200ft dive, but avoids the Chamber

[smatterchu]

Great...!

What is it with Tylenol, tho? It's my understanding that it does nothing to treat sore muscles and joints - like aspirin and ibuprofen do...?

Seriously? Then, I figure it's just a general pain reliever that maybe helped until the muscles relaxed - with the shower.

I think if I'd been DAN, maybe I might have published part of the letter with some of the specifics removed. Maybe there was a way to publish part of the letter/account without causing so many questions about DAN's actions/reactions. I think it is good to illustrate how important it is to be able to call DAN even if you've made a bonehead move, but that might have been possible without so many details that seemed to confuse/upset (and rightfully so). Because we didn't have so many of the other details anyway, it's hard to know how to react to DAN's reaction... I dunno...

 

[DandyDon]

Seriously? Then, I figure it's just a general pain reliever that maybe helped until the muscles relaxed - with the shower.

It is, but the other two will do that plus treat the problem. More important at my age

 

[The Chairman]

Hmmmm, that scenerio sounds awfully familiar. :anon: (say, 4 weeks ago??)

Thanks for being the voice of reason on the phone...just needed to hear it from someone who knew. And things pretty much went away once you confirmed my hopes that it was nerves....and I certainly would have seen about it if my symptoms had worsened...thanks!!

At least I didn't mention any names! But yes, it happens every so often. You weren't the first and you sure won't be the last!

Don, it's quite often that the student wants the input of their instructor, who was there with them. In the dive industry, "guilt by association" works two ways. If no one in your party is experiencing these problems, then it very well may be an attack of "nerves". However, I once pulled two narced gentlemen from the depths (way too deep) and got a chamber ride for my efforts. I was asymptomatic, but because I went to their depth and they WERE bent, I had to follow their protocol.

Everyone should remember that you just might be too close to the situation to make the correct call. Both denial and anxiety play havoc with your reasoning ability. I might have the number wrong, but I believe the AVERAGE time for someone with DCS to get to a chamber is 72 hours. This is not due to travel issues, but due to the out and out denial of the patient that he has undergone a hit. If anyone ever feels "symptoms", don't just assume that they are in your head or not. CALL SOMEONE! DAN is always there, ready and more than willing to get to the bottom of things.

In both of these cases, I would argue that the proof is in the pudding. Both DAN and I helped people to make decisions based not on emotion, but on reality. That's all we can ask.

 

[Sharky1948]

Great...!

What is it with Tylenol, tho? It's my understanding that it does nothing to treat sore muscles and joints - like aspirin and ibuprofen do...?

Acetaminophen (Tylenol) relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person. (I.e., not an anti-inflammatory) It reduces fever through its action on the heat-regulating center of the brain.

Aspirin and ibuprofen are both non-steroidal anti-infammatory drugs (NSAIDs) with with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation.

 

[xscreamsuk]

Taking ibuprofen and Tylenol together actually is a very good pain regime. The act of the tylenol potentiates the NSAID. Google, " Oxford League"

 

[Cacia]

Here is one question. NOT an accusation, just one of the things that entered my mind as I read the testimonial. (among others)

Does anyone else out there believe we need to keep an eye on our insurance companies, to feel satisfied that they are delivering the services we pay for? As budget constraints become more and more of a factor, you see HMO's limit treatments by raising the threshold for said treatment. (in some cases)

I am in no way saying I know anything about how this decision to not put this guy in the chamber was made. One reason I was curious about how they do make the decision, is that I would like to be able to analyze the situation a bit better, by answering the question in my mind, which was twofold.

1) To better understand the timeline of the treatment

2) To decide if I think the insurance company should have provided a chamber ride.

Now, I think there is certainly conflicting important details in the story.(mainly the symptoms) But real patients do that all the time, so that is the reality of a medical history given about an incident. I am not being judgemental, just trying to be a bit discerning.

Still, I always ask myself:

1) Who is telling me the story

2) What is their purpose

And then I try to keep an open mind. But, what I do not do, is take an advertisement for a money making company, and then just take it at face value without a tad of scrutiny.

The reason for this is that except for what they tell us, all we have to go on, really is the incidences we hear about and what transpired.

Also, I was trying to make the point that I think, how the physician speaks to you is not really as important as what medical treatment gets covered.

I certainly don't mean to seem jaded, I have seen amazing things happen in ER's, both wonderful and less than wonderful.

Everyone should remember that you just might be too close to the situation to make the correct call. Both denial and anxiety play havoc with your reasoning ability. I might have the number wrong, but I believe the AVERAGE time for someone with DCS to get to a chamber is 72 hours. This is not due to travel issues, but due to the out and out denial of the patient that he has undergone a hit. If anyone ever feels "symptoms", don't just assume that they are in your head or not. CALL SOMEONE!

Very, very, true

What I remain very curious about, is why some people get popped in the chamber for lesser indications (it seems, and why this physician felt comfortable and adequately conservative to just monitor him.

Maybe hyperbaric medicine is evolving to where the call is easier to make..based on some new information?

I was expecting some physicians to have been in here, by now to say that...

 

[DandyDon]

Thanks Sharky1948 and xscreamsuk for the info.

I'm sticking with the aspirin. Cheap and reduces chance of other problems.

Here is one question. NOT an accusation, just one of the things that entered my mind as I read the testimonial. (among others)

Does anyone else out there beleive we need to keep an eye on our insurance companies, to feel satisfied that they are delivering the services we pay for? As budget constraints become more and more of a factor, you see HMO's limit treatments by raising the threshold for said treatment. (in some cases)

I am in no way saying I know anything about how this decision to not put this guy in the chamber was made. One reason I was curious about how they do make the decision, is that I would like to be able to analyze the situation a bit better, by answering the question in my mind, which was twofold.

1) To better understand the timeline of the treatment

2) To decide if I think the insurance company should have provided a chamber ride.

Now, I think there is certainly conflicting important details in the story.(mainly the symptoms) But real patients do that all the time, so that is the reality of a medical history given about an incident. I am not being judgemental, just trying to be a bit discerning.

Still, I always ask myself:

1) Who is telling me the story

2) What is their purpose

And then I try to keep an open mind. But, what I do not do, is take an advertisement for a money making company, and then just take it at face value without a tad of scrutiny.

The good, bad, and ugly of managed care. But that Eastwood movie was before your time.

Even tho Dan does not actually own the insurance company that provides the coverage, I'm sure there is some connection there. Yet, as high profile as Dan is in the dive industry, I doubt that they'd cut corners on treatment and risk another internet attack.

 

[do it easy]

Everyone seems to like HMOs- I think the big draw is that it is based on a fixed price, but they might put people in the situation that you are writing about. The HMO assumes the insurance risk, so it is in their financial interest to control costs. Healthcare has it tough from both sides- if they control costs too much, then they might get sued and their malpractice insurance goes up.

In DAN's case, I'm not sure how the insurance works, but they probably have some skin in the game, just like the HMO. The actual insurance paper might be some "other" company, but there might be either profit sharing arrangements or "alternative risk transfer" arrangements. These are not necessarily bad things; the problems reported in the press are mostly about disclosing these arrangements, rather than having them.

For this case in particular, I'm not sure if the diver had insurance of any kind or not. In the worse case scenario, being insured might influence the advice that he received, although I think it would be highly unlikely if the specialists are incentivized to reduce the number of chamber treatments. Alternatively, DAN could reduce the number of treatments through education and research, which they do.

The message that I take from the story is that DAN is available and willing to help- they are the good guys. I believe that even non-members can call for advice, although I think only the members get the financial benefit of the insurance.

I work for a commercial insurance company. I don't have DAN insurance, but I do have other dive insurance.

 

[Cacia]

I doubt that they'd cut corners on treatment and risk another internet attack.

and, thus, my amazement that they chose this anecdote for their site. I was just curious about that. It even seems like a poor choice to me, politically, to be honest.

Alternatively, DAN could reduce the number of treatments through education and research, which they do.

Which also is expensive, let's remember.

The risk of raising a question is that it will seem like an accusation sometimes. I was only wondering and being honest about my thoughts, because there are people who will read that and wonder, they might not post, but they will wonder "so, why didn't this guy get a ride?" And yes, most people will trust the physician. I trust physicians except for when they are being told what to do by bean counters. They (docs) rely on us to keep the bean counters in check with a little scrutiny. They want to provide the optimal care, in my experience.

Still, the decision was probably based on something medical, like the timeline.

Actually, I might just formulate a question and post in the medical forum and ask Dr. V.

 

[Gradual Ascent]

I thought even with limited evidence that hot showers after diving may increase your chances of bringing on DCS by bringing nitrogen out of solution. To be on the safe side should they be avoided?

http://ambergriscaye.com/pages/town/hyperbaric.html

:I took a hot shower and a Tylenol and I was good to go....and dive the next morning.

...