scubadoc Ten Foot Stop

October 29, 2005

Diversified Therapy Signs Contracts for 17 New Wound Care Centers Nationwide

Filed under: Uncategorizedscubadoc @ 9:17 am

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

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

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

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

October 26, 2005


Filed under: Uncategorizedscubadoc @ 10:06 am


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Ten New Excellent Drugs for Women!

Take 2 and the rest of the world can go to hell for up to 8 full hours.

Plant extract that treats mom’s depression by rendering preschoolers
unconscious for up to two days.

Suppository that eliminates melancholy and loneliness by reminding you of how awful they were as teenagers and how you couldn’t wait till they moved out.

Liquid silicone drink for single women. Two full cups swallowed before an evening out increases breast size, decreases intelligence, and prevents conception.

When taken with Peptobimbo can cause dangerously low IQ, resulting in enjoyment of country music and pickup trucks.

Increases life expectancy of commuters by controlling road rage and the urge to flip off other drivers.

Injectable stimulant taken prior to shopping Increases potency, duration,
and credit limit of spending spree.

Relieves headache caused by a man who can’t remember your birthday, anniversary, phone number, or to lift the toilet seat.

A spray carried in a purse or wallet to be used on anyone too eager to share their life stories with total strangers in elevators.

When administered to a boyfriend or husband, provides the same irritation level as nagging him.


Deep Thoughts For Those Who Take Life Too Seriously

It’s good to review these occasionally…

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

2. He who laughs last thinks slowest.

3. OK, so what’s the speed of dark?

4. A day without sunshine is like…night.

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

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

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

8. Depression is merely anger without enthusiasm.

9. Save the whales. Collect the whole set.

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

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

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

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

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

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

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

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

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

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

20. Change is inevitable, except from vending machines.

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

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

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

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

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

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


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

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

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

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

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

A husband read an article to his wife about how many words women use a
30,000 to a man’s 15,000.
The wife replied, “The reason has to be because we have to repeat
everything to men…
The husband then turned to his wife and asked, “What?”

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

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

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


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

1. Don’t change horses……………………. until they stop running.

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

3. It’s always darkest before ……………. Daylight Saving Time.

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

5. You can lead a horse to water but……………………

6. Don’t bite the hand that ……………………..looks dirty.

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

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

9. You can’t teach an old dog new ………………… math.

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

11. Love all. Trust…………………………….. me.

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

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

14. Where there’s smoke there’s………………….. pollution.

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

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

17. Two’s company, three’s ………………….. the Musketeers.

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

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

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

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

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

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

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

The WINNER and last one!

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


Circle Flies

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

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

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

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

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

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

Then after a minute, he stops and says, “Are you trying to call me a horse’s ass?”

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

The trooper says, “Well that’s a good thing,” and goes back to writing the ticket.

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


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

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

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

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

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

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

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

The men clapped.


Duck Blind


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

ing to end up like this?


Deep Relief




Lost Dog

Japanese Hyperbaric Medical Society News

Filed under: Uncategorizedscubadoc @ 9:12 am

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


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

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

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

October 25, 2005


Filed under: Uncategorizedscubadoc @ 11:25 am

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

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

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

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

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

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

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

Thanks in advance!

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

October 24, 2005

Surgical Considerations Related to Diving

Filed under: Uncategorizedscubadoc @ 4:09 pm

General Guidelines

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

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

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

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

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

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

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

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

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

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

Diving after Urinary Tract Surgery

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

General Advice About Diving

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

DAN Diving and Hyperbaric Medicine Course

Filed under: Uncategorizedscubadoc @ 3:31 pm

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

For complete information go to

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

Divers needed for research survey

Filed under: Uncategorizedscubadoc @ 2:49 pm

Dear Scuba Diver:

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

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

Thanks and safe diving

Adam Beckett, DO

Link to the survey:

Dry Diving

Filed under: Uncategorizedscubadoc @ 2:07 pm

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

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

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

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

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

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

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

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

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

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

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

Ern Campbell, MD
scubadoc Diving Medicine

Diving Headaches

Filed under: Uncategorizedscubadoc @ 9:36 am

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

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

Carbon Dioxide Headaches

Symptoms: Post-dive localized throbbing pain

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

Tension Headaches

Symptoms: Post-dive neck and head pain

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

Migraine Headaches

Symptoms: Severe headaches with nausea

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

DCS Headaches

Symptoms: Post-dive headache with neurological deficit

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

Sinus Headaches

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

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

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

October 19, 2005

Online Eric Douglas Diving Short Story Available Now

Filed under: Uncategorizedscubadoc @ 3:36 pm

Complete short story now online

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

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

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

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

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