In-Water Recompression, Revisited

[Kay Dee]

I............ haven't pushed a 2.8 doing IWR

Nor have I.

Can you get away with it? Yeah, maybe but I wouldn't take those odds in water.

I am certainly not asking / advocating you or anyone else 'take those odds'. Just describing what I would do in a certain circumstance (as I described many pages ago,) that is far from 'hypothetical' (as someone else referred to it as) in my sphere of real world situations / experience.

Then again my thoughts on IWR is it's first aid, not treatment, treatment comes later

If you go back and read of my own personal experience using IWR, it was certainly treatment in my case, not just first aid. Breathing o2 on the surface is what I'd refer to as 'first aid', while in-water reco certainly is not, IMHO. But each to their own of course.

 

[Duke Dive Medicine]

I suspect you think of treatment as treatment to a the best outcome. Kinda a long term thing. I think of IWR on site reco regardless of the "how" as first aid until I can get the afflicted to someone like you

Oh, I agree with you completely. "Treatment" using IWR and "treatment" in a hyperbaric chamber have different objectives. That would be another advantage of having a flexible hyperbaric chamber around.

Best regards,
DDM

 

[Kay Dee]

Kay Dee, You've made your position quite clear, and I recognize that you are not advocating a practice. Please feel free to have whatever procedures performed on yourself that you'd like. It's your body. The reason I keep responding to statements like the one in all caps above is that I don't want anyone reading what you've written and thinking that it's a remotely reasonable option. It is absolutely not.

So basically what you seem to saying, in what you referred to as the / my 'hypothetical' situation I describe many pages ago (although I refer to that as a distinct possibility in my 'circles', not at all 'hypothetical'), is to just lay on deck / bunk breathing o2 while the paralyses gets markedly worse on the multi hour boat ride to shore (where there is / may be no chamber, nor any helo support to call on)? I am not saying you should recommend what I said I would try if I had to, but you better have a better plan than just brushing it off as a 'hypothetical' situation, that's for sure.

Please don't take this as me questioning your right to exercise your own free will. I just hope it never comes down to you having to make a decision like that.

Re first sentence, I don't; re second sentence, me too!

 

[cerich]

Nor have I.






If you go back and read of my own personal experience using IWR, it was certainly treatment in my case, not just first aid. Breathing o2 on the surface is what I'd refer to as 'first aid', while in-water reco certainly is not, IMHO. But each to their own of course.

what was your desired outcome from the IWR? Complete long term resolution or???

By first aid I am trying to help define the difference between a comprehensive medical treatment plan that medical professionals will craft and follow with a patient and what we are doing in the field. IWR, on site re compression can be a magical thing to see how it resolves issues. However what a lay person (such as myself) may consider as having been a treatment is really only removing immediate concerns. Yes it can be life saving, yes it can be really effective as some mitigation of long term issues to the victim. It isn't however "treatment" in a medical sense.

There is also the fact that non licensed individuals who do medical treatment using scheduled pharmaceuticals (oxygen) are committing a felony in most jurisdictions.

So, back to my use of terms. A trained DMT/commercial/mil dive sup/chamber operator can certainly do what some may call a "treatment", however it had better not be practicing medicine. It needs to be first aid.

 

[boulderjohn]

So basically what you seem to saying, in what you referred to as the / my 'hypothetical' situation I describe many pages ago (although I refer to that as a distinct possibility in my 'circles', not at all 'hypothetical'), is to just lay on deck / bunk breathing o2 while the paralyses gets worse on the ten hour or more boat ride to shore (where there is / may be no chamber, nor any helo support to call on)? I am not saying you should recommend what I said I would try if I had to, but you better have a better plan that just brushing it off as a 'hypothetical' situation, that's for sure.

That is a false dilemma. You do not have to choose between going to 60 feet on oxygen or lying on the deck while paralysis gets worse. Instead of going to 60 feet on oxygen, you can go to 20 feet on oxygen. Since going to 20 feet on oxygen is considered to be safer than going to 60 feet, you can make that better choice instead of the other two worse alternatives. The only reason you would go to 60 feet, as I thought you meant in your original post, is that Brett Gilliam was dictating the conditions of your treatment and you had no say in it whatsoever.

 

[cerich]

That is a false dilemma. You do not have to choose between going to 60 feet on oxygen or lying on the deck while paralysis gets worse. Instead of going to 60 feet on oxygen, you can go to 20 feet on oxygen. Since going to 20 feet on oxygen is considered to be safer than going to 60 feet, you can make that better choice instead of the other two worse alternatives. The only reason you would go to 60 feet, as I thought you meant in your original post, is that Brett Gilliam was dictating the conditions of your treatment and you had no say in it whatsoever.

just gonna throw out there that if a diver is exhibiting paralysis that even decompression to alleviation of said is hardly a comprehensive treatment plan. Doctors have a bunch of additional tricks and treatments to help there be a long term solution that hopefully doesn't involve wheelchairs, walkers, adult diapers and loss of sexual function. The earlier they get to use those tools and techniques in conjunction with hyperbarics the better. using IWR beyond a point may be denting a better long term outcome that medical pros may be able to facilitate.

If you choose IWR and get a few hours of lessened symptoms that can be used to transport to med professionals ..make sense. Using IWR beyond that in full on remote ops... Truthfully any excuse to not have better planning than IWR is rolling the dice and the diver(s) that play should be aware of the consequences.

 

[Duke Dive Medicine]

So basically what you seem to saying, in what you referred to as the / my 'hypothetical' situation I describe many pages ago (although I refer to that as a distinct possibility in my 'circles', not at all 'hypothetical'), is to just lay on deck / bunk breathing o2 while the paralyses gets markedly worse on the multi hour boat ride to shore (where there is / may be no chamber, nor any helo support to call on)? I am not saying you should recommend what I said I would try if I had to, but you better have a better plan than just brushing it off as a 'hypothetical' situation, that's for sure.
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Not at all. A diver in the situation you described may well benefit from IWR to an initial treatment depth indicated by an established protocol, e.g. 30 fsw as recommended by the US Navy. There's a big difference between that and going to 60 fsw.

Best regards,
DDM

 

[Kay Dee]

what was your desired outcome from the IWR? Complete long term resolution or???

Yes, long term resolution of course! I was paralyzed from the waist down after all! And given that was twenty five odd years ago, and I have been diving much deeper / longer on multi day / week expeditions ever since, it appears so (i.e. it was resolved). I still can walk (not limp) and talk without slurring (except when drunk) although some may refer to what I have to say as simply 'doggeral' though. ;-)

There is also the fact that non licensed individuals who do medical treatment using scheduled pharmaceuticals (oxygen) are committing a felony in most jurisdictions.

Very very funny! Almost spat out my gin and tonic on those last few words! ;-) As it certainly has no bearing whatsoever / is not in the areas / countries where I have dived regularly over the last 25 odd years.

So, back to my use of terms. A trained DMT/commercial/mil dive sup/chamber operator can certainly do what some may call a "treatment", however it had better not be practicing medicine.

Who said anything about 'practicing medicine'. I believe IWR is / or I refer to it as, simply emergency 'treatment' (for DCS) with the intent of full resolution, i.e. no post chamber ride required .

 

[cerich]

If you ever want to see a person get frustrated, watch a fully trained hyperbaric doctor try to help a badly bent diver at a remote location even with a chamber but NOT all the tools (drugs and diagnostic tools, multi place chamber) on hand that they know would help.

 

[cerich]

Yes, long term resolution of course. I was paralyzed from the waist down after all! And given that was twenty five odd years ago, and I have been diving much deeper / longer on multi day / week expeditions ever since, it appears so (i.e. resolved. I still can walk (not limp) and talk without slurring (except when drunk) although some may refer to what I have to say as simply 'doggeral' though.

you aren't alone, that said I also know divers that didn't have as much luck as you.