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Dive Dry with Dr. Bill

#724: Longbone Disease

A while back over dinner at Mr. Nings, Chuck Liddell and I were commenting about how calmly we are approaching our various medical issues. I suggested it might be because we were both in denial, but he said he hadn't visited Egypt in many years. Of course I did back in 2015 but I only crossed Da Nile in a felucca and didn't dive in its waters.

Some 10 months after cancer was first detected in my appendix we still don't know for sure what is going on in my interior. My first oncologist wanted to dose me with chemicals without further exploring what was really happening. My current doctor has taken an approach I prefer... investigation to obtain the data necessary to determine the best treatment protocol. As a scientist, I find this much more in line with my thinking.

Recently I had a full body PET or positron emission tomography scan. The doctor injected me with radioactive dye which was then absorbed by my organs and tissues. My body was then imaged three-dimensionally with potential cancer and other abnormalities showing up as black hot spots. When my oncologist reviewed the images, he was stumped by them. My vital organs were all clear but many hot spots appeared in my bones, especially the long bones in my arm (the humerus... NOT the funny bone) and leg (the femur).

Since I was approaching this as a scientist, I searched out potential explanations for these unusual hot spots. Although bone cancer and multiple myeloma are possibilities, my long history as a SCUBA diver suggested another possibility, dysbaric osteonecrosis. I discussed this with several other divers and they felt it offered a possible explanation. I'll bet you thought this column would be unrelated to King Neptune's Realm, but then it wouldn't be appropriate as a "Dive Dry" column, would it?

In the recent past I've done a lot of deep diving on air. I repeatedly dove to maximum depths of 200 feet to film what was down there for an episode of my cable TV show. Diving to such depths, well in excess of recreational limits, almost always involved "deco" or decompression time. Deco involves stops at selected depths to allow excess nitrogen in the diver's tissues to "off gas" or leave the body through respiration. By failing to include these deco stops, nitrogen may bubble up and clog portions of your circulatory system or body tissues leading to potentially serious effects or even death.

Now in my deep diving I almost always followed a self-imposed rule of extending my deco times to at least twice if not three times the required amount. Although the dives themselves were risky, I tried to minimize the risk by exceeding what was considered "safe" decompression times.

The presence of the hot spots in my humerus and femur suggested the possibility that nitrogen gas was bubbling in my bone marrow, cutting off circulation inside the bone and thereby causing what is known medically as dysbaric osteonecrosis. Divers occasionally refer to this as longbone disease. Essentially it is the death of tissue inside the bone. As bad as that is, I'd take it over bone cancer or multiple myeloma. You can learn more about dysbaric osteonecrosis by reading the following article in DAN's Alert Diver magazine: http://www.alertdiver.com/dysbaric-osteonecrosis.

As long time divers like myself are fond of saying, we remember back when diving was dangerous and "mating behavior" was safe compared to the reverse today. Well, don't be fooled... even today risky diving can still be dangerous just like risky "mating behavior."

In order to determine what exactly was causing these hot spots inside the long bones, my doctor requested bone biopsies. In the first one they drilled into my iliac (known as the pelvic bone by normal human beings) and biopsied the material withdrawn. This biopsy was inconclusive so they planned to drill into my humerus (upper arm bone) next. I met with that doctor last week but he refuted my hypothesis of dysbaric osteonecrosis because the lesions were mid-bone rather than at the ends.

As a scientist, I am aware that once a hypothesis is proposed it has to be tested. My very first hypothesis back in my Harvard daze was dashed to bits. Likewise my first hypothesis in my dissertation research proved to be false. One needs to be open to new data even if it causes one to abandon their original assumptions.

© 2017 Dr. Bill Bushing. Watch the "Dive Dry with Dr. Bill" underwater videos on Catalina Cable TV channel 29, 10:00 AM weekdays and on Charter Communications Cable channel 33 at 7:30 PM on Tuesdays in the Riverside/Norco area. You can also watch these episodes in iPod format on YouTube through my channel there (drbillbushing). Please help me climb out of self-imposed poverty... buy my DVD's (see this link). Yes, take Dr. Bill home with you... we'll both be glad you did!

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PET scan images of Dr. Bill showing hot spots (dark spots) in my long bones.

This document maintained by Dr. Bill Bushing.
Material and images © 2017 Star Thrower Educational Multimedia