Doctors Who Dive
For more than 32 years, the Temple School of Medicine’s Underwater Medicine program has educated physicians about saftey, health and scuba diving.
Story by Maria Raha
Imagine exploring a world populated by spiny, colorful creatures and glowing plants that thrive in an environment akin to that of another planet. This is very similar to being undersea, which piques the curiosity of approximately 4 million scuba divers in the U.S.
The Divers Alert Network, an organization that promotes diving safety, estimates that about 1,000 people are treated for injuries related to the sport each year. Since the ability to understand the body’s reaction to barometric pressure is necessary for safe diving expeditions, an increasing number of people need to assess their physical ability to withstand the pressure that accompanies the activity.
And with the number of certified divers increasing annually, more doctors every year have to be able to advise their patients about diving and its hazards.
Temple Underwater Medicine is a continuing medical education (CME) program that instructs doctors about the unique medical issues that confront divers. The 25-credit program takes place once a year in the Caribbean. In winter 2010, 35 doctors convened for six days in Little Cayman, the smallest of the three Caribbean islands that comprise the Caymans. On each trip, the doctors complete four hours of education per day, and the remainder of each day is left open for diving.
The idea for the program was developed by Temple Professor Emeritus of Medicine and Chief of Cardiology Alfred Bove, MED ’66, ’70, now the president of the American College of Cardiology, with former Professor of Physical Education Robert Leahy, EDU ’77, and former Professor of Physiology Peter Lynch, MED ’54, ’58.
The program was inspired by an undergraduate scuba diving course offered through the Department of Kinesiology in the College of Health Professions and Social Work in the 1970s. During spring break each year, Leahy would take undergraduate students on a scuba diving expedition.
Bove, who had studied submarine and undersea medicine while in the Navy a few years prior to returning to Temple in 1973, had both a personal and professional passion for the sport. Lynch and Bove decided to join Leahy and his class on the trip. In 1974, other doctors traveled with them. “Some physicians started to go because they wanted to dive,” Bove says. “I started teaching, and all of a sudden, it turned into a program."
After four years of alternately educating his peers and exploring the deep, Bove launched the program in earnest in 1978, when the Continuing Medical Education Department at Temple approved the course for CME credits. Since then, Underwater Medicine has increased from between 10 and 12 credits to 25. It has been steadily offered at Temple, even during the seven years when Bove ran it from a post at the Mayo Clinic that began in 1981. Since the early 1980s, his wife, Sandy Bove, CHPSW ’65, has coordinated participants’ travel arrangements, such as securing diving boats and reserving hotel rooms.
Bove’s interest in underwater medicine became a professional calling after he graduated from the School of Medicine and completed a residency there. In 1971, he was assigned a position at the Naval Medical Research Institute in Bethesda, Md., where he focused on submarine and diving medicine and began writing about it. In addition to publishing numerous articles, Bove is the co-author of Diving Medicine, a guide to the medical concerns, diagnoses and treatment of diving-related conditions. Today, the book is in its fourth edition and Bove is one of the nation’s leading experts in underwater medicine.
Photo courtesy Helene D. Darveau
Temple Professor Emeritus of Medicine and Chief of Cardiology Alfred Bove, MED '66, '70, has led Temple's Underwater Medicine program since its inception. Photo courtesy Ryan Brandenberg.
Nelson Wolf, MED ’68, professor of medicine and associate director of invasive and interventional cardiology at Temple, is another Underwater Medicine program faculty member. Similar to Bove, Wolf has been an avid diver since his days as a submarine and diving medical officer in the Navy.
Since 2006, he has participated in the Underwater Medicine program, teaching the activity’s basics, such as diving hazards and cardiovascular fitness. He also educates participants about disaster preparedness and bioterrorism.
“The symptoms of some diving conditions can be similar to other medical conditions, but treating a diving-related disorder is different, and frequently, we can cure the problem if we diagnose it early on,” Wolf says.
Discovering the Deep
Though risks for divers often differ depending both on the region in which they descend and on their individual medical histories, the program’s curriculum focuses on three main areas of the sport.
The first, environmental medicine, deals with the “extreme environment” encountered underwater, Bove explains. For instance, fluctuations in pressure can cause decompression sickness, which also is called “the bends” and is the most commonly known condition that results from diving. The bends occurs when nitrogen bubbles that settle in the body’s tissues during a dive return to the blood too quickly as a diver ascends to the surface. By slowly resurfacing, he or she can control the rate at which the nitrogen moves from body tissue to the blood.
Another illness that threatens divers, and is sometimes fatal, is arterial gas embolism, or AGE. The condition can occur when the lungs expand too much and air bubbles travel from the heart to the brain. According to The Scuba Site, AGE accounts for nearly 30 percent of scuba diving fatalities.
But the underwater dangers associated with the activity are not only related to pressure changes. Marine hazards, another aspect of environmental medicine, covers sea life and the possible toxicity of bites from various animals and cuts caused by coral or other underwater surfaces.
The second area of focus, fitness to dive, refers to the physical condition of a potential diver and whether his or her individual health concerns can handle the dramatic change of environment.
“Sport divers will ask a physician, ‘I want to take this scuba diving course—am I okay to do it?’” Bove says. “There is a set of medical conditions of which people who want to dive should be aware, and so ‘fitness to dive’ is another part of our program.”
Due to the need for strong lung capacity in diving, Bove mentions the hazards of participating in the sport if one suffers from a condition such as emphysema or angina or from congenital abnormalities. He also says that people with diabetes, most of whom rely on regular doses of insulin, can now undergo training to learn how to dive safely. Often, divers will need medical clearance in order to be permitted to descend.
The last aspect of underwater medicine that is covered in the course is hyperbaric oxygen therapy, where hyperbaric compression chambers—which create high-pressure environments of concentrated oxygen—are used for conditions including difficult-to-treat wounds such as burns. “[Hyperbaric oxygen therapy] works for certain types of carbon monoxide poisoning,” Bove explains, “where you can quickly remove the carbon monoxide and improve brain function. It works for certain kinds of wounds that don’t heal well. The hyperbaric oxygen will help the healing.”
In addition to providing doctors with the information they need to advise their patients about safe diving, the annual trip fosters camaraderie among its participants.
“The core of people who take the course continues to increase,” Bove says. “Almost everybody who comes once comes back again. It’s like a reunion: They’re all friends, they don’t see each other for a year, and then they all spend a week[together].” He estimates that 50 to 60 percent of his students return year after year.
“I love attending [Bove’s] seminars,” says Helene D. Darveau, an underwater medicine participant, senior medical advisor/pilot health for Air Canada and the photographer featured in this article. “I always learn new material that I bring back into my practice.”
Having known the Boves for 25 years, she returns “to see them, to hear about diving medicine and to dive with other physicians,” she says. “I hope his seminars continue for a long time.”
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