Saturday, October 29, 2005

Diversified Therapy Signs Contracts for 17 New Wound Care Centers Nationwide


Jacksonville, FL (PRWEB) October 29, 2005 -- Diversified Therapy, the nation’s leading disease management company focusing on collaborating with hospitals to establish and manage comprehensive outpatient wound care programs, announces the signing of 17 new hospital contracts this year. The new wound care centers will be located at hospitals across the country, from Redding, CA to Philadelphia, PA. This exceptional growth increases the total number of Diversified Therapy hospital partnerships to 69 in 23 states, including 17 centers in Florida.

Diversified Therapy has grown substantially since its inception in 1996. Initially, there were two wound care centers and six employees. Upon joining the company in 1997, President and CEO Jim Henry broadened the strategic focus from hyperbaric oxygen therapy to include the emerging wound care market and professional training.

Focused on clinical excellence, Diversified Therapy leads the industry in the number of its centers that are accredited by the Undersea and Hyperbaric Medical Society (UHMS). There are currently 14 UHMS accredited Diversified Therapy centers nationwide. The designation is based on an evaluation of the facility and equipment, staff training and the quality of care and patient safety. Additionally, Diversified Therapy is accredited with Disease-Specific Care Certification from the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) for demonstrating excellence in healthcare quality in its comprehensive wound care management services.

About Diversified Therapy:
Established in 1996, Diversified Therapy manages comprehensive wound care centers at more than 60 contracted hospitals in 23 states nationwide, allowing hospitals to provide a needed, value-added service to a growing patient population. Diversified Therapy plans, develops and manages the wound care centers, providing implementation guidelines, key staff, operating procedures, clinical algorithms, outcomes data tracking systems, education and billing and coding training.
Diversified Therapy is headquartered in Jacksonville, FL. More information is available at www.diversifiedtherapy.com.

Wednesday, October 26, 2005

Humor

Quotables



"Having sex is like playing bridge. If you don't have a good partner, you'd better have a good hand." Woody Allen

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"Bisexuality immediately doubles your chances for a date on Saturday night."
Rodney Dangerfield

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"There are a number of mechanical devices which increase sexual arousal, particularly in women. Chief among these is the Mercedes-Benz 380SL."
Lynn Lavner

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"Sex at age 90 is like trying to shoot pool with a rope." Camille Paglia

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"Sex is one of the nine reasons for incarnation. The other eight are unimportant."
George Burns

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"Women might be able to fake orgasms. But men can fake a whole relationship."
Sharon Stone

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"Hockey is a sport for white men. Basketball is a sport for black men. Golf is a sport for white men dressed like black pimps." Tiger Woods

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"My mother never saw the irony in calling me a son-of-a-bitch."
Jack Nicholson

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"Clinton lied. A man might forget where he parks or where he lives, but he never forgets oral sex, no matter how bad it is." Barbara Bush (Former US First Lady, and you didn't think Barbara had a sense of humor)

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"Ah, yes, divorce, from the Latin word meaning to rip out a man's genitals through his wallet." Robin Williams

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"Women need a reason to have sex. Men just need a place." Billy Crystal

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"According to a new survey, women say they feel more comfortable undressing in front of men than they do undressing in front of other women. They say that women are too judgmental, where, of course, men are just grateful." Robert De Niro

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"There's a new medical crisis. Doctors are reporting that many men are having allergic reactions to latex condoms. They say they cause severe swelling. So what's the problem?" Dustin Hoffman

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"There's very little advice in men's magazines, because men think, 'I know what I'm doing. Just show me somebody naked'." Jerry Seinfeld

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"See, the problem is that God gives men a brain and a penis, and only enough blood to run one at a time" Robin Williams

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" It's been so long since I've had sex, I've forgotten who ties up whom."
Joan Rivers

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" Sex is one of the most wholesome, beautiful and natural experiences money can buy." Steve Martin

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" You don't appreciate a lot of stuff in school until you get older. Little things like being spanked every day by a middle-aged woman. Stuff you pay good money for in later life." Elmo Phillips

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" Bigamy is having one wife too many. Monogamy is the same." Oscar Wilde

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" It isn't premarital sex if you have no intention of getting married."
George Burns


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Ten New Excellent Drugs for Women!


D A M N I T OL
Take 2 and the rest of the world can go to hell for up to 8 full hours.

ST. M O M M A'S W O R T
Plant extract that treats mom's depression by rendering preschoolers
unconscious for up to two days.

E M P T Y N E S T R O G E N
Suppository that eliminates melancholy and loneliness by reminding you of how awful they were as teenagers and how you couldn't wait till they moved out.

P E P T O B I M B O
Liquid silicone drink for single women. Two full cups swallowed before an evening out increases breast size, decreases intelligence, and prevents conception.

D U M B E R O L
When taken with Peptobimbo can cause dangerously low IQ, resulting in enjoyment of country music and pickup trucks.

F L I P I T O R
Increases life expectancy of commuters by controlling road rage and the urge to flip off other drivers.

B U Y A G R A
Injectable stimulant taken prior to shopping Increases potency, duration,
and credit limit of spending spree.

J A C K A S S P I R I N
Relieves headache caused by a man who can't remember your birthday, anniversary, phone number, or to lift the toilet seat.

A N T I-T A L K S I D E N T
A spray carried in a purse or wallet to be used on anyone too eager to share their life stories with total strangers in elevators.

N A G A M E N T
When administered to a boyfriend or husband, provides the same irritation level as nagging him.



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Deep Thoughts For Those Who Take Life Too Seriously

It’s good to review these occasionally…




1. Remember, half the people you know are below average.

2. He who laughs last thinks slowest.

3. OK, so what's the speed of dark?

4. A day without sunshine is like...night.

5. The early bird may get the worm, but it’s the second mouse that gets the cheese from the trap.

6. Eagles may soar, but weasels don't get sucked into jet engines.

7. When everything is coming your way, you're in the wrong lane.

8. Depression is merely anger without enthusiasm.

9. Save the whales. Collect the whole set.

10. Why do psychics have to ask you for your name?

11. How many of you believe in psycho-kinesis? Raise my hand.

12. 42.7 percent of all statistics are made up on the spot.

13. On the other hand, you have different fingers.

14. A clear conscience is usually the sign of a bad memory.

15. If you think nobody cares, try missing a couple of payments.

16. 99.9 percent of lawyers give the rest a bad name.

17. Light travels faster than sound. That is why some people appear bright until you hear them speak.

18. Every one has a photographic memory. Some just don't have film.

19. Support bacteria. They're the only culture some people have.

20. Change is inevitable, except from vending machines.

21. What happens if you get scared half to death twice?

22. How much deeper would the ocean be without sponges?

23. Hard work pays off in the future. Laziness pays off now.

24. Inside every older person is a younger person wondering what happened?

25. Life isn't like a box of chocolates.... it's more like a jar of jalapenos. What you do today, might burn your butt tomorrow.

26. Just remember - if the world didn't suck, we would all fall off.




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WOMEN'S REVENGE
"Cash, check 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
Pillsbury, 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.
( I figure this guy is the one on the milk carton! )

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.

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A first grade teacher had twenty-five students in her class. She presented each child the first half of a well-known proverb and asked them to come up with the remainder of the proverb. It's hard to believe these were actually done by first graders. Their insight may surprise you! While reading these, keep in mind that these are 6-year-olds - because the last one is classic!



1. Don't change horses......................... until they stop running.

2. Strike while the................................... bug is close.

3. It's always darkest before ................ Daylight Saving Time.

4. Never underestimate the power of ...................termites.

5. You can lead a horse to water but..........................how?

6. Don't bite the hand that ..........................looks dirty.

7. No news is................................... impossible.

8. A miss is as good as a ............................. Mr.

9. You can't teach an old dog new ..................... math.

10. If you lie down with dogs, you'll ..............stink in the morning

11. Love all. Trust................................... me.

12. The pen is mightier than the ................... pigs.

13. An idle mind is........................ the best way to relax.

14. Where there's smoke there's....................... pollution.

15. Happy the bride who...................... gets all the presents.

16. A penny saved is ............................. not much.

17. Two's company, three's ....................... the Musketeers.

18. Don't put off till tomorrow what............. you put on to go to bed.

19. Laugh and the whole world laughs with you, cry and .........you have to blow your nose.

20. There are none so blind as ................... Stevie Wonder.

21. Children should be seen and not .................. spanked or grounded

22. If at first you don't succeed .................. get new batteries.

23. You get out of something only what you.......... see in the picture on the box.

24. When the blind lead the blind .................get out of the way.

The WINNER and last one!

25. Better late than ........................ pregnant!


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Circle Flies

A cowboy in Montana got pulled over by a State Trooper for speeding; The trooper started to lecture the cowboy about his speeding, and in general began to throw his weight around to try to make the cowboy feel uncomfortable.

Finally, the trooper got around to writing out the ticket. As he was doing that, he kept swatting at some flies that were buzzing around his head.

The cowboy said, "Having some problem with Circle flies there, are ya?"

The trooper stopped writing the ticket and said, "Well yeah, if that's what they are. I never heard of Circle flies."

So the cowboy says, "Well, circle flies are common on ranches. See they're called circle flies because they're almost always found circling around the back end of a horse.

The trooper says, "Oh," and goes back to writing the ticket.

Then after a minute, he stops and says, "Are you trying to call me a horse's ass?"

The cowboy says, "Oh no, Trooper. I have too much respect for law enforcement to even think about calling you a horse's ass."

The trooper says, "Well that's a good thing," and goes back to writing the ticket.

After a long pause, the cowboy says, "Hard to fool them flies though."

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


On the aftermath of Hurricane Katrina this story emerged (not real, of course!)

As a helicopter approached a house roof top surrounded by raging flood waters, he noticed 10 people ...9 men and 1 woman frantically waving to him.

The helicopter dropped a line and all ten grabbed the rope. Unfortunately, the helicopter was unable to lift all ten off the roof because it was simply too much weight.

Then the pilot said over the loudspeaker, " I am sorry, but I am unable to lift all of you. You will have to decide who remains whil I lift the others. I will return as soon as possible."

At first everyone simply clung to the rope and no one let go.

Then the woman spoke, "I am a woman and used to sacrifice ... I sacrifieced for my kids, my husband, my home, my career, my church and so one more sacrifice will be acceptable to me."

"I hope you remember me and my sacrifice for you with kindness."

The men clapped.


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Duck Blind

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Did you ever work real hard on a project - and have a feeling that it was go

ing to end up like this?


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Deep Relief

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Lost Dog

Japanese Hyperbaric Medical Society News

News from the UHMS Newsletter, "PRESSURE"-July/August/September/October 05

YOSHHIRO MANO AND MAHITO KAWASHIMA LEAD THE UHMS AFFILIATE JHMS

Tokyo , Japan . Yoshihiro Mano, M.D., Ph.D. has been elected as Chairman of the UHMS affiliate society, the Japanese Hyperbaric Medical Society (JHMS). Dr. Mano has been a Professor and Department Head at Tokyo Medical And Dental University for several years. He was the prime force behind the construction of an ultra-modern hyperbaric medicine treatment facility at the university hospital that has been consistently busy since it opened. He is a long time member of the UHMS and has served on several committees from time to time.

Another long-time member of the UHMS, Mahito Kawashima, M.D., Ph.D. was elected as Vice Chairman of the JHMS. Dr. Kawashima is the Executive Director of Kawashima Orthopedic Hospital in Nakatsu City , Japan where he, too, has a very active hyperbaric treatment facility in his hospital.

The JHMS is undergoing change from a voluntary society to an approval corporative society and is scheduled to make this organizational change in September, 2005. With Dr.’s Mano and Kawashima in charge of the reorganization, all who know them will agree the change will go smoothly.

Tuesday, October 25, 2005

INTERNATIONAL SOCIETY OF AQUATIC MEDICINE, 31st Annual Spring Meeting

Executive Office • 6240 Turtle Hall Drive • Wilmington, NC 28409
(910) 452-1452 • FAX: (910) 799-5209
E-Mail: DivingDocs @ aol.com • Web Address: www.DivingDocs.orgISAM NEWS

31st Annual Spring Meeting
El Ocotal Beach Resort & Costa Rica Dive
May 20-27, 2006 • 60 Divers • 30 Hours Category 1 CME

The 2006 Annual Spring Meeting will find us at Ocotal Beach Resort in Guanacaste, Costa Rica. Costa Rica Dive, known for their legendary service, will handle our diving.
Costa Rica's North Pacific coast is the diving world's newest discovery. Few places in the world have waters with such varied and plentiful marine life. Costa Rica is known today as a unique dive destination, and not only for its marine life, but because of its many other attractions. Divers have the opportunity to visit National Parks, go white water rafting, sky trekking, zip lining or zipping, big game fishing, horseback riding, bird watching, swim on secluded beaches, enjoy breathtaking sunsets, warm star-filled nights, and feel welcomed by friendly Costa Rican people.

The Ocotal Beach Resort is a small luxurious hideaway where visitors can relax and enjoy the marvels of the Pacific Ocean in year round summer weather. Ocotal is only 2 miles from Playas del Coco, a quiet fishing village and vacations center, where guests can get a taste of local color and nightlife. Ocotal is also Costa Rica's premier diving resort. ISAM has reserved a special block of rooms that are hilltop full ocean view accommodations for our 2006 Spring Meeting. We have boats arranged for our group’s exclusive use during the dive week. Rolando Arburola, owner of Costa Rica Dive, will personally escort our group and dive with us in Costa Rica. We want ISAM members to personally experience the famous service of Costa Rica Dive. If you check out the scuba internet forums you will find Rolando's services highly praised.

The ISAM dive group has scheduled 3 days of local dives and 2 days of diving at Catalina Islands, which offers exciting pacific big animal action. These spectacular pinnacles are 14 miles from Ocotal Beach Resort. Mantas school here in large numbers between December and May. Monkey Head is a local dive site the ISAM divers will visit. Spotted Eagle Rays glide though here by the dozen. ISAM will dive Vidor, a singular rock formation, known for its giant morays and whale sharks. On most dives large schools of fish allow divers to swim freely among them. The local dive site, Punta Gorda, has been reported to have thousands of Cow-Nosed Rays swim by in columns. At the local dive site, Las Corridas, divers have come face to face with 200 to 300 Jewfish. At these same spots photographers may catch a tiny Sea Horse or Hawk Fish among the hydroids. On any of the dives with Costa Rica Dive you will be amazed by the tremendous variety of marine life and big pelagics in the water. The volcanic rock formations of Costa Rica’s northern gold coast provide a spectacular setting for some of the world’s best diving.

KEYNOTE SPEAKER: Kenneth Kizer, MD, will be featured as our keynote speaker. Ann Barker-Griffith, MD, of SUNY Upstate Medical University will conduct the scientific sessions. Dr. Kizer was once the highest-ranking physician in the federal Government and a recipient of the 2004 Gustav O. Lienhard Award, the topmost award given by the Institute of Medicine of the National Academy of Sciences. Dr. Kizer is widely credited as being the chief Architect and driving force behind the greatest transformation of VA Healthcare since the system was created in 1946. He served for five years as the Under Secretary for Health in the U.S. Department of Veteran Affairs. Presently, he serves as President and Chief Executive Officer of the National Quality Forum (NQF) in Washington, DC, where he has been voted one the "100 Most Powerful People in Health Care." Each year the Modern Healthcare magazine has been compiling this list. The NQF is a private, not-forprofit, corporation whose mission is to increase the delivery of high-quality American healthcare. Dr. Kizer is board certified in six medical specialties or subspecialties and is the author of over 350 articles, book chapters, and published medical reports. He is a former Navy diver and nationally recognized expert on diving and aquatic sports medicine, as well as a fellow of 10 professional Societies and several honorary organizations.


EL OCOTAL REGISTRATION
Member: _________________________________________________ T-Shirt Sizes: _____ _____ _____ _____
Guest: ___________________________________________________
Address: ________________________________________________________________________________________________________
City:__________________________________ State________ Zip:__________ Phone:__________________ Fax:________________
I would like Traveler's Choice to make airline reservations for ___________ persons
Departure City: _____________________________________ Airport Preference: ________________________________________
Please charge my airline ticket to the following credit card: Credit Card Name: _________________________________________________
Credit Card Number:_____________________________ Expiration Date:_________ Signature: _______________________________
Please call Traveler's Choice for Airline Reservations at (910) 452-1452. E-Mail: DivingDocs @ aol.com
$500 Deposit per person required at this time.
ISAM/Traveler's Choice • 6240 Turtle Hall Drive • Wilmington, NC 28409
#
INTERNATIONAL SOCIETY OF
AQUATIC MEDICINE
6240 Turtle Hall Drive
Wilmington, NC 28409
(910) 452-1452 • FAX: (910) 799-5209
Sam the Dolphin
E-Mail: DivingDocs @ aol.com
Web Address: www.DivingDocs.org
Costa Rica Dive
The Best of Costa Rica
May 20-27, 2006
31st Annual Spring Meeting
CREDITS AND OUTDOOR ACTIVITIES: Our next annual Spring
Meeting will be filled with great diving and stimulating medical
lectures. We hope to see you there!
CONFERENCE OBJECTIVES: ISAM is an association of diving
physicians dedicated to the promulgation of diving medicine
information to physicians in the United States and foreign
countries. The conference will include the study of such
topic as underwater physiology, diagnosis and treatment of
decompression sickness, physical examinations for divers,
and the treatment of injuries caused by poisonous and venomous
animals.
COSTS: Per person/double occupancy (No airfare included in this price. All
prices subject to change). Air fare should be purchased into Liberia, Costa
Rica.
Diver: ........................................................................ $1995.00 per person
Non-Diver: ................................................................ $1595.00 per person
Single Supplement: .................................................. $ 395.00 per person
Yearly dues to be current: ............................................................... $90.00
GROUP PACKAGE INCLUDES: 7 nights Hill Top Full Ocean View accommodations based on double occupancy, Breakfast, Lunch and Dinner Daily, Welcome Cocktail Party on Sunday evening, Airport Transfers from Liberia, Costa Rica, All taxes, 5 days of diving with 2 dives per day, 3 days of local diving, 2 days of, diving at Catalina Island, Gratuities to dive guides, 30 hours Category 1 CME
REQUIRED EQUIPMENT: C cards
RESPONSIBILITY: ISAM, Traveler’s Choice, Ocotal Beach
Resort and Dive Operation and Costa Rica Dive assume no responsibility or liability
as to the safety, quality of conditions, nor for the act of any employee or agent of
any establishments, firm, person or entity furnishing such services, transportation,
equipment, substitution or unperformed services, nor assume any responsibility
or liability for the safety of any participating individuals while engaged in
underwater activities. All trip participants will be required to sign an ISAM/Traveler's Choice liability waiver.

Thanks in advance!
Bridget

Bridget K. Thomas, RN, MSN
International Society of Aquatic Medicine
Executive Secretary
6240 Turtle Hall Dr
Wilmington, NC 28409
Telephone 910 452 1452
Fax 910 799 5209
web page www.divingdocs.org

Monday, October 24, 2005

Surgical Considerations Related to Diving

General Guidelines

A. Consider the illness or condition being operated upon and any relationship to the diving environment

B. Consider the physical limitations imposed as a result of the operation
Short term
Rate of wound healing of the specific body system
Complications (infection, wound disruption, temporary loss of function)
Long term
Disability from any source reducing the diver's functional ability.

C. Implants of any nature
Any implant that does not contain air or gas should not be a contraindication to diving. This includes all metallic, silicone, composite and fluid filled sacs. These objects are not compressible and therefore pose no danger to the diver. Any air or gas filled implant, such as an artificial eye or any other reconstructive body part is at hazard to explode or rupture due to the action of Boyle's Law.

D. Return to diving after surgery (See this web site under specific body system)
Neurological System
Link includes 'Brain, shunt surgery, herniated disc'
Eye
Link includes 'Diving after Eye Surgery', 'Post-surgical Waiting Period'
ENT
Absolute post-operative contraindications
Tympanoplasty, other than myringoplasty (Type I)
History of stapedectomy [This is being debated at this time].
History of inner ear surgery
Status post laryngectomy or partial laryngectomy
Radical mastoidectomy (posterior) involving the external canal is
disqualifying. (Closed childhood OK)
Tracheostomy, tracheostoma
Incompetent larynx due to surgery (Cannot close for valsalva
maneuver)
Heart
Cardiac and valvular surgery
Surgery without entering the chest cavity; six to eight weeks or whenever the diver has physically rehabilitated to reach 13 METS on the treadmill.
Surgery with entry into the chest for whatever reason; see thoracotomy.
Pulmonary
Thoracotomy
Pulmonary System: Patients with a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. Post operative wait of 12 weeks; surgical release recommended. Should be studied to rule out air trapping.

Lobectomy or pneumonectomy patients usually fill in the 'dead space' from the loss of tissue with fluid and scar. Depending on the cause of the surgery, postoperative course and results of pulmonary function and scans a person might be allowed to return to diving with the approval of their physician.

Divers with pulmonary barotrauma may return to diving after no less than a three month wait and a certification from a diving physician that there is no air trapping.


Gastrointestinal
A history of bowel obstruction is not disqualifying if the person is asymptomatic 3 months after corrective surgery. Wait six to 12 weeks postoperative before diving. Surgeon's advice recommended.

The postoperative wait after laparotomy depends greatly upon the cause for the surgery and the extent of surgery involved. A postoperative wait of six to twelve weeks is recommended, again with the approval of the diver's surgeon. Continent urostomy or ileostomy contraindicates diving because of Boyle's law.

A hernia that includes bowel is disqualifying until surgically repaired. A wait of 6 weeks is suggested for the simple repair. Advice of surgeon suggested.

Bone & Joint
Prostheses, joint surgery, fractures
Return to diving is entirely dependent on evidence of complete healing. Weight-bearing with 100 plus pounds of gear, exits and entries should be carefully considered by the surgeon before certifying return to diving. The effects of pressure and bubbling on the operative site are unknown at this time.

Diving after Urinary Tract Surgery

---Should await clearance by the operating surgeon
---Post op wait depends on the type and extent of surgery done
---Surgical incisions should be completely healed without infection, drainage or herniation
---Ostomies and appliances should contain no air that cannot be vented
---All medications should be carefully evaluated for symptoms dangerous in the underwater environment
---All postoperative anemia should be corrected


General Advice About Diving

Whether or not a person having had surgery should be certified as 'fit to dive' should be decided on the merits of each case, the type of surgery required, if symtomatic or on medication, and the length of time postoperative free of problems. Most probably can return to diving. Decision making ability, ability to self rescue and rescue other divers residual disabilities that would limit ability to gear up and move in the water should be taken into consideration. Prospective divers should in all cases provide full disclosure to the dive instructor and certifying agency - bearing in mind the safety of buddies, dive instructors, divemasters and other individuals who are always affected by diving incidents.

DAN Diving and Hyperbaric Medicine Course

Divers Alert Network will offer its 56th Diving and Hyperbaric Medicine Course April 22-29, 2006 in Cayman Brac.

For complete information go to http://www.diversalertnetwork.org/news/download/DAN%20CME.pdf.

Faculty include Drs. Guy Dear, James Caruso, Michael Curley, Neil Hampson, Brett Stolp, Karen Van Hoesen and Ms. Donna Uguccioni.

Divers needed for research survey

Dear Scuba Diver:

I need your help. I am writing to ask you to participate in a anonymous research survey. This survey looks at scuba diving practices and any injuries that result from diving. I am an Emergency Medicine resident and an avid dive enthusiast, I am conducting research into dive related injuries and diver safety, and asking scuba divers from the United States to respond. This short survey is administered through the Internet and will take about 10 minutes of your time.

This project was approved by the Institutional Review Board (the committee that oversees research at this institution) at the Resurrection Medical Center in Chicago, Illinois. If you are willing to help with this study, please complete the questionnaire via the link below and return it as directed. One option (unlinked to responses) at the end of the survey provides space for an email address entry for notification of results if you would like a copy.

Thanks and safe diving

Adam Beckett, DO
docadzz312003@yahoo.com

Link to the survey:
https://fs6.formsite.com/RMCEMRP/form298218861/secure_index.html

Dry Diving



If you didn't have decompression sickness and entered a recompression chamber for treatment or demonstration purposes, would there be any medical problems due to hyperbaric treatment when it was not needed?



Treating decompression illness (decompression sickness and arterial gas embolism) is just one of the uses for recompression chambers. They are now being used to treat quite a few other illnesses. In the United States, chamber treatment is approved by Medicare for some 13 conditions.

Being compressed in a chamber is in essence a "dry dive" without the dangers of being in a watery, alien environment. You would, however, be subjected to the same risks of barotrauma to air-containing body spaces and the possibility of ear, lung and sinus problems. If 100 percent oxygen were being used, you would also be at risk of oxygen toxicity if the oxygen intervals and pressure were not properly controlled. "Older divers remember the 'oxygen toxicity' test dives - in days bygone there was the periodic oxygen tolerance test. It was finally decided that the test results were good for the day you took the test without much predictive value. (Glen Egstrom, PhD). Dry dives can be fun if you are in a group with a good sense of humor".

The London Diving Chamber has a website that appears to be promoting a taste of Nitrogen Narcosis in the dry without risk of drowning or DCI. "It is not a bad idea to demonstrate a chamber to a trainee diver; this may both reassure but at the same time endorse the need to avoid an unscheduled visit - at a later date!" (Dr. Nick McIver).

"Dry dives mimic some of the effects of diving, such as N2 narcosis and the increase in gas density. Indeed, much of what we know about diving physiology comes from experiments in dry chambers. However, neither equipment not humans behave exactly the same in the water as in the dry". (Richard Moon, MD).

Captain Dick Carson, USN (Ret) (PADI Instr) recounts the following about 'dry dives'. "Being a frequent diver at Stoney Cove near Birmingham in England, I was often amazed as the dive store there used their mini-chamber to assemble semi-dry suits. The near 1-inch thick neoprene suit was compressed while taking the store clerk "down" to the point the "Whites Valve" could be installed on the suit at the location specified by the buyer. I did not time the "dive" but it seemed a bounce dive at the time. Another use for a chamber, and risks discounted." The USN practiced similar events for wannabe pilots up to the mid 90's as I recall to determine if the student was "susceptible to the bends."

Dr. Ed Kay relates that, "We still do (more conservative) dry chamber runs for scuba clubs and others interested in commercial diving at the Divers Institute (DIT)."

Dr. Allen Dekelboum describes his experience doing a dry dive with his course at NOAA. " We dove 200 feet on air and then on helium. For the air dive, we were all extremely narced, but we were told we had a great time. No one got bent, but I did have a very slight case of niggles on the helium dive, all disappearing very quickly on 100% O2 ."

Other comments include: "It circumnavigates the actual causes of diving deaths, and so it probably does little harm". (Carl Edmonds, MD). "A clever way to support running a chamber. Trying to experience narcosis in a relatively safe environment isn't totally a bad idea." (Ed Golembe, MD)

Some side effects of hyperbaric oxygenation treatment include seizures and lung damage from oxygen toxicity, finger numbness, inflamed middle ear and refractive changes in the lens of the eye.
In a 10-year study of 1,505 patients who received 52,758 2-hour HBO treatments at 2.4 ata once or twice daily (The maximum treatment protocol used for problem wounds around the world), the following side effects were noted:
Inability to equalize middle ear pressure 0.37%
Paranasal sinus blocks 0.09%
Confinement anxiety 0.05%
Oxygen convulsions 0.009% (all ceased after removing hood/masks)
Pulmonary oxygen toxicity 0.00%
Permanent ocular refractive changes 0.00%

Some of the contraindications for hyperbaric oxygenation are listed here. These could also apply to dry diving - but in each instance the person would probably not be certified as 'fit to dive' anyway.
1. Asthma - Small airway hyper-reactivity may result in air trapping and pulmonary barotrauma on ascent. A decision to treat such patients should not be undertaken lightly, particularly in light of evidence that the administration of some bronchodilators may increase the incidence of cerebral arterial gas embolism through pulmonary shunts from vasodilation. .
2. Congenital spherocytosis - Such patients have fragile red cells and treatment may result in massive hemolysis
3. Cisplatinum - There is some evidence that this drug retards wound healing when combined with HBO.
4. Disulphiram (Antabuse) - There is evidence to suggest that this drug blocks the production of suproxide dismutase and this may severely effect the body's defenses against oxygen free radicals. Experimental evidence suggest that a single exposure to HBO is safe but that subsequent treatments may be unwise. Whether or not this would apply to air diving is unknown.
5. Doxorubicin - (Adriamycin). This chemotherapeutic agent becomes increasingly toxic under pressure and animal studies suggest at least a one week break between last dose and first treatment in the chamber.
6. Emphysema with CO2 retention - Caution should be exercised in giving high pressures + concentrations of oxygen to patients who may be existing on the hypoxic drive to ventilation. Such patients may become apneic in the chamber and require IPPV (intermittent positive pressure ventilation). In addition, gas trapping and subsequent lung rupture are associated with bullous disease.
7. High Fevers - High fevers (>38.5degC) tend to lower the seizure threshold due to O2 toxicity and may result in delaying of relatively routine therapy. If patients are to be treated then attempt should be made to lower their core temperature with antipyretics and physical measures. Whether or not this would apply to air diving is unknown.
8. History of middle ear surgery or disorders - These patients may be unable to clear their ears, or risk further injury with vigorous attempts to do so. An ENT consult for possible placement of tubes is usually wise. The risk for a dry dive would not be worth the benefit.
9. History of seizures - HBO therapy may lower the seizure threshold and some workers advocate increasing the baseline medication for such patients. Whether or not this would apply to air diving is unknown.
10. Optic Neuritis - There have been reports in patients with a history of optic neuritis of failing sight and even blindness after HBO therapy. This complaint would seem to be extremely rare but of tragic consequence. Whether or not this would apply to air diving is unknown.
11. Pneumothorax - A pocket of trapped gas in the pleura will decrease in volume on compression and re-expand on surfacing during a cycle of HBO therapy. During oxygen breathing at depth nitrogen will be absorbed from the space and replaced with oxygen. These fluxes of gases and absolute changes in volume may result in further lung damage and or arterial gas embolization. If there is a communication between lung and pneumothorax with a tension component, then a potentially dangerous situation exists as the patient is brought to the surface. As Boyle's Law predicts, a 1.8 litre pneumothorax at 20 msw is potentially a 6 litre pneumothorax at sea level - certainly a life threatening situation. For this reason it is mandatory to place a chest tube to relieve a pneumothorax before contemplating HBO therapy. Particular care must be taken with patients who give a history of chest trauma or thoracic surgery. Whether or not this would apply to air diving is unknown.
12. Pregnancy - The fears that either retrolental fibroplasia or closure of the ductuc arteriosus may result in the fetus whose mother undergoes HBO appear to be groundless from considerable Russian experience. However, HHI continues to exercise caution in limiting treatment of pregnant women to emergency situations.
13. Upper Respiratory Tract Infections - These are relative contra-indications due to the difficulty such patients may have in clearing their ears and sinuses. Elective treatment may be best postponed for a few days in such cases.
14. Viral Infections - Many workers in the past have expressed concern that viral infections may be considerably worsened after HBO. There have been no studies to give convincing evidence of this and no reported activation of herpetic lesions associated with HBO.
For more information, go to: www.scuba-doc.com/hbocont.htm.

Ern Campbell, MD
Scubadoc's Diving Medicine
http://scuba-doc.com/

Diving Headaches

After diving, many people get minor to severe headaches. What's causing this? There are many different types of headaches, and if persistent, you'll need to visit a doctor familiar with diving for a thorough examination to determine whether yours are related to diving.

Most diving headaches are caused by either carbon dioxide retention or sinus barotrauma. However, there are other causes and here are some things you can do to prevent them from ruining your dives.

Carbon Dioxide Headaches

Symptoms: Post-dive localized throbbing pain

The carbon dioxide headache, one of the most common for divers, is caused by an increase in the body's carbon dioxide level, which stimulates receptors in the brain's blood vessels, causing them to dilate. An increase in the brain's blood flow to these receptors leads to headaches. Typically, they are caused by a diver taking shallow sips of air, which allows carbon dioxide to accumulate. This buildup can also occur when a diver "skip breathes" by pausing after each inhalation and holding the throat closed. Taking measured, slow, complete breaths under water is the best way to avoid carbon dioxide headaches, which don't respond to analgesics or migraine medications.

Tension Headaches

Symptoms: Post-dive neck and head pain

New divers often experience tension headaches resulting from the stress of their first experiences in the underwater world. Clenched jaws and muscular stress in the neck and back of the head from the hyperextended position required for diving lead to these types of headaches, which usually disappear once the diver gains experience and becomes more relaxed under water.

Migraine Headaches

Symptoms: Severe headaches with nausea

Post-dive vomiting can be caused by a migraine headache, but, if coupled with other symptoms, could possibly indicate a headache caused by decompression sickness. If the diver has a history of migraine headaches, then there could be a direct correlation between diving and the onset of the cranial pressure. Unless they are able to take measures to prevent a migraine attack, people with migraines should not dive. If the diver has migraines accompanied by aura (visual anomalies), he should be checked for patent foramen ovale, which may be a factor in undeserved DCS hits.

DCS Headaches

Symptoms: Post-dive headache with neurological deficit

A headache that comes on strong after a dive, coupled with other symptoms like nausea, vomiting, joint pain, dizziness, ringing in the ears, muscle aches, localized swelling, itching or skin rash, could indicate the onset of Type II decompression illness or an arterial gas embolism. This, the most severe dive-related headache, requires a quick response from onboard personnel and a call to the Divers Alert Network to coordinate hyperbaric treatment.

Sinus Headaches

Symptoms: Forehead, face and eye pain during ascent or descent

A diver without a history of migraines could be suffering from a sinus headache, especially if he has a history of problems equalizing. Shifting pressure based on changes in depth without proper equalization can lead to sinus barotrauma. This pain usually spreads across the forehead and eyes. Thus, inflammation of the sinuses, caused by colds or allergies, can further complicate diving.

For more about this see our web site at the following pages:

http://www.scuba-doc.com/headache.html
http://www.scuba-doc.com/mgrns.htm

Wednesday, October 19, 2005

Online Eric Douglas Diving Short Story Available Now

Complete short story now online


Divers everywhere interested in adventure fiction can feed that craving for free.


Eric Douglas, author of Cayman Cowboys, has just published the fourth and final installment of the dive adventure short story Going Down with the Ship online. The story can be found on the Scuba Radio website and Dive Now in the Netherlands.


GDWS is an adventure story set on a fictional island in the Florida Keys. It follows the adventures of an environmental activist and a local dive instructor when they discover something is not right with the sinking of a new artificial reef.


Scuba Radio is a nationally-syndicated radio show. And Dive Now is an online retailer that specializes in dive books. Check out the complete story on www.scubaradio.com or www.divenow.nl or visit the website for Cayman Cowboys at www.booksbyeric.com.


Need diving medical queries answered? Go to our Scuba Clinic Forum for quick, authoritative answers.

UHMS Classified Ads (Most recent first)


EMERGENCY MEDICINE/HYPERBARIC MEDICINE FACULTY PHYSICIAN

The Department of Emergency Medicine at SUNY Upstate Medical University, in Syracuse, NY, is seeking an Emergency Medicine/Hyperbaric Medicine physician. Clinical responsibilities include patient care and attending supervision in the University Hospital ED, as well as in the Hyperbaric Medicine Program. Academic responsibilities include teaching and scholarly activity.

University Hospital is a 350 bed Level I Trauma Center with an ED census of 52,000 patients per year, and a dedicated Pediatric ED. Other Department activities include: Poison Control Center, EM Residency Program, fellowships in Pediatric EM and EMS, Simulation Training/Research Center, Paramedic Training Program, Center for Emergency Preparedness, Flight Program, and participation in National and Regional EMS activities.

An excellent compensation and benefit package is offered, including relocation expenses. Protected time is also provided for research and academic missions. Qualified candidates are invited to send a signed letter of interest, CV, and three letters of recommendation to:

John McCabe, MD, FACEP

Professor and Chair

Department of Emergency Medicine

SUNY Upstate Medical University

750 East Adams Street

Syracuse, NY 13210
315-4649500

mccabej@upstate.edu



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

CHT or Hyperbaric Tech - Immediate Need

Huntington Beach Hospital Wound Care and Hyperbaric Medicine Center is seeking an experienced Hyperbaric Tech or CHT for per-diem mono-place chamber operations

Qualifications:
Hyperbaric chamber operations

Current certification as a CHT required

EMT certification and Computer skills preferred

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

Send resume to Rob Moryl, CHT

Safety Director, Hyperbaric Medicine

Huntington Beach Hospital

17772 Beach Blvd.

Huntington Beach, CA 92647-9932

Office: (714) 843-5530

Fax: (714) 843-5531

Robert.Moryl@hbhoc.com

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

Assistant Director


Assistant Director position open in a busy Comprehensive Wound Center in Luling, TX. Luling is easy driving distance from San Antonio and Austin. Position is 50% clinical, 50% administrative. RN required, BSN and management experience preferred. For more information contact Valerie 210-592-5349.

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Certified HBOT Technician Wanted



Certified or eligible for certification, HBOT technician wanted for new HBO program at premier hospital in Northern Kentucky / Cincinnati Ohio. Hospital has large outpatient Wound Care Center. Need your skills ASAP. Call Steve Telford, St Elizabeth Medical Center, at (859) 815-1005.

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

HBOT FACILITY FOR SALE

HBOT facility in Parsippany, NJ for sale.

3 Sechrist 2500 re-windowed monoplace chambers

2500 sq ft of office space

Visit www.njhbot.com or contact Julia at 973.951.4894

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2006 Winter Symposium on Hyperbaric Medicine and Wound Management

2006 Winter Symposium on Hyperbaric Medicine and Wound Management
January 29th - 31st, 2006

Copper Mountain Resort, Colorado

20 hours of CME in the Rockies!

Call for Abstracts and Conference Information is Posted at the Conference Website:

www.hbodoctor.com

Sponsored by Memorial Hospital and UHMS



More information about HBOT on our web site.

Monday, October 17, 2005

Shawn Beaty's Death Not An Accident-Industry Is Asked for Help!

The death of well-known and popular dive industry figure Shawn Beaty is being investigated as a homicide. Your help with the investigation is appreciated! Family has offered a $25K reward for information.

Jerry Beaty and the entire Beaty family feel it is time for the dive industry -- which has been their extended family for so many years -- to know the truth about Shawn’s death. It wasn’t an accident. Shawn was brutally murdered in her home on the night of January 31, 2005.

Shawn had been in the dive industry for over twenty years. She was a founding partner of Sun and Recreation Sports, a company that represented many major scuba equipment manufacturers. On her own she created a successful dive travel agency, All Sun Tours. Upon selling these two companies, she was hired as the Classified Manager for Dive Training magazine. She quickly demonstrated her talents in advertising and sales and was promoted to Territorial Sales Manager of Mexico and Latin America. She pioneered these two territories with tremendous success. Her career was one of the most important achievements in her life – second only to her marriage and family -- and she was very proud of her accomplishments.

To learn that Shawn’s death was not a tragic accident, but a brutal cold-blooded murder, has been a crushing blow to Jerry, Shawn and Jerry’s children and their entire family.

Initially, investigators asked that Jerry not comment on the matter. However, months have passed without an arrest or any solid leads. It is clear that the investigation has stalled.

All those who knew and loved Shawn must understand that we can’t sit by and let her murder investigation be relegated to the “cold case files.”

We want answers. And we need your help. The family is requesting that you contact the Oklahoma State Attorney General to insist that every available resource be employed to find Shawn’s killer or killers and see that justice is served. Please email, fax or call the Attorney General:

District Attorney Emily Redman – District 19

Phone: 580 – 924 - 4032

Fax: 580 – 924 - 3596

Email: emily_redman-da@shawnbeaty.com

In addition the family has issued a $25,000 for arrest and conviction of anyone involved in the murder.

Jerry wants to thank you for all the love and sympathy he has received during the last several months and to thank you in advance for your continued support in this matter.

Thursday, October 13, 2005

Katrina/Rita -Letter from Don Chandler, Exe. Director, UHMS

To all--

I have not sent an update for some time now, but please forgive me as I have been occupied with a couple of trips away from the office (DEMA and meeting with our publisher of the ONR book that is just about finished). In any case, I am sure you know that recovery is underway in the devastated areas but the danger of CO poisoning is still a very real threat...maybe even more so now what with "mud-out" operations where portable power washers will be used.

You have read the good news, considering the damage Katrina did, about the NBDMT spaces in Dr. VanMeter's facility...it could have been much worse and we are thankful that people are beginning to get things in order so they can operate in a somewhat normal manner. With Pauline and Melissa back at work and Dr. VanMeter's staff working hard making repairs we can expect that things will soon be ship-shape once again.

Dr. Mark Silady sent us notice that the Department of Hyperbaric Medicine at Slidell Memorial Hospital is again available for consults and wound care. This is good news and is indicative of the recovery that is in progress...slow, but certain.

Remember that if any of you who were displaced by Katrina needs a roof over your head, Helen Gelly has a house in Western North Carolina (as she says, "...far from the hurricanes") that sits empty most of the year. She is willing to make it available during the fall and winter. Just email her at hbowound@aol.com

Julio Garcia, Center Director at Springhill Medical Center in Mobile AL reported that "...the number of injuries and fatalities along the central Gulf Coast as related to generator usage is heartbreaking." Julio has done a yeoman's job of informing the local news media of the danger of improper/unsafe use of portable generators.

Our Immediate Past President, Dr. Neil Hampson is still working with the CDC with matters related to CO poisoning. Just in case you haven't had the opportunity to read the CDC's Morbidity and Mortality Weekly Report concerning Dr. Hampson's (and others) work with them concerning the very present danger, please see the attached...it's good reading and gives the UHMS a couple of good plugs.

Not of this subject, but important, is to encourage you to put our 2006 annual meeting in Orlando on your calendar as well as our 40th anniversary annual meeting in Maui, Hawaii in 2007. Not only are the rates Lisa negotiated in Orlando good ones, she also arranged for terrific reduced room rates in Maui (just over $200 for a 5-star resort yet!) that will include about 50 rooms at the government per diem rate of about $160. Both meetings are in mid-June and keep looking at our website www.uhms.org for updates and additional information.

Finally, please be reminded that our temporary job listing for HBO employees displaced by the hurricanes is still active. Indeed, there are some permanent positions also listed. You will see the link as soon as you open our website page.

Keep the news coming of recovery activities and I will keep distributing it to our members.

Don

Wednesday, October 12, 2005

Drinking beer and Diving? Not such a good idea!

Scuba divers are at increased risk of alcohol related injuries and fatalities. There is a definite increased decompression risk for a diver who drinks alcohol before, during and shortly after diving. This is due to the obligatory diuresis caused by the alcohol resulting in dehydration.

In addition, there are other cautionaries that should be recognized. These include the possibility of alcohol-induced hypoglycemia and loss of consciousness while diving, mental obtundation, cognition problems and the additive effect of nitrogen narcosis to the already narcotized brain.

Here is some information condensed from our web site , "Alcohol and Diving" at http://www.scuba-doc.com/alch.htm . Some divers insist on drinking beer before, during and after their dives. Is there any danger in drinking alcoholic beverages and diving? The short answer is that by drinking alcohol before and during diving trips a diver severely endangers not only himself but his buddy!

Research has shown that there is a definite reduction in the ability of the individual to process information, particularly in tasks that require undivided attention - for many hours after the blood alcohol level has returned to normal. This means that the risk for injury of a hungover diver is increased significantly, particularly if high BAC levels were reached during the drinking episode.

The AMA upper limit of the BAC for driving a vehicle in the US is 0.05%. Surely diving with any alcohol on board would be foolish, considering the alien environment (water) and the complex skills required to follow no deco procedures.

All of the following behavioral components required for safe diving are diminished when alcohol is on board or has been on board in the prior 24 hours:

Reaction time
Visual tracking performance
Concentrated attention
Ability to process information in divided tasks
Perception (Judgment)
The execution of psychomotor tasks.

The individual who has alcohol onboard may not feel impaired or even appear impaired to the observer but definitely is impaired and this is persistent for extended periods of time. The use of alcohol, even in moderate doses, clearly carries a self-destructive aspect of behavior and leads to higher probabilities for serious accidents.

If you or your drinking buddy are intelligent divers, surely you will understand that this is not preaching - a cool beer is highly appreciated by the author - but by drinking and diving one can turn a safe sport into a nightmare for himself and his family.

A study by Perrine, Mundt and Weiner found (scuba) diving performances significantly degraded at blood alcohol levels of 40 mg/dl (04%BAC). They also cite a clear increase in the risk of injury at this level which can be reached by a 180 lb. man who ingests two 12 oz. beers in 1 hour on an empty stomach. This very pertinent study once again points out that there is a diminished awareness of cues and reduced inhibitions at relatively low levels of blood alcohol. Their study used well trained divers who were being paid to do their best as their diving performances were being videotaped.

My friend, Dr. Glen Egstrom, PhD has stated the problem succinctly. He made personal review of over 150 studies on the effects of alcohol on performance has resulted in the following observations:

1. Ingestion of even small amounts of alcohol does not improve performance: to the contrary it degrades performance

2. While there are variables that can speed up or delay the onset of the effects of alcohol, they are minor issues which do not overcome the decrements to the central and peripheral nervous system.

3. Alcohol can be cleared from the blood at a predictable rate. Generally on the order of .015% BAC per hour. This does not necessarily mean that the decrements in performance have been completely eliminated in that time.

4. Alcohol is a depressant drug that slows certain body functions by depressing the entire central nervous system. Effects are noticeable after one drink.

5. The effects are mood elevation, mild euphoria, a sense of well being, slight dizziness and some impairment of judgment, self control, inhibitions and memory.

6. Increases in reaction time and decreases in coordination follow the dose/response curve quite well.

7. Alcohol is involved in 50% +/- of all accidents involving persons of drinking age.

8. The deleterious effects of alcohol on performance are consistently underestimated by persons who have been drinking alcohol.

9. Divided attention tasks are found to be affected by alcohol to a greater degree than those tasks with single focus of concentration, i.e. a task such as a head-first dive into shallow water, with many interrelated decisions necessary to a successful dive, will be impacted to a greater degree than lifting a heavy weight.

Here's a good corollary, as flying and diving are somewhat similar in the hazards encountered:
http://www.cami.jccbi.gov/AAM-400A/400alcohol.html

http://cgi.canoe.ca/HealthReference/arf_alcohol1.html

References:
--Alcohol use and aquatic activities--Massachusetts. (1990). Journal Of The American Medical Association -(Chicago), 264(1), 19-20.
--Fowler and Adams found that alcohol exacerbates the slowing of reaction time (RT) produced by inert gas narcosis. "Dissociation of the effects of alcohol and amphetamine on inert gas narcosis using reaction time and P300 latency." Aviat Space Environ Med 1993 Jun; 64(6):493-9
-- Michalodimitrakis E, et al.
Nitrogen narcosis and alcohol consumption--a scuba diving fatality.
J Forensic Sci. 1987 Jul;32(4):1095-7.
-- Fowler B, et al.
Effects of ethanol and amphetamine on inert gas narcosis in humans.
Undersea Biomed Res. 1986 Sep;13(3):345-54.
--. Monteiro MG, et al. Comparison between subjective feelings to alcohol and nitrogen narcosis: a pilot study. Monteiro et al, found in a pilot study in 1996 that ethanol and nitrogen may share the same mechanisms of action in the brain and that biological differences might account for interindividual variability of responses to both ethanol and nitrogen
Alcohol. 1996 Jan-Feb;13(1):75-8.
--Hamilton K, et al.
Nitrogen narcosis and ethyl alcohol increase the gain of the vestibular ocular reflex.
Undersea Biomed Res. 1989 Mar;16(2):129-37.

Tuesday, October 11, 2005

New UKSDMC Depression Guidelines, from Dr. Patrick Farrell

The UK Sport Diving Medical Committee has posted new guidelines for diving with depression and anti-depressants. In addition, there is also a questionaire form posted for follow-up of these individuals.

These can be seen at the UKSDMC web site at
http://www.uksdmc.co.uk/newsletters/UKSDMC_Depression_Guidline.doc
http://www.uksdmc.co.uk/newsletters/depression_questionaire.doc

We have reproduced these below in case you are unable to access the site.

**************************************************************************
UKSDMC Depression & Antidepressants Guideline

Depression in the UK is very common. Most cases are managed in primary care with only the most severe requiring specialist assessment & treatment. Secondary care doctors will come across patients who are taking antidepressants on a regular basis.

The aim of this guideline is to provide a basis for the assessment of divers who wish to dive whilst taking antidepressants.

Depression is a condition where the patient experiences a disorder of mood. They complain of “being down”, unhappy, sad, tearful, poor sleep, feelings of hopelessness & worthlessness, poor concentration & decision making, occasionally thoughts of self harm & suicide. These symptoms are also observed by close friends & relatives.

The cardinal diagnostic features are
Poor sleep
A black cloud hanging over the day when they waken
An inability to get pleasure from things such as hobbies that formerly provided pleasure.

The full diagnostic features are listed in ICD10
http://www3.who.int/icd/vol1htm2003/fr-icd.htm

The concerns are that a diver who is suffering from depression may not be able to function in the water due to anxiety, poor concentration & decision making, or the irrational decision to use diving as form of suicide. This would put the sufferer & his buddy at risk.

There are also concerns about theoretical risks of diving whilst taking antidepressants.

However a patient who’s depression has “lifted “ & is now clinically cured but requires antidepressants to maintain that state of well being can probably dive safely.

Divers who are taking antidepressants must satisfy the following criteria:

1.Patients should only dive on the newer antidepressants. The older tricyclics reduce the fit threshold, can cause dysrythmias & are sedative. Modern antidepressants such as the SSRIs citalopram, fluoxetine & paroxetine have a low seizure rate of <0.1% compared with the general population. They are also none sedating & do not appear to impair cognitive function.
2.They should only be on one psychotropic medication.
3.They should have been used for a minimum of three months before diving to allow for resolution of side effects e.g. heightened arousal & anxiety.
4.The condition for which they were prescribed should have resolved & treatment should be in the maintenance phase. This means that they should have returned to work & normal daily life.
5.There must be no history of upward mood swings associated with lose of judgement. For upward mood swings to be significant they have to be persistent for at least four days with an unequivocal change in functional mood observed by others. The symptoms include decreased need for sleep, racing thoughts and excessive involvement in pleasurable activities that have a high potential for painful consequences. Thus a history indicating loss of judgement with unrestrained buying sprees, sexual indiscretions etc are incompatible with diving. Antidepressants are known to worsen this condition.
6.There is a significant relapse rate when stopping antidepressants. Following withdrawal, further information regarding the patient’s mental health will need to be obtained from the GP. The patient should also not dive during the withdrawal phase. For short acting antidepressants such as Paroxetine, the suggested period is six weeks.

There is a small but significant inhibition in coagulation in some patients taking SSRIs. This would exacerbate the bleeding phase of DCI. It may also make the bleeding associated with barotrauma worse. It is therefore recommended that the maximum depth should be an E.A.D of 30 meters to minimise the risk of DCI & the slight theoretic risk that they might increase narcosis.

Referee Actions

We would expect the referee having contacted the diver & taken an appropriate history. To write to the patients GP requesting that the questionnaire is filled out. On this basis the referee may be able to sign the form without seeing the patient if there is any doubt the referee will have to see the patient.

The patients medical form & all correspondence should be sent to Dr’s Farrell & Beer at Townsend House, Harepath Rd , Seaton, Devon EX12 2RY.

This is so we can audit any problems with the new guideline .The patient must be asked for their consent for this to happen & be advised that we will be contacting them in one year.

References

Arch Fam Med 1998 7 78-84
J.Clin Psychiatry 2004 65 1642-53

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

Diving with Depression & Antidepressants Guideline Questionnaire

Please answer all questions below, then sign the form & return to the medical referee.
Patients name, D.0, B. address, phone number



1. Please list all medication currently taken by the patient



2. The date of starting the medication. Please confirm compliance with therapy.


3. Please confirm that the depression has lifted, that patient is on maintenance therapy & has returned to normal daily life & work.



4. Please confirm that there have been no upward mood swings



5. If the patient has been withdrawn from medication please confirm that this was at least six weeks ago & that the patient’s mental health is stable.

Signed Surgery Stamp

CO Monoxide poisoning from Hurricane related accidents

The CDC will be winding down their surveillance of the CO poisonings related to Hurricanes Katrina and Rita soon. Thanks to all of you who submitted reports to me. In case you did not see it, a special issue of MMWR was published about the epidemic, with kudos to the UHMS membership (http://scuba-doc.com/Katrina MMWR.pdf).

If you treated any other cases of CO poisoning that we related to the two hurricanes, please email me at neil.hampson@vmmc.org.

Thanks again for your help.

Neil Hampson, MD

Immediate Past-President, UHMS

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http://snipurl.com/ie1q

See also
http://www.scuba-doc.com/divfract.html
http://www.scuba-doc.com/surgdiv.html

Diving and Accutane
http://snipurl.com/ie1s

See also
http://scuba-doc.com/nl103104.pdf

Monday, October 10, 2005

UHMS Northeast Chapter - Still Time to Register

There is still time to register for the upcoming Northeast Chapter meeting, October 15-16, 2005, which will be held at the beautiful Cape Codder Resort & Spa in Hyannis, MA. See schedule below or go to the follow web page: https://www.uhms.org/Chapters/NORTHEAST/NORTHEAST.asp

If you have any questions, please contact me. lisa@uhms.org 410.257.6606 x104

Saturday, October 15



0800-0815 Welcome, Introduction Emmerman, Vandemoer

0815-0915 HBO ( A Clinically Useful Drug to

Ameliorate Extreme Reperfusion Injury) Van Meter

915-1015 Algorithm Based Multi-discipline Wound

Management Center Wassel

1015-1045 Break with Exhibitors

1045-1115 Fitness to Dive in Public Safety Divers:

Why We Should be Involved Wassel

1115-1145 Otic Barotrauma and HBO: Prevention

and Treatment Vandemoer

1145-1215 The Effect of Dive Conditions on the Risk

of Decompression Sickness Denoble


1215-1330 Lunch with Exhibitors (Provided)

1330-1530 HBO Case Presentations with Panel

Discussion Emhoff

1530-1600 Break with Exhibitors

1600-1645 Breakout Sessions

A Physician Session: Discussion of Wound

Care Issues

“Hartford Hospital Center for Wound

Healing and Hyperbaric Medicine:

Review of Program Activity after

Two Years” Perdrizet

Solicited Audience Q and A Vandemoer

B RN, CHT Session: Discussion of HBO

and Wound Care Issues Bello

1645-1715 Summary Report of Breakout Sessions Vandemoer/Bello

1715-1730 Annual Chapter Meeting Emmerman



Sunday, October 16



0800-0810 Opening Remarks Emmerman

0810-0850 Update on Chamber Certification Workman

0850-0915 “HBO and Acute Ischemic Injuries: The

Importance of Timing and Sequence of

Events” Perdrizet

0915-0935 “Prolonged Increases in Troponin T After

Carbon Monoxide Poisoning” Johnson-Arbor

0935-1000 “Hyperbaric Safety Concerns and the ICU

Patient” Shivery

1000-1015 “Eye Prosthesis (Artificial Eye) and HBO” Bello

1015-1030 Break

1030-1055 “Adaptations and Accommodations” Salka

1055-1120 “Nephrogenic Fibrosing Dermopathy: Lower

Extremity Wounds Respond to HBO” Corbett

1120-1145 “Complex Hypospadias Repair: Use of

Adjunctive HBO” Anderson

1145-1200 Panel Q & A/Closing Remarks Bello

UHMS Classified - from Lisa Wasdin

"Senior Hyperbaric Physician, Internationally known and active in the field since 1979. Available for teaching, consultation and short term locums coverage. Licensed in California, Texas, Wisconsin, Washington and Idaho. CV on request to fscramer2000@yahoo.com"

________________________________________


HBOT technician job

Need for outgoing, motivated, self-starter to work in HBO Clinic. Contact: kzs@aol.com



________________________________________





Medical Director Position Available (Full-time)

Location: Guthrie Center for Wound Care and Hyperbaric Medicine, Sayre, PA

Contact: Kathy Murray murray_kathy@guthrie.org, (800) 724-1295, Fax: (570) 882-3098



________________________________________



HBO PHYSICIAN

Provo, Utah: Intermountain Health Care (IHC) is seeking a BE/BC hyperbaric medicine physician for a clinical position and to serve as medical director for our new, state-of-the-art, multi-place hyperbaric center at Utah Valley Regional Medical Center in Provo. The center will have an ongoing relationship with our other centers in St. George and LDS hospital in Salt Lake City with Dr. Lin Weaver. Physician will be required to cover call one week out of four. We offer a competitive salary, which includes compensation for serving as medical director of the unit, and full benefits. There are openings for Department Manager and hyperbaric staff as well. The Provo area is well known for its wide variety of recreational opportunities and outdoor lifestyle. Northern Utah is consistently ranked as one of the best places to live in the country with excellent schools, colleges and universities as well as unsurpassed natural beauty. Sterling’s Best Places named Provo “Least Stressful Mid-Sized City in the Nation” in 2004. It is a beautiful university community of 400,000 built along the slopes of the majestic Wasatch Mountains. This bustling community provides the advantages of a small-town lifestyle along with the amenities offered in more cosmopolitan areas in Salt Lake City just 45 minutes away. Send/fax/e-mail CV to IHC Physician Recruiting, Attn: Wilf Rudert, 36 S. State Street, 20th Floor, Salt Lake City, UT 84111. 800-888-3134, menu option #1. Fax: 801-442-2999. E-mail: PhysicianRecruit@ihc.com. Web: www.ihc.com/physicianrecruiting. IHC is an Equal Opportunity Employer.

_____________________________________________



FOR MORE CLASSIFIEDS, PLEASE VISIT THE FOLLOWING LINKS

http://www.uhms.org/classifieds.htm

http://www.uhms.org/Katrina.htm (MOST OF THESE ARE TEMPORARY, BUT NOT ALL)

LISA

UHMS

News from the National Board of Diving and Hyperbaric Technology



October 8, 2005

To All,

I’m very happy to say that Pauline, Melissa and the “home” office have survived Katrina and Rita. Pauline and Melissa’s homes both suffered some structural damage but they both report that everything is “fixable”. Neither home experienced the terrible flood waters that most of New Orleans did but they did have some water damage from the rains that accompanied each hurricane. They both reported that their “forced” vacations were not something that they want to do again real soon. The office also suffered water damage and even though Dr. Van Meter’s staff is working hard to get everything back to normal (We occupy an office in Dr. Van Meter’s building) it has been slow going. We will expedite replacing and/or repairing everything that was damaged or ruined so that we can once again restore the “service” that we always strive to provide.

Pauline is now occupying our stripped office but she does have electricity, telephone, email service and, we believe, normal postal service. You may once again talk to someone that can actually answer all of your questions. Our phone number has remained the same, 1(504)328-8871.


I want to thank all of you for your concerns, prayers and patience during this terrible time in our history.


Sincerely,

Paul C. Baker, CHT

NBDHMT, President

Dived or dove, which is correct? From Dr. David Colvard

From the Guide to Grammar and Style by Jack Lynch. at Rutgers

Dive, Dived, Dove.

The traditional past-tense form of dive is dived.

Although dove is common in speech, it's probably safer to stick with dived in writing.

See also Sneak, Sneaked, Snuck. [Entry added 12 Jan. 2005.]


Also, the British only use "dived", but Canadians and Americans use "dived" and "dove".

And, verb conjugation is :

to dive I dive; you dive; he, she, it dives; we dive; you dive; they dive I dived/dove; you dived/dove; he, she, it dived/dove; we dived/dove; you dived/dove; they dived/dove dived/dove (Ex: They have dived too deep.)


Finally,

The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.

dive1

PRONUNCIATION: dv
VERB: Inflected forms: dived or dove ( dv), dived, div·ing, dives

INTRANSITIVE VERB: 1a. To plunge, especially headfirst, into water. b. To execute a dive in athletic competition. c. To participate in the sport of competitive diving. 2a. To go toward the bottom of a body of water; submerge. b. To engage in the activity of scuba diving. c. To submerge under power. Used of a submarine. 3a. To fall head down through the air. b. To descend nose down at an acceleration usually exceeding that of free fall. Used of an airplane. c. To engage in the sport of skydiving. 4. To drop sharply and rapidly; plummet: Stock prices dove 100 points in a single day of trading. 5a. To rush headlong and vanish into: dive into a crowd. b. To plunge one's hand into. 6. To lunge: dove for the loose ball. 7. To plunge into an activity or enterprise with vigor and gusto.

TRANSITIVE VERB: To cause (an aircraft, for example) to dive.

NOUN: 1a. A plunge into water, especially done headfirst and in a way established for athletic competition. b. The act or an instance of submerging, as of a submarine or a skin diver. c. A nearly vertical descent at an accelerated speed through the air. d. A quick, pronounced drop. 2a. Slang A disreputable or run-down bar or nightclub. b. A run-down residence. 3. Sports a. A knockout feigned by prearrangement between prizefighters: The challenger took a dive. b. An exaggerated fall, especially by a hockey player, intended to draw a penalty against an opponent. 4a. A lunge or a headlong jump: made a dive to catch the falling teacup. b. Football An offensive play in which the carrier of the ball plunges into the opposing line in order to gain short yardage.

ETYMOLOGY: Middle English diven, from Old English dfan, to dip, and from dfan, to sink; see dheub- in Appendix I.

USAGE NOTE: Either dove or dived is acceptable as the past tense of dive. Usage preferences show regional distribution, although both forms are heard throughout the United States. According to the Dictionary of American Regional English, in the North, dove is more prevalent; in the South Midland, dived. Dived is actually the earlier form, and the emergence of dove may appear anomalous in light of the general tendencies of change in English verb forms. Old English had two classes of verbs: strong verbs, whose past tense was indicated by a change in their vowel (a process that survives in such present-day English verbs as drive/drove or fling/flung ); and weak verbs, whose past was formed with a suffix related to ?ed in Modern English (as in present-day English live/lived and move/moved ). Since the Old English period, many verbs have changed from the strong pattern to the weak one; for example, the past tense of step, formerly stop, became stepped. Over the years, in fact, the weak pattern has become so prevalent that we use the term regular to refer to verbs that form their past tense by suffixation of ?ed. However, there have occasionally been changes in the other direction: the past tense of wear, now wore, was once werede, and that of spit, now spat, was once spitede. The development of dove is an additional example of the small group of verbs that have swum against the historical tide.


The American Heritage® Dictionary of the English Language, Fourth Edition. Copyright © 2000 by Houghton Mifflin Company. Published by the Houghton Mifflin Company. All rights reserved.


David F Colvard
www.DrColvard.com
Raleigh NC USA

Sunday, October 09, 2005

Pearls from the Past - REDUCED GRADIENT BUBBLE MODEL

In our DiveMed Newsletter for Feb 15, 2002, we had the following question and answer(s). These have initiated a really great response from Bruce Wienke et al regarding the differences between the VPM and RGBM bubble models.

Q: Can you explain the difference between VPM and RGBM deco models?
A:
The RGBM is based on the VGM. (Variable Permability Model)
You can read articles by Bruce Wienke on the RGBM here:
http://www.abysmal.com/pages/articles.html . Wienke's book on decompression theory, Basic Decompression Theory and Application (out of print) has additional information and graphs.


While there is little information on the RGBM there is extensive information on the earlier VPM algorithm. Eric Baker's articles and Fortran source code can be found here:
ftp://ftp.decompression.org/pub/Baker/

Along with the information and source codes for the VPM algorithm there is a page discussing aspects of the RGBM with graphs.
http://www.decompression.org/maiken/VPM/VPM_Publications.htm

Useful Articles for tech diving, DIR, Deep stops, etc
http://www.geocities.com/Pipeline/Shore/4331/articles.htm


Here is Bruce Wienke's response to our answers:

Just read your Newsletter Mailbox answer to question about RGBM vs VPM. There is quite a bit more all should know (major differences) -- actually the RGBM abandons the gel physics of the VPM as NOT applicable in toto to blood and tissue. With all due respects to my friend and decreased colleague, David Yount, I must go on record as NOT accepting that VPM gel dynamics apply routinely to the body, nor the properties he studied. Such VPM type bubble seeds have NEVER been found in the body -- nor outside of "gel-like" media. RGBM (EOS) bubbles do recover VPM bubbles in limiting circumstance of material strength and pressure, but that is not important to the RGBM. Naturally occuring bubble "seeds" in the atmosphere and oceans are NOT akin to VPM gel bubbles -- NOR should they be. The body, oceans, and atmosphere are NOT gel.

Consider comments:

1) RGBM does NOT use (VPM) gel bubbles as model for tissue and blood bubbles;

2) RGBM deduces bubble persistence time scales (how long they hang around) FROM seed skin structures (lipid or aqueous), not a-priori weeks as ASSUMED in the VPM;

3) RGBM bubbles are permeable to gas transfer DEPENDING on their skin structure always, NOT at some cutoff pressure as in the VPM gel studies;

4) biophysical equations-of-state (EOS) for lipid and aqueous substances relate seed pressure, temperature, diffusivities to gas transfer, and skin structure in the RGBM, and, as such, are OUTSIDE the VPM;

5) the RGBM transfers gas across the bubble interfaces, the VPM does NOT;

6) See new book "Technical Diving In Depth" by Wienke (Best) for more on same subject.

7) RGBM tables (NAUI Tec nitrox, heliox, trimix Tables), meters (Suunto, Plexus, HydroSpace, "new" ones), and commercial software (ABYSS and some Tim O'Leary and I will release) ABOUND (the past 3 - 4 years), and collectively have logged many 10,000s of technical and recreational dives with only a 2 reported cases of DCS So, RGBM DCS incidence rate is virtually zero, especially on the technical envelope where it matters most as a model test. NOT SO to my best knowledge for the VPM as far as validation, testing and use, though the crude dynamics are likely similar.

8) RGBM successes span technical deco, altitude, and mixed gas diving, which are the real test of any model. Recreational diving is a rather simple limit point for the RGBM -- albeit, an important one just considering diver numbers, but one that tests virtually nobody's deco or staging mode, except for repetitive and reverse profile diving maybe.

9) the RGBM bootstraps parameters to diving data (DCS rate) using maximum likelihood, the VPM does NOT.

10) NAUI RGBM Tables for the recreational diver on air, EAN32, EAN36, from sea level to 10,000 ft elevations have been tested over the past few years, and are being released as simple, no-calc, no group, no-bull tables with simple rules for repets, flying-after-diving, SIs, etc, etc. Check with NAUI Hdqts, or NAUI Tec Ops

11) NAUI RGBM Tec Tables have been forged over the past 8 yrs from operations of the LANL Countermeasures Team, NAUI Tec Instructor Training Courses, reported WKPP extreme diving profiles, and 100s of field reports graciously sent to me (us) by the technical community. (see TDID for more here).

12) Deep stops are natural to both the RGBM and VPM, but RGBM deep stops have NAUI Tec tests and stamps of approval down to 300 fsw on trimix -- ditto for the LANL Team.

13) RGBM modified Haldane meter algorithms are bubble folded schemes that exist in some deco meters, and have been used very successfully for repetitive, reverse profile, and multiday apps, but NOT so with the VPM.

NAUI Worldwide currently has trimix and hyperoxic trimix RGBM tables imbedded within the currently published NAUI trimix instructor guide (since 1998). These tables range from 100 fsw to 240 fsw.

Altitude tables from 2000 to 5000 feet and 5000 to 10000 feet for air and nitrox 32 and 36.

Trimix tables from 80 fsw to 350 fsw with mixes of 16/40 and 10/60

Constant PO2 tables (1.3 and 1.4) for nitrox and trimix from 60 fsw to 350 fsw with bottom times up to 180 minutes. Nitrox tables for FO2's of 28, 30, 32, 36, 40, 50 RGBM Hyperoxic trimix for depth between 80 and 150 fsw with and with out oxygen deco.

Recreational No stop , no calculation RGBM tables are also being published on plastic by NAUI Worldwide for air and nitrox from sea level to 10000 altitude.
These tables are full up RGBM and will not include RNT's and Pressure groups as seen in dissolved gas models. But will instead have delta P's with no stop limits for repts.

Drs Wienke and Tim O'Leary have kindly provided us with the following pdf articles that should be quite helpful in clearing up any confusion.
REDUCED GRADIENT BUBBLE MODEL:
DIVING ALGORITHM, BASIS, AND COMPARISONS (without formulae)
http://www.scuba-doc.com/rgbmim.pdf

REDUCED GRADIENT BUBBLE MODEL:
DIVING ALGORITHM, BASIS, AND COMPARISONS (with formulae)
http://www.scuba-doc.com/rgbm.pdf