Tuesday, November 30, 2004

Scubadoc's Ten Foot Stop Newsletter, 11/30/04

---NOTE FROM SCUBADOC---

We thought that we had made it clear last year that our newsletter is a free service, and that any emails that you might get from Paypal are actually holdovers from the days when we were charging for the publication. Paypal is still used by us to allow many of you to donate money to support the continuance of the newsletter. Other than completely discontinuing the service, we have no way of stopping them from sending you the requests for subscription money. So - there are still three ways that you can support our effort: use Paypal, use amazon.com or send us a small check by snail mail. See http://scuba-doc.com/sbscrb.html . We always appreciate thoughtful donations to our educational web site.

Please note that we are now placing changes to our web site on our Diving Medicine blog at http://scubadoc.blogspot.com/ . In addition, we will also continue publishing this newsletter on the Ten Foot Stop blog at http://tenfootstop.blogstop.com/ . All of our prior newsletters are stored in pdf at http://scuba-doc.com/archives.html .

We would like to hear from you regarding interesting diving medical problems, links and humor that would be fit to print. We test all the links on three different browsers before sending out the material - but sometimes your personal computer will require a cookie or will block the access until you register at the remote site.

Best regards:

scubadoc
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---QUESTION OF THE WEEK---

Here is a question from Prof. Dr. Schipke:

Dear Ern,

It is fun to receive your news and to realize that you are doing well. My question today: would you know articles (studies or reviews) on diving with pacemakers? I don't find much.

Kind regards from wintery Germany

Jochen

Dear Dr. Schipke:

Very nice to hear from you and hope that you are well!

I have discussed this from time to time in my newsletter, the last in November 2003.

"Cardiac pacemakers are used to regulate a person's pulse rate (both too slow and too fast). It is implanted in the person's subcutaneous tissue and will be exposed to the same ambient pressures as the diver. For most recreational diving, an adequate pacemaker must be rated to perform at least a maximum depth of 130 feet / 40 meters and must operate satisfactorily during conditions of wide pressure changes - as during ascent and descent.

What if most of your diving is deeper than this? The St. Jude Medical pacemaker is said to be rated to a depth of 230 feet. (70.104 meters). See pacemakers and arrhythmias on our web page at http://www.scuba-doc.com/pace.htm

Other links
UKSDMC Standards
http://snipurl.com/asls

Kratz JM, Blackburn JG, Leman RB, Crawford FA. Cardiac pacing under hyperbaric conditions. Ann Thorac Surg. 1983 Jul;36(1):66-8.
http://snipurl.com/aslv

A good review by my friend, Jim Caruso, written for DAN. http://diversalertnetwork.org/medical/faq/faq.asp?faqid=143

Interesting cautionary http://e-nekton.com/archive/edition3/feature-1.html

Dr. Simon Mitchell, mentioned in the above article as having developed a list of pacemakers and specifications can be contacted at the following :
Simon Mitchell, MB.ChB.,
DipDHM, Ph.D.
Wesley Centre for Hyperbaric Medicine
Medical Director
Sandford Jackson Bldg., 30
Chasely Street
Auchenflower, QLD 4066
Australia
smithchell@wesley.com.au

Basic information about pacemakers
http://circ.ahajournals.org/cgi/content/full/105/18/2136

Scuba Diving and the Heart. Cardiac Aspects of Sport Scuba Diving,
Claus-Martin Muth1 und Kay Tetzlaff2
http://www.bnk.de/herz/en/3805_3811.htm

This should get you started.

Warm regards:

Ernie Campbell

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---COOL SITE OF THE WEEK---

DAN's web site regarding diving medicine has continued to improve and add more and more material that answers many questions for divers and instructors. This is located at http://diversalertnetwork.org/medical/index.asp .

In addition, there is a medical research section located at http://diversalertnetwork.org/research/index.asp and a training and education page at http://diversalertnetwork.org/training/ .

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---MAILBOX POTPOURRI---


Wound Healing Society

13355 Tenth Avenue North, Suite 108 • Minneapolis, MN 55441-5554

Telephone: (763) 765-2377 • Facsimile: (763) 765-2329 • Visit www.woundheal.org for the latest information on the program.

The Wound Healing Society - your source for the most current and complete information on wound healing advances.

Wound Healing Society

15th Annual Meeting & Exhibition

Hyatt Regency Chicago
Add scientific impact by sharing your latest research findings with other experts in wound healing!

New Pathways to Discovery

M a y 18-21, 2 0 0 5Chicago, Illinois, U.S.A.

Keynote Address - Developing a Regenerative Medicine:

The Amphibian Limb as an Experimental System

David Stocum, PhD, Indiana University

Clinical Trials in Wound Healing Workshop

Dual Track Plenary Sessions

Angiogenesis:Paul Bornstein, PhD, University of Washington

Hynda Kleinman, PhD, NIOCR, NIHBioengineering:

Howard Greisler, MD, Loyola University

Phillip Messersmith, PhD, Northwestern University

Brenda Russell, PhD, University of Illinois at ChicagoClinical Trials:

David Margolis, MD, University of Pennsylvania

Martin Robson, MDStem Cells:

Darwin Prockop, MD, PhD, Tulane University

Shahin Rafii, MD, Cornell University

The 2005 Program Committee has organized a strong program of plenary speakers and sessions featuring:Translational Research:

Mark Ferguson, PhD, University of Manchester

Barbara Sosnowski, PhD, Selective Genetics

Blue Ribbon Industrial R & D Award

Presentations

Young Investigator Award Competition

Concurrent Abstract Podium Sessions

Poster Sessions

3M Award Presentation

Exhibition

And MORE!

“The best science of wound healing!”

WHS 2004 Annual Meeting Attendee
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Stracener Joins DAN Board of Directors


Douglas N. Stracener, a DAN Member, NAUI Instructor and longtime attorney based in Baton Rouge, La., has joined the DAN Board of Directors effective immediately.

Stracener, 55, joins William Anlyan, Dennis H. Liberson, Dr. E. Wayne Massey, Lee Selisky and Kathy Weydig as new members on the 11-member board for 2004-2005. He replaces Dick Long, whose term on the board has expired.

Prior to Stracener joining the board, at a meeting last week, board members chose Anlyan as its new chairman. He is a partner with Anlyan and Hively Wealth Management and certified scuba and nitrox diver.

“I welcome Mr. Stracener’s addition to the board,” said DAN President and CEO Michael D. Curley, Ph.D. “As he has been a DAN Member since 2000, he is familiar with our organization and its vision and mission. I look forward to his helping guide DAN toward fulfilling its goal of being the leading dive health and safety research organization.”

Stracener was admitted to practice law in Louisiana in 1977. From that year, he was a member of the Stracener, Stracener and Stracener firm engaged in general criminal and civil law before starting his own similar practice from 1999 through the present. He also is a notary public, a licensed commercial pilot and a communications officer with the state of Louisiana Office of Emergency Preparedness. As the latter, Stracener coordinates statewide amateur “ham” radio operators to serve as active communication support specialists to state and local government agencies during emergency operations, usually weather-related.

As a NAUI Instructor, Stracener has trained students from basic open-water through master diver courses, as well as nitrox, drysuit specialty checkout and rescue diver training and checkout. He teaches at Underwater Adventures Inc., a DAN Business Member operation in Baton Rouge.

In his application to be on the DAN Board of Directors, Stracener wrote: “I am excited about its ongoing research on dive medical, safety and associated research areas, and would love to work on behalf of the leading edge organization in this field.”

For more information on this press release, contact Wesley Hyatt, DAN Communications, at 1-800-446-2671 ext. 282 or email whyatt@dan.duke.edu .

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Question: Problems equalizing

A year ago I had problems diving and couldn't equalise properly in one ear. That night my ear was very painful and leaked a yellowy puss and traces of blood. I took antibiotics and it cleared up fairly quickly. Last month I noticed a very faint fluttering noise in my ear (tinnitus). Could this be as a result of the diving accident. I understand that if I were to develop tinnitus because of this that the onset would be fairly immediate, not a year later. I have been going through a bit of stress recently which I understand can also result in ringing noises.

Answer from Dr. Allen Dekelboum

Your request was referred to me for comment.

You are correct in assuming that tinnitus from a diving injury should
occur close to the time of the incident. Your original injury appears
to be a perforation of the ear drum. I hope you consulted an ear, nose
and throat doctor at the time. It is important that the ear drum has
healed completely.

You describe the tinnitus as a "flutter". That might be attributed to
spasms of one of the small muscles in the middle ear, the stapedius
muscle, which attaches to the stapes (stirrup) bone. This is not a
serious problem, often associated with stress, and is usually relieved
when the stress is controlled. True tinnitus is a ringing or buzzing
sound in the ear, usually continuous, but sometimes pulsing. If the
problem persists, I would consult an ear, nose and throat doctor.

Good luck.

Allen Dekelboum, M.D.

Links
http://www.scuba-doc.com/entprobs.html

http://www.scuba-doc.com/entprobs.html#Tinnitus

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Diving after surgery for splenic artery aneurysm?

Question:
If an anneurysm in the spenic artery was removed a year ago, can I dive and not worry or how deep? I feel fine. thanks.

Answer:
Given that you have made a complete recovery from your surgery with good wound healing and physical rehabilitation from the operation- then you would have no problems diving. If the spleen was removed during the operation - then you will need to be aware that you might be more subject to marine infections and have appropriate immunizations as determined by your doctor.

There would be no adverse effects of the surgery on depth/pressure or vice versa.

You should be able to physically don and doff your gear, perform entries and exits gracefully and without excess strain and should be able to perform self rescue and buddy rescue.

See also:
http://www.scuba-doc.com/surgdiv.html

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Question: Gas, abdominal distention, vomiting after diving
I have a friend who, after going to depths of about 20m or more has a problem with gas/air in his stomach upon surfacing. He feels fine under the water but on surfacing is sick, vomiting and needing to burb up the air. He thinks he is taking in too much air under water and while ascending it is expanding and causing this problem. It means he can't do a second dive that day. Do you have any suggestions on fixing this?

Answer:
Your friend's problem is from excessive air swallowing during the process of
equalizing his ears. He also may be an 'air swallower' due to excessive
nasopharyngeal mucous between dives and probably starts out with a gas load
in the stomach.

Remedies for the problem would be for him to avoid eating gas forming foods
and soda pop prior to the dive and to change his technique for clearing his
ears.

More about this on my web site at http://www.scuba-doc.com/hrtbrn.htm .

Here is a list of equalizing techniques by Allen Dekelboum, MD
http://www.scuba-doc.com/Equalizing_Techniques.pdf .

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Save yourself a heap of trouble!
Here is some very good information from my friend, Glen Egstrom:

We pass along jokes on the Internet; we pass along just about everything. Pass this information along. It could really help someone you care about.

1. The next time you order checks have only your initials (instead of first name) and last name put on them. If someone takes your checkbook they will not know if you sign your checks with just your initials or your first name but your bank will know how you sign your checks.

2. When you are writing checks to pay on your credit card accounts, DO NOT put the complete account number on the "For" line. Instead, just put the last four numbers. The credit card company knows the rest of the number and anyone who might be handling your check as it passes through all the check processing channels won't have access to it.

3. Put your work phone # on your checks instead of your home phone. If you have a PO Box use that instead of your home address. If you do not have a PO Box, use your work address. Never have your SS# printed on your checks. (DUH!) You can add it if it is necessary. But if you have it printed, anyone can get it.

4. Place the contents of your wallet on a photocopy machine, do both sides of each license, credit card, etc. You will know what you had in your wallet and all of the account numbers and phone numbers to call and cancel. Keep the photocopy in a safe place. I also carry a photocopy of my passport when I travel either here or abroad. We've all heard horror stories about fraud that's committed on us in stealing a name, address, Social Security number, credit cards, etc.

Unfortunately I, an attorney, have firsthand knowledge because my wallet was stolen last month. Within a week, the thieve(s) ordered an expensive monthly cell phone package, applied for a VISA credit card, had a credit line approved to buy a Gateway computer, received a PIN number from DMV to change my driving record information online, and more.

But here's some critical information to limit the damage in case this happens to you or someone you know:
1. We have been told we should cancel our credit cards immediately. But the key is having the toll free numbers and your card numbers handy so you know whom to call. Keep those where you can find them

2. File a police report immediately in the jurisdiction where it was stolen, this proves to credit providers you were diligent, and is a first step toward an investigation (if there ever is one).

But here's what is perhaps most important: (I never even thought to do this).

3. Call the three national credit reporting organizations immediately to place a fraud alert on your name and Social Security number. I had never heard of doing that until advised by a bank that called to tell me an application for credit was made over the Internet in my name. The alert means any company that checks your credit knows your information was stolen and they have to contact you by phone to authorize new credit.

By the time I was advised to do this, almost two weeks after the theft, all the damage had been done.

There are records of all the credit checks initiated by the thieves' purchases, none of which I knew about before placing the alert. Since then, no additional damage has been done, and the thieves threw my wallet away this weekend (someone turned it in). It seems to have stopped them in their tracks.

The numbers are:

Equifax: 1-800-525-6285

Experian (formerly TRW): 1-888-397-3742

TransUnion: 1-800-680-7289

Social Security Administration (fraud line):
1-800-269-0271
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Reporting email about illegal drugs to the FDA
Here is a note from Dr. Jolie Bookspan regarding reporting receipt of email touting what you consider illegal sales of drugs.

"I offered my friend at the FDA to send the following FDA request to those with medical bulletin boards for posting, where appropriate.

Good Things,
Jolie"

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If you ever run across anything on counterfeit or black market pharmaceuticals, significant trafficking in controlled substance pharmaceuticals, or adulteration/tampering/off-label marketing of food, drugs or cosmetics please keep us in mind.

Special Agent Marc Hess
FDA/Office of Criminal Investigations
US Attorneys Office
615 Chestnut Street, #1250
Philadelphia, PA 19106
215/861-8253
marc.hess@fda.gov
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DAN Sets Holiday Shipping Dates

For more information on this press release, contact Wesley Hyatt, DAN Communications, at 1-800-446-2671 ext. 282 or email whyatt@dan.duke.edu.

Know what to get for divers on your holiday list? Maybe a DAN backpack, jacket, board shorts or mock turtleneck? Or a first aid kit or oxygen unit?

To ensure that its customers’ gifts arrive in time for a happy holiday season, Divers Alert Network announces these shipping deadlines for ordering from the organization.

Please note the following dates:

• The last day to place an order before 3:30 p.m. EST via ground shipping (Federal Express Ground or U.S. Post Office First Class / Priority Mail) is Wednesday, Dec. 15.

• The last day to place an order before 3:30 p.m. EST via Fedex 2Day is Wednesday, Dec. 22.

• The last day to place an order before 3:30 p.m. EST via Fedex NEXTDAY is Thursday, Dec. 23.

For those wishing to do business on other days this season, the DAN offices will be closed on Nov. 25 and 26 in observation of the Thanksgiving holiday, Dec. 24 for Christmas and Dec. 31 for New Year’s Eve.

Customers may place orders to DAN by calling toll-free 1-800-446-2671 or +1-919-684-2948 or by using its product catalog on the website, www.DiversAlertNetwork.org. For regions outside the United States, Canada or U.S. Territories, please call DAN at +1-919-684-2948 ext. 614 for additional shipping information.

You can also purchase DAN products, including several exclusive items, without shipping deadlines at your area DAN Business Member stores. To locate the one nearest you, visit the Dive Business Directory at www.DiversAlertNetwork.org.

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---INTERESTING LINKS---

Hypothermia is not always bad:
Near-drowning treated with therapeutic hypothermia - The Medical Journal of Australia -1 November 2004 - Full text: http://www.mja.com.au/public/issues/181_09_011104/wil10138_fm.html

From Buenos Aires, Omar Sanchez, MD, Wetdoc.

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Medical Seminars has added material on their web page at http://www.medsem.com/destination_information.html . Outstanding destinations, outstanding diving medicine courses.

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This link from Jolie Bookspan:
Dolphins 'protect' lifeguards from great white
http://www.abc.net.au/news/newsitems/200411/s1249440.htm
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Doctors worried people are diving without training
http://snipurl.com/atpi
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Bends cases prompt warning for recreational divers.
22/11/2004. ABC News Online
http://snipurl.com/atpe

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Scientific Scuba Diver Manual
http://www.sbg.ac.at/ipk/avstudio/pierofun/transcript/ssd.pdf

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Headache and Facial Pain in Scuba Divers
http://tinyurl.com/6gw79

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Scuba Diving Hand Signal - Talking Below the Waves - Underwater Hand Signals
http://snipurl.com/aqgl

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---HUMOR---
[ Warning! Some may find this material offensive! ]

The best of the lot!

A guy walks into a bar with a pet alligator by his side. He puts the alligator up on the bar. He turns to the astonished patrons. "I'll make you a deal. I'll open this alligator's mouth and place my genitals inside. Then the gator will close his mouth for one minute. He'll then open his mouth and I'll remove my apparatus unscathed. In return for witnessing this spectacle, each of you will buy me a drink."

The crowd murmured their approval. The man stood up on the bar, dropped his trousers, and placed his privates in the alligator's open mouth. The gator closed his mouth as the crowd gasped. After a minute, the man grabbed a beer bottle and rapped the alligator hard on the top of its head. The gator opened his mouth and the man removed his genitals unscathed, as promised.

The crowd cheered and the first of his free drinks were delivered. The man stood up again and made another offer.

"I'll pay anyone $200 who's willing to give it a try!" A hush fell over the crowd. After a while, a hand went up in the back of the bar. A Blonde woman timidly spoke up. "I'll try, but don't hit me so hard on the head with the beer bottle!"

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A man's walking late at night when he sees a woman in the shadows.

"Fifty bucks," she says.

He's never been with a hooker before, so he decides what the hell.

They're going at it for a minute when all of a sudden a light flashes on them---it's a police officer.

"What's going on here, people?" asks the officer.

"I'm making love to my wife," he answers indignantly.

Oh, I'm sorry, I didn't know," says the cop.

"Well, neither did I until you shined that light in her face.

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Conversation overheard at the gas station between two blondes....

First blonde: "I expect they'll be raising the gas prices again soon."

Second blonde: "Won't affect me. I always put in just $20 worth."
************************************************************************
1. Two vultures board an airplane, each carrying two dead raccoons. The stewardess looks at them and says, "I'm sorry, gentlemen, only one carrion per passenger."

2. Two fish swim into a concrete wall. One turns to the other and says "Dam!".

3. Two Eskimos sitting in a kayak were chilly, so they lit a fire in the craft. Unsurprisingly it sank, proving once again that you can't have your kayak and heat it too.

4. Two hydrogen atoms meet. One says "I've lost my electron." The other says "Are you sure?" The first replies "Yes, I'm positive."

5. Did you hear about the Buddhist who refused Novocain during a root canal? His goal: transcend dental medication.

6. A group of chess enthusiasts checked into a hotel and were standing in the lobby discussing their recent tournament victories. After about an hour, the manager came out of the office and asked them to disperse. "But why?" they asked, as they moved off. "Because," he said, "I can't stand chess nuts boasting in an open foyer."

7. A woman has twins and gives them up for adoption. One of them goes to a family in
Egypt and is named "Ahmal." The other goes to a family in Spain; they name him "Juan." Years later, Juan sends a picture of himself to his birth mother. Upon receiving the picture, she tells her husband that she wishes she also had a picture of Ahmal. Her husband responds, "They're twins! If you've seen Juan, you've seen Ahmal."

8. Two friars were behind on their belfry payments, so they opened up a small florist shop to raise funds. Since everyone liked to buy flowers from the men of God, a rival florist across town thought the competition was unfair. He asked the good fathers to close down, but they would not. He went back and begged the friars to close. They ignored him. So the rival florist hired Hugh MacTaggart, the roughest and most vicious thug in town, to "persuade" them to close. Hugh beat up the friars and trashed their store,saying he'd be back if they didn't close up shop. Terrified, they did so, thereby proving that only Hugh can prevent florist friars.

9. Mahatma Gandhi, as you know, walked barefoot most of the time,which produced an impressive set of calluses on his feet. He also ate very little, which made him rather frail, and, with his odd diet, he suffered from bad breath. This made him...[Oh, man, how bad is this one?!!]...a super callused fragile mystic hexed by halitosis.

10. And finally, there was the person who sent ten different puns to his friends, with the hope that at least one of the puns would make them laugh.

No pun in ten did!


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