Sunday, March 13, 2005

Ten Foot Stop Newsletter, 03/15/05

TEN FOOT STOP NEWSLETTER

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< http://scuba-doc.com
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This newsletter can also be seen at http://tenfootstop.blogspot.com/
Aiming to improve diving safety by providing free information, the Ten Foot Stop Newsletter will reach over 5600 divers, instructors and doctors. Our web site has about 53,000 visits and 555,000 hits per month.
Thank you for being with us! It's a great time to be alive!

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

--> NOTE FROM SCUBADOC
Photo of Queen Elizabeth II bestowing OBE to Dr. Nick McIver, SAR diving, information about "Pressure", DAN AED Matching Grant

==> QUESTION OF THE WEEK!
Some questions about the 'pee factor' in diving.

==> COOL SITE FROM SCUBADOC
Dental Implants article

--> MAILBOX POTPOURRI
Compressed neoprene and inside attendants, Diving with MS

==>INTERESTING LINKS
Links from Larry "Harris" Taylor, Scuba Diver Dies, Medtronic Recalls Defibrillators, Wound center, Workers recovering, When Blood Fizzes, Sub-Aqua Deaths 'Highest for 30 Years', Chronic Pot Use

--> MEETINGS, COURSES, CONFERENCES
Cozumel international dive show, INTERNATIONAL CONFERENCE ON DIVING AND HYPERBARIC MEDICINE, Barcelona

==>HUMOR
United Airlines gate agent, birthday present, classic college paper, Some Cowboy Logic, American Newspapers

==>MY WEEKLY SELECTION OF UNIQUE & GREAT WEB SITES
FSU Underwater Crime Scene Program, Spirituality Online, Fire Coral Persistent Cutaneous Reaction, Free Articles in PubMed, Terra - Server Maps From Space, Infospace Yellow and White Pages, Mayo Clinic First Aid Guide

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~^~ JOIN THE CROWD AND VISIT SCUBA CLINIC~^~

Read interesting questions and see our experts answers. Make your own comments!
http://scuba-doc.com/scubaclinic/

Recent Questions

Is this DCI? http://scuba-doc.com/scubaclinic/viewtopic.php?t=100

Diving Elective for med student? http://scuba-doc.com/scubaclinic/viewtopic.php?t=107

Cracked ribs, diving? http://scuba-doc.com/scubaclinic/viewtopic.php?t=101

'Freezing'(deadening) for fillings, causes ear to clear. http://scuba-doc.com/scubaclinic/viewtopic.php?t=98

Hypothyroid condition http://scuba-doc.com/scubaclinic/viewtopic.php?t=106

Gas Permeable contacts http://scuba-doc.com/scubaclinic/viewtopic.php?t=103

Nasonex and Neoclarityn http://scuba-doc.com/scubaclinic/viewtopic.php?t=105

Effexor, diving? http://scuba-doc.com/scubaclinic/viewtopic.php?t=104


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--> NOTE FROM SCUBADOC

Here is a photo of Queen Elizabeth II bestowing the OBE to Dr. Nick McIver for outstanding service to the British Empire in diving safety. Dr. McIver is a good friend and a valued consultant for Diving Medicine Online.

http://scuba-doc.com/HM_NKIM.jpg

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SAR Diving

We had a question or suggestion from a reader that we write about SAR diving (Search and Rescue). This is a very large and diverse subject and one could envision several books being written on the subject. From my point of view as a PADI Rescue Diver, the course was difficult enough without having to go through the various machinations that some of the dive rescue organizations have in their guidelines. It would seem that the process could be simplified just by requiring a Rescue Diver certificate from one of the diving agencies. A caveat here might be the inequalities of training between the agencies or dive shops offering the training. However, getting past the basics of rescue diving and considering the more specialized areas gives one some pause as to the distinct need for expert instruction and intense practice by divers being placed in dangerous situations that maximize their risk. As an example, Dive Rescue International, which can be seen at http://www.diverescueintl.com/pdfs/Sections/training.pdf
, offers a broad range of training for search and rescue divers.

Dive Rescue I includes public safety drowning accidents, selecting, training and equipping dive teams, underwater investigation, evidence recovery, dealing with family, media and other agencies, search patterns, victim retrieval, vehicle accidents and an introduction to specialized equipment.

Dive Rescue II program topics can include: Surface-Supplied Air, Haz-Mat Diving, Boat-Based Operations, Dry Suit Diving, Ice Diving Operations, Helicopter Operations, Current Diving or other special regional training as determined by the hosting agency. Courses can also be taken by surface support personnel.

For more information about SAR diving,

Google Search http://tinyurl.com/62nry or http://snipurl.com/de0l

NASAR Guidelines http://www.vcsardive.org/nasar.pdf

DiveRescue Guidelines http://www.diverescue.com/sopsog.html

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From Lisa Wasdin at UHMS:

Due to the 'Pressure' magazine being behind schedule, we have combined the Jan/Feb & the Mar/Apr issues. This is now posted on our Members Only site (web version & pdf version).

http://www.uhms.org/

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DAN Announces First Recipient of AED Matching Grant

Thanks to a matching grant from Divers Alert Network, the University of South Florida Diving Safety Program will receive an automated external defibrillator (AED). This is the first such award conferred through the DAN AED Matching Grant program.

Jeff Myers, Vice President of DAN Training and chair of the AED Matching Grant Committee, said this grant enabled the USF Diving Safety Program, a DAN Business Member, to purchase a Philips Heartstart FR2+ AED, which will now become part of that program’s standard safety equipment and will accompany their divers.

“We are excited to support the University of South Florida Diving Safety Program through the AED Matching Grant,” Myers said. “My hope is that they never have to use the AED in an emergency, but it is nice to know that if someone needs assistance, their dive team will have the necessary tools to respond.”

The DAN AED Matching Grant program assists those individuals, businesses or organizations, who have a connection to diving or aquatics and can demonstrate a genuine need for the AED, for use in the course of their normal operations. Possible recipients must also demonstrate a financial need.

The goal of the Matching Grant program is to place at least one AED every six months (August and January of each year). This program is funded completely by donations.

For more information about the DAN AED Matching Grant program, visit the DAN Training website at http://www.diversalertnetwork.org/training/instructors/aedgrant.asp

For information about supporting the program contact: development@dan.duke.edu.

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==> CHANGING YOUR E-MAIL ADDRESS?
Don't miss a single issue. Update your subscription e-mail
address today: http://snipurl.com/buk8

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==> QUESTION OF THE WEEK!

Immersion diuresis

Some questions about the 'pee factor' in diving:

I've heard a lot about the 'pee factor' in diving, but I'm not sure I understand just why this happens. Also - "Should divers hold their urine or should they empty their bladders while diving?" What are the pros and cons to holding it until you get out of the water? and "Does holding or emptying your bladder effect thermal status?"

Answer:

The reason for this is called immersion diuresis. Here is the physiology of head out immersion and 'immersion diuresis':

What happens to respiration? Pressure outside chest wall is now positive, averaging about 10 cmH2O ("negative pressure breathing"). Intrathoracic pressure is less negative at end-expiration. Negative pressure breathing causes divers to lose about 350 cc/hour from their circulating blood volume from immersion diuresis, seen also in snorkelers and swimmers.

Result: about a 60% increase in the work of breathing.

Is the cardiovascular system changed? Increased venous return occurs due to elevated abdominal pressure and decreased pooling in peripheral veins. Cold inhibits anti-diuretic hormone, causes peripheral vasoconstriction, driving fluid back into the core and stimulating diuresis resulting in losses of plasma volume. The hypercarbia associated with diving decreases anti-diuretic hormone, promoting fluid loss from the plasma volume.

Increased venous return leads to increased central blood volume (approximately 500 ml). Right atrial pressure increases from about -2 to +16 mmHg.

Cardiac output and stroke volume increase about 30%.

Are the kidneys affected? Increased intrathoracic blood volume is thought to be the basic cause of this phenomenon that also includes a loss of sodium and potassium, atrial natriuretic factor playing a large part in the process. The causes are still being debated, however.

Urine flow increases 4-5 times but osmolal clearance increases very slightly.

There should be no problem with going ahead and emptying the bladder while diving - if the person is wearing a wet suit. The uriniferous odor will wash out if care is taken after diving. This is sure to happen in the diver due to 'immersion diuresis' that occurs in an obligatory fashion.

Holding the urine in could possibly be harmful as there have been cases of fainting when the stretch receptors are stimulated and a vagal reaction occurs. Fainting underwater is risky to say the least. In addition, why ruin a perfect sport by the sense of urgency that occurs as well as the distraction from multitasking.

The problem is different when wearing a dry suit. Men have a 'pee valve'. Women have to wear some absorbent shorts or diapers (Depends?).

Thermal status would be interesting to study. Loss of heat from the urine might be counteracted by the temporary heating of the wet suit. If using a dry suit, it would likely be a wash. To my knowledge, it has not been studied.

So- my best answer would be that 'yes, you need to go ahead and pee even if it is against your sensibilities'.


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==> COOL SITE FROM SCUBADOC

Dental Implants article from Alert Diver added to web site

We have added an article written by our dental consultant, Dr. Larry Stein to our web page about dental problems. The article was published in Alert Diver, DAN's bimonthly magazine, in the March/April 2005 issue. It is reprinted without photos with permission from the author and DAN. Many thanks go to my friend, Renee Duncan, Editor of Alert Diver.

To read the article, go to http://scuba-doc.com/Scuba and Dental Implants.pdf

As usual, Dr. Stein goes right to the 'root' of the matter, giving excellent background information and risk assessments associated with the dental procedure. We are fortunate to have Dr. Stein on our team and appreciate his support of Diving Medicine Online.

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--> MAILBOX POTPOURRI

Interesting note from Capt. Dick Carson (Ret. USN, PADI Instructor) in response to our article about chamber attendants:

Sea story. Whilst stationed in the UK 96-1998, we dove in central England at an ex-quarry named Stoney Cove. They had the only year-round and reasonably accessible dive spot from London. They had a great dive shop too. One very popular item was a Beaver semi-dry suit, made of one-inch neoprene. In order to attach the various valves, the salesperson would take the suit on a chamber ride, compressing the suit to near 1/4 inch, then inserting the valves before "surfacing." I could not help but notice the rapid trips and lack of concern for the salespersons. When asked, the operator merely replied they had not been diving so it was OK. HMMMM.
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Dear Scuba-docs

I was recently consulted by an experienced diver who has been diving without incident, for about 20yrs, he is now in his early 50's. He had a neurological episode early in his diving career, unrelated to diving, which was put down to sciatica, but which in retrospect was his first episode of MS. Things settled, but he developed additional symptoms about 8 yrs ago and an MRI brain confirmed the diagnosis.

He reports that he is now has stable neurology with slight R lower limb numbness.

Clinically he has a hint of ataxia, a patch of impaired light touch R lat lower leg, but otherwise is fine with no 'frontal' over confidence!

Obviously he is a bit of a nightmare if he were to have DCS in terms of symptom assessment. The hard thing is he is an experienced diver with no Hx of dive related detriment of symptoms.

Answer:

Hello Dr.:

Your patient is not alone in the world of diving and presents the typical difficulty in confirming a diagnosis of decompression illness. Other than a well done neurological exam, we have no other quick method of deciding whether to recompress a suspected decompression injury. It has been my observation that 'well done' neurological exams are not often seen aboard dive boats - so that leaves us in a quandary when a diver with MS surfaces with symptoms that s/he claim are new. So, the person is shipped off to the chamber for possible unnecessary treatment. Some feel that this may not be a bad thing - since there is anecdotal evidence that some MS patients are improved by the treatment modality.

Other caveats would include his inability to gear up, water entry and exit, buddy and self rescue and general strength/agility in the water. Vision can be affected and this might be a problem in reading gauges. Drugs that sedate are adverse to diving.


Seizure is apparently not an infrequent occurrence in multiple sclerosis - and occasionally is the first manifestation of relapse in the disease - which is characterized by remissions and relapses. Certifying a person with multiple sclerosis in remission as 'fit to dive' would seem to carry some risk of seizure underwater with subsequent drowning.

Links:

Diving Medicine Online http://www.scuba-doc.com/msdiv.htm

David Sawatsky, MD http://divermag.com/archives/march98/divedoctor_mar98.html

UKSDMC http://snipurl.com/d665

DAN http://snipurl.com/d667

Your diver will probably continue to dive until forced to stay out of the water by his inabilities (or the lack of a 'fitness to dive' certification). This becomes a judgmental nightmare for the physician wanting to protect the patient (and his hind side) and at the same time cater to the desires and joy of his patient.

Let us know if you have thoughts otherwise.

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--> INTERESTING LINKS

Links from Larry "Harris" Taylor,

Scuba Centre: http://www.scuba-centre.com/
Marineland of the Pacific Historical: http://www.marinelandofthepacific.org/pages/1/index.htm
Apnea Mania: http://www.apneamania.com/code/index.asp
American College of Hyperbaric Medicine: http://www.hyperbaricmedicine.org/
International Congress on Hyperbaric Medicine: http://www.ichm.net/
Keep Scuba Diving Safe: http://www.physsportsmed.com/issues/2000/05_00/scuba.htm
Scottish Diving Medicine: http://www.sdm.scot.nhs.uk/index.htm
DiverNet: http://www.divernet.com/index.shtml
Scuba Press: http://www.scubapress.com/
Trimix, Trimix, Trimix: http://www.cisatlantic.com/trimix/trimix.html

Other Links that we have found.

Medtronic Recalls Defibrillators Manufactured in 1997
http://www.medscape.com/viewarticle/500719?src=ddd

Wound center named for Bangasser
http://snipurl.com/ddqm

Workers recovering after poisoning
http://snipurl.com/d90l

When Blood Fizzes: Diving UB-88 WWI German Submarine
http://www.cdnn.info/article/ub-88/ub-88.html

Scotsman.com News - Latest News - Sub-Aqua Deaths 'Highest for 30 Years'
http://news.scotsman.com/latest.cfm?id=4204777

Chronic Pot Use Slows Blood Flow to Brain
http://www.healthopedia.com/news/article.php?id=523880

Scuba Diver Dies Off Apo Island http://tinyurl.com/46ct8


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--> MEETINGS, COURSES, CONFERENCES

See our web page at http://scuba-doc.com/meetcrse.html .

Cozumel will host an international dive show, this event will have seminars from many topics including cave diving and technical diving in Mexico.
Hope you can post this info in your site.

Thanks

German Yañez
Cozumel NSS-CDS Safety Officer
Yucatech Expeditions
Ph. + (987) 872 56 59
www.yucatech.net

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From Dr. Jordi Desola

INTERNATIONAL CONFERENCE ON DIVING AND HYPERBARIC MEDICINE

Barcelona 7-10 September 2005
http://www.barcelona-2005.com

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From Wesley Hyatt at DAN:

See DAN Representatives at Upcoming Dive Shows

With the dive show season now in full swing, attendees should be aware that Divers Alert Network (DAN) will have representatives at many of them to answer questions about its dive health and safety activities, offer DAN products and start or renew DAN memberships.

Among the upcoming shows DAN will attend include:

• Ohio ScubaFest, Columbus, March 11-13;

• Beneath the Sea, Secaucus, N.J., March 18-20;

• Ocean Festival, Ft. Lauderdale, Fla., April 15-17;

• Scuba Show 2005, Long Beach, Calif., May 21-22; and

• Seaspace, Houston, Texas, June 3-5.

Look for the DAN booth at these events. Also, many of them will have discounts for DAN Members to attend, such as the one for Beneath the Sea that can be found here: http://www.diversalertnetwork.org/news/article.asp?newsid=545 .

For the Seaspace show, DAN will host its second annual DAN / Seaspace Social on Friday night (June 3). On Saturday evening (June 4), the annual presentation of the DAN / Rolex Award will be made by DAN President and CEO Dr. Michael Curley at the beginning of the film festival.

Check back on the Events section of the DAN website (http://www.DiversAlertNetwork.org ) for future dive shows DAN will attend, including DEMA Show 2005 in Las Vegas in October, as well as other discounts offered to them for DAN Members.

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==>MY WEEKLY SELECTION OF UNIQUE & GREAT WEB SITES

Here are some sites that I've added to my Bookmarks

Underwater Magazine Article reprint - September/October 2003
FSU Underwater Crime Scene Program
By - Michael Zinszer http://www.underwater.com/archives/arch/035.01.shtml

Third Age Health - Spirituality Online
http://www.thirdage.com/features/healthy/spiritual/sb02.html

Fire Coral Persistent Cutaneous Reaction
http://www.mf.uni-lj.si/acta-apa/acta-apa-01-1/4-clanek.html

Hardin MD Subject Searches - Free Articles in PubMed
http://www.lib.uiowa.edu/hardin/md/ej.html

Terra - Server Maps >From Space http://terraservice.net/default.aspx

Infospace Yellow and White Pages http://infospace.com/

Mayo Clinic First Aid Guide http://snipurl.com/841u

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==>HUMOR

An award should go to the United Airlines gate agent in Denver for being smart and funny while making her point when confronted with a passenger who probably deserved to fly as cargo.

A crowded United Airlines flight was canceled. A single agent was re- booking a long line of inconvenienced travelers. Suddenly an angry passenger pushed his way to the desk. He slapped his ticket on the counter and said "I HAVE to be on this flight and it has to be FIRST CLASS."

The agent replied, "I am sorry, sir. I'll be happy to try to help you, but, I've got to help these folks first, and I'm sure we'll be able to work something out." The passenger was unimpressed.

He asked loudly, so that the passengers behind him could hear,
"DO YOU HAVE ANY IDEA WHO I AM?"
Without hesitating, the agent smiled and grabbed her public address microphone, "May I have your attention please, " she began, her voice heard clearly throughout the terminal.
"We have a passenger here at Gate 14 WHO DOES NOT KNOW WHO HE IS. If anyone can help him find his identity, please come to Gate 14."

With the folks behind him in line laughing hysterically, the man glared at the United agent, gritted his teeth and swore "**** You!".
Without flinching, she smiled and said, I'm sorry sir, you'll have to get in line for that too.


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A man was sitting on the edge of the bed, observing his wife turning back and forth, looking at herself in the mirror.

Since her birthday was not far off he asked what she'd like to have for her Birthday.

I'd like to be six again, she replied, still looking in the mirror.

On the morning of her Birthday, he arose early, made her a nice big bowl of Lucky Charms, and then took her to Six Flags theme park. What a day! He put her on every ride in the park: the Death Slide, the Wall of Fear, the Screaming Monster Roller Coaster, everything there was. Five hours later they staggered out of the theme park. Her head was reeling and her stomach felt upside down. He then took her to a McDonald's where he ordered her a Happy Meal with extra fries and a chocolate shake. Then it was off to a movie, popcorn, a soda pop, and her favorite candy, M&M's. What a fabulous adventure!

Finally she wobbled home with her husband and collapsed into bed exhausted. He leaned over his wife with a big smile and lovingly asked, "Well Dear, what was it like being six again?"

Her eyes slowly opened and her __expression suddenly changed. "I meant my dress size, you dumb ass!"

The moral of the story:

Even when a man is listening, he is gonna get it wrong.



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Collegiate Paper:
A college class was told that each student had to write a short story in as few words as possible. The short story had to contain the following three things:

(1) Religion (2) Sexuality (3) Mystery.

There was only one A+ paper in the entire class.

Below is that short story:

Good God, I'm pregnant. I wonder who did it.

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Some Cowboy Logic

* Your fences need to be horse high, pig tight and bull strong.
* Life ain't about how fast you run, or how high you climb, but how well you bounce.
* Keep skunks and bankers and some lawyers(not you , George) at a distance.
* Life is simpler when you plow around the stump.
* A bumble bee is considerably faster than a John Deere tractor.
* Words that soak into your ears are whispered...not yelled.
* Meanness don't jest happen overnight.
* Forgive your enemies. It messes up their heads.
* Do not corner something that you know is meaner than you.
* It don't take a very big person to carry a grudge.
* You cannot unsay a cruel word.
* Every path has a few puddles.
* When you wallow with pigs, expect to get dirty.
* The best sermons are lived, not preached.
* Most of the stuff people worry about ain't never gonna happen anyway
* Don't judge folks by their relatives.
* Remember that silence is sometimes the best answer.
* Live a good, honorable life; then when you get older and think back, you’ll enjoy it a second time.
* Don't interfere with somethin' that ain't botherin' you none.
* Timing has a lot to do with the outcome of a rain dance.
* The easiest way to eat crow is while it's still warm, 'cause the colder it gets, the harder it is to swaller.
* If you find yourself in a hole, the first thing to do is stop diggin'.
* It don't take a genius to spot a goat in a flock of sheep.
* Sometimes you get, and sometimes you get got.
* The biggest troublemaker you'll probably ever have to deal with watches you shave his face in the mirror every mornin'.
* If you get to thinkin' you're a person of some influence, try orderin' somebody else's dog around.
* Always drink upstream from the herd.
* Good judgment comes from experience, and a lotta that comes from bad judgment.
* Don't squat with your spurs on.
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American Newspapers........(as thought of by us in fly-over country)

1. The Wall Street Journal is read by the people who run the country.

2. The Washington Post is read by people who think they run the country.

3. The New York Times is read by people who think they should run the country and who are very good at crossword puzzles.

4. USA Today is read by people who think they ought to run the country but don't really understand The New York Times. They do, however, like their statistics shown in pie charts.

5. The Los Angeles Times is read by people who wouldn't mind running the country - if they could find the time -- and if they didn't have to leave Southern California to do it.

6. The Boston Globe is read by people whose parents used to run the country and did a far superior job of it, thank you very much.

7. The New York Daily News is read by people who aren't too sure who's running the country and don't really care as long as they can get a seat on the train.

8. The New York Post is read by people who don't care who's running the country as long as they do something really scandalous, preferably while intoxicated.

9. The Miami Herald is read by people who are running another country but need the baseball scores.

10. The San Francisco Chronicle is read by people who aren't sure there is a country ... or that anyone is running it; but if so, they oppose all that they stand for. There are occasional exceptions if the leaders are handicapped minority feminist atheist dwarfs who also happen to be illegal aliens from any other country or galaxy provided, of course, that they are not Republicans.

11. The National Enquirer is read by people trapped in line at the grocery store.

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--> VISIT THE DIVE MEDICINE ONLINE BLOG!
Check out some of the latest additions and changes to Diving Medicine Online.

http://scubadoc.blogspot.com/

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--> CHANGING YOUR E-MAIL ADDRESS?
Don't miss a single issue. Update your subscription e-mail address:
http://snipurl.com/buk8

Unsubscribe at the same site.

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Have a good week!

Ern Campbell, MD

scubadoc

==> A LITTLE ABOUT ME, SCUBADOC:

For those of you who have asked - and those of you who might like to know, here are my credentials.

Ernest S. Campbell, MD, FACS. Dr. Campbell, a retired Board Certified general surgeon, is an experienced sport diver who has used his combination of medical and diving knowledge to develop a web site, Diving Medicine Online, now in it's ninth year, located at www.scuba-doc.com . He is the author and webmaster of the widely visited and quoted site which is a free source of diving medical information for divers, instructors and diving medical professionals. In addition, he writes the diving medicine newsletter, Ten Foot Stop, which is read by some 5600 divers over the world.

A diver since 1967, initially certified by SSI, and now a PADI certified Advanced & Rescue Diver, Dr. Campbell has had over 1500 sport dives in all kinds of conditions all over the world while attending many diving medical courses and seminars DAN and Medical Seminars An avid sailor, Dr. Campbell has earned his USCG Master's license, with a 50 ton sailing attachment.

Dr. Campbell, who has been Medical Editor for the diving magazines, Scuba Times Online and Scuba Diving, has also written diving medical articles for DAN's Alert Diver and for the Internet medical web site, Medscape. In addition, he participated in physician workshops with Medical Seminars resulting in the earlier editions of the publication, "Medical Examination of Sport Scuba Divers", now edited by Bove.

Prior to his retirement, he had been President of the Medical staff, Chairman of the Department of Surgery and a member of the Board of Directors of Brookwood Health Services, Inc. and Medical Center in Birmingham Alabama. A Fellow of the American College of Surgery, his memberships included the American Medical Association, American College of Physician Executives, Southern Medical Association, Medical Association of the State of Alabama, Southeastern Surgical Congress, Birmingham Clinical Club, Birmingham Academy of Medicine, Birmingham Surgical Society and the UHMS.

Dr.Campbell, a Divers Alert Network referral physician and a member of the Divers Alert Network Strategic Education & Training Team, resides in Orange Beach, Alabama.