Wednesday, August 31, 2005

Don't Miss the Annual 'Dive Industry Bash', from Dan Leigh, DAN

Come to the second annual 'Dive Industry Bash', Tuesday, Oct. 4 from 6 to
8 p.m. at the Las Vegas Hilton Hotel Grand Ballrooms A & B (ground floor).

Enjoy food, drink and some great door prizes, all courtesy of your friends
at the Bahamas Diving Association, DAN, Dive Center Business magazine and
NAUI.

Your DEMA badge gets you in. The first 1,000 persons get two free drink
tickets for beer or wine! For a chance to win great door prizes such as
dive trips, equipment and accessories, present your business card.

For more information, visit the Bahamas Pavilion (#940 - 950 isle), Dive
Center Business / Dive Training magazines (booth #2835), DAN (booths #1539
& #1639) or NAUI (booth #1729). You must be present to win.

Great Lakes Chapter -- Undersea and Hyperbaric Medical Society

Great Lakes Chapter --
Undersea and Hyperbaric Medical Society

DIVING MEDICINE UPDATE - 2005

Saturday Oct. 22, 2005

Program
Alcohol and Diving - Fact and Folklore
Drugs and Diving
A New Diving Emergency Network in Quebec
DAN Data and Dive Computers
Diving with Computers and Avoiding DCS
Hyperbaric Services Around the Great Lakes
Human Factors and Diving
Rescue Diver - Real World vs Training
Myths of Diving Panel

We have outstanding speakers, interesting topics, our traditional Myths of Diving Panel and opportunities to make new friends in the diving and diving medical community. Lunch is provided, plus refreshments after the meeting.

Who is this for?
Recreational and Tech Divers
Professional Divers
Dive Masters & Instructors
Diving & Hyperbaric Medicine Professionals

For info & to register
Complete and mail attached registration form
Check our website www.uhms-glc.ca
Contact Ron Nishi glc-r.nishi@sympatico.ca

Time
0800 Register & Coffee
0830 to 1730 Symposium

Cost
$45.00 Cdn / $40.00 US before Oct. 7
$60.00 Cdn / $50.00 US after Oct. 7

Location
Again this year, we are in Burlington at the Canada Centre for Inland Waters.

Sponsors
Radiometer http://www.radiometer.com/
Environmental Tectonics Corporation http://www.etcbiomedical.com/
Hyperbaric Medical Unit - Toronto General Hospital http://www.uhn.ca/programs/hyperbaric/
Ontario Underwater Council http://www.underwatercouncil.com/
ACUC http://www.acuc.ca/
Sechrist Industries http://www.sechristind.com/


Where Diving and Medicine Meet

This Newsletter
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This newsletter was sent out in html format. Please advise if you want this sent out in text format.

Tuesday, August 30, 2005

NORTHEAST CHAPTER Of the UHMS Conference/Chapter Meeting

NORTHEAST CHAPTER Of the UHMS

Conference/Chapter Meeting


October 15-16, 2005

Cape Codder Resort & Spa
Route 132 & Bearse’s Way
1225 Iyanough Road
Hyannis, MA 02601

This year’s Northeast Chapter Meeting will be held October 15th and 16th at the beautiful Cape Codder Resort & Spa in Hyannis, MA.

Saturday, October 15: 8:00am-5:00pm

“Hyperbaric Oxygen: A Clinically Useful Drug to Ameliorate Extreme Reperfussion Injury” Keith Van Meter, MD
“Useful Hyperbaric Oxygen Protocols” John Wassel, MD
“Diving Medical Standards for Commercial, Scientific and Public Safety Divers” John Wassel, MD
Case Presentations
Panel Discussions
Short Paper Presentations
Sunday, October 16: 8:00am-12noon

TBA
Saturday Breakfast Buffet, Saturday Lunch Buffet and Sunday Continental Breakfast are included with Registration.

Room rate at the Cape Codder will be $119.00. All guest rooms are subject ot 9.7% tax. Check in time is 4:00 p.m., and check out is 11:00 a.m. Individuals are requested to make their reservations no later than September 14th to receive this special conference room rate. To make your reservations, please call their toll free reservation number at 888-297-2200. When making your reservations, you must identify yourself as part of the “NORTHEAST CHAPTER of UHMS.” A one night’s deposit is due with each reservation. The Cape Codder Resort accepts American Express, MasterCard and Visa.

From the Logan (Boston) Airport, there is a bus service (Plymouth & Brockton Street Railway Co., Inc.) that goes to Hyannis. This services starts at 6:45 am then every hour 15 minutes before the hour from 7:45 am to 9:45 pm with a late bus at 11:15pm. The fare is $21 one way and $38 round trip. Ticket may be purchased at the Hyannis terminal in baggage claim or when boarding the bus.

NBDHT CHT/CHRN Exam will be held Friday, October 14th at 5pm. If you sit for this test and attend the NE Chapter meeting, you will receive the credit hours towards your license. You will be required to sign-in daily.


CME Credits will be available.

TO REGISTER go to website: http://www.uhms.org/Chapters/NORTHEAST/NORTHEAST.asp

Legal Aspects of Wound Care and Hyperbaric Medicine

Legal Aspects of Wound Care and Hyperbaric Medicine

Pre-Course to the UHMS Gulf Coast Chapter

Annual Scientific Meeting

Sea Turtle Inn, Jacksonville, Florida

Wednesday, September 28, 2005



CLICK HERE FOR BROCHURE
http://www.uhms.org/Chapters/GCC/GCC 2005 Updates/GCC_2005_PreCourse.htm



Get answers to these questions:

· What should every medical professional know about the legal system?

· Why do medical professionals get sued?

· How do I avoid being sued?

· What do chart auditors look for?

· What are some ethical considerations for a hyperbaric medicine practice?



Schedule / Wednesday, September 28, 2005

1:30
p.m.
-
2:30
p.m.
What You Need To Know About The Legal System
Barry E. Swartz, MD, JD

2:30
p.m.
-
3:30
p.m.
Why Providers Get Sued: How to Avoid Being Sued
J. Martin Smith, MD

3:30
p.m.
-
4:30
p.m.
Ethics in Hyperbaric Medicine
Caroline E. Fife, MD

4:30
p.m.
-
5:00
p.m.
Common Finding in Chart Audits
Craig L. Broussard, PhD, RN

5:00
p.m.
-
5:30
p.m.
Findings of the OIG Hyperbaric Chart Audit
Thomas M. Bozzuto, DO

5:30
p.m.
-
6:30
p.m.
Panel Discussion
All Faculty




Who Should Attend

This program is appropriate for physicians, nurses, and others practicing wound care and hyperbaric medicine.



Faculty

Thomas M. Bozzuto, DO

Craig L. Broussard, PhD, RN

Caroline E. Fife, MD

J. Martin Smith, MD

Barry E. Swartz, MD, JD



Program Location

This seminar will be held at the Sea Turtle Inn in Jacksonville, Florida. The Sea Turtle Inn is located at One Ocean Blvd, Atlantic Beach, Florida 32233. To contact the hotel for Reservations call (904) 249-7402 or (800) 874-6000. In order to receive group rate please identify yourself with the UHMS GCC.



Registration Fee

Tuition for the Legal Aspects of Wound Care and Hyperbaric Medicine seminar is $100 for physicians, $75 for nurses and other practitioners, and $50 for students. Fees can be paid by cash, check, American Express, Discover, MasterCard, or VISA and should be received prior to course date.



For More Information Please Contact

International ATMO, Inc.

Education Department

414 Navarro, Suite 502

San Antonio, Texas 78205

(210) 614-3688 • FAX (210) 223-4864

education@hyperbaricmedicine.com

www.hyperbaricmedicine.com

CLICK HERE FOR BROCHURE
http://www.uhms.org/Chapters/GCC/GCC 2005 Updates/GCC_2005_PreCourse.htm

Monday, August 22, 2005

31st Annual Meeting, Pacific Coast Chapter, UHMS

Here is a letter from Jim Holm, MD, concerning the upcoming PacUHMS meeting in Colorado Springs:

Dr. Campbell,

I have attached some info about our PacUHMS meeting in Colo Springs next month as well as info for potential exhibitors and sponsors (although I don't know that that will of much use to you.) The details of the conference will be on the websites www.hbodoctor.com click PacUHMS conference and www.pacificuhms.org

I hope you can attend or at least post it on your website. It won't be a big one but will be a good one. The dates and info for the 2006 Winter HBO Symposium (and even the dates for the 2007 Winter HBO Symposium are posted on the www.hbodoctor.com website FYI.

Hope all is well.

Jim

James R. Holm, MD, FACEP
President PacUHMS

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

Diving & Hyperbaric Medicine Conference
September 23 & 24, 2005 in Colorado Springs, CO


31st ANNUAL MEETING
Pacific Coast Chapter
Undersea and Hyperbaric Medical Society

Friday, September 23: The hyperbaric medicine scientific symposium will provide an update about current knowledge of mechanisms of action and clinical applications. Presentations will include new research topics and reviews of clinical hyperbaric and underwater medicine.

Saturday, September 24: Diver's Day presentations, will cover diving safety and medical care for the scuba diver. Presentations during this session will be of interest to hyperbaric professionals and members of the commercial, scientific and recreational diving communities. Topics will include fitness to dive, recognition and treatment of dysbaric disorders, and other important information.

The conference site is the Wyndham Hotel, Colorado Springs, Colorado

The NBDHMT exam will be offered on the evening of Friday, September 23rd. Medical and Diving professionals are eligible for continuing education credits. Final CME approval is pending.


For meeting information contact:

James Holm, MD
President, Pacific Chapter UHMS
2570 Dunfries Ct.
Colorado Springs, CO 80919
hbodoctor@yahoo.com

Phone: 719-365-5592
Fax: 719-365-5630
Make your room reservations early at:

Wyndham Hotel
5580 Tech Center Drive
Colorado Springs, CO 80919

Reservations: 877-999-3223 or 719-260-1800
Identify yourself as a member of the “Pacific UHMS” (Group #0922783PAC)

*A special meeting rate of $89 per night, single or double occupancy. Attendees arriving up to 3 days prior to and three days after the meeting dates will be extended the special rate on a space available basis. There is no charge for parking.

Please visit our web site periodically for meeting updates: www.PacificUHMS.org or www.hbodoctor.com

Friday, August 19, 2005

Interesting Links

United Companies Signs Exclusive Distribution Agreement
http://snipurl.com/gp60

The Rapid Entry System is a mini scuba system that can quickly be donned over a uniform or street clothes, allowing a first responder, such as a police officer or firefighter, to initiate the location and extraction of victims of shallow water submersion accidents.

South African Sets World Scuba Depth Record
http://snipurl.com/fk47

NOAA Cites Threats to US, Pacific Coral Reefs
http://snipurl.com/h2k7

Negative neurofunctional effects of scuba diving
http://snipurl.com/h0k4

Nature VideoClip Octopus/Shark Encounter
http://snipurl.com/gtlf
Surprised?

DocVikingo's Diver Resources
http://snipurl.com/fmsw

Caritas Operating Wound Care Centers
http://snipurl.com/gyjw

Impulse-Adventure/Free Diving Lung Squeeze
http://www.impulseadventure.com/freedive/lung-squeeze.html
Excellent discussion of free diving lung squeeze.

HBOT for CRVO?

I am looking for a treatment for CRVO - Central Retinal Vein Occlusion in my left eye. Through a CRVO support group on the internet, I have found that HBOT helps in some cases.

Our Answer:

There have been reports of benefit from HBOT for CRVO
http://snipurl.com/f4zt .
Hyperbaric oxygen treatment combined with a blood vessel widening drug
(vasodilator) has been shown to improve visual function among individuals
experiencing retinal artery occlusion. (European Journal Ophthalmology 3;
89-94, 1993)

Hyperbaric oxygen treatment has been successfully used to improve vision
among patients with retinal swelling (macular edema) and retinal vein
occlusion. (Survey of Ophthalmology 39; 347-66, 1995)

Hyperbaric oxygen treatment has been administered successfully to patients
with central retinal swelling (macular edema) resulting from retinal vein
occlusion. Among 12 patients who were treated, 10 experienced visual
improvement, with median visual acuity improving from 20/100 to 20/25. The
hyperbaric oxygen treatment is believed to constrict retinal capillaries and
thus decrease leakage of fluid that causes edema. (Ophthalmologica 210;
168-170, 1996)

Treatment of CRVO with hyperbaric oxygenation is an off label indication
[not Medicare approved] and it might be difficult to find a local chamber
who would be willing to treat you. However, I'll ask around and try to find
someone who may know where you can be evaluated and possibly get treatment
and get back with you.

Best regards:

Ernie Campbell

Letter from Dr. Frank Butler:

Don't have any personal experience with treating CRVO with HBO. You have done a very nice job of summarizing the current literature. I'd add just one thing - if I had a patienet with an ACUTE (less than 4 hours old) CRVO - I would try recompressing them. Absolutely no data to support this (yet), but it might have some merit. After 4-6 hours without oxygen, the retina suffers ischemic damage that is ot reversible.


Is diving with hypertension dangerous?

What could happen to a scuba diver who uses DIOVAN HCT 80/12.5mg for treating hypertension. Is it OK to dive? Are there any problems by using this medication? What about the diuretic substance? I have read that someone who is using diuretics may not off gas nitrogen which could lead to bends and DCS. Is it true and how can someone prevent this?


Our answer:


Hello Diver:
Controlled hypertension is not a contraindication to scuba diving. The drugs you mention are usually not risky, particularly if you maintain a good blood volume and avoid salt depletion. The HCTZ is a diuretic that can cause dehydration if a person is not aware or careful to replenish body fluids. Side effects from the valsartan are few and not adverse to diving.
Of course, hypertension with target organ damage is a contra-indication to scuba diving, particularly if there is any coronary artery disease.
So, you may dive with the understanding that HCTZ can cause dehydration - which is a risk factor for decompression illness.
More about this on my web site at http://www.scuba-doc.com/hyptdiv.htm .

Be sure you have the right dive accident insurance!

Divernet News, dateline 13 August 2005
Diver faces £40,000 bill for treatment

A holidaying Briton could face a medical treatment bill of some £40,000 after suffering decompression illness off Marsa Alam, in the Egyptian Red Sea.

The diver's holiday insurer is refusing to meet treatment costs because, it says, the diver broke a requirement of his insurance policy.

Anthony Allen, from Solihull, carried out a dive to 49.5m, a depth confirmed by his tour company. The dive is reported to have been carried out correctly, in terms of profile requirements stipulated by his diving computer.

Despite this the 68-year-old, a PADI Advanced Open Water diver, suffered major 'Type II' decompression illness. He is hospitalised for recompression treatment that could last for several weeks.

In Britain, Allen's family has put in a claim to the insurer, LloydsTSB, only for it to be rejected because, says the company, Allen exceeded a depth limit of 30m imposed by his policy.

The family are pursuing the claim, saying that documentation in Egypt cites dehydration as the cause of the DCI. They believe the depth to which Allen dived is irrelevant.

LloydsTSB has stated that its own information from doctors treating Allen is that his illness is "directly related to him participating in a dive to that depth". But it added: "Should any additional medical evidence come to light we would of course reassess the situation."

Scuba Diving With Port in place

Hello ScubaDoc,

Would you be able to tell me if diving is permitted while a port a cath is in place? I am going to Roatan in November. I hate the thought of not diving, but if I can’t, I’m sure there is a hammock with my name on it. I am receiving chemo therapy and so far, doing quite well. My doctor has told me that he will cater my treatment to my trip.

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


Hi Diver:

There would be no reason why a person should not be allowed to dive with a portacath or any other indwelling drug delivery system, given the fact that there is no air in the system to enlarge or change in size due to the changes in pressure. [Remember Boyle's Law?]

However, there might be other caveats that would prevent a person diving, such as medication effects on the individual in the underwater milieu.

A person should not dive who has been immuno-suppressed, due to the possibility of infection from marine organisms that are not ordinarily pathogens - but which can overwhelm a person on anti-cancer drugs.

In addition, a person who is on anti-cancer meds is often weakened physically and cannot manage the ordinary requirements of scuba diving entries, currents, self and buddy rescue and exits. Anemia is another problem, there being an increased risk from hypoxia. Lung changes are also a consideration in persons taking some anti-cancer drugs. Pulmonary functions would then become important to the diver.

So - if you're between treatments and have no pulmonary problems, anemia or bone marrow suppression - scuba diving can be considered safe.

Dr. Sally Bauer writes and adds one more caveat to our list of cautions for the diver: that he/she takes care that the scuba gear does not chafe or erode the thin skin over the port's injection site.

Best regards:

Ern Campbell, MD

Scubadoc's Diving Medicine
http://scuba-doc.com/

Wednesday, August 17, 2005

You've got to read this!

Here is a great story about a deep cave dive rescue that goes awry.

"thought you might want to post a link to this heartwrenching story."

http://outside.away.com/outside/features/200508/dave-shaw-1.html

James A. Murray
Asst. Prof., Department of Biology
156 Lewis Science Center
University of Central Arkansas
Conway, AR 72035
PH: 501-450-5923
FAX: 501-450-5914
mailto:tritoniadiomedea@mac.com
http://www.uca.edu/newweb/biology/murrayj.php



Friday, August 12, 2005

Recent Interesting Bookmarks on my browsers

DIVING SAFETY AND EMERGENCY MANAGEMENT GUIDELINES
for the U-1105 BLACK PANTHER HISTORIC SHIPWRECK PRESERVE 18ST636 in the
POTOMAC RIVER, MARYLAND
Good resource for dive safety and emergency care in a diving operation.
http://www.marylandhistoricaltrust.net/u1105saf.pdf


FILL EXPRESS: Quality of Breathing gases
http://www.fillexpress.com/library/gasquality.shtml#co2


eMedicine: Eustachian Tube Function
Good discussion of ET function.
http://www.emedicine.com/ent/topic359.htm


Risks and Side Effects of HBOT
Simple listing of problems that not many know and few want to talk about.
http://www.hhi-kc.com/sideeffects.htm


Gender and Decompression Sickness: A Critical Review and Analysis
More than you could ever want to know about women and decompression illness.
http://tinyurl.com/7lq8k
http://ston.jsc.nasa.gov/collections/TRS/_techrep/TP-2004-213148.pdf


Acute Myocardial Infarction in a Professional Diver After Jellyfish Sting
Interesting article from the Mayo Clinic
http://tinyurl.com/c4grn


Dive Canister for FastFind and FastFind Plus PLB (Personal Locater Beacon)
For the diver who has ever had thoughts and fears of possibly being left behind.
http://tinyurl.com/a2j4f

Wednesday, August 10, 2005

Flying/Going to Altitude After Diving, Diving At Altitude

There is a recurring question that arises in one form or another about diving and then flying, or going to altitude and diving, going further to altitude and descending to place of abode or sea level. We have had a recent spate of queries about this culminating in a question that was forwarded me by Dr. Ed Kay for circulation among our consultants.

There are tables that address these issues in the NOAA textbook and the US Navy Diving Manual but these are not readily available to the general diving public. The US Navy made changes in it's recommendationsin their Revision 4 on the basis of research done by Divers Alert Network. [see below].

In addition, DAN has had a workshop in May, 2002, to sort out approaches to this problem and has made a review of the proceedings of the FAD Workshop Concensus http://scuba-doc.com/fad_web.pdf and has come up with these recommendations:

1. For a single no-decompression dive, a minimum preflight surface interval of 12 hours is suggested.
2. For multiple dives per day or multiple days of diving, a minimum preflight surface interval of 18 hours is suggested.
3. For dives requiring decompression stops, there is little evidence on which to base a recommendation, but a preflight surface interval substantially longer than 18 hours appears prudent.
4. These recommendations apply to air dives followed by flights at cabin altitudes of 2,000 to 8,000 feet (610 to 2,438 meters).
5. These recommendations are for recreational divers who do not have symptoms of decompression sickness (DCS).


A question that we recently received is as follows:

I’ll soon be moving permanently to the Big Island of Hawaii.
I plan to dive regularly out of Kawaihae Harbor on the Island’s west side. However, I will be residing in Kamuela-Waimea about 15 miles away and at an elevation of about 2600 feet. I will spend an hour at sea-level after the second of my two dives before heading “up the hill” to home.

I will be diving NITROX, either EANx32 or EANx36, and would, under normal circumstances, remain within standard no-decompression time limits; to include remaining at sea-level for 24 hours after my last dive. But, of course, this latter precaution will NOT be the case for me.
Has anyone developed tables which would account for this sort of altitude factor such that I could further precisely limit time-on-bottom and then safely go home without feeling “that strange twang” in my elbow a few hours later?

Answers:

A DAN researcher, Dr. Richard Vann has this to say about your query:
"See the attached FAD workshop proceedings [ http://scuba-doc.com/fad_web.pdf] that may be some help. The consensus guidelines probably won’t help much but look in the section by Ed Flynn about the USN guidelines that were based in part on the DAN trials. These procedures might work for you if you compute your EAD (Equivalent Air Depth) for your nitrox mix and estimate the USN Repet Dive Group for your dives. I believe that the Navy procedures may allow you to go home with little or no delay. Bear in mind, however, that other than the DAN trials, there has been little testing across the range of altitudes or for many dives. In fact, trials we are presently doing for the Navy suggest that our results might be different if our test subjects were immersed and exercising rather than dry and resting. We hope to test that idea in the coming year. Nothing is for sure, of course, but I wouldn’t be surprised if you can get away with it. Always a good idea to have 100% oxygen on hand at the dive site and in the car, too."

A highly respected PADI dive instructor has these remarks:
"Because people differ in their susceptibility to decompression sickness, no decompression table can guarantee that decompression sickness will never occur even though you dive within the table limits" is a common phrase to divers, and covers the real world variables. And most divers are aware that the waiting to fly after diving time is a function of the dive table used and types of dives made. Current minimum wait to fly times for PADI table users is in the 12 to 14 hour category, provided limits were not exceeded. Most every airline pilot I know on the Caribbean routes claims at least one passenger per flight returning to the USA after diving did not consider this advice and became a decompression sickness problem at altitude.
PADI has no specific time delay for those diving with the RDP before driving to altitude, but states divers should be conservative and allow as long a surface interval as possible, again trying to account for the myriad of diver profiles. So, we have concerns for after diving driving to altitude, have little data, and no table for this instance - only recommendations to wait.
I suggest that the diver contact the dive shops on Hawaii for information. There may be local knowledge on this matter which has not made it to the agencies."

Here are comments and caveats from a respected diving medical officer:
First, it depends on the amount of risk this diver wishes to assume. Some factors to consider are "can not wait", access to oxygen, use of experimental tables (not much data but appears reasonable, "tech diving" approach), access to recompression chamber etc.

Nitrox, surface oxygen all sound good coupled with conservative use of decompression procedures as well as use of flying after diving guidelines. Goes without saying the use of standard preventive measures are in effect; hydration, avoid questionable profiles, yo yo etc. There are dive computers that try to account for altitude exposure but again "experimental" probably due to every unique exposure.
This is a great illustration of the difficulty with the attempts at table investigation outside the "laboratory".

Ramifications of this "simple" question arise as can be seen in this query on the Scuba Clinic forum located at http://snipurl.com/gton .
"Most of our little group of divers have 10 or less dives under our belts. We are planning a dive which takes us from our home at about 600 ft to the dive spot, which is 3205 ft. The drive is approximately 7 hours long, covering appx 430 miles. We will be driving to the location and arriving Thursday morning about 3:00 a.m.

We figured we'd plan two dives for Friday and two for Saturday, both no more than than 25 ft deep, as that is the max depth of the pool. We had planned to leave about noon on Sunday to drive back.

So herein is the issue ..... in the afternoons we'd like to visit some area attractions. However, these other places are about another 2000 to 3000 additional feet in altitude. Will it be safe for us to take these little excursions in the afternoon or should we plan on bringing lots of boardgames and staying in? "

Answer:
The NOAA Diving Manual would say that you should consider that your dives would be in salt water [allowing you to leave out figuring in the difference in fresh water and salt water]. They would also allow you to subtract 600 feet from the 3205 foot projected altitude of the dive, a dive at about 2605 feet. This would round off to the nearest thousand, or 3000 feet.
In their Table 4.1 on page 4-25, a 25 foot dive at 3000 feet would be a sea level equivalent depth of 30 feet. However, correcting for pressure equivalents, it would closer to 27.75 fsw, placing you in Repetive group B on your dive tables. Rep dives then have to be figured as if the dives are from the sea level equivalent depth dives, possibly ending up as a group G [as an example].

NOAA also has a table [4.3] that gives the surface interval in hours:minutes before making a further ascent to altitude. The surface interval depends upon the highest repetitive group designator obtained in the previous 24 hour period at the altitude of the dive. Ascending to 6500 feet would be an increase of 3500 feet [rounded to 4000 feet], this entered on the table at rep Group G and the wait would be 1 hour, 23 minutes. There would be no wait with groups A-F.

Here is another question answered by Dr. Martin Quigley.
My query is about flying after a dive? Some say that the maximum altitude that one can go is 1000ft? others say it's 2000ft. justlast week my dive buddies had a discussion about the same topic. I'm trying to settle it once and for all. The question would be is what would be the maximum safe altitude that you can fly using a helicopter after making two dives with a maximum depth of 60 feet on the first and 40 feet on the second. between the dives you had a 90 minutes surface interval? after the second dive you have two fly out.

While your question might appear simple, the answer is not. I’ll try to pull together several different sources to give you an answer.

The current flying after diving guidelines from the Divers Alert Network (DAN) are:
Dives within the No-Decompression Limits
· A Single No-Decompression Dive: A minimum preflight surface interval of 12 hours is suggested.
· Multiple Dives per Day or Multiple Days of Diving: A minimum preflight surface interval of 18 hours is suggested.
(from: http://www.diversalertnetwork.org/news/art...asp?newsid=258)
Generally diving at an elevation of less than 1000 feet above sea level requires no adjustment of the No Decompression Limits (NDLs). [1000 feet altitude is approximately 0.95 ATA.]
Commercial airliners must be pressurized to no greater than 8000 feet (approximately 0.75 ATA) and are usually pressurized to a lower altitude.

Decompression theory is quite complex and I am going to oversimplify it. As an oversimplification, assume that the human body can stand a partial pressure of nitrogen of approximately 1.6 with getting decompression illness (DCI) symptoms. That means that as long as the partial pressure of nitrogen in any body tissue does not exceed 1.6 (approximately twice the nitrogen content at the surface) when surfacing, the DCI risk is minimal.

If you ascend to a higher altitude after diving, then the difference between the levels of absorbed nitrogen and the ambient pressure at altitude become the relevant measures. In my very crude example, if you ascended to 1000 feet altitude, you could only tolerate a maximum tissue nitrogen partial pressure of 1.55. At 8000 feet altitude, you could only tolerate 1.35.
In any case, decompression tables and dive computers only function to minimize the chances of getting DCS. The further you “push” the tables, the lower the margin of safety.

In your example, I don’t believe that a helicopter flight to 1000 feet altitude presents any significant increase in risk of DCS for the dive profiles you have described. There is no absolute “safe” altitude. 2000 feet elevation is riskier. At 8000 feet elevation (and this includes driving over mountains after diving), I’d recommend adherence to the DAN guidelines above.

Here is some information gleaned from the USN Diving Manual that is helpful in calculating the amount of time that should be spent waiting for safe ascent. One assumes that the diver has Repetitive Dive tables and is familiar with their use.

Equilibration at Altitude. Upon ascent to altitude, two things happen. The body off-gases excess nitrogen to come into equilibrium with the lower partial pressure of nitrogen in the atmosphere. It also begins a series of complicated adjustments to the lower partial pressure of oxygen. The first process is called equilibration; the second is called acclimatization. Twelve hours at altitude is required for equilibra-tion. A longer period is required for full acclimatization. If a diver begins a dive at altitude within 12 hours of arrival, the residual nitrogen left over from sea level must be taken into account. In effect, the initial dive at altitude can be considered a repetitive dive, with the first dive being the ascent from sea level to altitude. Table 9-4 gives the repetitive group associated with an initial ascent to altitude. Using this group and the time at altitude before diving, enter the Residual Nitrogen Timetable for Repetitive Air Dives (Table 9-7) to determine a new repetitive group designator associated with that period of equilibration. Determine sea level equivalent depth for your planned dive using Tabl e 9-3. From your new repetitive group and sea level equivalent depth, determine the residual nitrogen time associated with the dive. Add this time to the actual bottom time of the dive.
Example: A diver ascends rapidly to 6000 feet in a helicopter and begins a dive to 100 fsw 90 minutes later. How much residual nitrogen time should be added tothe dive? From Table 9-4, repetitive group upon arrival at 6000 feet is Group E. During 90 minutes at altitude, the diver will desaturate to Group D. From Tabl e 9-3, sea level equivalent depth for a 100 fsw dive is 130 fsw. From Tabl e 9-7, residual nitrogen time for a 130 fsw dive in Group D is 11 minutes. The diver should add 11 minutes to bottom time.

Table 9-4 can also be used when a diver who is fully equilibrated at one altitude ascends to and dives at a higher altitude. Enter Table 9-4 with the difference between the two altitudes to determine an initial repetitive group.

Example: Divers equilibrated at a base camp altitude of 6000 feet, fly by helicopter to the dive site at 10,000 feet. The difference between the altitudes is 4000 feet. From Table 9-4, the initial repetitive group to be used at 10,000 feet is Group C.

Table 9-4. Repetitive Groups Associated with Initial Ascent to Altitude.
Altitude (feet) Repetitive Group
1000 A
2000 B
3000 B
4000 C
5000 D
6000 E
7000 E
8000 F
9000 G
10000 H

ASCENT TO ALTITUDE AFTER DIVING/FLYING AFTER DIVING.

Leaving the dive site may require temporary ascent to a higher altitude. For example, divers may drive over a mountain pass at higher altitude or leave the dive site by air. Ascent to altitude after diving increases the risk of decompression sick-ness because of the additional reduction in atmospheric pressure. The higher the altitude, the greater the risk. (Pressurized commercial airline flights are addressed in Note 3 of Table 9-5.)

Table 9-5 gives the surface interval (hours:minutes) required before making a further ascent to altitude. The surface interval depends on the planned increase in altitude and the highest repetitive group designator obtained in the previous 24- hour period. Enter the table with the highest repetitive group designator obtained in the previous 24-hour period. Read the required surface interval from the column for the planned change in altitude.

Example: A diver surfaces from a 60 fsw for 60 minutes no-decompression dive at sea level in Repetitive Group J. After a surface interval of 6 hours 10 minutes, the diver makes a second dive to 30 fsw for 20 minutes placing him in Repetitive Group C. He plans to fly home in a commercial aircraft in which the cabin pressure is controlled at 8000 feet. What is the required surface interval before flying? The planned increase in altitude is 8000 feet. Because the diver has made two dives in the previous 24-hour period, you must use the highest Repetitive Group Designator of the two dives. Enter Table 9-5 at 8000 feet and read down to Repetitive Group J. The diver must wait 17 hours and 35 minutes after completion of the second dive before flying.

Example: Upon completion of a dive at an altitude of 4000 feet, the diver plans to ascend to 7500 feet in order to cross a mountain pass. The diver's repetitive group upon surfacing is Group G. What is the required surface interval before crossing the pass? The planned increase in altitude is 3500 feet. Enter Table 9-5 at 4000 feet and read down to Repetitive Group G. The diver must delay 1 hour and 23 minutes before crossing the pass.

Example: Upon completion of a dive at 2000 feet, the diver plans to fly home in an unpressurized aircraft at 5000 feet. The diver's repetitive group designator upon surfacing is Group K. What is the required surface interval before flying?
The planned increase in altitude is 3000 feet. Enter Table 9-5 at 3000 feet and read down to Repetitive Group K. The diver must delay 6 hours and 25 minutes before taking the flight.


Table 9-5. Required Surface Interval Before Ascent to Altitude After Diving.

Table at this site http://scuba-doc.com/USNTab9.5.html

Exceptional Exposure Wait 48 hours before flying

NOTE 1 When using Table 9-5, use the highest repetitive group designator obtained in the previous 24-hour period.

NOTE 2 Table 9-5 may only be used when the maximum altitude achieved is 10,000 feet or less. For ascents above 10,000 feet, consult NAVSEA 00C for guidance.

NOTE 3 The cabin pressure in commercial aircraft is maintained at a constant value regardless of the actual altitude of the flight. Though cabin pressure varies somewhat with aircraft type, the nominal value is 8,000 feet. For commercial flights, use a final altitude of 8000 feet to compute the required surface interval before flying.

NOTE 4 No surface interval is required before taking a commercial flight if the dive site is at 8000 feet or higher. In this case, flying results in an increase in atmospheric pressure rather than a decrease.

NOTE 5 No repetitive group is given for air dives with surface decompression on oxygen or air. For these surface decompression dives, enter the standard air table with the sea level equivalent depth and bottom time of the dive to obtain the appropriate repetitive group designator to be used.

NOTE 6 For ascent to altitude following a non-staturation helium-oxygen dive, wait 12 hours if the dive was a no-decompression dive. Wait 24 hours if the dive was a decompression dive.

Another novel approach to this problem is offered by Ben Zwart, MD, PhD using his multi-level dive calculator developed by him in 1998.

You're ACTUALLY looking at a fairly complex, MULTIPLE level dive, with a STAGING HOLD at sea level (3 FSW equivalent) for your Surface Interval! Your equilibrium condition is actually at 2600 feet - - and your dive actually begins during the descent, on AIR to sea level. It is at this point that you begin to on-load nitrogen compared to your equilibrium status. Remember!! Haldanian mechanics is ONLY applicable to excursion diving - - NOT to saturation diving!!

Scubadoc has asked me to comment on your question. Please understand that the following comments are my own and in no way represent an official position of the United States Air Force, Navy, or any other official body. The information / opinion I am providing is correct to the best of my knowledge at the time of my response. Other conflicting information may exist that I am either unaware of, or simply disagree with, and so I may not have not addressed those issues in my reply to you. 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. Diving is an inherently dangerous sport, and even if all the rules are correctly followed, significant injury and even death may result. I assume no liability for the use of information freely given without intent for willful or wanton negligence. Caveat Emptor.

The Multi-level diving calculator I designed back in 1998 using the Microsoft Excel spreadsheet (copy attached in PK-Zip format, including white paper in Adobe Acrobat PDF format) is the only thing I can think of that might help you out. Since you dive Nitrox, I assume you have a bit of technical expertise regarding use of mixed gases, and will be able to read through the Nobendem derivation to gain a better understanding of how the calculator will work for you. You may also download it from the USAF web site at http://www.brooks.af.mil/web/hyper/files/Nobendem.ZIP (this may be required if your Juno account does not allow attachments).

You will need to make a few adjustments!! You will have to set the LOCAL BARO settings to 692 Torr in the initial "Multi M1" segment (equivalent to -3 FSW), which represents your actual equilibrium condition at 2600 feet. I will assume that you make a relatively linear descent from your home to sea level over a period of 1 hour, you take an hour at sea level to park, get into your wet suit and begin the dive. I will limit your depth to 60 FSW, assume square dives, and will only give you an hour at depth (if you're using AL-80's, you have 74.8 SCF of Nitrox available at 3000 PSI, and if you breathe 1 liter tidal volume at 10 breaths per minute, this will leave you 500 PSI for ascent after 1 hour - assuming a 2 minute descent). You will have to remember to ADD those extra 3 feet to your depth below the surface of the water during calculations where the surface Baro is set to 692! Because the surface interval is spent at 0 FSW, I will set the second table with a Baro of 760, and the dive will actually END back at -3 FSW = 2600 feet altitude.

You don't specify anything regarding your planned dive profiles, so I'll have to make something up. I will select EANx 36, will use my standard (and fairly conservative) Safety Enhancement of 20 (for comparison, this would recommend 60 feet for 45 minutes instead of 60 for 60 using AIR!! for a diver equilibrated at 1 ATA)

If you are going to make TWO, one-tank dives, because of your use of EANx, you could actually spend more than an hour at 60 FSW on your first dive if you had sufficient tank volume, before you would need a decompression stop - - however, as indicated above, you'll probably run out of gas before then.

I'll assume a 1-hour SI between dives, and will use either the no-deco times at 60 FSW, or 1 hour, whichever is shorter.

So, here goes:

You have a linear transition from your "surface" at 2600 feet to a depth of 3 FSW over a 1-hour period on 0.21 "nitrox" = air :-)
You then spend 1 hour at 3 FSW (sea level compared to your starting point) parking your car and getting into your gear.
You spend a 2 minute descent to 63 FSW (60 FSW below the surface, but 63 FSW equivalent relative to your starting point) on EANx 36.
You stay at 63 FSW for 60 min again on Nitrox, and then ascend to 3 FSW (water's surface) over 2 minutes.

You need NO deco time for this dive, although when you emerge from the water, your 40 minute tissue group is close to the safety threshold with a buffer of 0.32. This is perfectly acceptable, as the safety factor is currently set at 20 (calculated in the Multi M1 spreadsheet).

You then spend 1 hour at the surface. Since the RNT is calculated via reverse engineering, I have elected to set this segment's calculation (Multi M2) with a baseline of 760 mm Hg, and will end the dive with your eventual return to 2600 feet (= -3 FSW equivalent). The calculator suggests your RNT back to 60 FSW at the end of your 60 minute SI is 35 minutes.

Since the "surface" is now at 760 Torr, your descent is to 60 FSW over 2 minutes, but you can only spend 32 minutes at 60 FSW on EANx 36, assuming a 2 minute, no deco ascent.

If you now jumped immediately into your car, and made a linear ascent back home, taking NO LESS than 9 minutes, you will not break the Nobendem (Navy) model decompression tables with a Safety Enhancement of 20.

Lets say you wanted to spend a little more time at depth on your second dive - - maybe maximize your time at depth (TAD 60). You could spend 50 minutes at 60 FSW on EANx 36, take a 2 minute ascent to 5 FSW, spend 4 minutes at 5 FSW, then ascend to the surface, within the current model limits.

If you now jumped immediately into your car, and made a linear ascent back home, taking NO LESS than 10 minutes, you will not break the Nobendem (Navy) model decompression tables with a Safety Enhancement of 20.

With either of these dives, the longer you spend on the surface before hopping into your car and going home, the safer you should be.

Please remember! Calculation of diving tables, particularly in a new, untested application such as this, can only be an approximation based on the extrapolation of currently accepted values. Although I believe these recommendations are valid, they have not been tested - hence my disclaimer above. In the end, the diver must be responsible for his selection of diving tables and any possible consequences thereof.

I hope this has been helpful.

Benton P. Zwart, MD, MPH

Saturday, August 06, 2005

Humor


A Cajun walks into a bar with a pet alligator by his side. He puts the alligator up on the bar. He turns to the astonished patrons. I'll make you a deal. I'll open this alligator's mouth and place my privates inside. Then the gator will close his mouth for one full minute.

Then he'll open his mouth and I'll remove my unit unscathed. In return for witnessing this spectacle, each of you will buy me a drink."

The crowd murmured their approval. The Cajun stood up on the bar, dropped his trousers, and placed his Johnson and related parts into the alligator's open mouth. The gator closed his mouth as the assembly gasped.

After a minute, the man grabbed a beer bottle and smacked the alligator hard on the top of its head. The gator opened his mouth and the man removed his genitals, unscathed as promised. The patrons cheered and the first of his free drinks was delivered. The man stood up again and made another offer.

"I'll pay anyone $100 who's willing to give it a try." A hush fell over the crowd. After a while, a hand went up in the back of the bar.

A Blonde woman timidly spoke up...

"I'll try It! Just don't hit me so hard with the beer bottle!"


***************************************************
WOMEN'S REVENGE

"Cash, cheque or charge?" I asked, after folding items the woman wished to purchase. As she fumbled for her wallet I noticed a remote control for a television set in her purse. "So, do you always carry your TV remote?" I asked. "No," she replied, "but my husband refused to come shopping with me, and I figured this was the most evil thing I could do to him legally."

UNDERSTANDING WOMEN
(A MAN'S PERSPECTIVE)

I know I'm not going to understand women.
I'll never understand how you can take boiling hot wax,
pour it onto your upper thigh, rip the hair out by the root,
and still be afraid of a spider.


MARRIAGE SEMINAR

While attending a Marriage Seminar dealing with communication, Tom and his wife Grace listened to the instructor,
"It is essential that husbands and wives know each other's likes and dislikes."
He addressed the man,
"Can you name your wife's favorite flower?"
Tom leaned over, touched his wife's arm gently and whispered, "It's Homepride, isn't it?

CIGARETTES AND TAMPONS
A man walks into a pharmacy and wanders up and down the aisles.
The sales girl notices him and asks him if she can help him.
He answers that he is looking for a box of tampons for his wife.
She directs him down the correct aisle.
A few minutes later, he deposits a huge bag of cotton
balls and a ball of string on the counter.
She says, confused, "Sir, I thought you were looking for some tampons for your wife?
He answers, " You see, it's like this, yesterday, I sent my wife to the store to get me a carton of cigarettes,
and she came back with a tin of tobacco and some rolling
papers; cause it's sooo-ooo--oo-ooo much cheaper.
So, I figure if I have to roll my own - so does she.

WIFE VS. HUSBAND
A couple drove down a country road for several miles, not saying a word.
An earlier discussion had led to an argument and
neither of them wanted to concede their position.
As they passed a barnyard of mules, goats, and pigs,
the husband asked sarcastically, "Relatives of yours?"
"Yep," the wife replied, "in-laws."

W O R D S
A husband read an article to his wife about how many words women use a day... 30,000 to a man's 15,000.
The wife replied, "The reason has to be because we have to repeat everything to men...
The husband then turned to his wife and asked, "What?"





CREATION
A man said to his wife one day, "I don't know how you can be so stupid and so beautiful all at the same time.
" The wife responded, "Allow me to explain.
God made me beautiful so you would be attracted to me;
God made me stupid so I would be attracted to you!

WHO DOES WHAT
A man and his wife were having an argument about who
should brew the coffee each morning.
The wife said, "You should do it, because you get up first,
and then we don't have to wait as long to get our coffee."
The husband said, " You are in charge of cooking around here and you should do it, because that is your job, and I can just wait for my coffee."
Wife replies, "No, you should do it, and besides, it is in the Bible that the man should do the coffee."
Husband replies, "I can't believe that, show me."
So she fetched the Bible, and opened the New Testament
and showed him at the top of several pages, that it indeed says.........."HEBREWS"

The Silent Treatment
A man and his wife were having some problems at home and were giving each other the silent treatment. Suddenly, the man realized that the next day, he would need his wife to wake him at 5:00 AM for an early morning business flight.
Not wanting to be the first to break the silence (and LOSE), he wrote on a piece of paper, "Please wake me at 5:00 AM." He left it where he knew she would find it.
The next morning, the man woke up, only to discover it was 9:00 AM and he had missed his flight. Furious, he was about to go and see why his wife hadn't wakened him, when he noticed a piece of paper by the bed. The paper said, "It is 5:00 AM. Wake up."
Men are not equipped for these kinds of contests.

God may have created man before woman,
but there is always a rough draft before the masterpiece.

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

The Little Firefighter....

A firefighter is working on the engine outside the station when he notices a little girl riding down the sidewalk in a little red wagon with little ladders hung off the sides and a garden hose tightly coiled in the middle.

The girl is wearing a firefighter's helmet and the wagon is being pulled by her dog and her cat.

The firefighter walks out to take a closer look. "That sure is a nice fire truck," he says admiringly.

"Thanks, Mister Fireman," the girl says.

The firefighter looks a little closer and notices the girl has tied the wagon to her dog's collar and to the cat's testicles. "Little Partner," the firefighter says, "I don't want to tell you how to run your rig, but if you were to tie that rope around the cat's collar, I think you could go faster."

The little girl replies sweetly, "You're probably right, but then I wouldn't have a siren.

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

Dinner

A man and woman were having dinner in a fine restaurant. Their waitress, taking another order at a table a few steps away, suddenly noticed that the man was slowly sliding down his chair and under the table, but the woman acted unconcerned.

The waitress watched as the man slid all the way down his chair and out of sight under the table.

Still, the woman dining across from him appeared calm and unruffled, apparently unaware that her dining companion had disappeared. After the waitress finished taking the order, she came over to the table and said to the woman, "Pardon me, ma'am, but I think your husband just slid under the table."

The woman calmly looked up at her and said, "No he didn't. He just walked in the door."

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

Who Wears the Pants?

Tim was going to be married to April, so his father sat him down for a little fireside chat.

He says, "Tim, let me tell you something. On my wedding night in our honeymoon suite, I took off my pants, handed them to your mother, and said, here - try these on."

So, she did and said, "These are too big, I can't wear them".

I replied, "...exactly. I wear the pants in this family and I always will."

Ever since that night we have never had any problems."


Hmmm," says Tim. He thinks that might be a good thing to try. So on his honeymoon, Tim takes off his pants and says to April, "Here try these on."

So she does and says, "these are too large, they don't fit me."

Tim says, "...exactly. I wear the pants in this family and I always will, and I don't want you to ever forget that."


Then April takes off her pants and hands them to Tim and says, "Here, you try on mine."

So he does and says, "I can't get into your pants."

April says, "...exactly. And if you don't change your smartass attitude, you never will!

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

The Rectum Stretcher

While she was "flying" down the road yesterday (10 miles over the limit), a woman passed over a bridge only to find a cop with a radar gun on the other side lying in wait.

The cop pulled her over, walked up to the car, and with that classic patronizing smirk we all know and love, asked,

"What's your hurry?"

To which she replied, "I'm late for work."

"Oh yeah," said the cop, "what do you do?"

"I'm a rectum stretcher," she responded.

The cop stammered, "A what? A rectum stretcher? And just what does a rectum stretcher do?"

"Well," she said, "I start by inserting one finger, then work my way up to two fingers, then three, then four, then with my whole hand in. I work from side to side until I can get both hands in, and then I slowly but surely stretch, until it's about 6 feet wide."

"And just what the hell do you do with a 6 foot asshole?" he asked.

"You give him a radar gun and park him behind a bridge..."

Traffic Ticket...............$95.00 Court Costs................$45.00

The Look on Cop's Face..PRICELESS

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

The Original Computer

The Original Computer?- was a Pencil!

Memory was something you lost with age
An application was for employment
A program was a TV show
A cursor used profanity
A keyboard was a piano
A web was a spider's home
A virus was the flu
A CD was a bank account
A hard drive was a long trip on the road
A mouse pad was where a mouse lived

And if you had a 3 and 1/2 inch floppy . . . . . . you just hoped nobody ever found out!

*************************************
Nick the Dragon Slayer had a long-standing obsession to nuzzle the beautiful Queen's voluptuous breasts, but he knew the penalty for this would be death.

One day he revealed his secret desire to his colleague, Horatio the Physician, who was the King's chief doctor. Horatio the Physician exclaimed that he could arrange for Nick the Dragon Slayer to satisfy his desire, but it would cost him 1,000 gold coins to arrange it. Without pause, Nick the Dragon Slayer readily agreed to the scheme.

The next day, Horatio the Physician made a batch of itching powder and poured a little bit into the Queen's brassiere while she bathed. Soon after she dressed, the itching commenced and grew intense. Upon being summoned to the Royal Chambers to address this incident, Horatio the Physician informed the King and Queen that only a special saliva, if applied for four hours, would cure this type of itch, and that tests had shown that only the saliva of Nick the Dragon Slayer would work as the antidote to cure the itch.

The King quickly summoned Nick the Dragon Slayer. Horatio the Physician then slipped Nick the Dragon Slayer the antidote for the itching powder, which he quickly put into his mouth, and for the next four hours, Nick worked passionately on the Queen's voluptuous and magnificent breasts.

The Queen's itching was eventually relieved, and Nick the Dragon Slayer left satisfied and was touted as a hero. Upon returning to his chamber, Nick the Dragon Slayer found Horatio the Physician demanding his payment of 1,000 gold coins.

With his obsession now satisfied, Nick the Dragon Slayer couldn't have cared less and, knowing that Horatio the Physician could never report this matter to the King, shooed him away with no payment made.

The next day, Horatio the Physician slipped a massive dose of the same itching powder into the King's underwear.

The King immediately summoned Nick the Dragon Slayer...


MORAL OF THE STORY: Pay your bills.


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

Subject: A.A.A.D.D.

Recently, I was diagnosed with A. A. A. D. D. - Age Activated Attention Deficit Disorder.

This is how it manifests:
I decide to water my garden. As I turn on the hose in the driveway, I look over at my car and decide my car needs washing.

As I start toward the garage, I notice that there is mail on the porch table that I brought up from the mail box earlier.
I decide to go through the mail before I wash the car.

I lay my car keys down on the table, put the junk mail in the garbage can under the table, and notice that the can is full.
So, I decide to put the bills back on the table and take out the garbage first.

But then I think, since I'm going to be near the mailbox when I take out the garbage anyway, I may as well pay the bills first. I take my check book off the table, and see that there is only 1 check left. My extra checks are in my desk in the study, so I go inside the house to my desk where I find the can of Coke that I had been drinking.

I'm going to look for my checks, but first I need to push the Coke aside so that I don't accidentally knock it over. I see that the Coke is getting warm and I decide I should put it in the refrigerator to keep it cold.

As I head toward the kitchen with the Coke, a vase of flowers on the counter catches my eye--they need to be watered.

I set the Coke down on the counter, and I discover my reading glasses that I ve been searching for all morning.

I decide I better put them back on my desk, but first I'm going to water the flowers.

I set the glasses back down on the counter, fill a container with water and suddenly I spot the TV remote. Someone left it on the kitchen table. I realize that tonight when we go to watch TV, I will be looking for the remote, but I won't remember that it's on the kitchen table, so I decide to put it back in the den where it belongs, but first I'll water the flowers. I pour some water in the flowers, but quite a bit of it spills on the floor. So, I set the remote back down on the table, get some towels and wipe up the spill.

Then, I head down the hall trying to remember what I was planning to do.

At the end of the day:
The car isn't washed.
The bills aren't paid.
There is a warm can of Coke sitting on the counter.
The flowers don't have enough water.
There is still only 1 check in my check book.
I can't find the remote.
I can't find my glasses.
and I don't remember what I did with the car keys.

Then, when I try to figure out why nothing got done today, I'm really baffled because I know I was busy all day long, and I'm really tired.

I realize this is a serious problem, and I'll try to get some help for it, but first I'll check my e-mail.

Do me a favor, will you? Forward this message to everyone you think I know, because I don't remember to whom it has been sent.

Don't laugh -- if this isn't you yet, your day is coming!!
GROWING OLDER IS MANDATORY.
GROWING UP IS OPTIONAL.
LAUGHING AT YOURSELF IS THERAPEUTIC.

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

Two elderly women were eating breakfast in a restaurant one morning. Ethel noticed something funny about Mabel's ear and she said, '"Mabel, do you know you've got a suppository in your left ear?" Mabel answered, "I have a suppository in my ear?" She pulled it out and stared at it.
Then she said, "Ethel, I'm glad you saw this thing. Now I think I know where to find my hearing aid."



When the husband finally died his wife put the usual death notice in the paper, but added that he died of gonorrhea.
No sooner were the papers delivered when a friend of the family phoned and complained bitterly, "You know very well that he died of diarrhea, not gonorrhea." Replied the widow, "I nursed him night and day so of course I know he died of diarrhea, but I thought it would be better for posterity to remember him as a great lover rather than the big shit he always was."




An elderly couple were on a cruise and it was really stormy. They were standing on the back of the boat watching the moon, when a wave came up and washed the old woman overboard. They searched for days and couldn't find her, so the captain sent the old man back to shore with the promise that he would notify him as soon as they found something. Three weeks went by and finally the old man got a fax from the boat. It read: "Sir, sorry to inform you, we found your wife dead at the bottom of the ocean. We hauled her up to the deck and attached to her
butt was an oyster and in it was a pearl worth $50,000 . please advise." The old man faxed back: "Send me the pearl and re-bait the trap."




A funeral service is being held for a woman who has just passed away. At the end of the service, the pall bearers are carrying the casket out when they accidentally bump into a wall, jarring the casket. They hear a faint moan. They open the casket and find that the woman is actually alive! She lives for ten more years, and then dies. Once again, a ceremony is held, and at the end of it, the pall bearers are again carrying out the casket. As they carry the casket towards the door, the husband cries out, "Watch that wall!"




When I went to lunch today, I noticed an old lady sitting on a park bench sobbing her eyes out. I stopped and asked her what was wrong. She said, "I have a 22 year old husband at home. He makes love to me every morning and then gets up and makes me pancakes, sausage, fresh fruit and freshly ground coffee."
I said, "Well, then why are you crying?" She said, "He makes me homemade soup for lunch and my favorite brownies and then makes love to me for half the afternoon.

I said, "Well, why are you crying?" She said, "For dinner he makes me a gourmet meal with wine and my favorite dessert and then makes love to me until 2:00 a.m." I said, "Well, why in the world would you be crying?" She said, "I can't remember where I live!"




Two elderly ladies had been friends for many decades. Over the years they had shared all kinds of activities and adventures. Lately, their activities had been limited to meeting a few times a week to play cards.

One day they were playing cards when one looked at the other and said, "Now don't get mad at me....I know we've been friends for a long time.....but I just can't think of your name! I've thought and thought, but I can't remember it. Please tell me what your name is." Her friend glared at her. For at least three minutes she just stared and glared at her. Finally she said, "How soon do you need to know?"







Signs Spotted!

On a Septic Tank Truck: Yesterday's Meals on Wheels

On a Septic Tank Truck sign: "We're #1 in the #2 business."

Sign over a Gynecologist's Office: "Dr. Jones, at your cervix."

At a Proctologist's door: "To expedite your visit please back in."

On a Plumber's truck: "We repair what your husband fixed."

On a Plumber's truck: "Don't sleep with a drip. Call your plumber."

Pizza Shop Slogan: "7 days without pizza makes one weak."

At a Tire Shop in Milwaukee! "Invite us to your next blowout."

On a Plastic Surgeon's Office door: "Hello. Can we pick your nose?"

At a Towing company: "We don't charge an arm and a leg. We want tows."

On an Electrician's truck: "Let us remove your shorts."

In a Nonsmoking Area: "If we see smoke, we will assume you are on fire and take appropriate action."

At an Optometrist's Office: "If you don't see what you're looking for, you've come to the right place."

In a Podiatrist's office: "Time wounds all heels."

On a Fence: "Salesmen welcome! Dog food is expensive."

At a Car Dealership: "The best way to get back on your feet -- miss a car payment."

Outside a Muffler Shop: "No appointment necessary. We hear you coming."

In a Veterinarian's waiting room: "Be back in 5 minutes. Sit! Stay!"

At the Electric Company: "We would be delighted if you send in your payment. However, if you don't, you will be."

In a Restaurant window: "Don't stand there and be hungry, Come on in and get fed up."

At a Propane Filling Station: "Thank heaven for little grills."

And don't forget the sign at a Chicago Radiator Shop: "Best place in town to take a leak."

British Hyperbaric Association Conference - Steve McKenna

The British Hyperbaric Association AGM is being held aboard HMS Belfast in London on 28th & 29th October 2005, Please open the attached PDF files for full details of how to book a place at the conference and details of events and speakers.
Attachments
http://scuba-doc.com/BHAAGMPage1.pdf
http://scuba-doc.com/BHAAGMPage2.pdf


Pacific Island Emergency Medicine

JOB DESCRIPTION:
Pacific Island opportunity! A unique opportunity for THREE BC/BE EM physicians or BC/BE IM or FP with 5+ years EM experience. This would be working in a Pacific Island Community. A great place to be if you are looking for world class SCUBA diving and windsurfing. This lifestyle choice provides peace, relaxation and freedom from mainland politics. The physicians often head for a walk along a deserted beach at sundown. Volume is 23,000 per year. Shift times are 8 hours, single days, double evenings and single nights. Low level of violence. ACLS and ATLS required. Need a minimum commitment of two months. Round trip transportation and local housing provided.

CONTACT:
If you are interested in this unique opportunity, please send me your CV at rodmanc@mdainc.com or fax it to 425-898-1689 or call toll free 877.611.3158.

Friday, August 05, 2005

Brown Recluse Spider Injury, Hyperbaric oxygenation?


The brown recluse spider bite is an injury that has been shown to respond to hyperbaric oxygenation treatments. Necrotizing arachnidism is a complication of the brown recluse spider bite which is characterized by progressive necrosis and inflammation of the tissue at the site of the spider bite. Diagnosis in most cases is purely presumptive and often made in retrospect by the signs and symptoms that later develop. The degree of the clinical response is relative to the amount of venom injected, location of the bite (with high fat areas being more severely affected) and the immune status of the patient.

Photos:
http://www.lib.uiowa.edu/hardin/md/brownrecluse.html
http://www.emedicine.com/derm/topic598.htm

It has been shown in at least one good study at Duke University that HBO is effective in reducing the necrosis of the toxin.

Brown recluse spider envenomation: a prospective trial of hyperbaric oxygen therapy.
Acad Emerg Med. 1997 Mar;4(3):184-92.
Maynor ML, Moon RE, Klitzman B, Fracica PJ, Canada A.

Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. mmaynor.103@aol.com

OBJECTIVES: Loxosceles reclusa (brown recluse) spider bites can produce severe skin lesions that may necessitate extensive surgical repair. This study delineated the effects of hyperbaric oxygen (HBO) therapy on these lesions by performing a prospective controlled animal study. METHODS: After approval by the Institutional Animal Care and Use Committee, 41 New Zealand white rabbits received 64 intradermal injections of 73 microL of raw venom extract mixed with physiologic buffered saline (Dulbecco's solution). Control injections were made with buffer. The animals were divided into 5 groups: 1) venom and no HBO; 2) venom and 1 immediate HBO treatment (100% O2); 3) venom and immediate HBO with 10 treatments (100% O2); 4) venom and then delayed (48 hr) HBO therapy with 10 treatments (100% O2); and 5) venom and immediate hyperbaric treatment with normal inspired PO2 for 10 treatments (8.4% O2). Three animals in group 2 also received a control sodium citrate buffer injection. HBO treatments were at 2.5 atm absolute (ATA) for 90 minutes twice daily. Daily measurements were made of the lesion diameter, and skin blood flow using a laser Doppler probe. RESULTS: There was no significant effect of HBO on blood flow at the wound center or 1-2 cm from the wound center. Standard HBO significantly decreased wound diameter at 10 days (p


Old Air in My Tank - Diving?

This may be a stupid question, I have not used my equipment for almost 7 years. I only use it in my work which is residential swimming pools. My last VIP was 7/98. My tank is still full, is this air still good and/or should I have it VIP and refilled? Will the tank need to be Hydro’d since it has been so long?

Second question is the regulator, again not used for 7yrs. “Scuba Pro” Should this also be checked out may it need to be re-built. Again, This is for leak checks in pools of no more than 10ft. and I have not had to need to use this equipment for all these years.

Please advise.

Answer by Stephen Barsky

Hello Diver:

Dr. Campbell asked me to respond to your questions.

I would recommend that you have the tank drained, inspected internally, hydroed and refilled.

There is probably nothing wrong with it, however, if there is active corrosion in the tank, this can deplete the oxygen inside the cylinder, which could be a problem. Tanks must be hydrostatically tested every five years, so your cylinder is definitely out of hydro.

Your regulator should also be serviced. Depending on how and where you stored your regulator, the o-rings may be very dry and/or cracked. This would cause the regulator to not perform properly.

While you're at it, you should have your BC inspected as well.

You'll be a lot more comfortable using your gear if you know it has been serviced and everything is operating correctly.
--
Regards,

Steve Barsky
Marine Marketing & Consulting/Hammerhead Press

2419 E. Harbor Blvd. #149
Ventura, CA 93001

Tel. 805-985-4644
FAX 805-382-6755

www.marinemkt.com
www.hammerheadpress.com

Now shipping! California Marine Life Identification on DVD!
********************************************************

Wednesday, August 03, 2005

Radiation to the nasopharynx -- Excerpt from 1958 Publication - sent by Dave Heaney

In 'Medical Problems Involved in Underwater Compression and Decompression', published by CIBA, Vol 10. number 4, July-August 1958, Capt. G.J. Duffner, MC, USN opines on the prevention of Aerotitis. He advises that those in those "who dive extensively because of vocation or avocation, the frequency of this condition may be reduced by radiation of the nasopharynx in order to shrink the lymphoid tissue present. This involves the use of 3 to 8 applications of radium, each application separated by two weeks to one month. Fifty mg. of radium, contained in a Monel metal cylinder 2 cm. long and 2.3 mm in diameter, is applied to the pharyngeal orifice of each Eustachian tube for a period of 8 to 10 minutes".

Wow, I almost *%$# when I read that. Please tell me that as late as 1958 this was not normal. ? pleaseee?
The original article has perhaps the best illustrations (by Frank Netter, the absolute BEST medical illustrator ever) of how gas embolism happens, of bubbles forming in tissues, and of the TEED scoring system. After long searching for the publication, the Duke Medical Library (associated with the UHMS now) found it in only days.

My answer:

Hi Dave:
Nasopharyngeal radium irradiation (NRI) was used widely from 1940 through 1970 to treat otitis serosa in children and barotrauma in airmen and submariners. There have been many studies to try and incriminate this outdated treatment modality - with little to indicate that there is any increased cancer morbidity.
"After a mean follow-up of 31 years, there was no strong evidence for an elevated risk of head and neck tumors or hormone-related disorders in adulthood among subjects who had been treated with nasopharyngeal radium irradiation during childhood. "
On another note, Frank Netter, MD was a hero figure to me - mainly because a Histology prof once compared some of my art to his. Of course, this pumped me up terribly - and I was enamored of his really great medical art forever.
Best regards:
Ernie Campbell

DAN Awards Two Oxygen Units Through Grant Program

DAN has awarded two Rescue Pak Extended Care Oxygen Units from the Oxygen Grant Program to the Broward County Sheriff's Office Marine Unit.

The award, made in May, helps equip the Dive Rescue Team and Marine Patrol in Broward County, Fla., the area that includes Fort Lauderdale.

Through the Oxygen Grant Program, DAN provides emergency oxygen units to deserving organizations. Public safety diving teams and/or organizations that can demonstrate critical operational and financial need receive DAN Oxygen Units to supplement their emergency preparedness.

Grant requests are decided case by case. Training in the use of the equipment by attending a DAN Oxygen First Aid for Scuba Diving Injuries course is a mandatory requirement to being considered for the grant.

The goal of the Oxygen Grant program, which is funded completely by donations, is to place three oxygen units every quarter year or 12 each year. DAN reserves the right to award more units than the amount stated.

For information about the Oxygen Grant Program, visit
www.diversalertnetwork.org/training/instructors/o2grant.asp.

Or simply go to the website and click on Training & Education and then Oxygen Grant Program. The current grant cycle closes the last day of this
month.

Free scuba diving short story available to read

Divers and anyone else interested in adventure fiction can now read a short story and get their fix for free.


Scuba Radio, a nationally-syndicated radio show, and Eric Douglas, author of Cayman Cowboys (www.booksbyeric.com), have teamed up to offer visitors to the Scuba Radio website (www.scubaradio.com) the opportunity to download a new short story in four installments. The story, called Going Down With the Ship, is an adventure story set on a fictional key in the Florida Keys. It revolves around the sinking of a new artificial reef.

Scuba Radio’s organizer, Greg Holt said “This is a great opportunity for divers. I really enjoyed Eric’s book, Cayman Cowboys, when I read it earlier this summer. I gave it two fins up. Now our listeners will have the chance to read a short story he wrote for free.”

Holt is currently revising the Scuba Radio website and plans to offer Douglas’ story as a benefit to his loyal listeners.

The first installment of the story is now available on the Scuba Radio website. New installments will be available every two weeks afterward. The story is currently posted in the website’s Dive Blog feature.

Cayman Cowboys, Douglas’ novel, is a dive action adventure story set on Grand Cayman. Douglas is currently the training director for Divers Alert Network and has been diving for 15 years. Cayman Cowboys is his first novel. The book’s website is www.booksbyeric.com


Sincerely,

Eric Douglas
Author, Cayman Cowboys

Dick Clarke's Eleventh Annual Advanced Hyperbaric Medicine Symposium

Hyperbaric Medicine 2006

Mark your calendars!

The Eleventh Annual Advanced Hyperbaric Medicine Symposium is scheduled for April 13-15, 2006. As in the past, it will be held in Columbia, South Carolina. A stellar cast of researchers and clinicians is being assembled but it is not too late for you to help develop the program.

If you have a particular speaker of topic you would like included go to http://baromedical.com/advanced_hyperbaric_symposia.asp


For additional details please contact: HBO2006@baromedical.com


Dick Clarke, President

National Baromedical Services

Five Richland Medical Park

Columbia, SC 29203 USA

ph 803.434.7101 fx 803.434.4354

www.baromedical.com