scubadoc Ten Foot Stop

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
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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.

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

Hyperbaric Oxygenation

Chambers for Sale
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

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In the News -

Couple Hopes Treatment Will Bring Daughter out of Coma.
http://www.nbc11.com/health/4296876/detail.html

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Breast cancer patients benefit from decompression chambers used for divers
http://www.medicalnewstoday.com/medicalnews.php?newsid=21477

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Study fails to show benefit of HBO in prevention of intra-abdominal adhesions

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

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Hyperbaric Oxygen and Radiotherapy.
Department of Radiation Oncology, Medical University of Graz, Austria.

Strahlenther Onkol. 2005 Feb;181(2):113-123.

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“Diabetics are losing legs unnecessarily: conspiracy of silence about HBOT”

Mailbox Potpourri

Letter from Dr. David Colvard:
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

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Letter from Michael Strauss, MD

I am amazed at the amount of information you compile in your e-mail newsletters and the variety of information you cover. What’s your secret? Where do you find the time to collect, review and comment on it.

Are you aware of Dr. Aksenov’s and my new Diving Science text. Attached is information about its features. Perhaps you might “see fit” to discuss it in one of your newsletters. If you have not seen the book and need a copy, let me know.

The following are five diving articles I authored that were recently published in the “non-diving” literature. If you need copies, let me know.

1. Strauss, MB. RC Borer, JR. Diving Medicine: Contemporary Topics and their Controversies, American Journal of Emergency Medicine, 19(3): 232-238, 2001.

2. Strauss, MB. IV Aksenov: Medical Problems of Diving and the Primary Care Physician, Primary Care Reports.

a. Part I: 8(19): 164-171, 2002

b. Part II: 8(20): 172-188, 2002

c. Part III: 8(21): 185-191, 2002

3. Strauss, MB. Disordered Decompression as a Cause of Undeserved Decompression Sickness, Proceedings of the Fourteenth International Congress on Hyperbaric Medicine, Best Publishing Company, Flagstaff, AZ, 2003, PP: 103-106.

4. Strauss, MB. Inert Gas Dynamics and Outcomes of Decompression, Proceedings of the Fourteenth International Congress on Hyperbaric Medicine ( Ed, D. Bakker & F Cramer), Best Publishing Company, Flagstaff, AZ, Pp: 288-291.

5. Strauss, MB. IV Aksenov. Diving Medicine: Questions Physicians Often Ask [Part-1], Consultant.

a. Part I: 44(7): 961-963, 2004.

b. Part II: 44(8): 1167-1171, 2004.

Although our hyperbaric medicine program at Long Beach Memorial Medical Center, Long Beach, CA is most occupied with treating non-diving related problems, we maintain active in diving medicine, treating two to three divers a month. For Dr. Hart and myself this adds up to managing over 600 divers diving the 30 year history of our unit. This must be somewhat of a record in as much as I doubt that any other physicians in the world have had this much accumulated experiences treating the diving population.

Recently we added Dr. Enoch Huang to our staff. He is board certified in both Emergency medicine and undersea and hyperbaric medicine. Dr. Huang has added a new dimension to our program by conducting a weekly diving clinic and directing our fellowship program in hyperbaric medicine.

Sincerely,

Michael B. Strauss

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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

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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

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The Wet Gazette

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/

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Underwater Forensics Research

Dear Dr. Campbell,

First of all, I would like to thank you for your continued support and information source for divers. I have been an avid subscriber to your news letter for many years and always find them to be very informative.

I recently authored a book on Underwater Forensics Research which Federal OSHA classifies as Commercial Scientific Diving. I am hoping that the book will be in publication by the end of this month.

I have enclosed a copy of the current Internet page for your information.
http://www.authorhouse.com/BookStore/SearchCatalog.aspx

I hope that this text will facilitate a better understanding of victim recovery and safe diving practices procedures and protocols.

Thank you for your interest in the diving community and your continued source of pro active diver safety.

Regards,

Mack House

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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

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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:

Among it’s many other actions, methotrexate has the ability to suppress the immune response - thus causing an increased risk of overwhelming infection from organisms that are not usually pathogens (germs that can cause disease). This means that marine organisms that we ordinarily should not fear, such as vibrio, fungal forms and certain viruses - can and do cause severe life threatening infections. Vibrio vulnificus is a prime example of this.

This having been said, I have never had a diver write me about having an infection while taking methotrexate - although I have personally taken care of many non-diving individuals with overwhelming sepsis while immunologically suppressed with drugs.

There are many other side effects and caveats to taking the medicine - which can be studied at this web site http://www.rxlist.com/cgi/generic/mtx_wcp.htm .

The only other risk factor that I can think of would be anemia from bone marrow suppression and the risk of weakness from the medication. If she is not anemic, has no fatigue or weakness and you are willing to risk the possibility of infection - then you might allow diving. There is nothing to indicate that depth/pressure would have any adverse effect on a person taking this drug nor would there be any increase in the risk of decompression illness or oxygen toxicity.

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

Question of the Week

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:

Hello New Nitrox diver:

The answer is “yes” you can get narked using Nitrox. Because nitrogen narcosis is a direct result of the increased partial pressure of that gas, diving on NITROX (reduced amount of nitrogen) reduces the effects when compared to diving on air at the same depth. You are less “narked” on NITROX. Although Enriched Air reduces the amount of nitrogen you breathe underwater, many diving physiologists don’t believe that Enriched Air significantly reduces narcosis.

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:

Muscle twitching and spasm

nausea and vomiting

dizziness

vision (tunnel vision) and hearing difficulties (tinnitus)

twitching of facial muscles

irritability, confusion and a sense of impending doom

trouble breathing, anxiety

unusual fatigue

incoordination

Because of the rapid heart rate that you describe, there is a suspicion that you might have had CO2 retention - either from a faulty regulator or from skip breathing. Regulators will sometimes function well until a certain depth is attained and then cause difficulty breathing and a rise in ppCO2. In addition, this can enhance ppN2 and cause narcosis at a shallower depth.

Panic is the other big cause of rapid heart rate. You will need to carefully examine your emotions and feelings at the time of your onset of tachycardia and see if you can relate them to the dive.

Hope this is helpful!

More about nitrogen narcosis .

Interesting Links

About Walking Octopuses:

From Omar Sanchez, MD, (Wetdoc), Buenos Aires

Underwater Bipedal Locomotion by Octopuses in Disguise
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.

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From the Russian Information Agency, Novosti
ISS CREW TO TRY ON NEW SUITS BEFORE SPACE OUTING

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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/

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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

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Stomach surgery for obesity
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

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Diving After a finger dislocation
http://scuba-doc.com/scubaclinic/viewtopic.php?t=118&highlight=

Links On Diving Medicine Online
Bone and Joint Problems and Diving

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DCS over time and prescription drugs
http://scuba-doc.com/scubaclinic/viewtopic.php?t=114&highlight=

Links on Diving Medicine Online
DCS
Drugs

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Nausea, vomiting and migraine immediately post dive

http://scuba-doc.com/scubaclinic/viewtopic.php?t=110&highlight=

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

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Bad tank air?
http://scuba-doc.com/scubaclinic/viewtopic.php?t=109&highlight=

Links
Pulmonary Edema of Diving
Saltwater Aspiration Syndrome

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Bullet through the lung, safe to dive?
http://scuba-doc.com/scubaclinic/viewtopic.php?t=115&highlight=

Links
Pneumothorax
Pulmonary Barotrauma
Reducing the Risks of Pulmonary Barotrauma

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Diving during and after root canal dental work
Answer by our Dental consultant, Dr. Larry Stein
http://scuba-doc.com/scubaclinic/viewtopic.php?t=117

Links
Dentistry and Diving

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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.

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Perilymphatic fistula in cabin attendants: an incapacitating consequence of flying with common cold. A similar situation occurs with scuba divers.

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Life raft entry from water: effect of strength, tallness, and weight burden in men and women. I thought that I was the only person who had trouble getting back into inflatables.

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Diving involves a mechanical strain on the heart. The plot gets thicker!
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.’

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Diving Links from Larry “Harris” Taylor

Diving:

Sawfish: http://www.hometown.aol.com/nokogiri/index.html
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/

OceanDive.: http://www.oceandive.com/

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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

Humor
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

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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.

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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

TEN FOOT STOP NEWSLETTER

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

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CONTENTS-WHAT’S IN YOUR NEWSLETTER THIS WEEK:

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

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

==> COOL SITE FROM scubadoc
Dental Implants article

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

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

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

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

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

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

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

Recent Questions

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

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

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

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

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

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

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

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

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-> NOTE FROM scubadoc

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

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

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SAR Diving

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

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

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

For more information about SAR diving,

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

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

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

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From Lisa Wasdin at UHMS:

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

http://www.uhms.org/

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DAN Announces First Recipient of AED Matching Grant

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

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

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

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

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

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

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

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

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==> QUESTION OF THE WEEK!

Immersion diuresis

Some questions about the ‘pee factor’ in diving:

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

Answer:

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

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

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

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

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

Cardiac output and stroke volume increase about 30%.

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

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

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

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

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

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

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

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==> COOL SITE FROM scubadoc

Dental Implants article from Alert Diver added to web site

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

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

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

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-> MAILBOX POTPOURRI

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

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

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

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

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

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

Answer:

Hello Dr.:

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

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

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

Links:

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

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

UKSDMC http://snipurl.com/d665

DAN http://snipurl.com/d667

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

Let us know if you have thoughts otherwise.

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-> INTERESTING LINKS

Links from Larry “Harris” Taylor,

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

Other Links that we have found.

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

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

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

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

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

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

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

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-> MEETINGS, COURSES, CONFERENCES

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

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

Thanks

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

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From Dr. Jordi Desola

INTERNATIONAL CONFERENCE ON DIVING AND HYPERBARIC MEDICINE

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

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From Wesley Hyatt at DAN:

See DAN Representatives at Upcoming Dive Shows

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

Among the upcoming shows DAN will attend include:

• Ohio ScubaFest, Columbus, March 11-13;

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

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

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

• Seaspace, Houston, Texas, June 3-5.

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

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

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

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

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

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

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

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

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

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

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

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

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==>HUMOR

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

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

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

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

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

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

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

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

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

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

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

The moral of the story:

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

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

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

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

Below is that short story:

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

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Some Cowboy Logic

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

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

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

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

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

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

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

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

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

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

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

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

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

http://scubadoc.blogspot.com/

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

Unsubscribe at the same site.

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Have a good week!

Ern Campbell, MD

scubadoc

==> A LITTLE ABOUT ME, scubadoc:

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

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

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

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

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

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