Scubadoc's Diving Medicine

Utah Web Page corrected and updated

2006-02-26T08:43:00.000-08:00

Hello Sir, I am emailing in regards to the “Diving Medicine Online” website which lists the hyperbaric physicians and chambers in my state when I Google search “utah hyperbarics” and then click on “Utah Dive Physicians and Chambers.” The information on that site for my facility is incorrect. Under “CHAMBERS” Dr. Michael Garey nor Tony Brownlee work for our facility anymore and the statement needs to be updated as well to read as follows: “Our state-of-the-art hyperbaric chamber is unparalleled in the Intermountain region, being the only Accredited, hospital affiliated, multi-place hyperbaric chamber in Utah. Our dual-lock chamber can accommodate up to 12 patients and 2 inside attendants and up to 6 ATA. Our Physicians are in attendance at all times. We are located on the campus of Lakeview Hospital, in Bountiful, Utah.” Also under “DIVING PHYSICIANS” it again lists Dr. Garey who no longer works for us. Could you please have the information corrected or please inform me how to get it corrected. Also please add the following physician:

Dr. Tommy Love, D.O.
Wound and Hyperbaric Medical Director
Bountiful, Utah 84010
tommy.love@att.net

Thank you for your time.

Sincerely,

Robb Samonte, Program Director

Robb Samonte CHT/ADMT
Utah Hyperbaric Program Director, HMS
Lakeview Hospital
Phone: 801.397.0890
Phone: 888.286.2873
Fax: 801.299.7899

Puerto Rico web page updated

2006-02-26T08:37:00.000-08:00

The web page entry for Puerto Rico has been changed to include the following:

"Chamber information in your website. Thanks for your initiative and let others that our Service is there to help those in need, in the Eastern Caribbean Region,not only in regular working hours but in an on call basis 24/7.

Our Chamber is a triple-lock 18 seated multiplace chamber located in Puerto Rico Medical Center, San Juan. The Staff consists of 5 physicans including myself, 5 hyperbaric nurses and 3 HBO techs.

Although the main purpose of the service is the clinical, those conditions associated to multisystemic and musculoskeletal trauma are more our bread and butter, last year we treated 75 DCS related cases in our chamber, a busy place year round. "

Once again thank you for posting us...

Juan Angel Nazario, M.D., FAAEM
Medical Director
Hyperbaric Medicine Service
Puerto Rico Medical Services Administration
Puerto Rico Medical Center
San Juan, PR 00922
Tel. 787.777.3535 ext. 6475, 6481
On Duty Cel. 787.390.3243
Fax:787.777.3828
email: juan.nazario@asempr.org

Swedish Hyperbaric facilities web page corrected

2006-02-26T08:32:00.000-08:00

The web page for Swedish Hyperbaric Facilities has been corrected with the following information added:

New adress should be:

Carl Johanson, MD, PhD/Surg LtCdr
Swedish Armed Forces
Institute of Medicine
P.O.Box 5155
SE-42605 VÄSTRA FRÖLUNDA
+46(0)31 – 69 2000
carl.johanson@mil.se

New entry for North Carolina Hyperbaric Facilities

2006-02-10T11:26:00.000-08:00

The following entry has been added to the web oage for North Carolina Hyperbaric Facilities

Huntersville

Medicor HBO (a division of the Jemsek Clinic)
14330 Oakhill Park Lane
Suite 140
Huntersville, NC
28078

Medical Director Dr. Joseph G. Jemsek, MD, FACP
Clinical Director Matthew J. Trenery, CHT

Phone (704) 987-2111
Fax (704) 987-2113
E-mail info@JemsekClinic.com

Web Page about USN Medical Exams revised

2006-01-17T14:05:00.000-08:00

We received the following letter about our web page on medical qualifications, which included some old information about the US Navy Medical requirements for diving.

Your web-site is outstanding! Some of your Navy physical qualification info is out of date though. Any questions please feel free to contact me. I just left the Naval Experimental Diving Unit, and am now in Bahrain with the Spec war guys.

V/R
Stephen Allain HMC(DSW)
NSWU-3 Medical Dept.
Diving Med. Tech.

----------------------------------------------------------------

We have revised the page to include some links to new information.
See "Why Have Medical Exams"

Dehydration web page updated

2006-01-01T09:18:00.000-08:00

Our web page on dehydration and diving has been rewritten. It now includes more basic information about defining the condition and how to recognize signs, symptoms and tests
that indicate dehydration.

To check this out go to our web page at http://scuba-doc.com/dehyd.htm .

Richard Draper, DO added to Diving Medical Officer listing for Missouri

2005-11-27T09:36:00.000-08:00

Dr. Richard Draper has attended the NOAA course for diving medical officers and is located with the Southeast Missouri Wound care and Hyperbaric Center in Cape Girardeau. His new listing has been added to the web page for Diving Facilities in Missouri on oue web site at http://scuba-doc.com/divmissou.htm

Southeast Missouri Hospital Wound Care and Hyperbaric Medicine Center
1701 Lacey Street
Cape Girardeau, Mo., 63701
1-573-331-6353

Richard E. Draper, DO, FACEP
Attendee, NOAA Diving Medical Officer Program
573 331-6953

Bozzuto Medical Director of Albany Georgia Chamber

2005-11-22T14:52:00.000-08:00

Dr. Tom Bozzuto is now Medical Director of the hyperbaric chamber at the Phoebe Putney Wound Care & Hyp. Cntr, Phoebe Putney Memorial Hosp.in Albany Georgia. Our web page for Georgia Hyperbaric Facilities has been changed to include this information.

Chamber Added for New York City

2005-11-16T13:15:00.000-08:00

New York Presbyterian Hospital Hyperbaric Program
525 East 68th Street
Suite L-705
New York, NY 10021
212-746-4958

Wanda See, NP
was9005@nyp.org

PFO Closure Information added to web pages

2005-11-07T08:58:00.000-08:00

The following information has been added to these web pages:
http://scuba-doc.com/pfo.htm

http://scuba-doc.com/surgdiv.html

Patent Foramen Ovale - A button closure (Amplatzer) is performed trans venously without entering the chest. Four weeks after the surgery, another echocardiogram is done to verify that the device is still in position.

After two-three weeks there is an overgrowth of endothelial cells covering the device, reducing the risk of infection.

After six to eight weeks the connective tissue has completely filled the spaces in the device and it becomes invisible to ultrasound. Return to diving is usually in six weeks (Wilmshurst), given the full recovery to the satisfaction of the cardiologist/surgeon. Others require a longer wait of twelve weeks.

See article by Wilmshurst, et al at http://heart.bmjjournals.com/cgi/content/full/81/3/257 .

Louisiana Facilities Closed

2005-11-06T08:17:00.001-08:00

Hyperbaric Facilities have closed down at the St. Charles Hospital in New Orleans. The Slidell Hyperbaric facilities will close on November 11, 2005.

Dr. Mark Silady writes to provide us with this information concerning these two facilities damaged during Hurricane Katrina.

New Orleans

St. Charles General Hospital
New Orleans, Louisiana
Medical Directors:
Monica Van Every, M.D. (Hyperbaric Medicine)
Paul G. Harch, M.D. (Hyperbaric Medicine & Hyperbaric Fellowship)
Keith Van Meter, M.D., FACEP (Emergency & Hyperbaric Medicine)
504-896-3186 (Hyperbaric Dept.)
504-896-3143 (FAX)

*This chamber is closed.

Slidell

Slidell Memorial Hospital and Medical Center
1001 Gause Blvd
Slidell, LA. 70458
(985) 643-2200 ext. 7610
FAX (985) 649-8580
Mark F. Silady, M.D.
Kumar A
Keith Van Meter, M.D.

* This chamber will close November 11, 2005.

Our web page has been corrected to include this information.

Bermuda Hyperbaric Resources web page updated

2005-11-03T10:51:00.000-08:00

Thanks to Phil Frazier, the Bermuda web page has been updated to reflect this new information:

Medical Director:
Dr. Edward A. Schultz, MD, FACEP
Dr Shultz is also board qualified with the College of Hyperbaric Medicine.

Assistant Medical Director
Dr. Roslyn Bascome-Adams, MD

Consultants to Diving and Hyperbaric Medicine
Dr. Basil Wilson, MD, CHT

Dr. Carol Ferris, MD, CHT

Dr. Peter Babeckas, MD

Dr. Peter Malan, MD

Clinical Co-ordinator
Lorraine Beasley, SRN, CHT

Hyperbaric Nurse
Mary Blakemore, RN BSc

Change in the information for French Hyperbaric Resources

2005-11-03T10:33:00.000-08:00

The link in French Hyperbaric Facilities has changed and should be:

http://www.medsubhyp.com/
for the welcome page

and / or
http://www.medsubhyp.com/site/caissons_civils.htm
for the direct listing of civilian facilities

and
http://www.medsubhyp.com/site/caissons_militaires.htm
for the direct listing of military facilities

If you have any further questions, feel free to ask me

Sincerely

DR Olivier SIMON
MD, hyperbaric physician
member of MEDSUBHYP
HYPERBARIC CENTER
CHU de Nice - Hôpital Pasteur
30, avenue de la voie romaine
BP069 - 06002 Nice cedex 1
TEL: +33.4.92.03.77.72
MAIL: simon.o@chu-nice.fr

New information added to our Michigan Hyperbaric Resources web page

2005-10-26T09:00:00.000-07:00

The following new information has been added to our web page about hyperbaric facilities in Michigan:

Macomb/Clinton Wound and Hyperbaric Medicine,LLC
43475 Dalcoma. Ste. 150
Clinton Township, Michigan 48038
Phone: 586-228-7308
Fax: 586-228-7315
E-mail: clintonhyperbaric@yahoo.com
3 Monoplace Sechrist 32" chambers
Medical Director: Dr.Richard Utarnachitt
We are open Monday through Friday 9a.m. to 5p.m. with extended
hours for weekends by appointment. Please call for added information.
www.hyperbaricandwoundcare.com

Dee Pastorelli
Office Manager

Cleveland Clinic Huron Hospital Hyperbaric Facility added

2005-10-26T08:54:00.000-07:00

The web page for hyperbaric facilities in Ohio has been upgraded and now contains the following information about Cleveland:

Cleveland Clinic Huron Hospital
13951 Terrace Road
East Cleveland, Ohio 44112
(216)761-6881

A multiplace chamber at Cleveland Clinic
Huron Hospital in Cleveland that opened Novemeber 19, 2004. We can hold
up 8-10 patients at a time.

Vincent F. Ferrini III MD FACEP
Mobile Hyperbaric Centers
Chief Medical Officer

Illinois Hyperbaric Facilities

2005-10-26T08:41:00.000-07:00

The web page for Illinois Hyperbaric Facilities has been upgraded and now includes the following center in Urbana:

Carle Hospital Hyperbaric Center

Mario Caruso, CHT, DMT – Safety Director

611 West Park Street

Urbana, Illinois 61801

217-326-4325

Mario.Caruso@carle.com

Hong Kong Hyperbaric Resources Web Page Updated

2005-09-27T08:39:00.000-07:00

You are referred to our web page at http://scuba-doc.com/divHK.htm for changes in information about hyperbaric and diving resources in Hong Kong. The new information was sent to us by Dr. LI Ronson.

scubadoc

Chilean Hyperbaric Resources Page Updated

2005-09-08T14:21:00.000-07:00

The following information has been added to our web page at http://scuba-doc.com/divchile.htm .

Viña del Mar

Hospital Naval de Viña del Mar
Av. Carlos Alesandri S/n,
Phone (56)-32-686758 extension 3380
Viña del Mar
Chile

Glossary web page updated to include 'skip breathing'

2005-08-19T08:42:00.000-07:00

In response to a question about 'skip breathing', we have updated our web page "Glossary" to include the following:

skip breathing - this simply means holding the breath after breathing in and/or holding the breath for a variable period of time after breathing out. This is done subconsciously or on purpose in order to "conserve air" - either to stop using too much air or to try to prolong a dive. It is dangerous for several reasons. It causes a subtle buildup of CO2 with all of the attendant risks [see our web pages about this at http://snipurl.com/h2l2 ]. In addition, it imposes the risk of pulmonary barotrauma from ascending with the glottis closed, even a few feet. There are several web sites that discuss breathing control in terms of learning buoyancy control - but managing breathing for this is entirely different and does not entail 'holding the breath' but increasing and decreasing volumes. See http://snipurl.com/h2le .

Dive Travel Web Page Updated

2005-07-26T08:10:00.000-07:00

The Dive Travel Web Page has been updated to include these new links:

Traveler's Health, References and Resources, CDC

Emporiatrics:An Introduction to Travel Medicine, Virtual Hospital

Travel Medicine Online, Pharmacy Journal

Web page for UK Hyperbaric Facilities has been changed

2005-07-25T08:27:00.000-07:00

The web page for UK Hyperbaric Facilities has been altered to reflect new emergency information.

Emergency Calls

Scotland

The centre in Aberdeen co-ordinates the treatment of Diving Emergencies in Scotland. This is an NHS service for which no charge is made to the patient. The single point of contact is now 0845 408 6008 stating that the call is a Diving Emergency. The service has chambers in Dunstaffnage, Aberdeen, Millport and Stromness.

Information about the National Health Service provision for diving related illness in Scotland is on at http://www.sdm.scot.nhs.uk/index.htm .

Wm Beaumont Hospital Chamber Added to Michigan Page

2005-07-19T15:36:00.000-07:00

The Hyperbaric Medicine Department of William Beaumont Hospital

4949 Coolidge Hwy.

Royal Oak, MI 48073

(248) 655-3144

Fax: (248) 655-3148

Email: jmosteller@beaumonthospitals.com

Website: Beaumont Hospitals - Hyperbaric Medicine

Polish Webpage changed

2005-07-19T07:38:00.000-07:00

Dear Dr Campbell,

Thank you for posting my address and telephone on your page within the Polish Diving Doctors section, two years back. I would like to actualize the information since I have changed jobs and moved into private practice only. I also have started a medical-diving web page in Polish language.

www.lekarznurkowy.pl is a Polish language medical page for divers I have created recently. "Lekarz nurkowy" means in Polish "diving doctor". It is nowhere near your page but one has to start somewhere :-). There is of course a link there to www.scuba-doc.com

My new coordinates:

Marcin Ajewski MD PhD

MedAire Medical Practice

phone +48 668 107 107

fax +48 22 615 68 78

www.lekarznurkowy.pl

maraj7@wp.pl

Best regards,

Marcin Ajewski

Swedish Dive Accident page corrected

2005-07-16T17:56:00.000-07:00

Information about Dr. Ornhagen has been changed to reflect his new status.

Hans Ornhagen, M.D., Ph.D.
Consultant, Swedish Sportsdiving Federation.
Research Director (Ret)

Phone and fax (46 ) 850030111
Mobile phone (46) 732503935
hans@ornhagen.se
www.ornhagen.se

www.divemed.net

Web page about Croatian dive accident facilities updated

2005-06-30T07:06:00.000-07:00

The web page about Croatian dive accident facilities has been updated with corrections and new information.

The new data was provided by:

CAPT (O6) Nadan M. Petri, MD, DMO, PhD
CO, Naval Medical Institute
Associate professor of occupational medicine
University of Split School of Medicine
President, Croatian Maritime, Undersea, and Hyperbaric Medical Society
21000 Split, p/o box 196 (HRM)
Republic of Croatia

phone 00385-(0)21-381-711
fax 00385-(0)21-381-716

Underwater Sex

2005-06-21T08:42:00.000-07:00

We have added a link to our web page at Women and Diving called Underwater Sex. The article is an interview with several women regarding their experiences with coitus underwater and some comments about safety issues.

scubadoc

TAPVR

2005-06-15T15:06:00.000-07:00

We have written and posted a new web page about Total Anomalous Pulmonary Venous Return at http://scuba-doc.com/TAPVR.html .

Bermuda Facilities Web Page Updated

2005-06-05T08:42:00.000-07:00

The web page containing hyperbaric facility information for Bermuda has been updated with the following information:

Hyperbaric and Wound Care Department
King Edward VII Memorial Hospital
P.O. Box HM 1023
Hamilton, HM DX, BERMUDA
Ph (441) 236-2345 ext 1896
Fax(441) 236-5012

http://www.scuba-doc.com/divber.htm

Asthma Web Page Updated

2005-06-01T08:05:00.000-07:00

Please visit our updated web page about Asthma and Diving.

Clickable ads have been added to help to maintain the web site.

Surgical Specialty Hospital of Arizona added to web page

2005-05-10T07:24:00.000-07:00

New entry for Arizona Hyperbaric Facilities added to web page at http://scuba-doc.com/divariz.htm .

Surgical Specialty Hospital of Arizona

Wound Care and Hyperbaric Medicine Center

6501 N. 19th Avenue, Suite C

Phoenix, Arizona 85015

Phone 602-441-4102

Fax 602-368-9257

Daniel McCluskey, CHT

www.woundcare@qwest.net

New Material Added to Kidney Transplant Section

2005-05-10T07:21:00.000-07:00

Go to this URL for new information regarding diving after renal transplant.

http://www.scuba-doc.com/kidprbs.htm

Review of Fitness to Dive Guidelines: Neurologic

2005-04-28T12:30:00.000-07:00

Suggestions for Review of Fitness to Dive Guidelines: Neurologic

In our last newsletter we brought up the suggestion that guidelines placing restrictions on diving in certain conditions and with certain drugs might be too stringent and might possibly be either misapplied or archaic.

The suggestion has also been made that guidelines have been promulgated for military, commercial and professional divers based on conclusions drawn from naval diving medical officers for military personnel and that a different set of rules should be considered for sport and recreational divers. In addition, many recommendations in various guidelines are based on physician judgment and anecdotal experience and not on good clinical evidence. There is not a large body of evidence in support of many of the 'absolute' and 'relative' contraindications usually listed. However, it also can be stated that the same physical forces are acting on the same human body when anyone descends beneath the surface, and that immutable physical laws should apply across the board. This is certainly true but it is the strict application of rules without any 'wiggle room' that is vexing to many people.

In the final analysis for many of the restrictions, it is actually the amount of risk that an individual is willing to take in order to participate in sport diving. Glen Egstrom, PhD wrote this about risk associated with diving:

"Scubadoc- I read your newsletter with the usual amount of stimulation. I feel that an old (1787) Ben Franklinism fits here very well. He observed “Having lived long I have observed many instances of being obliged by better information and for consideration to change opinions even on important subjects which I once thought right but found to be otherwise.” The evolutionary changes in the view of the relative levels of risk associated with diving often have the appearance of lowering levels of concern on the part of the medical and instructional communities of divers. I prefer to view it as a heightened appreciation for the nature of the risk vs. benefit evaluation. Risk assignment should be based upon objective, scientific analysis of a hazardous condition. The benefits, often less quantifiable, should be viewed in terms of physical as well as mental health aspects. The nature of the calculated risk should be clearly explained to the individual on the basis of the objective evidence. Most individuals, armed with specific knowledge about their fitness to dive and the risks placed in perspective, are likely to make good informed decisions. For those who do not pay attention, they will probably continue to let their minds make appointments that their bodies cannot keep. As is their right as an individual.

It has always been easier to be arbitrary and overly restrictive than it has been to get good evidence for a balanced opinion. I personally have always felt that regular doses of hyperbaric “therapy” in the form of diving have provided benefits to my life that make the risks more than acceptable. Good luck on your project, it could be a real challenge! "

Revisiting the "Absolute Contraindications" to diving - as outlined by various organizations such as the RSTC and NOAA and copied by most of the certifying agencies, turns out to be a difficult project, as there are few studies to be found that back up their recommendations. Making the guidelines more lenient turns out to be just as difficult - again because there are few suggestions that can be based on evidence. Expert opinion and anecdotal evidence are generally the substantiating factors in making decisions about fitness to dive. The obvious reasons why a person should not be allowed to dive are as follows:

* 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 our last newsletter, http://scuba-doc.com/nl041505.html , we looked into the ear, nose and throat. Today, we will investigate the evidence supporting the neurological restrictions.

RSTC Contra-indications
Neurologic abnormalities that affect a diver's ability to perform exercise should be assessed individually based on the degree of
compromise involved.

Absolute Contraindications:
Abnormalities where the level of consciousness is subject to impairment put the diver at increased risk of drowning. Divers with spinal cord or brain abnormalities where perfusion is impaired are at increased risk of spinal cord or cerebral decompression sickness.
. History of seizures other than childhood febrile seizures
. Intracranial tumor or aneurysm
. History of TIA or CVA
. History of spinal cord injury, disease or surgery with residual sequelae
. History of type II (serious and/or central nervous system) decompression sickness with permanent neurologic deficits

Relative Contraindications:
. Migraine headaches whose symptoms or severity impair motor or cognitive function
. History of head injury with sequelae other than seizure
. Herniated nucleus pulposus
. Peripheral neuropathy
. Trigeminal neuralgia
. History of spinal cord or brain injury without residual neurologic deficit
. History of cerebral gas embolism without residual (pulmonary air trapping has been excluded)
. Cerebral palsy in the absence of seizure activity

NOAA Absolute Contra-indications
Neurological

· History of Seizure disorder: After head injury, disallow diving during that period of time that the diver is at risk for seizures
http://www.scuba-doc.com/epildv.htm

Risk Assessment
No evidence exists that diving with compressed air scuba to the accepted 130 fsw limit increases the risk of epileptic seizures. One is no more likely to seize while diving than while driving: the risk is the same. There is no useful data to determine the potential for injury in divers with epilepsy. So the assessment of risk is mostly subjective rather than objective.

The general position that any sedating medication (includes those controlling epilepsy) is enhanced by high partial pressures of nitrogen is unproven. With the exception of very few studies, this is an assumption.

The position that seizure activity can be triggered by underwater pressure due to increased O2 pp has been shown to occur in a low percent of all dives. Increased seizure activity in epileptics due to glare, flickering light, psychological factors, cold water, hyperventilation or anxiety is unproven.

Recommended convulsion-free intervals on and off medication are highly variable depending upon the locale and are somewhat based upon the regulations concerning driving with epilepsy. (There is an increase of 1.3-2.0 times the accident rate in seizure free drivers). However, persons with seizure history are not passed as fit to pilot an airplane.

The risk of drowning or pulmonary barotrauma are high for any loss of consciousness.

Fitness to Dive?
From a 'common-sense' point of view it would appear that the risk of accident to the diver and associates is too great to approve a person with epilepsy as 'fit to dive'.

· Intracranial tumor or aneurysm
Our assessment:
The risk of both of these untreated diagnoses would be the same as on the surface - hemorrhage with loss of consciousness. The big difference is that underwater, drowning will surely occur.
Therefore, the risk of LOC is highly variable but present.
Increased risk of DCS has not been reported, to my knowledge.
The possibility of erratic and irresponsible behavior would seem to be minimal and not brought on by diving with these entities.
Ability to self and buddy rescue variable.

Fitness to dive?
It would probably be unwise to dive with these conditions unless treated and stable for a long enough period of time to assess the possibility of seizures.

· History of TIA (transient ischemic attacks) or CVA (cerebral vascular accidents)
See http://www.scuba-doc.com/tia.htm

Assessment:
TIAs and CVAs are both associated with an increased incidence of arterial disease and are apt to reoccur.
The risk of LOC is increased and certain diving activities can increase the intracranial pressure (Valsalva, straining) possibly increasing the risk of hemorrhage.
Most diving physicians feel that an area of deranged vascularity increases the risk of nitrogen bubble accumulation and DCS. (unproven?)
There would be no increase in erratic or irresponsible behavior.
There is the possibility of decreased ability to self and buddy rescue.

Fitness to dive?
Absolute restriction on sport diving seems draconian and each instance should require a case-by-case decision, made with the advice of the treating physician, family and diving partners. Consulting a neurologist familiar with diving medicine is also advisable. New divers should not be certified as fit to dive. Experienced divers should be assessed on a case by case basis.

· History of spinal cord injury, disease or surgery with residual sequelae.
This includes a history of having had Type II neurological DCS with permanent neurological deficits.

Risk Assessment
LOC not applicable
The risk in this situation is mainly the fear of further damage to the previously scarred spinal cord tissue from decompression injury.
Erratic and irrsponsible behavior is not applicable.
Ability to self and buddy rescue is problematic.

Fitness to Dive?
Reinjury to a previously damaged spinal cord would be disastrous and these divers should not be allowed to sport dive.

· Episodic loss of consciousness
A history of unexplained syncopal episodes, whether cardiovascular or neurogenic.
Until diagnosed and treated effectively, this is a valid contra-indication.

· Recurring neurologic disorders (ie: multiple sclerosis)
See http://www.scuba-doc.com/msdiv.htm

Risk Assessment
Risk factors are inability to self and buddy rescue, confusion of diagnosis of decompression accident.
Loss of consciousness is not a risk factor.
There is no evidence of increased risk for DCS.
Most people with this condition have no change in their personality and behave quite responsibly.
The condition comes and goes and is characterized by remissions and exacerbations.

Fitness to Dive?
Absolute contra-indication to sport diving seems overly restrictive and each instance should require a case-by-case decision, made with the advice of the treating physician, family and diving partners. Consulting a neurologist familiar with diving medicine is also advisable.

· Peripheral neuropathies associated with weakness or significant pain or sensory loss, or that it is recurrent/progressive, is disqualifying

Risk assessment:
Loss of consciousness is not a factor
Increased susceptibility to DCS is not reported as being a problem.
Confusion with the signs and symptoms of DCS would be a significant factor.
Behavior is not a problem.
Self and buddy rescue might be a significant problem.

Fitness to dive?
Absolute restriction on diving seems harsh and each instance should require a case-by-case decision, made with the advice of the treating physician, family and diving partners. Consulting a neurologist familiar with diving medicine is also advisable.

NOAA Relative Contra-indications

Neurologic
· Migraine: Those persons who have migraine with any of the following should not dive:
Aura, impairment of one of the senses, nausea and vomiting or photophobia.
This should not be a restriction in the sport diver. Obviously, a diver should not dive during an attack or if diving is known to bring on an attack. The relationship of PFO and migraine with aura should be restrictive.

· Head injuries: Persons can be cleared for diving following head injuries if they have no
history of: intracranial hemorrhage
· Brain contusion:
- Unconsciousness lasting 24 hours or longer
- Unconsciousness lasted 2-24 hours and the person has been seizure free for 2
years
- Unconsciousness lasted less than 2 hours and the person has a normal
neurological workup.
- Person is neurologically normal one year after experiencing 3-4 weeks of
amnesia.
- Neurologically normal nine months after experiencing 2-3 weeks of amnesia.
- Neurologically normal 6 months after amnesia for 1-2 weeks
- Neurologically normal 6 weeks after momentary amnesia.
· Simple febrile seizures: Seizures accompanying febrile episodes below the age of 6 with
no history of abnormal neurological exams, seizures of longer than 15 minutes duration
or non-febrile seizures in family members.
· Ruptured disc without neurological or physical impairments. Successful disc surgery below L1-L2 and uncomplicated, successful cervical disc surgery from an anterior
approach after 3 months.
· CNS (brain or spinal cord) decompression sickness with complete resolution of signs and symptoms within 24 hours.
· Cerebral gas embolism with complete resolution of signs and symptoms within 24 hours
assuming no complications from pulmonary considerations
· Brain surgery (tumor or aneurysm)

Ten Foot Stop Humor

2005-04-28T12:01:00.000-07:00

Humor for Ten Foot Stop, April 30, 2005

Victoria's Secret Story

<>A husband walks into Victoria's Secret to purchase some sheer lingerie for his wife. He is shown several possibilities that range from $250 to $500 in price, the more sheer, the higher the price. He opts for the most sheer item, pays the $500 and takes the lingerie home.

He presents it to his wife and asks her to go upstairs, put it on and model it for him. Upstairs, the wife thinks, "I have an idea. It's so sheer that it might as well be nothing. I won't put it on, but I'll do the modeling naked, return it tomorrow and keep the $500 refund for myself."

So she appears naked and strikes a pose.

Her husband says, "Goodness gracious! You'd think that for $500, they'd at least iron it!"

He never heard the shot.

Funeral on Friday.

*************************************************************

An elderly couple is enjoying an anniversary dinner together in a small

tavern.

The husband leans over and asks his wife, "Do you remember the first

time we had sex together over fifty years ago? We went behind this

tavern where you leaned against the fence and I made love to you."

"Yes," she says, "I remember it well."

"OK," he says, "how about taking a stroll round there again and we can

do it for old time's sake?"

"Oooooooh Henry, you devil, that sounds like a good idea," she answers.

There's a police officer sitting in the next booth listening to all

this, and having a chuckle to himself. He thinks, "I've got to see

these two old- timers having sex against a fence. I'll just keep an eye

on them so there's no trouble."

So he follows them. They walk haltingly along,

leaning on each other for support, aided by walking sticks.

Finally they get to the back of the tavern and make their way to the

fence. The old lady lifts

her skirt, takes her knickers down and the old man drops his trousers.

She turns around and as she hangs on to the fence, the old man moves in.

Suddenly they erupt into the most furious sex that the watching

policeman has ever seen.

They are bucking and jumping like eighteen-year-olds. This goes on for

about forty minutes! She's yelling, "Ohhh, God!" He's hanging on to her

hips for dear life.

This is the most athletic sex imaginable. Finally, they both collapse

panting on the ground.

The policeman is amazed. He thinks he has learned something about life

that he didn't know.

After about half an hour of lying on the ground recovering, the old

couple struggle to their feet and put their clothes back on.

The policeman, still watching thinks, that was truly amazing, he was

going like a train. I've got to ask him what his secret is.

As the couple passes, he says to them, "That was something else!

You must have been having sex for about forty minutes. How do you

manage it?

You must have had a fantastic life together. Is there some sort of

secret?"

The old man says,

"Fifty years ago that wasn't an electric fence."

***********************************************************************
OLD FRED

Old Fred's hospital bed is surrounded by well-wishers, but it doesn't look good. Suddenly, he motions frantically to the pastor for something to write on.

The pastor lovingly hands him a pen and a piece of paper, and Fred uses his last bit of energy to scribble a note, then dies.

The pastor thinks it best not to look at the note right away, so he places it in his jacket pocket..

At Fred's funeral, as the pastor is finishing his eulogy, he realizes he's wearing the jacket he was wearing when Fred died.

"Fred handed me a note just before he died," he says. "I haven't looked at it, but knowing Fred, I'm sure there's a word of inspiration in it for us all."

Opening the note, he reads aloud, "Move! You're standing on my oxygen hose!"

***********************************************************************

A Little Scotch Humor
Little Johnny's neighbour had a baby.Unfortunately, the baby was born without ears. When mother and new baby came home from the hospital Johnny's family was invited over to see the baby. Before they left their house, Little Johnny's dad had a talk with him and explained that the baby had no ears. His dad also told him that if he so much as mentioned anything about the baby's missing ears or even said the word ears he would get the smacking of his life when they came back home.

Little Johnny told his dad he understood completely. When Johnny looked in the crib he said, "What a beautiful baby."

The mother said, "Why, thank you, Little Johnny." Johnny said, "He has beautiful little feet and beautiful little hands, a cute little nose and really beautiful eyes. Can he see?"

"Yes",the mother replied, "we are so thankful; the Doctor said he will have 20/20 vision."

"That's great", said Little Johnny, "coz he'd be screwed if he needed glasses".

"Good trade"

For all of us who are married, were married, wish you were married, or wish you weren't married, this is something to smile about the next time you open a bottle of wine:

Sally was driving home from one of her business trips in Northern Arizona when she saw an elderly Navajo woman walking on the side of the road. As the trip was a long and quiet one, she stopped the car and asked the Navajo woman if she would like a ride. With a silent nod of thanks, the woman got into the car.

Resuming the journey, Sally tried in vain to make a bit of small talk with the Navajo woman. The old woman just sat silently, looking intently at everything she saw, studying every little detail, until she noticed a brown bag on the seat next to Sally.

"What's in the brown bag?" she asked. Sally looked down at the brown bag and said, "It's a bottle of wine. I got it for my husband." The Navajo woman was silent for another moment or two. Then speaking with the quiet wisdom of an elder, she said, "Good trade."

Earring

A man is at work one day when he notices that his co-worker is wearing an earring. This man knows his co-worker to be a normally conservative fellow, and is curious about his sudden change in "fashion sense."

The man walks up to him and says, "I didn't know you were into earrings."

"Don't make such a big deal, it's only an earring," he replies sheepishly.

His friend falls silent for a few minutes, but then his curiosity prods him to say, "So, how long have you been wearing one?"

"Ever since my wife found it in my truck.

DocVikingo to moderate 'Scuba Clinic"

2005-04-19T08:12:00.000-07:00

My friend, DocVikingo, has graciously agreed to help us with answers to our questions on our 'Scuba Clinic' forum. He will join our other moderators in helping me to keep ahead of the growing tasks of the web site, newsletter and the forum. DocVikingo has written about diving medical problems for various publications, including Undercurrent, Scuba Diving Magazine and DAN's Alert Diver. We have several of his articles on our web site, "Depression and Diving", "Safe Sea - Getting Nailed by Jellies and a Scuba Board Thread about Teen Divers. I am continuously impressed by his breadth of knowledge and wise use of common sense approaches to diving medical problems. We are indeed fortunate to have access to his expertise! Ern Campbell

An Introduction to Technical Diving Updated

2005-03-14T06:27:00.000-08:00

Bookstore web page updated with the correct address for 'Introduction to Technical Diving'.

An Introduction to Technical Diving

A CD-ROM for Windows® and Macintosh® Computers [US$29.95]

This CD-ROM introduces the realm of technical diving through the experiences of the expeditionary team El Proyecto de Buceo Espeleologico México y América Central , led by world record holders Jim Bowden and Dr. Ann Kristovich.

Dental Implants article from Alert Diver added to web site

2005-03-12T07:51:00.000-08:00

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

To read the article, go to http://scuba-doc.com/dentalimplants.html. As usual, Dr. Stein goes right to the heart of the matter, giving excellent background information and risk assessments associated with the dental procedure. We are fortunate to have Dr. Stein on our team.

scubadoc

*The article is also available in pdf on the web page at http://www.scuba-doc.com/dentprbs.html .

Electives in Diving Medicine for Medical Students

2005-03-11T08:21:00.000-08:00

We regularly get requests for information and/or contacts for electives in diving and hyperbaric medicine from medical students, often from the UK.

Here is a response that we have developed from information that we have gleaned from the web and from our consultants. Surely, there are many more that we don't know about and we would be delighted to include other sites and sources. Just let me know at scubadoc@scuba-doc.com .

Hello :

Here are some sources that we have developed for requests such as yours:

---A Spanish treatment center, CRIS in Barcelona, that you might want to
consider is run by Dr Jordi Desola cris@comb.es .

---Depending on your envisaged dates and academic needs, it is possible to arrange a rotation for you at the University of Pretoria, the Institute for Aviation Medicine, Divers Alert Network, and the Eugene Marais Hospital HBO Therapy Centre. Here is your contact person:

Frans Cronje
Medical Director EMHBOTC
Executive & Medical Director - Divers Alert Network Southern Africa
fcronje@hbo.co.za

---SHARM EL SHEIKH, Egypt

This would be a great elective in a very busy center run by a highly qualified person, Dr. Adel Taher.

Hyperbaric Medical Center
Phone +20 (69) 660 922/-3 (10.30-18.00h local time)
Fax: +20 (69) 661 011
24 hr Emergency Phone +20 (12) 212 42 92
Dr. Adel Taher, Director
Director, DAN - Egypt.
Email: hyper_med_center@sinainet.com.eg

Sources for contact in Australasia and New Zealand include the following:
Dr David Wilkinson
Hyperbaric Medicine Unit
Royal Adelaide Hospital
North Terrace
ADELAIDE
SA 5000

Ph: +61 8 8222 5116
Fax: +61 8 8232 4207
email: dwilkins@mail.rah.sa.gov.au

Dr Ian Millar
Hyperbaric Service
The Alfred Hospital
Commercial Road
PRAHRAN
VIC 3181

Ph: +61 3 9276 2269
Fax: +61 3 9276 3052
email: i.millar@alfred.org.au

Dr Margaret Walker
Hyperbaric Medicine Unit
Royal Hobart Hospital
PO Box 1061L
HOBART
TAS 7001

Ph: +61 3 6222 8322
Fax: +61 3 6222 8322
email: margaret.walker@dhhs.tas.gov.au

Dr Mike Bennett
Dept of Diving and Hyperbaric Medicine
Prince of Wales Hospital
Barker Street
Randwick
NSW 2031

Ph: +61 2 9382 3880
Fax: +61 2 9382 3882
email: m.bennett@unsw.edu.au

Dr David Griffith
Hyperbaric Medicine Unit
The Townsville Hospital
PO Box 670
TOWNSVILLE
QLD 4810

Ph: +61 7 4796 2080
Fax: +61 7 4796 2081

email: David_Griffith@health.qld.gov.au

Dr Robert Long
The Wesley Centre for Hyperbaric Medicine
Wesley Hospital
Suite 53, Sandford Jackson Building
AUCHENFLOWER
QLD 4066

Ph: +61 7 3371 6033
Ph: +61 7 3371 1566
email: Dr.Long@wesley.com.au

Dr Robert Wong
Department of Hyperbaric Medicine
Fremantle Hospital
PO Box 480
FREMANTLE
WA 6160

Ph: +61 8 9431 2233
Fax: +61 8 9431 2235
email: robert.wong@health.wa.gov.au

Other units in NZ are in Auckland but are private clinics or Navy. The Slark
Hyperbaric Unit at Devonport Naval Base in Auckland is currently run by
Cdr Alison Drewry, phone number is +64 9 445 5972

For possible resources in the UK you can contact the Plymouth Diving
Diseases Research Centre:

The Hyperbaric Medical Center (DDRC-Plymouth)
Tamar Science Park, Dernford Road,
Plymouth, Devon, UK, PL6 8BQ
Dr. P.J. Bryson
Telephone: 01752 209999.

---Aberdeen chamber. Try Dr Stephen Watt or Dr John Ross at the University Department of Environmental and Occupational Medicine s.j.watt@abdn.ac.uk &
j.a.ross@abdn.ac.uk .

Dr Stephen Watt runs the University Diploma courses in Diving Medicine, and they have had Student Elective Participants. He advises you should attempt to attend when there is a course running and that is a bonus as you can attend. The hyperbaric unit is huge, highly organized and is one of the busiest in the UK. Dr John Ross is the Director and is a Consultant Anaesthetist, and Dr Watt is a Consultant Respiratory Physician in addition. They are the most experienced group in the UK.
Telephone number as: 01224-558195.

In the U.S.:

Duke Center for Hyperbaric Medicine and Environmental Research Duke
University Medical Center DUMC-3823 Durham NC; 27710 USA
Ph: (919)684-3305 / 6726
Fax: (919)684-6002
Medical Staff:

Prof. Claude Piantadosi, MD (Director)
Prof. Richard Moon, MD; (Medical Director)
Bret Stolp, MD
Guy Dear, MB.ChB; FRCA
Website:
http://hyperbaric.mc.duke.edu

Baptist Medical Center
Hyperbaric Department
800 Prudential Drive
Jacksonville, FL 32207
904-202-1151
Dr. Tom Bozzuto
Thomas.Bozzuto@bmcjax.com
We can host medical students as well. 95% of our HBO Treatments are
wound care, but we see about 40 divers during the summer months.

Medical College of Wisconsin,
Clinics At Froedtert Mem. Lutheran Hospital
Hyperbaric Unit
Harry T. Whelan, MD
Professor of Neurology, Pediatrics & Hyperbarics
9200 W. Wisconsin Ave.,
Milwaukee, WI, 53226
414-454-5060
414-454-7823 fax
e-mail - hwhelan@mcw.edu
http://www.mcw.edu/whelan

The UHMS lists the following places that offer fellowships:

Memorial Medical Center
Long Beach, California
Contact: Enoch Huang, MD
(562)933-6951
ehuang7500@aol.com

Louisiana State University
New Orleans, Louisiana
Contact: Keith Van Meter, MD
(504)366-7638
504-896-3143 (FAX)

Duke University Medical Center
Durham, North Carolina
Contact: Richard Moon, MD
(919)684-6726
Moon0002@mc.duke.edu

University of Pennsylvania
Philadelphia, Pennsylvania
Contact: Stephen Thom, MD, PhD
(215)898-9095
sthom@mail.med.upenn.edu

Palmetto Richland Memorial Hospital
Columbia, South Carolina
Contact: Lindsie Cone, MD
(803)434-7101

Hermann Hospital (University of Texas)
Houston, Texas
Contact: Carolina Fife, MD
Caroline.E.Fife@uth.tmc.edu
(407)704-4268

University of California San Diego
San Diego, California
Contact: Karen Van Hoesen, MD
(619) 543-6463
jduchnick@ucsd.edu

University of Miami/Jackson Memorial Hospital
Miami, Florida
Contact: Luis A. Matos, MD, MPH
(305) 585-3483
http://surgery.med.miami.edu/hyperbaric/index.asp

I hope these contact sources are helpful! We would appreciate feedback on your experiences.

Ern Campbell, MD
'scubadoc'
Diving Medicine Online
http://scuba-doc.com/

Scuba Diving HQ Resource Directory Added to links

2005-02-28T07:01:00.000-08:00

The following link has been added to our web page at http://scuba-doc.com/lnks.html

Scuba Diving HQ Resource Directory

info@scubadiving-hq.com

scubadoc

Diving Medicine Online

http://scuba-doc.com

Re: HBO Links

2005-02-25T14:01:00.000-08:00

We have had a request from Best Publishing Company for a link on our HBO
Links page.
Best Publishing Company
www.bestpub.com
BPC is a well-respected publisher of quality books on hyperbaric medicine,
diving medicine and wound care.

The listing has been placed on our web page at
http://www.scuba-doc.com/hbolnks.htm and awaits your visit for approval.

UK physician Added to web pages

2005-02-24T09:03:00.000-08:00

Here is some new information that has been added to our web pages at http://www.scuba-doc.com/divuk.htm and http://scuba-doc.com/listchmbr.html .

DR JULES EDEN

HSE DIVING DOCTOR

SPORT DIVING DOCTOR

HYPERBARIC PHYSICIAN

located at The London Diving Chamber

The Hospital of St John and St Elizabeth

60 Grove End Rd

St Johns Wood London NW8 9NH

Phone GP and Diving Clinic 0207 806 4028

www.e-med.co.uk

doctor@e-med.co.uk

HBO Chamber added for Macomb/Clinton Michigan

2005-02-16T07:53:00.000-08:00

The following hyperbaric chamber has been added to our web page at http://scuba-doc.com/divmich.htm .

Macomb/Clinton Wound and Hyperbaric Medicine
43475 Dalcoma. Ste. 150
Clinton Township, Michigan 48038
Phone: 586-228-7308
Fax: 586-228-7315
E-mail: clintonhyperbaric@yahoo.com
3 Monoplace Sechrist 32" chambers
Medical Director: Dr.Richard Utarnachitt
We are open Monday through Friday 9a.m. to 5p.m. with extended
hours for weekends by appointment. Please call for added information.
Web site being developed.

Divers Supply USA Added to links page

2005-02-07T07:36:00.000-08:00

Added to our links web page at http/:/scuba-doc.com/lnks.html .

Divers Supply USA
Scuba Equipment and Snorkeling Gear at the guaranteed lowest price!

Ruptured TM and Doc's ProPlugs, Diving?

2005-02-05T16:09:00.000-08:00

Here is an interesting question and answer from a German physician on Scuba Clinic.

http://scuba-doc.com/scubaclinic/viewtopic.php?t=93

scubadoc

New addition to HBO links web page

2005-02-03T06:44:00.000-08:00

The following link has been added to our HBO Links web page:

The Jenny Rose Center
Hyperbaric clinic for problem wounds and services for special needs children .

http://www.scuba-doc.com/hbolnks.htm

Curriculum vitae web page revised

2005-01-31T07:43:00.000-08:00

The web page containing the CV of Ernest S Campbell, MD has been revised to update some items of interest.

This web page can be seen at http://www.scuba-doc.com/cvESC.html .

scubadoc

Philippine Dive Accident facilities webpage updated

2005-01-29T08:39:00.000-08:00

We have recently updated the Philippines Dive Accident Facilities web page to include updated and new information from Dr. Ben Luna, Cardiologist and Director, DANSEAP.

This information is as follows:

DAN SEAP Philippines

DIVE ACCIDENT FACILITIES:

1. MANILA

Armed Forces of the Philippines (AFP) Medical Center

V.Luna Rd., Quezon City

+(632) 920 7183 / 426 2701 to 14 ext. 6445 / 6245

Dr. Jose Bernardo

+(63-919) 347 1773 (mobile)

2. SUBIC

Subic Bay Freeport Zone, Philippines 2222

+(63-47) 252 7566 / +(63-47) 252 7052

Subic Yacht Club (24 hrs)

+(63-47) 252 5211

+(63-47) 2522431

Dr. David Calapatia

Calapatia Polymedic Clinic

+(63-917) 512 1963 (mobile)

+(63-47) 222 2002 (H) 24 hrs

+(63-47) 222 9600 (W)

Randy dela Rea

+(63-919) 419 6274 (mobile)

3. CEBU

Camp Lapu-Lapu Lahug, Cebu City

+(63-32) 233 9942

Mamerto Ortega

+(63-919) 517 5900 (mobile)

Kitoy Mercado

+(63-920) 782 6515 (mobile)

Dr. Jet Santos

Hyperbaric Physician – Cebu City

+(63-917) 620 2168 (mobile)

4. BATANGAS

St. Patrick’s Hospital Medical Center

Lopez Jaena St., Batangas City 4200

Batangas, Philippines

+(63-43) 723 8388

+(63-43) 723 2167

+(63-43) 723 7089 (Chamber)

Dr. Michael Francis M. Perez

General Surgery, Diving and Hyperbaric Medicine

+(63-917) 536 2757 (mobile)

mperezmd@batangas.net.ph

5. PALAWAN

Sea Dive Resort Hyperbaric Chamber

Coron, Palawan

Maribel Fortes

+(63-920) 458 1360

DIVE PHYSICIANS:

1. DR. BENJAMIN LUNA (Manila)

Director – Divers Alert Network SEAP Philippines

Cardiologist – Room 123, Makati Medical Center

Room 210, Asian Hospital and Medical Center

+(632) 815 9911 ext. 2123 (office)

+(63-917) 834 8363 (mobile)

blunamd@yahoo.com

2. DR. JOSE BERNARDO (Manila)

+(63-919) 347 1773 (mobile)

3. DR. DAVID CALAPATIA (Subic)

Calapatia Polymedic Clinic

+(63-917) 512 1963

+(63-47) 222 2002 (H) 24 hrs

+(63-47) 222 9600 (W)

4. DR. JET SANTOS (Cebu)

Hyperbaric Physician – Cebu City

+(63-917) 620 2168 (mobile)

5. DR. MICHAEL FRANCIS M. PEREZ (Batangas)

General Surgery, Diving and Hyperbaric Medicine

+(63-917) 536 2757 (mobile)

mperezmd@batangas.net.ph

6. DR. ALBERT Y. PINGOY (Davao)

DR. JEFFREY M. RAMOS (Davao)

+(63-917) 700 5677 (mobile)

jeframos_02@hotmail.com

Wind and Wave Dive Shop

PPA Bldg. Sta. Ana Wharf, Davao City, Philippines

+(63-82) 227 0234

+(63-82) 300 7914

scubadoc

Turkish Translation added to Diving Medicine Online Web Site

2005-01-04T08:43:00.000-08:00

Please note that a Turkish translation has been added to our translation facility on our home page. In addition, Turkish can also be used on the Site Map page.

The site map allows you to reach most of our web pages - and by accessing your web page through the translated site map - the linked page is automatically translated to the language that you are using.

Revised links to Scottish Diving Medicine Website

2005-01-04T08:14:00.000-08:00

We have revised links to the Scottish Diving Medicine website in response to this letter from Dr. John Ross. Their new web site is well done and contains good information for divers in their area of the UK. This site is linked at http://www.scuba-doc.com/divuk.htm and at http://www.scuba-doc.com/DCSLnks.html .

"The Scottish Diving Medicine website has been moved on to a new server. The old one on sams.ac.uk will not be updated. The new address is http://www.sdm.scot.nhs.uk/
Regards
John Ross"

Dr John A S Ross
Senior Lecturer, Hon. Consultant
Department of Environmental and Occupational Medicine
University of Aberdeen Medical School
Aberdeen AB25 2ZP

New web page created for ADD/ADHDhtml

2004-12-28T15:12:00.000-08:00

We have posted a new page on Diving Medicine Online "ADD/ADHD" - concerning the possible risks of diving with this condition or while taking medication for the condition. It can be accessed directly at http://scuba-doc.com/ADDADHD.html or from the link on our Mental Illness web page at http://scuba-doc.com/psyc.html .

Enjoy!

scubadoc

Changes in our subscription page.

2004-12-24T11:21:00.000-08:00

Our newsletter, Ten Foot Stop, is free to anyone who registers. It is supported by contributions and donations from those so inclined to help defray the expenses of operation. It is accessible on our web blog at http://tenfootstop.blogspot.com/ from our home page.

We have had a relationship with PayPal and amazon.com for the past three years for the convenience of subscribers. They can also send us money through the mail in the form of a check or money order.

When a person subscribed to our newsletter and sent funds through PayPal, they were told that they will receive recurring requests on a yearly basis. The subscriber also has the facility to donate and then immediately cancel their subscription so that they will not have their funds automatically renewed. Some did not see this part of the registration and became upset that their funds were being removed without permission. Most who did not want this to happen simply cancelled their subscription - we continued to send out the newsletter as they were on an entirely separate mailing list.

This automatic renewal has caused some confusion and we have tried to have it changed with PayPal, to no avail. Consequently, we are cancelling "PayPal subscriptions" (while retaining names on our mailing list) and removing the PayPal buttons from our web site. The individuals will still receive our newsletter, 'The Ten Foot Stop" as before.

Contributions and donations will be welcomed at amazon.com and by check or money order, but will not be necessary to receive the publication. The amazon.com button is located on this web page at http://scuba-doc.com/sbscrb.html .

Best regards, Merry Christmas and a healthy New Year!

Ern Campbell, MD

New web page created for diving accident facilities in Namibia

2004-12-15T14:35:00.000-08:00

We have made a new web page under dive accident facilities, titled Namibia. http://scuba-doc.com/divnam.html .

The following entry has been inserted:

Walvis Bay

Monoplace Chamber

Erongo Primary Health Services (Proprietary) Limited
Welwitschia Hospital, Walvis Bay, Namibia

Johan Wilken, B.Rad (UOVS), CHT
Chief Radiographer, Certified Hyperbaric Technologist.

Telephone : + 264 - (0)64 - 218 914
Facsimile : + 264 - (0)64 - 218 912
Website @ http://www.erongomedical.com/hotc.htm

New entry to UK section of Diving Medical Examiners

2004-12-10T08:23:00.000-08:00

Dr Dominic Gonzalez
MBChB DOccMed

2/2 51 Clouston Street
GLASGOW
G20 8QP
SCOTLAND
UK
Tel: +44 141 945 0836
Cell: +44 7989 408848
dominic.gonzalez@virgin.net

Full-Time Occupational Physician
UKSDMC Dive Referee
HSE Approved Medical Examiner of Divers
PADI Divemaster

************************************************************

Link added to Wilderness Medical Society

2004-12-06T14:36:00.000-08:00

Through the auspices of Dr. Jolie Bookspan, our web site has been added to the links page of the Wilderness medical Society. See http://www.wms.org/links/interest.asp .

We have also added them to our links page at http://www.scuba-doc.com/lnks.html .

****************************************************