Why not treat DCS yourself?

[WetSEAL]

Are you aware that Dr Mitchell is one of the preeminent researchers on decompression *in the world*? Some (several) of your assertions/questions do not seem to take his level of knowledge and expertise into account.

Exactly why I am so grateful to have him here to contribute to the discussion, and why I am looking forward to hear his answers to my honest questions after reading his paper.

 

[lv2dive]

Exactly why I am so grateful to have him here to contribute to the discussion, and why I am looking forward to hear his answers to my honest questions after reading his paper.

I imagine @Dr Simon Mitchell will join in, but I will be surprised if he will be able to answer questions to your satisfaction. This thread is 16 pages of seasoned divers providing thoughtful responses to your questions, which you have appeared to repeatedly ignore. If I was in your shoes, I’d start by doing enough reading to get more than “a vague understanding of some of the principles at play here,” and then come back and re-read the thread with an open mind.

... I readily admit that I have only a vague understanding of some of the principles at play here. However, it's also very clear that most of the recommendations and guidance around this issue is based more on reducing liability than on maximizing diver health...

 

[boulderjohn]

I imagine @Dr Simon Mitchell will join in, but I will be surprised if he will be able to answer questions to your satisfaction. This thread is 16 pages of seasoned divers providing thoughtful responses to your questions, which you have appeared to repeatedly ignore.

I think I speak for a number of people who believe your questions have been answered many times already, and they don't see the point in saying the same thing again and again.

 

[WetSEAL]

Yeah.
The OP does not seem to care what others think, especially if they have any experience or credentials,.and his questions are passive-aggressive attempts to discredit anyone who disagrees with him.

Um...excuse me? You have zero basis for making such claims against me. I came here to scubaboard to ask this question precisely because I respect the opinions of those with experience and credentials here.

I am grateful to have received many dozens of responses from professionals, and have read every post with interest. In reading these 15 pages, I have learned a great deal about the subject more rapidly than I would have learned any other way. For one thing, I learned that "IWR" is a thing. I hadn't even heard of the term when I created this thread. I learned that there are established IWR treatment protocols, I learned about how to prevent O2 toxicity based on P02 levels, I learned countless other things, and that is why I keep coming back to read this thread despite the attitude that some have shown me.

I have felt a persistent and toxic attitude expressed towards me by a few people who have repeatedly spread a false and completely baseless narrative about me that I am:

1) advocating for IWR. Actually, I never advocated for IWR, I was merely asking why IWR is not recommended, and trying to understand the basis behind that recommendation. I can even be quoted as saying "I am not yet convinced IWR is necessarily right in any situation."

2) That I am advocating for IWR as a catch all solution. Again no idea where this concept came from, given that every time I've brought it up, I've been first to admit that there are many situations it obviously doesn't make sense for.

3) That I'm promoting IWR without proper training. Never said anything of the sort, to the contrary every time I've talked about preventing oxygen toxicity I've mentioned it would require proper training.

4) That I'm ignoring evidence from a consensus among experts ....despite that probably at least half (possibly more) the experts who have replied on this thread have presented a favorable view of IWR

5) That I am a "troll" who simply wants to spark arguments, despite that in these 15 pages, you can find countless examples of users hurling personal attacks at me, and not a single example of my insulting anyone back, or sparking argument. The worst I have done is tried to engage with my critics by trying to take their short-handed comments seriously (eg, post #74), which I now regret.

When I ask a question online, I leave my ego at the door. I do expect that I will be roasted by the local trolls that exist in every community, that's simply the way the internet works...but this thread has been a genuine test for me. I've had to take extended breaks from reading it just to remind myself not to reply or engage with the vitriolic one-liners like, "You are wrong." or "I hope you kill yourself". Please, don't join them.

 

[dberry]

 

[lv2dive]

I do not recall any one-liners such as you reference, if they do exist, please report them so they can be deleted by staff.

...I've had to take extended breaks from reading it just to remind myself not to reply or engage with the vitriolic one-liners like, "You are wrong." or "I hope you kill yourself". Please, don't join them.

 

[Dsix36]

There's one major step which I haven't seen addressed yet in this thread: diagnosis.

Ask yourself if you're capable of properly diagnosing another diver who is presenting signs and symptoms of DCI.

I have a medical background, I'd be able to check a diver, but before making any suggestions to or decisions for another diver, I would absolutely get DAN on the phone, discuss my findings with a medical doctor and then follow his/her advice. I simply lack the medical knowledge to take full responsibility on my own for an IWR advice. Maybe a chamber is not reachable within 6 hours, but communication is more likely available to consult a hyperbaric doctor.

Also not discussed: communication with an injured diver. Someone who is in pain, will not make the same rational calculated decisions as you right now sitting behind a screen. Communication will be impaired, difficult, or there's even a language barrier (there are other languages besides English). These will make it difficult to get a good overview of all presenting symptoms. And will make your diagnosis even harder.

I do think IWR is beneficial in many cases, if you prepared for it upfront and have the knowledge to care for a patient. Unfortunately some reactions here make it sound like IWR is as easy as going back to the toilet to properly wipe your ass if you missed a spot.

You are damn right about a diver experiencing pain and not being able to make good decisions.

My hit involved girdle pain that was excruciating. Easily the worst pain of my life and my only real concern was getting my butt out of the water before I spit out my DSV to end it all. With hours of decompression in front of me it was extremely difficult to go back to depth and increase my time underwater to do IWR, but I was already paralyzed by the time I got up to 50'. I consequently did not pad my stop times in order to get out as soon as my computer would let me. The paralysis came back later and several chamber rides too.

Pain made me very stupid that day and I paid (am still paying) for it.

 

[Michael Guerrero]

I was merely asking why IWR is not recommended

Because recreational divers do not know how to do it safely.

2) That I am advocating for IWR as a catch all solution.

. OK, but you did ask why it wasn't a first option and taught in our OW scuba courses. That's why the extreme response. It requires quite a bit if training and experience to do safely/correctly, and I would say beyond the OW level by quite a bit.

3) That I'm promoting IWR without proper training. Never said anything of the sort, to the contrary every time I've talked about preventing oxygen toxicity I've mentioned it would require proper training.

Hmm...ok. But then you are effectively arguing for a LONG period of training that necessitates quite a few actual dives and experience building. That's why it's discussed as so far beyond OW.

4) That I'm ignoring evidence from a consensus among experts ....despite that probably at least half (possibly more) the experts who have replied on this thread have presented a favorable view of IWR

Under the right circumstances. Yes, IWR can be an effective, and sometimes the only, treatment to DCS. BUT...doing it SAFELY is a "whole nuther ball of wax." There's a reasonable chance you'll DIE doing it if done improperly. That is why so much emphasis is given to training, experience, proficiency. No taksies backsies.

5) That I am a "troll" who simply wants to spark arguments

Because it seems like you're not listening. Your questions have been addressed repeatedly and thoroughly, and you ask more. Seems like trolling behavior.

When I ask a question online, I leave my ego at the door. I do expect that I will be roasted by the local trolls that exist in every community, that's simply the way the internet works...but this thread has been a genuine test for me. I've had to take extended breaks from reading it just to remind myself not to reply or engage with the vitriolic one-liners like, "You are wrong." or "I hope you kill yourself". Please, don't join them.

I understand. I did/do unconventional things. But you need to be able to articulate what you are learning, not doggedly stick to presumptions or preconceived notions. If you've learned things, feel free to state them. We are all here trying to help you, and others reading this, understand the bounds and risks associated with this particular approach. We recognize your ignorance of this subject, so try harder to ferret out the specifics of that so we can clarify why this or that is not OK/recommended.

 

[KeithG]

Um...excuse me? You have zero basis for making such claims against me. I came here to scubaboard to ask this question precisely because I respect the opinions of those with experience and credentials here.

I am grateful to have received many dozens of responses from professionals, and have read every post with interest. In reading these 15 pages, I have learned a great deal about the subject more rapidly than I would have learned any other way. For one thing, I learned that "IWR" is a thing. I hadn't even heard of the term when I created this thread. I learned that there are established IWR treatment protocols, I learned about how to prevent O2 toxicity based on P02 levels, I learned countless other things, and that is why I keep coming back to read this thread despite the attitude that some have shown me.

I have felt a persistent and toxic attitude expressed towards me by a few people who have repeatedly spread a false and completely baseless narrative about me that I am:

1) advocating for IWR. Actually, I never advocated for IWR, I was merely asking why IWR is not recommended, and trying to understand the basis behind that recommendation. I can even be quoted as saying "I am not yet convinced IWR is necessarily right in any situation."

2) That I am advocating for IWR as a catch all solution. Again no idea where this concept came from, given that every time I've brought it up, I've been first to admit that there are many situations it obviously doesn't make sense for.

3) That I'm promoting IWR without proper training. Never said anything of the sort, to the contrary every time I've talked about preventing oxygen toxicity I've mentioned it would require proper training.

4) That I'm ignoring evidence from a consensus among experts ....despite that probably at least half (possibly more) the experts who have replied on this thread have presented a favorable view of IWR

5) That I am a "troll" who simply wants to spark arguments, despite that in these 15 pages, you can find countless examples of users hurling personal attacks at me, and not a single example of my insulting anyone back, or sparking argument. The worst I have done is tried to engage with my critics by trying to take their short-handed comments seriously (eg, post #74), which I now regret.

When I ask a question online, I leave my ego at the door. I do expect that I will be roasted by the local trolls that exist in every community, that's simply the way the internet works...but this thread has been a genuine test for me. I've had to take extended breaks from reading it just to remind myself not to reply or engage with the vitriolic one-liners like, "You are wrong." or "I hope you kill yourself". Please, don't join them.

May I suggest that shortening and hence simplifying your posts will get you some where faster? IWR is complex with many factors. Breaking them down and dealing with them individually will make the exchange more manageable.

For example you brought up Type I DCI (as one of many topics in a prior post) and my first thought was that IWR was unnecessary. I could be wrong. I would find it useful to discuss this single isolated aspect.

I am personally aware of 2 cases of skin bends that occurred on LOBs (via talking to the victims). Both cases presented in the middle of the night many hours after the previous dive. Both resolved after an hour or 2 on oxygen. No need for IWR or a chamber ride.

 

[Miyaru]

@WetSEAL - Several people have already tried to explain that's it's not the questions you ask, but the way you ask those questions.

The IWR discussion was started a long time ago, and this was one of the threads in which Simon Mitchell already mentioned the IWR study with David Doolette that has now been published. It's a study, if you want to understand the contents, you have to be able to determine the validity of the results. The questions you ask about the results, indicate that you are drawing your own, not completely correct conclusions.
It's understandable, since loads of others have drawn wrong conclusions from NEDU studies in the past.

I'll address one of your remarks, but keep in mind that Dr. Simon Mitchell is the specialist on this subject, not me.

...
Others in this thread have also mentioned patient deterioration as a risk, which confused me because it is known that recompression would immediatley reduce the size of nitrogen bubbles and one would naturally expect this to provide immediate relief of symptoms (a point you noted in your paper as well). You also provide some concrete statistics related to this...In the various studies you've quoted, it seems that in most of them 95-98% of patients treated with O2 IWR have a complete relief of symptoms, and the only examples you mentioned of deteriorating symptoms during IWR were when air was used instead of O2. If there are no documented examples of patient deterioration during O2 IWR, then why is it still considered a serious risk factor?

Recompression indeed reduces the size of any present bubbles. And the moment those bubbles are reduced, the blood flow will no longer be blocked.
Now imagine laying on your own arm, which impairs the circulation. You'll start to feel a tingling sensation, which will turn to a numb feeling and then to no feeling. After a minute you get off your arm and the circulation will no longer be impaired. Pins and needles.
Now imagine doing the same again for one hour and imagine the pins-and-needles sensation after that hour. It'll hurt bad. You'll feel worse than while your arm was just numb. My personal experience was that it can take way longer than those 20 minutes mentioned in the statistics, while breathing 100% oxygen.

What the study does, is looking at statistics from past cases, categorize them and draw conclusions. The main problem with this approach, is that individual different DCI cases cannot be easily compared with each other. For more valid conclusions and recommendations, the ideal situation would be to have multiple similar DCI cases, all treated with the same protocol and then draw conclusions on the outcome. David Doolette has been working on this.

But when it comes to a real life DCI situation, it will be a whole different ballgame. Every single diver starts a dive with DCI prevention as a goal and the majority of all dives are uneventful. When a diver presents him/herself with DCI, statistics and study results will not help you at that moment.

You'll have to diagnose that specific diver at that specific time, recognize and evaluate the limitations of the situation you're in, and finally decide on a course of action.

My impression is that you're turning the whole thing around, focusing on those actions and questioning them. Knowledge about just the actions will not be enough to handle a DCI/IWR situation.