Friday, January 14, 2005


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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 This keeps me jumping by having to maintain backup and alternate lists, which often rapidly get out of date.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 or and click 'bookmark'.

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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 "

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:

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


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
Dr. Bookspan's CV
Contact Dr. Bookspan


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 will not be updated. The new address is .
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 and at .


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 .

In addition, Turkish can also be used on the Site Map page . 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.


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

All DAN organizations together hope to be able in some way to assist the diving communities affected by this tragedy. Visit 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 .

Let us know if you have any news about divers affected by the tsunami. Write . scubadoc



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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.
To check your answers, go to the 'Problems with Gases' web page



Diving Safety

Here is a links page for diving safety issues. The items below can be accessed by going to this address:

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
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.


==> 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
More about alcohol and diving at



Environmental Tectonics Corporation Signs Major Hyperbaric Monoplace Order With Koike Medical Company, Ltd.


Diving Safety and Emergency Management Guidelines U-1105 BLACK PANTHER HISTORIC SHIPWRECK PRESERVE




Microsurgical penile replantation facilitated by postoperative HBO treatment.
Related Articles


Hyperbaric oxygenation combined with streptokinase for treatment of arterial thromboembolism of the lower leg (Full text)


The role and effectiveness of adjunctive hyperbaric oxygen therapy in the management of musculoskeletal disorders. (Full text)



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.


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.


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 .


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 ( 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 (also on our web site).
See .
Other books about diving medicine can be seen at .

Thank you for your interest in our little project!


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 .


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


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 . There is also an article on emergency management at . The entire article has some good information about management of some of the things that you ask about.



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 .

Here are some organizations giving courses linked to the above site:
DAN --
SPUMS Courses --
Medical Seminars --
Temple University Underwater Medicine --



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.....! more thing: What is the first thing you do in the morning & the last thing you do at night? U P


While we're discussing words, here are some
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.


==> 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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Ernie Campbell, MD