Ten Foot Stop Newsletter, March 31, 2005
Note from scubadoc
Several recent letters have brought to my attention the possibility that guidelines placing restrictions on diving in certain conditions and with certain drugs might be too stringent and might possibly be either misapplied or archaic. The most recent letter takes us to task for being overly strict in advising a depressed patient on antidepressants not to dive. There is no question that a properly treated depressed patient in remission is no longer a threat to himself or others when diving, and probably should be classified as ‘fit to dive’. Sedative effects seen when first taking the drugs often disappear with use. Many of the myriad of side effects reported by the drug companies are often never seen at all. Whether or not the treating drug is dangerous underwater is usually a matter of conjecture, with little or no basis in fact that depth/pressure will alter or add to the effects of the drug - which may be minimal in the first place.
There is the suggestion that restrictions have been applied based on conclusions drawn from US Navy diving medical officers for military personnel and that a different set of rules should be considered for sport and recreational divers. In addition, many recommendations in various guidelines are based on physician judgement and anecdotal experience and not on good clinical evidence. I personally sat in on several “brain storming” sessions with a group of physician divers that developed contraindications now being used by most diving agencies and insurance companies. Most observations were personal experiences and anecdotal in nature. There is not a large body of evidence in support of many of the ‘absolute’ and ‘relative’ contraindications.
Recent relaxations on restrictions for asthmatics and diabetics diving are good examples of careful re-examination of the pathophysiology of the conditions and then revision of the draconian rules governing the teaching and certification of divers. In DAN’s ‘Report on Decompression Illness, Diving Fatalities and Project Dive Exploration’, 2004 Edition (2002 Data), it is noteworthy that of all the 104 deaths studied there were only two medical conditions incriminated as causal factors that are included in the ‘unfit to dive’ lists. Twenty four of the deaths were thought to be cardiac related and one was specified as being related to panic attack, the rest were due to errors in technique causing air embolism (21), drowning (29), cerebral anoxia (2), unspecified (7) and decompression sickness (1). None of the deaths were specifically attributed to diabetes, epilepsy or asthma. A death due to seizure was related to oxygen toxicity from Nitrox - not epilepsy. From these data it would appear that diving medical physicians should focus on heart disease and conditions that increase the risks for coronary atherosclerosis, such as hypertension, diabetes and obesity. Although medications were listed as having been taken by some of the divers, I found it particularly interesting that none of the fatalities were attributed to drugs as the sole cause of death.
It might be time to go through all of the “relative” and “absolute” contraindications to diving that are publicized (some with little clinical evidence) and re-evaluate the reasoning behind the decision not to allow diving. I realize that there are those who strongly disagree with this position, positing that the unforgiving underwater milieu is not the place to equivocate or be half hearted about setting safety guidelines.
See also a related discussion about depression, antidepressive drugs and diving by DocVikingo, reprinted from DAN’s Alert Diver.
What do you think? Should there be a debate about this at all? Let me hear from you.
scubadoc
_________________________
California Marine Life DVD
Steve and Kristine Barsky have developed another winner! They have published a new DVD on California Marine Life.
California Marine Life Identification is the latest DVD video from Hammerhead Video. If you want to learn how to recognize the creatures you see while you’re diving, this program is the place to start.
If you’ve ever wondered how to tell the difference between a seal and a sea lion, which sharks are the most common in coastal waters, or where to find sand dollars, this program is made for you. It’s ideal for dive classes, marine biology courses, or anyone who has an interest in the fascinating critters and marine plants found off the coast of California. It contains information on the common species you’ll find during most dives, rather than on the exotic creatures few people ever have the chance to encounter. Some of the species featured in the program include nudibranchs, crabs, many different types of fish (from gobies to black sea bass), octopus, lobsters, moray eels, elephant seals, and much more. More than 85 different species of marine plants and animals are shown in their natural habitats.
The entire program runs 45 minutes in length. You can also navigate the DVD scene-by-scene if you want to watch specific segments of the program.
The program was filmed at the Northern Channel Islands, in San Diego, and at San Clemente Island. Truth Aquatics provided vessel support for portions of the footage.
California Marine Life Identification is hosted by Kristine Barsky, a professional marine biologist with more than 30 years of diving experience in California and around the world. Kristine provides common names and comments on the interesting behaviors and characteristics of each species shown.
California Marine Life Identification is offered exclusively on DVD and has a suggested retail price of $17.95. It’s available at most diving retailers throughout Southern California. You can see a free Quicktime preview on Hammerhead Press’ website at www.hammerheadpress.com. For more information, contact Hammerhead Press at 2419 E. Harbor Blvd. #149, Ventura, CA 93001. Tel. (805) 985-4644.
Retailers can order the program through Trident Diving Accessories and Pacific Books.
Ocean Realm going to press!
Richard Stewart writes:
“We are finally at press with Ocean Realm! I would like to offer anyone on your mailing list a free copy of the Premier Edition. Can you send an email out with this offer. All they need to is email us with an address and as soon as it is off the press we will mail them.
mailto:Richard@OceanRealmMedia.com
Feedback from readers always engenders interesting topics and discussions. Let us hear from you!


The following is a brief description of the 2 chambers we have for sale.
Sincerely,
Susan Reimer
905 544-4268
British Made Divex Chamber
13 ft. long 54 ” in diameter, working pressure of 140 psig (9.5 bar) or 314
FSW
8 oxygen, 8 mixed gas and 8 exhaust hookups
Dual Lock
Medical Lock
Two 15 hp Hydrovane Compressors
The following upgrades are underway
Fire suppression is pneumatically controlled so not affected by power outage
Fiber optic lighting and camera ports
Phone and PA system to operator
Additional Penetrators
New View Ports
Overhead continuous ventilation
Price $125,000 cdn or approx. $104,000 us
Canadian Built Chamber (Certified)
18 ft. long 6 ft. in diameter, working pressure of 100 psig (6.8 bar) or 225
FSW
18 oxygen, 18 mixed gas and 18 exhaust hookups
Dual Lock
Medical Lock
Two 20 hp Hydrovane compressors.
Fiber Optic Lighting
Cameras each end of chamber
Phone and PA system to operator
Six 9″View Ports with a thickness of 2 ¾ ” instead of 1 ¾ ”
Fire suppression is pneumatically controlled so not affected by power outage
Overhead continuous ventilation
This chamber has been over designed with expensive high-pressure hardware.
Air storage Tank
Fire Suppression Tank
Price $500,000 cdn or approx. $415,000 us
For more information
Call David Reimer
905 544-4268 (office) or 905 546-7341 (cell)
reimerhbo@on.aibn.com
In the News -
Couple Hopes Treatment Will Bring Daughter out of Coma.
http://www.nbc11.com/health/4296876/detail.html

http://www.medicalnewstoday.com/medicalnews.php?newsid=21477

An evaluation of low molecular weight heparin and hyperbaric oxygen treatment in the prevention of intra-abdominal adhesions and wound healing.
Am J Surg. 2005 Feb;189(2):155-60

Department of Radiation Oncology, Medical University of Graz, Austria.


Please help publicize this study:
Survey of Skin and Scuba Divers in the December 2004 Indonesian Tsunami
http://www.zoomerang.com/survey.zgi?p=WEB2247GPQ5XL9
This is a world-wide Internet survey of skin and scuba divers who were in
or on the water in the Indonesian tsunami on 26 December 2004 . There has
been little or no published information regarding the effects of natural
disasters on divers. Drs. Tom Skalko and Carmen Russoniello of East
Carolina University and I are studying what that experience was like for
divers and how it has affected their lives since then. We need divers who
were in or on the water to help us by completing the survey.
Some of the survey questions may be upsetting, even months after the
tsunami. It will take about 10 - 15 minutes to complete. The survey will
automatically skip past questions that do not apply based upon answers to
earlier questions. Results will be compiled and completed as a group only.
No individual identifying information will be released to anyone. The
risks of participating in this survey are considered minimal.
If you were in or on the water in the tsunami or know of any skin or scuba
divers who were in or on the water in the tsunami, then please ask them to
go directly to the survey URL to complete the survey:
http://www.zoomerang.com/survey.zgi?p=WEB2247GPQ5XL9
David F Colvard, MD
Diplomate of the American Board of Psychiatry & Neurology
ACRP Certified Clinical Research Investigator
Divemaster
3725-228 National Dr
Raleigh, NC 27612 USA
Office 919-781-3141
FAX 919-781-3141
Email: dcolvard@mindspring.com
URL: www.DrColvard.com and www.DivePsych.com
Letter from Michael Strauss, MD
- Strauss, MB. RC Borer, JR. Diving Medicine: Contemporary Topics and their Controversies, American Journal of Emergency Medicine, 19(3): 232-238, 2001.
DAN Hosts Educational Exposition in Cozumel
Join DAN staff and local DAN Instructors and Trainers for a weeklong training and educational extravaganza in Cozumel, Mexico, May 16-20 at the Hotel Casa del Mar.
The DAN event follows Mexico Underwater, the country’s first dive show. Set for May 12-14, Mexico Underwater features a complete seminar of Mexico’s natural underwater environment.
Beginning May 16, from 6-10 p.m. each evening, DAN’s Educational Exposition offers training programs in Oxygen First Aid for Scuba Diving Injuries, Hazardous Marine Life Injuries and On-Site Neurological Assessment of Divers.
Evenings feature seminars on medical and research information from 7-9 p.m. Seminar topics include: How DAN works; DAN injury and fatality data; acute effects of DCI; case histories; updates on fitness to dive issues such as asthma, diabetes, medications; frequently asked questions about ears, skin bends, nitrox and reverse profiles; and updates on kids, aging and women and diving.
To kick off the event on Sunday, May 15, DAN hosts a “meet and greet” event with DAN staff, including DAN’s president, Dr. Michael Curley. Participants who sign up in advance for courses and seminars are automatically entered into a raffle for DAN prizes at the social.
For more information or to sign up, visit DiversAlertNetwork.org or contact DAN at +1-919-684-2948 ext. 555 to sign up in advance. Information is available in Spanish and English.
Press contacts at DAN: Renee Duncan and Dan Leigh: +1-919-684-2948; rduncan@dan.duke.edu and dleigh@dan.duke.edu
New UHMS website committee
“At the UHMS Executive Committee meeting last month, it was determined that a professional website company should be employed to restructure the our website. The UHMS website is our initial interface with the public, including prospective members, and we want it to be as professional and user-friendly as possible.
I have been appointed Chair of the new UHMS website committee, tasked to determine appropriate site content and obtain bids for the work. We will be looking for a commercial company to do the redesign, not a freelancer, because we want them to be in existence when we need help in the future.
I am seeking members for the committee. I am not looking for
individuals to do the redesign work themselves, but rather for those who may have experience dealing with the professional redesign of a
commercial website and especially those who have recommendations for companies.
If you are interested in helping, please email me at neil.hampson@vmmc.org
Neil Hampson, MD
UHMS Immediate Past-President
Greetings!
Issue 35 of The Wet Gazette is being distributed to over 12,000 subscribers. We are working hard to keep our master list accurate but we do ask for your patience if you receive more than one copy. If you receive more than one copy this, please let us know so we can correct the files. It is possible there are still some duplicate listings
Because of the distribution change, it may be that this is your first contact with us. Our Master List was affected by the change and we have discovered some alterations did occur. We are correcting it as we go. If this is the first time you have received notification from us at The Wet Gazette, we do apologize.
The Wet Gazette is a free monthly E-Zine focused on Scuba Diving. It is NOT a discussion group and we do not share or sell our subscribers list. No one has access to our subscriber but us and we only send out the E-Zine. If a special circumstance occurs it is possible we would send a special notice out but we have only done that three times in as many years. You are not required to register, divulge personal information or purchase anything to be a subscriber.
We have no desire to waste your time or ours. If you decided you no longer wish to receive The Wet Gazette, just reply to this email with UNSUBSCRIBE in the subject line.
Our new website is http://www.thewetgazette.com/. You are more than welcome to share this site. The Wet Gazette - like most of our past projects — is free.
Welcome!
Mark Phillips
The Wet Gazette
Editor / Publisher
http://www.thewetgazette.com/
Dear Dr. Campbell,
http://www.authorhouse.com/BookStore/SearchCatalog.aspx
Diver’s Supply Web Site has published a web page on Scuba Diving Safety and Medicine. The page is almost entirely devoted to our web site, reproducing most of our main listings.
http://216.105.56.17/index.asp?PageAction=Custom&ID=11
Diving while taking methotrexate?
My wife has an autoimmune arthropathy (psoriatic) with very little skin signs but with important pain on both hands and one foot. She is taking methotrexate orally once a week (20 mg). and anti-inflammatory drugs seldom.
We wonder if there is any risk diving up to 20 meters.
Answer:
Quiz on Arterial Gas Embolism
Take the Self-grading quiz and see how much you know about Arterial Gas Embolism.
Links on Diving Medicine Online
AGE
Pulmonary Barotrauma


Can Nitrox divers get nitrogen narcosis?
Question:
During a Nitrox certification dive I experienced what I believe to be narcosis. I started feeling very strange and my depth guage indicated 109 feet. I ascended to 90 feet and the disorientation stopped but my heart beat went wild along with this extremely rapid heart rate I had cotton mouth. The other members of our dive team were ready to enter the hull of the ship but I refused to enter until my heart rate slowed down and I felt better. After a few minutes of communicating with my instructor, breathing slowly, rinsing my mouth out, etc. my heart rate slowed down and we continued our dive without entering the hull of the ship. I do not believe that I was afraid to enter the hull but that I knew that had I entered the hull with a physiological reaction (heart rate, etc) I would have been foolish. When we arrived at the boat and stated my narcosis affect everyone denied it saying you can’t get narcosis on nitrox. I disagree because I know what I experienced. Why the rapid heart rate and dry mouth. Was it narcosis? I believe so.
Answer:
Nitrogen narcosis results from the absorption of inert gases under pressure. Theoretically, if breathing a gas mixture containing less inert gas, like nitrox, one should be able to dive deeper without succumbing to narcosis. So there is some validity to the assumption, and many subscribe to the logic. But you should understand that there are no studies that have ever established such a relationship. In addition, the onset of narcosis is a highly variable phenomenon not only among individuals, but in the same person from day to day.
Also, depending on the O2 mixture of Nitrox you were using, it is entirely possible that you might have been experiencing premonitory oxygen toxicity at 109 fsw. Using the conservative diving limit of 1.4 ATM (1.6 ATM military), the maximum operating depth for EAN 32 is 110 feet and 90 feet for EAN 36. Some symptoms of O2 toxicity include:
More about nitrogen narcosis
.

C. L. Huffard, F. Boneka, R. J. Full
Science 307, 1927 (2005)
http://www.sciencemag.org/feature/misc/hp_jumps/octopus/index.html
In the 25 March 2005 issue of Science, Huffard et al. report on their study of two species of octopus, Octopus marginatus and Octopus (Abdopus) aculeatus, that walk along the seafloor using two alternating arms and apparently use the remaining six arms for camouflage. The team analyzed the movements of the invertebrates using underwater video, several clips of which accompany the paper on Science Online.
ISS CREW TO TRY ON NEW SUITS BEFORE SPACE OUTING
Shark Shield™ creates a unique protective electrical field around the user, which is detected through receptors located on the snouts of sharks. The field causes intense discomfort to the shark, resulting in them leaving the area.
http://www.sharkshield.com/
Threads from ’scuba clinic’— Questions and our answers. To discuss any of these, you can go to the ’scuba clinic’ site, register and fire away!
http://scuba-doc.com/scubaclinic/
A “bad” dive - Response by Dr. Ed Kay
http://scuba-doc.com/scubaclinic/viewtopic.php?t=120&highlight=
Links
ENT Problems in Diving
Dr. Ed Kay’s site

http://scuba-doc.com/scubaclinic/viewtopic.php?t=119&highlight=
Links on Diving Medicine Online
Obesity and Diving
GI Problems
Surgical Considerations Related to Diving

http://scuba-doc.com/scubaclinic/viewtopic.php?t=118&highlight=
Links On Diving Medicine Online
Bone and Joint Problems and Diving

http://scuba-doc.com/scubaclinic/viewtopic.php?t=114&highlight=
Links on Diving Medicine Online
DCS
Drugs

Links on Diving Medicine Online
Migraine
Headaches associated with scuba diving
PFO

http://scuba-doc.com/scubaclinic/viewtopic.php?t=109&highlight=
Links
Pulmonary Edema of Diving
Saltwater Aspiration Syndrome

http://scuba-doc.com/scubaclinic/viewtopic.php?t=115&highlight=
Links
Pneumothorax
Pulmonary Barotrauma
Reducing the Risks of Pulmonary Barotrauma

Answer by our Dental consultant, Dr. Larry Stein
http://scuba-doc.com/scubaclinic/viewtopic.php?t=117
Links
Dentistry and Diving
Medline Citations
Pneumomediastinum in student aviators: 10 cases with return to flying duty. This result from pulmonary barotrauma can occur with divers without collapsed lung or gas embolism.



This preliminary study reveals that N-BNP rises with scuba diving. ‘Our findings suggest that diving involves a mechanical strain on the heart with a persistent endocrine myocardial activity post-dive.’

Shark Gallery (Gerber): http://sharkgallery.netfirms.com/
NOAA Ocean Explorer: http://www.oceanexplorer.noaa.gov/
Seamount Catalog: http://www.earthref.org/cgi-bin/er.cgi?s=sc-s0-main.cgi
Volcanoes Of The Deep Sea: http://www.volcanoesofthedeepsea.com/
BSAC Rebreathers: http://www.bsac.org/techserv/rrc/index.html
South African Rebreather Site: http://www.rebreather.za.org/

Links to Meetings, Courses and Conferences
http://scuba-doc.com/meetcrse.html
Here are some organizations linked to the above site that sponsor courses: DAN SPUMS Medical Seminars UHMS Temple Underwater Medicine EUBS ISAM NOAA DCIEM DDRC


Dearest Redneck Son,
I’m writing this slow because I know you can’t read fast. We don’t live where we did when you left home.
Your dad read in the newspaper that most accidents happen within 20 miles of your home, so we moved. I won’t be able to send you the address because the last West Virginia family that lived here took the house numbers when they moved so they wouldn’t have to change their address.
This place is really nice. It even has a washing machine. I’m not sure about it. I put a load of clothes in and pulled the chain. We haven’t seen them since.
The weather isn’t bad here. It only rained twice last week; the first time for three days and the second time for four days.
About that coat you wanted me to send; your Uncle Billy Bob said it would be too heavy to send in the mail with the buttons on, so we cut them off and put them in the pockets.
Bubba locked his keys in the car yesterday. We were really worried because it took him two hours to get me and your father out.
Your sister had a baby this morning, but I haven’t found out what it is yet so I don’t know if you are an aunt or uncle. The baby looks just like your brother.
Uncle Bobby Ray fell into a whiskey vat last week. Some men tried to pull him out but he fought them off and drowned. We had him cremated, he burned for three days.
Three of your friends went off a bridge in a pickup truck. Butch was driving. He rolled down the window and swam to safety. Your other two friends were in the back. They drowned because they couldn’t get the tailgate down.
There isn’t much more news at this time. Nothing much out of the normal has happened.
Your Favorite Aunt,
Mom
Raising Boys
a) For those with no children - this is totally hysterical!
b) For those who already have children past this age, this is hilarious.
c) For those who have children this age, this is not funny.
d) For those who have children nearing this age, this is a warning.
e) For those who have not yet had children, this is birth control.
The following came from an anonymous Mother in Austin, Texas…
Things I’ve learned from my Boys (honest and not kidding):
1.) A king size waterbed holds enough water to fill a 2000 sq. ft. house 4 inches deep.
2.) If you spray hair spray on dust bunnies and run over them with roller blades, they can ignite.
3.) A 3-year old Boy’s voice is louder than 200 adults in a crowded restaurant.
4.) If you hook a dog leash over a ceiling fan, the motor is not strong enough to rotate a 42 pound Boy wearing Batman underwear and a Superman cape. It is strong enough, however, if tied to a paint can, to spread paint on all four walls of a 20×20 ft. room.
5.) You should not throw baseballs up when the ceiling fan is on. When using a ceiling fan as a bat, you have to throw the ball up a few times before you get a hit. A ceiling fan can hit a baseball a long way
6.) The glass in windows (even double-pane) doesn’t stop a baseball hit
by a ceiling fan.
7.) When you hear the toilet flush and the words “uh oh”, it’s already too late.
8.) Brake fluid mixed with Clorox makes smoke, and lots of it.
9.) A six-year old Boy can start a fire with a flint rock even though a 36-year old Man says they can only do it in the movies.
10.) Certain Lego’s will pass through the digestive tract of a 4-year old boy.
11.) Play dough and microwave should not be used in the same sentence.
12.) Super glue is forever.
13.) No matter how much Jell-O you put in a swimming pool you still can’t walk on water.
14.) Pool filters do not like Jell-O.
15.) VCR’s do not eject “PB & J” sandwiches even though TV commercials show they do.
16.) Garbage bags do not make good parachutes.
17.) Marbles in gas tanks make lots of noise when driving.
18.) You probably DO NOT want to know what that odor is.
19.) Always look in the oven before you turn it on; plastic toys do not like ovens.
20.) The fire department in Austin, TX has a 5-minute response time.
21.) The spin cycle on the washing machine does not make earthworms dizzy.
22.) It will, however, make cats dizzy.
23.) Cats throw up twice their body weight when dizzy.
24.) 80% of Men who read this will try mixing the Clorox and brake fluid.
25.) Women will pass this on to almost all of their friends, with or without kids.
20 Thoughts …….. Worth Reading
- Regular naps prevent old age… especially if you take them while driving.
- Having one child makes you a parent; having two you are a referee.
- Marriage is a relationship in which one person is always right and the other is husband !
- I believe we should all pay our tax with a smile. I tried but they wanted cash
- A child’s greatest period of growth is the month after you’ve purchased new school uniforms.
- Don’t feel bad.. A lot of people have no talent.
- Don’t marry the person you want to live with, marry the one you cannot live without… but whatever you do, you’ll regret it later.
- You can’t buy love . . .. but you pay heavily for it
- True friends stab you in the front
- Forgiveness is giving up my right to hate you for hurting me.
- Bad officials are elected by good citizens who do not vote.
- Laziness is nothing more than the habit of resting before you get tired
- My wife and I always compromise. I admit I’m wrong and she agrees with me.
- Those who can’t laugh at themselves leave the job to others.
- Ladies first. Pretty ladies sooner.
- It doesn’t matter how often a married man changes his job, he still ends up with the same boss.
- Real friends are the ones who survive transitions between address books.
- Saving is the best thing. Especially when your parents have done it for you.
- Wise men talk because they have something to say; fools talk because they have to say something
- They call our language the mother tongue because the father seldom gets to speak