Tuesday, December 14, 2004

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!



-- HBO:


--> Having problems getting around 'Diving Medicine Online'? Use these tools for maximum benefit.
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--->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
2/2 51 Clouston Street
G20 8QP
Tel: +44 141 945 0836
Cell: +44 7989 408848
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


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

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

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

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
Thursday 16th June - Saturday 18th June, 2005
Flamingo, Las Vegas, NV


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.

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

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

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

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

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.



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

Beach Diving Stingray injury http://www.scuba-doc.com/hazard.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'
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


BSAC NDC 2004 Diving Incidents Report 2004
Compiled by Brian Cumming
DivingSafety & Incidents Advisor
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.
This was sent in by Dr. Omar Sanchez, Argentina

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:

-->Sanguine's PHER-O2 is in Trials with Virginia Commonwealth University for the U.S. Navy
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
--->Diving Medicine/Safety in about.com http://glclk.about.com/?zi=21/Npi

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

--->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

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

--->Hemoptysis provoked by voluntary diaphragmatic contractions in breath-hold divers.

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



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


==>Sun Screens and Sun Blocks for Scuba Divers

==>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.
Related links: http://snipurl.com/azvv

Middle Ear Pressure in Patients with Dizziness
Related Links

Arterial Gas Embolism and Decompression Sickness by Tom Neuman, MD

Barotrauma in eMedicine
Barotrauma links on Diivng Medicine Online


Autopsy & the Investigation of Scuba Diving Fatalities

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


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


Neurological accidents caused by repetitive breath-hold dives: two case reports
Links on Diving Medicine Online


Risk factors for pulmonary barotrauma in divers.
Links on Diving Medicine Online


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


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

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



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


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
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.

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