) seems to help let more gas dissolve out while you breathe, and may lower risk. Exercise soon after surfacing may increase gas coming out and increase risk according to other work. Some interesting studies look into whether exercise done days before a dive can reduce risk by "using up" specific components that decompression sickness bubbles need to be able to form. The kind of exercise and timing seems important. I will post more on this another time.

Some work looks at physical fitness, and whether that affects risk of decompression sickness (DCS). Would someone in better physical shape have lowered risk? What constitutes being in better shape? Is it body fat? Is it the amount of oxygen you can use to exercise? How might any one of those components affect DCS risk?

Here at the UHMS scientific meeting, one of the studies presented by French naval researchers is, "Does the VO2 max value predict the formation of intravascular circulating bubbles during decompression of healthy divers?" VO2 max (pronounced vee-oh-too-max) is the most oxygen you can use when doing the most exercise you can do. It is usually higher in people who can do more aerobic exercise (other factors also contribute). The maximum amount of exercise an average person can do is about ten times their resting level of oxygen use. Marathoners usually max at around 20 times better than resting levels. A top aerobic athlete can use about 30 times resting level (a horse - more than twice the top human max). Someone badly out of shape, or with heart disease or other problems that limit ability to get oxygen to cells, generally has a low VO2 max. You can raise your level with regular exercise at any age. It is not set.

In the French study, divers were tested for VO2 max a week before their experimental dive. They avoided any physical exercise 48 hours before the dive. Then half completed a dive in a dry hyperbaric chamber and the other half in the open sea with the same dive profile and decompression stop according to French military decompression table MN90. After the dive they were all tested for presence of small decompression bubbles in the bloodstream.

Bubbles can form in the body painlessly after a dive without creating decompression sickness. It is not the case that bubbles always form after every dive, as often thought. Certain bubbles can be detected audibly (they sound like pops and squeeks) using Doppler ultrasound, and other kinds of instruments being developed. I will post more another time about these bubbles and what ultrasound can and can't determine about bubbles and decompression sickness.

The French researchers found that bubble formation in both types of dive was related to the age and body mass index of the divers, but not to VO2max.

Being in good shape makes many aspects of diving safer, even if it doesn't affect risk of decompression sickness. Being in better aerobic shape helps you swim more easily against currents that may take you away from your dive site or boat. Strengthening your body through weightlifting with good body mechanics helps you lift and haul gear with less chance of injury, and practicing all your physical skills helps you be more able to rescue someone or yourself.

What about physical fitness and risk of decompression sickness in space? Several studies here at the meeting address that. Astronauts who go outside the space vehicle go to lower pressures, similar to divers coming up from a dive. Many considerations, including exercise, go into their preparation for that. The interesting story is posted in Space Walks.

Labels: aerobic, aerospace, hyperbaric, scuba

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Hyperbarics for Diabetic Foot Injury

It is estimated that every 30 seconds someone in the world has their foot amputated because of a diabetic foot ulcer. Reduced blood supply to the feet and lower legs in people with diabetes delays wound healing and increases infection and chance of gangrene. Foot infection worsens the situation of inadequate blood supply by increasing the area's need for oxygen but decreasing blood supply. Poor blood supply further decreases ability to fight infection. Diabetic ulcers treated with antibiotics can become colonized with drug-resistant bugs.

I am at the annual meeting of the Undersea and Hyperbaric Medical Society (UHMS). Several interesting studies are being presented on diabetic wound healing. Enhancement of healing in selected problem wounds is one of the 13 approved indications for use of hyperbaric oxygen therapy as defined by the Hyperbaric Oxygen Therapy Committee. Hyperbaric treatments are done by putting the entire person in a small room or chamber and increasing the pressure inside so that the person breathes oxygen at higher pressure than what you are breathing now. The post Does Hyperbaric Oxygen Help Exercise Ability? explains more of how it works.

One of the studies presented here looked at 50 patients with severe diabetic foot ulcers. Half were treated with hyperbaric oxygen therapy (age and gender matched with the half who did not). Diabetic patients treated with hyperbaric oxygen had 56% chance of healing and 16% chance of amputation. Diabetic patients not receiving hyperbaric oxygen therapy had a 32% chance of healing and a 32% chance of amputation. Supplying oxygen to compromised areas, such as diabetic wounds, is important to restoring health. Hyperbaric oxygen is established to help that.

From the President's Competition came another study on hyperbaric oxygen therapy and stem cell mobilization in people with diabetes. This study was by researchers at the University of Pennsylvania's Institute for Environmental Medicine, where I did nine years of my research in diving medicine. Hyperbaric oxygen is already known to mobilize bone marrow stem cells in animals, healthy humans, and in patients with a history of radiation exposure. This study looked at diabetic patients with refractory foot ulcers or radiation necrosis who were receiving hyperbaric oxygen treatments. The study was small and results varied more than in previous trials. However, the researchers reported that overall, hyperbaric oxygen therapy increased circulating CD34+ stem cells three-fold in the patients with diabetics, and was shown to play a role in wound healing. Three patients of twelve in the study group did not increase stem cells. The researchers said that the reason for no increase should be investigated.

In the exhibit hall of the hyperbaric conference, various companies display their fun oximetry units. There are several kinds of oximeters. The most common ones painlessly assess oxygen levels through the skin. Oximetry is used to assess oxygen available to the injured and surrounding tissue, and to tell how well hyperbaric oxygen treatments are working to improve oxygenation and new blood vessel growth. I like to try them all on, on different parts of my body. I experiment with different exercises to see the different effects on oxygenating different areas. Movement makes rapid, effective increases in oxygen levels.

In the past, people with diabetes were cautioned not to exercise because it was felt that they would injure themselves. Now it's known that exercise is an important part of preventing injuries from diabetes, and preventing or curbing diabetes itself. Regular exercise:

• Helps your body burn more sugar.
• Increases the number of insulin receptors on your cells and increases the sensitivity of your body to insulin.
• Helps your body grow new blood vessels and improve circulation.
• Improves oxygen levels to areas to help them heal.
  
• Reduces high blood fat levels (cholesterol and triglycerides) which leads to early aging of blood vessels.
  
• Increases blood flow to the feet, which helps prevent diabetic foot problems.

Keep moving for many aspects of preventing disease, secondary effects from disease, and to improve your health.


Here is the next post from the conference Exercise and Fitness in Decompression Sickness Risk.

Labels: circulation, diabetes, feet, fix pain, hyperbaric, scuba

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Exercise and Medicine Underwater and at High Pressure

For the next week, I will be at scientific meeting of the Undersea and Hyperbaric Medical Society (UHMS). My colleagues attending are flight surgeons, SEAL team captains, commercial divers, submersible and submarine craft personnel from navies of many countries, and scientists from all over the world who study the science of what happens to the body when working under different pressures, temperatures, and breathing gases - at altitude, underwater, and in the specialized dry compartments to build bridges and structures deep underwater. There are also physicians, technicians, nurses, and aerospace scientists and astronauts who use hyperbaric chamber technology to prevent or treat specific non-diving conditions. Allied health workers, divers, and non-divers also attend.

Originally, we were the Undersea Medical Society (UMS). As use of high-pressure oxygen chambers to treat illnesses other than diving climbed, more sessions on how hyperbaric oxygen works (and doesn't work) were added. Wound healing increased in focus. In 1986, we became the Undersea and Hyperbaric Medical Society (UHMS). Forums, sometimes strangely heated for brainy, cool-headed scientists, are held about which conditions legitimately respond to hyperbaric oxygen treatment and which are felt not to have evidence (no matter how much we wish it would work and alleviate the suffering of the patients).

Some of the established benefits of hyperbaric oxygen and some uses that are not shown to be effective are explained in the post and comments of Does Hyperbaric Oxygen Help Exercise Ability?

The meeting will cover many interesting topics in decompression bubbles that are thought to cause (or be part of) decompression sickness, or "the bends," and mathematical and empirical models of decompression. Decompression theory and bubbles were my research area for many years along with the effects of too much oxygen on the body during exercise underwater and in dry habitats underwater. The meeting will have many sessions in clinical hyperbaric oxygen therapy for several specific conditions (abbreviated HBO, HBOT, HB02 and other), chamber equipment, and wound treatment. There will be a session of The Veterinary Hyperbaric Medicine Society. Animals get problem wounds that need help healing, too.

The national board exam for hyperbaric chamber nurse and technician will be administered. There is also a board exam for physicians in hyperbaric medicine held each fall through the American Board of Preventive Medicine & Emergency Medicine. Information and background on both exams is on the UHMS web site. I wrote the study guides for both exams. I tried to make them fun, user-friendly, and packed with understanding, not just lists of facts and equations to memorize. The guides cover the entire contents of both areas and are a nice review or compendium for anyone interested I the field. Info is on my web site books page.

I won't be staying at the fancy conference hotel but at a backpacker's hostel. Over the next week, I will try to get to Internet cafes to post on some of the interesting topics and research at the meeting - and swim and go underwater for real. That is good for a researcher in underwater exercise and medicine to do.


Here is the next post from the conference Hyperbarics for Diabetic Foot Injury.

Labels: aerospace, education, hyperbaric, injury, scuba

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Forensic Anthropology and Bone Density

A few weeks ago, I attended a lecture on forensic anthropology. In general, this is the study of things you can tell from human bones in a crime setting. How old was the person? Were they male or female? How big were they? What was their probable race or ancestry?

Why was I there when my work is with the living? Two main reasons. I am the science officer for the Vidocq Society, an international forensic society. I might evaluate data, for example in an aviation disaster, whether someone might have been conscious at each point when undergoing G-forces or different temperatures and amounts of oxygen after a depressurization at various altitudes. In a scuba death, I might advise on physical changes that occur with different situations. The second reason was to learn more about bones. Bones are remarkable. Your bones know a lot about you. What was your health like? Were you active? What kind of activity did you do? When I was small, I read about an archaeological dig in ancient Rome. The bones of a girl were recovered. The account stated they could tell she carried loads too heavy for her, and was therefore (in conjunction with other evidence) probably a servant or slave. I was riveted. How could they know that? I spent years after that learning more about telling how someone moved from looking at their bones.

Throughout your entire life, when you exercise you stimulate growth of new bone cells. The physical pull of muscles thickens your bones where the muscles attach. Using your arm muscles thickens arm bones. Using your legs strengthens leg bones, and so on. This is a main mechanism of how exercise prevents osteoporosis. Without exercise, you don't stimulate enough new cells to counter the normal loss as old ones break down. Your bones thin no matter how much calcium you eat. The post Exercise is More Important Than Calcium Supplements for Bones tells more about this. Bone demineralization is rapid and serious in astronauts in microgravity (Collapsing Astronaut Gives Healthy Reminder).

How you use your muscles causes them to pull differently, giving evidence about the kind of habitual motion. More interesting is that when you are active, your bones grow and shape themselves to facilitate your motion. An example of interest to readers following the posts on squatting is that people who habitually sit for normal daily life in full squat grow "squatting facets" on their lower leg bones. These are small areas on the bone that quickly grow to make squatting more comfortable. At one point, it was a debate in anthropology that squatting facets were a marker of someone of Asian ancestry, until it was found that others who squat also grow them, and that squatting facets disappear when the person adopts a Western sitting habit of chairs and no longer squats. Babies of all races can have them.

Someone who habitually slouches can change the shape of their bones, eventually deforming them. This can occur in the spine, knees, hips, ankles, shoulders, feet, toes - everywhere you pressure your bones. Changing positioning habits to healthier ones can, in many cases, reshape the bones back to healthier shape. Think of braces on your teeth. It's human bonsai. In cases of extreme dystrophies of the muscles, someone who sits without function of their trunk muscles to hold the spine upright, can eventually deform their spine until their ribs sit on their hip bones. How are you sitting right now? The recent post What Does Stretching Do? explained a bit of why stretching isn't reducing injuries. People are stretching, then exercising and going about daily life in bent over positions that rub and grind the joints and soft tissue.

You literally shape your own health. Use the posts throughout this Fitness Fixer blog to do healthy exercise in healthful positioning so that your bones will only tell good tales about you.

Labels: achilles stretch, aerospace, ankle, arm, feet, forensic, injury, leg stretch, osteoporosis, posture, scuba, sitting, squat, toes

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New First Aid Training

A new first aid training course has been developed by NAUI. The National Association of Underwater Instructors (NAUI) is one of several scuba diving training and certifying organizations. The first aid course is open to divers and nondivers.

Each of the different scuba training agencies has different approaches and philosophy. NAUI stresses "Safety through Education." Similar to discussions on which university or car is best, there are spirited exchanges by divers from different organizations on which scuba organization is "best." I did my training to become a scuba instructor with NAUI and have been active to help develop some of their textbooks and training courses. I was one of three fact-checkers in developing the new course text. NAUI did a nice job of keeping it clear and simple.

The new First Aid Training course includes all standard first aid, plus first aid for aquatic life and diving injuries, CPR (including professional rescuer), defibrillators, blood-borne pathogens, and emergency oxygen administration.

The NAUI First Aid course meets International Liaison Committee on Resuscitation (ILCOR) recommendations. Effective June 1, 2007, the course also meets acceptance of the United States Coast Guard. We received a letter from their Training and Assessment Division stating our course "meets or exceeds the standards of the American Red Cross Standard First Aid and Emergency Care or Multimedia Standard First Aid and will satisfy the first aid training requirements of 46 CFR 10.205(h)(1)(iii) for a merchant mariner license."

NAUI Vice President Jed Livingstone said, "For the first time in the emergency responder training market there exists an international consensus on what constitutes effective CPR and First Aid skills and the training methods and content needed to educate the general public and professional rescuer communities."

NAUI offers several diving courses from skin diver (using no air tanks) to scuba instructor, and specialty courses such as rescue, Nitrox, and technical diving. Their certification is accepted internationally.

Here is the Frequently Asked Questions (FAQ) list for the first aid course
More information on this and other diving books on my web site

Labels: education, scuba

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Train Exercise is Exercise Training

Reuters News India reported that yesterday in the eastern state of Bihar, the driver of a stalled electric train asked passengers to help get it moving again. We call this a G.O.P. car (get out and push).

The train had stopped in an electrically neutral area between wires. Hundreds of passengers pushed for more than half an hour to move the train until it connected with the electric contact overhead to supply power again (different distances, time, and why the electric connection to overhead wires was lost, according to different news sources).

In the 1970s and 80s, I often worked as a scuba instructor and dive guide in the Caribbean Islands and Mexico. There were strange tides one day, and the boatman accidentally ran the old wooden dive boat (with no radio) aground, far from shore. It seemed reasonable enough (to me) to put everyone out in the waist deep water, decreasing the weight and draft (distance from the waterline to the bottom of the hull). All the paying passengers and I got to enjoy a yo-heave-ho of functional exercise in the water pushing the boat free under the shining sun. The boatman stayed onboard to steer. I also put the two children on the trip with us off the boat to help, although the shorter one rode on my shoulders, excitedly pushing with both hands and feet.

For many years, it has been an interesting question whether exercise will increase or decrease risk of decompression sickness after scuba diving. Exercise seems to affect evolution and dissolution of bubbles from the dissolved nitrogen absorbed and released during and after scuba dives. It is turning out that exercise can both increase and decrease risk, depending on the timing of the exercise, to be covered in future posts. It is a topic for divers from military operations to vacationers trying to adjust their risk factors, and divemasters and scuba instructors who haul anchors, gear, and passengers up and down boat ladders (and G.O.P. boats).

Going back to trains, at least 20 years ago, my mother and I came up with the idea that in addition to dining cars, rail lines should have an exercise car, instead of passengers being confined to long sitting. We envisioned stationary bicycles and other simulators hooked up to generators that would run lights (or television), or record the distance traveled, with windows or screens showing passing scenery like a nice bike trip or race. Participants could race with or against each other. (Originally, Mom thought the cyclists could power the entire train.) Ideas flowed, like having proceeds help set up exercise and health programs that develop body and spirit in poor neighborhoods passed though. We came up with several names like "Training" and other variations, and thought it would be a new exercise craze and sure-sell for the rail industry. We made inquiries and didn't hear much back. You heard it here first - now date-stamped in this blog as our fun idea.

I was one of the first people to develop fitness on cruise ships, back when cruises were thought of as only deck chairs and buffets. Let me know if you want stories (or to set up a fitness cruise). Rail lines, are you interested? I will develop it for you as a fun fitness program.

Labels: arm, education, performance enhancing modality, scuba, strength

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Does Hyperbaric Oxygen Help Exercise Ability?

Heavyweight boxing champion Shannon Briggs was in the Black Athlete Sport Network news for getting sessions in a hyperbaric oxygen chamber. According to the news, Briggs stated he believed the treatments would help him improve physically and get in better shape for his upcoming fight to undefeated heavyweight Sultan Ibragimov. What is hyperbaric oxygen treatment and what is the basis for use?

"Hyper" means more or above. "Baro-" comes from a Greek word meaning weight or pressure. Some words that use this word root are barometer, an instrument measuring atmospheric pressure, and bariatrician, which is a physician who manages obesity. In general, hyperbaric oxygen treatment consists of breathing 100% oxygen while inside a dry treatment chamber that is pumped to a pressure higher than you are breathing now.

Hyperbaric oxygen treatment is used to treat two kinds of scuba diving accidents - decompression sickness and air embolism, which can result from rapid pressure reduction if you come up too fast. Hyperbaric treatment has also been found effective for treating wounds that do not heal because they do not have enough oxygen, certain infections of problem wounds, diabetic ulcers, and other conditions to be covered in future posts.

Hyperbaric oxygen is a documented modality in treating problem wounds which have a poor blood supply (are hypoxic). Bringing additional oxygen to the deprived area makes the body better able to repair itself. There is no current evidence that hyperbaric oxygen speeds healing of normal injuries, sore muscles, or that it improves physical ability. In sports injuries there is no lack of oxygen. Often the opposite problem occurs. For example, an area that is hot and swollen may have plenty of oxygen and blood supply. Adding more oxygen would not make it heal faster. There are occasional debates about using treatment chambers for athletes. As evidence becomes available, I will add it here. There is heated debate whether hyperbaric treatment is applicable to conditions such as vascular headache, brain injury, neurologic conditions, and others.

For a sick patient with problem wounds, diving injuries, carbon monoxide poisoning, or gangrene, hyperbaric treatment can be life and limb saving. Regarding athletes who believe it will make them a better athlete, and feel they should use hyperbarics regardless of hard evidence, there are minor side effects to hyperbaric treatments. Without the ability to heal regular muscle soreness or improve athletic performance, the side effects would not be helpful, and could be potentially detrimental to the athlete.

One of many resources for information on hyperbaric treatment and chamber directories is the Undersea and Hyperbaric Medical Society UHMS. For books about hyperbaric chamber treatment, and becoming credentialed see my web site books page.

Labels: fix pain, hyperbaric, injury, martial arts, performance enhancing modality, scuba

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What Medical Students Told Me About Nutrition

Early tomorrow we're traveling to the Great Smokey Mountains of Tennessee to teach for a week at the Wilderness Medical Society medicine elective. I posted about the elective in December.

This year I will teach the medical students the entire curriculum of diving physiology and hyperbaric medicine, and some fun seminars in orthopedics and stretching.

Last year we brought flashlights but no phone, as no cell signal got through there. Before arriving last year, I asked the medical director if we should pack in food. He said, "Not at all, the camp has its own chef." He told us there was plentiful vegetarian food. When we arrived, the breakfasts were sugared, packaged cereal, or sugared processed oatmeal packages, lunchmeats with greasy gloppy potato salad and fruit salad for lunch, meat loaf or other meat for dinner with small sides of vegetables soaked in fat. This is more than innutritious, it is harmful to health. There were many unfermented soy loafs and products. Unfermented soy, popular in protein powders, drinks, bars, and meat substitutes, is not turning out to be healthy as previously thought, and does not have the benefits of fermented soy products. Two previous posts, Is Your Health Food Unhealthy and Exercise is More Important Than Calcium Supplements for Bones explained that unfermented soy is known to slow the thyroid and has estrogen-promoting qualities - increasingly documented to contribute to estrogen-dependent tumors like fibroids, cystic ovary, breast cysts, and endometriosis. Hundreds of thousands of women annually have needless, serious, and painful surgery for conditions they might alleviate by avoiding estrogenic foods and the numerous "women's" supplements sold in "health" food stores. There were plenty of cookies, cakes, and muffins, coffee, and, in fairness, a bowl of fruit.

We were surprised that a medical education program would serve unwholesome food. Should we have been surprised? At the several medical conferences I attend every year, the breakfasts and meals at functions and meetings are bacon or sausage (these are not helpful protein sources; they do more damage than good), cheese Danish, and other junk food. The fruit is served covered with sugar and cream or as a small side. The only vegetables are the decorations. "Break-out" snacks are confections, candy bars, and ice cream. I was once on a committee that decided and promoted national health policy. The box lunches were ham, cheese, and mayonnaise sandwiches on white bread (or processed flour wraps) with a wisp of something green sticking to it, a bag of potato chips, a package of cookies, and a can of soda. I inquired one time about it and was told by the people in charge that it was "perfectly healthy and contained greens." At another conference, I was told they once tried to have healthful food, but were threatened by their physician members with reduced enrollments if they did. These are the physicians and health providers you go to, to safeguard your health. But, they are of the old generation and times have changed, haven't they?

At the Wilderness elective last year, I went believing that the young, "hip," privileged medical students had grown up with all the right information. I queried one student there about the food, and he replied without hesitation that it was no different from what he ate at home because healthy eating, "was too expensive and too time consuming and you need too many special pots and pans to cook that weird healthy stuff." I was taken aback by his misinformation. Several medical students agreed that they couldn't be expected to eat right with their difficult schedules, and that healthful food tastes terrible. Most had candy bars and bags of chips in their packs, or fancy "energy bars," which truthfully, are little more than candy (with unfermented soy and some synthetic vitamins) not the health products that advertising wants us to believe. I always thought that people know what is bad and would be embarrassed if anyone knew they did bad things. But the students didn't know it was unhealthy and flaunted their bad habit. These are the next generation of doctors who will make decisions about your health? Or prescribe drugs and surgery for things they don't know are from bad eating habits?

Our job there as their teachers is to give them information and open doors of insight. But their mind was set, and they did not want to hear how to have easy, inexpensive, and good-tasting healthful food (without needing special pots and pans).

I went to the director, a friend and sensible man, with the great idea to teach a healthful eating course at the next elective. He told me the students wouldn't be interested. I offered the idea to just change the menus to beneficial food at each meal, to live what they learn. The director smiled and told me they had a hard enough time getting enrollments and didn't want anything to decrease numbers. I said, "Don't tell them it's healthy food ahead of time." He winked, "Word would get out!"

I will let you know what happens this year with the students. We're bringing vegetables, fruit, onions, and spices for ourselves. If you're interested in how to make easy, inexpensive, fast, and good-tasting food, see the book Healthy Martial Arts. The interesting information I will be lecturing about this week on diving physiology and hyperbarics, is also on web site books page.


/Addendum: Here is the link to how we did - When Did Health Become Thinking Out Of The Box?

Labels: fix pain, nutrition, performance enhancing modality, scuba

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