In-Water Recompression, Revisited

[Kay Dee]

@Kay Dee have you done any root cause corrective action *RCCA* analysis to figure out why you are bending people at such a high rate?
.

With all due respect, thone1004 - and I am sure others will be very happy to see the last of me - but I am going to have to stop answering yours and other folks questions if you / they misrepresent / put words in my mouth (and as far as I am concerned in this instance, insult me). Why do you say "........you are bending people at such a high rate" as if it's me causing the bending of them?

WTF has someone else getting bent got to do with me! Just cause I am there? I thought I explained clearly my 'relationship' to some of the incidents, no? That is, I don't run their dive profiles and as I said I just happened to be there on many occasions when the events took place, and I might add / clarify, often during an expedition some of us were running, while other people were also diving in same location or even off the same boat, but were not part of 'our expedition'. Might seem odd or a coincidence to some, but I was known to 'get around' (and thats not chest betting!) but a fact.

And yes I have done a very lot of what people would say is high risk diving - I'd be the last person to call 'risk averse' by any means - (and again not chest beating here, just stating facts) and know others who were doing same, but NOT ALWAYS ON OUR EXPEDITION TEAM / or under our control as it were, who got bent doing their own thing, and sometimes even off the boat we were diving from. I, occasionally, but not always, stepped in after the fact to help in some way, but certainly did not 'run' their treatment. So again, let me repeat, I have only personally run three IWR's myself, that is where I was more or less in complete control of the treatment, but have witnessed quite a few others I might add. But that's a big difference IMO to me bending them / running the treatment, no? And those three are; my own incident - without an FFM (which I was a bit less than more in control of, but I ran it / called the shots), and two others I treated / ran with my own pro IWR kit in a remote location out in the Pacific. And yes all three of these were in the 90's, and all three had complete resolution (even the other one who started to develop the very same symptoms as my own IWR, literally as he was climbing up the dive boat ladder, and we had him kitted up and back in the water at 9m on o2 on the FFM rig (comms and all) in a matter of minutes. No hesitation there.

All the others I 'saw' were between 2002 and 2010, and IIRC all or almost all happened to divers on CCR's (while the three i 'ran' were on OC).

So, with all due respect thone1004 please read my posts a bit more thoroughly before putting words in my mouth / making undue accusations towards me. Please.

Comprehende amigo?

 

[RainPilot]

So, with all due respect DDM please read my posts a bit more thoroughly before putting words in my mouth / making undue accusations towards me. Please.

That is really ironic since it was @tbone1004 not @Duke Dive Medicine that posted the question.

 

[Kay Dee]

That is really ironic since it was @tbone1004 not @Duke Dive Medicine that posted the question.

Yes saw my slip of the keyboard right after posting and have since corrected. Sincere apologies to DDM if any others read it prior to my correction.

But I did read the post itself thoroughly, just auto typed DDM in my reply, as he seems one of the few people I am communicating here with and one reasonable enough to bother communicating with. ;-)

 

[Dr Simon Mitchell]

Are you sure this is exactly what you intend to say? This could leave the impression that they intentionally bend divers for the purpose of treating them. Wouldn't it be more accurate to say that they expect to bend some percentage of divers as part of the process of determining limits? Basically the procedure is too conservative when nobody gets bent.

At the opposite extreme, I know of several studies that were cancelled when the percentage was too high (back to the drawing board). Over the years this process has provided more than enough opportunity for them to secondarily test DCS treatment procedures.

What I said was exactly accurate. The studies I cite have nothing to do with determining limits or testing treatment procedures.

Simon M

 

[Dr Simon Mitchell]

Maybe is the choice of words. ...showing that almost all cases of DCS presenting early and treated early in these programs get better with no long term problems.

Almost is not every case. I read it as when you're deliberately bending divers followed by immediate recompression, almost every diver has a good outcome. Almost = Not every diver. And that's where ethics come into play.
On the other hand, I agree that a valid study on recompression outcome requires comparable controlled cases of DCS. I am very interested in the results of your IWR review.

Hello Miyaru,

I am not deliberately bending anyone. These are not my studies, and I am therefore not intimately familiar with the outcome in every one of the subjects that experienced DCS as part of the investigations. My understanding is that few (if any) have had issues after treatment, and the IRB involved have considered the ethical issues from a more informed perspective than you or I are capable of from a distance. In any event, it is ethically not that different to normal operational diving which has a known incidence of DCS.

Thanks for your interest in the IWR review. It will be published in a medical journal and made immediately available to the general diving public. I will certainly notify everyone on here when that is so. Probably late this year.

Simon M

 

[tbone1004]

@Kay Dee i read all of the posts thoroughly. The you was as a collective group not you individually. You made it appear that all of the incidents were part of your expedition group. Being part of an expedition group generally means some predefined and agreed upon decompression strategy to be made. If that decompression strategy was causing a high incident rate of DCS that required IWR, then you as a group were obviously choosing either very aggressive profiles, or some other incident.
Where I was trying to go with this was somewhere about this before you get defensive.

"all incidents occurred in the 90's, we didn't know what we didn't know, didn't have the right gas mixes, and have diving more conservatively since"
"they all occurred with *insert X algorithm* and we have chosen to go to a different algorithm due to the high incident rate"

trying to better understand if they were a long time ago based on your profile here, if they were spread evenly and are just a factor of a boat load of dives, or if there was any underlying cause that you looked at. If you are admitting to running aggressive profiles that is fine, it is your prerogative to choose to do that and you are obviously accepting the higher risk of those profiles

 

[Kay Dee]

Hello Miyaru,

Thanks for your interest in the IWR review. It will be published in a medical journal and made immediately available to the general diving public. I will certainly notify everyone on here when that is so. Probably late this year.

Simon M

If you dont mind me asking, if it is not confidential, may I ask how many actual people, either 'treater' or 'treatees' were personally involved with input into your IWR reveiw?

Whatever that number, I look forward to reading the reveiw.

 

[Kay Dee]

@Kay Dee[/USER] i read all of the posts thoroughly. The you was as a collective group not you individually. You made it appear that all of the incidents were part of your expedition group

FIRST APOLOGIES FOR THE CAPITALS, BUT WRITING THIS FROM A TABLET THAT MAKES CUTTING AND PASTING QUOTE PARENTHESES NEXT TO IMPOSSIBLE, HENCE THE CAPITALS. I AM NOT SHOUTING, JUST DIFFERENTIATING 'TBONE1004' AND MY TEXT.

SO WITH THAT SAID;

SORRY, YOUR ASSUMPTION WAS NOT MY INTENT, AND HOPEFULLY I CLARIFIED THAT IN MY INITIAL REPLY TO YOU.

. Being part of an expedition group generally means some predefined and agreed upon decompression strategy to be made.

AS STATED THEY WERE NOT ALL, OR MOSTLY NOT, PART OF OUR GROUP, BUT WHERE THERE ALL THE SAME. SOME OF US DO NOT HAVE THE MONEY TO CHARTER A WHOLE BOAT JUST FOR OUR REALATIVELY SMALL GROUPS ENDEVOURS AFTER ALL.


If that decompression strategy was causing a high incident rate of DCS that required IWR, then you as a group were obviously choosing either very aggressive profiles,

I REPEAT, AGAIN, THEY WERE NOT ALL PART OF OUR GROUP, AND EVEN OUR GROUP MEMBERS WERE NOT FORCED / TIED TO ANY ONE DECO REGIME, OR BE KITTED UP TO DIVE LIKE GUE ENFORCES, FOR WANT OF A BETTER TERM, AND NO OFFENCE MEANT TO THEM.

.or some other incident.
Where I was trying to go with this was somewhere about this before you get defensive.

I GOT DEFENSIVE / OFFENDED BECAUSE THE WAY YOU WROTE YOUR POST (TO ME) MADE A LOT OF ASSUMPTIONS, ESPECIALLY RE MY ROLL IN MATTERS.

"all incidents occurred in the 90's, we didn't know what we didn't know, didn't have the right gas mixes, and have diving more conservatively since"
"they all occurred with *insert X algorithm* and we have chosen to go to a different algorithm due to the high incident rate"

WELL AS MY REPLY TO YOUR POINTS OUT, THE MAJORITY WERE AFTER 2000 AND 'HAPPENED' WHILST THEY WERE DIVING ON CCR,S

trying to better understand if they were a long time ago based on your profile here, if they were spread evenly and are just a factor of a boat load of dives, or if there was any underlying cause that you looked a

PERSONALLY I HAVE LITLE INTEREST WHY OTHERS GET BENT, BUT AS I SAID I SAW A FEW STUPID THINGS DONE THAT GOT SOME PEOPLE BENT (AND CERTAINLY TOOK THAT LESSON ON BOARD. AFTER ALL I AM JUST A DIVER, NOT AN MD.

If you are admitting to running aggressive profiles that is fine,

I DO NOT IN MY OPINION, AND COMPARED TO MANY OTHERS, RUN AGGRESSIVE PROFILES, I JUST SAID I WAS NOT RISK ADVERSE, WHICH IN MY PLAYBOOK IS NOT THE SAME THING BY ANY MEANS. I WAS OFTEN, TO THE FRUSTRATION OF OTHERS, OVERALL RATHER CONSERVITIVE RE THE LENGTH OF MY SHALLOW 02 STOPS. BUT WE WERE OFTEN 'A LONG WAY FROM HOME', SO IMO "BETTER SAFE THAN SORRY"!

it is your prerogative to choose to do that and you are obviously accepting the higher risk of those profiles

AGAIN, GIVEN WHAT I HAVE SAID / SAYING YOU ARE MAKING BIG ASSUMPTIONS ABOUT HOW I DIVE. WHAT RISK OTHERS CHOOSE TO TAKE IS THEIR BUSINESS, NOT MINE. I AM NOT ABOUT TO START PREACHING TO THEM THEY WERE ALL BIG BOYS, AND MOSTLY, KNEW WHAT THEY WERE DOING, OR SEEMED TO. FOR THOSE I DID NOT KNOW AT ALL, AT THE TIME THEIR 'C' CARD CERTAINLY IMPLIED (BUT WOULD NO LONGER) THEY KNEW ANYWAY.

BUT DON'T GET ME STARTED RE WHAT I PERCEIVE TODAY AS THE POOR LACK OF TRAINING FOR MANY SO-CALLED 'TECH' DIVERS, AND THE SLIPSHOD COURSES SOME, AND ONLY SOME (BUT IT ONLY TAKES 'SOME), INSTRUCTORS RUN. I.E. IN OTHER WORDS SOMEONES C CARD NOW MEANS NOTHING TO ME.

EDIT; AND BY THE WAY TBONE1004, AND NO OFFENSE DIRECTLY MEANT, BUT I ASKED SEVERAL NON-RHETORICAL QUESTIONS OF YOU IN MY REPLY AT TOP OF PAGE. SEEMS YOU EXPECT ANSWERS FROM ME, BUT GIVE NONE IN RETURN (TO QUESTIONS DIRECTLY ASKED OF YOU BY ME). THAT, IMO, IS A BIT ONE SIDED IF I MAY SAY SO. KINDA LIKE THE SOUND OF ONE HAND CLAPPING.

BEST FISHES ANYWAY.

 

[Kay Dee]

Well it’s been five days, that is according to counting the number of fingers on one hand mind you, since posting the above questions to both Simon Mitchell, and ‘tbone1004’ and nary a sound resembling a reply, just a deafening silence from both of them.

Now tbone1004, I quickly (i.e. within 24hrs) answered / clarified your questions / misinterpretations of my previous post/s, and then asked you to kindly reply to several specific questions I had previously asked of you, but it seems that you don’t have even the common courtesy to reply to the questions I asked of you. (And seeing as I am now back on my computer - instead of my bloody tablet – I don’t have to use CAPITALS, which in case you didn’t notice, I apologised for having to use in previous.)

As for Mr Mitchell, well with all due respect to my old fair-weather friend, I suppose I should not have expected anything different from him, given past experience. But as he should well know, I am never one to give up, never ever (even when it comes to fair-weather friends), although I did expect more from him in this open forum as it were, where I asked a direct and specific question of him. But then, I can blame only myself for my own expectations.

Be that as it may, seems like some, and I repeat only some, of the old boy network on this thread / forum just don’t like upstart intruders (FNG’s as referred to in another thread), that question the ‘status quo’ or voices a contrary opinion here to what the ‘accepted wisdom’ may be.

Of course, the two folks concerned here may well come back on with a reason for not posting (busy, away, working, diving, etc, etc), but I find it rather odd, or is it just a coincidence, that they are back posting in flash when, for want of better words, if it is something they want to denounce, criticise or pontificate on.

Not to worry, I can take a hint; still I wish you all, all the very best just the same. So stay safe, and don’t be too surprised at my diving practices should you bother to read either of the interview pieces I allowed myself to be subjected to recently below. ;-)

Anyway, I’d like to say it’s been fun, but………………………………..adios amigo’s will just have to do for now.

But for a last laugh, some photos also inserted below, with what I consider to be funny captions in some instances, but how some of you interpret them is anyone's guess.

Best fishes, Kay Dee (aka KD aka Kevin Denlay) ;-)

WW2 Shipwreck exploration by Kevin Denlay: “Going back in time and bringing the ships back to life” – PART 1 – WW2Wrecks.com

The WW2 shipwrecks that disappeared: Underwater explorer Kevin Denlay’s interview on the lost fleet of the Pacific – PART 2 – WW2Wrecks.com

Simon on a very secret NZ wreck, with very difficult penetration options as can be seen, and in a very cold lake I might add, whose GPS marks Simon keeps up his rather long sleeve, and if I revealed them, or even the depth - as I just know some of you are already thinking of all the booty that could be liberated from this beauty - I'd have "the men with green faces hard knocking on my door"! ;-)

Simon (right) on one of the the few 'deep' - 80m +/- a few m's maybe - wrecks (and only trawlers at that!) we had available to dive off Brisbane, Oztralia.

Simon inspecting a trawler wreck off Brisbane a few days after it sank. Again in about 80m; but after all Simon has pulled deco stops deeper than that (as have I for that matter).

Yours truly, quite some time ago I might add, and the sticker on my Mk15.5 says it all! As Paul Simon sang "Still crazy after all these beers" (or was that 'years'?). ;-)

 

[Dr Simon Mitchell]

Well it’s been five days, that is according to counting the number of fingers on one hand mind you, since posting the above questions to both Simon Mitchell, and ‘tbone1004’ and nary a sound resembling a reply, just a deafening silence from both of them.

...and...

Of course, the two folks concerned here may well come back on with a reason for not posting (busy, away, working, diving, etc, etc), but I find it rather odd, or is it just a coincidence, that they are back posting in flash when, for want of better words, if it is something they want to denounce, criticise or pontificate on.

I've got a newsflash for you Kev. I have a real job and my life does not revolve around posting on internet forums. The five days you are referring to I have spent travelling and speaking at a cardiac surgery meeting in Australia. You can satisfy yourself of the veracity of this here:

Programme - PDU

I arrived home at midnight last night, and have been catching up at work today. Have you seen me posting on any other forums over that time? I give a fair amount of my free time providing educational content to sites like this. I think it is a little disingenuous of you to characterise this as "denouncing, criticising and pontificating", and it is totally out of line getting petulant because you had to wait for a reply.

I am also a little taken aback by the reference to "fair weather friend" because I always considered you to be a friend of the normal variety.

As a friend, I am going to give you a couple pieces of advice:

1. If you want particular responsiveness from friends you need to ensure they know who they are speaking to. Hiding behind a non-de-plume is not going to work. A PM might have been a good idea.

2. Attaching your star to Bret Gilliam's rocket on this issue as you do on the Undercurrent site, and concocting a highly implausible scenario which is vaguely supportive of him here is disappointing from an analytical chap like yourself. Your mate is flat out wrong on this issue. It is not a matter of debate. He is not medically qualified, and should not be providing medical advice. His Undercurrent site recommendation to perform IWR at 2.8 ATA breathing oxygen, if followed, carries a significant risk of a serious accident and possibly death. He has been told this by several diving medicine authorities, but has not removed the blog.

To answer your question, the review is an holistic appraisal of IWR as an intervention; not merely a review of cases and outcomes. As part of the appraisal we have reviewed the published evidence which contains quite a few cases and case series, some of which were large (such as the Australian Pearl Divers). We have also gone looking for evidence that early recompression is useful as mentioned earlier. The overall tone of the review is positive for IWR (but not at 2.8 ATA).

Simon M