scubadoc Ten Foot Stop

April 30, 2008

New and Unique Hyperbaric Neurology Book Published by Best Publishing

Filed under: News, Publicationscubadoc @ 8:15 am

BEST PUBLISHING COMPANY“A Complete Line of Books on Hyperbaric Medicine and Wound Care”

NEW RELEASE - IN STOCK NOW! Hyperbaric Oxygen for Neurological Disorders

HBOT for Neurological

Edited by John Zhang, MD,PhD

Professor of Neurosurgery, Anesthesiology, and Physiology & Pharmacology, Director of Neurosurgery Research, Director of Anesthesiology Basic Science Research, Associate Chair and Physiology Graduate Program Coordinator, Loma Linda University, School of Medicine, Loma Linda, CA

This timely textbook is the first ever to be published on hyperbaric oxygen and its potential applications in neurological diseases. The stellar list of 37 national and international contributors is more than impressive.

“One of the key issues that has prevented HBO from becoming part of mainstream medicine for neurological diseases is the lack of scientific evidence to support a possible neuroprotective effect of HBO. That is the reason for publishing this book.

This book has four features. First, a basic science section of four chapters to demonstrate the effect of HBO on brain physiology and metabolism as well as pathophysiology. Lacking basic mechanisms for the effect of HBO has been the major hurdle preventing the use of HBO for neurological diseases.

Second, this book emphasizes the potential use of HBO in stroke treatment with three chapters, because stroke is the third leading cause of death and the leading cause of long term disability in the nation. Targeting stroke has the potential to take HBO to a new level in future applications.

Third, the experimental application of HBO is discussed with five chapters on traumatic brain injury, cerebral palsy, autism, multiple sclerosis, and on amyotrophic lateral sclerosis. There are tremendous debates in these fields and this book will provide a forum for extensive discussions.

Fourth, several FDA approved HBO applications are presented in three chapters on carbon monoxide poisoning and on radiation-induced neurological injury.

Using an old Chinese phrase ‘Throwing a piece of rock to attract a gem quality of jade,’ this book is a first effort to bring experts from all over the world in the HBO community to target neurological diseases. We hope this is just a beginning, and that more books on HBO in neurological diseases will be published in the future.”

-John Zhang, Editor

“This textbook, therefore, becomes an important reference point for clinicians, researchers and others who care for these difficult conditions and underwrite related health care costs. It is hoped that this textbook will also serve to stimulate further scientific scrutiny. These unfortunate patients are certainly that deserving.”

-Dick Clarke, Director - The Baromedical Research Foundation, Columbia, SC

B1181 $79.00 (445 pages) In Stock, Order Now at: Hardcover

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April 29, 2008

Introduction to Hyperbaric Medicine and Wound Care course

Filed under: Newsscubadoc @ 3:26 pm

Hello fellow heath care professional,

Our next Introduction to Hyperbaric Medicine and Wound Care course is starting this Monday, May 5 !!!!!

The Department of Hyperbaric Medicine at Long Beach Memorial Medical Center is offering an upcoming 40 CME-hour program:

Introductory Course in Hyperbaric Medicine and Wound Care

May 5-9, 2008

This course has been approved by the UHMS Education Committee as meeting the rigorous standards of a UHMS Designated Co-Sponsored Introductory Course in Hyperbaric Medicine.

The primary purpose of this program is to use both didactic and practical chamber-side teaching formats to introduce and educate physicians, with a background in a variety of specialties, in the theory, principles, and practices of hyperbaric medicine and wound care.  Additionally, this CME program is designed to educate nursing, allied health professionals, and medical administrators who have educational interests or needs in hyperbaric medicine and wound care. 


This course is expected to provide the participant with core knowledge about the theory and practices of hyperbaric medicine and wound care and to be a solid base for which further education and training in hyperbaric medicine and wound care can be built upon. 


The faculty at LBMMC Department of Hyperbaric Medicine is uniquely qualified to provide this education. Members of our faculty include leaders in the field of hyperbaric medicine. We take advantage of our multi-specialty background (e.g., orthopedic surgery/wound care, emergency medicine, hematology/oncology, and pulmonary/critical care medicine) to provide a well-rounded perspective of the specialty.


The next course is scheduled to take place in Long Beach, California on:

                                             May 5-9, 2008

if you can’t make this class….we hope to see you in November.                                      

Discounted hotel accommodation information is available upon request.

If you are interested in attending this course or would like more information, please see the included brochure and fill out/fax the registration form or contact:

Shari Hart at:

Department of Hyperbaric Medicine

Long Beach Memorial Medical Center

2801 Atlantic Ave.

Long Beach, CA  90806

(562) 933-6950



Department of Hyperbaric Medicine

Long Beach Memorial Medical Center


Interesting Newsletter From Jonathan Bird

Filed under: Uncategorizedscubadoc @ 9:11 am

Hey Everyone,

I don’t have any new trips to report, but some interesting news.


ORG’s newest educational film Sharks: Predators with a Purpose won the documentary category at the Very Short Movies Festival, beating out several excellent films including one by Leonard Nimoy. If you haven’t seen it, go check it out on-line. You can watch the whole film on the ORG website!


In the Blue World, our big news is that Jonathan Bird’s Blue World is going to start appearing on public TV stations all across the country in May. We have been picked up by Public Television and already have confirmation in several states and are awaiting more confirmations. I am just finishing up editing season 1 and we are already shooting season 2 in High Definition.

We are looking for a corporate underwriter to support the series in exchange for sponsorship advertising in the show. I am working all my contacts to find people who know CEOs at large companies that might like to support a quality educational program about the ocean. Everyone on this list is an ocean lover….anyone know a “big wig” at Google, Apple, Shell or any large company like that? Please e-mail me if you can help us find a sponsor to keep Blue World going! Meanwhile, check out the latest episode about the wreck of the Prinz Eugen in Kwajalein:


Don’t forget to attend the premiere of my new feature-length film about coral reefs Secrets of the Reef at the New England Aquarium SImons Imax theatre on May 31. It is completely sold out now, so if you reserved seats, BE THERE!


Just in case you may be wondering why I have been hard to reach, I have had a crazy busy spring. I was in the Bahamas for two weeks with several of my dive friends doing Tiger shark trips. Then I was home for a week and off to Statia (St. Eustatius) in the Caribbean for Sport Diver Magazine. Then I was home for a week and off again to the Turks & Caicos for Sport Diver. Now I’m home and I have a month to get the house ready for all our guests who are coming for the Secrets premiere….I have a lot of work to do….some major construction of my daughter’s new bedroom. My new book Creatures of the Deep Blue has been printed and I just got an advance copy. I’m excited about it and I can’t wait to have more copies to show off! I have a story in Sport Diver Magazine this issue (St. Kitts) if anyone gets that. That’s about it for me.

One last bit of sharky news:

For you shark lovers out there in the Boston area I want to let you know about a film being shown at the New England Aquarium Simons IMAX theater on Monday May 5th at 7pm, “Island of the Great White Shark”. It’s 43 minute film about the great white sharks of Guadeloupe Island, Mexico. Here’s a description of the film.

Off the coast of Baja, Mexico, a remote island serves as one of nature’s dwindling sanctuaries to a fearsome ocean predator, the great white shark. In a race against time, marine researchers and eco-tourists have forged a unique alliance in the hopes of protecting these animals from potential slaughter. This film provides a stunning, realistic portrait of great white sharks that recognizes the sharks’ majesty and beauty and positions the animals as a crucial link in nature’s intricate balance of predator and prey.

Richard Theiss, filmmaker, and Mauricio Hoyas, shark biologist, will be at the showing to present their findings in this visually lovely and informative film. There will be a reception following the film.

It is free to the public but registration is required:\

I haven’t seen it but it sounds pretty cool.

I hope you are all doing well and I’ll see many of you at the end of May!




Do you know the Secret of the Reef?
Jonathan Bird
Underwater Photography/Cinematography

Jonathan Bird’s Blue World:

Coming to public television summer 2008!

Underwater Photography Chat

Oceanic Research Group, Inc.

April 21, 2008

Resumption of diving 4 years after Type II DCS?

Filed under: Article, Uncategorizedscubadoc @ 10:28 am

Question: A 38 year old female asked if she should try diving again or hang it up for good. 4 years ago this April she was diving around St Johns, the fourth day of diving her max depth this day was 70 feet. Upon surfacing she experienced poss dcs symptoms. She was chambered for 4 days; she was advised she had suffered dcs type 2.
One day after release from hosp she flew back to the U.S. Upon descent of the air craft, symptoms reoccured she was again addmitted to the hosp. Boston Medical Center for 4 days and chambered. She was advised that if she had no further symptoms within 3 years she could dive again. Its been almost 4 years ?
Answer: There are those who would say that your diver probably should not dive again. Then there are those who feel that if she has no neurological abnormalities (as determined by the neurological examination), she should be allowed to resume diving.
One thought that you might consider - have her checked out for the possibility of a PFO (patent foramen ovale), Although it would be hard to imagine that this has not already been done- it would still be worthwhile having a bubble contrast echocardiogram.
There are few protocols and no case reports that guide the advice about returning to diving after a decompression accident. Clinical judgment has to be foremost in making this decision.
The main consideration is the worry that a diver with residual clinical and pathological neurological changes will have an increased risk of the development of bubbling in areas of deranged blood supply (scarring) in the brain or spinal cord. There is no clinical evidence that this occurs.
Because of the known increase in bubbling in low flow areas, divers with any residual manifestations of their neurological hit are best advised not to resume diving. If their DCS hit was caused by a non-provocative dive, they should by all means be checked out for a patent foramen ovale.
The closest thing to a protocol that I have found is that in Edmonds’ Textbook, Diving and Subaquatic Medicine, p. 196.(3rd Edit)
“For complicated type 1 DCS, neurological and other type 2 DCS it outlines the following:
1. Exclude other causes i.e., cardiac shunts, pulmonary barotrauma
2. Follow-up with full testing until complete recovery
3. Resume limited diving after the above has been achieved and at least 1 month has elapsed; as follows:

a. no-decompression dives with allowable bottom times halved.

b. maximum depth 15 meters (50 feet).

c. surface intervals in excess of 6 hours.
4. If sequelae (symptoms) persist and are stable after many months - as long as the diver’s psychological and physical fitness is not impaired, scuba diving may be permitted to 9 meters (about 30 feet) for short periods.”
The British Subaqua Club (organization that controls scuba diving in the UK) has the following to say about return to diving after gas embolism and severe neurological DCS. “Individuals who have had pulmonary barotrauma or neurological decompression illness are thought to be generally more susceptible to subsequent episodes as a result of pre-existing abnormal pathology, including lung disease and intracardiac right-to-left shunts. In addition, subsequent neurological insults in these individuals are thought to be more difficult to treat and are believed to leave greater residual disability. Therefore, any person who has suffered from pulmonary barotrauma or neurological decompression illness, should be carefully assessed to determine whether they should resume sport diving. The assessment will involve enquiry into the circumstances of the incident (including a precise dive history). Particularly when the episode of dysbaric illness occurred within the tables, assessment will often require tests to exclude the presence of an intracardiac shunt and lung disease likely to predispose to pulmonary barotrauma. The tests which may be performed include contrast echocardiography and sophisticated tests of lung function. The case should be examined by a Medical Referee who has obtained information from the treating physician. If the individual is permitted to resume diving, restrictions on depths, times and repeat dives may be imposed.”
Type I and neurological DCS that has responded completely to recompression without residua can be allowed to return to diving with the understanding by the diver that there is the possibility of increased risk of a decompression accident in the area of damaged tissue. Alterations in the dive patterns should be undertaken in order to reduce the risk of bubble formation.


“Glue Ear”

Filed under: Articlescubadoc @ 10:10 am

 Could a pediatric problem be a clue as to why some people have extreme difficulty clearing while diving? According to an article published in The Lancet (2002;359:493), glue ear may be a result of acid reflux, which occurs when stomach acid backs up into the esophagus.
Glue ear, medically known as otitis media with effusion, is a type of middle ear infection affecting about 20% of 2-year-olds and is a leading cause of hearing loss in young children.
For the Lancet study, ear fluid samples were evaluated from 54 children between the ages of 2 and 8 with glue ear who were undergoing ear surgery. Analysis of the fluid revealed that 45, or 83%, of the samples tested positive for pepsin, or its precursor, pepsinogen, at up to 1,000 times the concentration found in surrounding bodily fluids. The acid pH of the refluxate could damage the eustachian tube and the middle ear mucosa causing inflammation. This damaged state could be ideal conditions for bacterial growth and lead to the symptoms seen in glue ear and blockage. As a result of the findings, the authors suggested that anti-reflux therapy, like antacids that reduce acidity of gastric juice and the activity of the pepsin protein by targeting the stomach, could be used to prevent glue ear. This finding has not been extended into adults but offers an interesting thought. If it can be shown that new divers with extreme difficulty equalizing also have a high incidence of heartburn or reflux - then it might be helpful to place these individuals on some kind of H2 blocker or antacid prior to their dives.


April 16, 2008

Thoracic Outlet Syndrome and Diving?

Filed under: Uncategorizedscubadoc @ 5:06 pm

 Often, we get queries that have no answers that are backed by data. Rather than rebuff the diver or prospective diver, we will try to come up with a reasonable deduction that will provide a means whereby the person can dive safely - or not dive at all. Many times we have to use basic non-diving knowledge about disease entities and fit this knowledge into a pattern that will allow an answer that fits the main contraindications to diving, which are: –Disorders that lead to altered consciousness –Disorders that inhibit the “natural evolution of Boyle’s Law” –Disorders that may lead to erratic and irresponsible behavior. In addition, attention needs to be directed toward measures designed to specifically detect those conditions that place a person in jeopardy for the following:
1). decompression illness
2). pulmonary over pressure accidents
3). loss of consciousness
4). inability to mentally or physically handle the in-water environment because of Post-surgical or post-debilitating illness



Age Related Problems (more…)

Panic in Divers

Filed under: Article, Publicationscubadoc @ 3:39 pm

Dr. David Colvard, a diving psychiatrist in Raleigh NC has kindly offered to allow us to use his material that was presented to a DAN South Africa conference held in September 2007. The lectures are presented on his webpage at .and below.


“Understanding Stress, Anxiety & Panic in Divers

“Identifying Anxiety & Panic Risk in Divers”

“Prevention Strategies for Anxiety & Panic in Divers”

“Anxiety, Panic and Psychiatric Problems in Divers”

David F Colvard MD or

Raleigh NC USA 919-781-3141

Toll Free: 1-877-COLVARD (265-8273)



MRI of Inside Attendants for Possible Dysbaric Osteonecrosis

Filed under: Uncategorizedscubadoc @ 9:40 am

Ozkan H, Uzun G, Yildiz S, Sonmez G, Mutlu H, Aktas S.

Department of Orthopaedics and Traumatology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.

Inside attendants are medical staff who accompany patients during hyperbaric oxygen treatments. Dysbaric osteonecrosis (DON) is a well-known consequence of hyperbaric exposure. The aim of this study was to evaluate DON in inside attendants using magnetic resonance imaging (MRI). The bilateral shoulder, hip and knee joints of 12 inside attendants (four men, eight women; mean age 29 years; age range 22 - 36 years) were investigated. The mean +/- SD duration of employment as an inside attendant was 3.8 +/- 3.0 years (range 1 - 9 years) and the mean +/- SD number of hyperbaric exposures was 198 +/- 267 (median 96; range 30 - 950). None of the inside attendants had a history of decompression sickness. The MRIs of the attendants did not reveal bone lesions consistent with DON. This study failed to find an increased risk for DON in inside attendants. Additional multicentre epidemiological studies are warranted to investigate the occupational safety of inside attendants.


April 15, 2008

Undercurrent Online Update

Filed under: Uncategorizedscubadoc @ 10:19 am

U N D E R C U R R E N T   O N L I N E    U P D A T E
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Undercurrent — Consumer Reporting for
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Dive News

April 15, 2008

You have received this message because you have signed up on our website to receive this email or your are a former subscriber or Online Member of Undercurrent . Removal instructions are below.

A Lucky Draw Wins a Borneo Dive Trip : Feeling lucky? Island Dreams Travel is sponsoring a lucky draw for a seven-day cruise on the M/V Celebes Explorer, sailing the waters of Borneo, Malaysia. This liveaboard offers the best opportunity to dive the waters around famous Sipadan Island. To register for your chance to win and to learn more about M/V Celebes Explorer, visit You can also contact Island Dreams Travel toll free at (800) 346-6116.

Get Teenagers Interested in Marine Life : The Little Cayman Research Centre is hosting its annual Caribbean Sea Camp August 15 to 22 for teenagers age 14 to 18. This year’s activities are based on the National Oceanographic Atmospheric Administration’s coral reef conservation program. Open to divers and non-divers, teenagers learn about Caribbean marine biology and conservation through seminars with experts and diving, snorkeling and sea kayaking Little Cayman’s reefs. The cost is $2,300 for room, meals, diving, field trips and airport transfers. Applications to join are being accepted through April. More information is at

The Death of A Shark Diver : The latest diving shocker happened in late February when Austrian diver Markus Groh died from a shark bite while diving from the MV Shear Water in the Bahamas. Rumors, hearsay and theories abound about what actually happened but no one is officially talking. Either way, Groh’s death emphasizes the divides between divers, businesses and governments about diving with sharks, and it may have an affect on how it is done now in Bahamian waters. Read our detailed article at Undercurrent.

What Happens When There’s Not Enough Divers? : We’re doing a future story addressing that question. Have you ever booked a dive trip that has been changed or canceled because the dive operation’s minimum number of divers has not been met? Such as a trip to that far dive site or a night dive, or a switch from a small boat only with divers to one jammed with snorkelers. Has something similar happened to you, after you paid a bundle to get to your destination? Or did a dive operation that lacked its minimum capacity still take you diving or do something for you that made you happy you booked with them? Send your stories to

A Diver’s Guide to The Art of Underwater Photography : This book by Andrea and Antonella Ferrari, is filled with spectacular images, designed not only to offer great technical guidance, but also help the underwater photographer discover and develop the artist within. Clearly the best and most beautiful ‘how-to” book ever produced. Rigorously field-tested digital techniques; the hidden techniques behind imaginative framing and lighting, wide-angle and fish-eye to macro photography, from fish portraits to above/below split images, from basic point-and-shoot digital pocket cameras to complex housed professional DSLR systems, it’s all here in a highly-readable, technically-accessible, step-by-step guide. 360 color photos. Purchase at Undercurrent and the commission we receive from Amazon will go directly to projects to save coral reefs.

Peter Hughes’ Paradise Dancer Delayed : In our October issue last year, we wrote about the Paradise Dancer, the massive liveaboard scheduled to set sail this month in Indonesia. Subscriber Richard Bennett (Napa, CA) was booked on one of the first trips this month but received notice on March 19 that the boat will not be ready. “The weather Gods in Indonesia have decided not to favor us as well. Kalimantan in Borneo, where the keel was laid and the hull built, was flooded so severely that the vessel was two months late in its launch date and subsequent scheduled arrival in Bali for completion. But Bali too has had extremely unusual weather, which hampered our catch-up efforts. At this point, we are not 100% sure if Paradise Dancer will have completed all required sea trials by the time our first two charters occur.” As an insurance policy, Peter Hughes chartered a Sea Safari Cruises boat Sea Safaris 9 ( for the first two voyages to go as scheduled. It now says that the Paradise Dancer will be ready to sail starting May 12.

Abandoned Diver Gets Permission to Sue Dive Boat : A Superior County judge has ruled that Daniel Carlock can take to trial his $4 million lawsuit against Ocean Adventures Dive Co. in Venice Beach and Sundivers Charter for abandoning him in the ocean during an April 2004 dive trip. After getting separated from 20 other divers, Carlock was left in the ocean amid foggy conditions seven miles off Newport Beach while the crew never realized he was missing. Carlock floated for four hours until he was found by a boat of Boy Scouts (read all the details from the June 2004 issue of Undercurrent.). He sued for emotional and physical trauma (he developed skin cancer from his bad sunburn) but Ocean Adventures and Sundiver Charters tried to dismiss his case on the grounds that he assumed the risk of being left in the ocean. The case is set for trial on June 9.

Too Much Time on These Divers’ Hands? : There’s actually a Guinness World Record for time spent by the most people ironing while underwater (70). On March 31, 72 divers broke the record near St. Leonards, Australia. Divers marched into the water with tanks on their backs, ironing boards under their arms and an article of clothing to iron. Breaking the record proved a challenge when some divers struggled to sink with their surprisingly buoyant ironing boards. But they succeeded and raised $865 for reef protection.

Special Discounted Introductory Offer : Sign up now for a one-year membership to Undercurrent for $29.95, $9 off the standard offer, PLUS it includes a free copy of our Travelin’ Divers’ Chapbook 2009 (when printed), with reviews of more than 1,000 dive resorts and liveaboards worldwide.

Coming Up in the May Issue :
• Reef’s End, Tobacco Caye, Belize
• Malapascua and Panglao, Philippines
• Why Divers Die: Part III
• Proper Hygiene on Liveaboards
• Yoga for Scuba Divers
• And much, much more

Ben Davison, editor/publisher 

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


April 11, 2008

Pharmacological interventions to decompression sickness in rats: comparison of five agents.

Filed under: Uncategorizedscubadoc @ 10:20 am
There is an article in Aviat Space Environ Med. January 2008 by Fahlman and Kayar comparing five pharmacological agents in the possible prevention of symptoms of DCS in rats. This research investigated whether decompression sickness (DCS) risk or severity could be reduced using drug interventions that are easier to implement and equal to or more efficacious than recompression therapy.
Using a rat model of DCS, anti-inflammatory or anticoagulant drugs, including lidocaine, aspirin (ASA), methylprednisolone (MP), alpha-phenyl-N-butylnitrone (PBN), and transsodium crocetinate (TSC) were tested to determine their effect on incidence of DCS, death, and time of symptom onset. Each treatment group consisted of approximately 40 animals that received the drug and approximately 40 controls. Animals were exposed to one of five compression and decompression profiles with pressure ranging from 6.3 ATA (175 fsw) to 8.0 ATA (231 fsw); bottom time was either 60 or 90 min; and decompression rate was either 1.8 or 15 ATA x min(-1). Following decompression, the rats were observed for 30 min while walking on a wheel. DCS was defined as an ambulatory deficit or abnormal breathing.
None of the drugs reached statistical significance for all DCS manifestations. Lidocaine post-dive and MP were the only treatments with marginally (P < 0.15) significant differences in DCS outcomes compared to controls. Lidocaine post-dive significantly decreased the incidence of neurological DCS from 73-51%. MP significantly extended the time of onset of death from DCS from 5.4 min to 7.1 min.
Of the treatments investigated, lidocaine given post-dive has the best chance of success in adjuvant therapy of DCS. Future studies might investigate adjuvant drugs given in combination or during recompression.


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