Wednesday, December 29, 2004

SCUBADOC'S TEN FOOT STOP NEWSLETTER, DEC. 31, 2004

SCUBADOC'S TEN FOOT STOP NEWSLETTER, DEC. 31, 2004
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It's Friday! Here's our last newsletter for 2004.
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BUT FIRST, A small amount of business....

As I noted in my special letter to you last week - for various reasons we are discontinuing the use of PayPal for your contributions to our web site and newsletter. We will continue to use amazon.com and snail mail for those of you who wish to continue donating on a regular basis. Let me say thank you for your help that goes a long way toward providing appropriate services for this "one man operation".

Subscribe at http://scuba-doc.com/sbscrb.html

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==> CHANGING YOUR E-MAIL ADDRESS?<== Don't miss a single issue. Update your subscription e-mail address: Send both you old and new email addresses and we'll make the change immediately. scubadoc@scuba-doc.com

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==>NOTE FROM SCUBADOC <==
.. Lend a hand to tsunami victims

The human tragedy caused by the recent earthquake and tsunami in Asia and Africa is overwhelming. You can help.

Organizations are accepting donations of cash and specific supplies. Kim Komando has put together a listing of Web sites to assist victims.

Please be aware that many of the Web sites listed are experiencing heavy traffic. If you're unable to connect the first time, try again
later. You'll be glad you did.

TO VISIT THIS SITE, GO HERE:
http://www.komando.com/giveaid.asp

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More about the tsunami - and the post traumatic stress syndrome from Dr. David Colvard.

Last night I rewrote my website to provide practical information about the
development and prevention and treatment of PTSD to help the victims of the
Dec26-Tsunami:

www.DivePsych.com

Please let them know.


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For later in January 2005:

A post-Dec26-Tsunami PTSD (Post Traumatic Stress Disorder) study of divers
and snorkelers and swimmers who were in/on/near the water when the tsunami
hit their location is being prepared.

I would greatly appreciate assistance in contacting anyone who was
in/on/near the water when the tsunami hit their location or who know of
anyone who was in/on/near the water when the tsunami hit their location,
including dive operators, etc.

They may contact me directly by email at dcolvard@mindspring.com
or by going to www.DivePsych.com.

Participation will be entirely voluntary. At this time the study does not
have external funding.


David F Colvard, MD
Diplomate of the American Board of Psychiatry & Neurology
ACRP Certified Clinical Research Investigator
Divemaster
3725-228 National Dr
Raleigh, NC 27612 USA

Office 919-781-3141
FAX 919-781-3141
Email: dcolvard@earthlink.net
URL: www.drcolvard.com and www.divepsych.com
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How “Tough” is Your DAN Oxygen Unit?

DAN Oxygen Units and First Aid Kits in watertight green Pelican® cases are seen at most dive sites around the U.S. and the Caribbean. In fact, it is the single most identifiable Pelican case in diving.

Has the green Pelican case protecting your DAN Oxygen Unit or First Aid Kit gone above and beyond the normal call of duty? If so, here now is an opportunity for you to tell your story or show pictures of it and earn more gear in the process.

Pelican Products recently announced its “Pelican Tough” photo contest. Running from Nov. 15, 2004-Feb. 28, 2005, contestants have a chance at a share of nearly $5,000 worth of Pelican gear prizes in three different categories: Most Scenic; Most Adventurous; and Best Story. Winning photos and stories must feature Pelican cases and lights. Full contest details can be found at www.DiversAlertNetwork.org/news/article.asp?newsid=503.

If your story or photo features a DAN Oxygen Unit or First Aid Kit in a green Pelican case, DAN would like to know about it as well. In addition to submitting your entry to Pelican, send a copy to DAN at 6 W. Colony Place, Durham, NC 27705, phone +1-919-684-2948 or 1-800-446-2671 (toll-free), fax +1-919-490-6630, or email pelican@DiversAlertNetwork.org. Selected photos and stories may be featured on the DAN website and in DAN literature.

For more information regarding Pelican Products, write Pelican at 23215 Early Ave., Torrance, CA 90505, phone 1-800-473-5422 (outside California) or +1-310-326-4700, fax +1-310-326-3311, email sales@pelican.com or visit www.pelican.com . For more information regarding DAN Oxygen Units and First Aid Kits, visit www.DiversAlertNetwork.org.

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“I’d like to use DAN oxygen equipment, but it costs too much.”

Forget that statement. Divers Alert Network has taken action for those who want safety at a price that will not bust their budgets with a new line of lower-priced DAN oxygen units to supplement its current oxygen equipment. Just remember these key letters – BF.

You see, the new units will use the B & F multifunction regulator, and coincidentally they are “Budget Friendly.” Hence the product names – the DAN BF Rescue Pak, the DAN BF Rescue Pak Extended Care and the DAN BF Dual Rescue Pak Extended Care.

As with the standard DAN Rescue Paks, these items contain DAN Oxygen Units able to deliver 100 percent oxygen to an injured diver. They still come in the waterproof DAN Green Pelican case – the single most identifiable piece of dive safety equipment at dive sites today. They also include the B & F brass multifunction regulators that allow treatment of two divers with both constant-flow and / or on-demand using a DAN demand valve to provide the injured diver with the highest concentration of oxygen in an efficient manner. All oxygen units can be upgraded with the MTV-100 (flow-restricted oxygen-powered ventilator). The differences between the units are the size and available oxygen in the cylinders used – the DAN BF Rescue Pak will last approximately 20 minutes, the DAN BF Rescue Pak Extended Care will last approximately 60 minutes and the DAN BF Dual Rescue Pak Extended Care will last approximately 120 minutes.

Now, for a limited time, Divers Alert Network is offering the new DAN BF Rescue Pak for less than $400. Contact DAN for details.

DAN is rolling back the calendar on oxygen equipment pricing – these new special prices are lower than what DAN charged for oxygen units in 1995. Prices on all DAN oxygen equipment, including the DAN BF Rescue Pak Extended Care and the DAN BF Rescue Pak Extended Care, have been lowered with this special offer.

Research and experience by DAN and its members have shown there are still some areas and divers without the equipment they should have for emergencies. By offering another lower-cost option, DAN hopes to make it possible for more divers to have emergency oxygen equipment and save lives.

To order any DAN BF Rescue Pak or other oxygen equipment at reduced prices, contact Divers Alert Network at +1-919-684-2948 or 1-800-446-2671 toll-free, fax +1-919-490-6630, or visit the product catalog on the DAN website at www.DiversAlertNetwork.org/catalog/index.asp.


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==> QUESTION OF THE WEEK <==
GERD?, DCS?, Labyrinthitis?

Here is a question with multiple facets that we referred to our able consultant, Martin Quigley, MD. The back and forth responses are interesting and enlightening.

Question:
I noticed that there is such a phenomenon as diving induced GERD. I had never had a case of acid reflux until iIdove in cozumel last feb. After a few days of diving I had some bouts of dizziness coupled w/itching. I immediately thought the worst, however all of my dives were no deco dives and I'm pretty safe. I flew back home a few days later as scheduled. My symptoms continued along w/ mild chest pain. After going to the hospital and having a gamut of tests run, all it took was a few nexxium to bring me back to normal. Well, I figured I was "good to go".
I recently returned from another week of diving. Well, the same thing happened, except this time I feel more dizzy and the chest discomfort is not really there. It's been six days since my last dive. I did not go into deco on any dive and made three min. safety stops on every dive. I started the nexxium last night but it has not helped. Is there a chance I could be suffering from a very mild form of DCS? If not, can you help render a Dx???

Dr. Quigley's Answer:

Dear Diver,

DCS is a very funny condition, the symptoms are variable and it sometimes happens to divers who have stayed within the NDL limits and observed all the other "rules".

There are certainly many aspects of scuba diving that can produce GERD symptoms - tight wet suits, over-inflation of BCDs, air swallowing, etc.Dizziness and itching are not generally symptoms of GERD.

If you are still symptomatic, I would suggest that you be evaluated by a physician experienced in diving medicine [check with DAN 1-919-684-4DAN (collect) or 1-800-446-2671 (toll-free) for a physician in your area.] It may well take a trail of recompression (hyperbaric chamber) to determine if your symptoms are indeed due to DCS. If your symptoms resolve with re-pressurization, then they are likely due to DCS.
Martin M. Quigley, MD

Writer's Credentials: Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology. Trained in Diving and Hyperbaric Medicine by NOAA and UHMS. Current PADI Instructor. Certified Cave and Trimix Diver. Faculty Member at DAN's 2001 and 2005 Dive Medicine Courses.

Diver's Answer and responses from Dr. Quigley:
Dr. Quigley,
Thank you very much for your time. I am a young dentist but I do understand what being busy at the office is all about! I feel a little better today. From my reading, it seems very unlikely that DCS can be present one week after the last dive was made with nothing more than intermittent dizziness being the main symptom. The itching has nearly gone away. It might be prudent to note that I was diving w/ a small group the entire time that dove pretty much the same profile as me w/ no adverse effects. I have no muscle or joint pain, no nausea, no skin rashes or erythematous areas. It's just odd that this happened last feb. in a similar manner. I started the nexxium last night so I will certainly give it time to work. I know for a fact that I do hold my breath while i'm diving to conserve air. I did not realize that this could trigger GERD.
I guess ultimately the question is... is it possible to have such a mild form of DCS that one could experience symptoms (mild), continue to dive, and fly home without risking serious injury and the DCS still being present. If so, I need to get checked out. If not, can dizziness be present as one of the symptoms of GERD in my case and resolve in a short period of time?
I know you are busy. I do appreciate your time in this matter because I am still worried; I am a 29 year old healthy male who exercises regularly...
Thanks so much for your time and please let know if there is anything i can do for you
Sincerely,

Dr. Quigley responded:
DCS is funny - it's unusual to have symptoms that begin more than about 12-24 hours after a dive, but flying after diving (within 12-48 hrs) can cause symptoms. Once symptoms occur, they can persist long after the last dive. There's much individual variation in susceptibility to DCS, small differences, such as differences in ascent rate, may be an explanation.
If your symptoms are resolving, I'd guess that I'd not worry. But if they ever recur after diving in the future, I'd get them checked out promptly.

Diver's response:
I just wanted to let you know that using my better judgment i heeded your advice and went to see the director of the hyperbaric medicine unit. I do not have DCS but rather he suggested i may have labrynthitis. sometimes we younger divers forget the basic principles and now looking back i realize i ascend much faster than i should. it should take 1 min. 30 sec. to go from 60 ft. to the safey stop bar at 15 ft. when in actuality i do it in at least half that time. i also have a tendency to hold my breath to extend bottom time. now after being yelled at i know these are bad habits!
thanks again for devoting your time and expertise to help make diving safer for the rest of us...
sincerely,
Last word from Dr. Quigley:
Actually, fast ascents are one of the main suspects in causing DCS. Fort the last several years I've been stopping for 1-2 minutes at 1/2 my maximum depth (e.g. 50 fsw for a 100 fsw dive) and then do 3-5 minutes at 10-20 feet. 20 feet/min is the maximum rate you should go from 20 fsw to the surface. Breath holding ("skip breathing") can lead to an increase in carbon dioxide levels which, in itself, may be a risk factor for DCS. I think you've been given good advice. [By the way, labrynthitis can be a symptom of DCS.}

Related Links
Heartburn and Peptic Disease
Labyrinthitis, Inner ear dysfunction

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==> COOL NEW WEB PAGE ON DIVING MEDICINE ONLINE <==
ADD/ADHD and Diving?

We often get questions from parents and instructors about scuba diving with attention deficit disorder [ADD] and attention deficit hyperactive disorder [ADHD]. Because of the frequency and interest in these conditions and the increased interest in children diving, I have developed a web page concerning these conditions. Linked at http://scuba-doc.com/psyc.html, it can be directly accessed at http://scuba-doc.com/ADDADHD.html . Your input about this interesting problem would be appreciated.

DAN's Article on ADD

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==> Unusual Diving Medical Question from the Archives<==
In our January 31, 2004 issue is a query about piranha bites in scuba divers.

Question about Piranha bites in scuba divers: We have many dammed up rivers in Brazil that are full of piranha. Are there any reports of divers being attacked by these fish?

Answer:We have had no questions or reports of scuba divers being attacked or bitten by piranha. However, we have found a report in Wilderness and Environmental medicine that deals with piranha bites. The abstract of this article can be seen here. A piranha bite is unlike the bite of any other animal in that it results in a 100% loss of flesh. They are equipped with powerful jaws and razor sharp triangular teeth that neatly fit together in such a way that there are no gaps. The resulting wound from a piranha bite has a smooth surgical look to it. There are no abrasions or puncture marks but rather a complete tissue loss. If you are bitten while diving, get out of the water immediately and initiate the following steps:

  1. Stop bleeding
  2. Clean well with a brush, soap and water
  3. Scrub and debride foreign particles
  4. Bed rest, elevation, antibiotics for severe cuts
  5. Be aware of danger of anaerobic infection and clostridial infection
  6. Topical antibiotics
  7. Tetanus prevention

Photo of a piranha bite on the hand of a child.
http://snipurl.com/47b6

Photo of another piranha bite of the hand. http://www.lunkerlink.com/piranha.html

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==> INTERESTING LINKS <==

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Obesity may increase Mountain Sickness risk
http://www.paktribune.com/news/index.php?id=88102

Related Link

Obesity and DCS

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Opinion: The Ultimate Public Library

Google, the world's most popular Internet search engine, has announced plans to put the holdings of great libraries online and in searchable form.

Google has announced agreements with Oxford, Harvard, Stanford, the University of Michigan and the New York Public Library, to scan large parts of their non-copyrighted collections and make them freely available.

http://tinyurl.com/6bqf7

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From wetdoc (Omar Sanchez, MD)
Whales, Like Humans, Get Decompression Sickness From Deep Dives
http://tinyurl.com/6bmus
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Scuba Fitness Staying Active During the Winter Months
http://scuba.about.com/od/divemedicine/a/fitness.htm

Related Links
Travel Exercises
Exercises for Abs
Physical Fitness for Sports Divers
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Marine Neurotoxins: Envenomations and Contact Toxins.
http://snipurl.com/be7r

Related Links
Hazardous Marine Life

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Diving-related fatalities caused by underwater explosions: a report of two cases.
http://snipurl.com/be7i

Related Link
Underwater Blast Injuries
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Current problems in prophylaxis and treatment of acute decompression disease of mild degree
http://snipurl.com/be7h

Related link
Decompression Accidents
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Before going on a diving holiday--consider this]
http://snipurl.com/be71

Related Link
Fitness for Diving
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Scuba diving and the heart. Cardiac aspects of sport scuba diving]
http://snipurl.com/be74

Related Link
Heart Problems and Diving
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Submarine escape from depths of 30 and 60 feet: 41,183 training ascents without serious injury.
http://snipurl.com/be7a

Related Google links
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Validation of diving decompression tables.
http://snipurl.com/be7d

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Delayed onset pulmonary barotrauma or decompression sickness? A case report of decompression-related disorder.

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New from Larry "Harris" Taylor:
International Diving Institute: http://www.internationaldivinginstitute.com/
Conserve Our Ocean Legacy: http://www.oceanlegacy.org/

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==> MAILBOX POTPOURRI <==
Dr. Larry Stein, our 'toothdoc' gets recurring questions regarding diving with temporary crowns. Here is the latest and his answer.

Question:
.....Diving with a temporary crown (no root canal). Is it advisable? It seems to be on solid... Barotrauma?
Answer:
Scubadoc forwarded your question to me.

I do have reservations about diving with a temporary crown but it is not because of dental barotrauma.

You indicate that the affected tooth does not have a root canal. In this case a properly fabricated temporary crown shouldn't have any air spaces to cause trauma.

My concern however, is that the temporary is....temporary! By its very nature, the temporary is supposed to be removable. Unfortunately, we can't alway control when it gets removed. In the event the temporary were to come loose during a dive, it can become an aspiration hazard. The weakest link is the temporary cement. It doesn't stick to either the temporary plastic or the tooth. It is meant to fill the space between the tooth and the temporary. The plastic used is also brittle. Excessive pressure can break it. Either way it can come loose forming pieces that can be inhaled. Forget a sensitive tooth. If the temporary comes off and it is inhaled it can induce a laryngospasm. Simply having a foreign object touching the vocal cords...even momentarily...can close the windpipe.
The temporary can even get into the mainstem bronchus and then be inhaled further into the individual lungs. How far it can go is anyone's guess. Now, you can have a pulmonary obstruction and THAT can become a barotrauma problem.
If you manage to survive the dive, someone is going to have to get the crown out of the lungs. Nearly all temporary crowns except perhaps prefabricated metal temporaries are radiolucent...they are not visible on an x-ray. Determining which bronchus or lung it is lodged in is more difficult. There will be diminished breath sounds on the affected side. In order to get the temporary out of the lung, you'll have to be sedated and a bronchoscope will have to be used to retrieve the temporary. The deeper within the lung it is lodged, the more difficult the removal.
All this being said, I am personally unaware of any particular dive accident involving the aspiration of a temporary crown. Perhaps Scubadoc has an insight into that possibility.

If possible, try to have the permanent crown completed before you next dive. You're usually looking at two weeks max. If you have made plans to dive that cannot be changed, the only advice I can offer you is to have your dentist cement your temporary crown with a very strong temporary cement or even a permanent cement. He should still be able to remove the temporary possibly with some difficulty. He might even break the temporary...which is not too much of a problem
unless the temporary must be used again. The permanent cement will also stick to the tooth and must be removed (with difficulty) before the permanent crown can be cemented.

Temporaries can also be loosened or removed by chewing gum or eating candy...anything with sugar will stick to it. You want to avoid chewing ice, hard nuts or the un-popped kernels of popcorn at the bottom of the bucket at the movies.

If you are going out of town to dive and must dive with the temporary, carry a package or two of temporary cement from the pharmacy. You can find them in
the dental section.

If you have more questions just let me know.

Happy holidays

Laurence Stein, DDS

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Lisa Wasdin, with UHMS, sends these job opportunities with Praxis.

PROGRAM DIRECTOR - RN

Praxis Clinical Services, a leading national provider of wound care and hyperbaric oxygen therapy services seeks a PROGRAM DIRECTOR for its center at Tennessee Christian Medical Center in Madison, TN.


Ideal candidate will be an RN with strong experience in wound care and hyperbaric oxygen therapy (preferred). The candidate will also have experience in employee supervision, department management, and sales/ marketing. Proficient in business software.


Education/Experience: RN (BSN or higher preferred). Currently licensed in the state of Tennessee. Woundcare and Hyperbaric Oxygen Therapy (HBO) experience, minimum 3 years healthcare management experience, marketing experience preferred. BLS certified, ACLS strongly recommended. Special training provided. Strong communication skills are essential.

We offer a competitive benefits package.

Visit our website at: www.praxisusa.com

Email resume w/salary required to:

Belinda Blair, Regional Director of Operations

at bblair@praxisusa.com

or fax to 270-689-1216

Praxis is an Equal Opportunity Employer.

_______________________

REGIONAL DIRECTOR OF OPERATIONS POSITION

Northeast - New Jersey and Pennsylvania

Full Time

Praxis Clinical Services, Inc.. is seeking a Regional Director of Operations (RDO) with management level skills for our Northeast Region. This Regional Director must be actively licensed in their residing state. This position directs the operations, programs, and activities of all Comprehensive Wound Healing Centers and Hyperbaric Oxygen Therapy units within their defined region. They must actively demonstrate expertise and knowledge of wound healing practices.

Job Description:

· In conjunction with the Vice President of Clinical Services, and the Director of Quality Services, the RDO ensures ongoing compliance of all sites to Praxis Clinical Services Policies and Procedures, and adherence to all state and federal regulations, such as JCAHO, HCFA, etc.

· Works closely with Medical Directors and Program Directors to increase volume of business and manage expenses.

· Completes on-going site assessments. Ensures the plan for any needed corrective action.

· Serves as liaison between Praxis Clinical Services, Inc. and all hospital personnel.

· Establishes and implements Praxis’ Quality Improvement Plan.

· Ensures local Safety Director is in place, trained and properly completing safety procedures.

Job Requirements:

· Clinical/Business Degree;

· 5-10 years of progressively responsible management experience;

· Current clinical license in the state(s) residing;

· Hospital based and multi-site experience preferred;

· Marketing and Business Development experience preferred; and

· BLS Certified

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please send a resume and salary history to the following:

J. Chandler, Human Resources, (714) 579-8329 FAX or,

Email to jchandler@praxisusa.com

Thank you for your interest in Praxis Clinical Services.

Praxis is an Equal Opportunity Employer.

__________________________________

PROGRAM DIRECTOR - RN

Praxis Clinical Services, a leading national provider of wound care and hyperbaric oxygen therapy services seeks a PROGRAM DIRECTOR for its center at Gottlieb Memorial Hospital, Melrose Park, IL.


Ideal candidate will be an RN with strong experience in wound care and hyperbaric oxygen therapy (preferred). The candidate will also have experience in employee supervision, department management, and sales/ marketing. Proficient in business software.


Education/Experience: RN (BSN or higher preferred). Currently licensed in the state of Illinois. Woundcare and Hyperbaric Oxygen Therapy (HBO) experience, minimum 3 years healthcare management experience, marketing experience preferred. Special training provided. Strong communication skills are essential.


We offer a competitive benefits package.

Email resume w/salary required to:

Don Uhlmeyer at duhlmeyer@praxisusa.com

Fax to D.Uhlmeyer @281-298-1570

Praxis is an Equal Opportunity Employer

_________________________________

PROGRAM DIRECTOR, Wound Healing Center

Praxis Clinical Services is a leading national provider of wound care and hyperbaric oxygen therapy services is seeking a dynamic individual to lead our Comprehensive Wound Healing Center in Memorial Hermann Baptist Hospital, in Beaumont, TX.


The Program Director is responsible for the leadership within the Comprehensive Wound Healing Center at Memorial Hermann Baptist Beaumont. The position will provide program development, direction to all unit personnel, daily operations supervision, marketing of Center services, and ensuring delivery of Quality Care. The Program Director is accountable for the growth of the center both in terms of patient volumes and revenues, while insuring standards of high quality.


Appropriate candidates will be a Registered Nurse (BSN or higher preferred), currently licensed to practice in the state of Texas. Minimum 3 years operations/marketing/management experience preferred. Current BLS certification is mandatory, ACLS is preferred. Candidates should have strong management experience, preferably working in a multidisciplinary environment. Wound care/hyperbaric experience preferred, however special training provided. Strong communication skills are essential.


Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please fax or email a resume and salary history to:

Don Uhlmeyer @ (281) 298 1570 (FAX)

or duhlmeyer@praxisusa.com

Praxis is an Equal Opportunity Employer.

__________________________________

RN, PROGRAM DIRECTOR,

for Brownsville Surgical Hospital Wound Healing Center

Praxis Clinical Services is a leading national provider of wound care and hyperbaric oxygen therapy services is seeking a dynamic individual to lead our Comprehensive Wound Healing Center at Brownsville Surgical Hospital.


The Program Director is responsible for the leadership within the Comprehensive Wound Healing Center. The position will provide program development, direction to all unit personnel, daily operations supervision, marketing of Center services, and ensuring delivery of Quality Care. The Program Director is accountable for the growth of the center both in terms of patient volumes and revenues, while insuring standards of high quality.


Appropriate candidates will be a Registered Nurse (BSN or higher preferred), currently licensed to practice in the state of Texas. Minimum 3 years operations/marketing/management experience preferred. Current BLS certification is mandatory, ACLS is preferred. Candidates should have strong management experience, preferably working in a multidisciplinary environment. Wound care experience preferred however special training provided. Strong communication skills are essential.


Candidates must be willing to travel for training and occasionally for meetings.

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please fax or email a resume and salary history to:

Don Uhlmeyer at duhlmeyer@praxisusa.com

Fax to (281) 298 1570

Praxis is an Equal Opportunity Employer.

___________________________________

RN POSITION

Wound Healing and Hyperbaric Nurse - Per Diem

Tennessee Christian Medical Center

Praxis Clinical Services, Inc.. We are seeking a Per Diem RN with energy, and a willingness to learn new skills, for our Wound Healing and Hyperbaric Unit at Tennessee Christian Medical Center in Madison, TN. This RN must be actively licensed in nursing in the state of Tennessee. This individual must be able to communicate effectively in a multidisciplinary environment.

Job Description:

· The RN must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit as described in unit-based competencies, policies and procedures.

· The RN delegates and collaborates with other staff members.

· Demonstrates critical thinking and independent decision making; utilizing policies and procedures, standards of care and data analysis. (e.g., manages crisis prevention and intervention at unit level).

Job Requirements:

· Nursing Degree from an accredited nursing school (BSN preferred).

· Critical Care experience a plus.

· Strong Wound Care experience preferred.

· BLS (Basic life support) certified.

· ACLS strongly recommended.

· Hyperbaric Oxygen Therapy experience preferred.

· Ability to interact with and maintain a respectful, positive and friendly manner with supervisors, co-workers and internal and external customers to include being flexible with work schedules and requests; keeping commitments; keeping others informed of work progress, timetables and issues; addressing problems and issues constructively to find mutually acceptable and practical business solutions.

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please send a resume and salary history to the following:

Belinda Blair @ 270-689-1216 (Fax) or,

E-Mail bblair@praxisusa.com

Thank you for your interest in Praxis Clinical Services.

Praxis is an Equal Opportunity Employer.

_____________________________________

RN POSITION - HYPERBARIC NURSE - Per Diem

St. Josephs Our Lady of Fatima

Praxis Clinical Services, Inc.. We are seeking a Per Diem RN with energy, and a willingness to learn new skills, for our Hyperbaric Unit at St. Josephs Our Lady of Fatima in North Providence, RI. This RN must be actively licensed in nursing in the state of Rhode Island. This individual must be able to communicate effectively in a multidisciplinary environment.

Job Description:

· The RN must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the

patients served on his or her assigned unit as described in unit-based competencies, policies and procedures.

· The RN delegates and collaborates with other staff members.

· Demonstrates critical thinking and independent decision making; utilizing policies and procedures, standards of care

and data analysis. (e.g., manages crisis prevention and intervention at unit level).

Job Requirements:

· Nursing Degree from an accredited nursing school (BSN preferred).

· Critical Care experience a plus.

· Wound Care experience a plus.

· BLS (Basic life support) certified.

· ACLS strongly recommended.

· Hyperbaric Oxygen Therapy experience preferred.

· Ability to interact with and maintain a respectful, positive and friendly manner with supervisors, co-workers and

internal and external customers to include being flexible with work schedules and requests; keeping commitments;

keeping others informed of work progress, timetables and issues; addressing problems and issues constructively to

find mutually acceptable and practical business solutions.

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please send a resume and salary history to the following:

Phil Scelfo @ 401-456-3953 or E-Mail Pscelfo@saintjosephri.com

Thank you for your interest in Praxis Clinical Services.

Praxis is an Equal Opportunity Employer.

____________________________________

FOR MORE CLASSIFIED LISTINGS, VISIT OUR WEBSITE http://www.uhms.org/classifieds.htm

IF YOU HAVE ANY QUESTIONS OR WOULD LIKE TO POST A CLASSIFIED, PLEASE CONTACT ME.

LISA
UHMS

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==> MEETINGS, COURSES AND CONFERENCES <==

The latest news in this area can best be obtained by going to the respective web sites of the agencies involved. These are listed on our web page at http://scuba-doc.com/meetcrse.html .
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==>HUMOR<==
Subject: Touche

A college student challenged a senior citizen, saying it was impossible for their generation to understand his.
"You grew up in a different world," the student said. "Today we have television, jet planes, space travel, nuclear energy, computers..."

Taking advantage of a pause in the student's litany, the geezer said, "You're right. We didn't have those things when we were young; so we invented them! What are you doing for the next generation??"
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Subject: Single

A woman was shopping at her local supermarket where she selected:

* a half-gallon of 2% milk
* a carton of eggs
* a quart of orange juice
* a head of romaine lettuce
* a 2 lb. can of coffee
* a 1 lb. package of bacon

She was unloading her items on the conveyor belt to check out.

A drunk standing behind her watched as she placed the items in front of the cashier.

While the cashier was ringing up her purchases, the drunk calmly stated,"You must be single."

The woman was a bit startled by this proclamation, but she was intrigued by the derelict's intuition, since she was indeed single. She looked at her six items on the belt and saw nothing particularly unusual about her selections that could have tipped off the drunk to her marital status.

Curiosity getting the better of her, she said "Well, you know what, you're absolutely correct. But how on earth did you know that?"

The drunk replied:

"Cause you're ugly."
********************************************************************************
This one has been told before --- but still good the second time around!

Linda Burnett, 23, a resident of San Diego, was visiting her in-laws and while there went to a nearby supermarket to pick up some groceries Several people noticed her setting in the car with the windows rolled up and her eyes closed, with both hands behind the back of her head.

One customer who had been in the store for a while became concerned and walked over to the car. He noticed that Linda's eyes were now open and she looked very strange.

He asked her if she was OK, and Linda replied she'd been shot in the back of the head and had been holding her brains in for over and hour.

The man called the paramedics, who broke into the car because her doors were locked and Linda refused to remove her hands from her head.

When they finally got in, they found that Linda had a wad of bread dough on the back of her head, The Pillsbury biscuit canister had exploded from the heat, making a loud noise that sounded like a gunshot, and the wad of dough hit her in the back of the head.

When she reached back to find out what it was, she felt the dough and thought it was her brains.

She initially passed out, but quickly recovered and tried to hold her brains in for over an hour until someone noticed and came to her aid.

Linda is a blonde, but I'm certain that's not relevant.
***********************************************
A MALE BLONDE JOKE
A BLONDE GUY GETS HOME EARLY FROM WORK AND HEARS STRANGE NOISES COMING FROM THE BEDROOM. HE RUSHES UPSTAIRS TO FIND HIS WIFE NAKED ON THE BED, SWEATING AND PANTING.
"WHAT'S UP?" HE SAYS. "I'M HAVING A HEART ATTACK," CRIES THE WOMAN.
HE RUSHES DOWNSTAIRS TO GRAB THE PHONE, BUT JUST AS HE'S DIALING, HIS
4-YEAR-OLD SON COMES UP AND SAYS "DADDY! DADDY! UNCLE TED'S HIDING IN YOUR CLOSET AND HE'S GOT NO CLOTHES ON!"
THE GUY SLAMS THE PHONE DOWN AND STORMS UPSTAIRS INTO THE BEDROOM, PAST HIS SCREAMING WIFE, AND RIPS OPEN THE WARDROBE DOOR. SURE ENOUGH, THERE IS HIS BROTHER, TOTALLY NAKED, COWERING ON THE CLOSET FLOOR.
"YOU ROTTEN SOB," SAYS THE HUSBAND, "MY WIFE'S HAVING A HEART ATTACK AND YOU'RE RUNNING AROUND NAKED SCARING THE KIDS!"
*************************************************
Zen from Glen
Nuggets of Zen

Do not walk behind me, for I may not lead. Do not
walk ahead of me, for I may not follow. Do not walk
beside me, either. Just leave me the hell alone.


Sex is like air. It's not important unless you
aren't getting any.


If you lend someone $20, and never see that person
again, it was probably worth it.


Give a man a fish and he will eat for a day. Teach
him how to fish, and he will sit in a boat & drink beer all day.


If at first you don't succeed, skydiving is not for you.


Before you criticize someone, you should walk a
mile in their shoes. That way, when you criticize
them, you're a mile away and you have their shoes.


If you think nobody cares if you're alive, try
missing a couple of car payments.


It is far more impressive when others discover your
good qualities without your help.


It may be that your sole purpose in life is simply
to serve as a warning to others.


Never test the depth of the water with both feet.


Always remember you're unique.
Just like everyone else.


No one is listening until you make a mistake.


Don't be irreplaceable. If you can't be replaced,
you can't be promoted.


It's always darkest before dawn. So if you're going
to steal your neighbor's newspaper, that's the time to
do it.


The journey of a thousand miles begins with a broken
fan belt and a leaky tire.

***************************************
Subject: The Drunk Man

A drunken man walks into a biker bar, sits down at the bar and orders a drink. Looking around, he sees 3 men sitting at a corner table. He gets up, staggers to the table, leans over, looks the biggest, meanest, biker in the face and says: "I went by your grandma's house today and I saw
her in the hallway buck-ass naked. Man, she is one fine looking woman!"
The biker looks at him and doesn't say a word. His buddies are confused, because he is one bad biker and would fight at the drop of a hat.
The drunk leans on the table again and says: "I got it on with your grandma and she is good, the best I ever had!"
The biker's buddies are starting to get really mad but the biker still says nothing.
The drunk leans on the table one mor e time and says, "I'll tell you something else, boy, your grandma liked it!"
At this point the biker stands up, takes the drunk by the shoulders looks him square in the eyes and says.... "Grandpa, go home, you're drunk ."
******************************************************
Something of Value!

Sally was driving home from one of her business trips in Northern
Arizona when she saw an elderly Navajo woman walking on the side of
the road.

As the trip was a long and quiet one, she stopped the car and asked
the Navajo woman if she would like a ride.

With a word or two of thanks, she got in the car.

After resuming the journey and a bit of small talk, the Navajo woman
noticed a brown bag on the seat next to Sally.

"What's in the bag?" asked the old woman.

Sally looked down at the brown bag and said, "It's a bottle of wine.
Got it for my husband."

The Navajo woman was silent for a moment, and then speaking with the
quiet wisdom of an elder said, "Good trade"
*****************************************************
==> Dr. Snakebelly's Poetry <==

haiku 1

with wide cavern mouth

a grouper seems hypnotized

by a tiny shrimp


haiku 2

shiny goldblack silk

eel slithers thru coral doors

--- life in the ocean


haiku 3

the cold wind finds me

old snow monkey shivering

just after a dive


Unsubscribe (if you must!) by sending me an email with your email address and the word unsubscribe as the subject.
scubadoc@scuba-doc.com

We wish you health, happiness and golden days for 2005!

Enjoy!

scubadoc

Tuesday, December 14, 2004

Scubadoc's Ten Foot Stop Newsletter

THE TEN FOOT STOP NEWSLETTER
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
Issue Date: Dec. 15, 2004
Diving Medicine Online Home Page: http://www.scuba-doc.com/
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Ho-Ho-Ho! Santa and the elves here at the Diving Medicine Online have been working especially hard to bring you this particularly fact-filled issue of the free 'Ten Foot Stop' Newsletter. Now serving well over 4800 by e-mail with over 50000 visitors per month to our web site from viewers throughout the world.! Thank you for joining us!

****************************************************

CONTENTS--WHAT'S IN YOUR NEWSLETTER THIS WEEK:

-- NOTE FROM SCUBADOC:
-- MAILBOX POTPOURRI:
-- QUESTION OF THE WEEK:
-- COOL DIVING MEDICINE SITE:
-- INTERESTING LINKS:
-- HBO:
--MEETINGS, COURSES AND CONFERENCES:
-- HUMOR:


*****************************************************
*****************************************************

--> Having problems getting around 'Diving Medicine Online'? Use these tools for maximum benefit.
Site Map http://scuba-doc.com/sitemap.html
Appendix http://snipurl.com/baz0
Problem Oriented Index http://www.scuba-doc.com/proborndx.html
Glossary http://scuba-doc.com/glssry.html
Search Site and Web http://www.scuba-doc.com/serchpg.htm
Google Site Search http://snipurl.com/baz3

-->Got any tips or suggestions about improving our newsletter or web site?

*****************************************************
*****************************************************

--->NOTE FROM SCUBADOC<---
--->Interesting stuff about Diving Medicine Online<---
Since January 1, 2004, we have been visited by 534,430 individuals who have seen 1,291,874 pages, 4,726,875 files and had 5,633,082 hits. In November, the top ten entry pages have been :
Mainpage = 6970
/seasnks.htm = 2114
/pfo.htm = 1235
/inearprobs.htm = 1068
/Exabs.html = 721
/entprobs.html = 658
/divingexaminer.html = 656
/hypoth.htm = 629
/Gagrflx.htm = 591
/Q&A.html = 551

Origin of visitors by country and frequency include:
USA, Australia, United Kingdom, Canada, Netherlands, Italy, Singapore, Germany, Ploand, Belgium, Switzerland, Japan, New Zealand, Mexico, Brazil, Greece, France, Saudi Arabia, Finland, Austria, Russia, Russia, Thailand, Israel.

Seeing these figures and noting that we now have over 4800 opt-in subscribers to our newsletter - there is no wonder that we get almost daily requests for our ad rates to advertise on our web site and newsletter. We traditionally have not accepted ads but wonder if this might not be the way to go instad of relying on donations from those of you who continue to be quite generous in your contributions.

*************************************************
Wikipedia Diving Medicine Page
We have run across an interesting web site that is "encyclopedic" in it's scope. Titled "Wikipedia", it can be composed, edited and added onto by anyone with appropriate information. The scary part is that it can also be corrupted by poor information either unintended or by the 'hacker'. There was no section on 'Diving Medicine' - so naturally I wrote one . This led to links to subjects that also were vacant and - of course, since I like to write so much - I wrote sections for them.

If you're interested in this work in progress and would like to see what I've written (and possibly write something yourself) just go to this web link at http://en.wikipedia.org/wiki/Diving_medicine"

************************************************
The following physician has been added to our Diving Medical Examiner list at http://scuba-doc.com/divingexaminer.html .
Dr Dominic Gonzalez
MBChB DOccMed
2/2 51 Clouston Street
GLASGOW
G20 8QP
SCOTLAND
UK
Tel: +44 141 945 0836
Cell: +44 7989 408848
dominic.gonzalez@virgin.net
Full-Time Occupational Physician
UKSDMC Dive Referee
HSE Approved Medical Examiner of Divers
PADI Divemaster
**********************************************
==>New Book on Commercial Diving from Hammerhead Press<==

Occasionally, we get requests from people who are interested in becoming commercial divers and I have to refer them to others for advice. I'm a sport diver and the two types of diving are worlds apart. Now, my friend Stephen Barsky has sent a new book that I have reviewed, "The Simple Guide to Commercial Diving", written in conjunction with Robert Christensen. The book is quite complete in explaining and describing what it takes to become a commercial diver - written by experts who have actually been commercial divers and are now teaching and consulting in the field. The book emphasizes the work ethic and philosophy of the commercial diving industry, providing details on the tools used, and duties required of, both tenders and commercial divers. Personal experiences are recounted and form vital examples of the lives of commercial divers.

Replete with excellent photos, the topics are clear and concise. Some of the information included in the book includes chapters on how to select a commercial diving school, job hunting, working as a tender and practical tools for tenders, diving, using tools underwater, rigging, and the future of commercial diving.

The authors were both successful commercial divers who are still associated with the industry. Steve Barsky worked for SubSea International in the North Sea and Gulf of Mexico. He currently works as a diving consultant and assisted in drafting the ADCI standards for contaminated water diving. Bob Christensen was in the Underwater Demolition Teams (UDT), worked as heavy gear diver in California and Alaska, and taught at Santa Barbara City College's Marine Diving Technology program.

The Simple Guide to Commercial Diving is 178 pages, softbound. It has a suggested retail price of $29.95.
For more information, or to download a free sample chapter, visit Hammerhead Press' website at www.hammerheadpress.com. Or contact Hammerhead Press at 2419 E. Harbor Blvd. #149, Ventura, CA 93001. Tel. (805) 985-4644.

**************************************************
==>Visit our Scuba Clinic forum at http://scuba-doc.com/scubaclinic/ and browse around, ask questions or comment if you feel you have something valuable to say.
Visit our 'blogs' on the mainpage at http://scuba-doc.com/ . One contains the Ten foot Stop newsletters and the other has recent updates of the Diving Medicine Online web site.

Many thanks to those of you who continue to send in your donations to help defray the cost of this free service to divers, instructors and diving physicians.

Warm regards:

Ernie Campbell

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--->MAILBOX POTPOURRI<---

Clarke Becomes New DAN Field Representative

Divers Alert Network announces that Julie Clarke became the organization’s newest Field Sales and Services Representative effective Dec. 1. She joins Cary O’Brien, who has been with DAN since Sept. 6, as a fellow DAN “Road Warrior.”

As a DAN Field Sales and Services Representative, Clarke will be responsible for representing DAN at dive shows and industry functions, visiting DAN Business Members and other dive operations in person, and managing DAN advertising and promotional efforts throughout the USA, Canada and the Caribbean. She will report to Steve Barnett, Director of DAN Marketing.

“Having been previously a DAN Business Membership Liaison since July 2002, Julie already has had many contacts within the dive industry,” said Tony Bacci, Vice President, DAN Marketing. “With more than seven years’ experience in sales andcustomer support in the industry, I anticipate she will be an invaluable asset along with Cary in promoting DAN’s Mission of providing emergency medical advice and assistance and promoting dive safety, health and research. She will interact with dive retailers and professionals to show how essential their support is in making DAN ‘Your Dive Safety Association.’”

Clarke graduated with a BFA from the University of Tulsa in Oklahoma in 1994. She owned a dive operation in Oklahoma from 1997-2000. She has earned certifications from IANTD for technical diving and is a certified cave diver.

She may be contacted at DAN at +1-919-684-2948 ext. 239 or via email at jclarke@dan.duke.edu.

*************************************************
DAN Auction Ends, Raises $58,000-Plus for DAN

When the third annual DAN Online Auction ended bidding at noon Eastern Time Dec. 1, it raised an estimated more than $58,000 from more than 2,400 bids.

Auction items included artwork, books, clothing, dive equipment, vacations and much more. There were more than 235 items up for bid. Bidders did not have to be DAN Members to participate.

As in the previous DAN Auctions, all money raised from the highest bids will support DAN initiatives. These include The DAN Endowment; Oxygen Grant Program; AED Matching Grant Program; DAN Research Internship Program; Project Dive Exploration; Technical Diver Study; and Diver Day Program.

Winners should hear from the donor of the item(s) they purchased by Dec. 15. If they have not heard from them by that date, winners should contact donors, and not DAN, by email.

Anyone wanting to bid on an item not available in this year’s auction should send an email to development@dan.duke.edu saying what it is and who provides it. DAN Development will try to secure the item for the 2005 Online Auction next November.

DAN thanks all buyers and sellers for their participation in this year’s auction and look forward to their participation in next year’s event. We hope divers will patronize those businesses that support diver safety and health through their affiliation and support of DAN as a DAN Business Member and / or DAN Corporate Donor. For a list of these businesses, go to the DAN website at www.DiversAlertNetwork.org.

*************************************************
Question from the resource manager of a dive fishery regarding marijuana use in commercial diving

Hi, I found a lot of useful information on the website related to marijuana use and diving although my specific question regards our drug policy for dive harvesters. We test all our divers quarterly for drug use and our policy states that if there is a positive test, that diver must get an evaluation from a drug counselor and follow through with any recommendations before they can dive again. Our first positive received a recomendation for 1 month intensive outpatient and the 12 months of semi monthly meetings with random drug tests. My question is, should this diver be banned for an entire year or can they continue to dive if they test negative for drug use? As you can imagine, this situation is a contentious one but we ultimately want to protect the health of our harvesters. We need some kind of expert opinion to back us up on our policy. Many Thanks...

Our Answer:
Thank you for registering and subscribing to my newsletter. Your question is
very interesting and has not been addressed (to my knowledge) in a fashion
that could be interpreted as "guidelines for commercial diving of your
tribe". The NOAA and USN Diving Manuals mention the problem only in passing.

Most texts describe the risks of marijuana usage but do not address your
needs.

From a usage point of view, some things should be obvious:

---the person should not dive while under the influence of the drug. The
short term effects of marijuana use include problems with memory and
learning; distorted perception; difficulty in thinking and problem-solving;
loss of coordination; and increased heart rate, anxiety, and panic attacks.
Consider also the possible pulmonary risks from smoking the substance. See
http://www.scuba-doc.com/marij.html and
http://scuba-doc.com/psych.htm#Marijuana .

--- Recent research findings also indicate that long-term use of marijuana
produces changes in the brain similar to those seen after long-term use of
other major drugs of abuse.

Chronic use may also cause:
· Bronchitis, Sinusitis, Pharyngitis, Chronic cough, Emphysema, Lung cancer.
· Poor immune system functioning; severe marine infections
· Poor motivation, depressed mental functioning.

--- The half-life of THC concentration ranges between 0.8 to 9.8 days. There is too much human variation to even approximate how long THC will be detected in the urine of an individual. Infrequent users with a fast metabolism will have the shortest detection time. Frequent users with a slow metabolism will have long detection times. The only way to estimate a detection time is to consider the lower and upper bounds (3-30 days), and
decide based on the above factors.

The Brooklyn Treatment Court Program states that marijuana (THC/Cannabinoids) excretion times vary depending on many factors. Variations occur exclusively with marijuana and not other drugs because the body stores THC in adipose (fat) tissues and slowly releases it back into the bloodstream. The exact mechanism that controls excretion is not known and many other variables affect the process, specifically, metabolic rate, physical condition, frequency of urination, fluid intake, kidney function, as well as frequency and duration of prior use. In some situations, due to erratic patterns of excretion, it is possible to test negative one day and positive a day or two later without having used the substance. The average amount of time elapsing prior to consistently negative test results after the cessation of marijuana use is as follows:

Occasional Smoker: (1x week): 3 -5 days
Moderate smoker: ( 4x a week) 5 -10 days
Heavy smoker: (daily) 10-15 days
Chronic (daily use over several months) 20-25 days

In an effort to accommodate differing excretion rates for THC, all users are given the benefit of the doubt and are given 30 days to completely excrete THC.

--- It would seem to be reasonable for your guidelines to allow resumption of diving after the
end of the drug free one month intensive outpatient monitoring period. Of course, any
recidivism found at random testing would disallow diving until such time as the diver was again found to be drug free.

I realize the importance of this problem to you and your harvesters and hope that this is helpful. I will forward your question to several of our consultants for their opinions and
expertise.

*****************************
Dr. Nick McIver, in the UK had the following to say:

I have been mulling this over because I do not feel that cannabis usage is quite as benign or as rapidly "self limiting" as is sometimes described. There have been reported encounters with psychotic episodes in a commercial divers who have had delusions and hallucinations at depth.

This current week's British Medical Journal online does contain an article showing cannabis
usage moderately increases the risk of psychotic symptoms in younger people (ages 14 to 24 yrs In Holland), and more so in those with evidence of predisposition to psychosis.Henquet C et al "Prospective cohort study of cannabis use, predisposition to psychotic symptoms in younger people."

I wonder of 4 weeks is long enough to demonstrate absence of further recreational drug intention in a "safety critical" activity such as commercial diving? Also the fact of being caught out suggests either ignorance of impending testing or a rather cavalier attitude?

************************
This from an MD who is also U.S. Navy Diving Medical Officer/Flight Surgeon
I am a die-hard antidrug and staunch anti-smoking type of physician and even I think a year is a little extreme. My practice includes extensive use of drug testing facilities and to be honest everything Ern said was right on. We can usually detect the fat soluable molecule THC for up to 30 days after use. It has no predictive value in how recent the use was.

I would say slightly random monthly testing for someone in rehab is fine. Besides the obvious no diving while impaired, the rest of marijuana use hinges on long term effects. The changes in the respiratory system are slow and parallel those of any smoker. The long-term memory issues are more variable and open for debate.

For occupational drug screening I support random testing and then no diving while going through acute rehab....first 30-60 days, followed by testing as described above while returning to diving under a 2 strikes and you are through policy.

*********************
--and finally, Dr. Edmond Kay really nails it!

Dr. Campbell kindly copied me on this matter, and as you may recall I serve as one of Dr. Campbell's regional diving medical consultants for his web site "Diving Medicine Online". We last communicated with you by e-mail in July of 2002 about a conference for Native American seafood harvesters.

I heartily agree with Dr. Campbell's assessment of the problem. His summary is useful as it provides a guideline for return to diving after a period of one month, and specifies a "drug free" period. The issue of "recidivism found at random testing" is a thorny one and deserves a bit of
clarification. To help clarify the commercial industry standard I turned to The ADC (Association of Diving Contractors) "Consensus Standards" at http://www.adc-usa.org/stan_con.htm .
The relevant section is labeled paragraph 2.8.6 "Disqualifying Conditions".

Chronic Alcoholism and drug abuse are listed as disqualifying, but a single use should be addressed with treatment, not absolute disqualification. If a diver or surface tender was found to repeatedly offend with either alcohol or drug use, that individual should be permanently disqualified from diving. I know this sounds severe, but I can share with you cases where fatalities have occurred when alcohol use was not taken seriously.

I would recommend a diligent approach with ongoing monitoring. The exact details and durations would be subject to interpretation by the medical examiner and agency involved, but the approach is fairly standard in high risk occupations. Many in the industry would have a two step protocol (two strikes and you're out), but I tend to favor a three step approach to the
problem.

1) First offense (drug or alcohol): As stated by Dr Campbell with random drug testing for a year.
2) Second offense: Drug treatment and stern warning of "Zero Tolerance". Return to diving only after successful completion of certified drug treatment program.
3) Permanent disqualification from commercial diving (zero tolerance).

I sincerely hope it never comes to that but the consequences of continued known drug or alcohol use while diving are severe for any organization that "allows" such behavior without penalty or rehabilitation options. Good luck!

- doc

References to marijuana on Diving Medicine Online
http://tinyurl.com/5ebt3
*****************************************************
CALL FOR ABSTRACTS FOR THE 2005 UHMS ANNUAL SCIENTIFIC MEETING
Thursday 16th June - Saturday 18th June, 2005
Flamingo, Las Vegas, NV

DEADLINE FOR SUBMISSION: JANUARY 15, 2005

Colleagues, presenters and friends
Following the success of the 2004 meeting, the format for this year's meeting will be similar. In order to provide all authors with an adequate opportunity to present their data while ensuring the most effective dissemination of information, ALL authors will present their data via poster discussion. Abstracts of significant scientific merit will be selected by the scientific committee for a brief oral presentation.

In order to allow for poster presentations to remain on display throughout the day and ensure maximal viewing opportunities, a VERTICAL or HORIZONTAL poster orientation format will be used for this year's meeting. Poster board space for the display of illustrative materials (graphs, charts and tabular matter) will conform to international poster presentation standards measuring 6 ft (1.8 m) by 3 ft (0.91 m). Accepted posters will be scheduled for specific sessions based on their research / presentation topic categories and authors will be expected to be in attendance at their poster board during this designated session time to discuss their work with interested colleagues.

For abstracts subsequently selected for oral presentations, additional formatting instructions will be provided with the acceptance letter.

INSTRUCTIONS FOR SUBMISSION OF ABSTRACTS
Please note: If any of the following requirements are not met, your abstract submission may be returned for modification, or declined.

ABSTRACT FORMATTING GUIDELINES
Language - All abstracts are to be written in English. The Program Committee reserves the right to alter abstracts where the English structure makes comprehension difficult.
Title - Capitalize all words.
Author(s) - List primary author first. List all names last name first with up to 2 initials with no spaces.
Affiliation(s) - At the end of the author list specify the primary lab affiliation name, city, state and zip/postal code. If other affiliations must be specified, these may follow the primary affiliation using appropriate superscripts to identify the associated authors (see second sample abstract below).
Abstract Body Format
* Must be 300 words or less, exclusive of title, author(s) names, and institutional affiliation(s).
* All submissions should be in Microsoft Word format
* Only text and text tables will be accepted. NO graphs or images may be submitted.
* Contents should include the following sections:
- Introduction / Background
- Materials and Methods
- Results
- Summary / Conclusions

OTHER ABSTRACT INSTRUCTIONS
Presenter information
Ensure that the following information for the presenting author(s) is included in the submission:
1. Complete mailing address
2. Telephone with area code
3. Fax number with area code
4. E-Mail address, most important for future communication.

Suggested Presentation Category
Specify one of the following categories that best characterizes your presentation:
* Decompression Illness or diving-related illness
* Diving / Habitat science or practice
* HBO Clinical
* HBO Laboratory
* BNA / HTNA presentation

DEADLINES
1. Deadline for abstract submission: JANUARY 15, 2005
2. Confirmation of abstract acceptance: FEBRUARY 15, 2005

MAILING INSTRUCTIONS
1. Via webform - <http://www.uhms.org/Meetings/ABSTRACTS_Eform.asp>
2. Via electronic mail - guyuhms@hotmail.com - refer to "UHMS ABSTRACT" on the subject line.
3. Mail CD or Disk along with hardcopy to: UHMS, 10531 Metropolitan Avenue, Kensington, MD 20895
4. If you do not receive confirmation of your submission within one week, please resubmit.


+++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++

--->QUESTION OF THE WEEK<---

Sting Ray Injury
Question: I was stung by a stingray in Costa Rica one month ago. 3 days after the puncture occured, I was admitted to the hospital with a pretty severe infection. I spent 8 days in the hospital, receiving antibiotics every 6-8 hours via IV. I took the antibiotics orally for 10 days after I was released from the hospital. I have been off the antibiotics for a week or so, and my foot is still slightly swollen and slightly red-- not so much as to even look infected, but it is still sore, and I am concerned about a re-infection. I have no insurance, so I want to avoid visiting a doctor in the U.S. if at all possible. Is it normal for swelling and pain to still exist after this long and this much antibiotic treatment?

Also, the doctor in Costa Rica took an x-ray to determine if there was any part of the ray still imbedded in my foot, and the xray showed no unusual objects. Thank you for your help. I am rather concerned.

Answer: So sorry to hear about your sting ray injury - which must have been quite painful. It would appear that you not only had an infection - but also a foreign body reaction from the integumentary sheath - a frequent occurrence.
The continued redness and swelling may well be due to the presence of portions of the sheath of the barb remaining in your foot. Unless you had surgical removal or "debridement" of the wound - this may well be the case. The sheath is a proteinaceous substance that will not show up on an X-ray. Obviously, the wound will not heal properly until this substance is either removed or absorbed - the latter often taking a long time to occur.
It might be wise for you to 'bite the bullet' and present to a surgeon for further examination and possible debridement. Special studies might be helpful, such as a sonar, xerogram or MRI to exhibit the problem.
Please keep us in touch!
Ern Campbell, MD, FACS
Diving Medicine Online
http://scuba-doc.com/

Beach Diving Stingray injury http://www.scuba-doc.com/hazard.htm
http://scuba-doc.com/~scubadoc/inject.htm
More about stingrays in our newsletter for November 15, 2003. http://scuba-doc.com/nl111503.pdf and in the July 15, 2004 issue at http://scuba-doc.com/nl071504.pdf

Google Search Page for 'sting ray injury'
http://snipurl.com/bc5j
Here are a couple of articles:
Fenner PJ. Stingray envenomation: a suggested new treatment. Med J Aust http://www.marine-medic.com.au/pages/articles/pdf/article_m15.pdf
Fenner PJ, Williamson JA, Skinner R. Fatal and non-fatal stingray envenomation. http://www.marine-medic.com.au/pages/articles/pdf/article_m07.pdf
References to sting ray injury on Diving Medicine Online
http://tinyurl.com/4uv8l

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--->COOL DIVING MEDICINE SITE<---

BSAC NDC 2004 Diving Incidents Report 2004
Compiled by Brian Cumming
DivingSafety & Incidents Advisor
Introduction
This section contains the 2004 Diving Incidents Report, produced by The British Sub-Aqua Club (BSAC) in the interest of promoting diving safety. It is important to note that it contains details of UK diving incidents occurring to divers of all affiliations, plus incidents occurring world-wide involving BSAC members.
http://www.bsac.org/techserv/increp04/intro.htm
This was sent in by Dr. Omar Sanchez, Argentina

+++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++
--->INTERESTING LINKS<---
--> WATCH AS THE FLU APPROACHES YOUR HOUSE
If you really, really want to know the flu conditions in your locality,
there is a free program available. Flu Tracker is installed to your
computer, and accepts updates from the Web. The program also offers
detailed reports based on ZIP codes. You can download Flu Tracker at:
http://tamiflu.com/consumer_dtflutracker.asp

*********************************
-->Sanguine's PHER-O2 is in Trials with Virginia Commonwealth University for the U.S. Navy
http://tinyurl.com/3r3ub
Sanguine a bio-pharmaceutical company focused on the development of an oxygen-carrying synthetic substitute for human red blood cells, today announced that its synthetic red blood cell substitute, PHER-O2, is being used in trials conducted by Virginia Commonwealth University for the U.S. Navy on submarine crew and deep sea diving oxygenation treatment of the bends.

************************************
--->Dentist, lawyer killed in Cancun diving accident
http://snipurl.com/bal5
*************************************
--->Diving Medicine/Safety in about.com http://glclk.about.com/?zi=21/Npi

************************************
--->Changes
The following page has been changed: http://www.scuba-doc.com/diveye.htm

*************************************
--->Syncope Article by Leonard Ganz, MD in eMedicine http://www.emedicine.com/med/topic3385.htm
References to syncope on Diving Medicine Online
http://tinyurl.com/6qvcj

*************************************
--->Middle ear pressure in patients with dizziness. http://tinyurl.com/4tsd4
Links on Diving Medicine Online -- http://snipurl.com/bcrj

************************************
--->Long-term malaria prophylaxis for travelers http://tinyurl.com/5j6jt

Google references -- http://tinyurl.com/46kfh

************************************

--->Horses can take a deep breath : http://tinyurl.com/4cwxu

**********************************
--->Dogs with paralyzed hind legs walk again with lab injection. Purdue Research Offers Hope For Canine, Human Spinal Injuries
http://tinyurl.com/4pvqo

**********************************
--->Psychotic symptoms more likely with cannabis | New Scientist
http://snipurl.com/b4xs
Links on Diving Medicine Online -- http://snipurl.com/bcrc

***********************************
--->Hemoptysis provoked by voluntary diaphragmatic contractions in breath-hold divers.
http://snipurl.com/bb8c

Google references -- http://snipurl.com/bcr8

**********************************

==>SUBMARINE ESCAPE AND RESCUE - AN OVERVIEW
http://tinyurl.com/4mhf4

Google References -- http://tinyurl.com/6jttb


**********************************

==>Sun Screens and Sun Blocks for Scuba Divers
http://tinyurl.com/5hzzs

********************************
==>Larry "Harris" Taylor's New Links
Dives sites: new or corrected redirects:
Family Diving Net: http://www.familydivingnetwork.com/index.php
SoYouWanna Be a Scuba Diver: http://www.soyouwanna.com/site/syws/scuba/scuba.html
Cave Diving in Greece: http://www.cavediving.gr/
European Karst Plain Project: http://www.ekpp.org/
Hooked On Cave Diving: http://www.scubadr333.com/
SMART: http://www.smartdivers.com/
Steve Gerrard: http://www.deephorizon.info/index.php
Commercial Diving Academy: http://www.commercialdivingacademy.com/
Coral Reefs-World Status (AIMS): http://www.aims.gov.au/pages/research/reefs/wcr-status/wcr-00.html
Nembro : http://www.nembro.info/
Octocorals: http://www.calacademy.org/research/izg/orc_home.html
Sea Slugs-Sulawesi : http://www.bunaken.pwp.blueyonder.co.uk/sulawesi.htm
Shark Mountain: http://www.pbs.org/wnet/nature/sharkmountain/index.html
Bodrum Museum of Uw Archaeology (Tuekey): http://www.bodrum-museum.com/
Nova Scotia Museum Underwater Archaeology: http://museum.gov.ns.ca/arch/uwat.htm
Asia Web Direct: http://asiaweb-direct.com/forums/postlist.php?Cat=&Board=UBB3
BSAC Members Forum: http://www.bsacforum.co.uk/forums/diveforum/
Digital Diver: http://www.digitaldiver.net/yabbse/index.php
DIR-Quest : http://www.dirquest.com/ubb-bin/Ultimate.cgi?action=intro
Dive-Oz Forums: http://www.diveoz.com.au/discussion_forums/default.asp
Hawaiian Dive: http://www.hawaiiscubadiving.com/phpBB2/index.php
Mid-Atlantic: http://www.my-town.com/dive/forum/
NY Diver: http://www.nydiver.com/
Scuba Monster: http://www.scubamonster.com/
Underwater (Australia): http://www.underwater.com.au/discussion_board.php
Wraysbury (UK Inland): http://www.wraysbury.ws/index.php?name=Forums
AIDA-International: http://www.aida-international.org/
Annabel Briseno: http://www.freediving.us/
Desert Diving: http://www.desert-divers.com/page14.html
F.R.E.E. International: http://www.divingfree.com/
Freediving (MA): http://www.massfreedivers.org/
Freediving: http://freediving.dyndns.org/
Martin Stepanek: http://www.martinstepanek.com/
Zen of Freediving: http://www.sfdj.com/sand/freedive.html
Cryosphere: http://nsidc.org/cryosphere/index.html
CA-Article 152. Diving Operations: http://www.dir.ca.gov/Title8/sb7g26a152.html
Underwater Warfare: http://www.chinfo.navy.mil/navpalib/cno/n87/mag.html
Mote Marine Lab: http://www.mote.org/
Palau International Coral Reef Center: http://www.picrc.org/
Asthma (SPUMS): http://www.spums.org.au/SPUMS_policy_asthma.htm
Asthma Standards (UK): http://www.uksdmc.co.uk/standards/Standards-%20asthma.htm
Diabetes & Diving (BSAC): http://www.tolgus.com/medical/diabetes.htm
Diabetes & Diving (DAN): http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=18
Diabetes & Diving (DDRC): http://www.ddrc.org/popups/research_divingDiabetes.htm
Diabetes & DIving (UK): http://www.uksdmc.co.uk/main/Diver%20info-%20diabetes%20and%20diving.htm
Diabetes (SPUMS): http://www.spums.org.au/SPUMS_Diabetes.htm
Diabetes Monitor Comment: http://www.diabetesmonitor.com/diving.htm
Diabetes Protocol (YMCA): http://www.ymcascuba.org/ymcascub/diabetic.html
Diabetes Self-Management-Safe Scuba Diving: http://www.diabetesselfmanagement.com/article.cfm?aid=1017&sid=9&sk=5WZB
Fitness To Dive (Medic 8): http://www.medic8.com/healthguide/articles/fitnesstodive.html
CMAS Standards: http://www.divernet.com/technol/cmasntrx.htm
Technical Diver: http://www.technicaldiver.com/
NASA-Remote Sensing of Coral Reefs: http://eol.jsc.nasa.gov/reefs/
British Marine Life Study Society: http://ourworld.compuserve.com/homepages/BMLSS/homepage.htm
NUMA - : http://www.numa.net/
City Seahorse: http://www.cityseahorse.com/
Deep Sea Images: http://www.deepseaimages.com/dsilibrary/reindex.php
Eye Fathom (John Gordon): http://www.eyefathom.com/
Light & Dark: http://www.cosmos.ne.jp/~breach/
Photo Clinic: http://www.utahdiving.com/photos/pic-clas.htm
Photography By Michelson: http://www.pbmphoto.com/
Software-Long Beach Dive: http://www.longbeachdive.com/GPS-software.htm
Nautilus Underwater Systems: http://www.nautilussystems.com/links.htm
PSUBS Sources: http://www.psubs.org/sources.html
Silvercrest Submarines: http://www.silvercrestsubmarines.co.uk/
DCIEM (PDF): http://www.divetable.de/skripte/p125936.pdf
RGBM (PDF): http://www.divetable.de/skripte/ntable.pdf
DAN SEAP: http://www.danseap.org/index.html
DAN South Africa: https://www.dansa.org/index2.html
DAN-Course Roster: http://www.diversalertnetwork.org/training/roster.asp
Scottish Sub Aqua Club: http://www.scotsac.com/home.htm
Bahamas-UNEXSO: http://www.unexso.com/
Bali Underwater: http://www.baliunderwater.com/
Divestarr: http://www.divestart.com/index.php
Diving Maps: http://www.divingmaps.com/
Egypt-Sunshine Diving: http://www.sunshinediving.com/
Mexico-Cozumel Resource: http://www.scuba-diving-cozumel.com/
California Videodiver: http://members.aol.com/videodiver/
Diving Into History: http://www.mahsnet.org/vidcourse.html
Center for Historical Archaelogy: http://www.flmnh.ufl.edu/anthro/Caribarch/chaweb.htm
Nautical Archaeology -Texas A&M: http://nautarch.tamu.edu/
Nautical Archeologicy-East Carolina: http://www.ecu.edu/maritime/
P.S. Lady Sherbrooke: http://collections.ic.gc.ca/lady/archw.htm
Shipwreck Central: http://www.shipwreckcentral.com/map/index.php
Uw Archaeology Com: http://archaeologic.com/underwater_archaeology.htm
Uw & Maritime Archaeology: http://www.cyberpursuits.com/archeo/uw-arch.asp
Uw Archaeology- USN: http://www.history.navy.mil/branches/nhcorg12.htm
Uw Archaeology-MnSU: http://www.mnsu.edu/emuseum/archaeology/underwater/index.shtml
Uw Archaeology-Nordic: http://www.abc.se/~m10354/uwa/
Uw Archaeology-SE Center: http://www.cr.nps.gov/seac/underh2o.htm
Uw Archeology-St. Agnes: http://www.st-agnes.org/~dcrank/student/mich.html
Uw Archeology-U Texas: http://www.utexas.edu/courses/wilson/ant304/projects/projects97/ricop/ricop.html
*****************************************************
Exostoses of the external auditory canal: a long-term follow-up study of surgical treatment.
http://tinyurl.com/3wgfk
Related links: http://snipurl.com/azvv

*****************************************************
Middle Ear Pressure in Patients with Dizziness
http://tinyurl.com/67xfq
Related Links
http://snipurl.com/azvj

****************************************************
Arterial Gas Embolism and Decompression Sickness by Tom Neuman, MD
http://tinyurl.com/3nv23

***************************************************
Barotrauma in eMedicine
http://www.emedicine.com/emerg/topic53.htm
Barotrauma links on Diivng Medicine Online
http://snipurl.com/bcqc

*****************************************************

Autopsy & the Investigation of Scuba Diving Fatalities
http://tinyurl.com/22qgh

Google links -- http://tinyurl.com/5tt3s

****************************************************

Recurrent pulmonary barotrauma in scuba diving and the risks of future hyperbaric exposures: a case report.
http://tinyurl.com/4smy7
Links on Diving Medicine Online -- http://snipurl.com/bcqj

***************************************

Neurological accidents caused by repetitive breath-hold dives: two case reports
http://tinyurl.com/5sg94
Links on Diving Medicine Online
http://tinyurl.com/3j2y5

**************************************

Risk factors for pulmonary barotrauma in divers.
http://tinyurl.com/6om55
Links on Diving Medicine Online
http://tinyurl.com/7x46d

**************************************

Value of bronchial challenge in scuba diving candidates.
http://tinyurl.com/688hn
Links on Diving Medicine Online -- http://tinyurl.com/65pga
Google links -- http://tinyurl.com/4pnvb

+++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++
--->HBO<---

From Lisa Wasdin, UHMS
Hyperbaric and Wound Healing Center Management Position

A position is available for an experienced hyperbaric nurse with National Baromedical Services at its headquarters facility in Columbia, South Carolina. Palmetto Health Richland is a leading international hyperbaric and comprehensive wound healing program. The first to achieve national accreditation, the center operates within a busy Level 1 Trauma Center and academic setting. Several hundred health care professionals visit from throughout the world each year to train. Sponsored wound healing and hyperbaric medicine research is a consistent feature of the program.
We seek a manager, one with excellent leadership and interpersonal skills. A busy clinical practice, teaching responsibilities, and national and international travel await a deserving applicant.
For further details please contact Wayne Cromley, at l.803.434.7101, fax number 803.434.4354, or e-mail wayne.cromley@palmettohealth.org.

*********************************************
Hyperbaric Nurse Manager Position

National Baromedical Services has an opportunity for an experienced hyperbaric RN to manage its program at Roper Hospital, in beautiful Charleston, South Carolina. The facility provides care for the full range of referable patient states, and is highly regarded by the regional communities. It is headed by an outstanding medical director.
We seek an enthusiastic and motivated nurse with excellent interpersonal skills. Teaching, preceptor and travel opportunities make this a unique position for those seeking professional enrichment.
For further details please contact Wayne Cromley, at 803.434.7101, fax: 803.434.4354, or e-mail to wayne.cromley@palmettohealth.org.

**********************************************
==>International Indications for HBO Therapy
http://tinyurl.com/4hyua

+++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++
==> MEETINGS, COURSES AND CONFERENCES <==
The latest news in this area can best be obtained by going to the respective web sites of the agencies involved. These are listed on our web page at http://scuba-doc.com/meetcrse.html .
Here are some organizations giving courses linked to the above site:
DAN -- http://www.diversalertnetwork.org/cme/events.asp
SPUMS Courses -- http://www.spums.org.au/courses.htm
Medical Seminars -- http://www.medsem.com/destination_information.html
UHMS -- http://www.uhms.org/Courses/Courses.htm
Temple University Underwater Medicine -- http://www.scubamed.com/educ.htm
EUBS -- http://www.eubs.org/
ISAM -- http://www.divingdocs.org/
NOAA -- http://www.uhms.org/Courses/NOAA01/noaa.asp
DCIEM -- http://www.dciem.dnd.ca/publications/factsheets/t22_e.html
DDRC -- http://www.ddrc.org/docs/ddrcpage.asp?pageid=10

+++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++

--> HUMOR --SOME OLDIES BUT GOODIES<---

Hollywood Lessons

It does not matter if you are heavily outnumbered in a fight involving martial arts: your enemies will wait patiently to attack you one by one, dancing around in a threatening manner until you have knocked out their predecessors.

Honest and hard-working policemen are traditionally gunned down three days before their retirement.

All beds have special L-shaped sheets that reach the armpit level of a woman, but only the waist level of the man lying beside her.

At least one of a pair of identical twins is born evil.

Most laptop computers are powerful enough to override the communications system of any invading alien society.

All grocery bags contain at least one stick of French bread.

Rather than wasting bullets, megalomaniacs prefer to kill their arch enemies using complicated machinery involving fuses, pulley systems, deadly gasses, lasers, and man-eating sharks, which will allow their captives at least a half-hour to escape.

You're very likely to survive any battle in any war unless you make the mistake of showing someone a picture of your sweetheart back home.

A man will show no pain while taking the most ferocious beating, but will wince when a woman tries to clean his wounds.

If a large pane of glass is visible, someone will be thrown through it before long.

If staying in a haunted house, women should investigate any strange noises in their most revealing underwear.

Even when driving down a perfectly straight road, it is necessary to turn the steering wheel vigorously from left to right every few moments.

All bombs are fitted with electronic timing devices with large red readouts so you know exactly when they're going to go off, but luckily you'll always blindly choose to cut the right wire.

A detective can only solve a case once he has been suspended from duty.

Police departments give their officers personality tests to make sure they are deliberately assigned a partner who is their total opposite.
*********************************************
"Kentucky" jokes sent in by Merlin.
The owner of a golf course in Kentucky was confused about paying an invoice,
so he decided to ask his secretary for some mathematical help.

He called her into his office and said, "You graduated from the University
of Louisville and I need some help. If I were to give you $20,000, minus
14%, how much would you take off?" The secretary thought a moment, then
replied, "Everything but my earrings."

You gotta love those Kentucky women

=================================

Kentucky Mountaineers, A group of Kentucky friends, went deer hunting and
paired off in twos for the day. That night, one of the hunters returned
alone, staggering under the weight of an eight-point buck. Where's Henry?"

the others asked. "Henry had a stroke of some kind. He's a couple of miles
back up the trail," the successful hunter replied.

"You left Henry laying out there and carried the deer back?" they inquired.
"A tough call," nodded the hunter. "But I figured no one is going to steal
Henry"!

===============================================

Regarding the year 2000, a senior at U.K. was overheard saying that when the
end of the world comes, I hope to be in Kentucky.

When asked why, he stated that everything happens here 20 years later than
the rest of the civilized world.

==================================================

The young Mountaineer came running into the store and said to his buddy,
"Bubba, somebody just stole your pickup truck from the parking lot!" Bubba
replied, "Did you see who it was?" The young Mountaineer answered, "I
couldn't tell, but I got the license number."

=======================================================

NEWS FLASH! - Albany, KY----- Kentucky's worst air disaster occurred when a
small two-seater Cessna 150 plane, piloted by two University of Kentucky
students, crashed into a cemetery earlier today in Albany. Search and rescue
workers have recovered 300 bodies so far and expect the number to climb as
digging continues into the evening. The pilot and copilot survived and are
helping in the recovery efforts.
****************************************************
A good one from 'the big guy'!
Subject: Senior generosity

A tour bus driver drives with a bus full of seniors down a highway, when a little old lady taps him on his shoulder. She offers him a handful of almonds, which he gratefully munches up.

After approx.15 minutes, she taps him on his shoulder again and she hands him another handful of almonds. She repeats this gesture about eight times.

At the ninth time he asks the little old lady why they do not eat the almonds themselves, whereupon she replies that it is not possible because of their old teeth, they are not able to chew them.

"Why do you buy them then?" he asks puzzled.

Where upon the old lady answers, "we just love the chocolate around them."

****************************************************
---and another good one from 'toothdoc'
A very elderly gentleman, (mid nineties) very well dressed, hair well
groomed, great looking suit, flower in his lapel smelling slightly of
a good after shave, presenting a well looked after image, walks into an
upscale cocktail lounge.
Seated at the bar is an nicely turned out, elderly looking lady, (mid
eighties).
The gentleman walks over, sits along side of her, orders a drink,
takes a sip, turns to her and says:
"So tell me, do I come here often?
****************************************************
---and this one from Georgia, who sounnds as if she's " been there-done that!"
Ralph returns from the doctor and tells his wife that the doctor has told him he has only 24 hours to live. Given this prognosis, Ralph asks his wife for sex. Naturally, she agrees, and they make love.
About six hours later, the husband goes to his wife and says, "Honey, you know I now have only 18 hours to live. Could we please do it one more time?" Of course, the wife agrees and they do it again.
Later, as the man gets into bed, he looks at his watch and realizes he now has only 8 hours left. He touches his wife's shoulder and asks, "Honey, please... just one more time before I die ?"
She says, "Of course, dear." And they make love for the third time. After this session, the wife rolls over & falls asleep. Ralph, however, worried about his impending death, tosses & turns until he's down to 4 more hours.
He taps his wife, who rouses. "Honey, I have only 4 more hours. Do you think we could.....?"
At this point the wife sits up and says, "Listen Ralph, I have to get up in the morning ... you don't."
***************************************
An old farmer in Florida had owned a large farm for several
years. He had a large pond in the back, fixed up nice; picnic
tables, horseshoe courts, and some apple and peach trees.
The pond was properly shaped and fixed up for swimming
when it was built.
One evening the old farmer decided to go down to the pond,
as he hadn't been there for a while, and look it over. He grabbed
a five gallon bucket to bring back some fruit.
As he neared the pond, he heard voices shouting and laughing
with glee.
As he came closer he saw it was a bunch of young women
skinny-dipping in his pond. He made the women aware of his
presence and they all went to the deep end of the po nd. One of the women shouted to him, "We're not coming out
until you leave!"
The old man frowned, "I didn't come down here to watch you
ladies swim naked or make you get out of the pond naked."
Holding the bucket up he said, "I'm here to feed the alligator."
Moral: Old age and cunning will triumph over youth and enthusiasm
every time.
***************************************************

--> CHANGING YOUR E-MAIL ADDRESS?
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*****************************************************
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