Friday, January 28, 2005

Ten Foot Stop, January 31, 2005



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

--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

--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

--HBO plus antibiotic carrier is effective in reducing the staphylococcus colony count in experimental osteomyelitis.
Related Links

--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

--For you history buffs there is an interesting review of Caisson Disease during the construction of the Eads and Brooklyn Bridges by WP Butler.
Related Links


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!


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. "


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


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 ( ) 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

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



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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.



The Divemaster's Quick Accident Response Guide

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.


==> 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)



Guidelines for CPR Seldom Followed by Trained Personnel

For a discussion of 'expired air resuscitation', seeour April 30, 2004 newsletter at

Hearing threshold in sport divers: is diving really a hazard for inner ear function?

See also 'long term effects of diving' at

UHMS Abstracts, 2004 abs/UHMS_menu.htm

Seamounts Offer Marine Life Peaks of Viands (

Decompression sickness and recreational scuba divers. (Full text)

Decompression Illness on Diving Medicine Online at

Interesting report about death of a South African cave diver with links to a forensic report attributing the death to 'deep water blackout'.

Migraine-PFO study
Migraine - New Study to Examine Possible Link With the Heart

On Diving Medicine Online



Diving with MS and a Foley Catheter?

Multiple Sclerosis
Kidney Problems

Antidepressants and diving?

Decompression sickness?

Deafness after infection and flying/diving



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

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.

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

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 .

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!

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.

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.

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.
Here is an article that details multiple sports injuries. It may be more than you really wanted to know.
Another article on scuba risks

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.

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)

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

(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

(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.



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 --


SAVE THE DATE: JUNE 15-19: (15th Pre-courses - 16-18 Annual Meeting - 19th Post-Courses)


* 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

* Call for Nominations for Associate Officers
* Associates/BNA Call for Abstracts
* Associates/BNA Program (available soon)
* PAUL BAKER Award Nominees Needed
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



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!
Aussie Humor from 'Georgia'
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

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."
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.


==> 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.


Ernie Campbell, MD