The Ten Foot Stop

Ten Foot Stop has moved

2006-09-01T09:31:00.000-05:00

This is to let you know that the address for the Ten Foot Stop has been moved to our in-house blog site at http://scuba-doc.com/tenfootstop/.

Nothing has changed in the format - we will still post items as we find them and as they come in. We will send out a weekly compilation of the posts to our mailing list, just as before. You will also now be able to make comments.

We hope this upgrade will be to your advantage and make reading the posts more enjoyable.

GALVESTON POLICE DEPARTMENT DIVE ACADEMY - Public Safety Diving Seminar - PSDA Underwater Crime Scene Investigator 1

2006-08-29T15:09:00.000-05:00

GALVESTON POLICE DEPARTMENT DIVE ACADEMY

Aug 25, 2006 Galveston, Texas

GALVESTON POLICE DEPARTMENT DIVE ACADEMY
Public Safety Diving Seminar

PSDA Underwater Crime Scene Investigator 1
September 29, 30 and October 1, 2006

REGISTRATION FORM Please mail or Fax
ONGOING CLASSES THROUGHOUT YEAR
(CALL IN ADVANCE TO CONFIRM SCHEDULE)

DATE: ____________
AGENCY NAME:__________________________________
ADDRESS:____________________________________
PHONE:____________________
FAX____________________
CONTACT PERSON: ________________________
ALTERNATE PHONE:_________________________
EMAIL ADDRESS: ________________________
Total Number of participants ________
Number of Divers _______________

This is a 24-hour Public Safety Diving Association Specialty course and TCELOSE credit WILL be available for law enforcement. Class size is limited to 30.

STUDENTS MUST BE AFFILLIATED WITH A FIRE, LAW ENFORCEMENT,SAR, EMS or PUBLIC SAFETY TEAM.

PREPAID advanced registration - $95.00 per person.
After September 21, 2006, registration will be $125.00.

Please make check or money order payable to: "Galveston PD Training Division" and return to 601 54th Street, Suite 200, Galveston, Texas 77552. For more information or to RESERVE spots, call 409-765-3642 or FAX Registration for to 409-765- 3641

MEDICAL and LIABILITY RELEASE FORMS

These forms MUST BE COMPLETED and submitted before participants will be allowed to participate. These forms can be downloaded at www.psdiver monthly.com.

The forms may be submitted in advance or at the start of the course. Medical conditions that require a physician release will disallow divers participating in the scuba exercises if a medical release is not presented PRIOR to the start of the programs.

Scuba participants MUST be a minimum of OW certified with a dive log showing no less than 15 dives.

Students MUST participate in all evolutions to qualify for certificate of completion and payment will NOT insure certificate. Participants are requested to bring as much of their equipment as possible. If necessary, some extra gear will be available but prearrangement will be required to insure you will have what you need. Please bring tanks and weights if you are driving. Air refills will be provided at no cost. We would also encourage teams to bring as much of the gear they use to the seminar.

HOST HOTELS for the GPD Dive Academy

Baymont Inn
www.baymontinngalveston.com
1 King Bed 65.00 Weekday 75.00 Weekend
2 Queen Beds 69.00 Weekday 79.00 Weekend
All non-smoking rooms – Just opened in August 2006!

Super 8 Galveston
1 King Bed 50.00 Weekday 60.00 Weekend
2 Queen Beds 55.00 Weekday 65.00 Weekend

To make reservations contact ASH at 409-744-3000
or email: baymontinngalveston@earthlink.net

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

Nearest Airport is Houston Hobby .

For driving directions use GOOGLE MAPS and enter: 601 54th Street, Suite 200, Galveston, Texas 77552

Download all forms CLICK HERE

PSDiver Monthly

PSDiver Monthly is a free Internet magazine for Public Safety Divers and Water Rescue Technicians. Go to the website and click on the subscribe link or just browse.

Website: http://www.PSDiverMonthly.com

PSDiver Monthly

Mark Phillips

Editor / Publisher

email: mark@psdivermonthly.com

phone: 409-658-7247

Mater Dei Hospital to be equipped with hyperbaric chambers

2006-08-29T14:59:00.000-05:00

Diving interest on Malta and Gozo has intensified over the past several years emphasizing the need for facilities for early recompression of diving accidents. This article gleaned from the web shows that the people of the islands are doing something about the problem.

Mater Dei Hospital to be equipped with hyperbaric chambers

by Ruben Cassar, dive news

VALLETTA, Malta (dive news) -- August 28, 2006 -- 1605CEST -- Two new hyperbaric chambers to be used in the Mater Dei Hospital have arrived in Malta from Germany.

The main function of a Hyperbaric Unit is to provide elective and emergency baro-medicine treatment and also tutorials and practical training in baro-medicine.

These chambers are used to manage certain medical conditions and to treat divers who may encounter difficulties whilst diving. The Hyperbaric Unit at Mater Dei Hospital is designed to house three decompression chambers.

One of the new chambers is a Low Pressure Chamber, the second is a High Pressure Chamber while a third Hyperbaric Chamber is presently used at St. Luke's Hospital and eventually is to be transferred to Mater Dei Hospital.

Once at the Mater Dei Hospital the three chambers will be installed on a raised flooring to allow for the supply of cables and other services. In the same area, there is a control console for the personnel managing the chambers.

The two chambers costing €1.6 million and weighing 55 tons and 15 tons respectively are expected to arrive at the hospital on Monday evening.

The installation of these chambers is expected to start early on Tuesday morning.

Advanced Undersea and Hyperbaric Medicine Team Training Program in Costa Rica

2006-08-29T14:14:00.000-05:00

Hyperbarics International and IIDEXO are please to offer a specialized training program in Hyperbaric Medicine. The Advanced Undersea and Hyperbaric Medicine Team Training Program is available to a wide range of interested students from the medical and professional diving communities.

The training will be held November 20-24, 2006. Seminars will be conducted in English by Dick Rutkowski of Hyperbarics International and translated to Spanish by Gene Condon of IIDEXO. Lectures will be held at the Best Western, Las Espuelas, in Liberia, Costa Rica. The location is approximately 15 minutes from the Liberia International Airport.

Payment for the course may be made by major credit card to Hyperbarics International. For hotel reservations, contact Best Western, Las Espuelas in Costa Rica, at 506-666-0144. Ask for the hyperbaric course rate.

The seminar is also offered monthly at the Hyperbarics International facility in Key Largo. For more information and reservations, contact:

Dick Rutkowski, Hyperbarics International
dick@hyperbaricsintl.com
US Phone: 888-451-2551
Direct or International: 305-451-4107
www.hyperbaricsintl.com

Hyperbaric Oxygen Therapy Cost and Utilization Survey

2006-08-29T07:53:00.000-05:00

From Lisa Wasdin, UHMS

Hyperbaric Oxygen Therapy Cost and Utilization Survey

Please complete and return both pages of this survey via fax (703-269-5501) by SEPTEMBER 13, 2006 . Contact Ushma Patel at 703-269-5720 with questions. Thank you for your help!

SURVEY FORM: WORD VERSION PDF VERSION
___________________________________________________

TO: UHMS Members

From: Sue De Santis, RRT, MBA
Executive Director, HOTA/AACWM

Date: August 24, 2006

Topic: Lewin Survey in Response to CMS Proposed Payment Rates for CY 2007 (SURVEY FORM ABOVE)

The CMS Proposed Rule for Calendar Year (CY) 2007 have been published. The following link is provided for your review of the data. Our rate is proposed at $98.02 per thirty (30) minute increment. http://tinyurl.com/jbqzy

The Hyperbaric Oxygen Therapy (Association) division of the American Association for Wound Care Management has engaged the Lewin Group again this year to query the methodology utilized by CMS in the calculation of the payment rate for hyperbaric oxygen therapy. With the assistance of the Lewin Group, we have been able to replicate a payment rate of ~ $115. per 30 minutes when costs are specifically related to hyperbaric oxygen departments.

We are attempting to establish replication of this data for three consecutive years to evaluate a fair and consistent methodology utilized by CMS now and in the future. We are, therefore, requesting that you provide the attached survey to your Hospital Administrator for completion by September 13, 2006. Our past experience helps us understand that the form requires approximately ten (10) minutes for completion. This is little time for long- term gain and understanding of a fair calculation method.

We appreciate your assistance in the very important endeavor as overall outpatient payment rates for hospitals are declining and we are making every effort to assist the hospitals by securing our specific payment calculations.

If any questions arise from your Administration, please feel free to contact me at desantissue@yahoo.com and please include a phone number and contact person.

News from PSDiver Monthly

2006-08-24T08:11:00.000-05:00

PSDiver Monthly Announces
CHANGE IN DISTRIBUTION -
Aug 22, 2006 GREETINGS!

We are forced by GROWTH to change our distribution methods once again. For 29 issues we have managed to find ways to keep our costs as low as posible but we have finally reached a point where free or minimal cost distribution are no longer available.

The GOOD NEWS is our Sponsor support has allowed us to continue to offer PSDiver Monthly for free but we are counting on YOU to do some work.

To produce a NEW email distribution list that can be fully integrated into the new programing, we need you to do just TWO things.

FIRST: RECONFIRM your subscription.

If you haven't done so already, click to CONFIRM your interest in receiving email campaigns from us.

SECOND: If you have not done so already, Go to www.PSDiverMonthly.com (the link is below) and download the CURRENT ISSUE of PSDiver Monthly - Issue 29

PSDiver Monthly - Issue 29
IN THIS ISSUE:

OAHU Seminar
Galveston Underwater Crime Scene Seminar **PRESS RELEASE TO FOLLOW! **
NIMS Resource Typing and How it Effects US
Firefighter Fatality - Swift Water Rescue
PSD NEWS
COACH
More Continuing Education
FUTURE DISTRIBUTION
Once we have integrated the new system and reconfirmed YOUR email subscriptions, we will send out similar notices when the new Issues of PSDiver Monthly are available.

PSDiver Monthly will continue to be a download file but to save space and download time, it will be offered in TWO versions: PDF and ZIP.

We will be much more web site oriented and our web site will begin revision ASAP. Look for changes SOON!
This new method will allow us to continue to grow and offer even more services without overloading your email with attached files. With this service, we will be able to send email notices for:

TRAINING SEMINARS
SPONSOR PRESS RELEASES
SPECIAL NOTICES
EQUIPMENT RECALL NOTICES THAT EFFECT SAFETY
CONTINUING EDUCATION
TRAINING AND STANDARDS NOTICES
and MORE

CLICK HERE to launch to the PSDiver Monthly Web Site

About PSDiver Monthly

PSDiver Monthly was created as a way to help improve awareness, education and safety for Public Safety Dive Teams and Water Rescue and Recovery Teams. PSDiver Monthly subscriptions are FREE.

PSDiver Monthly is an Internet E-zine specifically designed for Public Safety Divers and Water Rescue Technicians. News articles and information from around the world as well as independent articles, special features, safety notices and continuing education will be shared in each issue.

Corporations who believe in the work that Public Safety Divers and Water Rescue and Recover Teams perform and who wish to show their support sponsor this e-zine. This is and will be the place to get the most current news affecting the Public Safety Diving and Water Rescue community as well as the most current equipment and ocassionally, special pricing from our sponsors.

Fire Department Dive Teams, EMS Dive Teams, Police Divers, SAR divers and Flood and Swift Water rescue teams should all benefit from this publication.

HELP US SPREAD THE WORD!

FORWARD THIS EMAIL TO OTHER TEAM MEMBERS

THE LINK IS AT THE BOTTOM OF THE PAGE!

PSDiver Monthly Website: http://www.PSDiverMonthly.com
FREE Internet Discussion Group for Public Safety Divers and Water Rescue and Recovery Teams

We also offer a free RELATED Discussion Group for Public Safety Divers and Water Rescue and Recovery Teams.

Founded on Dec 9, 2000 this MODERATED discussion group has over 1,100 members worldwide, and provides an incredible resource for your team and team members!

SPREAD THE WORD - FORWARD THIS EMAIL TO OTHER TEAMS AND TEAM MEMBERS!

DISCUSSION GROUP http://groups.yahoo.com/group/PSDivers-PublicSafetyDiversForum/

STAY SAFE!
Mark Phillips
Editor / Publisher
email: psdivermonthly@aol.com

Trademark in progress.

Undercurrent Online Update

2006-08-24T07:58:00.000-05:00

U N D E R C U R R E N T O N L I N E U P D A T E
F O R S U B S C R I B E R S

Undercurrent -- Consumer Reporting for the Scuba Diving Community since 1975
www.undercurrent.org

Dive News
August 23, 2006

Dive Luggage and Carry on Bags: The August issue of Undercurrent details airline restrictions coming in September that not only limit the weight of each bag a passenger checks, but also the total luggage weight. If you don't abide by the rules you'll be charged a fee. Too much weight and you'll be required to ship the bag (which means you'll miss your flight while you track down an airport shipper - and it will cost a fortune). The latest baggage restrictions, imposed August 11, should not affect divers, however, keep in mind that each country establishes its own rules. In many smaller countries, officious immigration and customs personnel can be haughty and arbitrary. They often order travelers to remove strobes, battery packs, even computers from carry on luggage. Be prepared. For information on US restrictions visit http://www.tsa.gov.

Underwater Across the English Channel: Seven divers swam the Channel in an underwater relay in early August.They left Dover at 6 a.m. and arrived at Calais, France, 12 hours later. On each leg, the six men and one woman spent about 30 minutes in the sea before they exhausted their air and they handed over their baton - a surface marker buoy - to another team member and surfaced. They used the feat to raise nearly $100,000 for research into the diagnosis, prevention and treatment of testicular, prostate and penile cancer. It's great to see divers raising money for important causes, so ....

Help Save Coral Reefs: Undercurrent has raised more than $7000 to stop poaching and preserve reefs in Belize and Fiji. We need to double that amount, so for every dollar you give -- up to $7000 -- Undercurrent will match it, dollar for dollar. Please give back to the reefs you love by making a tax deducible contribution at http://www.undercurrent.org. Click on "Donate to Save the Reefs," for more information and to contribute. We will send you a receipt acknowledging your tax deductible gift. Send us any foreign currency you have collected, and we'll convert it to dollars. Undercurrent is a registered nonprofit, 501 (c) (3) organization.

So, Where Have You Been Diving? We want your reports for the all new 2007 Chapbook, which will be mailed to all subscribers in December. If you have been diving any time since last September, by all means file your report at http://www.undercurrent.org/subscribers/UCnow/subrdrrpt.php . The value of the Chapbook is only as good as the reports we get. Please send yours now. Or, you can email them to me at editor@undercurrent.org.

Collect Fish in the Bahamas: The New England Aquarium needs divers to join their staff on a fish collecting expedition to Bimini from September 29th through October 8th 2006. They're collecting specimens for their giant ocean tank. The trip is open to beginners and experienced divers, and you'll dive with and learn from Aquarium professionals. The cost is $3,278 for accommodations aboard the R/V Coral Reef II (meals, lodging, cocktails), up to five dives per day, and a rare opportunity to dive in the Aquarium's 200,000 gallon Caribbean reef exhibit. (Since you're volunteering for a nonprofit organization, the costs are tax deductible, says our accountant). Call Sherrie Floyd, Senior Aquarist or Sarah Zibailo, Aquarist at 617-973-5248 or email sfloyd@neaq.org or szibailo@neaq.org.

Life Insurance: Many divers tell us that once they reveal they are divers, their life insurance cost skyrockets - or they can't get life insurance at all. Has that happened to you? Please let us know your experience. We'll follow up with insurance companies that take divers and let you know how to keep or get affordable life insurance.

Deeper into Diving: Here's the all new, comprehensive second edition of John Lippman's 1990 classic, the definitive book for serious divers who want to dig deep to understand their sport. Lippman and co author Dr. Simon Mitchell, cover virtually all decompression procedures, computers and their various algorithms) physical and medical aspects of deeper diving, including nitrogen narcosis, carbon dioxide, heat loss, decompression sickness, multi-level diving, and everything you ever cared to know about diving. At $65, it's a serious book for a serious diver's reference library. Click here: http://www.aquaquest.com/books/deeper_aqp.htm to order directly from the publisher. Mention Undercurrent in the comment section and Aqua Quest will donate 15% of your total purchase to our Belize and Fiji Reef Projects.

Dive Master Rip Offs: We've been informed recently of divers who have gotten into financial deals with an offshore dive operation, operator or dive master, only to find their money has disappeared. If this has happened to you or to anyone you know, please send us the details. Bendavison@undercurrent.org

Free Chapbooks for Clubs: We have three hundred 2006 chapbooks left, so if you send us your club roster, will ship free you up to 30 books to pass out at your next gathering. Email Pete@undercurrent.org

Note: Undercurrent is a not-for-profit organization. Our travel writers never announce their purpose, are unknown to the destination, and receive no complimentary services or compensation from the dive operators or resort.

Ben Davison, editor/publisher
editor@undercurrent.org

Published with permission

Links and Articles That Might Interest You

2006-08-24T07:20:00.000-05:00

Here are some links and news items that I found particularly interesting and thought that I'd pass them on to you.

---In the Divernet 'News for Divers' there is an article about a quadriplegic who reaches the highest level in diving certification. Titled "Wheelchair Diver Reaches Highest Level", it can be seen at this link: http://snipurl.com/vc8j .
More about Disabled Divers at http://scuba-doc.com/divdis.htm .

---We found this story on the BBC News website and thought you should like to read it.
Isle of Man | Divers urged to be more careful
** Divers urged to be more careful **
Divers are urged to take more care off the Manx coast following a spate of dangerous incidents.
http://news.bbc.co.uk/go/em/fr/-/1/hi/world/europe/isle_of_man/5241208.stm

---Here is an unusual occupational diving job that I found to be interesting.
"Getting TANKED"Diving crew checks out Cornelius’ water facility and comes up with a smidgen of sediment
By Mateusz Perkowski
The Forest Grove News-Times Aug 16, 2006
http://snipurl.com/vddf

---In Scientific American.com there is a section called Ask The Experts. This article purports to answer the question that many have asked: "How do deep-diving sea creatures withstand huge pressure changes?"
http://snipurl.com/vbjv

PADI Response to August 11 blog: "Expert Warns That Scuba Crash Courses Are Putting Lives at Risk"

2006-08-23T20:24:00.000-05:00

We have received the following request from PADI to publish a response to our posting of an article about "scuba crash courses". We are delighted to do so and hope that this lays this to rest. Here is the letter in toto. In order to understand this fully, we suggest that you follow the link to the original posting and read the article.

Dear Ern,

We would like to post a response to your 11 August Blog; would you be so kind as to consider including our comments, listed below, on your site archives for this date?

Best regards,
___________________________________

Heather Tremblay
Assistant to the President
___________________________________

PADI Worldwide
The Way the World Learns to Dive®
30151 Tomas
Rancho Santa Margarita, CA 92688
USA
Direct:949 858 7234 x2270
Main: 800 729 7234
Fax: 949 267-1265

Visit PADI: padi.com

Ref: Your item dated August 11, 2006 -

Expert Warns That Scuba Crash Courses Are Putting Lives at Risk

I would like to comment on some of the quotes listed in this article attributed to Dr Bryson. I work in PADI’s office in the UK and am very familiar with the diving scene here. I was one of the individuals quoted in the Guardian News article.

To clarify some points of fact that are, at best, unclear in the article: on the 8th August 2006 a Plymouth Coroner commenced a series of Inquests into four separate diving fatalities that had occurred on the south coast of England during the previous year. Of the four men who tragically died, two were trained by PADI. Both of these accidents occurred during non-training dives.

Dr Bryson from the Plymouth based Diving Disease Research Centre (DDRC) appeared at one of these four inquests where he made some comments about training that were widely reported in the British press at the time. Unfortunately, some of the media coverage was slanted so that it appeared that the quality of PADI training was being brought into question in all these investigations. In fact, (although his final report is yet to be published) the Coroner did not make any negative comments about PADI courses in any of the Inquests.

Dr Bryson has been reported as voicing some personal opinions that are controversial and need addressing with facts rather than emotion.

Dr Bryson states: “PADI have brought that reduction in training down and they claim they have done it with valid data and that there are very, very few problems. Other UK-based diving groups which had longer training regimes have had to come into line.” If this statement is true then one would expect there would have been a significant increase in diving accidents in the UK since PADI started to train large numbers of divers there. In fact this is not the case as the following data indicate.

PADI was little known in the UK prior to 1990, training less than 5,000 Britons a year. During the ten year period of 1980-1989, the average number of recreational diving fatalities per year was 12.1 in the UK1. This was a period when there were significantly less divers than in recent years; for example, the British Sub-Aqua Club (BSAC), the main training provider at the time, had 34,861 members in 1985; by 1995 they had 52,364.1

From 1990 onwards, PADI training increased in popularity dramatically, and to date PADI has trained over 400,000 Britons as divers. During the last ten years the average number of recreational diving fatalities per year1 has been 17.8. This compares to the 12.1 average in 1989-89, yet the number of divers has risen dramatically, for example it is estimated that there are 699,257 active divers in the UK today,2 far more than in 1985 when the BSAC’s membership of 34,861 made up the bulk of the UK diver population. In proportional terms, the number of fatal accidents has decreased during a time when the number of divers trained by PADI has increased.

Dr Bryson is further quoted as making two comments concerning what he describes as advanced divers: “People want to be advanced divers. They want that certificate and they are willing to pay for it. We have people presently in diving who feel they are advanced but have no experience whatsoever. The diving community needs to be totally re-educated.” And: “I do not believe that someone with eight dives should be classified as an advanced diver. That is madness, end of conversation.”

Dr Bryson is misinformed. Firstly, there is no PADI course named “Advanced Diver”; the nearest title is PADI Advanced Open Water Diver. Secondly, to attain that qualification, a diver must have made at least five confined water divers and nine open water dives. It is probable that Dr Bryson’s mental image of an “advanced diver” is coloured by long experience with the BSAC’s training syllabus. This does include an Advanced Diver qualification, a level that requires at least some sixty dives experience and which aims to qualify a diver to be able to organise groups of divers; a much more similar level to a PADI Divemaster in fact.

The PADI Advanced Open Water Diver in contrast, is designed to allow an Open Water Diver to increase their experience in a controlled way, literally to advance their open water diver skills so that they can begin to broaden their experience. This interpretation of the word ‘advanced’ is well understood in the rest of the recreational diving world. The objectives and limitations of the PADI Advanced Open Water Diver course are also clearly explained to the divers themselves.

Even from a cursory reading of the original news story it is clear that there were factors that contributed to the accidents that were unrelated to whether or not the divers held an ‘advanced’ qualification. Fortunately, the Coroner noted these and restricted his findings to the hard facts available to him.

It is relevant to note that subsequently, Dr Bryson’s parent organisation, the DDRC, issued the following position statement:

“DDRC is an independent charity, which provides support and advice to members of all recreational diving agencies at every level of experience.

DDRC believes that where training guidelines, in particular the guidance on diving in different environments and conditions, and medical recommendations are followed diving is a pursuit that can be carried out and enjoyed safely in the UK. The underwater environment and its potential hazards must be respected. DDRC acknowledges the overall high quality of training provided in the UK but feels that divers must recognise their own limitations and gain experience safely in accordance with their training agency guidelines. It is well recognised that a series of small events before and during a dive can accumulate and result in a serious incident. DDRC recommends that all divers follow the procedures taught in their training before, during and after every dive.

Divers have a responsibility to themselves and their dive buddy to honestly and truthfully consider their personal fitness to dive before every single dive and seek advice if they are uncertain. Those guiding or teaching divers must have the confidence to express reservations or abort a dive if they have any doubts regarding the ability or fitness of a diver for the planned dive.

DDRC continues to provide medical advice to divers who contact us and will answer each question to the best of our ability and knowledge.”

In summary, it is unfortunate that Dr Bryson has made a number of emotive comments that are not supported by facts. It is pleasing however to see that the DDRC have clarified their position in responsible terms.

I apologise for the length of this comment but hope that you may be able to include it on your site.

Sincerely,

Mark Caney
Vice President, Training, Education and Memberships
PADI International Ltd
UK

cc: Dr. Drew Richardson
President & Chief Operating Officer
PADI Worldwide

References:

1. British Sub Aqua Club Incident Reports, 1980-2005
2. Maritime and Coastguard Agency’s National Watersports Omnibus Report, June 2005

Toronto Hyperbaric Medicine Symposium

2006-08-21T17:12:00.000-05:00

Toronto Hyperbaric Medicine Symposium

Friday September 29 /2006

- Mark Your Calendar!

The THMS is a one-day symposium that focuses on research level topics relevant to individuals involved in the provision of hyperbaric medicine and related physiology.

The symposium serves as a venue for learning and collaboration.

It will feature both thematic and plenary sessions provided by leaders in hyperbaric medicine.

The opportunity for interaction with faculty is a priority of the meeting: ... A post meeting sunset dinner cruise (at additional nominal fee) has been planned aboard the world class Tall ship, the Empire Sandy. Enjoy the lush greenery of Toronto Islands in front of the spectacular Toronto skyline. Enjoy the blue skies and spectacular sunsets. Superb food and hospitable crew also awaits you. Don’t miss out. We look forward to seeing everyone there! You won’t be disappointed!

Sunset Aboard the Empire Sandy

For more information, visit us at www.hyperbaricmedicine.ca
A.Wayne Evans, M.D.
Assistant Professor - Department of Anaesthesia,
Faculty of Medicine, University of Toronto
wayne.evans@utoronto.ca
Ontario Medical Association, Chair - Hyperbaric Medicine
Hyperbaric Medicine Consultant, Hyperbaric Medicine Unit,
Medical Consultant, Chiropody Wound Clinic, Adult Radiation Late Effects Clinic - University Health Network
GC 405, 200 Elizabeth St., Toronto, Ont. M5G-2C2
t.(416)340-4450 f.(416)340-4481 wayne.evans@uhn.on.ca

New UHMS Brazilian Chapter Scientific Meeting

2006-08-21T15:21:00.000-05:00

UHMS Brazilian Chapter Scientific Meeting
(held together with the III Congress of the Brazilian Hyperbaric Medical Society)

City of Curitiba, State of Paraná

Sept. 07 - 09, 2006

Special guests
Don Chandler, UHMS Executive Director
Bret Stolp, MD, UHMS President

Contacts and reservations: eventos@onetur.com.br
If you wish you can add my e-mail for contacts: rbammann@terra.com.br

UHMS Gulf Coast Chapter 2006 Annual Scientific Meeting

2006-08-21T11:01:00.000-05:00

For meeting details click here.

Call for Papers

SUBMISSION OF ABSTRACTS

Abstracts and Lectures are invited from all members of the Undersea and Hyperbaric Medical Society and those other individuals who have demonstrated a clear interest in clinical, technical and safety factors germane to the hyperbaric and undersea environment.

Abstracts are due by September 15, 2006.

Abstracts will be selected for presentation on the basis of quality. Individual presentations as well as group presentations in the following topics are being solicited:

1. Diving Medicine Issues

2. Hyperbaric Medicine Issues

3. Research/Training Issues

4. Safety/Technical Issues

The name of the paper should be capitalized and the author and organization underlined. First sentence in each paragraph indented 5 spaces.

A LCD projector will be available in the session room. Other equipment can be made available if essential to the presentation and the author indicates the equipment needed on the abstract.

ABSTRACT FORMATTING GUIDELINES
Language – All abstracts are to be written in English. The Program Committee reserves the right to alter abstracts where the English structure makes comprehension difficult.

Title - Capitalize all words.

Author(s) - List primary author first. List all names last name first with up to 2 initials with no spaces.

Affiliation(s) – At the end of the author list specify the primary lab affiliation name, city, state and zip/postal code. If other affiliations must be specified, these may follow the primary affiliation using appropriate superscripts to identify the associated authors (see second sample abstract below).

Abstract Body Format

· Must be 300 words or less, exclusive of title, author(s) names, and institutional affiliation(s).

· All submissions should be in Microsoft Word format

· Only text and text tables will be accepted. NO graphs or images may be submitted.

· Contents should include the following sections:

o Introduction / Background

o Materials and Methods

o Results

o Summary / Conclusions

Slides - In addition to your abstract, a paper copy of your slides will be added as part of the participant handout. Please submit the powerpoint file of your slides to Suzanne Pack by Monday, October 9, 2006.

INVITED LECTURES AND ORIGINAL PAPERS PRESENTATIONS

Body Format

· Title of Presentation

· Lecturer Name and Credentials (e.g. John Smith, MD)

· Introduction - A brief description of your presentation

· Objectives - List objectives that will be covered in your presentation (Upon completion of this presentation participants should be able to...)

· Commercial Interest

o If you have not Commercial Interest please list NONE

o If you do have Commercial Interest please list the name of the company and the nature of the relationship (e.g. ABC Company - Consultant). Remember to only list commercial interest that are relevant to your presentation.

· Lecture Outline - This section can be your slide presentation and will be due by Monday October 9, 2006. If you choose not to you use your slides as the hand out, please provide a detailed outline following your slides. If you have any questions about your handout please contact Suzanne Pack at gcc@uhms.org or call 210-614-3688.

· References - provide a list of references applicable to your presentation

SLIDE PRESENTATIONS

Abstracts and original papers will be scheduled for presentation November 2-4, 2006. Presenting authors will be notified of the disposition of the abstract and time for presentation in September 15, 2006. It is preferred that the selected papers be presented and discussed by the first named author.

SUBMITTAL INSTRUCTIONS

DEADLINE FOR RECEIPT OF ABSTRACTS

September 15, 2006

Abstracts cannot be accepted without a completed Abstract Submittal Form, a Faculty Disclosure Form and a brief CV. All presenters will need to be registered attendees in the meeting.

Abstracts should be submitted by email to gcc@uhms.org.

or Mail CD to

Suzanne Pack

UHMS Gulf Coast Chapter

414 Navarro, Suite 502

San Antonio, Texas 78205

MELAS (Mitochondrial myopathy) an unusual condition and diving

2006-08-19T18:12:00.000-05:00

QUESTION.
My husband has been diagnosed with mitochondrial myopathy, namely MELAS. He so wants to dive again but I don't think it is safe. Is there any information for this disease subset and diving?

Answer:
So sorry to hear of your husband's diagnosis. The disease consists of mitochondrial myopathy, encephalopathy, lactacidosis, stroke (MELAS) and is a progressive neurodegenerative disorder.

The typical presentation of patients with MELAS syndrome includes features that comprise the name of the disorder such as mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes. Other features, such as diabetes mellitus and hearing loss, clearly are part of the disorder.

Organ systems included in the multisystemic involvement are the central nervous system, skeletal muscle, eye, cardiac muscle, and more rarely the gastrointestinal system.

First, there is nothing in the diving medical literature about the effects of pressure/depth on the condition; and second, there is nothing in the literature about the risks involved with this particular disease entity - in other words, his fitness to dive. The disease encompasses a broad range of organ systems and stages of incapacitation - thereby making it almost impossible to determine his fitness to dive from afar. We do not know the stage of the disease in your husband.

However, here are some factors that would increase his diving risks:
--Multiple strokes occur and are associated with seizures, adverse to diving. Residual neurologicals from the strokes would make it difficult to manage the physical requirements of diving.
--Myopathy would make it difficult to manage the gear and perform self and buddy rescue.
--Eye problems might make it difficult to gear up and read the gauges.
--Diving can effect hearing. Hearing loss should be quantified before diving.
--Cardiac myopathy might make diving quite risk, as there are changes in the central circulation that can put a borderline heart problem into heart failure.

It's doubtful that diving would make your husbands condition worse or speed up the changes that are bound to occur. If he's early into his condition and can handle his gear, entry and exits without difficulty, then he might dive in shallow, warm water without current or surge. He must be aware of the increased risks involved with the possibility of stroke and cardiac effects and inform all divers, divemasters and instructors of his condition. Shallow diving is a must because of the difficulty in differentiating his neurological illness from the effects of decompression illness.

Response:
My husband's illness is at a point of "TIA" symptoms frequently, heart disease, gait difficulties, orthostatic hypotension and muscle atrophy. He had a heart attack in 1996 and bypass in 1997. He has diabetes but has always been controlled with oral meds. After 2 years, he received 3 stents for restenosis. He passed a stress test and was allowed to dive to 45 feet only by his cardiologist. The last time we dove was 3 1/2 yrs ago in Cozumel. He did fairly well but I did notice he tired easy. So since that time his neurological symptoms starting showing up and over the course of the 3 years, he has had 7 more stents, an MI in April and a positive muscle biopsy for mitochondrial disease. CT scans and a PET scan do not show strokes but he has had to do PT for 9 months for residual stroke like symptoms. Speech therapy to work on cognitive memory issues. But looking at the prognosis for the disease and his complicated medical history....of course he wants to dive again. He is also on parkinson drugs and neurontin for peripheral neuropathy.The neurologist told him no way so he is having a hard time accepting that loss to. Thanks again for your information. He is only 51 so it is very hard to deal with. I guess since he has seen people with MS dive he was holding out hope! Sorry if I wasted your time. It's very hard for men to loose independence!! thanks

My answer:
You did not waste my time! This is a very interesting case and I really would like for him to be able to participate in some water activity - but on the surface! I invariably suggest that people try snorkeling over shallow reefs. This usually turns out to be a good second choice to diving and the dive shops on your trips always know of good places to enjoy the reef fish.
He really does not need to be underwater with his situation.

Cave Diving: A dangerous hobby if untrained

2006-08-18T10:05:00.000-05:00

In the Suwannee Democrat, August 17, 2006
http://snipurl.com/v4uh

Published: August 17, 2006 06:06 pm Reprinted with Permission

Cave Diving: A dangerous hobby if untrained

Cave diving is dangerous! In Suwannee County, according to Chief Suwannee County Deputy Ron Colvin, there have been five cave-diving related deaths in the past five years.

John Orlowsky is the Sheriff’s Office go-to guy for recoveries. Colvin said often they don’t have to call someone to recover a dead diver because their buddies go in, find them and bring them out. For river rescues and recoveries, the Suwannee County Sheriff’s Office uses the Taylor County dive team.

Orlowsky has been on many recoveries. He pulled two out of Convict Springs in Lafayette County in the early 90s. In May of 2003 Orlowsky pulled a diver out of Cow Springs. According to Orlowsky, the diver was found in the upstream section of the spring with gas in the tanks and a full buddy bottle.

Right after New Year’s Eve in 2005, Orlowsky pulled a diver out of Peacock 3. This diver was cavern-certified only and Orlowsky found him 1300 feet into the system. From the diver’s wrist-mounted computer, Orlowsky determined the diver had descended as far as 180 feet. He was found at 55-60 feet. His death was ultimately attributed to a heart attack, according to the Suwannee County Sheriff’s Office.

On Nov. 8 in 2002, a diver was recovered from a Peacock Springs cave. This diver also died of a heart attack.

All these deaths could have been prevented by paying attention to Orlowsky’s first rule. “If it doesn’t feel right turn around,” Orlowsky said.

Colvin echoes that sentiment. “If it doesn’t feel right, don’t do it.”

Orlowsky said mind games play with you when you’re really deep inside a system. That’s called the time/stress factor.

“I teach my students to listen to it,” Orlowsky said. “As soon as something feels wrong mentally or physically, turn around.”

Since Peacock Springs became a state park, the numbers of divers dying in caves in Suwannee County has dropped. Rangers at the state park only allow certified CAVE divers to dive the springs. According to Orlowsky, it’s not cave divers that die in caves, but open water divers. There are signs clearly posted at Peacock Springs that say “No open water divers.”

A local dive instructor and owner of Cave Excursions Bill Rennaker, a dive shop specializing in cave diving instruction and outfitting Bill Rennaker, says his number-one rule for cave diving is always have a continuous guide-line to the surface.

Rennaker says there is a whole new set of rules for “overhead environment diving.” That can be diving under rock (caves), under steel (shipwrecks) or diving under ice. The separation between open-water diving and overhead environment diving is when air bubbles from the divers can’t reach the surface.

“You can’t put an open-water diver in a cave,” Rennaker said. “Everything we do in training is in total darkness because that’s the environment.”

Rennaker stressed the darkness factor. He said without any light in water, humans get mixed up and turned around so badly, they can’t tell up from down. That’s why he stresses the guide-line. If the lights go out, it’s a cave divers only path to the exit.

Because of the danger of cave diving, there are no open-water divers allowed in Suwannee’s cave systems. Divers have to take special classes, (and that’s where Orlowsky comes in), to become certified in cave diving. Even after becoming certified, divers can only enter some caves if they have a certain number of recorded dives to their credit.

Even for certified, experienced cave divers, cave diving can be deadly. Suwannee County’s Sheck Exley was one of the most famous cave divers ever. He was a pioneer in cave diving and lived near Falmouth Springs. Exley owned Cathedral Sink Hole in his back yard. This sink connects to the Falmouth Springs system. As experienced as Exley was, he died pushing himself to the limit in a very deep cave in Mexico. Exley died at over 900 feet trying to dive deeper than any man had gone before in a cave.

The National Speleological Society, NSS, cave diving section, has a great website at www.nss.cds.org. At this website it says, “Are you planning a CAVE DIVE but you are . . .

1. Neither formally trained nor certified in Cavern or Cave Diving?

2. Making one of your initial dives into a spring, cave, or blue hole?

3. Not using at least two dependable underwater lights, a guideline on a reel, a submersible pressure gauge, and an additional second stage?

If your answer is “yes” to any of these questions, then you are typical of most cave-diving fatalities. Since 1960, more than 431 divers fitting the above description — that is, untrained, inexperienced, and improperly equipped — have died in cave diving accidents in Florida, Mexico and the Caribbean.

The website states that no amount of previous open water diving experience or training can adequately prepare you for cave diving.

According to the NSS-CDS website, regardless of the prior open water experience, most cave diving accident fatalities were untrained in cave-diving procedures, inadequately equipped for the planned dive, and/or making one of their initial cave dives. Many were extremely experienced in other types of diving. No less than 19 were FULLY CERTIFIED OPEN WATER SCUBA INSTRUCTORS — but without any training in the specialized area of cave diving.

Interviews with some of the surviving dive buddies suggest that frequently the divers originally planned only to take a quick peek “just inside the cave entrance” — that they weren’t really planning a full-fledged “cave dive.” But in many instances the divers got into trouble immediately — “just inside the cave entrance!” In other cases, they decided to continue further into the cave despite their plan and became hopelessly lost. When their bodies were recovered later, there was every evidence that their pre-death experience was panic-stricken and horrifying. At the website, you can read the rules and learn how to become certified.

The Suwannee County Sheriff’s Office said they support the rules of the NSS-CDS. “We encourage all divers to practice all of the rules of cave diving,” Colvin said.

New 6th Revised Printing of Diving Physiology in Plain English

2006-08-14T20:03:00.000-05:00

Hello ScubaDoc friends,

We have come out with the new 6th revised printing of Diving Physiology in Plain English
The new cover is above. It was designed by Lisa Wasdin at UHMS.

New book will be off the presses in the next few days. For orders, Contact
Lisa Wasdin
Undersea and Hyperbaric Medical Society (UHMS)

new address:
10020 Southern Maryland Blvd
Suite 204, The Gateway Center
Dunkirk Maryland 20754
(410) 257-6606
work fax (410) 257-6617

Lisa@uhms.org
other LisaWasdin@uhms.org

Executive director DonChandler@uhms.org

Good Things,
Jolie
Dr. Jolie Bookspan
Director, Neck and Back Pain Sports Medicine
www.DrBookspan.com

Transient Global Amnesia and PFO

2006-08-14T10:29:00.000-05:00

Right-to-left shunts in the heart are associated with low arterial oxygen, TIA, decompression illness, migraine with aura and transient global amnesia. The most frequent cause of a right-to-left shunt is a large persistent (or patent) foramen ovTransient global amnesia ale (PFO).

is a condition that seems to be associated with PFO and has been reported in divers. See this thread on our Scuba Clinic forum with discussion by DocVikingo.

Usually, the diver relates normal diving activity with little or no current, surge or wave action. The dives are usually relatively shallow and leisurely, with little in the way of exertion. Occasionally, there is the history of some difficulty clearing with excessive valsalva maneuvers. The problem is that the diver cannot remember any activities after leaving the water for variable periods of time, usually only a couple of hours. There may or may not be associated decompression illness symptoms.

Valsalva-like activities often precede the occurrence of attacks of transient global amnesia (TGA) and abnormalities consistent with hypoperfusion (decreased blood flow) of deep limbic (brain) structures have been reported during a typical TGA episode. The search for an increased frequency of PFO in TGA patients has yielded conflicting results. In the first study, PFO was found in 55% of TGA patients, in 26% of stroke patients and in 26% of controls (Kloetzsch et al., 1966). Another study was unable to replicate this finding in a cohort of 46 consecutive patients in whom the prevalence of PFO (19.5%) was no higher than that found in 33 age-matched control subjects ( 19,6 %) and nonsignificantly lower than in 31 TIA patients (33.3%) (Anzola et al., 2000).

A study in the Archives of Neurology, "Arch Neurol. 1996 Jun;53(6):504-8.
showed an increased frequency of patent foramen ovale in patients with transient global amnesia. Fifty-three consecutive patients with TGA were evaluated by the 2 centers between 1988 and 1995. Using contrast transcranial Doppler sonography they have observed a PFO in 55% of the patients with TGA, compared with 27% of a control group of 100 patients. This difference was statistically significant (P < .01). Twenty-five patients with TGA (47%), 15 of them with a proven PFO, reported a precipitating activity, such as the lifting of heavy weights, immediately before the TGA occurred.

So, here we have another symptom complex from patent foramen ovale in divers that we need to be aware of - the diver who has a temporary but complete loss of memory coming on immediately after a dive and often associated with valsalva-like exertions, such as lifting or climbing right after a dive.

Should the defect be closed? Probably so in the working diver who cannot call his shots; possibly not in sport divers who can control their dives (and consequently the venous bubble load).

A Traveler's Emergency Kit (or A MASH Unit?)

2006-08-13T18:59:00.000-05:00

I ran across this article on eScuba and thought you might want to have this information available for your next diving expedition, particularly if you have a doctor along on the trip. Permmission to publish by the author - who is a personal friend.

A Traveler's Emergency Kit
by Dr. Bruce Miller

This section lists supplies and medications that you should consider taking along when you travel to areas where little or no medical care exists. If you're a physician, you'll find plenty of problems in the indigenous population that can use your help.

For those who want to avoid collecting the supplies and medications, I enthusiastically recommend DAN's DSS Guardian First Aid Kit. It contains most of the supplies I've listed in a handy, compact travel kit. You can easily customize it to your own specifications as well. For example, you can't take along too many one-inch Band-Aids®-I carry at least 100-and several rolls of 1-inch-wide cloth adhesive tape. You'll be the most popular diver on the trip! All of this fits inside a zipper bag the size of a loaf of bread.

Hardware
5 disposable scalpels with #15 blade*
1 needle holder*
1 pair pickups (e.g., Adson™)*
2 small hemostats*
2 3.5cc syringes with 25-gauge needle or dental syringe with 30-gauge needles*
1 tissue scissors*
1 oto-ophthalmoscope*
1 disposable airway*
1 Swiss Army knife or Leatherman tool-really useful to have along!
1 stethoscope

Materials
2 packs each 4-0 Ethanol-Vicryl™ sutures on a PS-2 needle*
1 bottle 1 percent Xylocaine®* with epinephrine (or 2 percent dental capsules)
Ed. Note: The use of the epinephrine in the hand or foot...especially the fingers or toes is contraindicated. There is the possiblity of an ischemia serious enough to lose a digit.
12 packets alcohol swabs
2 sterile drapes with eyeholes
2 pair each sterile and disposable gloves
2 rolls 3-inch Ace™ elastic wrap
2 rolls 1" cloth tape
1 box Steri-strips™
1 box Telfa™ pads
1 box 1" Band-Aids® #100
2 rolls self-adherent roller gauze (wide)
1 roll Coban™
1 packet of Duoderm™ (thin)

Drugs
1 tube fluorinated steroid (Temovate®, Diprolene® AF)*
1 tube 1 percent hydrocortisone cream
1 tube antibiotic ointment
1 tube topical antifungal cream (Naftin®, Lotrimin®, etc.)
1 tube Duolube™*
20 Tylox® caps
30 Ibuprofen® or Aleve®
30 enteric coated ASA or Tylenol® tablets*
30 prednisone tablets (20mgm)*
20 Cipro® or Cephalexin® tablets (500mgm)*
20 Famvir® or Valtrex® 500 mgm tabs or Zovirax® 800 mgm tabs*
20 oral antifungals (Sporanox®, Diflucan®, Lamisil®)
20 acid blockers (Pepcid®, Tagamet®) or Prilosec®*
20 nonsedating antihistamines with pseudoephedrine (Claritin®-D or Allegra®-D)
Miscellaneous
1 bottle Jungle Juice
1 box Pepto-Bismol® tablets
1 Ana-Kit®
#15 (or higher) broad-spectrum (UVA/UVB) waterproof sunscreen and Chapstick®
1 bottle Domeboro Otic®*
1 bottle Afrin® Nasal Spray
1 box Transderm-Scop® patches*
1 water filtration device
* Indicates either a prescription drug or equipment that requires specialized training to use, so tailor this list to your own skill level.

Oregon physician Dr. Bruce Miller's recommendations are based on 20-plus years' experience backpacking, climbing, ski patrolling (in the Pacific Northwest), travelling, scuba diving around the world, and, "most hazardous of all, spending water-ski weeks in a houseboat on Lake Shasta."
==============================================================================
Reader/diver Jan Kempiak writes in response:
Ern, wouldn't a person need an RX to get a "mash" unit like that, containing steroids and antibiotics? It didn't mention any instant ice packs, jan
My response:
You're absolutely right! That's why I called his kit a 'MASH unit 'in jest; a lot of his items require a prescription or have to be bought by a physician. However, it is a well stocked kit for a physician. Note that I state that it would be good particularly if you have a doctor in the group. Also note that he provides an asterisk for those items requiring a prescription.

You're also correct in that instant ice packs and heatable packs would be a good idea.

Recommended Diving Medical Books

2006-08-13T10:55:00.000-05:00

We recently had a question concerning which Diving Medicine books I would recommend. There are many excellent books available, each with advantages in certain areas. Here are the books that I have on my desktop and that I use on a regular basis. in no particular order.

Assessment of Diving Medical Fitness for Scuba Divers and Instructors by Peter B. Bennett, Frans J. Cronje, and Ernest S. Campbell
Order from www.bestpub.com or email divebooks@bestpub.com
Order from http://scuba-doc.com/orderbook.html .

Medical Examination of Sport Scuba Divers, 3rd Edition, AA Bove, MD
Technical Diving in Depth by B. R. Wienke
Order from amazon.com

Bennett and Elliotts' Physiology and Medicine of Diving by Alf Brubakk and Tom Neuman
Order from amazon.com

Diving Medicine by Alfred A. Bove and Jefferson Davis
Order from amazon.com

United States Navy Diving Manual, Revision 4, Vol. 5: Diving Medicine & Recompression Chamber Operations

Diving and Subaquatic Medicine (A Hodder Arnold Publication) by Carl Edmonds, Christopher Lowry, John Pennefather, and Robyn Walker
Order from amazon.com

Diving Science by Michael Strauss and Igor V. Aksenov

Textbook of Hyperbaric Medicine by K. K. Jain, Richard A., M.D. Neubauer, S. A. Baydin, and Jolie Bookspan

Diving Physiology in Plain English by Jolie Bookspan
Order this at amazon.com

Hyperbaric Medicine Practice, Second Edition by Eric P. Kindwall

NOAA Diving Manual: Diving for Science and Technology, Fourth Edition

Deeper Into Diving by John Lippmann and Simon Mitchell, MD 2nd Edition, 2005 [DAN S.E. Asia - Pacific]
www.submarinerpublications.com

The Sports Diving Medical: A Guide to Medical Conditions Relevant to Scuba Diving by John Parker

Here are some other publication sources:
UHMS-Publications - http://www.uhms.org/Publications/publicat.htm
Medical Seminars - http://www.medsem.com/publications.html
Best Publishing - http://www.bestpub.com/

Finally, I have a Diving Medicine Bookstore on my web site at http://scuba-doc.com/DMbkstr.htm .

I hope this is helpful!

Ern Campbell

US Navy Hyperbaric Tables in Metric

2006-08-13T10:26:00.000-05:00

We received a question concerning operation of a new Hyperbaric chamber in an island nation. Good questions were asked that might be beneficial to others who are opening or running chambers calibrated to the metric system.

"I am concerned with getting a copy of the USN tables for treatment in metric, so far no luck, do you know of any links, although it is not a problem shooting anyone down to 60ft (18m), I really would prefer if the instructors and nurses all had metric tables in front of them as this is a metric machine, even the manufacturers had a hard time finding any.

Another question, not related to diving, but hyperbarics, is how would a doctor go about prescribing treatment for a diabetic injury? We know it is around 30 treatments of 30 minutes, but is there a reference for this anywhere, though there is now a trained staff, I feel it is going to be "my baby to bathe and care for", so I had better find as many refrences and texts as I can before it becomes official.

Any ideas?

thanks

Marine Manager

Hello:

Here is the British Hyperbaric Association tables for recompression that has the British Royal Navy tables in meters. These are comparable to the USN tables. http://www.hyperbaric.org.uk/tables.htm .

Also, here is a web site that gives extensive background and rationale in the use of HBO in the treatment of diabetic [and other non-healing] wounds, as well as it's use in approved conditions other than decompression illness. http://www.emedicine.com/plastic/topic526.htm .

I hope this is helpful!

Ern Campbell, MD

DAN Announces DEMA Show Seminar Schedule

2006-08-13T09:59:00.000-05:00

From DiveNewsWire

Important information, updates to be presented by DAN staff proffesionals during DEMA Show 2006

A complete list of DAN seminars at the DEMA Show follows. For more information about these offerings, call (919) 684-2948 ext. 626.

DAN’s DEMA Show Seminars

Wednesday Nov. 8

10 a.m.–11 a.m.
Topic: DAN Research Presentation
“Diving with Diabetes”
Presenter: Donna Uguccioni

11 a.m.-noon
Topic: Instructor Update
“What’s New with DAN Dive Safety Courses”
Presenter: Jeff Myers, Vice President, DAN Training

1 p.m.-2 p.m.
Topic: DAN Research Presentation
Presenter: Donna Uguccioni, M.S.

2 p.m.-3 p.m.
Topic: DAN Medical Presentation
Presenter: DAN Doctor TBA

Thursday Nov. 9

10 a.m.-11 a.m.

Topic: DAN Medical Presentation
“Steps to Recognizing DCI in Divers”
Presenter: Marty McCafferty, DAN Medic

11 a.m.-noon

Topic: DAN Research Presentation
“Risk Factors for Decompression Sickness”
Presenter: Richard D. Vann, Ph.D.

1 p.m.-2 p.m.

Topic: Instructor Update
“What’s New with DAN Dive Safety Courses”
Presenter: Jeff Myers, Vice President, DAN Training

2 p.m.-3 p.m.

Topic: DAN Research Presentation
“Most Common Disabling Injuries and Adverse Events in Fatal Diving Accidents”
Presenter: Petar J. Denoble, M.D., D.Sc.

Friday Nov. 10

10 a.m.-11 a.m.
Topic: DAN Medical Presentation
“Hyperbaric Chambers and Their Use for Dive Accidents”
Presenter: Marty McCafferty, DAN Medic

11 a.m.-noon

Topic: Aptitud para el Buceo: Consideraciones de Salud y Restricciones que todo Instructor Debería Conocer
Presenter: Cuauhtemoc Sanchez, M.D.

Noon-1 p.m.
Topic: Latin American Forum and Lunch

1 p.m.-2 p.m.

Topic: DAN Research Presentation
“The History of Special Operations Diving: Part I”
Presenter: Richard D. Vann, Ph.D.

2 p.m.-3 p.m.

Topic: Instructor Update
“What’s New with DAN Dive Safety Courses”
Presenter: Jeff Myers, Vice President, DAN Training

Web Stuff from Larry "Harris" Taylor, PhD

2006-08-12T08:57:00.000-05:00

Divers,

First, and most importantly, last weekend, the University of Michigan Human Powered Sub team won the 2006 Human Powered Submarine Competition in Escondido, CA. Their first run was 3.99 knots with the final winning run at 4.587 knots This represents some very impressive work from a group of dedicated university students. Attached is a picture I took of 4 of the human sub team divers at their first in-water testing (at the University of Michigan Naval Architecture's Tow Tank Facility) this spring.

For more information:

The 2006 Competition: http://sections.asme.org/sandiego/HPS2006.htm
U of MI Sub Team: http://www.engin.umich.edu/org/hps/index.html

While on the topic, here are some more HPS sites:

Australian HPV Resources: http://www.ihpva.org/people/tstrike/resorce.htm
Bath U: http://www.bath.ac.uk/mech-eng/burst/Home.htm
Blue Space: http://foxxaero.homestead.com/indsub_03.html
History of World Submarine Invitational: http://www.hte.com/subrace/history.html
HPS 2004: http://sections.asme.org/sandiego/hps2004.htm
HPVA: http://www.ihpva.org/hpva/index.html
HTM: http://parents.hightechhigh.org/0-gillywadesub.php
Human Sub-Tools: http://www.ihpva.org/tools/index.html
Human-Powered Vehicles: http://www.nasg.com/hpv-e.html
International Submarine Races: http://www.isrsubrace.org/
Norwegian University: http://www.marin.ntnu.no/%7Eneptunus/
Omer-5: http://www.mec.etsmtl.ca/club/omer/
Pictures & Results: http://www.wisil.recumbents.com/wisil/hpra.htm
St Augustine Sub: http://www.hte.com/saintaug/
Sub-Lime: http://home1.gte.net/doctrbob/subalert.htm
Submarine Races: http://www.atlimp.com/subteam.htm
Texac A & M: http://mtssname.tamu.edu/mts/sub/index.htm
U BC: http://batman.mech.ubc.ca/%7Esubc/about.html
U Iowa: http://www.engineering.uiowa.edu/~subclub/
U Maine: http://www.umaine.edu/MechEng/Peterson/Classes/Design/General_resources/HPS/Submarine/Overview.htm
U Michigan Naval: http://www.engin.umich.edu/dept/name/research/projects/submarine/sub.html
U of MI-Wilson Center: http://www.engin.umich.edu/teamprojects/Teams/HPS/hps.html
U Washington: http://courses.washington.edu/uwsub/
UCSD: http://www-acs.ucsd.edu/~asme/sub.htm
Utah: http://www.eng.uah.edu/~wallace/projects/hps/hps.htm
Virginia Tech: http://www.hps.vt.edu/
WASUB: http://wasub.oli.tudelft.nl/
WildCatfish-Progress Report: http://www84.homepage.villanova.edu/brian.comber/progressreportfall2004.htm

This month's additions, re-appearances, and bunches of updated/re-directs this month to my list of about 8000 links at

http://www-personal.umich.edu/~lpt/links.htm

( the dive only links section of this list is at: http://www-personal.umich.edu/~lpt/mlinks.htm )

Diving
Scuba Guru: http://www.scubaguru.com/
Ghost Ships of the Great Lakes: http://www.geocities.com/hockegrrl/Ships.html
Ghost Ships: http://www.gettysburgghosts.net/ghostships.htm
Phantom Ships: http://www.unmuseum.org/phantomship.htm

Submarine Volcanoes: http://volcano.und.nodak.edu/vwdocs/Submarine/
Marine Affairs (U RI): http://www.uri.edu/cels/maf/

Jack & Sue Drafahl: http://www.jackandsuedrafahl.com/
World of Underwater Photography: http://perso.orange.fr/pcourty/english.htm

GAP recently made its gas-mixing appllication (part of its larger dive planning software) available as freeware at

http://www.gap-software.com/download/free.html/

Dive long and prosper,

"Harris"

http://www-personal.umich.edu/~lpt

http://www.mindspring.com/~divegeek

Diving News From Other Sources

2006-08-09T14:18:00.000-05:00

Divernet.com News
Dive tables creator dies Dr Val Hempleman, a leading British scientist in the development of diving decompression tables over the past 50 years, has died, aged 84. 8 August 2006

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Reef for Sharm An artificial reef has been established in Naama Bay, at Sharm el Sheikh in Egypt. 8 August 2006

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Accident claims two in family A British father and son died together when they got into difficulties off the Maltese island of Gozo. 4 August 2006

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Devon fatality A diver has died after getting into difficulties while ascending from a wreck off Plymouth. 3 August 2006

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Divers leave nothing to chance People going on scuba holidays have a good record for taking out suitable insurance cover, an industry survey has suggested. 31 July 2006

New Zealand Diver poisoned from air tank

2006-08-09T09:17:00.000-05:00

A coroner has found a crayfish diver suffered carbon monoxide poisoning from his air tank, which led to his death in a diving accident in Marlborough two years ago.

Article in the Marlborough Express by Dave Williams

See also:
Carbon Monoxide Poisoning
and the specialist. Carbon Monoxide Carbon monoxide poisoning is a rare cause ... carboxy hemoglobin) Carbon Monoxide signs: Tachycardia (rapid ... than 20% Carbon monoxide in diving is

Beach Pollution, Scuba Diving Precautions

2006-08-08T15:44:00.000-05:00

A recent Associated Press article attracted my attention and made me remember a question that was posted on our Scuba Clinic Forum recently. The article is about an environmental group that is sueing the EPA over beach polution, charging that the US Environmental Protection Agency has failed to protect beaches around the country from pollution and exposed swimmers [and divers] to potential illness.

The lawsuit was filed Thursday by the Natural Resources Defense Council in U.S. District Court, the Associated Press reported.

Under a law passed by Congress in 2000, the EPA was supposed to update its beach water quality health standards by 2005. The lawsuit says the agency missed that deadline and its current standards are two decades old.

The Natural Resources Defense Council wants the court to order the EPA to complete the water quality studies and issue revised standards, the AP reported.

An EPA spokesman did not comment on the lawsuit but said the state of the nation's beach health "remains high," the AP reported.

In a question on our Scuba Clinic Forum, Amir asks about guidelines for the management of contaminants accumulation in wetsuits over time. There follows several answers concerning the washing and care of wet suits and basically stating that there needs to be studies to determine the correct way to rid wet suits of contaminants. You might want to vist the thread and post if you have any suggestions about maintaining your gear in polluted water and beaches.

The answer is that basically wet suits cannot be adequately cleaned after contamination.

Here is a great letter from Sean Sheldrake the Deputy Dive Safety Officer, USEPA, Region 10. We have his permission to publish.
"Dear Dr. Campbell,

We here in the Region 10 dive unit very much enjoy your blog and read it with some regularity. We did read some disturbing posts recently regarding "contaminated water diving" with a wetsuit*, and what was more disturbing, the implication that the wetsuit could somehow be cleaned.

Other than covering or neutralizing foul odors, removing salts, etc., wetsuits cannot be cleaned. The diver always has a level of dermal exposure using a wetsuit (and by implication ingestion due to the use of an "in the mouth" regulator), and to varying degrees the wetsuit forever carries the contaminants to which it has been exposed. NOAA and EPA have done studies in the 1980's which well establish the fact that neoprene materials will become impregnated with contaminants, and should be considered contaminated to varying degrees after diving in polluted water. See the excerpt from the Traver study at the link below "Interim protocol for diving operations in contaminated water":

http://yosemite.epa.gov/r10/oea.nsf/webpage/Dive+Team+Safety

The EPA dive safety manual section on polluted water may also be of interest. We continue to post what polluted water information resources we can to our website, and advocate that public safety and commercial divers should always wear a full face mask, drygloves, and a non-neoprene drysuit like the Viking. Some like Mr. Barsky suggest that hardhat, surface supplied diving is always the way to go for any level of pollution, but when I see commercial divers working for a "low bid" commercial dive contractor in polluted water wearing wetsuits and recreational regulator units, I think a middle ground can be advocated which gives the diver a modicum of protection (significant decrease in dermal and ingestion pathway exposure) without spending $10k to outfit one diver in the water.

Thank you for your time.

Sean Sheldrake, Deputy Dive Safety Officer USEPA, Region 10 Environmental Cleanup Office
1200 Sixth Avenue Mailstop: ECL-110 Seattle WA 98101-1128 sheldrake.sean@epa.gov Phone: 206/553-1220 / Fax: 206/553-0124 or -0910 http://yosemite.epa.gov/r10/oea.nsf/webpage/dive+team http://yosemite.epa.gov/r10/cleanup.nsf/sites/ptldharbor
"

More about diving in polluted water on our web site here: http://www.scuba-doc.com/polwater.html

TWO NEW NON-UHMS SPONSORED COURSES NOW LISTED

2006-08-08T11:47:00.000-05:00

Lisa Wasdin, UHMS, sends this information about two new courses listed on the UHMS web site.
Note: Courses listed have not been reviewed by the UHMS Education Committee
____________________________________________________________________________________

Comprehensive Introduction to Hyperbaric Medicine and Wound Care

MATRIX Health Services, LLC offers a 43.5 hour Hyperbaric Medicine and Wound Care Course that can be conducted at your facility. This course has been reviewed and approved by the National Board of Diving and Hyperbaric Medical Technology as a Basic Hyperbaric Medicine Course. This presenter-directed Nursing CE activity is approved by the Louisiana State Nurses Association (LSNA), an accredited approver by the American Nurses Credentialing Center ’s Commission on Accreditation, for 43.5 contact hours.

For more information contact:

Becky Toups (504) 906-1024
btoups@matrixhealthservices.net
or
Mary Hirsch (504) 913-9195

mhirsch@matrixhealthservices.net

MATRIX Health Services, LLC: www.matrixhealthservices.net

____________________________________________________________________________________

The Introduction to Hyperbaric Medicine

National Polytechnic College of Engineering and Oceaneering (College of Oceaneering)

Credits: 50 hour course. This course is approved by the NBDHMT and is conducted either Monday thru Friday, or a weekend course conducted on a Saturday/Sunday than a Friday/Saturday/Sunday.

These course are conducted at both the Wilmington campus (Los Angeles) or the San Diego campus.

Contact Jim Spelich or Kathie Christenson at 310-834-2501, 800-432-3483 fax 310-952-8532 or jspelich@natpoly.edu Or kchristenson@natply.edu

Course dates:

CHT Wilmington (Los Angles)

Monday thru Friday 11/27/06
Monday thru Friday 02/19/07
Monday thru Friday 06/04/07

San Diego

Monday thru Friday 10/16/06
Sat, Sun, Fri, Sat, Sun 03/24/07

13 year old diver treated for DCS

2006-08-07T19:51:00.000-05:00

We have long been severe critics of allowing youngsters below the age of 16 to dive.This age is not arbitrary, being the age of 'consent' , the age of driving licenses, etc.

Here is a report of an 'experienced' 13 year old diver treated for DCS.

http://tinyurl.com/qn7s9

More about children diving on these web pages on our web site:

Teenagers and Diving
Description of requirements and dangers of teen divers, particularly the psychology and physical needs for maturity.Traits that are important -good judgment ...

Age and Diving
and dangers of teen divers, particularly the psychology and physical ... Diving Teens Problem -- Teen Age Divers Sport diving imposes no legal ... for young ...

[PDF] Teenagers and Diving
factors should be restricted in the growing teen-ager who has a life-time of. diving ahead. Arbitrary depths and times have to be chosen to maintain ...

Questions and Answers
Teen Divers Do Teens Get DCS More Frequently? I will get certified when I'm 15. My parents are worried about an increased risk of decompression sickness ...

FREE Listing – OceanRealmDirectory.com

2006-08-07T10:50:00.000-05:00

FREE Listing – OceanRealmDirectory.com

If you are a dive professional or manager/owner of a dive related business, sport or commercial, you are qualified for a FREE listing in the Ocean Realm Directory.

Send contact name, business name and address with telephone, email and web information to listing@oceanrealmdirectory.com.

PSDiver Monthly - Issue 29 - NIMS - Firefighter Fatality, Continuing Ed - PSD News - and MORE

2006-08-07T10:40:00.000-05:00

In this issue: Galveston Underwater Crime Scene Seminar NIMS Resource Typing and How it Effects US Firefighter Fatality - Swift Water Rescue PSD NEWS COACH Continuing Education

*********

PSDiver Monthly is now available as a direct download at our web site: PSDiver Monthly

**A news video of the firefighter fatality is available for viewing on the home page.

ISSUE 29 * THE PDF VERSION is 956KB

Issue 29 * I The .zip file is 623 KB . You WILL need an unzip program to open this file. Winzip is one such file.

*********

Greetings!

Welcome - If you are a new subscriber, please take a moment to read this. PSDiver is sent almost exclusively to Underwater Recovery and Swift Water Rescue Teams and team members. This includes Fire Department, Police Department, EMS, Independents, Military and a few others.

Our magazine is NOT a discussion group and we do not send out email frivolously. If you wish to join our discussion group, Click here: Public Safety Diving Discussion Group.

We will continue to build the http://www.psdivermonthly.com/ web site as funds and time become available. Please feel free to share the site and if you have a web site of you own, please add a link to PSDM.

Stay Safe! Mark Phillips Editor / Publisher PSDiver Monthly

2ND CONGRESS OF THE ALPS-ADRIA WORKING COMMUNITY ON MARITIME, UNDERSEA, AND HYPERBARIC MEDICINE

2006-08-07T10:26:00.000-05:00

Croatian Maritime, Undersea, and Hyperbaric Medical Society
proudly announces:

2ND CONGRESS OF THE ALPS-ADRIA WORKING COMMUNITY ON MARITIME, UNDERSEA, AND HYPERBARIC MEDICINE
will be held in Hotels Falkensteiner, Zadar, Republic of Croatia,
from 18 to 21 October 2006
under the auspices of the GOVERNMENT OF THE REPUBLIC OF CROATIA and the ALPS-ADRIA WORKING COMMUNITY

For more information, please visit us at www.marmed.hr

SCIENTIFIC TOPICS
History of maritime medicine
Occupational medicine in maritime industry
Urgent medicine in maritime industry
Diving medicine
Maritime epidemiology
Maritime infectious and tropical diseases
Maritime and diving psychology
Marine biology and maritime environmental health
Health problems of seafarers
Health problems in maritime migrations
Hyperbaric medicine
Forensic problems in maritime, undersea, and hyperbaric medicine
Legal aspects in maritime, undersea, and hyperbaric medicine
Free topics

Deadline for the submission of abstracts is 01 Sep 2006

You are cordially invited to share with us your expertise and experience.

Welcome to Zadar, welcome to Croatia!
Nadan M. Petri
President of the Organizing Committee
Alessandro Marroni
President of the Scientific Committee

Navy Chief Submerges 2,000 Feet, Sets Record

2006-08-05T07:55:00.000-05:00

By Mass Communication Specialist 3rd Class Mark G. Logico, Fleet Public
Affairs Center, Pacific
MV KELLIE CHOUEST, At Sea (NNS) -- A Navy diver submerged 2,000 feet,
setting a record using the new Atmospheric Diving System (ADS) suit, off the
coast of La Jolla, Calif., Aug. 1.

Chief Navy Diver (DSW/SS) Daniel P. Jackson of Navy Reserve Deep Submergence
Unit (DSU) was randomly selected to certify the ADS suit for use by the
Navy.

"I feel like the luckiest guy in the world," said Jackson. "I am honored and
privileged to be the first diver to go down to that depth."

The certification was the culmination of 11 years of planning, designing and
testing by multiple agencies to develop the ADS suit, also known as the
Hardsuit 2000.

"This is the biggest piece of teamwork that I have ever seen in the Navy,"
said Cmdr. Keith W. Lehnhardt, the officer in charge of the project.

Lehnhardt said the project was a collaboration of so many different
organizations, such as DSU, Submarine Squadron 5 and Diving Systems Support
Detachment.

Jackson said, "I was just a guy tied to a rope. It was the ADS team that
made it all possible. They were incredible."

Developed by OceanWorks International from Vancouver, British Columbia, the
Hardsuit 2000 was designed to withstand underwater pressure at 2,000 feet.
Current models have only been able to go down as far as 1,200 feet.

"The suit worked incredibly," said Jackson. "It did everything it was
intended to do. I always heard that around 1,300 feet, the joints of the
Hardsuit 2000 would work even better, and it worked exactly the way they
said it would."

Meeting the Navy's high safety requirements, the ADS suit was designed and
acquired by the Navy to support submarine rescue.

"Its specific purpose is to be part of the advance assessment system during
a submarine rescue operation," said Lehnhardt. "The diver in the suit will
see what the damage to the sub is and find out where the survivors might
be."

"At 2,000 feet, I had topside turn off all the lights, and it was like a
star show. The phosphorescence that was naturally in the water and in most
of the sea life down there started to glow," Jackson said. "When I started
to travel back up, all the lights looked like a shower of stars going down
as I was coming up. It was the best ride in the world."

-USN-

INVASIVE LIONFISH FOCUS OF NOAA RESEARCH CRUISE

2006-08-04T09:41:00.000-05:00

August 3, 2006 — NOAA Ocean Service researchers, in collaboration with the Essential Image Source Foundation, embarked aboard the NOAA research vessel Nancy Foster to further examine the status in the Atlantic Ocean of the invasive Indo-Pacific lionfish. Research will be conducted off the coast of North Carolina from water depths of 115 to 150 feet deep, from Cape Lookout to Cape Fear.
view of lionfish about 40 miles off the North Carolina coast in 140 feet of water taken during the summer of 2001 by Paula Whitfield, of the NOAA Center for Coastal Fisheries and Habitat Research in Beaufort, N.C. Please credit “NOAA.”)

Lionfish, a native of the Indian and Pacific oceans and the minor seas between the two in the general area of Indonesia, have now established a population in the Atlantic Ocean. First discovered off of the coast of North Carolina in 2000, they are believed to have been present off the east coast of Florida since the mid 1990's. Lionfish, popular in the aquarium trade, were most likely introduced through releases by amateur aquarists no longer wishing to keep the fish.

Researchers will conduct surveys to quantify lionfish and native fish populations, including snapper and grouper. In addition, researchers will document native prey fish populations, retrieve long-term water temperature sensors, collect live lionfish for reproduction and life history studies, conduct plankton tows for lionfish larvae and conduct multibeam sonar mapping—topographic mapping of the ocean floor—of potential lionfish habitat, while aboard the R/V Nancy Foster.

"NOAA believes that non-native lionfish populations may continue to increase and have adverse consequences for native communities within the Atlantic," said Paula Whitfield, NOAA fisheries biologist at the NOAA Center for Coastal Fisheries and Habitat Research at Beaufort, N.C. "This research will continue to build on what we have learned in the past three years and is the next step toward understanding the impact of this invasive species."

The lionfish (Pterois volitans) is a popular saltwater aquarium fish and voracious predator of small fish, shrimp and crabs. Lionfish have spines containing a neurotoxin that can cause painful stings to unwary humans and paralyze other fish. Although there have been no known fatalities caused by lionfish stings, persons punctured by one of the sharp spines will immediately feel strong pain and rapid swelling of the affected body area.

For the full article and links, go to the web page in the NOAA Magazine at
http://tinyurl.com/ndllf

See also on our web site http://www.scuba-doc.com/hzrdmrnlf.html

and a previous article about this in 2004 at http://snipurl.com/83ud

August Humor

2006-08-04T09:35:00.000-05:00

1) When I die, I want to die like my grandfather--who died peacefully in his sleep. Not screaming like all the passengers in his car." --Author Unknown

2) Advice for the day: If you have a lot of tension and you get a headache, do what it says on the aspirin bottle: "Take two aspirin" and "Keep away from children." --Author Unknown

3) "Oh, you hate your job? Why didn't you say so? There's a support group for that. It's called EVERYBODY, and they meet at the bar." --Drew Carey

4) "The problem with the designated driver program, it's not a desirable job, but if you ever get sucked into doing it, have fun with it. At the end of the night, drop them off at the wrong house." --Jeff Foxworthy

5) "If a woman has to choose between catching a fly ball and saving an infant's life, she will choose to save the infant's life without even considering if there is a man on base." --Dave Barry

6) "Relationships are hard. It's like a full time job, and we should treat it like one. If your boyfriend or girlfriend wants to leave you, they should give you two weeks' notice. There should be severance pay, the day before they leave you, they should have to find you a temp." --Bob Ettinger

7) "My Mom said she learned how to swim when someone took her out in the lake and threw her off the boat. I said, 'Mom, they weren't trying to teach you how to swim.'" --Paula Poundstone

8) "A study in the Washington Post says that women have better verbal skills than men. I just want to say to the authors of that study: "Duh." --Conan O'Brien

9) "Why does Sea World have a seafood restaurant?? I'm halfway through my fish burger and I realize, Oh my God.... I could be eating a slow learner." --Lynda Montgomery

10) "I think that's how Chicago got started. Bunch of people in New York said, 'Gee, I'm enjoying the crime and the poverty, but it just isn't cold enough. Let's go west.'" --Richard Jeni

11) "If life were fair, Elvis would be alive and all the impersonators would be dead." --Johnny Carson

12) "Sometimes I think war is God's way of teaching us geography." --Paul Rodriguez

13) "My parents didn't want to move to Florida, but they turned sixty and that's the law." --Jerry Seinfeld

14) "Remember in elementary school, you were told that in case of fire you have to line up quietly in a single file line from smallest to tallest. What is the logic in that? What, do tall people burn slower?" --Warren Hutcherson

15) "Bigamy is having one wife/husband too many. Monogamy is the same." --Oscar Wilde

16) "Suppose you were an idiot. And suppose you were a member of Congress. But I repeat myself." --Mark Twain

17) "Our bombs are smarter than the average high school student. At least they can find Afghanistan ." --A. Whitney Brown

18) "You can say any foolish thing to a dog, and the dog will give you a look that says, 'My God, you're right! I never would've thought of that!'" --Dave Barry

19) Do you know why they call it "PMS"? Because "Mad Cow Disease" was taken. --Unknown, presumed deceased

20) "Everybody's got to believe in something. I believe I'll have another beer." -- W. C. Fields

This email was cleaned by emailStripper, available for free from http://www.papercut.biz/emailStripper.htm
================================================================================
Why Men Wear Earrings

A man is at work one day when he notices that his co-worker is wearing an earring. This man knows his co-worker to be a normally conservative fellow, and is curious about his sudden change in "fashion sense."

The man walks up to him and says, "I didn't know you were into earrings."

"Don't make such a big deal, it's only an earring," he replies sheepishly.

His friend falls silent for a few minutes, but then his curiosity prods him to say, "So, how long have you been wearing one?"

"Ever since my wife found it in my truck."

(I always wondered how this trend got started)

===
===========================================================================
Mafia Lawyer

A Mafia Godfather finds out that his bookkeeper has screwed him out of ten
million bucks; his bookkeeper is deaf. It was considered an occupational
benefit, and the reason he got the job in the first place, since it was
assumed that a deaf bookkeeper would not be able to hear anything that he'd
ever have to testify about in court.

When the Godfather goes to shakedown the bookkeeper about his missing $10
million bucks, he brings along his attorney, who knows sign language.
The Godfather asks the bookkeeper: "Where is the 10 million bucks you
embezzled from me?"

The attorney, using sign language, asks the bookkeeper where the 10 million
bucks is hidden.

The bookkeeper signs back: "I don't know what you are talking about." The
att
orney tells the Godfather: "He says he doesn't know what you're talking about."
That's when the Godfather pulls out a 9 mm pistol, puts it to the
bookkeepers temple, cocks it, and says: "Ask him again!" The attorney signs
to the underling: "He'll kill you for sure if you don't tell him!"
The bookkeeper signs back: "OK! You win! The money is in a brown briefcase,
buried behind the shed in my cousin Enzo's backyard in Queens!"

The Godfather asks the attorney: "Well, what'd he say?" The attorney
replies: "He says you don't have the balls to pull the trigger."

Don't ya just love lawyers?

==============================================================================
Best Genie Joke Lately

A Husband took his wife to play her first game of golf. Of course, the
wife promptly hacked her first shot right through the window of the
biggest house adjacent to the course. The husband cringed, "I warned you
to be careful!

Now we'll have to go up there, find the owner, apologize and see how
much your lousy drive is going to cost us."

So the couple walked up to the house and knocked on the door. A warm
voice said, "Come on in." When they opened the door they saw the damage
that was done. Glass was all over the place, and a broken antique
bottle was lying on its side near the pieces of window glass.

A man reclining on the couch asked, "Are you the people that broke my
window?"

"Uh... yes sir. We're sure sorry about that," the husband replied.

"Oh, no apology is necessary. Actually I want to thank you. You see, I'm
a genie, and I've been trapped in that bottle for a thousand years. Now
that you've released me, I'm allowed to grant three wishes. I'll give
you each one wish, but if you don't mind, I'll keep the last one for
myself."

"Wow, that's great!" the husband said. He pondered a moment and blurted
out, "I'd like a million dollars a year for the rest of my life."

"No problem," said the genie. "You've got it, it's the least I can do.
And, I'll guarantee you a long & healthy life!"

"And now you, young lady, what do you want?" the genie asked.

"I'd like to own a gorgeous home complete with servants in every country
in the world," she said.

"Consider it done," the genie said. "And your homes will always be safe
from fire, burglary and natural disasters!"

"And now," the couple asked in unison, "what's your wish, genie?"

"Well, since I've been trapped in that bottle, and haven't been with a
woman in more than a thousand years, my wish is to have sex with your
wife."

The husband looked at his wife and said, "Gee, honey, you know we both
now have a fortune, and all those houses. What do you think?"

She mulled it over for a few moments and said, "You know, you're right
Considering our good fortune, I guess I wouldn't mind, but what about
you, honey?"

You know I love you sweetheart," said the husband. I'd do the same for
you!"

So the genie and the woman went upstairs where they spent the rest of
the afternoon enjoying each other.

The genie was insatiable. After about three hours of non-stop sex, the
genie rolled over and looked directly into her eyes and asked, "How old
are you and your husband?"

"Why, we're both 35," she responded breathlessly.

"No Kidding," he said. "Thirty-five years old... and both of you still
believe in genies?"

=================================================================================
3-Minute Management Course

Lesson One
An eagle was sitting on a tree resting, doing nothing.
A small rabbit saw the eagle and asked him, "Can I
also sit like you and do nothing?" The eagle
answered: "Sure, why not." So, the rabbit sat on the
ground below the eagle and rested. All of a sudden,
a fox appeared, jumped on the rabbit and ate it.

Management Lesson

To be sitting and doing nothing, you must be sitting
very, very high up. ____________________________________

Lesson Two
A turkey was chatting with a bull. "I would love to
be able to get to the top of that tree," sighed the
turkey, "but I haven't got the energy." "Well, why
don't you nibble on some of my droppings?" replied
the bull. "They're packed with nutrients." The
turkey pecked at a lump of dung, and found it
actually gave him enough strength to reach the lowest
branch of the tree. The next day, after eating some
more dung, he reached the second branch. Finally
after a fourth night, the turkey was proudly perched
at the top of the tree. He was promptly spotted by a
farmer, who shot him out of the tree.

Management Lesson

- Bullshit might get you to the top, but it won't
keep you there. _____________________________________

Lesson Three
A little bird was flying south for the winter. It
was so cold; the bird froze and fell to the ground
into a large field. While he was lying there, a cow
came by and dropped some dung on him.

As the frozen bird lay there in the pile of cow
dung, he began to realize how warm he was. The dung
was actually thawing him out! He lay there all warm
and happy, and soon began to sing for joy. A passing
cat heard the bird singing and came to investigate.
Following the sound, the cat discovered the bird
under the pile of cow dung, and promptly dug him out
and ate him.

Management Lesson -
(1) Not everyone who shits on you is your enemy.
(2) Not everyone who gets you out of shit is your friend.
(3) And when you're in deep shit, it's best to keep your mouth shut!

This ends your three-minute management course.

=================================================================================

Anger Management

When you occasionally have a really bad day, and you just need to take it out on someone, don't take it out on someone you know, take it out on someone you don't know.

I was sitting at my desk when I remembered a phone call I'd forgotten to make. I found the number and dialed it. A man answered, saying "Hello."

I politely said, "This is Chris. Could I please speak with Robyn Carter?"

Suddenly a manic voice yelled out in my ear "Get the right fuckin number!" and the phone was slammed down on me.

I couldn't believe that anyone could be so rude. When I tracked down Robyn's correct number to call her, I found that I had accidentally transposed the last two digits.

After hanging up with her, I decided to call the 'wrong' number again.

When the same guy answered the phone, I yelled "You're an asshole!" and hung up. I wrote his number down with the word 'asshole' next to it, and put it in my desk drawer.

Every couple of weeks, when I'm paying bills or had a really bad day, I'd call him up and yell, "You're an asshole!" It always cheered me up.

When Caller ID was introduced, I thought my therapeutic "asshole calling" would have to stop.

So, I called his number and said, "Hi, this is John Smith from Verison. I'm calling to see if you're familiar with our Caller ID Program?"

He yelled "NO!" and slammed down the phone. I quickly called him back and said, "That's because you're an asshole!"

One day I was at the store, getting ready to pull into a parking spot. Some guy in a black BMW cut me off and pulled into the spot I had patiently waited for. I hit the horn and yelled that I'd been waiting for that spot, but the idiot ignored me. I noticed a "For Sale" sign in his back window which included his phone number, so I wrote down the number.

A couple of days later, right after calling the first asshole (I had his number on speed dial) I thought that I'd better call the BMW asshole, too. I said, "Is this the man with the black BMW for sale?"

"Yes, it is", he said. "Can you tell me where I can see it?" I asked." Yes, I live at 34 Mowbray Blvd, in Vaucluse. It's a yellow house, and the car's parked right out in front."

"What's your name?" I asked. "My name is Don Hansen," he said. "When's a good time to catch you, Don?" "I'm home every evening after five." "Listen, Don, can I tell you something?" "Yes?"

"Don, you're an asshole!" Then I hung up, and added his number to my speed dial, too.

Now, when I had a problem, I had two assholes to call. Then I came up with an idea. I called Asshole #1.

"Hello." "You're an asshole!" (But I didn't hang up.)

"Are you still there?" he asked.

"Yeah," I said.

"Stop calling me," he screamed.

"Make me," I said.

"Who are you?" he asked.

"My name is Don Hansen."

"Yeah? Where do you live?"

"Asshole, I live at 34 Mowbray Blvd, Vaucluse, a yellow house, with my black Beamer parked in front."

He said, "I'm coming over right now, Don. And you had better start saying your prayers."

I said, "Yeah, like I'm really scared, asshole," and hung up.

Then I called Asshole #2. "Hello?" he said.

"Hello, asshole," I said.

He yelled, "If I ever find out who you are..."

"You'll what?" I said.

"I'll kick your ass," he exclaimed.

I answered, "Well, asshole, here's your chance.

I'm coming over right now."

Then I hung up and immediately called the police, saying that I lived at 34 Mowbray Blvd, Vaucluse, and that I was on my way over there to kill my gay lover.

Then I called Channel 9 News about the gang war going down on Mowbray Blvd, Vaucluse.

I quickly got into my car and headed over to Mowbray. I got there just in time to watch two assholes beating the crap out of each other in front of six cop cars, an overhead police helicopter and a news crew.

NOW I feel much better.

Anger management really works...

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

"You know you're a redneck when......

1. You take your dog for a walk and you both use the same tree.

2. You can entertain yourself for more than 15 minutes with a fly swatter.

3. Your boat has not left the driveway in 15 years.

4. You burn your yard rather than mow it.

5. You think "The Nutcracker" is something you do off the high dive.

6. The Salvation Army declines your furniture.

7.You offer to give someone the shirt off your back and they don't want it.

8. You have the local taxidermist on speed dial.

9. You come back from the dump with more than you took.

10. You keep a can of Raid on the kitchen table.

11. Your wife can climb a tree faster than your cat.

12. Your grandmother has "ammo" on her Christmas list.

13. You keep flea and tick soap in the shower.

14. You've been involved in a custody fight over a hunting dog.

15. You go to the stock car races and don't need a program.

16. You know how many bales of hay your car will hold.

17. You have a rag for a gas cap.

18. Your house doesn't have curtains, but your truck does.

19. You wonder how service stations keep their restrooms so clean.

20. You can spit without opening your mouth.

21. You consider your license plate personalized because your father made it.

22. Your lifetime goal is to own a fireworks stand.

23. You have a complete set of salad bowls and they all say "Cool Whip" on the side.

24. The biggest city you've ever been to is Wal-Mart.

25. Your working TV sits on top of your non-working TV.

26. You've used your ironing board as a buffet table.

27. A tornado hits your neighborhood and does $ 100,000 worth of improvements.

28. You've used a toilet brush to scratch your back.

29. You missed your 5th grade graduation because you were on jury duty.

30. You think fast food is hitting a deer at 65.

===============================================================================

Here are a few things to think about that you probably have never
thought about: SCROLL DOWN.

Can you cry under water?

How important does a person have to be before they are considered
assassinated instead of just murdered?

Why do you have to "put your two cents in"... But it's only a "penny
for your thoughts"? Where's that extra penny going to?

Once you're in heaven, do you get stuck wearing the clothes you were
buried in for eternity?

Why does a round pizza come in a square box?

What disease did cured ham actually have?

How is it that we put man on the moon before we figured out it would
be a good idea to put wheels on luggage?

Why is it that people say they
"slept like a baby" when babies wake up like every two hours?

If a deaf person has to go to court, is it still called a hearing?

Why are you IN a movie, but you're ON TV?

Why do people pay to go up tall buildings and then put money in
binoculars to Look at things on the ground?

Why do doctors leave the room while you change? They're going to see
you naked anyway.

Why is "bra" singular and "panties" plural

Why do toasters always have a setting that burns the toast to a
horrible crisp, which no decent human being would eat?

If Jimmy cracks corn and no one cares, why is there a stupid song
about him?

Can a hearse carrying a corpse drive in the carpool lane?

If the professor on Gilligan's Island can make a radio out of a
coconut, why can't he fix a hole in a boat?

Why does Goofy stand erect while Pluto remains on all fours? They're
both dogs!

If Wiley E. Coyote had enough money to buy all that ACME crap, why
didn't he just buy dinner?

If corn oil is made from corn, and vegetable oil is made from
vegetables, what is baby oil made from?

If electricity comes from electrons, does morality come from morons?

Do the Alphabet song and Twinkle, Twinkle Little Star have the same
tune?

Why did you just try singing the two songs above?

Why do they call it an asteroid when it's outside the hemisphere,
but call it a hemorrhoid when it's in your butt?

Did you ever notice that when you blow in a dog's face, he gets
mad at you, but when you take him for a car ride; he sticks his head
out the window?

Do you ever wonder why you gave me your e-mail address in the first
place?

------------------------------------------------------------------------------

Pilot Philosophies

The difference between a duck and a copilot?
The duck can fly.

A check ride ought to be like a skirt -- short enough to be interesting,
but long enough to cover everything.

Speed is life. Altitude is life insurance.

It only takes two things to fly: airspeed, and money.

The three most dangerous things in aviation:
A Doctor or Dentist in a Cessna
Two captains in a DC-9.
A flight attendant with a chipped tooth.

Aircraft Identification:
If it's ugly, it's British.
If it's weird, it's French.
If it's ugly and weird, it's Russian.

Without ammunition, the USAF would be just another very expensive flying club.

The three best things in life are a good landing, a good orgasm, and a
good bowel movement. A night carrier landing is one of the few
opportunities to experience all three at the same time.

The similarity between air traffic controllers and pilots?
If a pilot screws up, the pilot dies.
If ATC screws up, the pilot dies.

It's better to break ground and head into the wind than to break wind and head into the ground.

The difference between flight attendants and jet engines is that the
engines usually quit whining when they get to the gate.

New FAA motto: "We're not happy, till you're not happy."

A copilot is a knot head until he spots opposite direction traffic at 12 o'clock, after which he's a goof-off for not seeing it sooner.

If something hasn't broken on your helicopter--it's about to.

I give that landing a 9, on the Richter scale.

Basic Flying Rules:
1. Try to stay in the middle of the air.
2. Do not go near the edges of it.
3. The edges of the air can be recognized by the appearance of
ground, buildings, sea, trees and interstellar space. It is much moredifficult to fly in the edges.

Unknown landing signal officer to carrier pilot after his 6th unsuccessful landing attempt:

"You've got to land here son. This is where the food is."

===================================================================================

Grins

I was in the express lane at the store, quietly fuming. Completely ignoring the sign, the woman ahead of me had slipped into the check-out line pushing a cart piled high with groceries. Imagine my delight when the cashier beckoned the woman to come forward, looked into the cart, and asked sweetly, "So which six items would you like to buy?"
----------------------------------------
Because they had no reservations at a busy restaurant, my elderly neighbor and his wife were told there would be a 45-minute w ait for a table. "Young man, we're both 90 years old," the husband said. "We may not have 45 minutes." They were seated immediately.
------------------------------------------
The reason congressmen try so hard to get re-elected is that they would hate to have to make a living under the laws they've passed.
-----------------------------------------
All eyes were on the radiant bride as her father escorted her down the aisle. They reached the altar and the waiting groom; the bride kissed her father and placed something in his hand. The guests in the front pews responded with ripples of laughter. Even the minister smiled broadly. As her father gave her away in marriage, the bride gave him back his credit card.
-----------------------------------------
Women and cats will do as they please, and men and dogs should relax and get used to the idea.
----------------------------------------
Three friends from the local congregation were asked, "When you're in your casket, and friends and congregation members are mourning over you, what would you like them to say?" Artie said, "I would like them to say I was a wonderful husband, a fine spiritual leader, and a great family man. Eugene commented, "I would like them to say I was a wonderful teacher and servant of God who made a huge difference in people's lives." Don said, "I'd like them to say, 'Look, he's moving!'"
--------------------------------
Smith climbs to the top of Mt.Sinai to get close enough to talk to God. Looking up, he asks the Lord, "God, what does a million years mean to you?" The Lord replies, "A minute." Smith asks, "And what does a million dollars mean to you?" The Lord replies, "A penny." Smith asks," Can I have a penny?" The Lord replies, "In a minute."
----------------------------------------
A man goes to a shrink and says, "Doctor, my wife is unfaithful to me. Every evening, she goes to Larry's bar and picks up men. In fact, she sleeps with anybody who asks her! I'm going crazy. What do you think I should do?" "Relax," says the Doctor, "take a deep breath, and calm down. Now, tell me, exactly where is Larry's bar?"
---------------------------
An old man goes to the wizard to ask him if he can remove a "curse" he has been living with for the last 40 years. The wizard says "Maybe, but you will have to tell me the exact words that were used to put the curse on you." The old man says without hesitation, "I now pronounce you man and wife."
---------------------------------
Joe was on his deathbed and gasped pitifully. "Give me one last request, dear," he said. "Of course, Joe, " his wife said softly. "Six months after I die," he said, "I want you to marry Bob." "But I thought you hated Bob," she said. With his last breath Joe said, "I do!"
----------------------------------
A man goes to see the rabbi. "Rabbi," he says, "something terrible is happening and I have to talk to you about it." The rabbi asks, "What's wrong?" The man replies, "My wife is poisoning me." The rabbi, very surprised by this, asks, "How can that be?" The man then pleads, "I'm telling you, I'm certain she's poisoning me, what should I do?" The rabbi then offers, "Tell you what. Let me talk to her, I'll see what I can find out and I'll let you know." A week later the rabbi calls the man and says, "Well, I contacted your wife . She talked to me on the phone for three solid hours. You want my advice?" The man says, "Yes." The rabbi replies, "Take the poison!"
===================================================================================

They Walk Among Us
*********************
Some guy bought a new fridge for his house. To get rid of his old, still working fridge, he put it in his front yard and hung a sign on it saying: "Free to good home. You want it, you take it". For three days the fridge sat there without even one person looking twice at it. He eventually decided that people were too untrusting of this deal. It looked to good to be true, so he changed the sign to read: "Fridge for sale $50". The next day someone stole it. Caution ... They Walk Among Us!
***
While looking at a house, my brother asked the real estate agent which direction was north because, he explained, he didn't want the sun waking him up every morning. She asked, "Does the sun rise in the North?" When my brother explained that the sun rises in the East, and has for sometime, she shook her head and said, "Oh, I don't keep up with that stuff." ... They Walk Among Us!
***
I used to work in technical support for a 24/7 call center. One day I got a call from an individual who asked what hours the call center was open. I told him, "The number you dialed is open 24 hours a day, 7 days a week." He responded, "Is that Eastern or Pacific time?" Wanting to end the call quickly, I said, "Uh, Pacific" ... They Walk Among Us!
***
My colleague and I were eating our lunch in our cafeteria, when we overheard one of the administrative assistants talking about the sunburn she got on her weekend drive to the shore. She drove down in a convertible, but "didn't think she'd get sunburned because the car was moving" ... They Walk Among Us!
***
My sister has a lifesaving tool in her car; it's designed to cut through a seat belt if she gets trapped. She keeps it in the trunk! ... They Walk Among Us!
***My friends and I were on a beer run and noticed that the cases were discounted 10%. Since it was a big party, we bought 2 cases. The cashier multiplied 2 times 10% and gave us a 20% discount. ... They Walk Among Us!
***
I was hanging out with a friend when we saw a woman with a nose ring attached to an earring by a chain. My friend said, "Wouldn't the chain rip out every time she turned her head?" I explained that a person's nose and ear remain the same distance apart no matter which way the head is turned. ... They Walk Among Us!
***
I couldn't find my luggage at the airport baggage area. So I went to the lost luggage office and told the woman there that my bags never showed up. She smiled and told me not to worry because she was a trained professional and I was in good hands. "Now," she asked me, "has your plane arrived yet??. ... They Walk Among Us!
***
While working at a Pizza Parlor I observed a man ordering a small pizza to go. He appeared to be alone and the cook asked him if he would like it cut into 4 pieces or 6. He thought about it for some time before responding. "Just cut it into 4 pieces; I don't think I'm hungry enough to eat 6 pieces. Yep, They Walk Among Us too. They walk among us, and reproduce!

===============================================================================

FOR LEXOPHILES

1. A bicycle can't stand alone; it is two tired.

2. A will is a dead giveaway.

3. Time flies like an arrow; fruit flies like a banana.

4. A backward poet writes inverse.

5. In a democracy it's your vote that counts; in feudalism, it's your
Count that votes.

6. A chicken crossing the road: poultry in motion.

7. If you don't pay your exorcist you can get repossessed.

8. With her marriage she got a new name and a dress.

9. Show me a piano falling down a mine shaft and I'll show you A-flat
miner.

10. When a clock is hungry it goes back four seconds.

11. The guy who fell onto an upholstery machine was fully recovered.

12. A grenade fell onto a kitchen floor in France resulted in Linoleum
Blownapart.

13. You are stuck with your debt if you can't budge it.

14. Local Area Network in Australia : The LAN down under.

15. He broke into song because he couldn't find the key.

16. A calendar's days are numbered.

17. A lot of money is tainted: 'Taint yours, and 'taint mine.

18. A boiled egg is hard to beat.

19. He had a photographic memory which was never developed.

20. A plateau is a high form of flattery.

21. The short fortuneteller who escaped from prison: a small medium at
large.

22. Those who get too big for their britches will be exposed in the end.

23. When you've seen one shopping center you've seen a mall.

24. If you jump off a Paris bridge, you are in Seine.

25. When she saw her first strands of gray hair, she thought she'd dye.

26. Bakers trade bread recipes on a knead to know basis.

27. Santa's helpers are subordinate clauses.

28. Acupuncture: a jab well done.

29. Marathon runners with bad shoes suffer the agony of de feet.

Note: No trees were killed in the sending of this message, but a large
number of electrons were terribly inconvenienced
==================================================================================

Senior Research Scientist Needed

2006-08-03T16:31:00.000-05:00

UNIVERSITIES SPACE RESEARCH ASSOCIATION'S
DIVISION OF SPACE LIFE SCIENCES
http://www.dsls.usra.edu/

Senior Research Scientist
Universities Space Research Association's (USRA) Division of Space Life Sciences (DSLS), a non-profit consortium of universities, has an immediate opening for a senior level Research Scientist to work at NASA Johnson Space Center to support and lead biomedical research in the area of decompression sickness (DCS) for NASA's Extravehicular Activity (EVA) Physiology Project in support of the Project Scientist. The successful candidate will be expected to perform applied research on the physiological processes of living organisms and systems, including the effects of EVA and DCS in varying space environments on the vestibular, cardiovascular, renal, respiratory, musculoskeletal, and/or thermoregulatory systems. The incumbent will also be expected to develop relevant grant proposals for submission to NASA granting organizations. Applicant must be a citizen of the United States or possess permanent residence status. Some travel may be required.

Applicants must have a PhD, ScD, or MD in the area of applied physiology, biochemistry or a related biomedical/allied health field, with experience in decompression sickness research or related activity, managing a physiology research laboratory for human testing. Knowledge of human and environmental physiology concepts and applications, along with biomedical ethics, and principles of test subject safety is required. Superior oral and written communication skills are required, along with exceptional organizational skills and the ability to multi-task.

UNIVERSITIES SPACE RESEARCH ASSOCIATION IS AN EQUAL OPPORTUNITY EMPLOYER

Please reference job number: SRS-H, with a note confirming U.S. citizenship or permanent residence status. Please send your curriculum vitae and summary of research experience, publications and three references to:

Universities Space Research Association
Division of Space Life Sciences
3600 Bay Area Boulevard, Houston, TX 77058
Fax: 281-244-2006
E-mail: recruitment@dsls.usra.edu

3rd All-Russian Conference “Actual Problems of Clinical Hyperbaric Oxygenation”

2006-08-02T17:45:00.000-05:00

Federal Agency of Health and Social Development
SEI Russian Post Graduate Medical Academy
January 24-26, 2007

Organized by:
Hyperbaric Oxygenation Department of SEI Russian Post Graduate Medical Academy;
Federal State Unitary Enterprise M.V. KHRUNICHEV STATE RESEARCH AND PRODUCTION SPACE CENTER; Medical Equipment and Consumer Goods Division.

We invite:

- members of Hyperbaric Oxygenation Department of Russia, CIS and other countries;

- science members who refer to hyperbaric medicine problems.

Main topics of the conference:

- Hyperbaric Oxygenation as an intensive care component;

- Hyperbaric Oxygenation in curing injuries and infections;

- Hyperbaric Oxygenation in curing injuries made during the war actions;

- Modern idea of Hyperbaric Oxygenation role in cardiology;

- Use Hyperbaric Oxygenation in neurology;

- Tocology and childhood;

- Monitoring in Hyperbaric Oxygenation;

- Hyperbaric Oxygenation in different spheres of medicine (round table discussion).

The Conference participants are requested to provide us with PARTICIPANT QUESTIONARY FORM, THESES in electronic format (CD-ROM, diskette or E-mail: conf@zavodmt.ru) no more than 2 pages (A4, Word format, type 12, double space) and a printed copy. No later than 1st December 2006 to the address:

123995, Moscow, Ul.Barrikadnaya, 2/1, RMAPO, Chair of HBO.

Contact us: +7(495) 166-87-74; +7(495) 145-94-56.

E-mail: Petrakova@zavodmt.ru, Tchekina@zavodmt.ru

Practical Approaches to Wound Healing

2006-08-01T11:43:00.000-05:00

FOUNDATION FOR EFFECTIVE WOUND MANAGEMENT
Practical Approaches to Wound Healing

Two Medical Park
Lower Level Conference Center
Palmetto Health Richland Hospital
Columbia, South Carolina

August 28 & 29, 2006

================================================
TARGET AUDIENCE:
This activity is for Physicians, Nurse Practitioners, Nurses, Physical Therapists, Wound Specialists and other interested Clinicians.
EDUCATIONAL OBJECTIVES:
After attending this activity, participants should be able to:
♦ Discuss the physiology of tissue injury and wound repair.
♦ Describe wound assessment and documentation.
♦ Select and use basic and advanced wound care products/technologies.
♦ Describe wound bed preparation including debridement, diagnosis of infection, and
use of topical antimicrobials.
♦ Describe proper care of atypical wounds.
♦ Identify differential diagnosis and management of arterial, venous, and neuropathic wounds.
♦ Recognize the role of adjunctive therapies including support surfaces, offloading,
nutrition, medications, etc.
♦ Identify appropriate surgical management of chronic wounds.
♦ Make decisions regarding fundamentals of billing for wound care products and
services.

EDUCATIONAL METHODS:
Lecture presentations with time for questions and answers and live demonstrations will be utilized to facilitate the exchange of information and audience participation.

ACCREDITATION AND CREDIT:
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Undersea & Hyperbaric Medical Society (UHMS) and National Baromedical Services. The UHMS is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement for AMA/PRA Category 1 Activities
The UHMS designates this educational activity for a maximum of 14.5 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
The program has been approved for 14.5 contact hours by the Center for Nursing
Leadership. The Center for Nursing Leadership is an approved provider of continuing
education by the South Carolina Nurses Association, an accredited approver by the
American Nurses Credentialing Center’s Commission on Accreditation.
===============================================
~ REGISTRATION ~
FOUNDATION FOR EFFECTIVE WOUND MANAGEMENT
Practical Approaches to Wound Healing
~ Please register early as seating is limited~
___________________________________________________
First Name MI Last Name
___________________________________________________
Credentials (MD, RN, etc.)
___________________________________________________
Street Address
___________________________________________________
City, State, Zip Code
___________________________________________________
Phone Fax
___________________________________________________
Email Address
Please check if you need assistance with hearing, vision or mobility.
Please indicate any special meal concerns:_____________________________________________
If unable to attend, would you wish to attend in the future? Yes _____ No _____
Please email your contact information to april.mciver@palmettohealth.org
Registration Fee: $225.00
~ Onsite registration is on a space available basis only ~
Method of payment:
Check #______________________ (payable to Palmetto Health Richland)
Visa _____ Master Card _____ Discover _____ AMEX _____
Name on card_________________________________________________________
Card#_______________________________________ Expiration Date:__________
Signature (for credit card)_______________________________________________
Please mail or fax registration form to:
National Baromedical Services
Attn: April McIver
5 Richland Medical Park
Columbia, SC 29203
Tel: 803.434.7101 Fax: 803.434.4354
Email: april.mciver@palmettohealth.org
=================================================================
PLANNING COMMITTEE
Dick Clarke, CHT
Stacy Handley, RN, ACHRN, CWCN
Dolores Farrer, DPM, CWS, CHT
Beth Hawkins-Bradley, RN, MN, CWOCN
April McIver
Tom Norris, MD, FAAFP
HOTEL ACCOMMODATIONS
CANCELLATION POLICY
Embassy Suites - 1.800.EMBASSY (1.800.362.2779)
Clarion Hotel Downtown - 803.771.8711
Hampton Inn - 803.231.2000
Holiday Inn - 803.799.7800
Comfort Suites - 803.744.4000
All refunds should be requested in writing at least 10 days of each course start
date and will be subject to a $25 administrative fee. No cancellation requests
will be accepted after that date. Substitutions are welcome.
This CME is planned and presented in accordance with the Essential Areas and
policies of the Accreditation Council for Continuing Medical Education.
Faculty and commercial support relationships will be disclosed to participants at
the conference. Off-label/investigative uses of commercial products/devices
will also be disclosed.
===============================================
Faculty

Beth Hawkins-Bradley, RN, MN, CWOCN
Seminar Instructor; Cross Country Seminars
Nurse Educator, South Carolina Spinal Cord Injury Association
Columbia, South Carolina
Joseph Cantwell, CP, BOP
Certified Pedorthics and Orthotics
Columbia, South Carolina

D. Lindsie Cone, MD
Medical Director , Hyperbaric Medicine Service
Palmetto Health Richland Hospital
Chief Information Officer and HIPAA Security Officer
University of South Carolina School of Medicine
Columbia, South Carolina

Damon Daniels, MD
Assistant Professor
Department of Family and Preventive Medicine
University of South Carolina School of Medicine
Columbia, South Carolina

Dolores Farrer, DPM, CWS, CHT
National Baromedical Services
Columbia, South Carolina

C. Scott Lamar, MD
Assistant Professor, Family and Preventive Medicine
University of South Carolina School of Medicine
Columbia, South Carolina

Thomas Norris, MD, FAAFP
Associate Medical Director
HealthSouth Rehabilitation Hospital
Columbia, South Carolina

Richard Wassermann, MD, MPH, FACS
Plastic Surgery Consultants
Columbia, South Carolina

Robert Wilson, RN
Director, Patient Care Services
Medsource, Inc.
Columbia, South Carolina

Michael J. Yost, Ph.D
Director of Research, Department of Surgery
University of South Carolina School of Medicine
Columbia, South Carolina

Hyperbaric Safety Director Training Course

2006-08-01T11:38:00.000-05:00

Hyperbaric Safety Director Training Course
September 20-23, 2006

Meeting Location
Drury Inn & Suites Riverwalk
201 N. St. Mary’s Street
San Antonio, Texas 78205

To make hotel reservations, please click on the link below.

http://reservations.druryhotels.com/GroupReservationConfirmation.aspx?GroupNo=212857

This CME Activity is hosted by

International ATMO, Inc., 414 Navarro, Suite 502, San Antonio, Texas 78205

Phone: 210-614-3688, Fax: 210-223-4864

Email: education@hyperbaricmedicine.com

www.hyperbaricmedicine.com

Free magazine, "X-ray" now online

2006-08-01T11:28:00.000-05:00

X-Ray Mag #12 is now online! and ready to download. The magazine is free/complimentary

From the cool blue wilderness of the Canadian high Arctic (by Louise Murray) to the red hot deserts of Jordan - from Beluga whales close to magnificent wrecks. Also in this issue lots of Ocean Art including Chihulys Seaforms. We have a talk with photographer Kurt Amsler and AP Valves' Martin Parker. Cedric Vedier dives 200m on CCR in Thailand and Cindy Dale explore caves in Bosnia. Technique: Leigh Cunningham tells why we should watch our partial pressure and Jason Heller and Dan Beecham explains how we can rig your photogear. + Lots of other news and new gear too - as always.

► Click here to go to our download-page (pdf) ◄ (that's : www.xray-mag.com/article/193 )

MEDICAL ASPECTS OF DIVING ACCIDENTS AND ILLNESSES, 15-20 October 2006

2006-08-01T11:27:00.000-05:00

LAST CALL

ROYAL NETHERLANDS NAVY
DIVING MEDICAL CENTRE, TECHNICAL CENTRE AND DIVING SCHOOL

ADVANCED COURSE

MEDICAL ASPECTS OF DIVING ACCIDENTS AND ILLNESSES
15-20 October 2006

The management of all types of illnesses and accidents that arise from all forms of diving is the theme of this practical course, another in the series run by the RNN during the last 15 years. The scope includes and extends beyond the treatment of decompression illness brought to a hyperbaric chamber and covers the on-site medical management of illnesses and injuries arising during deep mixed-gas and saturation diving. This is for doctors who are interested in the advanced medical and physiological concepts and for those who have a duty of care for divers. It will be an intensive course with emphasis on practical training with the RNN and leading towards competence in diving physiology and medicine.

This course is at Level IIa of the requirements of the European Diving Technology Committee, EDTC, as approved by the Diving Medical Advisory Committee (DMAC).
Attendance will be recognised by the International Marine Contractors Association, IMCA, as appropriate worldwide for doctors with medical responsibilities for working divers.
The Faculty of Occupational Medicine at the Royal College of Physicians, London, has approved it for 40½ hours CPD (Continuing Professional Development). This approval is recognised for postgraduate education in occupational medicine and in all hospital specialties in the UK. For previous courses, this approval has been sufficient for equivalent recognition in many other countries.
The week is also recognised towards meeting essential requirements of the distance learning course of the University of Stellenbosch leading towards BScMedScHons (Underwater Medicine).

Rob van Hulst, the Senior Diving Medical Officer of the Royal Netherlands Navy will be the Course Director with a teaching faculty that includes Hans Ornhagen, lately Director of Research, Swedish Defence Research Agency, and David Elliott, Civilian Consultant to the Royal Navy. The many practical aspects are supported by naval divers and diving officers of the Royal Netherlands Navy. Candidates should have previously attended an introductory course such as for the medical examination of divers or as approved by UHMS for CME. The course will include practical diving and recompression chamber sessions, so candidates should meet the fitness requirements (but this is not obligatory).

The Tuition Fee will be €1,500 if paid by before 10 September 2006, and after that date €2,000. Candidates are responsible for their own travel and living expenses.

Further details on the course and accommodation are available from:

mj.veen@mindef.nl

Diving Medical Centre, Royal Netherlands Navy
PO Box 10.000, 1780 CA Den Helder
The Netherlands
Tel: 00-31-223-653214; Fax: 00-31-223-653148

Torpedo Ray Injury

2006-07-27T08:22:00.000-05:00

Frequent correspondent, Jim Grier calls our attention to an interesting posting on one of the boards about a torpedo ray injury. This was posted on the 'scubadiving' board by "TexasTechdiver" with a follow-up posting. It is an interesting account of a commercial diver who was inspecting a pipeline looking for a small oil leak. He called that he was in trouble, felt something like electricity and shock, then became silent. The video that he was wearing showed a stationary sea floor so the rescue diver immediately went down and retrieved the unconscious diver who had thrown up in his Kirby-Morgan hardhat. He was placed in the chamber and the dive ship unmoored and set sail for the coast, in order to decompress. They stabilized him and he was coherent but didn't know what had happened.

The video was retrieved from the boat and reviewed, and showed, moments before the diver lost consciousness, the approach of a sizeable torpedo ray. The sound indicated four separate electrical discharges from the ray that knocked the diver cold. He was lucky to be in a surface supplied hardhat rig, because on SCUBA he would be dead.

The diver is OK. He's getting an extensive workup looking for possible reasons why the extreme reaction to the electrical shocks. Everyone agrees he's very fortunate to be alive, and that the reaction on the dive crew to the incident was 100%. It's nice when things work out. It is thought that the reasons for the attack was that it was night and the ray was attracted to the diver's helmet light.

In a followup posting, TexasTechdiver relates a conversation with a dive accident consultant in which he talked to the consultant that was called in to investigate the torpedo ray incident, who related the debrief of the diver. The diver reported feeling electrical "tingles", then got hit the first time by the ray. The guy monitoring the diver asked how he was, and the diver said he was ok, but didn't know what had hit him. Then he reported feeling tingles again, and got hit again. He said "electricity" and "fish" then got hit a third time. By then he was out and keeling over. He was hit a fourth time, and that was it. The relief diver got down to him within eight minutes of the first hit, which was fortunate, as the stricken diver's helmet was filling with water.

Also, these rays are apparently far less electrically "active" in the day time, which might explains our being able to play with them and living to tell about it.

The medical exam pretty much ruled out any weird pathology on the part of the diver that would have contributed. He was healthy. He has an irregular heartbeat now, and they'll shock him and try to get him lined back out.
====================================================================================

The Pacific electric ray (Torpedo californica) can be distinguished by its two dorsal fins and lack of a venomous spine on the tail and can muster up to 50 volts of electricity - enough to stop the heart of a human. Apparently the creature can send a 'bolt' of electricity toward a perceived threat - causing discomfort or pain, so touching the animal is not necessary for an injury.

The bigger Atlantic torpedo ray, occurring from Nova Scotia to Florida and beyond, is even more powerful. It can measure six feet across and weigh 200 pounds. Beachgoers, however, have nothing to fear from either of these species. They live in deep, cold waters and are mostly active at night. Fishermen occasionally catch the Atlantic torpedo in their trawls. Pulling up the net, their hands tingle. They know a ray is in the net before they even see it.

Jay Sisson, a diver working with Wood's Hole has the following to say about this interesting creature.
"I was shown your 'Torpedo Ray Injury" story by our DSO Terry Rioux (I work as a scientific diver for the Woods Hole Oceanographic). A couple years back I was hit by an Atlantic torpedo, twice. I never saw what hit me and my buddy Glenn witnessed all of it, then told me about it later. I was momentarily paralyzed by each hit but suffered no lasting injury. I believe Glenn estimated it's wingspan about 5 ft.
The location was in 52' of water about 1.5 nm south of Martha's Vineyard, at a research tower we maintain there. Torpedo was on the bottom near one of the piles."

Jay Sisson
Woods Hole Oceanographic Inst.
Woods Hole, MA 02543

Inspiration for 'Men of Honor' dies - Carl Brashear was first black U.S. Navy diver

2006-07-26T08:54:00.000-05:00

Navy diver Carl Brashear lost a leg in 1966 helping to recover a lost hydrogen bomb.

Carl M. Brashear,75, the first black U.S. Navy diver died Tuesday at the Naval Medical Center Portsmouth of respiratory and heart failure. He was the diver who was portrayed by Cuba Gooding Jr. in the 2000 film "Men of Honor". Retired from the Navy in 1979 after more than 30 years of service, he was the first Navy diver to be restored to full active duty as an amputee, the result of a leg injury he sustained during a salvage operation for a nuclear weapon in 1966 in waters off the coast of Spain.

In 1954 he was accepted and graduated from the diving program, and went on to train for advanced diving programs before his 1966 incident.

Last Call to Receive Complimentary New Edition of Ocean Realm

2006-07-24T15:39:00.000-05:00

Richard Stewart, Publisher and Editor-in-Chief of the Ocean Realm Journal, has informed us the new edition of Ocean Realm has finally arrived from Singapore and is on the dock yards of Long Beach, California. This new edition is a beautiful, high-quality color book with more than 107 pages of the best quality photography and content available. If you have not yet sent Ocean Realm your address this is the final call to receive a complimentary copy with free shipping. Please respond as soon as possible to; ComplimentaryEdition@OceanRealmJournal.com. You will receive a bulk mailed copy within 2-3 weeks.

For What It's Worth - Hyperactive Gag Reflex Remedy

2006-07-24T10:21:00.000-05:00

Here is a letter that we thought we'd pass on for those of you suffering from a hyperactive gag reflex. There must be a lot of you because we get numerous hits on our web page about this at http://www.scuba-doc.com/Gagrflx.htm .

"FYI in case it may help others:

I came across your web site a month ago while researching about the severe gag reflex problem that has prevented me from snorkelling for the past several years. I discovered only a week ago that my problem completely disappears if I wear a wristwatch while snorkelling! I'd stopped wearing watches in the water years ago because I'm rough on them and they unpredictably develop leaks.

The eureka moment for me came when a friend told me she'd worn "Sea-Band" on her wrists and experienced no sea-sickness on a recent cruise even though she's prone to nausea. Those bands are worn where one would place a wrist watch! Because of the neighbour's "Sea Band" experience, I bought a new water-tight watch which I now wear while snorkelling and much to my delight the gag problem has completely disappeared! "

My response: A study of many divers would be needed to show a significance.

I'll pass this on as a possibility.

scubadoc

==================================================================================
Dr. Larry Stein, our resident diving dental consultant, has the following note about the gag reflex:
"
I saw the article on your site about the gag reflex. A number of compounding pharmacies make and "electrolyte tablet" that is supposed to suppress the gag reflex. It is supposed to be useful for giving anesthetic, taking impressions. swallowing tablets, performing oral hygiene.

This suppresses the reflex rather than eliminating it. I don't want to imagine the outcome of a diver with a suppressed reflex suddenly wearing off under water.

Here is a copy of some of the text from a pharmacy website and a journal reference:

Suppressing the Gag Reflex

The gag reflex can cause a patient considerable discomfort as well as interfere with dental procedures. An electrolyte tablet administered and retained intraorally a few minutes before the start of a procedure can suppress the gag reflex, allowing a mandibular block to be given with much greater ease, which further reduces the gagging reflex.

Tablets can be prescribed for home use for patients who can not properly perform oral hygiene procedures due to the gagging problem. Severe gaggers may need to repeat a dose in 15 to 20 minutes. (Dent Today. 1991 Dec;10(9):68-71)

Some patients and dentists prefer to use electrolyte lollipops.
==============================================================================

UHMS Announcements

2006-07-23T14:16:00.000-05:00

8 NEW CLASSIFIEDS were listed

https://www.uhms.org/classifieds.htm
_______________________________

The National Board of Diving and Hyperbaric Medical Technology (NBDHMT) launches their new website (www.nbdhmt.org).

The new site has been designed so that it is more user friendly and provides the information that you need and want. As you navigate around the website you will find a short “History of the NBDHMT”, some information on “Who we are”, a “Resource Manual” for CHT’s, DMT’s and CHRN’s, the “Testing Schedule”, “Approved Training Facilities”, an “Online Store”, and a list of our “Board of Directors” complete with email addresses and a “Contact” page. The Resource Manuals contain all of the information, with forms, that you need to attain your certification/recertification. You can download these manuals and forms to your files and use them as a quick reference. A listing of all members certified through the NBDHMT will be added to the website in the near future.

If you have any suggestions as to how we can make this website more useful please don’t hesitate to contact us.

Paul C. Baker, CHT
NBDHMT, President
1816 Industrial Blvd.
Harvey, LA 70058
504.328.8871
fax: 504.366.1029

Undercurrent Online Update

2006-07-23T14:00:00.000-05:00

Dive News
July 18, 2006

Malaria Risk in the Bahamas: In June, 18 people tested positive for malaria on Great Exuma Island in the Bahamas. Of these, 2 were from the U.S., 1 from Canada, and 1 from Germany. The Centers for Disease Control (http://www.cdc.gov/travel) is temporarily recommending that travelers to Great Exuma take chloroquine, an antimalarial medication, as a preventative (it requires a prescription), and use mosquito repellents containing 30 to 50 percent DEET. No cases of malaria have been reported beyond Exuma and there are no health advisories for other islands. (Centers for Disease Control, July 17)

See also: Travel Medicine http://scuba-doc.com/travel.html
Biting Insects, Malaria and Lariam http://www.scuba-doc.com/insects.htm

Scubapro Recalls X650 Second Stages: A serious manufacturing error could cause the cover and diaphragm to become dislodged, interrupting air flow underwater: Affected X650 regulators have been sold overseas since 2004 and in the U.S. since mid-2005. Owners should contact Scuba Pro at (800) 808-3948 between 8 a.m. and 5 p.m. PDT, Monday through Friday, or visit their website at http://www.scubapro.com. The company promises to send out a free replacement regulator within 30 days.

Dangerous Error in Suunto Computer Software: Certain models of Suunto's D6 and D9 wrist computers have a software bug that may cause them to track time wrong when the computers automatically recalibrate to the correct time, or when the user updates the seconds in set mode. Suunto estimates these models will malfunction one out of 167 dives. When the error occurs, the computer shorts a dive by 25 percent and the surface interval by 25 percent. An hour dive would show as 45 minutes, an hour surface interval as 45 minutes. The error could seriously affect decompression requirements. The products affected are: D9, serial numbers 62102582 and below, and D6, serial numbers 62103693 and below. See http://www.suuntoservice.com/safetynotice/diving Return it to your dealer or e-mail the Suunto Help Desk at SuuntoD9-D6@nordictelecenter.fi Or call 1 800 543 9124 in the USA and Canada. Suunto is also providing the free update for computers purchased through gray marketers such as Leisure Pro.

Big Animal Encounters: No trip leader offers more thrilling trips for serious photographers than award-winning photographer Amos Nachoum. He's offering two in May 2007 to Malpelo and Cocos Islands, the first led by Dr. Sylvia Earle, a leading marine environmentalist and National Geographic resident scientist, the second by Dr. Kathryn Sullivan, astronaut and environmentalist. Boats are the SeaHunter and UnderSea Hunter. Undercurrent subscribers will get a five percent discount and free Nitrox. Contact him at phototrip@biganimals.com or phone 415 923 9865. Visit http://www.biganimals.com/newsletters/spring06/page1.html

Fiji Fish Poisoning: Ciguetera poisoning can provide severe bends-like symptoms – heavy legs, exhaustion, tingling, prickling or numbness of the skin, abnormally low blood pressure, and slower than normal heart rate – that can last for months. It comes from eating affected fish, normally barracuda and larger fish that get it by ingesting smaller fish carrying the toxin. Though uncommon, it occurs worldwide cannot be detected in the flesh of the toxin-carrying fish. Undercurrent readers and others at the Kadavu Dive Resort in Fiji were struck after a fish dinner in late June. They didn't get proper treatment and are still reporting serous symptoms . See the full story in the August issue, as well as how to treat it should you encounter it.

See also:
Ciguatera references
50 references concerning ciguatera. ... [Ciguatera: from the etiology of the phenomenon to the treatment of its symptoms] ...
www.scuba-doc.com/cig.htm

Ingested Toxins
CIGUATERA. The toxin, icthyosarcotoxin, is heat stable, lipid soluble and comes from the dinoflagellate Gambierdiscus toxicus. It is common in the tropics, ...
www.scuba-doc.com/ingest.htm

Help Save Coral Reefs: Undercurrent has raised more than $7000 for important projects to stop poaching and preserve reefs in Belize and Fiji. We need to double that amount. Please give back to the reefs you love my making a tax deductible contribution at https://www.undercurrent.org/secure/UCnow/donate_cc.html. We will send you a receipt acknowledging your tax deductible donation.

Reproduced with permission from Ben Davison, editor/publisher
editor@undercurrent.org

IOWA CONFERENCE FOR HYPERBARIC APPLICATIONS AND TREATMENTS (IOWA CHAT)

2006-07-23T13:58:00.000-05:00

IOWA CONFERENCE FOR HYPERBARIC APPLICATIONS AND TREATMENTS (IOWA CHAT)

Date: September 9, 2006

University of Iowa Hospitals and Clinics

Physicians, Podiatrists, Dentists $100.00
All other allied health professionals $50.00

Register by calling 339-335-8599

Additional information please visit http://www.medicine.uiowa.edu/cme/.

THMS: 2006 Toronto Hyperbaric Medicine Symposium

2006-07-23T13:51:00.000-05:00

T.H.M.S
2006 Toronto Hyperbaric Medicine Symposium
Date: September 29, 2006
Location: Toronto General Hospital (MaRS building)

THMS Themes:
* Technological Frontiers * Critical Care
* Clinical Chamber Ergonomics * Preconditioning with HBOT
* Osteogenesis * Radiation Injury Managment
* And More...

The THMS is a 1-day symposium that focuses on research level topics. The morning will feature both thematic and pleanry sessions proveded by leaders in hyperbaric medicine. The afternoon will be varied and consist of small group sessions as well as hands-on demos. The opportunity for interaction with faculty is a priority of the meeting.

For More Information, Updates, & Early-Bird Specials: Visit us online at: www.hyperbaricmedicine.ca

Course Director: A. Wayne Evans, MD wayne.evans@utoronto.ca

Should All Divers be Screened for PFO?

2006-07-23T13:11:00.000-05:00

An increased prevalence of brain lesions has been found in divers even in the absence of recognized decompression illness. Permanent neuropsychological changes such as memory disturbances and depression have been found in professional divers, even in those who have never had decompression sickness. The changes are probably the result of intravascular gas bubbles insufficient to cause acute symptoms. A study examined amateur divers with long histories of self-contained underwater breathing apparatus diving by magnetic resonance imaging and compared them with normal controls. Hyperintense lesions of the subcortical cerebral white matter and degenerative changes of the cervical disks were significantly more common in the divers. 27 of 52 divers had a total of 86 focal hyperintensities versus 10 of 50 controls with 14 focal hyperintensities (p < 0.01). [Reul J, Weis J, Jung A, Willmes K, Thron A. Department of Neuroradiology, Technical University, Aachen, Germany.]

In a seminal study, transcranial Doppler ultrasonography detected a right-to-left shunt in all divers with multiple brain lesions. Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.[Michael Knauth et al, Department of Neuroradiology University of Heidelberg Klinikum Heidelberg Im Neuenheimer Feld 400 D 69120 Heidelberg Germany, b Department of Neurology, University of Heidelberg, Klinikum Mannheim, Germany, c Department of Biology, University of Frankfurt, Klinikum Frankfurt, Germany]

A foramen ovale no doubt accounted for most of these cases. A comparative investigation regarding brain lesions and the presence of a foramen ovale in sport divers and non-diving controls showed that brain lesions were more common in individuals with a foramen ovale, although divers had more brain lesions than non-divers, irrespective of the presence of a PFO. In a Swiss University and dive club study, the risk for decompression illness events was 4.5-fold greater in divers with patent foramen ovale than in divers without patent foramen ovale (risk ratio, 4.5 [95% CI, 1.2 to 18.0]; P = 0.03). Among divers, 1.23 ± 2.0 and 0.64 ± 1.22 ischemic brain lesions per person (mean ± SD) were detected in those with and those without patent foramen ovale, respectively. Among controls, 0.22 ± 0.44 and 0.12 ± 0.63 lesion per person were detected (P < 0.001 for all groups). Conclusions: Regardless of whether a diver has a patent foramen ovale, diving is associated with ischemic brain lesions. [Schwerzmann et al]

This has led some diving schools to recommend screening for the presence of a PFO for professional divers or avid amateurs. In such divers, PFO closure would make sense. If a non-invasive, inexpensive, valid method for determining the presence or absence of a PFO could be found - would it be protective for decompression illness, or better yet protective for brain lesions in the absence of decompression illness.

There is a study that was done in 2001 in Finland that found that ear oximetry fit the bill for all of these factors. As reported in Stroke. 2001;32:448, "Ear Oximetry: A Noninvasive Method for Detection of Patent Foramen Ovale", the following results were noted:—Dye dilution curves were obtained from 67 patients. Dye dilution correctly diagnosed 35 of the 46 patients who had PFO in TEE and all the 21 patients without PFO. Thus, the sensitivity (95% CI) of the dye dilution method was 76% (61% to 87%) and its specificity 100% (84% to 100%). Ear oximetry was done on 83 patients. Oximetry correctly diagnosed 45 of the 53 patients who had PFO in TEE and all of the 30 patients without PFO. Thus, the sensitivity of ear oximetry was 85% (72% to 93%) and its specificity 100% (88% to 100%). When only the largest shunts were included, oximetry had a sensitivity of 93% (38 of 41).The interrater agreement was excellent ({kappa} value 0.94 for dye dilution and 0.90 for oximetry).

Conclusions—Dye dilution and oximetry are both sensitive and specific methods for the detection of PFO. Oximetry has the following primary advantages over the currently available diagnostic methods: it is noninvasive, safe, and inexpensive and causes no discomfort for the patient. We suggest that oximetry could be used as a first-line screening method for PFO in patients with cryptogenic stroke. Ear oximetry also has potential use in epidemiological studies. [Vesa Karttunen, MD et al from the Department of Neurology (V.K., M.H.) and the Department of Cardiology (M.I., M.N.), Oulu (Finland) University Hospital; and the Department of Cardiology (M.V.), Helsinki (Finland) University Central Hospital. ] Full Text at http://snipurl.com/to33 .

Scientists in Switzerland have also found that those with PFOs more than 9mm in diameter had a much higher risk of DCI. They were up to 13 times more likely to have ended up in a chamber for treatment and five times more likely to have had major DCI than divers without a PFO or divers with a small PFO.

Research by Dr Peter Wilmshurst, a British expert in this field, has confirmed the importance of PFO size. He says: ‘There is no doubt that here, as in most things, size really does matter. The bigger your PFO, the greater your chance of getting bent. But to put this into perspective, only 1.3 per cent of the population have PFOs that are 10mm in diameter or larger and these people suffer between 30 and 40 per cent of all bends.’

Dr. Avi Shupak, Haifa, Israel writes :
I have read with great interest your excellent summary on PFO as a risk factor for DCI and long term neurological effects in divers.

I would like to draw your attention to a recent article published in Mayo Clin Proc 2006;81:602-8 (Petty GW, et al. Population-based study of the relationship between PFO and cerebrovascular ischemic event.). The study results showed that PFO is not an independent risk factor for cryptogenic ischemic stroke or TIA. The data analysis also included separate evaluation of large PFO as a risk factor that reach identical conclusion.

Although the damage mechanism of paradoxical gas emboli (anticipated during a dive) might differ from the pathogenesis of cerebrovascular event by solid emboli, the remarks of the authors about possible methodology flaws in previous studies reporting PFO to be a risk factor for cryptogenic CVA might be of relevance to parallel studies in divers.

Best Regards,

Avi Shupak, MD

Haifa, Israel

We posted this article May 30, 2006 without very much comment. See http://snipurl.com/tuy2

See also:
Patent Foramen Ovale
http://www.scuba-doc.com/pfo.htm

B. Meier and J. E. Lock
Contemporary Management of Patent Foramen Ovale
Circulation, January 7, 2003; 107(1): 5 - 9.
[Full Text] [PDF]

7/23/2006

Suunto Dive Computers Recalled After Decompression Hazard

2006-07-23T09:29:00.000-05:00

Suunto Dive Computers Recalled After Decompression Hazard

The U.S. Consumer Product Safety Commission in conjunction with Suunto Oy, of Finland, is issuing a voluntary recall for 3,900 Suunto D9 and D6 Model Wristop Dive Computers.

Suunto has found that these dive computers could incorrectly track dive time, which could cause incorrect calculation of decompression requirements, possibly leading to decompression illness.

There have been no incidents or injuries reported but the company still feels the product is unsafe.

The dive computers in question are the D9 and D6 diving instruments which are advanced, gas-switching, multi-mode, decompression dive wristop computers.
The products included are: the D9 model with serial numbers 62102582 and below; and the D6 model with serial numbers 62103693 and below. The serial number is located on the side of the product. The model number is located on the back of the product.

The computers were sold at diving specialty shops nationwide, as well as various Web sites, from September 2004 through June 2006 for about $1,275 for the D9 (without wireless transmitter) and $900 for the D6.

Divers should only use these dive computers with backup instrumentation and should bring the recalled units to the nearest authorized Suunto dealer for a software update to correct the problem. A free battery replacement and pressure testing will be provided as part of the free software update service. All updated products will be marked with an indelible white dot on the back of the unit, or with an engraved "U" near the serial number.

Consumer Contact: For additional information and a list of authorized retailers, visit Suunto's Web site at www.suunto.com, call Suunto at (800) 543-9124 between 8 a.m. and 4 p.m. ET Monday through Thursday, and between 8 a.m. and 12 p.m. Friday, or email the firm at SuuntoD9-D6@nordictelecenter.fi

More About the Hyperbaric Chamber in Dominica

2006-07-18T14:04:00.000-05:00

Since our report about the hyperbaric chamber in Dominica, we have received this press release from Arun Madisetti.

"The long awaited hyperbaric chamber is now installed, tested, and
operational at the Princess Margaret Hospital, Roseau.

A staff comprising of emergency nurses, hospital technicians, and Dive
Instructors have been trained by the manufacturer to operate and man it.
The chamber has been needed for a long time, and through the Ministry of
Tourisms, Ecoutourism Development Program, funded by the European Union, one
was sourced and brought to the island.

The chamber is a Haux Starcom 1500, able to take 4 seated or 2 seated and
one lying patient.

The Dominica Watersports Association anticipates that it would be used for
at worst case scenario 2 cases a year,acting mainly as a safety blanket,
should the unforseen occur.The Watersports Associations standards are
amongst the highest in the region for all watersports. The benefits for
medical applications are obvious.

Hyperbaric medical training was conducted under the auspices of the Undersea
and Hyperbaric Medical Society,by Dr. Julian Eden of the London Diving
Chamber and E-Med., hyperbaric technical training was undertaken by Haux.

Arun Madisetti
Marine Manager
Soufriere Scotts Head Marine Reserve
Dominica Marine Reserves
C/o Fisheries Division
Bay Front Headquarters
Roseau
Commonwealth Of Dominica
00109-8000, West Indies

tel: (767) 266-5266
fax:(767)448-0140
http://www.avirtualdominica.com/ssmr/
http://www.dominicamarinereserves.com "

Assessing Fitness to Return to Diving after Decompression Illness

2006-07-17T10:08:00.000-05:00

The DMAC in the UK, (The Diving Medical Advisory Committee) has the following 'Guidance' concerning the return to diving of commercial divers who have had decompression illness. These have not been updated since 1994, but appear valid for divers now. The main difference between commercial divers and sport divers is the multiday, multidive aspect of recreational diving and the ability of commercial diving to recompress immediately on the dive boat. These recommended times away from diving differ somewhat for the diving instructor, who comes under commercial regulation by the HSE directive at
http://hse.gov.uk/diving/ma1.pdf. [Thanks to Dr. John Ross for this information].
* See below for times away.

"The following minimum periods are recommended before returning to diving after decompression illness. The period begins after completion of successful treatment (there are no residual manifestations). It is stressed that these recommendations represent minima and longer lay-offs may be necessary in individual cases.

A. Limb pain, cutaneous (skin rash with severe itching), lymphatic (swelling of tissues) or non-specific (persistent headache, excessive fatigue, loss of appetite, nausea) manifestations only
i) With uncomplicated recovery: 24 hour lay-off
ii) Where there has been a recurrence or relapse requiring further recompression: 7 day layoff

B. Neurological or pulmonary manifestations:
i) Altered sensation involving the limbs only: 7 day layoff
Return to diving only after review by a diving medicine specialist
ii) Other neurological (including audiovestibular) or pulmonary manifestations: 28 day lay-off
Return to diving only after review by a diving medicine specialist

C. After an incident of pulmonary barotrauma resulting in a pneumothorax or mediastinal/subcutaneous emphysema, the diver should be assessed by a diving medicine specialist. Return to diving may be permitted, but not normally until at least 28 days following complete recovery.
In cases where there are significant residual neurological manifestations, even after repeated treatment, the diver should normally be considered unfit to dive. Return to diving should only be permitted if sanctioned by a diving medicine specialist.

Divers Alert Network has a question and answer FAQ about returning to diving after decompression illness. This link also reproduces the recommendations of the US Navy.

Lippmann and Mitchell, in the latest edition of their book, "Deeper into Diving", state that most resolved cases of decompression illness should wait at least one month before returning to diving. They feel that divers who have had CAGE (cerebral arterial gas embolism) from pulmonary barotrauma should not return to diving due to the probability of lung scarring and elevated risk of subsequent recurrence of DCI.

Others feel that return to diving depends upon the cause of the barotrauma and allow resumption of diving after three months and no evidence of air trapping upon spiral CT scan study of the lungs.

For example, if a diver has a cause for the pulmonary barotrauma, such as an emergency ascent or other breath holding rise from depth - then a resumption of diving in three months can be entertained after ascertaining that there is no air trapping as shown by functional tests (helium loop), chest x-ray or a CT scan.
=====================================================================================

*Times away from diving

13. The recommended minimum times away from diving after successful treatment with no sequelae are:
SIMPLE DECOMPRESSION ILLNESS, LIMB PAIN, SKIN "BEND” LYMPHATIC SWELLING, FATIGUE etc
---Uncomplicated recovery 24 hours
---Recurrence/relapse requiring further recompression 7 days

NEUROLOGICAL DECOMPRESSION ILLNESS
---Altered sensation in limbs only--- 7 days
---Audiovestibular, motor---- 28 days
Other
Pulmonary decompression Illness--- 28 days
14. Because of the nature of their diving patterns and profiles and the lack of supervision, it is recommended that the time away from diving for those diving at work in the recreational sector should be longer. The Diver’s Alert Network (DAN) Website recommendations on diving layoff times for recreational divers are found at:
http://diversalertnetwork.org/medical/faq/faq.asp?faqid=137

Driving to Higher Altitude After Diving

2006-07-15T08:32:00.000-05:00

Driving to higher altitude after diving.

Several years ago I ran across this explanation of the physiology of driving to higher altitudes after diving and found it well written. Author unknown.

"So here's my understanding of the physiology: Obviously, nobody worries about the altitude of their room in that high-rise Honolulu hotel. So it's simply incorrect to say, "Never go to higher altitude after a dive." The issue is "How much altitude?" and "How do you adjust your dive plan for anticipated changes of altitude after the dive?" Increasing altitude DOES increase the risk of decompression illness, but this risk is manageable by appropriate dive planning. The atmospheric pressure at 5000 feet (my home in Alpine Utah) is approximately 640 mm Mercury. This compares to 760 mm Hg at sea level. (The difference is the equivalent of about 5 feet of water. So when diving at altitude, you become nitrogen-saturated a little less quickly. This isn't a big factor, and the deeper you dive, the less significant it becomes.) When you emerge from the water, there's less pressure to hold nitrogen in solution in your blood. Example: When diving at, say, 65 feet depth at 5000 feet of altitude, you'd absorb nitrogen 5% slower. But once you emerge, there's 15% less pressure holding the absorbed nitrogen in solution.

The pressure holding the nitrogen in solution is the critical factor in preventing decompression illness. So divers at altitude adjust their dive plan by substituting DEEPER depths for the actual depths they've dived. They assume they'll absorb nitrogen faster (they don't really). But when those numbers are plugged into the "sea level" dive table, it balances out. In other words, at 5000 feet, you assume you have 15% more nitrogen rather than 15% less pressure holding the nitrogen in solution, and it balances out. That way, you don't need a full dive table for every altitude. So how about diving at low altitude, then driving to higher altitude later? Well, let's assume we're ALREADY diving at that altitude. It poses no significant risk to travel to altitude if you've planned your dive AS THOUGH YOU'LL BE EMERGING FROM THE WATER AT THAT ALTITUDE. Got that concept? If you compute your safe level of nitrogen saturation as if you'll be emerging from the water at 5000 feet, how can it be more dangerous emerge from the water at sea level then drive to 5000 feet? Seems to me, the time it takes to drive to that altitude is one hell of a safety stop.

So my advice for diving, then driving to altitude is:
(1) Switch from computer to dive tables. The dive tables, properly used, will be more conservative. And they allow you to adjust for altitude.
(2) Use an altitude-adjusted depth in your dive table. Specifically, you should use the highest altitude you'll reach within 24 hours of the dive AS THE ALTITUDE OF THE DIVE.
(3) Substitute this "drive-altitude-adjusted depth" for the actual depth of the dive in your dive table.
(4) PLAN YOUR DIVE, AND DIVE YOUR PLAN. For example, if I'm diving at 6000 feet elevation, but driving home by way of a mountain pass at 9,500 feet, I use 10,000 feet as the depth of the dive (instead of 6000). There is a table for altitude-adjusted depths at http://www.UtahDiving.com/divetabl.htm

More information about this from Jim Grier in an article he wrote for ScubaDiving .com "Tips".
http://dive.scubadiving.com/members/divetips.php?s=517

See also:
1. history of decompression safety and dive tables
2002 Flying After Diving DEMA Flying After Diving: History, Research & Guidelines Richard Vann ... 1st Report Cabin altitude 8-10,000 ft Pilot ... 4 hrs after diving to 30 fsw Flight
http://www.scuba-doc.com/FADDEMA2002.ppt

2. Diving Physics
Diving Physics Register || Site Map || SiteSearch ... Email || Translate || Home Diving Physics and Physiology In order ... be encountered while diving, one must thoroughly understand
http://www.scuba-doc.com/physics.pdf

3. Flying After Diving-
fly too soon after diving, gives parameters for time limits and ... flying. Flying after Diving* This website is written and ... Campbell, MD, FACS 'Diving Medicine' The question is often
http://www.scuba-doc.com/flyngaft.htm

4. Microsoft Word - 3CA4866A-1252-C19C.doc
FALL PARACHUTING AFTER DIVING PROJECT REPORT Funded by U ... when flying follows diving. Male volunteers completed simulated 60 ft/60 min dives followed by three hours at 25,000 ft to
http://www.scuba-doc.com/MFFAD.pdf

5. Diving At Altitude
to correct for diving at altitude DIVING MEDICINE ONLINE Diving At Altitude (A simplified method to obtain ... Ware, PhD [CAUTION: Diving at altitude requires special training which
http://www.scuba-doc.com/divealt.html

6. Parameters for Flying After Diving
for Flying After Diving Flying after Diving* This website is written and ... Campbell, MD, FACS 'Diving Medicine'The question is often ... to fly after diving"? The answer to the question
http://www.scuba-doc.com/fad.pdf

7. Flying After Diving
take place with diving and flying HOME > Here ... Flying and Altitude Parameters for Flying After Diving Diving After Flying? DAN has ... Flying After Diving Presentation, Dr. Richard
http://www.scuba-doc.com/flyafdv.html

Abandoned Divers, What to do, How to Prevent

2006-07-14T19:23:00.000-05:00

The Boat

* Check out the boat and boat captain before diving
* Ask questions about rescue action plans
* Ask about the history of the motor
* Ask about the credentials of the crew
* Ask about the system for counting heads (Names!)
* Find out if the boat has a functioning radio
o Request to see and hear it function
o Ask who they call for assistance
* Be alert to location of the nearest land

Important! Don't be put off by an officious captain! Your life may be at stake. If the captain doesn't want to cooperate - ask your dive leader to intervene or get off the boat.

The Dive

* If a drift dive, listen carefully for instructions, stay with the group
* Check for current, tide and wind conditions; imagine yourself out of sight of the boat
* Always start your dive by swimming upcurrent after orienting yourself
* Develop navigational skills. See http://snipurl.com/tcv0

Equipment possibly helpful

* Inflatable Sausage
* Reflector
* Whistle or other noise maker
* Slate
* Line

Hazards of being left behind

* Dehydration and thirst
* Hypothermia
* Severe sunburn and immersion injury
* Marine animal injury
* Drowning

Things to do

* Inflate BC
* Drop weights, preserving belt
* Inflate sausage
* Flash reflector (Someone might see it, even though you can't see them)
* Blow whistle
* Write time, approximate location and speed of current on your slate
* If you swim, swim diagonally with the current toward any known dry land.
* Stay with others involved. Use a tie up method using empty weight belt or other straps. This gives a larger target for searchers.
* Remember that there will be rescue attempts and searchers.

'Seven Steps to Survival'

Survival at sea depends on the recognition that you are in danger of losing your life. There are commonly described "seven steps" to survival that may make a difference in the outcome of some rather terrible situations. Even an accident fairly close inshore in cold water can quickly lead to hypothermia and drowning. The seven steps to survival are: recognition, inventory, shelter, water, food, signals and play. Of course, flotation is a prerequisite for any survival after only a short time in the water. Other factors come into play, the most important of which is unmeasurable, "the will to live".

The seven steps to survival include recognizing that you are in peril and realizing that what you are wearing constitutes a form of shelter. Use signals in the form of mirrors, flares, colored objects or waving arms, suits or objects about to attract attention. Finally, "play" comes into action as you have memories, fantasies, prayer, tell jokes and get rid of your anger.

SCUBA diving for individuals with disabilities

2006-07-14T19:11:00.000-05:00

We get fairly frequent requests for information concerning diving with various disabling conditions and have generally applied the knowledge known to exist for all divers to the limitations of the particular disability involved. This has in most cases been satisfactory but occasionally we run into a wall of lack of pertinent information, such as the effect of pressure on electronic implants and pumps. Cheng and Diamond published a review of potential problems that they recognized as being important to divers with disabilities in the American Journal of Physical Medicine and Rehabilitation in May of 2005 and the article is paraphrased below.

Cheng J, Diamond M.
SCUBA diving for individuals with disabilities.
Am J Phys Med Rehabil. 2005 May;84(5):369-75. Review.
http://snipurl.com/o92y

Potential Medical Problems in Divers
with Disabilities

Osteoporosis and Fractures
Immobilization and paralysis can place some people with disabilities are at risk for osteoporosis.8,9 Divers at risk for pathologic fractures should seek dive boats with access platforms near water level for easier transfers in and out of the water. It would be rare for dive boats to have lifts that are commonly found in accessible pools. Many neurologic disorders have loss of sensation and fractures may go unrecognized. Unexplained lower limb swelling or redness should be evaluated for possible pathologic fracture.

Medical Implants
Questions are posed concerning the integrity of medical appliances when exposed to the increased barometric pressures associated with SCUBA diving. Many individuals with disabilities such as spina bifida have connections between the brain anf the abdominal cavity (ventriculoperitoneal shunts) for the treatment of hydrocephalus (excessive fluid on the brain). Huang et al.10 subjected four ventriculoperitoneal shunts to one and four atmosphere absolute in a hyperbaric chamber and found that all shunts performed according to manufacturers’ specifications. They reasoned that any increase in pressure will compress all fluid-filled compartments. Therefore, there would be no significant change in gradient between intracranial and intraperitoneal pressures. Preliminary studies have been carried out for cochlear implants in a hyperbaric chamber, illustrating that the implantable components of various cochlear mplants can withstand pressures of up to six atmospheres without damage or failure of critical seals.11

Intrathecal baclofen pumps are increasingly being utilized in the management of spasticity and dystonia. Akman et al.12 described a case of retrograde leakage of cerebrospinal fluid (CSF) into the infusion pump reservoir of an intrathecal baclofen pump (Medtronic SynchroMed, Medtronic, Minneapolis, MN) during hyperbaric oxygen therapy. Medtronic does not recommend exposing their intrathecal baclofen pumps to pressures of 2.0 atmospheres absolute (SynchroMed II Technical Manual, Medtronic).

Thermal Regulation
Some disabled have an inability to maintain heat regulation. For those individuals with this problem, diving should be undertaken in warm water regions and cold protection wetsuits should be utilized. Deeper diving will cause increased compression of the air in neoprene wetsuits. Because a large component of the insulating quality of wetsuits is provided by the air trapped in the material, compression of these garments will decrease their insulating capabilities.13 When diving to greater depths, the need for increased thermal protection should be anticipated due to the compression of neoprene and the much colder water. Peripheral vasoconstriction, as an adaptation to minimize the strain caused by loss of body heat, may compromise circulation to the limbs and may need to be minimized.13 This vasoconstriction may decrease already decreased circulation to the limbs of some individuals with paraplegia. For example, Boot et al.14 found that individuals with spina bifida and spinal cord injury have peripheral arterial vasculature that was of smaller diameter, lower flow, and higher shear stress when compared with controls. These changes may compromise optimal regulation of the peripheral vasculature. For individuals with spinal cord injury at the neurologic level of T6 and above, exposure to cold water may increase sympathetic nervous system activity, inducing or exacerbating autonomic dysreflexia. 15 Development of autonomic dysreflexia at greater depths may become life-threatening. The need for slow ascent and safety stops may prevent the individual from receiving needed medical care quickly. Individuals with spinal cord injury who are at risk for autonomic dysreflexia should be monitored for common symptoms such as headache, vision changes, and flushing.

Atrophy and Hypotrophy
It should be noted that due to atrophy and hypotrophy of the lower limbs associated with paraplegia and tetraplegia and other disorders, regular wetsuits may not fit properly and custom wetsuits may be necessary to ensure proper fit and optimal heat retention. Because of decreased muscle mass in the lower limbs there may be increased buoyancy and ankle weights may be required to gain neutral buoyancy in the lower limbs. Due to increased buoyancy, this may be worsened when a full wetsuit is worn. 7

Cardiovascular Issues
Paraplegics and some amputees must rely on the upper limbs for propulsion and there are some physiologic factors that need to be considered when the upper limbs alone are used for propulsion. Activities performed with the upper limbs compared with the lower limbs require higher myocardial oxygen consumption at the same total oxygen consumption inducing more stress by upper limb propulsion underwater. Cardiac disorders are common with many neurologic and muscular conditions such as the muscular dystrophies/myopathies, Friedreich’s ataxia, and many syndromes. The shift of blood into the central circulation resulting from water immersion may aggravate congestive heart failure.17 There is also increased myocardial demand in diving due to increased exertion.13 In addition, immersion in cold water can also cause a significant increase in metabolic rate.15 Given these potential stresses on the cardiovascular system during diving, cardiac function should be evaluated carefully in those individuals who have documented cardiac disorders or conditions that predispose them to cardiac pathology. The use of webbed gloves can help facilitate propulsion with the upper limbs and disabled divers may also opt for the use of motorized propulsion devices that are available from several manufacturers and utilized by many nondisabled divers as well.

Venous Stasis
Levey et al. investigated the relationship of spina bifida and deep venous thrombosis and speculated that individuals with spina bifida may be at higher risk due to venous insufficiency and lower limb paresis.18 There is no direct evidence that SCUBA diving increases the risk of deep vein thrombosis. But, given the increase in prevalence of deep vein thrombosis in individuals with spina bifida, it would be prudent to monitor closely for signs and symptoms such as lower limb swelling and dyspnea that may suggest deep vein thrombosis or pulmonary embolus.

Decompression Sickness
The brain and spinal cord contain myelin, which is very susceptible to excess nitrogen supersaturation after ascent.17 Symptoms of air embolism affecting the brain or spinal cord include unconsciousness with stroke-like symptoms, paralysis, seizures, bowel/bladder dysfunction, sensory abnormalities, fatigue, personality change, poor concentration, irritability, and changes in vision.17 The cortical gray matter is more efficient at releasing nitrogen compared with the spinal cord.1,19 Therefore, the spinal cord is at particular risk for decompression sickness. Venous bubbles can cause thrombosis of the venous plexus surrounding the spinal cord, resulting in venous stasis and spinal cord ischemia.1 However, there is no direct evidence that individuals with spinal cord dysfunction or cortical neurologic disorders are at greater risk of decompression sickness of the brain or spinal cord. Boot et al.14 found that individuals with spina bifida had common femoral arteries that were smaller, with decreased blood flow, compared with normal controls. It is unknown if these arterial characteristics increase the risk of decompression sickness and there are currently no studies investigating the appropriateness of the use of current dive tables by the disabled population. Individuals with disabilities may be at increased risk in the context of decompression sickness because neurologic impairment caused by the decompression sickness can be confused with or masked by the neurologic signs and symptoms associated with the divers’ disease processes. Therefore, it is very important for the disabled diver and his or her dive companions to be familiar the signs and symptoms of decompression sickness and be able to contrast them with the disabled individual’s baseline state.

Seizure
Many individuals with disabilities have seizure disorders related to their disease processes. Any seizure underwater would result in severe drowning risk and would also be a danger to that diver’s partner. Therefore, seizure disorder requiring ongoing medical management is a strict contraindication to SCUBA diving.17,20 Some certifying agencies, however, will allow divers who have been seizure-free without medications for 5 yrs to participate in their diving programs.

Pneumothorax
Pneumothorax can be spontaneous or result from trauma. Spontaneous pneumothorax can be associated with structural abnormalities and lung disease.21 It is a strict contraindication for SCUBA diving because the underlying cause may still be present at the time of diving.20 Many individuals who have disabilities resulting from traumatic events have had pneumothoraces. Traumatic pneumothorax, however, is not a contraindication provided that the injury is well healed.

Latex
Latex allergy is rare in the general population, with a prevalence of 1%.22 However, it is a concern for individuals with spina bifida and other disorders.22–25 Latex allergy is very common in these populations, with up to 60% of individuals with spina bifida having allergies to latex.25 It is an immunoglobulin E–mediated hypersensitivity reaction to natural rubber latex that can result in urticaria, rhinitis, bronchospasm, and anaphylaxis.23 Bernardini et al.25 found that 25% of subjects with spina bifida had latex sensitization, and only 33% of those individuals have had clinical reactions to latex. Although severe reactions are rare, such reactions at greater depths would present a life-threatening event. Therefore, previous screening is important. Individuals at risk for latex allergies, especially people with spina bifida, may wish to consult an allergist for skin prick or serum latex-specific immunoglobulin E antibody testing before considering SCUBA diving. Those individuals who are at risk may wish to have antihistamines and intramuscular epinephrine available in case of a serious reaction. It may also be prudent to contact the manufacturers of the equipment to be used to determine the precise material content to further decrease the risk. The majority of modern diving masks and snorkels are made from silicone. Also, there is usually no natural latex in neoprene wetsuits. However, certain seals and tubing may contain latex, as may seams in certain wetsuits. Latex seals are much more common in dry suits in which water-tight seals are required. Wetsuits manufactured from neoprene rarely have latex seals. Air tubing may contain natural latex, but the latex is usually vulcanized with other materials and therefore would not likely cause a hypersensitivity reaction. However, it may be best to contact individual manufacturers to confirm the latex content in their air hoses. Alternatively, silicone tubing can be utilized to further reduce the risk.

Skin
Many conditions resulting in paraplegia are also associated with sensory deficits. Because of insensate skin, these individuals are at risk for developing pressure ulcers and injuries from trauma. Muscle atrophy also results in decreased protection normally afforded by muscle mass and therefore increases the risk of pressure ulcers. In addition, these individuals are at risk for unrecognized burns from sun exposure. Wetsuits may provide a certain level of protection from skin injury. During the dive, they may protect from abrasions and lacerations while preventing sunburn while on the surface.

Bladder Management
Water immersion and cold exposure have been found to cause diuresis by increasing plasma volume and increasing the release of factors such as atrial natriuretic peptide.26,27 Changes in urine production can become a factor in individuals requiring catheterization because of a neurogenic bladder. Individuals whose bladder programs include clean intermittent catheterization may be required to catheterize more often to address the increased diuresis. This may be difficult given the limited space of a dive boat. It would be an important consideration to identify dive boats that have private spaces available for bladder management and a means of washing hands to maintain the aseptic nature of the procedure. Individuals who are on clean intermittent catheterization programs may regularly limit their intake of fluids to reduce the frequency of catheterizations throughout the day. While SCUBA diving, the sources of fluid loss as previously described and those associated with increased exertion and ambient temperature may predispose the diver to dehydration. In addition, wetsuits provide significant thermal protection while in the water. However, prolonged wetsuit wearing may result in hyperthermia, increased sweat production, and dehydration. 13 Therefore, careful monitoring of fluid intake and output balance and monitoring for symptoms of dehydration are very important in this population. Also, bladder distention can be of particular concern for spinal cord–injured patients with a neurologic level above T6 who are at risk for autonomic dysreflexia.

Ear Barotrauma
Problems associated with middle-ear spaces and paranasal sinuses are the largest source of morbidity among SCUBA divers.20 As a diver descends, external pressure increases and pushes on the tympanic membrane. This pressure needs to be equalized in the middle ear through the oropharynx via the eustachian tube.17 Equalization involves forcefully exhaling against closed (pinched off) nares. Inability to properly equalize will cause barotrauma and may result in pain, acute hemorrhagic otitis media, or tympanic membrane rupture. 17,20,28 Therefore, before diving, each individual should be evaluated for the ability to perform this maneuver independently or with the assistance of another diver.

Asthma
Asthma affects 6–7% of the general population in the United States, often with childhood onset.17 Some have supported that any history of asthma is a strict contraindication.20 However, asthma varies greatly in severity and in its triggers across individuals. 3 Bove17 states that individuals with mild asthma should not be prohibited from diving. Neuman et al.3 suggests that individuals with normal airway function at rest with little airway reactivity to exercise or cold air inhalation may have risks of pulmonary barotrauma similar to nonasthmatic individuals. However, air-trapping at depth while breathing compressed air in individuals with asthma can lead to serious pulmonary barotrauma. 3,29 Therefore, subjects with a history of asthma should be screened carefully. Additional research may be helpful to better describe the risks for different asthma severities and triggers as opposed to using a history of asthma as a strict contraindication for diving.

Certification
Certifying bodies for recreational SCUBA diving such as the Professional Association of Diving Instructors and the National Association of Underwater Instructors have requirements for swimming and fitness. For example, Professional Association of Diving Instructors requires that an individual be able to tread water for 10 mins and swim for 200 meters independently, even though these skills are rarely needed in SCUBA diving. The authors advocate that for full certification, individuals with disabilities should be held to the same requirements and standards as their able-bodied peers. This is to ensure the highest level of safety for the disabled diver. In addition, an important component of SCUBA certification is the ability to perform skills necessary to assist a dive partner. Any disabled individual who is to be a candidate for full certification should be able to carry out these responsibilities. The Handicapped SCUBA Association has established a hierarchical certification structure based on each diver’s abilities. This system allows individuals with disabilities to participate in SCUBA diving at different levels of independence based on their level of function (Table 1).7

CONCLUSIONS
SCUBA diving is an adventurous sport that allows participants to explore a diverse, exciting marine environment. Guidelines have been established by SCUBA certification organizations to minimize injury and injuries often occur when these guidelines are violated. However, some individuals may experience injury even when diving conservatively. Mortality rates in recreational SCUBA diving are estimated to be one to nine in 100,000 divers.1,2,30 The authors advocate that SCUBA diving be made available to as many interested individuals as possible. It can be a great source of self discovery and a means of building confidence and independence. However, individuals with disabilities present with many medical conditions that need to be considered carefully by their physicians before certifying them as fit to dive. Recognizing and addressing risk factors can help to limit morbidity and mortality. Additional research into how the unique anatomy and physiology of individuals with disabilities interact with a hyperbaric, marine environment would help to better refine guidelines and allow safer diving in the least restrictive framework.

TABLE 1 Levels of certification available from the Handicapped SCUBA Association
Level A
Able to provide equal assistance to a fellow diver in case of an emergency. Qualified to dive with another certified diver, including a level A diver.

Level B
Able to care for self in case of an emergency but cannot provide a fellow diver equal assistance in case of an emergency. Qualified to dive with two certified divers who may be level A.

Level C
Able to safely use SCUBA underwater but unable to effectively care for self or a fellow diver in case of an emergency. Must dive with two certified divers, one of whom has been trained by a nationally recognized diver training agency in diver rescue. In most cases, this would be an instructor, assistant instructor, or dive master.

REFERENCES
1. DeGorordo A, Vallejo-Manzur F, Chanin K, et al: Diving emergencies. Resuscitation 2003;59:171–80
2. Spira A: Diving and marine medicine review part II: Diving diseases. J Travel Med 1999;6:180–98
3. Neuman TS, Bove AA, O’Connor RD, et al: Asthma and diving. Ann Allergy 1994;73:344–50
4. Pelletier JP: Recognizing sport diving injuries. Dimens Crit Care Nurs 2002;21:26–7
5. Frankel H: Aqualung diving for the paralysed. Paraplegia 1975;13:128–32
6. Williamson JA, McDonald FW, Galligan EA, et al: Selection and training of disabled persons for scuba-diving: Medical and psychological aspects. Med J Aust 1984;141:414–8
7. Madorsky JG, Madorsky AG: Scuba diving: Taking the wheelchair out of wheelchair sports. Arch Phys Med Rehabil 1988;69(3 pt 1):215–8
8. Chan YY, Bishop NJ: Clinical management of childhood osteoporosis. Int J Clin Pract 2002;56:280–6
9. Apkon SD: Osteoporosis in children who have disabilities. Phys Med Rehabil Clin N Am 2002;13:839–55
10. Huang ET, Hardy KR, Stubbs JM, et al: Ventriculo-peritoneal shunt performance under hyperbaric conditions. Undersea Hyperb Med 2000;27:191–4
11. Backous DD, Dunford RG, Segel P, et al: Effects of hyperbaric exposure on the integrity of the internal components of commercially available cochlear implant systems. Otol Neurotol 2002;23:463–7; discussion, 467
12. Akman MN, Loubser PG, Fife CE, et al: Hyperbaric oxygen therapy: Implications for spinal cord injury patients with intrathecal baclofen infusion pumps. Case report. Paraplegia 1994;32:281–4
13. Doubt TJ: Cardiovascular and thermal responses to SCUBA diving. Med Sci Sports Exerc 1996;28:581–6
14. Boot CR, van Langen H, Hopman MT: Arterial vascular properties in individuals with spina bifida. Spinal Cord 2003;41:242–6
15. Sramek P, Simeckova M, Jansky L, et al: Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol 2000;81:436–42
16. Braddom R: Physical Medicine and Rehabilitation, ed 2. Philadelphia, WB Saunders, 2000
17. Bove AA: Medical aspects of sport diving. Med Sci Sports Exerc 1996;28:591–5
18. Levey EB, Kinsman KF, Kinsman SL: Deep venous thrombosis in individuals with spina bifida. Eur J Pediatr Surg 2002;12(suppl 1):S35–6
19. Barratt DM, Harch PG, Van Meter K: Decompression illness in divers: A review of the literature. Neurologist 2002;8: 186–202
20. Dembert ML, Keith JF III: Evaluating the potential pediatric scuba diver. Am J Dis Child 1986;140:1135–41
21. Noppen M: Management of primary spontaneous pneumothorax. Curr Opin Pulm Med 2003;9:272–5
22. Turjanmaa K, Makinen-Kiljunen S: Latex allergy: Prevalence, risk factors, and cross-reactivity. Methods 2002;27: 10–4
23. Mazon A, Nieto A, Linana JJ, et al: Latex sensitization in children with spina bifida: Follow-up comparative study after two years. Ann Allergy Asthma Immunol 2000;84: 207–10
24. Hochleitner BW, Menardi G, Haussler B, et al: Spina bifida as an independent risk factor for sensitization to latex. J Urol 2001;166:2370 –3; discussion, 2373–4
25. Bernardini R, Novembre E, Lombardi E, et al: Risk factors for latex allergy in patients with spina bifida and latex sensitization. Clin Exp Allergy 1999;29:681–6
26. Hope A, Aanderud L, Aakvaag A: Dehydration and body fluid-regulating hormones during sweating in warm (38 degrees C) fresh- and seawater immersion. J Appl Physiol 2001;91:1529–34
27. Nakamitsu S, Sagawa S, Miki K, et al: Effect of water temperature on diuresis-natriuresis: AVP, ANP, and urodilatin during immersion in men. J Appl Physiol 1994;77: 1919–25
28. Newton HB: Neurologic complications of scuba diving. Am Fam Physician 2001;63:2211–8
29. Orlowski JP: Adolescent drownings: Swimming, boating, diving, and scuba accidents. Pediatr Ann 1988;17:125– 8, 131–2
30. Morgan WP: Anxiety and panic

Handicapped Scuba Association, Israel

2006-07-14T17:36:00.000-05:00

HSA Israel Announced
Dr. Nathan Cohen To Lead HSA in Israel and the surrounding region.

Who could have guessed that behind a tall white fence in a serene residential neighborhood not far from Tel Aviv, history was in the making: the creation of the Handicapped Scuba Association, Israel.
It all began with Dr. Natan Cohen, sponsor of a whirlwind week of HSA training: a Course Director Training Course (CDTC) followed by an Instructor Training Course (ITC) held from November 28 through December 4, 2005.
Since then the on-going process of formalizing the structure of HSA Israel continues to establish its presence under the leadership of Dr. Cohen, President of HSA Israel. The rigors of leadership, however, don’t faze Natan who serves as Deputy Director of Hillel Yaffe Medical Center and Founder of the Child Development Center, an extensive and impressive facility within the hospital.
Dr. Cohen refers to himself as a “Developmental Pediatrician,” meaning he specializes in child development. With that in mind, Natan contacted HSA International, curious to know how scuba diving might benefit young people who are cognitively impaired. He made up his mind and organized the first HSA Course Director Training Course (CDTC) in Israel. The CDTC requires 3 days of intense lectures that train the Course Director candidates how to use the manuals, lectures and water work to develop empathy and instructor teaching skills in their future HSA ITCs.
For each of 3 evenings, the 4 HSA Course Director candidates, including Natan, met in the Cohen’s’ home for highly verbal, even thought-provoking interactions between Gatacre and themselves that lasted long into the night. Natan’s wife, Nurit, graciously provided a tantalizing array of refreshments with which to fuel the active minds of the candidates.
Following their certification exams on the last night of the CDTC, few hours remained for sleep before the ITC they were about to teach was to begin in Eilat many miles south across the starkly beautiful Negev Desert.
All young Israeli men and women serve in the military so there was no mention of fatigue as the Course Director convoy arrived in Eilat countless hours later and immediately launched into Day 1 of the intensive 3-day HSA Instructor Training Course.
Each of the new Course Directors (Dov Bensman, Larry Tenenbaum, Sani Sanilevich and Dr. Natan Cohen) would co-teach the ITC to 8 underwater professionals at Meduza Israeli Sea Center. There on the Bay of Eilat with its calm, shimmering waters, a narrow curve of beach separated the fringe of shoreline from Meduza, operated by Sani and chosen as the host facility for HSA Israel’s debut Instructor Training Course.
It’s easy to see why. As a dive center Meduza has it all, from Nitrox and Tech diving to wreck and cave diving. The Center is replete with an on-site gear shop, a tropical-style snack bar, even its own floating pier.
Not only does Meduza have it all, Sani prides himself in making his Sea Center unique by making it wheelchair accessible. Now Meduza can add one more dive training specialty: training and certifying divers with physical as well as cognitive disabilities.
David Ederi, a Senior Dive Instructor at Meduza for over 3 years, is also the Center’s Web Master.
“Before we even thought about doing the HSA Course I went to your web site and saw that many diving agencies recognize you,” David observed. “The first time I saw handicapped divers going into the water, I thought that can’t be happening,” he exclaimed, “I mean, for a person who cannot walk to strap himself onto scuba gear and GO...what’s going on there!”
When the HSA Instructor Course appeared on Meduza’s schedule, David signed up.
“I thought the HSA Instructor’s Course would be a good experience for me,” he reasoned, “it’s a great satisfaction for myself and a great satisfaction for the handicapped diver. That was what motivated me to take the Course. And it was a very insightful Course...so much information I didn’t even know existed.”
David is with good company: he’s one of 2,400 HSA Instructors in 46 countries throughout the world whose integrity and sensitivity have transformed the lives of handicapped people eager for safe adventures to enrich their memories.
The Handicapped Scuba Association is an international, independent training and certifying agency with over 4,000 members. HSA Founder and President Jim Gatacre warmly calls them “our army of good guys” as the HSA celebrates its 27th year as the world-wide authority for handicapped diving.
Contacts: Dr. Natan Cohen natush@netvision.net.il

DVD from GUE About Decompression Illness

2006-07-14T10:17:00.000-05:00

Like to get your information on a DVD? Tony Rue with GUE sends us this information about Decompression Illness:

"You might be interested in the latest diver education DVD from Global
Underwater Explorers. "The Mysterious Malady: Toward an Understanding
of Decompression Injuries" is a series of interviews with the leading
researchers from Duke's Center for Hyperbaric Medicine, DAN, the
NEDU, and GUE. The program is general enough to appeal to the
recreational diver interested in learning more about what happens to
the body during a dive, yet also has enough information to hold the
interest of the most advanced of technical divers.

From the website: "Decompression techniques are skills to be
cultivated as you progress through dive training, yet this experience
is best framed by a solid understanding of the nature of
decompression and its associated injuries. Global Underwater
Explorers is pleased to present the first in a series of educational
DVD's designed to greatly expand one's knowledge of decompression and
its associated maladies. This DVD emphasizes an overview of
fundamental decompression concepts and the injuries associated with
decompression stress."

https://secure.gue.com/catalog/order/video.shtml

Best,
Anthony Rue
true@gue.com "

More about Decompression Illness at http://www.scuba-doc.com/dcsprbs.html

Study Advises Smoking Cessation in Divers

2006-07-14T10:07:00.000-05:00

In an article in the journal Chest titled "Decline of FEV1 in Scuba Divers", a study is reported by Tetzlaff et al that puts to rest the supposition that prolonged diving causes lung problems.
(Kay Tetzlaff, MD; Jens Theysohn, MD; Caroline Stahl; Sabine Schlegel, PhD; Andreas Koch, MD and Claus M. Muth, MD)
Abstract of the article
Correspondence to: Kay Tetzlaff, MD, Medical Clinic and Polyclinic, Department of Sports Medicine, University of Tuebingen Silcherstrasse 5, 72076 Tübingen, Germany; e-mail: Kay.Tetzlaff@med.uni-tuebingen.de

Study objectives: Obstructive changes in lung function have been reported with cumulative scuba diving exposure. The aim of this study was to investigate the decline in FEV1 in scuba divers over time.

Design: Prospective controlled cohort study.

Setting: German Naval Medical Institute.

Patients: Four hundred sixty-eight healthy, male, military scuba divers and 122 submariners (control subjects) were entered.

Measurements and results: Pulmonary function tests were performed in all subjects on at least three occasions with a minimum interval of 1 year between first and last measurement. The decline in FEV1 was investigated fitting a general linear model to FEV1 across time with a factorial main-effects model for slopes and intercepts with respect to the factors group, smoking status, and baseline FEV1. Mean baseline age of all subjects was 32 years (SD, 9.1), and mean body mass index was 24.7 kg/m2 (SD, 2.4). Subjects were followed up for 5 years (range, 1 to 9 years) on average. Baseline FEV1 exceeded the predicted values in both divers and nondiving control subjects. There was no significant difference in the decline of FEV1 between divers and control subjects. Over time, FEV1 declined more rapidly in smokers than in nonsmokers (p = 0.0064) and declined more rapidly also in subjects with a baseline FEV1 above average compared to subjects below average (p < 0.0001). The annual decline of FEV1 peaked in smoking divers who had a high FEV1 at baseline.

Conclusions: The data indicate that scuba diving is not associated with an accelerated decline in FEV1. Combined exposure to diving and smoking contributes to the fall of FEV1; therefore, smoking cessation is advised for divers.

Full text of the article.

Thanks to Dr. Howard Hommler who sent us the article.

Related links on Scubadoc's Diving Medicine Online
'Smoking and Diving'

Cigarette smoking and decompression illness severity: a retrospective study in
recreational divers.
http://snipurl.com/3ldd

Should Divers Smoke and vice versa
http://snipurl.com/3ldf

Pearls of Diving Wisdom: Great Lakes Chapter --- Undersea and Hyperbaric Medical Society

2006-07-13T12:25:00.000-05:00

Great Lakes Chapter --- Undersea and Hyperbaric Medical Society
Pearls of Diving Wisdom
See Poster at http://scuba-doc.com/GLCPoster.pdf

Partial list of topics:
Police Diving in Ontario
Diving for a Living
PFO’s (Patent Foramen Ovale) & the Bends
Cold Water Diving
Diabetes & Diving
Children & Diving - How Safe?

Saturday Oct. 21 , 2006

Where Diving and Medicine Meet
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, with refreshments after the meeting.

This is for you---
Recreational and Tech Divers
Professional Divers
Dive Masters & Instructors
Diving & Hyperbaric Professionals

For info & to register
Contact Ron Nishi glc-2006@levity.ca

0800 Register & Coffee
0830 to 1730 Symposium

Cost
$50.00 Cdn / $45.00 US before Oct. 6
$65.00 Cdn / $55.00 US after Oct. 6

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

Medical Program in Israel

2006-07-12T13:11:00.000-05:00

Announcement:

Pascack Valley Hospital , Westwood, NJ
5th Annual Medical Study Program in Israel
November 8-19, 2006

Subjects include:
Medical Aspects of Scuba Diving
Hyperbaric Medicine
Medical Response to Terrorism
Medical Advances

Itinerary includes Tel Aviv, Beer Sheva, Eilat, Dead Sea, Jerusalem
25-27 CME Category 1 credits

Touring (Including Petra), Scuba Diving Guide, Bus and Driver and Hotels approx $2800

Continental Flights from Newark Airport separate

Contact: William L. Cantor, MD
219 Old Hook Road
Westwood, NJ 07675
201-666-8787
Fax: 201-358-6686
email:drbillactor@aol.com

Note: Despite the chaos in Israel now, Dr. Cantor writes and tells us that he still plans to go.

Ernie

Upcoming DAN Events

2006-07-11T16:30:00.000-05:00

» Trainer Workshops & Instructor Update (7/25/06)
» DAN 57th Diving & Hyperbaric Medicine Course (8/3/06-8/5/06)
» Instructor Trainer Workshop (8/11/06-8/13/06)
» Duke/DAN DMT Course (9/10/06-9/15/06)
» Instructor Trainer Workshop (10/6/06-10/8/06)

More Events
Plan your meetings, courses and events on into 2007.

DCS Support Group started on Yahoo! Groups

2006-07-11T14:28:00.000-05:00

Here is a letter from a Leila Cara, a PADI dive instructor, about a DCS support group that she has started on Yahoo! Groups. I've not seen any such thing before but think that it might serve a good purpose for some people. Care must be taken to prevent it's derogation by people who might use it for venting anger. I will watch it with great interest.

Hi,
I have started a DCS support group to help those recovering from DCS. I would like to alert the diving medical community of this new group. I started it because of a DCS incident 1 year ago and realized there is little support after leaving the hospital. I would love for you, or anyone to visit.

http://groups.yahoo.com/group/DCSsupportGroup/

Please spread the word and post wherever suitable.
Thank you again,
Leila

Visit me at http://www.dream-mermaid.com

New books and classes to fix pain and improve health - Dr. Jolie Bookspan

2006-07-11T08:20:00.000-05:00

Next workshop to Fix Your Own Back and Neck Pain: Snowmass Colorado at the Wilderness Medical Society annual conference, Monday July 24,
plus two workshops on Tuesday July 25th: Stretches That Harm, and Core Training Without Crunches. Information and registration: http://www.wms.org

NEW books are out - with hundreds more effective techniques, fully illustrated, than would fit on my web site articles, and for all of you who can't get to the workshops:

"Healthy Martial Arts"
Huge wealth of information for training body and mind. eBook and Print Edition.

and
New THIRD Edition of "The Ab Revolution - No More Crunches No More Back Pain" eBook and Print Edition.

and
"Fix Your Own Pain - Without Drugs or Surgery"
Step-by-step how to fix pain - neck, upper back, lower back, disc, sciatica, impingement, shoulder, hip, foot, leg, knee, mystery all-over pain, it's all here. Print Edition.

and, still a scuba cult classic:
"Diving Physiology in Plain English"
NEW 6th printing coming in the next few weeks

and
"Stretching Smarter Stretching Healthier"
eBook and print edition

see the books: http://www.drbookspan.com/books.html

Good Things,
Dr. Jolie Bookspan,
named "St Jude of the Joints" by Harvard Medical School clinicians

****************
"Movie music is noise. It's even more painful than my sciatica."
- Sir Thomas Beecham (celebrated British conductor)
****************

NEW- The Ab Revolution 3rd edition
No More Crunches No More Back Pain

Third edition, completely reorganized and expanded. Easier to follow and use.

Dr. Jolie Bookspan's Ab Revolution is a groundbreaking core training and back pain relief technique. Used by athletes, military, law enforcement, and top spine docs and rehab centers around the world.

Recommendations of the World Congress on Drowning

2006-07-10T17:33:00.000-05:00

Appendices to Recommendations of the World Congress on Drowning
Amsterdam 26 – 28 June 2002
Overview recommendations task force Diving (breath hold, scuba and hose diving)

During the World Congress on Drowning, experts of the task force Breath hold, scuba
and hose diving have finalised a consensus document on a variety of topics.
It was agreed that
1. Well-constructed national regulations have been effective where enforced and
that any significant improvements in health and safety would arise only from a
more inclusive definition of working divers and a wider application of existing
procedures.
2. Self-regulation within the world-wide recreational diving industry continues to
be the practical route for further improvement but that there is a need to counter
a perception that there is a conflict between commercial interests and safety.
3. The training agencies comply with international quality assurance and control
procedures (QA/QC) such as the International Standard ISO 9000 series and
also encourage independent monitoring to assure the effective and safe use of
existing and new procedures.
4. Subsistence fishermen who are predominantly found in the poor countries
around the world, use equipment that is minimal and that their training,
regulations and medical support appear to be zero.
To improve diving-fishermen safety and reduce drowning there is a need to
collect data on accidents and drowning among representative samples of diving
fishermen around the world.
This should be followed up with international non-governmental organisations
(NGOs), other charities and appropriate UN development initiatives so that
existing academic societies, training organisations and others could deliver
suitable medical and diving advice and training for fishermen compatible with
the limits of available local resources.
5. The collection of diver morbidity and mortality data and the associated
contributory factors for each incident is a necessary first step in reducing
drowning incidents among divers. Also needed are the denominator data that
will allow the calculation of risk.
6. Recreational divers are free to dive when, where and how they like but the diver
also has an obligation to the public. Any underwater accident to a diver can put
buddy divers and rescuers at considerable risk.
7. Greater stringency is needed in the assessment of the physical, mental and
medical fitness of all who choose to dive. A single assessment of fitness for
diving at the beginning of diver training should not be considered valid
throughout the rest of the diver's life. Re-assessments are recommended at
intervals that may diminish with advancing years and re-assessment may also
be needed after illness or injury.
8. To give a medical opinion on a diver's fitness, the doctor should have prior
knowledge of the unique hazards faced by a diver. Whenever possible, the
medical assessment should be conducted by a doctor acknowledged as
competent in this special subject. It is recommended the training of diving
doctors, both for the medical examination of divers and also for the treatment of
medical emergencies in diving, complies with guidance such as that published
by the European Diving Technology Committee (EDTC) and the European
Committee for Hyperbaric Medicine (ECHM). Periodical revision training is
also important.
9. The mental, physical and medical standards of fitness in each category of
diving should be harmonised internationally.
10. Greater emphasis should be placed at all levels of training on the causation and
prevention of in-water fatalities.
11. After some 3 to 5 years without regular diving, the individual should be subject
to a formal re-assessment of competence before re-entering the water.
12. The policy of training children as young as 8 years old to dive should
emphasise the immaturity of mental outlook that many young persons may have
when an emergency occurs.
13. Emergency procedures should be consistent with a variety of equipment in a
variety of configurations.
14. Programs of refresher training should be established to maximise practical re-learning
and updating of basic emergency skills. This is needed particularly
after an individual's equipment has been modified.
15. Self-rescue and buddy-rescue procedures should be compatible with the
equipment used and the environmental conditions.
16. Training of rescuers should include the procedures for recovery of the victim
from the water into a boat and transfer of the patient from the deck of a boat to
a helicopter or some other emergency transport vehicle.
17. Hand signals and basic procedures used in diving emergencies, whether at
depth or on the surface, should be standardised and promoted through rescue
and diving agencies throughout the world.
18. Rescuers must be made aware that the treatment of drowning in a diver might
be complicated by other medical conditions such as carbon monoxide
poisoning, envenomation and omitted decompression arising from that same
dive.
19. National and international standards of medical care should be written for all
medical emergencies in diving by suitable academic bodies.
20. Drowning is mostly a diagnosis of exclusion and often is a presumptive
diagnosis based on purely circumstantial evidence. All diving-related deaths
should be thoroughly investigated, including a complete autopsy, evaluation of
the equipment and a review of the circumstances surrounding the fatality by
knowledgeable investigators with appropriate training and experience.
The post-mortem examination of a drowned diver should be conducted by a
pathologist who is knowledgeable about diving (or who is advised by a doctor
who is knowledgeable about diving).

UHMS ASSOCIATES ACHIEVEMENT RECOGNITION SCHOLARSHIP

2006-07-10T16:53:00.000-05:00

UHMS ASSOCIATES ACHIEVEMENT RECOGNITION SCHOLARSHIP

The $2,000.00 scholarship is designed to assist the recipient to attend the UHMS Associates Annual Scientific Meeting (ASM).

REQUIREMENTS

The nominee must be a member in good standing of the UHMS Associates;

The nominee must submit an abstract, and deliver the presentation at the upcoming ASM.

If selected, the scholarship recipient will agree to:

1. Submit the abstract and paper for publication on the Associates website education column.

2. Submit his or her bio and photograph for viewing on the Associates website.

SELECTION CRITERIA

A. Be relatively new to the field, and who has already shown great promise (enthusiastic and self-motivated, who has obviously spent non-compensated time furthering their knowledge-base). Preference will be given to those who have made "significant" contributions (published a pertinent article, assisted in the creation of the standards for hyperbaric staffing and patient care, acted as faculty for related training programs, etc.), or;

B. Has been employed in the field of diving/hyperbaric medicine/technology for some time and has yet to attend the ASM (the reason being lack of financial means rather than lack of interest). It would be considered that the early opportunity to attend the meeting might further motivate and stimulate this individual to achieve administrative and clinical advancement, or;

C. A long-standing member who has worked tirelessly, and without expectation, to further the goals of the Associates and to advance the field.

SELECTION PROCESS

Nominations can be made by any UHMS Member, but the nominee can only be an ASSOCIATE Member in good standing. The nomination must be signed off by the nominee and the nominee’s supervisor from the nominee's facility or organization who is also a member of the UHMS. Nominations are made by completing the application form. The deadline for nomination is 150 days (5 months) prior to date of the ASM for that calendar year. The justification statement on the application form must include how the nominee fulfills the selection criteria (above). Applications and resumes must be emailed to Education Committee Chair who will then screen applications for validity under the selection process. Partially completed applications will not be accepted for consideration. The Education Committee will review all accepted applications and vote to select the scholarship recipient for that year. The winner will be notified by letter. Formal announcement will be made at the Annual Meeting, the Associates website and in the next edition of Pressure. An official presentation of the award will be made during the UHMS Annual Meeting. A photograph and bio of the recipient will also be posted on the UHMS Associates website.

FOR ONLINE SUBMISSION: https://www.uhms.org/Associates/SCHOLARSHIP_AWARD.asp

APPLICATION ONLINE FORM WORD PDF

Legal Article: Diver hit by jet sled

2006-07-10T09:16:00.000-05:00

Diver hit by jet sled: Negligent operation: Failure to properly diagnose and treat: Decompression illness: Fractures: Settlement
Law Reporter, Jun 2003

Errickson v. Horizon Offshore Contractors, Inc., U.S. Dist. Ct., E.D. La., No. CV01-2133-"C", Nov. 4,2002.

The diver, Errickson, 36, suffered multiple fractures to his left leg while he
was helping place a jet sled on an underwater pipeline 100 feet below the surface when the sled was dropped on him.

He was raised rapidly to the surface causing him to suffer decompression illness from being raised to the surface too rapidly after the incident. No recompression treatment was provided by his employer. Errickson underwent two surgeries to repair his orthopedic injuries. He incurred medical expenses of approximately $200,000, paid by his employer.

Errickson, who had earned approximately $40,000 annually as a commercial diver, is unable to return to that work. He is now pursuing education toward an alternative career.

Errickson sued his employer under the Jones Act, 46 U.S.C. [sec] 688, alleging failure to properly plan and supervise the operation-which allegedly took place under unsafe sea conditions-and failure to ensure that the rigging to the sled was safe. Plaintiff also alleged defendant was vicariously liable for the hospital's failure to properly diagnose and treat his decompression illness. Following mediation, the parties reached a settlement for $1.4 million.

Plaintiff's experts were John W. Grimes, vocational rehabilitation, Lafayette, La.; G. Randolph Rice, economics, Baton Rouge, La.; and John W. Thompson Jr., neuropsychiatry, and Paul G. Harch, hyperbaric medicine, both of New Orleans, La.

Defendant's experts were Kenneth Adams, neuropsychiatry, Ann Arbor, Mich.; and Kenneth Boudreaux, economics, New Orleans, La.

Plaintiffs Counsel

*Bobby J. Delise, Metairie, La.

*Alton J. Hall Jr., Metairie, La.

*R. Justin Garon, New Orleans, La.

*Scott E. Silbert, New Orleans, La.

Delise has attended the UHMS course on Medical Fitness to Dive and now gives lectures to the course as part of the curriculum.

NORTHEAST CHAPTER Of the UHMS Conference/Chapter Meeting

2006-07-10T08:32:00.000-05:00

Lisa Wasdin, UHMS sends this information:

NORTHEAST CHAPTER Of the UHMS
Conference/Chapter Meeting

NOVEMBER 4-5
(pre-courses: November 3)

Hartford Marriott Downtown
200 Columbus Blvd., Hartford, CT
860-249-8000

REGISTRATION: ONLINE WORD PDF

PRE-COURSES: ACRYLICS WINDOW CHT/CHRN PRE-EXAM REVIEW COURSE

SPONSOR/EXHIBIT INFORMATION: WORD PDF

HOTEL INFORMATION

Bubble Grade Study in Actual Scuba Diving Conditions

2006-07-09T10:15:00.000-05:00

June 2, 2006 — An echocardiographic study done on healthy volunteers in actual scuba diving conditions found an important bubble grade in all, according to a report in the May issue of Chest [Chest. 2006;129:1337-1343]. The hemodynamic changes suggested that hypovolemia [low blood volume] is an important factor and that restoration of fluid balance should be considered after all dives.

"During a scuba dive, subjects undergo environmental constraints such as immersion, exposure to cold, and increased ambient pressure," write Alain Boussuges, MD, PhD, from the Institut de Médecine Navale du Service de Santé des Armées in Marseille, France, and colleagues. "Intravascular gas bubbles are carried from the venous circulation to the pulmonary vessel, where they are eliminated through the lungs. The formation of bubbles is recognized as the basis for decompression illness, but such bubbles are also commonly detected in venous circulation of asymptomatic divers."

Ten divers were studied and one hour after the dive, microbubbles were detected in the right-heart chambers of all subjects, and left atrial and left ventricular diameters were significantly decreased. Cardiac output measured by aortic blood flow remained unchanged, but heart rate increased and stroke volume decreased after the dive. Left ventricular filling, which was assessed on transmitral profile, was partially increased by atrial contraction. Right cavity diameters were unchanged, but there was an increase of the right ventricular/right atrial gradient pressure.

"The diving profile studied promotes a rather important bubble grade in all volunteers," the authors write. "Two factors can explain these results: low volemia secondary to immersion, and venous gas embolism induced by nitrogen desaturation. Consequently, restoration of the water balance of the body should be considered in the recovery process after diving."

Clinical Context
Scuba diving invilves immersion in water and the use of self-contained breathing units known to produce some interesting effects on the circulation, including a reduction in peripheral blood flow that concentrates blood in the central circulation. This effect, in turn, stimulates increased release of atrial natriuretic peptide and diuresis. In addition, the increase in ambient pressure associated with diving increases the arterial concentrations of oxygen and nitrogen, and the higher levels of oxygen may impair cardiac relaxation.

Previous studies have suggested possible cardiac changes associated with scuba diving. The current study follows up 10 healthy male volunteers with echocardiography before and after diving to document these changes.

Study Highlights
*Study subjects underwent echocardiography at baseline and 1 hour following a 25-minute dive at a mean depth of 34.3 m. Participants breathed a standard mixture of nitrogen and oxygen and wore neoprene diving suits.
*Circulating bubbles following the dive were detected with 2-D echography.
*The main study outcomes were differences in echocardiogram data before and after the experimental dive.
*All participants had evidence of circulating bubbles, and 7 of the 10 divers had grade 3 bubbles (the majority of cardiac periods contained bubble signals singularly or in group).
*The authors conclude that a relative hypovolemia and venous gas embolism help explain the changes in echocardiographic findings following diving, and they recommend oral rehydration following diving. Rehydration might be especially important in the setting of repeated diving.

Take home stuff:
Scuba diving can reduce peripheral blood flow, increase the release of atrial natriuretic peptide and diuresis, and increase the arterial partial pressures of oxygen and nitrogen.
The current study suggests that oral rehydration following recreational scuba diving may reduce echocardiographic changes associated with diving.

Cayman Brac to Have Hyperbaric Chamber

2006-07-09T09:28:00.000-05:00

In an article on Cayman Net News, "Diving safety upgrade with hyperbaric chamber" which can be seen in full at http://snipurl.com/syjg it is noted that Cayman Hyperbaric Services (CHS) is expanding to the Brac and will install a hyperbaric chamber at Faith Hospital that should be operational by the end of the year.

John and Ann Elliott own and manage CHS, the company that has operated the hyperbaric chamber at the Cayman Islands Hospital in George Town for the last ten years.

The chamber on the Brac should be supported by twelve volunteers initially. This is a major investment, and the company must recoup some of this before there are funds to pay staff, explained Mr Elliott.

However, the chamber has always been well-supported by the diving community on Grand Cayman and he is certain that support would be forthcoming from dive staff on Cayman Brac.

Operators who show particular interest will be sent for training to Duke University, which has its own hyperbaric chambers and where Divers Alert Network (DAN) run courses in conjunction with the university.

The Brac chamber will be smaller than the one in Grand Cayman, holding one bed rather than two. It is expected to be on the Island in September, and will then have to be put into operational order with all the ancillary equipment attached before use.

“It should be running by the end of the year, sooner if possible,” said Mr Elliott.

Dominica Chamber to be Installed

2006-07-07T11:06:00.000-05:00

The Times Newsletter of Dominica has an article that relates information about a new recompression chamber just arrived and being installed. Funded by the European Union and the Government of Dominica as part of the Dive Improvement Program, the chamber will be a huge boost to both the hospital and dive industry of the island.

From the inception of the Dive Industry, the Dominica Watersports Association depended on the French West Indies for these services.

In addition, the chamber will also be of immense benefit to the health care system in Dominica and is equipped with an oxygen generator sufficient to supply the oxygen needs of the Princess Margaret Hospital.

The manufacturer contracted to construct and install the chamber will be arriving in Dominica next week to effect installation as well as to provide technical training to the medical staff and to certified instructors of the Dominica Watersports Association, The objective of the training program is to ensure proper use of the chamber as well as effective staffing and maintenance.

The hyperbaric chamber will be housed at the Princess Margaret Hospital.

Beau's lines in saturation divers

2006-07-07T10:50:00.000-05:00

H.Schwartz of the Hyperbaric Treatment Center at the University of Hawaii reports an interesting finding in the fingernails of saturation divers in a study done in the NEDU at Panama City FL.

Transverse furrows, or Beau's lines, were noted in the fingernails of all 6 divers following a deep saturation dive to a pressure equal to 1100 feet (335 meters) of sea water (3,370 kPa), and in 2 of 6 divers following a similar dive to 1000 feet (305 meters) of sea water (3,164 kPa). Both dives took place at the Ocean Simulation Facility of the Navy Experimental Diving Unit in Panama City, Florida. The divers breathed a partial pressure of 0.40 - 0.44 atm abs (40.5 - 44.6 kPa) oxygen, with the balance helium, during most of the time under pressure. All divers performed hard work on bicycle ergometers during the dives. Four of the divers on the first dive were treated during the dive for pain-only decompression sickness. Beau's lines have been reported in numerous medical conditions such as typhus, rheumatic fever, malaria, myocardial infarction, and other severe metabolic stresses. To the author's knowledge this is the first report of Beau's lines associated with saturation diving.

Beau's lines are depressions across the nail plate that often follow local trauma or some other inciting event. They also may reflect poor nutritional status, febrile illness, or a reaction to medication. Beau's lines are a temporary cessation in nail growth and tend to appear about one month after the inciting event. Beau's lines tend to resolve spontaneously as the nail grows out.
[Photo from the Cleveland Clinic]

Pendergast Receives Top Award from Undersea and Hyperbaric Society

2006-07-07T10:41:00.000-05:00

In a news release from the University of Buffalo, David R. Pendergast of Hamburg, professor in the Department of Physiology and Biophysics, University at Buffalo School of Medicine and Biomedical Sciences, has received the Albert R. Behnke Award, the most prominent honor awarded by the Undersea and Hyperbaric Medical Society (UHMS).

Pendergast received the award, presented in recognition of outstanding scientific contributions to advances in the undersea or hyperbaric biomedical field, at the annual scientific meeting of the UHMS, held in late June in Orlando, Fla. The UHMS is the primary source of information for diving and hyperbaric medicine physiology worldwide.

UHMS Press Release - New Book - Assessment of Fitness to Dive

2006-07-06T13:04:00.000-05:00

PRESS RELEASE

ASSESSMENT OF DIVING MEDICAL FITNESS FOR SCUBA DIVERS AND INSTRUCTORS
By
Peter B. Bennett, Frans J. Cronje, Ernest S. Campbell

A dive instructor is the first person to assess the general health and medical fitness of a prospective diver before he or she enters the water. Whether the diver is a recreational scuba diver, commercial, military or research diver, the same evaluation of physical fitness will apply.

Internationally recognized authors, surgeons and researchers Bennett, Cronje and Campbell collaborated on this new book, Assessment of Diving Medical Fitness for Scuba Divers and Instructors, to provide instructors and divers a clear and concise reference addressing the principles behind the necessary medical considerations and related decisions on diving fitness. It will help instructors and active divers determine when the input from a diving physician is mandatory and how to sensibly screen prospective divers for medical problems.

Assessment of Diving: Medical Fitness for Scuba Divers and Instructors is also an excellent reference for first-time divers and experienced divers who may have medical questions related to their personal health and fitness. It is designed to provide advice in relatively simple non-medical language.

In the final analysis, it is the personal responsibility of each diver to make a decision whether or not to dive, and Bennett, Cronje and Campbell compiled this laymen’s guide for just that purpose.
(Hardcover, 241 pages) ISBN: 1930536313

Book No: B1136 Price $29.95

· ORDER ONLINE AT: www.bestpub.com

· CALL Best Publishing Company 1.800.468.1055 or 928.527.1055

· Email: Customerservice@bestpub.com

"This book has a wealth of information useful to the casual and hardcore recreational scuba diver, as well as the diver education professional. This valuable resource can help all divers make informed decisions critical to their safety." --Dan Orr, CEO Divers Alert Network

"Doctors Bennett, Cronje and Campbell have provided a useful and readable source of reference for medical information related to scuba diving. This book will be of value to individuals who have medical questions relating to their health and compatibility with scuba diving. My compliments to the authors for producing a useful work." --Dr. Drew Richardson, PADI Worldwide COO

"Finally, a clear concise guide to evaluating a person's fitness to dive. Every dive leader, diver, and prospective diver should own and read this book." --Frank J. Toal, Jr., MAED President CMAS Americas

UHMS New Classified Ads

2006-07-06T12:40:00.000-05:00

Hyperbaric/Wound Care Physician

Hill Country Wound and Hyperbarics is seeking physicians for wound care and hyperbarics in San Antonio, Texas. Full and part time positions are available. Experience is preferred but training is available for the right physician. Flexible scheduling is possible. Current board certification a plus.

Please email Donald C. Frame, MD at frame@donframe.com with your contact information and a CV.

==================================================================================
Program Director

Do you have excellent leadership, delegation and organizational skills?
Do you have the ability to effectively interact with others?
If you said yes, then read on…

Diversified Clinical Services is currently seeking a Program Director for our Comprehensive Wound Healing Center. The Program Director will represent the center in an administrative role to hospital administration, physicians, referring physicians and other customers. Position is located in Valdese, NC.

Job Description:

The Program Director is responsible and accountable for daily operations, fiscal management, marketing, administrative policies, personnel management, performance improvement and clinical practices to ensure the delivery of quality care.

Duties:
§ Ensure all policies and procedures are current and all manuals necessary to operate the Center are current to DCS and Hospital standards

§ Ensure the Center has adequate staffing, patient care supplies and adequate and safe patient care equipment

§ Manage the Center in accordance with the established Strategic Plan

§ Develop an annual Strategic Plan for the Center in conjunction with DCS and Hospital resources

§ Serve as a liaison between Hospital, Center staff and Diversified Clinical Services

§ Facilitate communication between physicians providing care in the Center and between Center physicians and referral sources and Center physicians and Diversified Medical Leadership

§ Continuously assess reimbursement for Center services and initiate processes necessary to ensure the correct level of reimbursement for the Hospital

§ Ensure performance improvement program is in place and current

Job Requirements:

§ North Carolina Registered Nurse license

§ Bachelor's degree in health care affiliated or business field

§ CWOCN or CWS

§ BLS required

§ Minimum 3 years management experience in a health care setting

§ Marketing experience preferred

§ Basic word processing and spreadsheet skills

§ Excellent written and verbal communication skills

In return for your hard work and dedication, we offer a competitive salary, excellent benefits and a positive working environment!

Location: Comprehensive Wound Healing Center, Valdese General Hospital, Valdese, NC.

Job Type: Exempt full time employee

Contact Info.: Please forward resume and salary history to abaxter@diversifiedclinicalservices.com or fax to (714) 415-3099.

Diversified is an Equal Opportunity Employer

================================================================================
Medical Director

A great opportunity exists for an immediate position available as the Hyperbaric Medical Director at University Hospital, in Augusta, Georgia (www.universityhealth.org). National Baromedical Services (www.baromedical.com) just assumed contract with the hospital to provide a hyperbaric medical center of excellence. The present program will be greatly expanded with a fully trained nursing staff, and become nationally accredited through the UHMS. Additionally, there are unique teaching opportunities available for ‘Primary Training in Hyperbaric Medicine' at the NBS headquarters, just minutes away, in Columbia, SC. For additional information please contact Dick Clarke at 803.434.7101 or dick.clarke@palmettohealth.org
_________________________________________

Medical/Surgical
Christchurch Hospital
Hyperbaric Technical Officer
Hyperbaric Medicine Unit, Part-time, (0.8 FTE), 32 hours per/wk
Vacancy 4117DNZ. Closing date open

We seek an experienced Hyperbaric Technician, able to work efficiently without supervision and who has effective communication and interpersonal skills. You should have clinical Hyperbaric experience and a relevant diving industry qualification (eg. Life Support Technician or ALST as recognised by AODC), or appropriate military Hyperbaric/diving training and experience. Preferably, you should have a current C.P.R. certificate. A Diver Medical Technician’s certificate would also be desirable.

You will participate in a wide range of duties, especially the safe operation and maintenance of the Hyperbaric Chamber and ancillary equipment as laid down by the relevant regulatory authorities. You will be required to participate in an on-call roster.

The unit provides elective and emergency Hyperbaric medical services for the South Island and Wellington region of New Zealand, delivering 1200-1400 Hyperbaric treatments per year. Christchurch Hospital is a tertiary referral teaching hospital hosting a tertiary level intensive care unit, specialty surgical services (Cardiac, Neurosurgical, etc) and Radiation Oncology.

For enquiries contact Sandy Inglis, Supervising Technician, phone 0-3-364 1521, email sandy.inglis@cdhb.govt.nz

Applicant Information: Visit www.healthfirst.govt.nz/hr for full details.
Human Resources, Christchurch Hospital, Private Bag 4710,
Christchurch, email hradmin@cdhb.govt.nz
CDHB has a Smokefree policy

Oxyheal University

2006-07-05T17:18:00.000-05:00

www.oxyhealuniversity.com
877.699.8648

Hyperbaric Education Specialists

· Clinical Hyperbaric Medicine Introductory Training

10-14 July, 2006 Detroit
11-15 September, 2006 Las Vegas

· Hyperbaric Facility Safety Director Training

17-19 August, 2006 Las Vegas
16-18 November, 2006 Las Vegas

· PVHO Acrylic Window Inspection Training

3 November, 2006 Hartford

· Hyperbaric Facility Fire Safety Training

20 August, 2006 Las Vegas
19 November, 2006 Las Vegas

· Pre-Certification Examination Training for Nurses and Technicians

3 November, 2006 Hartford

· Hyperbaric Business Related Education:

On-line- Face to Face- Mobile Training Options Available
Hyperbaric Certified Training Staff

OxyHeal University -The One “Stop” For All of Your Hyperbaric Training Needs!

Call 877.OXYUNIV (699.8648)

UHMS News

2006-07-05T14:38:00.000-05:00

UNDERSEA AND HYPERBARIC MEDICAL SOCIETY
PACIFIC COAST CHAPTER – 32th ANNUAL MEETING
SEPTEMBER 15 & 16, 2006

BY POPULAR REQUEST – THE DEADLINE FOR SUBMISSION OF ABSTRACTS HAS BEEN EXTENDED TO JULY 30, 2006.

NOTIFICATION OF ACCEPTANCE WILL BE AUGUST 15, 2006

CALL FOR ABSTRACTS

Abstracts are requested for presentations to provide a review and update on clinical hyperbaric medicine topics suitable for a medical/professional audience, and on diving medicine topics suitable for medical personnel, diving professionals and recreational divers.

Abstracts for research presentations can cover either clinical hyperbaric medicine or diving medicine. Special consideration will be given to resident presentations.

For meeting information contact:

Lorre T. Henderson, OD, MD, FACS
President, Pacific Chapter UHMS
301 Seacliff Way
Point Richmond, CA 94801
Phone: (707) 771-9718
Fax: (707) 432-2666

Make room reservations early at:
Waterfront Plaza Hotel*
10 Washington Street
Oakland, California 94607
Toll Free reservations (800) 729-3638
Identify yourself as a member of:
Pacific Undersea and Hyperbaric Medicine

Email: PacificUHMS2006@yahoo.com.

Exercising After Diving - Not a Bad Thing to Do?

2006-07-05T14:34:00.000-05:00

Here is a study reported in the Journal Aviation, Space and Environmental Medicine that reports a decline in the bubble count during strenuous exercise after a 99 foot open sea dive.

Dujic Z, Obad A, Palada I, Ivancev V, Valic Z. of the Department of Physiology, University of Split School of Medicine, Croatia report that venous bubble count declines instead of rising as feared by divers and aviators. They report this in Aviat Space Environ Med. 2006 Jun;77(6):592-6.
http://snipurl.com/spmr

Here is the abstract of the article:

INTRODUCTION: The effect of post-dive exercise on bubble formation remains controversial, although the current practice of divers and aviators is to avoid strenuous exercise after diving. Previously, we have shown that exercising 24 h before a dive, or during a decompression stop, significantly reduces bubble formation in man. The objective of this study was to determine whether a short period of strenuous post-dive exercise promotes venous bubble formation.

METHODS: Seven male military divers performed an open-sea field dive to a maximum depth of 30 m for 30 min. At maximum depth, subjects performed mild underwater fin swimming, followed by standard decompression. Diving was followed by a post-dive exercise session consisting of short, strenuous incremental upright cycle ergometry, up to 85% of maximal oxygen uptake, for about 10 min. Subjects were monitored for venous gas bubbles in the right heart with an echo-imaging system starting 20 min post-dive while in the supine position, during cycle ergometry in the seated upright position, and immediately after exercise in a supine position.

RESULTS: The average number of bubbles was 1.5 +/- 1.4 bubbles x cm(-2) 20 min after diving. Changes in posture from supine to seated upright resulted in significant reduction of bubbles to 0.6 +/- 1.3 bubbles x cm(-2) (p = 0.043), with further reduction to 0.2 +/- 0.3 bubbles x cm(-2) at the end of exercise (p = 0.02). No cases of DCS or intra-pulmonary shunt were observed during or following post-dive exercise.

DISCUSSION: These results suggest that post-dive strenuous exercise after a single field dive reduces post-dive gas bubble formation in well-trained military divers. Additional findings are needed for normal sports divers.

Links to related References

References on Scubadoc's Diving Medicine Online that differ from these recommendations.
http://www.scuba-doc.com/exerdcs.html

All Four Stanzas, by Isaac Azimov

2006-07-05T13:16:00.000-05:00

One of my constant supporters and readers, Capt. Richard Carson sent me an article yesterday on the Fourth Of July that I had seen before but seemed somehow particularly apropos in this time of war and danger and questions about our flag and national identity. It is an article written by the great science/fiction writer Isaac Azimov about his emotional attachment to the national anthem of the United States and his penchant for singing all four verses of the song and the reaction that it always caused when he did so. For you who don't know the words of the first stanza, much less the entire four stanzas, here they are for you to read and really take some time to digest and think about what was happening at the time the poem was written. Our country has not always been as powerful as it is now and this shows just how important the flying of the flag was and still is to all of us. Here are all four stanzas for US citizens to refresh your memory - and for others to consider as reasons for them to take home as models of patriotism.

All Four Stanzas

By Isaac Asimov

I have a weakness -- I am crazy, absolutely nuts, about our national anthem.

The words are difficult and the tune is almost impossible, but frequently when I'm taking a shower I sing it with as much power and emotion as I can. It shakes me up every time.

I was once asked to speak at a luncheon. Taking my life in my hands, I announced I was going to sing our national anthem -- all four stanzas.

This was greeted with loud groans. One man closed the door to the kitchen, where the noise of dishes and cutlery was loud and distracting. "Thanks, Herb," I said.

"That's all right," he said. "It was at the request of the kitchen staff."

I explained the background of the anthem and then sang all four stanzas.

Let me tell you, those people had never heard it before -- or had never really listened. I got a standing ovation. But it was not me; it was the anthem.

More recently, while conducting a seminar, I told my students the story of the anthem and sang all four stanzas. Again there was a wild ovation and prolonged applause. And again, it was the anthem and not me.

So now let me tell you how it came to be written.

In 1812, the United States went to war with Great Britain, primarily over freedom of the seas. We were in the right. For two years, we held off the British, even though we were still a rather weak country. Great Britain was in a life and death struggle with Napoleon. In fact, just as the United States declared war, Napoleon marched off to invade Russia. If he won, as everyone expected, he would control Europe, and Great Britain would be isolated. It was no time for her to be involved in an American war.

At first, our seamen proved better than the British. After we won a battle on Lake Erie in 1813, the American commander, Oliver Hazard Perry, sent the message "We have met the enemy and they are ours." However, the weight of the British navy beat down our ships eventually. New England, hard-hit by a tightening blockade, threatened secession.

Meanwhile, Napoleon was beaten in Russia and in 1814 was forced to abdicate. Great Britain now turned its attention to the United States, launching a three-pronged attack. The northern prong was to come down Lake Champlain toward New York and seize parts of New England. The southern prong was to go up the Mississippi, take New Orleans and paralyze the west. The central prong was to head for the mid-Atlantic states and then attack Baltimore, the greatest port south of New York. If Baltimore was taken, the nation, which still hugged the Atlantic coast, could be split in two. The fate of the United States, then, rested to a large extent on the success or failure of the central prong.

The British reached the American coast, and on August 24, 1814, took Washington, D. C. Then they moved up the Chesapeake Bay toward Baltimore. On September 12, they arrived and found 1000 men in Fort McHenry, whose guns controlled the harbor. If the British wished to take Baltimore, they would have to take the fort.

On one of the British ships was an aged physician, William Beanes, who had been arrested in Maryland and brought along as a prisoner. Francis Scott Key, a lawyer and friend of the physician, had come to the ship to negotiate his release. The British captain was willing, but the two Americans would have to wait. It was now the night of September 13, and the bombardment of Fort McHenry was about to start.

As twilight deepened, Key and Beanes saw the American flag flying over Fort McHenry. Through the night, they heard bombs bursting and saw the red glare of rockets. They knew the fort was resisting and the American flag was still flying. But toward morning the bombardment ceased, and a dread silence fell. Either Fort McHenry had surrendered and the British flag flew above it, or the bombardment had failed and the American flag still flew.

As dawn began to brighten the eastern sky, Key and Beanes stared out at the fort, tyring to see which flag flew over it. He and the physician must have asked each other over and over, "Can you see the flag?"

After it was all finished, Key wrote a four stanza poem telling the events of the night. Called "The Defence of Fort M'Henry," it was published in newspapers and swept the nation. Someone noted that the words fit an old English tune called "To Anacreon in Heaven" -- a difficult melody with an uncomfortably large vocal range. For obvious reasons, Key's work became known as "The Star Spangled Banner," and in 1931 Congress declared it the official anthem of the United States.

Now that you know the story, here are the words. Presumably, the old doctor is speaking. This is what he asks Key

Oh! say, can you see, by the dawn's early light,
What so proudly we hailed at the twilight's last gleaming?
Whose broad stripes and bright stars, through the perilous fight,
O'er the ramparts we watched were so gallantly streaming?

And the rocket's red glare, the bombs bursting in air,
Gave proof thro' the night that our flag was still there.
Oh! say, does that star-spangled banner yet wave,
O'er the land of the free and the home of the brave?

"Ramparts," in case you don't know, are the protective walls or other elevations that surround a fort. The first stanza asks a question. The second gives an answer

On the shore, dimly seen thro' the mist of the deep,
Where the foe's haughty host in dread silence reposes,
What is that which the breeze, o'er the towering steep.
As it fitfully blows, half conceals, half discloses?

Now it catches the gleam of the morning's first beam,
In full glory reflected, now shines on the stream
'Tis the star-spangled banner. Oh! long may it wave
O'er the land of the free and the home of the brave!

"The towering steep" is again, the ramparts. The bombardment has failed, and the British can do nothing more but sail away, their mission a failure.

In the third stanza, I feel Key allows himself to gloat over the American triumph. In the aftermath of the bombardment, Key probably was in no mood to act otherwise.

During World War II, when the British were our staunchest allies, this third stanza was not sung. However, I know it, so here it is

And where is that band who so vauntingly swore
That the havoc of war and the battle's confusion
A home and a country should leave us no more?
Their blood has washed out their foul footstep's pollution.

No refuge could save the hireling and slave
From the terror of flight, or the gloom of the grave,
And the star-spangled banner in triumph doth wave
O'er the land of the free and the home of the brave.

The fourth stanza, a pious hope for the future, should be sung more slowly than the other three and with even deeper feeling.

Oh! thus be it ever, when freemen shall stand
Between their loved homes and the war's desolation,
Blest with vict'ry and peace, may the Heav'n - rescued land
Praise the Pow'r that hath made and preserved us a nation.

Then conquer we must, for our cause is just,
And this be our motto -- "In God is our trust."
And the star-spangled banner in triumph doth wave
O'er the land of the free and the home of the brave.

I hope you will look at the national anthem with new eyes. Listen to it, the next time you have a chance, with new ears.

And don't let them ever take it away.

-- Isaac Asimov, March 1991

CNS toxicity in closed-circuit oxygen diving: symptoms reported from 2527 dives.

2006-07-05T09:33:00.000-05:00

CNS toxicity in closed-circuit oxygen diving: symptoms reported from 2527 dives.

There is a report in the journal "Aviation Space & Environmental Medicine for May, 2006 that you might find interesting. The study was done by a group at the Israel Naval Medical Institute in Haifa, Israel and led by Dr.s Arieli, Shochat and Adir.
< rarieli@netvision.net.il > The following is an abbreviated abstract of the article:

INTRODUCTION: Little work has been done on the problem of oxygen toxicity in divers 'in the water'. Various aspects of oxygen diving have been studied in dry hyperbaric chambers, but there is a lack of information on in-water diving using closed-circuit oxygen apparatus.

METHOD: We collected 2527 dive reports from 473 closed-circuit oxygen divers, and analyzed the relationships between various symptoms and their dependence on depth and diving time.

RESULTS: No CNS oxygen toxicity-related symptoms were reported at a depth of 2 m seawater (msw), but their proportion increased at depths from 3 to 6 msw. We found that CNS oxygen toxicity-related symptoms appeared in 2.5% of dives conducted at a Po2 of 119 kPa. The main symptoms and signs reported were headache: 4.5%; nausea: 2.6%; hyperventilation: 2.6%; heavy breathing: 2.4%; dizziness: 1.6%; hiccups: 1.5%; bloody sputum: 1.4%; cold shivering: 1.1%; tinnitus: 0.9%; difficulty maintaining a steady depth: 0.9%; disorientation: 0.6%; tiredness: 0.5%; tingling in the limbs: 0.4%; hearing disturbances: 0.4%; a choking sensation: 0.4%; extreme effort: 0.4%; and loss of consciousness: 0.3%.

DISCUSSION: Environmental factors, light vs. dark and temperature, had no effect on symptoms. The number of symptoms increased with diving time. Divers who experienced amnesia, facial twitching, hearing disturbances (p < 0.001), and disorientation (p < 0.014) were prone to suffer loss of consciousness. It was found that some divers are more sensitive to oxygen than others (p < 0.0001).

Related links:
All related articles

Corals at Risk from Atmospheric Acidity

2006-07-05T09:03:00.000-05:00

Growing Acidity of Oceans May Kill Corals
http://snipurl.com/sred

An article by Juliet Eilperin, Washington Post Staff Writer on Wednesday, July 5, 2006 discusses the escalating level of carbon dioxide in the atmosphere which making the world's oceans more acidic, government and independent scientists say.

A coalition of federal and university scientists is to issue a report today describing how carbon dioxide emissions are, in the words of a press release from the National Center for Atmospheric Research and the National Oceanic and Atmospheric Administration, "dramatically altering ocean chemistry and threatening corals and other marine organisms that secrete skeletal structures."

Scientists have conducted a few ocean acidification experiments in recent years. All have shown that adding carbon dioxide to the water slows corals' growth rate and can dissolve pteropods' shells.

Traveling Abroad: Tips for Staying Healthy

2006-07-05T08:51:00.000-05:00

Here is a handout from the American Academy of family Practice that we thought might be helpful.

TRAVEL

Traveling Abroad: Tips for Staying Healthy

Do I need to see my doctor before I travel to other countries?

It is a good idea to have medical and dental check-ups before your trip. You should be aware of any problems and find out about any medicines you should take. Also, remember that your health insurance may not pay for treatment in another country. Find out what your insurance covers before you leave.
See also: DAN

Depending on where you are going, you should see your doctor at least six weeks before you leave. People traveling to certain countries will need to get shots. These shots can take up to six weeks to work.

What shots might I need before I leave?

Tell your doctor where you are going, and ask if you need any shots. The shots you had when you were a child also may need to be updated. Some shots that people get before they travel are:

• Hepatitis A or B

• Influenza ("the flu")

• Japanese encephalitis (say: en-CEF-uh-LI-tis)

• Measles-mumps-rubella (or MMR, for short)

• Meningococcal meningitis (say: muh-NIN-juh-cok-ul men-un-JIE-tis)

• Pneumococcal (say: NEW-mo-cok-ul)

• Polio

• Rabies

• Tetanus and diphtheria (say: TET-nus, dip-THEE-ree-uh)

• Typhoid fever (say: TY-foid)

• Chickenpox

• Yellow fever

What should I take with me?

Carry enough of your regular medicines to last your whole trip, with some extra in case your trip home is delayed. Pack the medicines in the containers they came in, along with extra prescriptions for them. You could also take your prescription for glasses or contact lenses. Ask your doctor if you need a prescription for an antibiotic that you can take if you get traveler's diarrhea. Wear a medical information bracelet if needed.

It can be helpful to take a first-aid kit with you (see the box on the next page).

How can I stay healthy while I am traveling?

Eat carefully if you are going to a country with a high risk of traveler's diarrhea. Steaming hot, well-cooked food is usually safest. Do not eat foods from street vendors, dairy products that are not pasteurized, or raw or undercooked seafood.

Water also can carry germs that cause traveler's diarrhea. Drink water from sealed bottles if possible, and do not use ice. Use bottled water when you brush your teeth. Remember that fruits and vegetables may have been washed in dirty water. Do not eat salads, and peel your fruits.

If you're going to a country with a risk of malaria, your doctor can give you a prescription for medicine that can help you stay well. Remember to start taking your malaria medicine before you leave for your trip, and keep taking it for four weeks after you get home.

Avoid swimming and other water activities in freshwater lakes and streams. This can put you at risk for disease in some areas.
See also: http://www.scuba-doc.com/dvpolwtr.html

Travel First-Aid Kit

A first-aid kit to take with you could contain:

• Your prescription medicines in the containers they came in.

• Antibiotic ointment (one brand: Neosporin), adhesive bandages, and hydrocortisone cream for cuts and scrapes.

• Tools like scissors, tweezers, nail clippers, or a pocket knife. A mirror also may be helpful.

• Medicines for common problems, like diarrhea and upset stomach, coughs and colds, and allergies.

• Pain medicines like aspirin, acetaminophen (one brand: Tylenol), naproxen (one brand: Aleve), ibuprofen (one brand: Motrin) or ketoprofen (one brand: Orudis KT).

• Medicine for motion sickness, such as dimenhydrinate (one brand: Dramamine), and an antinausea drug like promethazine (brand name: Phenergan). Acetazolamide (brand name: Diamox) may help prevent altitude sickness.
See also:http://www.scuba-doc.com/seask.html

See also:
http://www.scuba-doc.com/FAkit.pdf

Remember that mosquitoes can carry disease. If you are going to a country with a high risk of disease carried by mosquitos, take insect repellent. Insect repellents with DEET work the best. Cover your bed with a mosquito net while you sleep.
See also: http://www.scuba-doc.com/insects.htm

Where can I get more information?

Your doctor

Diving Medicine Online
http://www.scuba-doc.com/travel.html

American Society of Tropical Medicine and Hygiene
Web site: http://www.astmh.org

Centers for Disease Control and Prevention
Web site: http://www.cdc.gov/travel

International Society of Travel Medicine
Telephone: 1-770-736-7060
Web site: http://www.istm.org

World Health Organization
Web site: http://www.who.int/ith

Interesting Articles

2006-07-03T16:46:00.000-05:00

Some interesting articles off the beaten path.

Human Diving Response
http://snipurl.com/scz8
The human diving response in a functional and comparative perspective
Erika Schagatay, Associate Professor
Department of Natural and Environmental Sciences
Mid Sweden University, Sweden

Highway Traffic Science
http://snipurl.com/sdg3
For the past six weeks I have been doing a lot of highway travel and have been puzzled at the way traffic flows - freely in some places and suddenly almost to a standstill for no good reason. here is an article that purports to explain this phenomenon.

Scientific American Frontiers - PBS: Super people, Weight of Water
http://snipurl.com/scyx
Dr. Claes Lundgren, Director of the Center for Research in Special Environments at the University of Buffalo Medical School, studies what happens to the human body during flight, space travel and diving. According to Lundgren, the high water pressure divers experience at extreme depths can injure the heart and lungs in a number of ways—some of them lethal.

Occupational Safety and Environmental Health
http://snipurl.com/scys
Articles on the University of Michigan Occupational health and Environmental Health web page. Articles are by Lee Somers, Karl Huggins and Larry "Harris" Taylor and encompass a wide array of subjects that are guaranteed to keep your interest.

July Humor

2006-07-03T13:05:00.000-05:00

Fishing

Two good old boys are sittin' in a bass boat suckin' down beer when all of a sudden James says, "I think I'm going to divorce my wife – she hasn't spoken to me in over 6 months."
Earl sips his beer and calmly says, "You better think it over – women like that are hard to find."

=====================================================================
Bob, a 70-year-old, extremely wealthy widower, shows up at the
Country Club with a breathtakingly beautiful and very sexy 25
year-old blonde who knocks everyone's socks off with her youthful
sex appeal and charm and who hangs over Bob's arm and listens
intently to his every word.
His buddies at the club are all aghast. At the very first chance,
they corner him and ask, "Bob, how'd you get the trophy
girlfriend?"
Bob replies, "Girlfriend? She's my wife!"
They're knocked over, but continue to ask. "So, how'd you
persuade her to marry you?"
"I lied about my age", Bob replies.
"What, did you tell her you were only 50?"
Bob smiles and says, "No, I told her I was 90."
================================================================================

GREAT TRUTHS THAT LITTLE CHILDREN HAVE LEARNED:

1) No matter how hard you try, you can't baptize cats.
2) When your Mom is mad at your Dad, don't let her brush your hair.
3) If your sister hits you, don't hit her back. They always catch the second person.
4) Never ask your 3-year old brother to hold a tomato.
5) You can't trust dogs to watch your food.
6) Don't sneeze when someone is cutting your hair.
7) Never hold a Dust-Buster and a cat at the same time.
8) You can't hide a piece of broccoli in a glass of milk.
9) Don't wear polka-dot underwear under white shorts.
10) The best place to be when you're sad is Grandpa's lap.

GREAT TRUTHS THAT ADULTS HAVE LEARNED:

1) Raising teenagers is like nailing jelly to a tree.
2) Wrinkles don't hurt.
3) Families are like fudge...mostly sweet, with a few nuts.
4) Today's mighty oak is just yesterday's nut that held its ground.
5) Laughing is good exercise. It's like jogging on the inside.
6) Middle age is when you choose your cereal for the fiber, not the toy.

GREAT TRUTHS ABOUT GROWING OLD

1) Growing old is mandatory; growing up is optional.
2) Forget the health food. I need all the preservatives I can get.
3) When you fall down, you wonder what else you can do while you're down there.
4) You're getting old when you get the same sensation from a rocking chair that you once got from a roller coaster.
5) It's frustrating when you know all the answers but nobody bothers to ask you the questions.
6) Time may be a great healer, but it's a lousy beautician.
7) Wisdom comes with age, but sometimes age comes alone.

THE FOUR STAGES OF LIFE:

1) You believe in Santa Claus.
2) You don't believe in Santa Claus.
3) You are Santa Claus.
4) You look like Santa Claus.

SUCCESS:

At age 4 success is . . . not peeing in your pants.
At age 12 success is having friends.
At age 17 success is . . . having a driver license.
At age 35 success is . . . having money.
At age 50 success is . . . having money.
At age 70 success is . . . having a driver license.
At age 75 success is . . . having friends.
At age 80 success is . . . not peeing in your pants.

==================================================================================
Doctor Bill had sex with one of his patients and felt guilty all day long. No matter how much he tried to forget about it, he couldn't.

The guilt and sense of betrayal was overwhelming. But every once in a while he'd hear an internal, reassuring voice that said, "Bill, don't worry about it. You aren't the first doctor to sleep with one of his patients, and you won't be the last. And you're single. Just let it go."

Invariably, another voice would bring him back to reality, whispering, "Bill, you're a veterinarian."

=================================================================================
Two Alabama boys were sitting around talking one afternoon over a cold beer...

After a while the first guy says to the second, "If'n I was to sneak over to your trailer Saturday and make love to your wife while you was off huntin,' and she got pregnant and had a baby, would that make us kin?"

The second guy crooked his head sideways for a minute, scratched his head, and squinted his eyes thinking real hard about the question. Finally, he says, "Well, I don't know about kin, but it sure would make us even."

=================================================================================

Two Chimps and a Blonde
Best 2006 blonde joke so far..........

A blonde lady motorist was about two hours from San Diego when she was flagged down by a man whose truck had broken down. The man walked up to the car and asked, "Are you going to San Diego?" "Sure," answered the blonde, "do you need a lift?" "Not for me. I'll be spending the next three hours fixing my truck. My problem is I've got two chimpanzees in the back which have to be taken to the San Diego Zoo. They're a bit stressed already so I don't want to keep them on the road all day. Could you possibly take them to the zoo for me? I' ll give you $100 for your trouble."

"I'd be happy to," said the blonde. So the two chimpanzees
were ushered into the back seat of the blonde's car and carefully strapped into their seat belts. Off they went.
Fiv
e hours later, the truck driver was driving through the heart of San Diego when suddenly he was horrified!! There was the blonde walking down the street and holding hands with the two chimps, much to the amusement of a big crowd. With a screech of brakes he pulled off the road and ran over to the blonde. What the heck are you doing here?" he demanded, "I gave you $100 to take these chimpanzees to the zoo."

"Yes, I know you did," said the blonde," but we had money left over---so now we're going to Sea World......

====================================================================================

To All Grandparents

At one point during a game, the coach called one of his 9-year-old baseball players aside and asked, "Do you understand what cooperation is? What a team is?"

The little boy nodded in the affirmative.

"Do you understand that what matters is whether we win or lose together as a team?"

The little boy nodded yes.

"So," the coach continued, "I'm sure you know, when an out is called, you shouldn't argue, curse, attack the umpire, or call him a pecker-head. Do you understand all that?"

Again the little boy nodded.

The coach continued, "And when I take you out of the game so another boy gets a chance to play, it's not good sportsmanship to call your coach a dumb a__?"

Again the little boy nodded.

"Good," said
the coach. "Now go over there and explain all that to your grandmother."
==================================================================================
And here is a scuba diving take off on the 'Buffalo Theory' of deep diving as explained by Cliff Clavin, of Cheers.(substituting deep diving for 'beer drinking') One afternoon at Cheers, Cliff Clavin was explaining the Buffalo Theory to his buddy Norm. Here's how it went:

"Well ya see, Norm, it's like this... A herd of buffalo can only move as fast as the slowest buffalo. And when the herd is hunted, it is the slowest and weakest ones at the back that are killed first.

This natural selection is good for the herd as a whole, because the general speed and health of the whole group keeps improving by the regular killing of the weakest members. In much the same way, the human brain can only operate as fast as the slowest brain cells.

Excessive and deep diving, as we know, kills brain cells. But naturally, it attacks the slowest and weakest brain cells first. In this way, regular deep diving eliminates the weaker brain cells, making the brain a faster and more efficient machine.

That's why you always feel smarter after a few dives."

====================================================================================
Never too young!!!

Here's a truly heartwarming story about the bond formed between a little 4 year old girl and some construction workers that makes you believe that we CAN make a difference when we give a child the gift of our time...

A young family moved into a house, next door to a vacant lot. One day a construction crew turned up to start building a house on the empty lot. The young family's 4 year old daughter naturally took an interest in all the activity going on next door and spent much of each day observing the workers.

Eventually the construction crew, all of them gems-in-the-rough, more or less adopted her as a kind of project mascot. They chatted with her, let her sit with them while they had coffee and lunch breaks, and gave her little jobs to do here and there to make her feel important.

At the end of the first week they even presented her with a pay envelope containing a check for a couple of dollars. The little girl took this home to her mother who said all the appropriate words of admiration and suggested that they take the two dollar "pay" she had received to the bank the next day to start a savings account.

When they got to the bank, the teller was equally impressed and asked the little girl how she had come by her very own paycheck at such a young age. The little girl proudly replied, "I worked last week with the crew building the house next door to us."

My goodness gracious," said the teller, "and will you be working on the house again this week, too?"

The little girl replied, "I will if those assholes at Home Depot ever deliver the f---ing sheet rock..."

Kind of brings a tear to the eye.

==================================================================================

Larry "Harris" Taylor's Dive Links

2006-07-03T09:41:00.000-05:00

Divers,

Happy Independence Day!

This month's additions, re-appearances, and bunches of updated/re-directs this month to my list of about 8000 links at

http://www-personal.umich.edu/~lpt/links.htm

( the dive only links section of this list is at: http://www-personal.umich.edu/~lpt/mlinks.htm )

Diving

ScubaLinx: http://www.scubalinx.com/Wet Suits: http://www.wet-suit.org/

100 Foot SCUBA Club: http://www.divegeek.com/
DivingTasmania: http://www.fishndivetas.com/
Midwest Scuba Diving: http://www.midwestscubadiving.com/MSDMagazine.aspx

Chamber-BayArea: http://www.bayareahyperbarics.com/
Quickie Diving Medicine: http://www.utahdiving.com/medicine.htm
Scottish Diving Medicine: http://www.sdm.scot.nhs.uk/
Gas Diving UK: http://www.gasdiving.co.uk/
Seamount Catalog: http://earthref.org/cgi-bin/er.cgi?s=sc-s0-main.cgiSubmarine Volcanoes: http://volcano.und.nodak.edu/vwdocs/Submarine/

BSAC: http://www.bsac.com/
IDD: http://www.iddworld.com/index.php?newlang=english
RSTCEurope: http://www.rstc-eu.org/World Recreational Scuba Training Council: http://www.wrstc.com/main.php

Dive long and prosper,

"Harris"

http://www-personal.umich.edu/~lpt

http://www.mindspring.com/~divegeek

Captain Frank Butler Leaving USSOCOM

2006-07-02T13:25:00.000-05:00

Our consultant in Ophthalmology, Dr. Frank Butler, writes to let us know that he will no longer be at the USSOCOM. Beginning in September 2006, he will be starting a new position with the Navy Medical Lessons Learned Center at the Naval Operational Medicine Institute.

More about Captain Butler here:
http://www.special-operations-technology.com/article.cfm?DocID=743

http://www.scuba-doc.com/medbutler.html

The Sweeter Science Of Free Diving

2006-07-02T12:49:00.000-05:00

DeeperBlue.net has an article about a synposium at the recent UHMS meeting called "The Sweeter Science of Free Diving" by Paul Kotik. Tec Clark, Fort Lauderdale native and longtime pioneer of freediving's renaissance generation, reports from an historic gathering of the tribes at http://snipurl.com/scyj .

The Undersea and Hyperbaric Medical Society (UHMS) and Divers Alert Network (DAN) has co-hosted a symposium (June 20-21) on breath-hold diving in Orlando, Florida, as a pre-course to the UHMS’ Annual Scientific Meeting.

The proceedings of the Breath-Hold Diving Symposium in transcript format will be available in the near future through DAN.

Scott Taylor Is the 2006 DAN/Rolex Diver of the Year

2006-06-29T07:08:00.000-05:00

FOR IMMEDIATE RELEASE

From Divers Alert Network • 28 June 2006

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Scott Taylor, co-owner of A-1 Scuba and Travel Center in Denver, Colo., has been named the 2006 DAN/Rolex Diver of the Year. Dan Orr, DAN president and CEO, presented the award at the DAN Divers Day event held June 17 at Denver’s Downtown Aquarium.

The DAN/Rolex Diver of the Year Award is given each year to a person who has contributed significantly to diving safety or the mission of Divers Alert Network, either regionally or nationally. The award committee is made up of previous award winners, a representative of DAN and one from Rolex USA Inc.

Taylor was recognized for his enthusiasm, support and work for the safety of recreational diving. Inspired by Lloyd Bridges as scuba diving investigator Mike Nelson in the television series “Sea Hunt” and French naval officer, explorer, ecologist, filmmaker and researcher Jacques Cousteau, Taylor became a scuba diver in 1969. Taylor embraced diving, eventually becoming a PADI Course Director, DAN Instructor Trainer and one of the first Instructor Trainers to be certified by the Handicapped Scuba Association (HSA).

In 1991, as a DAN Instructor Trainer, he began teaching the instructors and certified assistants at A-1 Scuba and Travel Center and at many of the PADI and SSI stores in Colorado. He took the program on trips and trained the dive crews on the Turks and Caicos Aggressor, Cayman Aggressor, Peter Hughes’ Wave Dancer, Anthony’s Key Resort and Dive Paradise in Cozumel.

One of the best compliments he ever received came from the owner of Dive Paradise, Renée "Apple" Applegate, who said, “Scott, you’ve cost me a lot of money!” She explained she had just purchased DAN Oxygen Units for all 13 of her boats.

Taylor joined other Colorado dive store owners in forming the Colorado Scuba Retailers Association in the mid-1990s, a group of full retail dive centers offering a variety of dive travel and other services for the diver or snorkeler. The CSRA developed the Colorado Scuba ExtaSea Expo.

In the 1970s, Taylor graduated from the University of Colorado Medical Center with a degree in physical therapy. While working at the spinal cord/head injury center at Craig Hospital in Denver, he began assisting with scuba classes. “It was awesome,” he said. “Suddenly people confined to a wheelchair could be independent for a period of time. I quickly discovered that water is a great equalizer that allows the physically challenged to escape their crutches, wheelchairs and prosthetic devices. I continue teaching the physically challenged to this day.”

Every six weeks, four patients from the hospital visit A-1 Scuba and try scuba. For many, it is their first time out of the hospital since their injury. Taylor also volunteers each summer at the Colorado Easter Seals Camp, introducing children with muscular dystrophy to scuba diving. “It’s a blast for the kids and for me,” Taylor said.

Taylor received a plaque and a personally engraved Rolex Submariner Dive Watch.

By Eileen Sahlin, DAN Chief Development Officer

Hyperbaric/Diving Medical Chamber Treatment Program

2006-06-25T16:06:00.000-05:00

Dick Rutkowski announces a hyperbaric/diving medical chamber treatment program for all medical and chamber operators in November 20-24, 2006. This is to be held in Liberia, Costa Rica and the program will be in Spanish and English thru translation. There will be 40 hours accreted for cme's and ceu's for all medical and chamber operators.

For more information contact Dick Rutkowski
dick@hyperbaricsinterational.com

Hyperbarics International, Inc.
http://hyperbaricsinternational.com

Tropical Fish Collectors Find Life at 200 Feet

2006-06-25T09:49:00.000-05:00

In the Miami Herald for 6/24/2006 there is an article that is interesting from several points of view. In describing another commercial diving modality there is the casual remark that "Before jumping in, they (the divers)took extract of prickly pear cactus pills to ward off decompression sickness."

Extract from the skin of prickly pear fruit, called OFI, had previously been shown to dampen inflammatory response. A study was reported a couple of years ago in the Archives of Internal Medicine (vol 164, p 1334)that showed a remarkable reduction in hangovers after a night of partying.

The morning after the parties, those given OFI were nursing less severe hangovers than those given placebo. In particular, it slashed the risk of a severe hangover by half.

The researchers also measured levels of a protein produced by the liver, called C-reactive protein, which is thought to be involved in the inflammation process.

The higher the levels, the worse the hangover, they found. This is the first study to show this, the team believes. Levels of this protein were also 40 per cent higher in the people who took placebo pills compared with those who took the OFI.

The researchers therefore believe that OFI eases hangovers by soothing the inflammatory response to alcohol.

I had the following information in my Ten Foot Stop Newsletter for June 30, 2004.

"Hangover cure = Heat stress proteins = Decompression injury protection?There is a flutter in the media about a study in the Archives of Medicine on 'Hangover Prevention Formula' [HPF]. It appears that an extract of the fruit of the prickly pear has been shown to decrease the effects of hangovers in a study reported by Jeff Wiese, MD, at Tulane University. HPF contains Tex-OE™, a patented, all-natural extract derived from the fruit of the Prickly Pear Cactus (Opuntia ficus indica), and has it's effect through the elevation of protective heat shock proteins. The reason that this should be interesting to divers is that it was reported to be protective for decompression injury in divers in 1998 at the EUBS meeting.http://www.daneurope.org/eng/hsp.pdf

Diving causes a rise in the level of HSP and early high levels of HSP are induced following pre-dive ingestion of TEX-OE. Reported at the EUBS Meeting by Cali-Corleo, et al in their Collection of Manuscripts; pages 20-33. Similar findings reported by the same group at the BHA Annual meeting, 1998.

It would be interesting to see the results of a good study indicating benefits from taking this substance in divers.

Venous Air Embolism

2006-06-24T09:00:00.000-05:00

Dr. Omar Sanchez sends us this from Argentina:

About Venous Air Embolism...

Available at The New England Journal of Medicine -
Volume 354:e26 June 22, 2006 Number 25

Venous Air Embolism
A. Cuvelier and J.-F. Muir
Extract | FREE Full Text |

From Buenos Aires, Omar Sanchez, Wetdoc.

An 82-year-old man was transferred to our hospital for the treatment of respiratory distress after computed tomography (CT) of the thorax. He had undergone a follow-up evaluation seven years after a lower left lobectomy for bronchial carcinoma. At the end of the examination, when the patient got down from the examining table, he had acute dyspnea, weakness of the arms and legs, and dizziness. He did not lose consciousness. The CT demonstrated a large amount of air in the left subclavian vein (Panel A, arrowheads), the superior vena cava, the right ventricle (Panel B, arrowheads), and the pulmonary-artery trunk (Panel C, arrowheads). The patient was immediately placed in the left lateral and Trendelenburg's position while breathing 100 percent oxygen and was transferred. At admission, the patient's clinical status improved quickly and he recovered without any sequelae.
Ninety milliliters of air had been injected in error instead of contrast solution because the injector had been repositioned but the disposable syringe had not been replaced with a new syringe. This incident emphasizes the need to ensure the safety of injector devices and intravascular catheters to prevent the injection of air.

PADI Chamber Endowment Fund

2006-06-23T11:37:00.000-05:00

For Immediate Release Contact: Theresa Gulledge
PADI Americas
+1 949 858 7234, ext. 2322
theresa.gulledge@padi.com

PADI Chamber Endowment Fund Accepting Grant Requests

More than $30,000US is available to support hyperbaric chambers worldwide.

Rancho Santa Margarita, CA – 23 June 2006 – The PADI Chamber Endowment Fund, which was established in 2004 to benefit recreational dive communities, is currently accepting requests for grants in support of hyperbaric chambers worldwide. This year, more than $30,000US is available to qualified applicants and no reasonable proposal will be overlooked within the funding available and the number of requests received.

The PADI Chamber Endowment Fund provides funding for projects including, but not limited to:
Staff training and certification
General chamber maintenance costs
Equipment costs
New chamber construction

PADI’s Chamber Endowment Fund is supported by a $2 donation from every enrollment in the PADI-endorsed Diver Protection Program - a comprehensive dive accident insurance program administered by Vicencia and Buckley. The Diver Protection Program is available to all divers globally and accepted by all institutions worldwide.

Previous Fund beneficiaries include: the Utila Hyperbaric Chamber & Trauma Center, Utila Honduras; Orkney Hyperbaric Trust, Orkney; Scotland; University of Hawaii at Manoa; Pacific Grove Hyperbaric Chamber Facility; Pacific Grove CA, and the National Hyperbaric Center; Dublin, Ireland. Donations ranged from $1,000 to $2,500 per recipient.

For more information on the PADI Chamber Endowment Fund, for application procedures, or to apply for funding, please email chamberfund@padi.com, or phone 800 729 7234 (US and Canada) ext.2368, or +1 949 858 7234 ext.2368. All applications are due no later than 14 August 2006.

PADI, the Professional Association of Diving Instructors, is the world's largest recreational diving organization, with more than 5300 dive centers and resorts and 130,000 dive professionals worldwide. For 40 years, PADI has set the standard for quality, fun and excellence in diver education. More divers participate in PADI programs than any other; making a PADI certification the most recognized and respected in the world.

Teen Injured After Sucking In Divers Carbon Dioxide

2006-06-18T10:28:00.000-05:00

A TV news report makes it unclear as to the cause of a swimmer's injury in Volusia County Florida. The injured 17 year old is said to have coughed blood upon surfacing and when taken to the hospital - treated in the hyperbaric chamber. A short report and video can be seen at this web site:
http://snipurl.com/rx3c

CO2 poisoning would certainly be a possibility but coughing up blood is not a symptom of CO2 poisoning.

Pockets of air in a cave chamber can accumulate from expired compressed air from scuba divers, among other causes. This air can contain less oxygen and more CO2 than ambient air - and can have insufficient O2 for oxygenation. More likely what happened is that the swimmer gave out of air, found a pocket of air at depth and then surfaced holding his breath, thereby sustaining pulmonary barotrauma with gas embolism. The process occurs in as little as four feet of water and can be deadly.

Addendum: Rik Rosken, one of our long time readers writes to say that the article also got his attention. " I also personally contacted the reporter and this seem to be a case of AGE due lung overpressure due breath-holding after breathing compressed
air at depth from the air pocket."

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See also:
http://www.scuba-doc.com/pulbt.html
http://www.scuba-doc.com/risksPBT.html

Testing Cave Air Quality
http://thelances.org/hr3/badair.html

Technical Director and Nurse Supervisor, The Mayo Clinic Section of Aerospace Medicine in Rochester , Minn

2006-06-17T20:03:00.000-05:00

Technical Director and Nurse Supervisor

The Mayo Clinic Section of Aerospace Medicine in Rochester , Minn. , will open a hyperbaric and altitude medicine program in Fall 2007 to provide hyperbaric oxygen therapy for patients and clinical research. The facility will include hypobaric capability to conduct altitude physiology and applied research for aerospace technology.

We are currently seeking a Technical Director and Nurse Supervisor for this new and exciting initiative.

The chamber will be a multiplace, triple lock 3/6 ATA rectangular system with two treatment compartments each accommodating 12 patients. It is being built by Fink Engineering of Cheltenham, Victoria, Australia. Medical Multiplex, Inc., of Louisville , Ky. , has been enlisted to consult on operational planning and training.

Mayo Clinic, one of Fortune magazine’s “100 Best Companies to Work For,” offers an excellent salary and benefits package. To learn more about Mayo Clinic and Rochester , MN , visit www.mayoclinic.org. For additional information regarding these opportunities, please contact:

Paul L. Claus, M.D., Medical Director

Mayo Clinic Hyperbaric & Altitude Medicine Program

Phone: 507-266-4602

Fax: 507-266-0909

Email: claus@mayo.edu

Dr. Claus will be attending both the Hyperbaric Medicine 2006 Symposium ( March 23-25, 2006 ) in Columbia , South Carolina and the 2006 Annual UHMS Scientific meeting ( June 22-24, 2006 ) in Orlando Florida . Interested individuals attending those meetings may be reached through Medical Multiplex, Inc. representatives at their booth.

Mayo Clinic is an affirmative action and equal opportunity employer.

International Society of Aquatic Medicine is having the 14th Annual Summer Meeting in St Lucia

2006-06-11T09:18:00.000-05:00

Bridget Thomas, RN, Executive Secretary of ISAM informs us that ISAM is having the 14th Annual Summer Meeting in St Lucia. More information can be obtained by clicking here.

Bridget K. Thomas, RN, MSN
International Society of Aquatic Medicine
Executive Secretary
6240 Turtle Hall Dr
Wilmington, NC 28409
Women Divers Hall of Fame Class of 2001
Telephone 910 452 1452
Fax 910 799 5209
ISAM International Society of Aquatic Medicine

Scuba Scouts

2006-06-10T19:11:00.000-05:00

In the St. Petersburg Neighborhood Times there is an excellent article about Scuba Scouts.

"Young salts study a vast blue world

Scuba Scouts, students 11 to 18, immerse themselves in science, rescue and exploration, not just fish gazing.

By JENNIFER DUPONT
Published May 10, 2006"

Performance of Infusion Pumps in Hyperbaric Conditions

2006-06-10T19:07:00.000-05:00

Performance of Infusion Pumps in Hyperbaric Conditions

Abstract [Full Text]

Background: Many hyperbaric facilities use infusion pumps inside the chamber. It is therefore important to ensure that this equipment will perform accurately during hyperbaric conditions. The authors tested the function and accuracy of the Imed 965 and Infutec 520 volumetric infusion pumps, the Easy-pump MZ-257 peristaltic infusion pump, and the Graseby 3100 syringe pump.

Methods: The authors calculated the deviations of infused volumes at low and high rates (12-18 and 60-100 ml/h) on three different hyperbaric protocols (up to 2.5, 2.8, and 6 atmospheres absolute [ATA]), resembling a standard hyperbaric oxygen treatment and US Navy treatment tables used for decompression illness and for arterial gas embolism. Two examples of each pump model were examined in every experiment.

Results: The Easy-pump MZ-257 failed to function completely beyond a chamber pressure of 1.4 ATA, making it unsuitable for use inside the hyperbaric chamber. The Graseby 3100 failed to respond to all keyboard functions at 2.5-2.8 ATA, making it unsuitable for use in most hyperbaric treatments. The Imed 965 performed within an acceptable volume deviation (≤10%) during most hyperbaric conditions. During the compression phase of the profiles used, and for the low infusion rates only, exceptional volume deviations of 20-40% were monitored. The Infutec 520 demonstrated an acceptable deviation (within 10%) throughout all the hyperbaric profiles used, unaffected by changes in ambient pressure or infusion rate.

Conclusions: Commercially available infusion pumps operating during hyperbaric conditions demonstrate substantial variations in performance and accuracy. It is therefore important that the hyperbaric facility staff make a careful examination of such instruments to anticipate possible deviations in the accuracy of the equipment during use.