Friday, January 28, 2005

Ten Foot Stop, January 31, 2005


Archives
http://scuba-doc.com/archives.html
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==>NOTE FROM SCUBADOC <==

My latest issue of the Undersea and Hyperbaric Medicine journal for Winter, 2004 has arrived and contains some interesting articles.
--The Navy, in a brief communication, was unable to demonstrate previously reported changes in pulmonary function in the Navy divers studied. Other authors have reported a number of short term studies that have concluded that diving is associated with accelerated decline in pulmonary function. Related Links
http://snipurl.com/cb80

--A study about the effectiveness of HBO2 therapy in pneumatosis cystoides intestinalis (a condition where there are multiple air-containing cysts in the wall of the bowel) concluded that care must be taken in choosing when this modality of treatment should be used. The cysts contain nitrogen and the use of oxygen to displace this gas is beneficial. However, if there is air secondary to necrosis, an operation should be performed and not delayed by HBO treatment. Related Links
http://snipurl.com/cb8e

--An article about the use of HBO in the treatment of traumatic brain injury from the University of Texas, Galveston branch. Cerebral blood flow was studied and found not to be suignificantly changed by the use of HBO. Related Links
http://snipurl.com/cb8c

--HBO plus antibiotic carrier is effective in reducing the staphylococcus colony count in experimental osteomyelitis.
Related Links
http://snipurl.com/cb90

--A study on chamber attendants showed that there is a significant decompression stress with venous gas embilism found in most hyperbaric chamber attendants. The study was done after one of the attendants developed neurological DCI. There is a discussion of measures that can be taken to reduce the incidence of this side effect of HBO treatment.

--An article on experiments to assess the risks of DCS in flying after diving. As one would expect, the incidence of DCS decreased as preflight surface intervals increased. Repetitive dives required longer PFSI. No DCS occurred in 52trials of 17 hours PFSI [the longest tested].
Related Links
http://snipurl.com/cb90

--For you history buffs there is an interesting review of Caisson Disease during the construction of the Eads and Brooklyn Bridges by WP Butler.
http://tinyurl.com/4k489
Related Links
http://snipurl.com/cbfz

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The Alert Diver [DAN Magazine] for January/February 2005 has a good article on keeping the ears clean, by Dr. Cameron Gillespie. The article goes into detail about the dangers of a wax plug in the ear canal and diving. It can cause ear drum rupture from air trapping and dizziness from caloric vertigo. Dr. Gillespie describes the wrong ways to clean the ear canal and follows this up with the right ways. He also describes the management of an insect in the ear.

In addition to this article, there are articles on Diving Safety [Robert Rossier], a discussion of the similarities of West Nile Virus to DCI [Dan Nord], an article about the risks of peer pressure by Jeff Myers, an article on diving headaches by Dr. Allan Kayle, an excellent article on physical fitness and diving by Dr. Yancey Mebane, an account of diving with the Ama in Japan by Dr. Jolie Bookspan, an article on Plastic Surgery and Diving by Wesley Hyatt and an article with pictures and narrative about the blue ringed octupus by Elizabeth Cook and Robert Yin.

My congratulations to Dan Leigh and Renee Duncan for pulling together the Twenty-fifth Anniversary format using the great material in this issue. If this is going to be the result for the rest of this year - then my advice would be for anyone not already a member of DAN to join just for the publication - not that DAN doesn't already have many other rrasons for divers to join up!


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Comments By Lindell Weaver, MD from the UHMS magazine, 'Pressure'.

From Pressure, UHMS, Sept-Oct. 2004
"The Executive Committee also voted unanimously to relocate our Library to Duke University. I echo the comments supporting this decision by Dr. Elliott in the last issue of Pressure. Let me review the rationale for this decision, which may trouble some. The major reason we need to relocate the UHMS Library is to make our holdings available electronically, through a professional medical library, around the world. Duke University will categorize our holdings, and in time, we anticipate much of our library will become available electronically worldwide. The UHMS is an International organization and making our library holdings available through Duke University will support our International members well. Although, the details of our relationship with the Duke University Library have yet to be finalized, UHMS members may have complete access to their holdings, by virtue of being UHMS members, which will be terrific. In addition, important historical works will be stored in the Duke Library atmosphere-controlled environment, which will guarantee longevity of irreplaceable historical documents. Presently, the UHMS office does not have this capability, and to provide this special environment requires room we do not have and is very expensive. Also, it is important that the UHMS library holdings are made available to those interested in and studying Undersea and Hyperbaric Medicine. Duke University has a fellowship program in Undersea and Hyperbaric Medicine, has a large hyperbaric medicine department, and is proximate to the Divers Alert Network. It is sensible to relocate our library there because of so much interest in our field at that institution. I appreciate that some will be opposed to this dramatic change, but hopefully will reflect on this proposal and see the tangible benefits. "

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January 2005 DAN Safety Stop for DAN Research

The latest edition the DAN Safety Stop, the official monthly newsletter of the DAN Research Department, is now available.

Included in this edition is an update on research intern Jennifer Wiley, a brief discussion of hepatitis and diving and much more.

To get a copy of the newsletter, simply download the PDF attachment below.

Additional Resources:
Jan2005.pdf PDF
http://diversalertnetwork.org/news/download/Jan2005.pdf


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DAN Website Awarded Standard of Excellence

The official website for Divers Alert Network (DAN) recently won the Standard of Excellence award in the Web Marketing Association’s 2004 WebAward Competition.

The DAN website (http://www.DiversAlertNetwork.org ) won in the categories of Associations and Non-Profits. More than 1,300 websites from 19 countries took part in the competition.

“We are honored to win this distinguished award,” said Panchabi Vaithiyanathan, Vice President, DAN Chief Information Officer. “We are constantly striving to make our website as efficient, up-to-date and easy to use for DAN Members and other site visitors who look for DAN to provide them with scuba diving safety, health, research and education information, products and services. This award indicates we are on the right path with our website.”

The Web Marketing Association (WMA) was founded in 1997 to help set a high standard for Internet marketing and corporate web development on the World Wide Web. Staffed by volunteers, this organization is made up of Internet marketing, advertising, public relations and design professionals from around the country who share an interest for improving the quality of advertising, marketing and promotion used to attract visitors to corporate websites.

The Web Marketing Association produces the WebAward Competition, now in its seventh year. The WebAwards is the premier annual award competition that judges website development against an ever-increasing Internet standard and against peer sites within their industry.

Many websites win awards, but few awards recognize the individual achievement behind the creation of today’s top sites. The goal of the WebAward Competition is to provide a forum to recognize the people and organizations responsible for developing some of the most effective websites on the Net today.

There are 80 industry categories, and each site goes head-to-head with other sites in their categories and the highest score is selected Best of Industry winner in that category. Of the remaining entries, if they received a score of 60 or greater out of a possible 70 points granted by the judges, the entry receive the Outstanding Website award. Entries that scored between 50 and 59.9 receive the Standard of Excellence.

Entries were judged on design, copy writing, innovation, content, interactivity, navigation, and use of technology. Judges from all over the world reviewed and critiqued some of the most comprehensive websites, and the winners speak for themselves.

To learn more about the competition, visit http://www.webaward.org/whywma.asp

Scubadoc's Note:

I have watched as DAN's web site has become more and more sophisticated over the past several years - including information for all divers, even though they might not be members of DAN. In a highly competitive and specialized field of diving and hyperbaric medicine, the web site has become a 'go to' site for all types of information about diving safety. My hearty congratulations to all involved and responsible. This from someone who has been in the online diving information arena almost from the start.

What do you think?

Ernie Campbell, MD

scubadoc



==> 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
Lost your copy of the newsletter? See the latest at http://tenfootstop.blogspot.com or at http://scuba-doc.com/archives.html .


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==> QUIZ OF THE WEEK <==

Prevention of Decompression Accidents

Take this Quiz
Prevention of Decompression Accidents: Self-grading Quiz
Click on "Next Question" to start quiz. Be sure to use small letters.
http://www.scuba-doc.com/quizdcsrsks.html


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==> COOL WEB PAGE ON DIVING MEDICINE ONLINE <==

The Divemaster's Quick Accident Response Guide
http://www.scuba-doc.com/qkrsp.htm

A valuable guideline for all divers for the quick response to accidents and injuries. In addition, we provide you instructions to make your own water proof dive slates of the material.

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==> Unusual Diving Medical Question from the Archives<==

What Does Position have to do with it?

I. Recovery Position
"If any form of decompression illness (DCI) is suspected, then the diver must be laid flat and not allowed to sit-up or stand as this may cause bubbles to distribute from the left ventricle and aorta to the brain. Although such posture-induced phenomena are unusual (rare), they have a very poor outcome. This posture must be maintained until the injured diver with DCI is inside a recompression chamber (RCC). A headdown posture is no longer advocated as it may increase the return of and subsequent "arterialization" of venous bubbles, it causes cephalic-venous engorgement such that subsequent middle-ear inflation (e.g. in a RCC during treatment) is very difficult, it limits access for resuscitation and assessment, and, in animal-model studies it actually retards the recovery of brain function in comparison to the horizontal posture."

Is it better to decompress in the vertical or horizontal position? There is definitely a gradient between the hydrostatic pressures between the upper and lower parts of the body in the upright position. There would also be a difference in the effects of physical laws. This difference would
become progressively greater as the diver ascends into more shallow water. Proponents of the horizontal position feel that the deco stops are so important that this should certainly be taken into consideration - and that the moderate amount of exercise that would be required to maintain the horizontal position is beneficial to the diver in off-gassing. Recumbency should also promote blood flow in the legs because the pressure in the veins is not as great as when one is erect, increasing the possibility of off-gassing. The obverse is that it would be difficult for some divers to maintain this position without some sort of stabilizer; and, that there would be a danger of overhead obstructions that the diver would be unable to see. One would suspect that this is not so important in the sport diver doing no deco dives and just taking safety stops. However, in other types of diving this just might be the decompression edge that would prevent numerous diving accidents.

Post Immersion Collapse
Occasionally, people who are found conscious in cold water with life jackets perish within minutes of being rescued and lifted out of the water in a vertical position. The cause of this is post-immersion circulatory collapse. There is a 32-66% increase in the cardiac output caused by the pressure exerted by surrounding water with a 16% increase in the heart rate. On leaving the water there is a gravitational venous pooling and the normal baroreceptor reflexes are not operative due to the cold water. Rescue should be accomplished in the sitting or horizontal position to prevent sudden cardiopulmonary failure.

Golden FStC, Hervey GR, Tipton MJ. Circum-Rescue Collapse: Collapse, sometimes fatal, associated with rescue of immersion victims. J Roy Nav Med Serv 1991; 77: 139-149 (No abstract Available)
http://snipurl.com/cbgv


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==> INTERESTING LINKS <==

Guidelines for CPR Seldom Followed by Trained Personnel
http://www.medscape.com/viewarticle/497552?src=mp

For a discussion of 'expired air resuscitation', seeour April 30, 2004 newsletter at http://scuba-doc.com/nl043004.pdf

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Hearing threshold in sport divers: is diving really a hazard for inner ear function?
http://tinyurl.com/4cc8l

See also 'long term effects of diving' at http://www.scuba-doc.com/LTE.htm

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UHMS Abstracts, 2004
http://www.uhms.org/AccAbsDBase/2004 abs/UHMS_menu.htm

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Seamounts Offer Marine Life Peaks of Viands (washingtonpost.com)
http://snipurl.com/c2pd

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Decompression sickness and recreational scuba divers. (Full text)
http://snipurl.com/c0dm

Decompression Illness on Diving Medicine Online at http://www.scuba-doc.com/dcsprbs.html

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Interesting report about death of a South African cave diver with links to a forensic report attributing the death to 'deep water blackout'.
http://snipurl.com/cbm2

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Migraine-PFO study
Migraine - New Study to Examine Possible Link With the Heart
http://snipurl.com/cc5m

On Diving Medicine Online
PFO http://www.scuba-doc.com/pfo.htm
Migraines http://www.scuba-doc.com/mgrns.htm


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=>QUESTIONS AND ANSWERS FROM SCUBA CLINIC FORUM <=
http://scuba-doc.com/scubaclinic/

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Diving with MS and a Foley Catheter?
http://snipurl.com/cc5r

Multiple Sclerosis http://www.scuba-doc.com/msdiv.htm
Kidney Problems http://www.scuba-doc.com/kidprbs.htm

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Antidepressants and diving?
http://snipurl.com/cc5s

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Decompression sickness?
http://tinyurl.com/3qf4l

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Deafness after infection and flying/diving
http://tinyurl.com/4kqro

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==> MAILBOX POTPOURRI <==

CHT Test Dates
National Board of Diving and Hyperbaric Medical Technology
1816 Industrial Blvd.
Harvey, LA 70058
(504) 328-8871; fax: (504) 328-8872;
email: nbdhmt@bellsouth.net
Visit the Board’s website: www.NBDHMT.org

2005 TEST DATES
January 14: Seattle, WA
January 22; Kissimmee, FL
January 28: Miami, FL
February 4: Tallahassee, FL
February 18: Cape Girardeau, MO
February 25: Quebec, Canada
March 8: Plymouth, England
March 17: Louisville, KY
April 2: Harvey, LA - Board HQ (1-3pm)
Please note: CHT candidates must apply 30 days before exam date. CHRN candidates must apply 60 days before exam date. Also, the exams are offered at all UHMS Annual Sc. & Chapter Mtgs. You must register for the exam separately through Board HQ.

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Esophageal Varices, Diving?

I am a physician in Ireland and had aquery about a patient of mine who is very interested in diving. he had got small to medium size oesophageal varices that have never bled due to cryptogenic cirrhosis, is it safe for him to dive.
many thanks

Answer:
Thanks for writing. There would be a risk to your diver from depth/pressure in so far as the varices or chronic hepatitis would be concerned. Immersion causes a central shunting of blood into the GI blood volume. People with portal hypertension have an exaggerated response to central venous pressure changes, further increasing the central blood vessel engorgement.
Divers are also at risk for a gas bubble in the fundus enlarging due to the effects of Boyle's Law on air upon ascent from a dive. The gas is produced by the diver swallowing air as s/he attempts to equalize the middle ears during descent. This enlarging air can overwhelm the lower esophageal sphincter - causing severe acid reflux at times. This increase in pressure has also been reported to cause ruptures of the stomach and lower esophagus. Whether or not this would increase the risk in your patient, I cannot say but would hazard a guess that there would be some danger due to further vessel engorgement.

More about gastrointestinal problems at http://www.scuba-doc.com/giprbs.html .

Nguyen has reported one case of scuba diving causing massive variceal bleeding.
Nguyen MH, Ernsting KS, Proctor DD.
Massive variceal bleeding caused by scuba diving.
Am J Gastroenterol. 2000 Dec;95(12):3677-8.

Finally, if the person has symptoms of fatigue, weakness or is taking medication - there might be other reasons for her/him not to dive.
I would be reluctant to certify this patient to dive - unless there were overriding reasons such as livelihood considerations - even then there would be adverse occupational health factors to consider.
I hope that this is helpful!

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Diving with cracked ribs?

I have at least one cracked rib from my martial arts class. I am leaving for Cozumel Weds. morning and planned on getting my open water certification while on this trip. Is it safe for me to dive to a depth of up to 60' with this condition.

Answer:
There are some possible risks that you need to take into consideration. First, and possibly the most dangerous is the risk of lung puncture with
pneumothorax occurring during any strenuous diving with heavy gear about your chest. This could lead to collapsed lung and a serious situation should it occur at depth and you have to ascend. Ascent would increase the size of the pneumothorax, possibly causing cardiopulmonary arrest.

Rib fractures are quite painful, causing a decrease in respiratory excursions and the possibility of CO2 retention and hypoxia, both of which are dangerous to divers. Entry and exit activities might worsen an undisplaced fracture. (See below).

On the other hand, if the fracture is undisplaced, causes you little pain when you deep breathe and requires no sedating pain medication - then you might consider diving with the knowledge of the risks that I have mentioned. I would advise informing your divemaster of the situation, shallow diving, slow ascent and consider the possibility of getting help on climbing back into the boat.

All this having been said - I once cracked three ribs jumping back onto a rocking dive platform in heavy seas (weight belt). This occurred in the
middle of a week of active diving on a remote island without medical facilities. It was very painful, but nothing happened as concerned my diving activities.

It might be wise to get a chest exam and x-ray to be sure that you don't have a small pneumothorax.

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Comparative risks for various sports?

It is interesting that I came across your website while trying to find some statistics regarding diving injuries/fatalities. I am interested in any statistics that compare diving injuries to other sports such as baseball, golf, etc. I would appreciate any help or resources that you could recommend.
Answer:
Here is an article that details multiple sports injuries. It may be more than you really wanted to know.
http://www.physsportsmed.com/issues/2004/1104/ppe.htm
Another article on scuba risks
http://arts.usask.ca/policynut/ducks.htm

Comparative Statistics
Comparative statistics to other sports Death rates experienced in different activities are sometimes difficult to compare because of different ways of expressing exposure to risk. Below skiing/snowboarding fatalities per million are presented based on "visits" (can be referred to as days of participation) and by participants. Scuba, swimming, boating and drowning (due to boating/drowning) are also listed below.

Skiing/snowboarding
1998 number of fatalities* 39
Number of participants (in millions)** 10.4
Fatalities per million participants 3.75
Days of participation (in millions)* 51.9
Fatalities per days of participation rate (per million) .75

Scuba Diving
(most recent figure available - 2002)
2002 number of fatalities*** 89 (DAN figures for Canada and USA)
Number of participants** 3.0+ (Probably more)

Swimming
1998 number of fatalities*** 1,500
Number of participants (in millions)** 58.2
Fatalities per million participants 25.7
Days of participation (in millions)** 2,324.4
Fatalities per days of participation rate (per million) .65

Boating
(registered recreational vessels) (most
Recent figure available- 1997)
1997 number of fatalities*** 821
Number of registered vessels (in millions)*** 12.3
Fatalities per million registered vessels 66.7
Days of participation (in millions) n/a
Fatalities per days of participation n/a

Bicycling
(resulting from collisions with motor vehicles-additional bicycling-related deaths, such as collisions with other bicyclists in 1996 was 87.)
1998 number of fatalities*** 700
Number of participants (in millions)** 43.5
Fatalities per million participants 16.1
Days of participation (in millions)** 2,564.8
By days of participation rate (per million) .27
These are the only figures that I can find - golf, B-ball, F-ball, tennis, etc. would be negligible.

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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 .

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

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TO ALL UHMS MEMBERS From Lisa Wasdin, UHMS

SAVE THE DATE: JUNE 15-19: (15th Pre-courses - 16-18 Annual Meeting - 19th Post-Courses)
FLAMINGO, LAS VEGAS, NEVADA

VISIT OUR ANNUAL MEETING WEBSITE http://www.uhms.org/Meetings/AMMeetingsMain.htm
FOR THE FOLLOWING ASM INFORMATION

* 2005 General Information
* 2005 Registration: Online (now available) Word & Pdf (coming soon)
* 2005 Tentative Program
* Pre & Post Course Information
* Accompanying Person Events
* 2005 Call For Abstracts: Deadline for Submission EXTENDED: Feb 15, 2005
* 2005 Call For Officer Nominations
* 2005 Award Nominees Needed
* 2nd UHMS Oxygen Golf Classic
* Sponsor/Exhibitor Information

ASSOCIATES/BNA ANNUAL SCIENTIFIC MEETING INFORMATION
* Call for Nominations for Associate Officers
* Associates/BNA Call for Abstracts
* Associates/BNA Program (available soon)
* PAUL BAKER Award Nominees Needed
PLEASE FORWARD THIS INFORMATION TO ANYONE WHO YOU THINK WOULD BE INTERESTED IN ATTENDING THE UHMS ANNUAL SCIENTIFIC MEETING.
****************************************************
From Georgia Siebenaler, B.Ed., RRT, CHT
5th Annual Hyperbaric Medicine Update

Sponsored by ProMedica Health System,
Department of Hyperbaric Medicine at The Toledo Hospital and the
Undersea & Hyperbaric Medical Society, MidWest Chapter.

Dates: Friday, October 7, 2005
Saturday, October 8, 2005
7:00 AM - 4:30 PM
(Social Mixer Friday evening

Location: TBA

Content will include: tissue oximetry, dive medicine, hyperbaric oxygen
therapy used to treat diabetic wounds of the lower extremities, USN Table
VI, and hyperbaric case studies.

CHT and CHRN Certification exams for the National Board of Diving and
Hyperbaric Medical Technology will be offered to eligible candidates.

Keynote speaker: Dick Clarke, CHT
Program Director, Hyperbaric Medicine,
Palmetto Richland Memorial Hospital,
Columbia, S.C.

Director, The Baromedical Research Foundation
President, National Baromedical Services

Additional guest speakers and content to follow.

Program fliers will not be available until last summer, but I will keep you
apprised of any updates.

Any further questions can be directed to:
The Toledo Hospital
Department of Hyperbaric Medicine
(419) 291-2072

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==>HUMOR<==

2005 Edition of "You know you're a redneck when......."

1. You take your dog for a walk and you both use the same tree.

2. You can entertain yourself for more than 15 minutes with a fly swatter.

3. Your boat has not left the driveway in 15 years.

4. You burn your yard rather than mow it.

5. You think the "Nutcracker" is something you do off the high dive.

6. The Salvation Army declines your furniture.

7. You offer to give someone the shirt off your back and they don't want it.

8. You have the local taxidermist on speed dial.

9. You come back from the dump with more than you took.

10. You keep a can of Raid on the kitchen table.

11. Your wife can climb a tree faster than your cat.

12. Your grandmother has "ammo" on her Christmas list.

13. You keep flea and tick soap in the shower.

14. You've been involved in a custody fight over a hunting dog.

15. You go to the stock car races and don't need a program.

16. You know how many bales of hay your car will hold.

17. You have a rag for a gas cap.

18. Your house doesn't have curtains, but your truck does.

19. You wonder how service stations keep their restrooms so clean.

20. You can spit without opening your mouth.

21. You consider your license plate personalized because your father made it.

22. Your lifetime goal is to own a fireworks stand.

23. You have a complete set of salad bowls and they all say "Cool Whip"

on the side.

24. The biggest city you've ever been to is Wal-Mart.

25. Your working TV sits on top of your non-working TV.

26. You've used your ironing board as a buffet table.

27. A tornado hits your neighborhood and does a $100,000 worth of improvements.

28. You've used a toilet brush to scratch your back.

29. You missed your 5th grade graduation because you were on jury duty.

30. You think fast food is hitting a deer at 65 mph!
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Aussie Humor from 'Georgia'
MEMO
Re: Swearing at work

Dear Employees:

It has been brought to management's attention that some individuals throughout the company have been using foul language during the course of normal conversation with their co-workers. Due to complaints received from some employees who may be easily offended, this type of language will no longer be tolerated. We do, however. realize the critical importance of being able to accurately express your feelings when communicating with co-workers.

Therefore, a list of 18 New and Innovative "TRY SAYING" phrases have been provided so that proper exchange of ideas and information can continue in an effective manner.

1) TRY SAYING: I think you could use more training.
INSTEAD OF: You don't know what the f___ you're doing.

2) TRY SAYING: She's an aggressive go-getter.
INSTEAD OF: She's a f___ing bit__.

3) TRY SAYING: Perhaps I can work late.
INSTEAD OF: And when the f___ do you expect me to do this?

4) TRY SAYING: I'm certain that isn't feasible.
INSTEAD OF: No f___ing way.

5) TRY SAYING: Really?
INSTEAD OF: You've got to be sh___ing me!

6) TRY SAYING: Perhaps you should check with...
INSTEAD OF: Tell someone who gives a sh__.

7) TRY SAYING: I wasn't involved in the project.
INSTEAD OF: It's not my f___ing problem.

8) TRY SAYING: That's interesting.
INSTEAD OF: What the f___?

9) TRY SAYING: I'm not sure this can be implemented.
INSTEAD OF: this sh__ won't work.

10) TRY SAYING: I'll try to schedule that.
INSTEAD OF: Why the f___ didn't you tell me
sooner?

11) TRY SAYING: He's not familiar with the issues.
INSTEAD OF: He's got his head up his a__.

12) TRY SAYING: Excuse me, sir?
INSTEAD FO: Eat sh__ and die.

13) TRY SAYING: So you weren't happy with it?
INSTEAD OF: Kiss my a__.

14) TRY SAYING: I'm a bit overloaded at the moment.
INSTEAD OF: F__ it, I'm on salary.

15) TRY SAYING: I don't think you understand.
INSTEAD OF: Shove it up your a__.

16) TRY SAYING: I love a challenge.
INSTEAD OF: This f___ing job sucks.

17) TRY SAYING: You want me to take care of that?
INSTEAD OF: Who the f___ died and made you boss?

18) TRY SAYING: He's somewhat insensitive.
INSTEAD OF: He's a pr_ck.

Thank You,

Human Resources

**************************************************************************
A Very Loyal Wife...

This woman's husband had been slipping in and out of a coma for several months, yet she had stayed by his bedside every single day. One day, when he came to, he motioned for her to come nearer.

As she sat by him, he whispered, eyes full of tears, "You know what? You have been with me through all the bad times. When I got fired, you were there to support me. When my business failed, you were there. When I got shot, you were by my side. When we lost the house, you stayed right here. When my health started failing, you were still by my side... You know what?"

"What dear", she gently asked, smiling as her heart began to fill with warmth.

"I think you're bad luck."

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

A six year old little boy was examining his testicles while taking a bath.

"Mama," he asked, "Are these my brains?"

Mama answered, "Not yet."
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Random Thoughts....


If you're headed in the wrong direction, u-turns are allowed

For every 60 seconds of anger, you lose one minute of happiness.

Kindness: a language the deaf can hear, the blind can see, and the mute can speak.

When you see someone without a smile, give him one of yours.

I do not think happiness is too hard to find -- it is how you treat it once you get hold of it that counts.

What holds you together is far greater than what can tear you apart.

My grandfather once told me that there were two kinds of people: those who do the work and those who take the credit. He told me to be in the first group; there was much less competition.

Respect costs nothing.

Don't marry the person you think you can live with. Marry the one you can't live without.

When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one, which had been opened for us.

The days are very long, but the years are very short.

Sorrow looks back, worry looks around, faith looks up.

Answer just what the heart prompts you.

The heart is wiser than the intellect.

Fortune truly helps those who are of good judgment.

Speak only well of people, and you need never whisper.

Time is precious, but truth is more precious than time.

Pray for what you want, but work for the things you need.

Wise men learn more from fools, than fools from wise men.

Get your mind set; confidence will lead you on.

It is better to share happiness than keep it to yourself.

Be direct; usually one can accomplish more that way.

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==> Dr. Snakebelly's Poetry <== without further questions describe to me the shallow coral reef even though i don't understand why without further questions the surface interval seems too long bits of colored fish are coming from my brain i am never tired of the world but it seems we have done this before ******************************** and don't worry about it as my feet sink into the water the slaves of memory get under my skin close your eyes and speak in tongues imagine you are a nitrogen bubble that always rises always enlarges i lost my name somewhere in the deep i don't worry about it ++++++++++++++++++++++++++++++++++++++++++++++ Unsubscribe (if you must!) by sending me an email with your email address and the word unsubscribe as the subject. scubadoc@scuba-doc.com


Enjoy!

Ernie Campbell, MD
scubadoc

Thursday, January 20, 2005

DAN Creates Tsunami Web Portal

TEN FOOT STOP EXTRA


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

DAN Unveils International Tsunami Relief Information Portal on Internet

Working in conjunction with its affiliates DAN Europe, DAN South East Asia-Pacific and DAN Southern Africa, DAN America unveiled Jan. 19 its new DAN International Tsunami Relief information portal.

The portal provides a coordinated response by DAN America and its international affiliates to the effects of the tsunamis in South and Southeast Asia in December and the efforts following it. It relays and consolidates news that affects DAN Members, diving and travel updates in the area, relief efforts, vital information, personal stories of some survivors and more. It may be found at a link from the home page of the DAN website, www.DiversAlertNetwork.org, or by directly going to www.DiversAlertNetwork.org/tsunami/index.asp

The page has seven basic links to other, more detailed pages on the following topics:
• About the Tsunami (the basic facts about the disaster, plus what a tsunami is);
• DAN Responds (medical services, insurance and assistance that DAN has, is and will be providing to its members in regard to the tragedy);
• Relief Efforts (reputable aid agencies where people may contribute, as well as details of a fund DAN Europe and DAN Southern Africa have to help the families of lost divers);
• Hotlines & Other Resources (phone and related contact information for all DAN affiliates, plus details regarding the tsunami’s aftermath from the U.S. State Department);
• Diving & Travel in Southeast Asia (updates on what areas are in operation or will be soon for divers and other tourists to enjoy);
• Divers’ Tsunami Stories (personal accounts DAN America has received from people who were there when it hit in Thailand and the Maldives); and
• Photo Gallery.

The portal will be updated periodically with information received from DAN affiliates worldwide. The general public as well as DAN Members are encouraged to check it regularly to get the latest details to the millions of people affected by this event and see how DAN as well as the international community at large tries to help them recover.

scubadoc

Friday, January 14, 2005

SCUBADOC'S TEN FOOT STOP NEWSLETTER, January 15, 2005

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==>NOTE FROM SCUBADOC <==

BUT FIRST, A small amount of business.... Our mailing list platform is quite shaky - and for some reason will either freeze up or just disappear. This keeps me jumping by having to maintain backup and alternate lists, which often rapidly get out of date. This has just happened again, and if some of you get this newsletter after having requested that you be unsubscribed, this is the reason. Just let me know again and I 'll take care of it. To bookmark this newsletter for future reference go to http://tenfootstop.blogspot.com/ or http://scuba-doc.com/archives.html and click 'bookmark'.

Useful Links
To Register http://scuba-doc.com/Register.html
To access the Scuba Clinic Forum http://scuba-doc.com/scubaclinic/
To check for recent web site updates of Diving Medicine Online Updates (Blog) http://scubadoc.blogspot.com/
To Subscribe Ten Foot Stop Newsletter http://snipurl.com/buk8
To see the latest 10 Foot Stop Newsletter (Blog) http://tenfootstop.blogspot.com/
To Donate to Diving Medicine Online or Ten Foot Stop Newsletter http://scuba-doc.com/sbscrb.html

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Dr. Nick McIver Awarded OBE for service to divers.

We received this note from Dr. David Elliott, OBE about Dr. Nick McIver:
"In the United Kingdom the New Year's Honours List has listed Nick McIver for the O.B.E. (Order of the British Empire) for services to Diving Safety. A great honour, and about time too! David "
See http://snipurl.com/bpgx

Nick McIver has been a valued consultant for Diving Medicine Online for the past 6 years, offering assistance in answering many and varied questions concerning dive safety and, in particular, providing us local information for British and European divers. In the UK, being designated as an Officer of the British Empire is one of the highest honors that can be bestowed on an individual. A description of the OBE can be found at this web site: http://www.royal.gov.uk/output/Page498.asp

We are quite proud to have been associated with Nick McIver and to also be able to call him 'friend'. For more information about Dr. McIver, go to his CV page at http://www.scuba-doc.com/cvnick.html

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Back pain remedy!

We have recently had several divers to write in about their back problems. One in particular had been placed on chronic doses of narcotics and wanted to know if diving would be permitted while taking the medication. A veteran diver with long-standing back pain, he was still not willing to give up his love for the sport. Having chronic back pain myself, I definitely identified with the person and in an effort to help the person overcome his malady - I referred him to one of my consultants, Dr. Jolie Bookspan, PhD, who has written articles on our web site about managing back pain. Her regimen has helped me and several other divers and I hoped that at the least that this diver would be benefitted by not having to take chronic painkillers.

Not to my surprise, the experienced diver is now back in the water, off pain medication and is almost pain free.

Dr. Bookspan's articles on back pain
http://scuba-doc.com/nomobkpain.html
http://scuba-doc.com/backpainII.html
http://scuba-doc.com/baddiscs.htm
Dr. Bookspan's CV
http://www.scuba-doc.com/joliecv.html
Contact Dr. Bookspan

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New website for Scottish Diving Medicine

We have revised links to the Scottish Diving Medicine website in response to this letter from Dr. John Ross.
"The Scottish Diving Medicine website has been moved on to a new server. The old one on sams.ac.uk will not be updated. The new address is http://www.sdm.scot.nhs.uk/ .
Regards
John Ross"

Dr John A S Ross
Senior Lecturer, Hon. Consultant Department of Environmental and Occupational Medicine University of Aberdeen Medical School Aberdeen AB25 2ZP

Their new web site is well done and contains good information for divers in their area of the UK. This site is linked at http://www.scuba-doc.com/divuk.htm and at http://www.scuba-doc.com/DCSLnks.html .

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Turkish Translation added to Diving Medicine Online Web Site

Please note that a Turkish translation has been added to our translation facility on our Diving Medicine Online home page http://scuba-doc.com/ .

In addition, Turkish can also be used on the Site Map page http://scuba-doc.com/sitemap.html . The site map allows you to reach most of our web pages - and by accessing your web page through the translated site map - the linked page is automatically translated to the language that you are using.

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DAN and the Tsunami

This has already been sent out but thought it important enough to repeat. We thought that you might be interested in these news reports from Wesley Hyatt at DAN:

DAN South-East Asia Pacific Coping With Tsunami Tragedy DAN America has been in frequent contact with its independent affiliate DAN South-East Asia Pacific (SEAP), whose coverage area includes most of the countries affected by the December tsunami, including Thailand and India. Additionally, DAN America is in contact with its other independent affiliates DAN Europe and DAN Southern Africa, who are also responding to the needs of their members who were in the area at the time of the tsunami.

According to John Lippmann, DAN SEAP President, this is what he understands at present (Jan. 4) based on his most recent conversations with DAN:

There are reports of large numbers of missing divers, but the reality is that it will still be some time before it is really known who is missing. There are lots of people in hospital wards without proper identification and waiting in turn to be seen and assisted. Communication is very poor, and this delays the process of knowing who is accounted for and who is not. Apparently quite a few of the liveaboard dive boats in the region have not returned yet. It is unknown whether this is because they have perished or because there is so much devastation on shore with no jetties or services available.

DAN America and its independent affiliates are now jointly looking at the best ways the organizations can assist dive operations that have been directly affected by the disaster through their missions of dive safety and educational services. All organizations strongly encourage their members to donate directly to reputable aid agencies within their own countries (for a list of those for DAN American members, visit http://www.DiversAlertNetwork.org/news/article.asp?newsid=517

All DAN organizations together hope to be able in some way to assist the diving communities affected by this tragedy. Visit www.DiversAlertNetwork.org for follow-ups on what can be done by the organizations and is being done currently.

********************************************************************************** Divers Helping Divers SM: DAN Responds to Tsunami’s Impact

The recent devastating events in the Indian Ocean and beyond have captivated and dominated world headlines. The degree of devastation and human loss is tragic, and many DAN Members are among those sadly caught up in this disaster. The role of DAN in dive medicine, health and safety has evolved during its 25 years of operation. For this catastrophic event, that mission of service prepared DAN to respond effectively in time of need.

Here is a summary of what DAN has done and will be doing to serve its Members and their needs from this event. Medical Services Joel Dovenbarger, Vice President of DAN Medical Services, has noted the following regarding the organization’s efforts in the wake of the tsunami’s destruction:
• No DAN Members have been reported missing as of Jan. 4, but there are thousands of tourists still not accounted for in the region.
• DAN has repatriated two DAN Members to their home countries. They had little more but the swimsuits they were wearing.
• DAN is currently providing medical monitoring for hospitalized DAN Members who require advanced medical care – furthermore, medical evacuation / repatriation has been arranged for three of these cases. Dovenbarger added that many divers have called to volunteer to go to Thailand to assist with recovery efforts. However, host countries have said they do not need direct assistance and are not allowing anyone in the ocean. Thus, officials are asking that no divers respond in person to the tsunami relief effort in the affected areas at this time. Insurance and Assistance DAN TravelAssist continues to work nonstop to ensure that urgent care and needed services are quickly and effectively delivered to DAN Members. Beginning soon after the massive waves struck the shorelines, DAN TravelAssist began its standard process of urgently evacuating DAN Members to advanced regional medical facilities, providing cash payments for clothing and other basic needs, arranging Embassy and Consulate services to re-establish identities and make contact with families, and delivering replacement airline tickets for travel home.
IMPORTANT NOTICE: If you have been affected by these events and require urgent DAN or DAN TravelAssist support, please call 1-800-684-9111 (toll free in the U.S. or through an international AT&T operator) or +1-919-684-9111, fax +1-919-493-3040 or email to emergency@dan.duke.edu .

Let us know if you have any news about divers affected by the tsunami. Write scubadoc@scuba-doc.com . scubadoc

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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 Lost your copy of the newsletter? See the latest at http://tenfootstop.blogspot.com or at http://scuba-doc.com/archives.html .

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==> QUESTION[s] OF THE WEEK <==

Take this Quiz

So you think you know all there is to know about the problems that gases can cause divers? If so, then take this self-grading test and then check out your answers at this web page. http://www.scuba-doc.com/quizgases.html
To check your answers, go to the 'Problems with Gases' web page http://www.scuba-doc.com/gasesprbs.html

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==> COOL WEB PAGE ON DIVING MEDICINE ONLINE <==

Diving Safety

Here is a links page for diving safety issues. The items below can be accessed by going to this address: http://www.scuba-doc.com/dvsaf.html

Divemasters Quick Accident Response
Divemaster's Quick Response [PDF]
Divemaster's Quick Response for Dive Slates [PDF]
Dive Slates, Instructions Easy to make teaching tool!

Dive Accident Management PDF
Dive Accident Management Power Point Presentation

The Importance of a First Aid Kit PDF
Basics of a Good First Aid Kit

Pre-Dive Risk Assessment PDF
Some things divers need to consider in prevention of diving accidents.
Scuba Diving Emergency Rescue Plan An excellent SCUBA Rescue Plan Joe Schottman Webmaster www.vbs.vt.edu
Model Action Plan for Divemasters PDF
Outline of a Model Action Plan for Divemasters for download

Safe Scuba PDF Some tips and recommendations for safe diving
Man Overboard PDF Discussion of what to do to aid a person fallen overboard.
The Abandoned Diver PDF Discussion of this catastrophe and it's prevention
Problems With Moving Water PDF Diving in Currents and Surges

Lead Poisoning PDF
Lightning and Diving PDF
Diving Safety for the Disabled PDF
Information and sources about Disabled Diving

Hypothermia PDF
Immersion hypothermia and Near-drowning
Cold Acclimatization PDF An article by Jolie Bookspan, PhD

Diving in Polluted Waters PDF Information for Search & Rescue Divers
Post-Dive Procedures PDF Some things that a divemaster needs to consider after all dives, modified after OSHA Commercial Guidelines Technical Diver Series Download

Commentary Articles by Ernest Campbell, MD Danger! "Hotel Scuba" PDF
An article on how not to learn diving

Apres Diving in Palau PDF Fun article on a good way to have a surface interval.

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==> Unusual Diving Medical Question from the Archives<==

Is there a relationship between alcohol ingestion and nitrogen narcosis?
1 ATA=33 fsw=1 Martini?
50 MSW Onset of Inert Gas Narcosis (Peter Bennett in Bove's Diving Medicine)

In a comparison between subjective feelings to alcohol and nitrogen narcosis: a pilot study. Monteiro, Hernandez, Figlie, Takahashi, and Korukian from the Department of Psychobiology, Escola Paulista de Medicina, Sao Paulo, Brazil, compared the effects of nitrogen narcosis to alcohol intoxication. If a common mechanism of action is responsible for the behavioral effects of these substances, biological variability of response to alcohol should correlate to that of nitrogen in the same individual. To test this hypothesis subjective feelings were assessed in two separate occasions in 14 adult male, healthy volunteer nonprofessional divers. In one occasion, each subject received 0.75 ml/kg (0.60 g/kg) alcohol 50% (v/v PO) and in another day underwent a simulated dive at 50 m for 30 min in a hyperbaric chamber. There was a significant correlation between reported feelings in the two sessions; subjects who felt less intoxicated after drinking also felt less nitrogen narcosis during the simulated dive. The results, although preliminary, raise the hypothesis that ethanol and nitrogen may share the same mechanisms of action in the brain and that biological differences might account for interindividual variability of responses to both ethanol and nitrogen.
More about nitrogen narcosis at http://www.scuba-doc.com/nitronarc.html
More about alcohol and diving at http://www.scuba-doc.com/alch.htm

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==> INTERESTING LINKS <=

Environmental Tectonics Corporation Signs Major Hyperbaric Monoplace Order With Koike Medical Company, Ltd.
http://snipurl.com/bssx

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Diving Safety and Emergency Management Guidelines U-1105 BLACK PANTHER HISTORIC SHIPWRECK PRESERVE
http://snipurl.com/bykc

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VIRTUAL MAGAZINE OF MEDICINE HIPERBARICA
http://snipurl.com/bykh

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Microsurgical penile replantation facilitated by postoperative HBO treatment. http://snipurl.com/byuy
Related Articles http://snipurl.com/byuz

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Hyperbaric oxygenation combined with streptokinase for treatment of arterial thromboembolism of the lower leg (Full text)
http://snipurl.com/byv4

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The role and effectiveness of adjunctive hyperbaric oxygen therapy in the management of musculoskeletal disorders. (Full text)
http://snipurl.com/byvc

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==> MAILBOX POTPOURRI <==

Leg Cramps and Diving?

My friend wants to start scuba diving, however he told me he is unable to swim for longer than 10 minutes without getting cramps? His circulation is poor in his legs, he cannot sit for longer than an hour without them going numb. He also informed me as a child he wore braces on his legs to treat Scurvey. He does not wear them any longer Is this a condition that can be treated so he can scuba dive?

Answer by Dr. Martin Quigley:
"Answers to questions are offered as information only and not as medical diagnosis or advice and should always be used in conjunction with advice from your personal diving physician. Given our inability to examine you and without the findings of your doctors it's impossible to offer a personal answer that's entirely accurate."

At a minimum, an introductory scuba course ("Open Water Diver") requires that a student complete a 200 yard (meter) swim and then tread water for 10 minutes, all without equipment (fins, etc.). An average scuba dive probably lasts about 45 minutes, and almost always involves swimming the entire time (except for a "drift dive"). There will occasionally be an unexpected current that will require significantly more physical effort. From the limited information that you have provided, it appears that you friend is presently physically unable to complete these requirements. I would suggest that your friend consult a physiatrist (an MD who specializes in physical and rehabilitative medicine) for a more accurate assessment of his physical condition and any possible corrective measures.
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.

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Sinuses, headache and nausea with diving?

I am 16 and I just finished my openwater referal in Cozumel. I have done a few "resort courses" before becoming certified, and had dove down to around 60 feet with no problems. For my four certification dives I felt fine, and was starting to get a lot more comfortable underwater, but those dives were just to 12 feet of water. Two days after becoming Padi OpenWater certified, I went on a two tank boat trip. Before the dive started I preventatly took afrin, and my sinuses felt clear. For the dive we descented to 30 feet, and than eased down to 60 feet. I felt on pain while descending and thought I had no problems equalizing. For the first apx. 20 minutes I felt fine, and was having a lot of fun. But than I slowly started to get a headache, and it kept getting worse and worse, untill finally having to ascend and than threw up. After this I was reluctant to go on the next dive, but after taking sudafed and a lot of advil I felt fine, and wanted to go on the next dive. On this dive it was a similar dive profile and after again 10-20 minutes I started to get a headache and just kept getting worse. The divemaster had me level off at around 25-30 feet to see if it would help, but it didn't seem to help so I surfaced and ended the dive. A day after this I went on another 12 foot deep shore dive and after aprx. 15 minutes I got a headache from this also and nausea and ended the dive again. Note: I definently did not have a "Mask Squeeze" Is this just simple sinus congestion?? Or may I be expierencing a different conditon?? Any help would be greatly appreciated. Thank you

Answer by Dr. Allen Deckelboum Your question was referred to me for comment. Do you have a history of headache prior to starting to dive? Do you have migraines? In what part of your head did you have your pain? Was it in the same location each time? How long did it last after surfacing? Did you have nausea each time? Were you trying to conserve your air supply by "skip breathing"? It is more important to continuously breathe normally and not try to breathe every other breath to preserve your gas supply. That can cause a retention in CO2, which can produce headache and nausea. If that is not the problem, I would consult an ear, nose and throat doctor to evaluate your sinuses or other causes of headache.

Response from diver:

Hello, Yes, I do have a history of headaches. I have gone to a doctor about this a few times before, but there were no real answers. I also do get congested easily. I have had a few migraines before, but only after being very dehydrated from cross-country running. My headache was in my forehead mostly, and I showed the divemaster the area of pain and she said it was the sinuse squeeze. After surfacing I took 3 ibuprofen and 1 sudafed and the headache went away within 30 minutes. I only had nausea on the first dive, and on that dive I tolerated my headache a lot longer before surfacing hoping it would go away. I was trying to conserve air greatly so I wouldn't be the typical newly certified airhog ending the dive for everyone else. And the 12 foot dives were at the same location. One other thing I thought I would note was that it wasn't a sharp pain, that I would think of more as a squeeze. Just a gradually increasing headache which wrecked the dive and became untolerable. Thanks for your time.

Dr. Deckelboum's response:

Thanks for your prompt reply. It appears that there might be several possible causes for your pain. The first thing I would do would be to consult an ear, nose and throat doctor, preferably one who has some knowledge in diving medicine, to rule out any sinus disease. The area of concern would be the frontal sinuse (forehead). If that is normal, it is possible that your attempt at not being an "air hog" might be the root cause of your headache, and with a history of migraine and other headaches, could be the trigger for the headache. Conserving air comes naturally with experience and multiple dives. Don't be concerned about that. Just breathe normally and let us see what happens. Good luck on your diving career.

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Diving with CAD, angioplasty and four stents?

Can a person with CAD whom has had angioplasty with 4 stents safely warm water dive less than 30 meters?

People who have had angiography and stents can return to diving but should have fulfilled the following guidelines. This is most often an individual call made by your physician and cannot be strictly delineated. (Omar Sanchez, MD)
---They were an established diver prior to their coronary revascularization.
---They have no cardiac symptoms when off all cardiac medication (although lipid lowering drugs and antiplatelet agents are permitted).
---They can perform satisfactorily a treadmill exercise test, achieving a good workload (for age, sex and build), with a normal heart rate and blood pressure response without evidence of ischemia on a 12 lead ECG. This usually means 4-5 on the Bruce scale or attaining 13 METS.
Discuss this with your doctor as this is associated with rather heavy exercise.
---There is little residual myocardial dysfunction (particularly a preserved left ventricular ejection fraction).
---They must dive with experienced companions who can render assistance if required. ---Fitness to dive should be reviewed annually irrespective of the diver's age, but should symptoms recur between medical examinations, the diver must cease diving until reviewed.
Please read our section on coronary artery disease at http://www.scuba-doc.com/cad.html .

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From a Turkish physician: First of all, I really would like to thank you very much for your efforts in your adding Turkish language to your translation service on your home page. There is another thing I would like to have . Do you have the CD form of your website (www.scuba-doc.com)? There might be more than one CD's. If there is or there are, how can I have this or these ? If you can answer my question , I will be very happy. Thank you very much, indeed. Happy new years.


Sorry, but we don't have CD's of the web site. It is updated frequently and a CD would be out of date almost immediately. Might I suggest a good text of Diving Medicine? Edmonds 'Diving and Subaquatic Medicine', 4th Edition. This can be bought easily on amazon.com (also on our web site).
See http://snipurl.com/bpgp .
Other books about diving medicine can be seen at http://scuba-doc.com/DMbkstr.htm .

Thank you for your interest in our little project!

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Coral injury and itch?

I was diving in Cuba and think I was cut by fire coral on my leg. I had some fire like pain on my leg where the cut was, but also on my hands. I have developed a rash over parts of my body (legs) that used to itch - but now don't. Now I have massive itching/red dot hands that feel swollen. I did rub my hands when I got back to my room - probably made it worse, but I don't know what to do know. What do you recommend? Thanks - greatly!

Our answer: Coral scrapes do have a tendency to become both chronically irritated and infected. Occasionally, coral scrapes and cuts will have trouble healing and break out in a chronic dermatitis or a weeping wound. This is thought to be due to the persistent toxic or allergic effects of the small bits of coral (often microscopic) that are embedded in the wound at the time of the injury.

Initially, wounds should be flushed with large quantities of vinegar or whatever sterile fluid you have available. You should get a tetanus shot and treat the wound with a combination of triple antibiotic/steroid cream until healing occurs. If the wound does not appear to be healing after 24 to 36 hours, there might be a need to undergo a procedure called debridement (removal of foreign bodies).

Hyperpigmentation (dark color changes) is more difficult to manage and requires the assistance of a good dermatologist. The rash on your legs and hands is most likely due to nematocysts floating in the water (skin bather's itch) or from brushing against hydroids (a form of soft coral). Topical steroid creams reduce or inhibit the actions of chemicals in the body that cause this inflammation, redness and swelling. It is used to treat the inflammation caused by a number of conditions such as allergic reactions, eczema and psoriasis and would possibly be indicated for the coral dermatitis that can occur. People have varying reactions to the dermatitis and the medication. Most dermatologists are highly trained to manage conditions of this nature and a visit to one might be wise in the long run.

Also, more information can be obtained by reading my web page about this at http://www.scuba-doc.com/otherderms.htm .

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Hypertension and GBR diving?

I have been diagnosed with hypertension and take an ACE inhibitor and a beta blocker. Can I get medical approval to dive at the Great Barrier Reef?

Our answer: Well-controlled hypertension is not a contraindication to diving. However, it is usually accompanied by some degree of coronary artery disease and this does pose a risk. The diver with hypertension should have a clearance by his physician for the presence or absence of CAD.

The drugs that you mention are not usually thought of as being particularly dangerous - although some feel that a beta blocker could blunt the heart's response to stress. ACE blockers are not adverse to diving but can cause a troublesome cough while underwater. I can't answer your query about getting medical approval for GBR diving. It would depend upon the findings of the medical examiner.

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

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Things to carry to Cozumel for First Aid?

I will be diving in Cozumel, Mexico the end of February. What do you recommend I bring with me for first aid? (cuts, stings, coral toxins, etc).

Our answer: There is a first aid kit for divers on my web page at http://www.scuba-doc.com/FAkit.html . There is also an article on emergency management at http://www.scuba-doc.com/qkrsp.htm . The entire article has some good information about management of some of the things that you ask about.

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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 .

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

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==>HUMOR<==

Interesting Uses for the word 'UP'. You lovers of the English language might enjoy this. It might also be educational for those who are trying to learn English/American idiom. There is a two-letter word that perhaps has more meanings than any other two-letter word, and that is "UP."
It's easy to understand UP, meaning toward the sky or at the top of the list, but when we awaken in the morning, why do we wake UP?
At a meeting, why does a topic come UP? Why do we speak UP and why are the officers UP for election and why is it UP to the secretary to write UP a report?
We call UP our friends and we use it to brighten UP a room, polish UP the silver, we warm UP the leftovers and clean UP the kitchen.
We lock UP the house and some guys fix UP the old car.
At other times the little word has real special meaning. People stir UP trouble, line UP for tickets, work UP an appetite, and think UP excuses.
To be dressed is one thing but to be dressed UP is special.
And this UP is confusing: A drain must be opened UP because it is stopped UP. We open UP a store in the morning but we close it UP at night. We seem to be pretty mixed UP about UP!
To be knowledgeable about the proper uses of UP, look the word UP in the dictionary. In a desk-sized dictionary, it takes UP almost 1/4th of the page and can add UP to about thirty definitions.
If you are UP to it, you might try building UP a list of the many ways UP is used. It will take UP a lot of your time, but if you don't give UP, you may wind UP with a hundred or more.
When it threatens to rain, we say it is clouding UP. When the sun comes out we say it is clearing UP. When it rains, it wets the earth and often messes things UP. When it doesn't rain for awhile, things dry UP.
One could go on and on, but I'll wrap it UP, for now my time is UP, so............ It is time to shut UP.....!
Oh...one more thing: What is the first thing you do in the morning & the last thing you do at night? U P

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While we're discussing words, here are some
NEW WORDS FOR 2005:
Essential additions for the workplace vocabulary
1. BLAMESTORMING: Sitting around in a group, discussing why a deadline was missed or a project failed, and who was responsible.
2. SEAGULL MANAGER: A manager, who flies in, makes a lot of noise, craps on everything, and then leaves.
3. ASSMOSIS: The process by which some people seem to absorb success and advancement by kissing up to the boss rather than working hard.
4. SALMON DAY: The experience of spending an entire day swimming upstream only to get screwed and die in the end.
5. CUBE FARM: An office filled with cubicles
6. PRAIRIE DOGGING: When someone yells or drops something loudly in a Cube farm, and people's heads pop up over the walls to see what's going on.
7. MOUSE POTATO: The on-line, wired generation's answer to the couch potato.
8. SITCOMs: Single Income, Two Children, Oppressive Mortgage. What yuppies turn into when they have children and one of them stops working to stay home with the kids.
9. STRESS PUPPY: A person who seems to thrive on being stressed out and whiny.
10. SWIPEOUT: An ATM or credit card that has been rendered useless because the magnetic strip is worn away from extensive use.
11. XEROX SUBSIDY: Euphemism for swiping free photocopies from one's workplace.
12. IRRITAINMENT: Entertainment and media spectacles that are annoying but you find yourself unable to stop watching them. The J-Lo and Ben wedding (or not) was a prime example.
13. PERCUSSIVE MAINTENANCE: The fine art of whacking the crap out of an electronic device to get it to work again.
14. ADMINISPHERE: The rarefied organizational layers beginning just above the rank and file. Decisions that fall from the adminisphere are often profoundly inappropriate or irrelevant to the problems they were designed to solve.
15. 404: Someone who's clueless. From the World Wide Web error message "404 Not Found," meaning that the requested document could not be located.
16. GENERICA: Features of the American landscape that are exactly the same no matter where one is, such as fast food joints, strip malls, and subdivisions.
17. OHNOSECOND: That minuscule fraction of time in which you realize that you've just made a BIG mistake.
18. WOOFS: Well-Off Older Folks.

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==> Dr. Snakebelly's Poetry <==

haiku 1

we will soon come to
the base of an ancient wall
here at the reef edge

haiku 2

can the tiger shark
know the beauty of its form?
does it know i'm here?

haiku 3

diver, you must know
the old soft coral garden
where silence has died

haiku 4

grouper, plump and gray
loiters, only for itself
just beyond my reach

haiku 5

this backwards image
of last night's nightmare dive
melts into the morning

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

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Enjoy!

Ernie Campbell, MD
scubadoc