scubadoc Ten Foot Stop

January 30, 2006

Inhaled Insulin Approved by FDA (from Medscape)

Filed under: Uncategorizedscubadoc @ 9:56 am

Inhaled Insulin Approved by FDA

Daniel J. DeNoon

Jan. 27, 2006 — The first inhaled insulin (Exubera) was approved today by the US Food and Drug Administration (FDA) for the treatment of adult patients with type 1 and type 2 diabetes. An inhaled powder form of recombinant human insulin (rDNA), the drug and delivery system is the first new insulin formulation introduced since the discovery of insulin in the 1920s, according to the FDA.

The FDA approval requires the manufacturer to distribute medication guides along with Exubera. The guide contains FDA-approved information written especially for patients.

Exubera is not to be used by smokers or people who have quit smoking within the previous 6 months, according to the FDA. It is also not recommended for people with asthma, bronchitis, or emphysema. However, people with colds or or other upper respiratory infection should still be able to take the drug, although it may cause coughing.

The FDA recommends pulmonary function testing prior to starting inhaled insulin and then every 6 to 12 months thereafter.

The treatment has been in development for 10 years in a joint effort by Pfizer, Sanofi-Aventis, and Nektar Therapeutics. Earlier this month Pfizer bought Sanofi-Aventis’ rights to Exubera.

“Until today, patients with diabetes who need insulin to manage their disease had only one way to treat their condition,” Steven Galson, MD, director of the FDA’s Center for Drug Evaluation and Research, says in a news release. “It is our hope that the availability of inhaled insulin will offer patients more options to better control their blood sugars.”

The device that administers the insulin is not as small as an asthma inhaler. Folded up, it is the size of a standard flashlight. A retractable inhaler tube comes out from the body of the device; when extended it reaches from the chest to the mouth. A blister pack of insulin then must be inserted before the device is triggered. Patients and doctors will get extensive training on how to use Exubera.

Inhaled insulin is not the only alternative form in development. Others include insulin mouth sprays, insulin patches, and even oral forms of insulin. And other companies — notably a collaboration between Eli Lilly & Co. and Alkermes Inc. — are racing to develop their own versions of insulin inhalers.

Concern Over Lung Safety

The FDA approval of Exubera follows a 7-2 vote recommending approval by a panel of expert advisors. The advisory panel — in a 5-4 vote — also called for new studies of Exubera’s long-term safety in people with underlying lung disease.

The FDA’s approval requires the manufacturer to perform long-term studies to confirm Exubera’s safety.

The drug is approved for treatment of both type 1 and type 2 diabetes. However, clinical trials found that fewer than 30% of people with type 1 diabetes were able to reduce their blood sugar to recommended levels after 6 months of treatment with the inhaled insulin.

Pfizer and Sanofi-Aventis did not seek FDA approval for Exubera in children and teenagers. Early trials in children were stopped due to concerns about Exubera’s effects on children’s breathing. The companies plan to restart pediatric studies after consultation with the FDA.

The European Union yesterday approved Exubera for treatment of type 1 and type 2 diabetes in adults.

More about diabetes and diving on our web site at

The 4th Karolinska Post Graduate Course in Clinical Hyperbaric Oxygen Therapy will be April 26-28, 2006.

Filed under: Uncategorizedscubadoc @ 9:03 am

The 4th Karolinska Post Graduate Course in Clinical Hyperbaric Oxygen Therapy will be April 26-28, 2006.

We will have the opening of our great new rectangular ICU chamber and we will have an educational and important academic meeting where it is possible to meet the faculty and get involved in future clinical multicenter trials, etc..

For more information on this course, please visit our website:

January 29, 2006

More Free Full Text Articles about decompression

Filed under: Uncategorizedscubadoc @ 4:07 pm

Using animal data to improve prediction of human decompression risk following air-saturation dives.


Arterial gas embolism and decompression sickness.

More about AGE and DCS at these sites:


Hyperbaric oxygen may reduce gas bubbles in decompressed prawns by eliminating gas nuclei.


Ascent rate, age, maximal oxygen uptake, adiposity, and circulating venous bubbles after diving.

More about obesity at this site:


Modulation of decompression sickness risk in pigs with caffeine during H(2) biochemical decompression.


Heat stress attenuates air bubble-induced acute lung injury: a novel mechanism of diving acclimatization.


British Thoracic Society guidelines on respiratory aspects of fitness for diving.

More about pulmonary problems at


Contemporary management of patent foramen ovale.

More about PFO at


NOS inhibition increases bubble formation and reduces survival in sedentary but not exercised rats.


Biophysical basis for inner ear decompression sickness.

More about this at


Evaluation of decompression safety in an occupational diving group using self reported diving exposure and health status.


[Acute myelopathy in a diver caused by decompression sickness. A case description and a survey of the literature]


Decompression sickness and recreational scuba divers.


Should computed chest tomography be recommended in the medical certification of professional divers? A report of three cases with pulmonary air cysts.

More about this at


Simulated high altitude diving experiment for the underwater construction operation.


[Somatosensory evoked potentials in decompression sickness]


High-altitude decompression illness: case report and discussion.


Exercise and nitric oxide prevent bubble formation: a novel approach to the prevention of decompression sickness?


Indications for the closure of patent foramen ovale.


Aerobic exercise before diving reduces venous gas bubble formation in humans.


A 32-year-old man with acute bilateral leg weakness following recreational diving.


Exercise and decompression sickness: a matter of intensity and timing.


Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale.


Aseptic bone necrosis in an amateur scuba diver.

More about this at


Cardiac decompression sickness.


Cardiac decompression sickness after hypobaric chamber training: case report of a coronary gas embolism.


The powerful microbubble: from bench to bedside, from intravascular indicator to therapeutic delivery system, and beyond.


January 27, 2006

Some Links of Interest

Filed under: Uncategorizedscubadoc @ 4:38 pm

Conservation International Frontlines: Ravaging the Reefs

Divers? Lifesaver Closed

NASA Space Station On-Orbit Status 25 January 2006

Peninsula Wound Center Adds Largest Hyperbaric Oxygen Chamber on Delmarva

Bahamas Recompression Chamber Announcement by Paul Kotik on

January 25, 2006


Filed under: Uncategorizedscubadoc @ 2:38 pm

Here is a note from Lisa Wasdin, UHMS


2006 CALL FOR ABSTRACTS: Deadline for Submission: FEBRUARY 28, 2006

EXTENSION: If you need to request a submittal extension, a fee of $75.00 will apply. Extension deadline is March 31, 2006.




January 24, 2006

New Book, Dangerous Marine Animals, Recognition, first aid and prevention

Filed under: Uncategorizedscubadoc @ 10:03 am

We have received a note form one of our long-standing newsletter subscribers, John Serton, who has written a book about dangerous marine animals - titled “Gevaarlijke Zeedieren. Herkenning, eerste hulp en preventie”. [Dangerous Marine Animals, Recognition, first aid and prevention]

Here is his note and a pdf flyer concerning his new book written in conjunction with a biologist. The book is in Dutch.


Hello Ernest,

Together with a biologist I have written a new Dutch language book on dangerous marine animals called “Gevaarlijke Zeedieren. Herkenning, eerste hulp en preventie”.

It is a prizewinning (Scienceprize of the Dutch National Dive league NOB/CMAS) book with a medical-biological aproach on the subject. With how to recognize the animal, first aid and prevention. It has over 200 references of scientific articles and books of experts like Fenner, Burnett, Williamson etc.

We write about sponges, jellyfish, sea-urchins, stingrays, sharks, stonefish and several other fishspecies to seasnakes, seacrocodile and mammals.
It has become the standardwork for the Dutch Navy.

It has over 300 great and interesting pictures of seacreatures and wounds inflicted by them. 200 full color pages and a luxury hard-cover. See flyer at

To order:
- +31-(0)40-2116363

We also do lectures on this topic.


John Serton
Author Gevaarlijke Zeedieren


For more information about this subject, go to our web pages at

January 22, 2006

Free Full Text Articles in the Diving Medical Literature

Filed under: Uncategorizedscubadoc @ 11:32 am

Have you ever been interested in a subject, really needing more information and finding that all you can get is an abstract. Sure, the full article might be available through a library for significant money or through the Journal if you are a subscriber. Who, for goodness sake, has the need to subscribe to numerous journals or the cash to pay for articles in order to research a subject.

Well, here is my contribution to the problem that many of us face when trying to keep up with medicine. Listed below, in no particular order, are some free full text articles that you might find interesting and might just want to bookmark.

Free Full Text Article
Aerobic exercise before diving reduces venous gas bubble formation in
humans — Dujic et al. 555 (3): 637 — The Journal of Physiology Online

Free Full Text Article
J Appl Physiol 93: 1349-1356, 2002.
Ascent rate, age, maximal oxygen uptake, adiposity, and circulating venous bubbles after diving

See also on our web site:
Exercise and DCS

Full text article
British Thoracic Society guidelines on respiratory aspects of fitness
for diving — 58 (1): 3 — Thorax

See also on our web site:
Pulmonary Problems Associated with Diving

Free Full text
Cardiovascular problems in divers — WILMSHURST 80 (6): 537 — Heart

See also on our web site:
Heart Problems and Diving

Free full text article
Exercise-induced intrapulmonary arteriovenous shunting in healthy humans
- Eldridge et al. 97 (3): 797 — Journal of Applied Physiology

See also article in NEJM about shunting.

Free Full text article
Bleomycin and scuba diving

See more about bleomycin and diving on our website.

Free Full text article
Hemoptysis Provoked by Voluntary Diaphragmatic Contractions in
Breath-Hold Divers — Kiyan et al. 120 (6): 2098 — Chest

More about this on our web site here.

Free Full text article
Neurologic Complications of Scuba Diving - June 1, 2001 - American
Family Physician

See more on our web site here.

Free full text article
Recreational scuba diving, patent foramen ovale and their associated risks

More about PFO on our web site.

Free Full text Article
Should computed chest tomography be recommended in the medical
certification of professional divers? A report of three cases with
pulmonary air cysts — Toklu et al. 60 (8): 606 — Occupational and
Environmental Medicine

More about Chest CT scans and pulmonary barotrauma on our web site.

Free Full text article
Computed tomography of the chest in diving-related pulmonary barotrauma
- Reuter et al. 70 (833): 440 — The British Journal of Radiology

More here.

Free Full text article
Diving and the risk of barotrauma — Russi 53 (Supplement 2): 20 — Thorax

More about the risk of barotrauma on our web site.

Free Full text article
Pulmonary barotrauma and related events in divers — Raymond 107 (6):
1648 — Chest

More about pulmonary barotrauma on our web site.

Free Full text article
Pulmonary barotrauma in divers: can prospective pulmonary function
testing identify those at risk? — Bove 112 (3): 576 — Chest

More about pulmonary function testing and pulmonary barotrauma.

Free Full text article
Risk Factors for Pulmonary Barotrauma in Divers

More about the risk of barotrauma on our web site.

January 20, 2006

The Medical Examination and Assessment of Divers (MA1)

Filed under: Uncategorizedscubadoc @ 11:01 am

Here is the HSE guideline for medical examination and evaluation of divers in the UK.
This is in pdf format and can be seen in it’s entirety at

It is interesting to note that disabled divers are not to be refused diving privileges without due consideration and examination (p. 7)

The Medical Examination and Assessment of Divers (MA1)

The Medical Examination and Assessment of Divers (MA1)

The role of the medical examiner
The Diving at Work Regulations 1997
Initial medical examination
Annual medical examination
Recommended times away from diving
Certificate of medical fitness to dive
Certification of fitness with restrictions
Second opinions and additional advice
Medical Records
HIV Infection and impaired immunity
Communicable diseases
The Disabled Diver
Alcohol, drug or substance misuse
Ischaemic Heart disease
Patent foramen ovale
Valvular Heart Disease
Blood pressure
Peripheral Cir
Thyroid disease.
1. Pre-employment matters
2. Existing diver health issues
3. Certificate of Medical Fitness to Dive (MA2)
4. Appeals

January 19, 2006

Hyperbaric Study of Brain Injury, LDS Hospital

Filed under: Uncategorizedscubadoc @ 1:03 pm

There is an article in the Salt Lake Tribune about a study at the LDS Hospital to determine whether hyperbaric oxygen therapy is effective in treating a range of brain injuries including those from stroke, hypoxia resulting from carbon monoxide poisoning, cardiac arrest and trauma. They request patients suffering from “brain injury’ contact them.

LDS Hospital researchers are exploring whether a treatment used for wounds and carbon monoxide poisoning has any clinical value for those suffering traumatic brain injuries.

Patients who undergo the therapy are administered 100 percent oxygen in an enclosed chamber at pressure two to three times greater than normal sea level pressure. (Hyperbaric oxygen)

LDS Hospital is offering hyperbaric oxygen to people with brain injury who meet other qualifications. For instance, patients must be an adult and the injury at least one year old. Currently, there are about 10 people at various stages of the study, but the researchers want to enroll at least 30 more.

Anyone interested in this study can call the LDS Hospital Hyperbaric Medicine Center for more information at 801-408- 3623 .

Things Your Instructor Didn’t Tell You! (Scuba diving Humor)

Filed under: Uncategorizedscubadoc @ 9:19 am

From time to time we get humor that is particularly good or apropos to scuba diving. Here is a set of ‘funnies’ or truisms sent me by Bill Henss.

Things Your Instructor Didn’t Tell You!


* Don’t take up diving to get a suntan.
* People who look good with a mask on are usually ugly without one.
* Inverse Law of Patches: A diver’s ability is inversely proportional to
the number of patches they wear
* Diving unprotected with a stranger is like having unprotected sex with
a stranger.
* Never clear a snorkel on a Mexican Federale’
* Anyone who says they have never been afraid while diving hasn’t been
diving or is a bad liar.
* Never use a sun intensifier lotion within 30 miles of the Equator.
* People say the funniest things when you shut their air off.
* Never have sex underwater above a coral reef.
* Dry Suits and Beers do not mix
* How to avoid shark attacks:
1. Never Leave Kansas
2. Roll in manure before diving. Sharks hate anything breaded
3. Always dive with a buddy. On sharks approach, point to buddy
4. Dive with a briefcase. Shark may mistake you for an attorney and
leave you alone out of professional courtesy
* Buddies are never where you need them to be.
* You WILL run out of film before the Whale Shark Swims By
* 60 minute camcorder batteries aren’t
* One should never make a night dive on a coral reef after taking:
1. Acid
2. Marijuana
3. Black Russians
4. Prosaic
5. Sleeping Pills
* You can spot divers by:
1. Funny Tan Lines
2. Big Watch
3. Says “Huh” alot
4. Bad shocks and springs in car
5. Scars from trigger fish bites
6. Expertise on anti-histamines
* You can spot old time divers by:
1. Funny Tan Lines
2. Big Expensive Watch
3. Old Jeep with bad shocks
4. Log Book has volume number on cover
5. Deaf in at least one ear
6. Has multiple scars.
7. Has cylinders older than you are
8. Talks about making their first wet suit
9. Dive gear is faded
10. Limps from Dysbaric Osteonecrosis
* You can spot newbie divers by:
1. Sunburned
2. Timex Watch
3. Nice car
4. Fills in all the blanks in their logbook
5. No diving related scars
6. Says “Wow, did you see that” alot
7. Equipment looks nice
8. Perfect hearing

Good Things to say to Students or Things Instructors Say

* Welcome to the foodchain folks, you are no longer on the top!
* So what’s your point?
* Ah, we did cover this in class didn’t we?
* What part of this did you understand?
* No, descending butt first is not acceptable
* You couldn’t make it to class because your what died?
* I’m sorry, but no matter what the store owner said I’m not going to
carry all your gear around for you
* Yes Sir, a bad attitude does come with the job
* I see, you just forgot to mention the epilepsy
* Yes, I know you were scared, but don’t ever bite me again!
* What do you mean you always bleed like that?
* You don’t want to do the buddy breathing because you have what!
* No, this isn’t all I do for a living
* Yes, this is what I do for a living…why?
* No Sir, I really can’t explain all the biochemical reactions in the
body to hyperbaric stress..BTW, what did you say you did for a living?
* Don’t worry about this dive UNLESS..______ ! (fill in from below)
1. You hear the theme music from JAWS
2. You see someones foot hanging out of a fish’s mouth
3. All the fish on the reef disappear
4. You see the boat pass you going down while you’re on the anchor
* You know your too deep when I start looking good
* You know you need to lose weight when remore’ and pilot fish start
hanging around you.
* You know you need to lose a lot of weight when you can’t complete a
beach dive because the “Save The Whale Foundation” folks keep pushing
you back in the water.

Things Dive Masters Say

* I don’t care who the hell you are Mr. Cousteau. Everyone does a pool
* To a nice looking lady carrying her handbag onboard:
o Can I help you with that mam?
* To a guy carrying a set of twin 120’s onboard
o Looks heavy dude!
* You should’ve been here last week, the visibility was great
* You didn’t see the whale shark?
* This is just my day job. I want to be an instructor and make the big

Things Store Owners Say

* REFUNDS!..We Don’t Give No Stinking REFUNDS!!!!
* Ok, it’s 2 AM, you drive till we get there
* As their instructor, they trust sell like hell!
* Look, I’m, letting you take the boat trips for free, what else do you
* I can’t pay you anymore, you know I don’t make money on classes
* I can’t pay you anymore, you know I don’t make money on trips
* I can’t pay you anymore, you know I don’t make money on equipment
* Sorry about the problem with that check
* Well, I couldn’t find the student certification forms you signed, so I
signed them off myself. BTW, did I mention that I had enough
certifications now to get my Master Instructor!
* Let’s see, that will be $3,289…ooops! I forgot the mask clear, that
will be $3,292.45!
* If I gave you 10% off, I couldn’t stay in business!
* It’s the instructor’s fault
* Sure, anyone can learn to dive, now what was that problem you had?
* Ok, so your out of the hospital, when can you take another class?
* You want a compass…hmmm, you must mean a directional monitor

Things Divers and Customers Say

* Yeah, like I was in the SEALS, but I can’t find my card
* You got any of that scuba stuff here? (toothpick in mouth manditory)
* Can I be certified by tonight, I’m leaving for Cancun tomorrow
* My friend Chuck took me diving once. Can I get a discount?
* I never had this problem before
* Can I hold your hand during the dive?
* Are you married?
* What do you mean I made a 36 on the test?
* I hate your guts
* Thank you very much!

The Great Lies of Scuba Diving

* Sure, anyone can learn to dive!
* Diving is perfectly safe!
* Nah, you don’t have to be a good swimmer to dive
* You can learn to dive in just three days!

Useful Hand Signals Not Found in Diving Manuals

* Point finger at SPG. Means: How much air do you have? Raise middle
finger if partner has more air than you!
* Point at mask. Draw line across chest followed by drawing line from
sternum to stomach. Means: Look at the babe over their who’s top has
fallen off. Variation #1 Draw line from hip bone to hip bone. Means:
Look at the stud muffin/babe over there who’s trunks/bottoms have
fallen down.
* Point in a direction, followed by making squeezing motions with both
hands. Means: Lets follow the gal/guy in the thong!
* Make a motion with hand simulating the use of a yo-yo preceeded with a
pointing motion. Means: Look at the Yo-Yo!
* Point at divers fins. then make circle with right hand while thrusting
left index finger into hole made by right hand followed by pointing at
the bottom. Means Hey you jerk, stop kicking up the F’ing bottom!
* Point at yourself, point at partner. Then make circle with right hand
while thrusting left index finger into hole made by right hand. Means:
Hey, ever done it underwater?
* Thrust finger of either hand against mask of another diver until their
head bounces off cylinder valve. Means: Please pay attrention!
* Point at regulator, then point at crotch or rear end. Means Bite me!

Reactivated and Maintained by Centrum Nurkowe Aquanaut Diving