OK Now what am I to think

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Very welcome, folks. A take home msg fundamentally is the more diluted the information comes from the original source, the higher the likelihood of misinterpretation ... in this case Divernet's article misses a number of important issues included in Dr. Flooks' original report. However, in its reported facts, it indeed is 100% accurate, but it is strung together to read, in my interpretation, that yoyo diving to 100' is not such a bad idea, it is, and is not supported by Flooks' paper. Flooks' paper suggests safety is really in the 60' and shallower zone.

Often, a more precise description is a press release from Dr. Flooks' representative, but the best printed reference is the actual study itself, and later quering Dr. Flook in a press conference. If it reads somewhat difficult and is not entirely clear, it probably is the issue is not so clear cut too.

The overall msg of Flook's report is that offgassing in short dives to ~ 50' is quite clean for the profiles done by the fishtrap divers, however she defines what short is. Since ongassing in the early phase of dives is ~ linear, then 10min of bottom time, is almost fully offgassed by a 10 min SIT, thus critical controlling compartments are suitably cleaned out, in this case the CNS and blood. However, if the same time is spent entirely at depth, then the gas uptake enters a different slope, because ongassing is logarithmic, and thus, the tissues have ongassed more.

However, in dives past 60', and more clearly at 100' and deeper, the rate of ongassing is great enough that the yoyo dives provide no benefit in offgassing.

These model reports are independent of the effects of ascent rate or nucleation ... Flook focuses more on inert gas tissue tensions.

A more reasonable lesson from this report is in relation to reinforcing the safety of the procedures done by fish trap divers for shallow depths and for open water instructors, who dive similar profiles. For instructors that is, repeated pool work for several student groups over a day, and later shallow check-out dives to 20-30' often require yo-yo like profiles. DAN's recent accident report suggests a higher accident rate [bends] among instructors though, but doesn't clarify the conditions that led to the accidents.
 
Hello Readers:

PDF File

With the PDF file being available, I was able to read the report by Dr Flook. While the DIVERNET article had an illustration with a hyperbaric chamber, the actual report concern a study that is by calculation only. My original answer concerned obtaining an answer on diving questions by performing a diving experiment. It also concerned how the answer might depend in a large measure on how the experiment was set up. I was surprised to find that the report contained information derived solely by calculation. While all dive tables are first calculated, it is not a problem to see calculations – they are a part of diving sine the time of JS Haldane.

Model

I was however, surprised to see a model that was ostensibly so fine tuned that it gave relative bubble volumes in brain tissue following a set of dive profiles. While the author states that the model has been calibrated, I must say that I am a bit skeptical of all of the results of this particular method. That is not uncommon among scientists.

Possibly most disturbing is the relationship of NDLs to brain DCS. In actual diving practice, NDLs are determined in a laboratory and the first presenting sign is joint pain. An NDL with a neurological problem would not be used. Thus we are confronted with something occurring in the water that is different than NDLs as found in laboratory studies.

Laboratory NDLs

Since NDLs are determined for joint pain DCS, the brain as a target organ is not involved. Open water diving does not necessarily show this pattern and we must seek another explanation. Possible it is poor hydration or possibly it is physical exertion (nucleation effects) that far exceeds laboratory conditions. :06:

The bottom line, to me, is that this study does not really represent a very definitive answer. I would have many issues with the model used, but this FORUM is not the place to go into this.

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm
 
Thanks Dr Deco.

When I read through it seemed the square profile was rather unrealistic. If I understood the report, they made a straight ascent to the surface with no safety stops, not the way most of us dive today.

Also if their bubble model was as accurate and well tested as claimed there must have been multiple studies verifying it? We have several top decompression experts here, have the results of these studies been reported in the Literature?

Ralph
 
Dr Deco makes a good point (as ever). For the benefit of those that don't know the HSE (Health & Safety Executive) is a government body that regulates the diving industry in the UK. Like all govt. it is short of money (unless there is something pointless to do in which case funds are unlimited!!) which I suspect is the reason for the calculations-only approach.
I too was a bit mystified by the brain bubbles stuff. Michael, I rather thought you didn't agree with them???

Does anyone have a view on brain bubbles or the validity of this viewpoint? I'm sure on a practical basis a slow ascent and a short stop are the key to safe diving, but I'm with Curt - a single 60 minute dive has been shown to be safe - the jury is out on the 3 20 minute ones..

Chris
 
Hello chrish:

Brain Bubbles :06:

The problem with “brain bubbles” is getting the micronuclei in a structure that does not move. This is to be contrasted with the other portion of the central nervous system, the spinal cord, which is in a flexible structure and can experience some degree of motion.

In experiments performed by Dr Merrill Spencer and I when I was at the Institute of Applied Physiology and Medicine in Seattle, we implanted an ultrasound probe over the sagittal sinus of the brain in several sheep. These sheep then went very large gas loadings with rapid decompressions. We did not find any gas bubbles coming from the brain unless they appeared first in the carotid artery (and these came from the venous side through the lung circulation). This observation, along with few bubbles produced by the kidneys, they lead to my initial thoughts on the mechanical stress-assisted nucleation hypothesis. [These are given in references 1 - 5, below]

My interpretation of his is that the brain itself has few gas micronuclei and thus cannot form (in reality, grow) a decompression gas phase. Brain problem arise mainly from embolism. The spinal cord is different in that it appears to form an in situ gas phase more readily.

Model Predictions

It is for the reasons cited above that I doubt the validity of a model that can predict brain gas phases from tissue gas loadings. A growing, decompression gas phase requires elevated gas loadings and the presence of a bubble nucleus larger than the Laplace cut off (= nucleus radius where the internal, surface tension pressure equals the dissolved gas pressure).

Model Description

I have not read a description of the model, its development, or its testing. It is based on the model of Burkhart and VanLiew. We do not believe this model to be accurate in several respects. The arguments can be found in references 6-9, below.

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm


References
1. MP Spencer and MR Powell. The etiology of convulsions after hyperbaric exposures. Undersea Biomed. Res., 4, (1), A23 (1977).
2. MR Powell. The Physiological Significance of Doppler-detected Bubbles in Decompression Sickness. In: Early Diagnosis of Decompression Sickness, Undersea Medical Society, Bethesda (1977).
3. MR Powell and MP Spencer. The Pathophysiology of Decompression Sickness and Doppler-detectable Gas Bubbles. Final Technical Report, O.N.R., Contract #N00014-73-C-0094, (1980).
4. MR Powell, MP Spencer, and O von Ramm. Ultrasonic Surveillance of Decompression. In: The Physiology and Medicine of Diving, 3rd Edition, [P.
5. MR Powell. Target Organs. In: The Physiological Basis of Decompression, Undersea Hyperbaric Medical Society, Bethesda, MD, (1987).
6. Srinivasan RS, WA Gerth, MR Powell. Mathematical models of diffusion-limited gas bubble dynamics in tissue. J. Appl. Physiol., 86 (2), 732 – 741, (1999).
7. Srinivasan RS, WA Gerth, MR Powell. A mathematical model of diffusion-limited gas bubble dynamics in tissue with varying diffusion region thickness. Respiration Physiology, 123, 153 – 164, (2000)
8. Srinivasan RS, Gerth WA, Powell MR. Mathematical model of diffusion-limited gas bubble dynamics in unstirred tissue with finite volume. Ann Biomed Eng. 2002;30(2):232-46.
9. Srinivasan, R.S., W. A. Gerth, and M. R. Powell. Mathematical model of diffusion-limited evolution of multiple gas bubbles in tissue, Ann. Biomed. Eng., 31:471-481, 2003.
 
Well I have never heard of anyone getting a "brain bend" in 20 years of diving. so this makes sense to me. As best I know the real "killer" if you will, is AGE which blocks the flow to vital organs, mainly the brain. There seems to be a strong correlation between fast ascent and embolism DCI from what I read (unscientific as that may be!!).

This is what I had understood (prior to the report) to be the issue in the fish farm divers who ascended fast in the belief they were "immune" to DCI due to the short exposure to hyperbaric pressure.

As ever, there is more to be learnt than is known. It is a priviledge to be in such learned company..

Chris.
 
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