Why not treat DCS yourself?

[Superlyte27]

There's Chambers randomly open in central Florida. It just depends on their mood. Go to the nearest ER. Deal with their incompetence for 90 minutes while they try to argue that it's a stroke or vertigo. Once they rule out everything, they'll get you to a chamber. Recently Orlando and a Catholic hospital south of yeehaw junction. Forget the name. My buddy was getting bent alot.

Is is funny watching them flip out when you tell them the dive profile like 2 hours at 100'

 

[Snoweman]

There are quite a few divers who self treat due to lack of insurance and/or money.

I don't want to sound elitist, but I would think the minimum plan for DAN at $40/year shouldn't be an issue. If it is, then one something else needs to be cut back in the budget.

 

[Dsix36]

I recently got bent and became paralyzed before I reached 50'. I used IWR before ever exiting the water to relieve my symptoms. I had a full support team for the dive and we were all active tech divers and knew the risks.

As others have already stated, IWR can be a very valuable tool but there are serious risks involved and may not always be the best option. In my case, I believe it prevented permanent paralyses at the least and probably saved me a lot more than that, possibly even death.

 

[WetSEAL]

Why not buy DAN insurance and let a controlled chamber ride do the trick instead of risk O2 toxicity in a self treatment (that could go really bad -being under water)?

Money is a non issue with Dan and health insurance.
There are procedures, depending on the country, for "in water recompression." Search that phrase and you'll read all about it.
IMO, IWR is based solely on the ability to get to a chamber, not money.

Because from what I've heard DCS symptoms don't come on instantly. It takes time for the nitrogen to seep out of your blood, bones, etc. So, if you realized you ascended too fast or accidentally blew through a safety stop, such that you're likely to get DCS but haven't had any bad symptoms yet, it seems to me that the most responsible thing to do would simply be to re-descend and do that safety stop, rather than ending the dive and waiting for symptoms to develop into an emergency on the surface.

By the same token, if you are starting to see symptoms develop on the surface, but they aren't serious yet, then you know it's likely going to get worse...so why would you not immediately do something to prevent it from getting worse? You could either breathe pure O2 at the surface, or go back down and do a longer safety stop at 15 ft on compressed air, or breathe some O2 on your safety stop if you have it.

Not doing so honestly strikes me as refusing to put on a tourniquet after a gunshot wound, and just saying you'll wait until the professionals do it in the hospital. By the time you get to the hospital, you've lost a ton of blood and it's now very serious -- but could have been prevented if you did a little first aid immediately. Seems to me the situation is exactly the same with DCS. In most cases, it starts non-serious, and only gets worse over time if you're not doing anything about it.

OP, look up innumerable threads on "in-water recompression" (IWR) and do some reading. The biggest single problem is that if you go deep enough for long enough to simulate a chamber treatment, you are risking OxTox, so even those who advocate IWR say you need a full-face mask and a safety diver with you. If no chamber is available, IWR may be better than nothing,

I don't think you would need to go deep enough or long enough to simulate chamber treatment though, since the symptoms take time to develop, so if you just started noticing a problem developing immediately after ending your dive, then you're not going to need the most severe hyperbaric treatment. If you wait around on the surface, get a ambulence, then wait around in the lobby at an ER, then get put on a flight to a hyperbaric chamber, etc, now you've given time for all that extra nitrogen bubbles to come out and do more damage, so it seems like you'd need a much more extreme treatment due to your own negligence of failing to respond quickly.

...but pure O2 at the surface plus a chamber is the clear recommendation.

I do have a medical O2 cylinder and mask that I got for emergencies on the surface, so if myself or someone else needs it, they can get on oxygen right away. Nobody recommended that I purchase this, and it seems to be a fairly unconventional practice...it's so cheap and easy to have on hand, I don't understand why it's not something that they tell every new diver to have, like a backup second stage regulator.

Because oxygen toxicity will kill you way before the DCS does

There are tables you can follow, the same as the tables you follow for nitrogen loading...

A Frank Discussion on In-Water Recompression – Dive Gainesville

My original post was never about breathing O2 at depth for an un-specified period of time. I am specifically talking about breathing it at a time and depth that is determined based on safely established limits to avoid oxygen toxicity. Obviously, since this isn't currently a recommended practice, it would take effort consulting medical professionals to establish what those safe limits are and get training etc before attempting it -- but it seems to me that this is the sort of thing that perhaps should be considered as a basic safety requirement for scuba.

You're probably not going to get deep enough to get any added value from your self decompression

If that were true, then safety stops wouldn't be a thing. We know that by slowing your ascent rate, it prevents the nitrogen from coming out too quickly, and then breathing compressed air gives your body time to replace the high nitrogen content. If this works with compressed air at 15 ft during a routine safety stop, then it must work faster at 15 ft on pure O2.

Permanent paralysis has such an ugly sound to it...

My friend got bent, the chamber put a nurse in with her to keep her from convulsing (or anything else) plus the dr. monitored everything thru the glass. Hard to do underwater.

Was she convulsing as one of her FIRST symptoms of DCS? Your anecdote seems to be only confirming my suspicion that motivated this thread, which is that the real danger of DCS is delaying treatment until you get to a hyperbaric chamber.

 

[doctormike]

I'm not a hyperbaric doc, but there are a number of unfounded assumptions, misunderstandings and outright errors in the above post (e.g. "From what I understand, oxygen toxicity is something that will happen AFTER all the excess nitrogen bubbles have been absorbed from your body tissues"). To cite one more example, convulsing isn't a symptom of DCS, it's a risk of hyperbaric O2, which is why you have a tender with you in a chamber.

I'm not going to go over them all point by point, but let me just say that the standards for DCS treatment are based on many decades of hard won experience, massive dive profile databases and scientific research. Not everything is clearly understood about decompression stress (just like in most areas of medicine), but to assume that you can simply and safely replicate the profile of a chamber treatment with IWR is just not true.

Some very experienced and knowledgeable people recommend IWR in certain circumstances, and the decision to do this is based on the severity of the symptoms, the clinical stability of the patient, and the estimated time to get to a chamber. But I wouldn't consider it the first choice for any and all DCS.

 

[WetSEAL]

I'm not a hyperbaric doc, but there are a number of unfounded assumptions, misunderstandings and outright errors in the above post...I'm not going to go over them all point by point, but let me just say that the standards for DCS treatment are based on many decades of hard won experience, massive dive profile databases and scientific research. Not everything is clearly understood about decompression stress (just like in most areas of medicine), but to assume that you can simply and safely replicate the profile of a chamber treatment with IWR is just not true.

I'm also not a doctor, and 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. Hence, I wanted an honest discussion to find out what is truly in the diver's best interest, in contrast to what is recommended to merely reduce liability.

Let me give a few examples of that:

1) It is recommended to take oxygen on the surface after DCS symptoms, and it is known that if oxygen first aid is received promptly, it improves the outcome of hyperbaric treatment. However, it is not usually recommended for divers carry around a backup O2 cylinder for this purpose. Instead, it's recommended that you "leave it to the professionals" to take care of you, despite that it will necessarily delay your oxygen treatment, increasing risk of problems later on, and breathing O2 from a medical O2 tank is not exactly rocket science and could easily be learned by any diver. This right here is already proof that the "advice" given about this subject is more about reduction in liability rather than maximizing diver health, and is a prime example of why this type of discussion is important.

2) We know that safety stops reduce the risk of DCS considerably, and we are recommended to do safety stops, and we know that DCS symptoms usually take a while to come on. So, if a diver blows through a safety stop by accident, wouldn't it make sense to go back down and redo the safety stop? Yet nowhere in my training did they cover "re-doing" missed safety stops. Correct me if I'm wrong, but seems like another clear example where the advice given is actually not the best.

3) All the arguments against IWR so far have merely been that "it's too risky if you don't know what you're doing"...saying there is a risk of oxygen toxicity if you don't manage your time/depth properly. Well, oxygen toxicity, nitrogen narcosis, HPNS, hypoxia, etc, are routine risks of diving if you don't manage time/depth properly already. We don't say "because there is a risk of DCS, nobody should dive." We say, "because there is a risk of DCS, we should all understand how to manage our nitrogen loading levels and keep them below a safe level." That argument can apply equally well to oxygen loading for recompression purposes. Instead of telling people to avoid doing something potentially life saving, perhaps we should be requiring everyone to know how to do this potentially life saving thing in safe way?

(e.g. "From what I understand, oxygen toxicity is something that will happen AFTER all the excess nitrogen bubbles have been absorbed from your body tissues"). To cite one more example, convulsing isn't a symptom of DCS, it's a risk of hyperbaric O2, which is why you have a tender with you in a chamber.

Thank you for correcting me

 

[MaxBottomtime]

2) We know that safety stops reduce the risk of DCS considerably, and we are recommended to do safety stops

The original purpose of safety stops was to get divers to slow their ascents. I don't believe it reduces the risk of DCS considerably.

 

[doctormike]

I'm also not a doctor, and 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.

I'll reply on the off chance that you are not trolling.

What you cite as "very clear" is ludicrous and incorrect. The recommendations and guidance around the emergency management of decompression sickness is based on the current understanding of decompression stress and pathophysiology.

1) It is recommended to take oxygen on the surface after DCS symptoms, and it is known that if oxygen first aid is received promptly, it improves the outcome of hyperbaric treatment. However, it is not usually recommended for divers carry around a backup O2 cylinder for this purpose. Instead, it's recommended that you "leave it to the professionals" to take care of you, despite that it will necessarily delay your oxygen treatment, increasing risk of problems later on, and breathing O2 from a medical O2 tank is not exactly rocket science and could easily be learned by any diver. This right here is already proof that the "advice" given about this subject is more about reduction in liability rather than maximizing diver health, and is a prime example of why this type of discussion is important.

It is commonly recommended that surface O2 be available, and most reputable dive charters do provide this for exactly that reason. There is no argument against the use of surface O2 no matter what the clinical scenario is, ranging from mild questionable symptoms to life threatening obvious DCS. Not sure where your straw man argument comes from - people saying that you shouldn't carry or use surface O2 and instead "leave it to the professionals", but I have never heard anyone say that.

2) We know that safety stops reduce the risk of DCS considerably... Correct me if I'm wrong

You are wrong.

3) All the arguments against IWR so far have merely been that "it's too risky if you don't know what you're doing"...saying there is a risk of oxygen toxicity if you don't manage your time/depth properly. Well, oxygen toxicity, nitrogen narcosis, HPNS, hypoxia, etc, are routine risks of diving if you don't manage time/depth properly already. We don't say "because there is a risk of DCS, nobody should dive." We say, "because there is a risk of DCS, we should all understand how to manage our nitrogen loading levels and keep them below a safe level." That argument can apply equally well to oxygen loading for recompression purposes. Instead of telling people to avoid doing something potentially life saving, perhaps we should be requiring everyone to know how to do this potentially life saving thing in safe way?

Ever medical intervention - ranging from antibiotics for a sore throat to cardiac transplantation - involve balancing risks and benefits. IWR simply IS associated with significant risks of death, believe it or not. So while it sometimes may make sense (severe DCS symptom far from a chamber), to imply that if we just were smart enough about it we could do IWR "in a safe way" is simply incorrect.

Yes, we don't say that because of a risk of DCS, no one should dive. But that has nothing to do with the question you are posing. Given that someone has developed DCS, there are basically two options. The standard one is immediate surface O2, hydration, and rapid transport to a recompression chamber, with IWR reserved for special cases as mentioned above. Yours seems to be IWR as a first choice for all DCS cases that don't take place in the parking lot of a recompression chamber facility.

So while it is nice that you have discovered the concept of IWR, if you are really posting in good faith, you might want to listen to the standard recommendations for DCS management that come from people who have spent their life studying decompression physiology instead of just being a rightfighter on the internet.

 

[ofg-1]

I think you should treat it yourself. And do your own dentistry. And who hasn't treated their own STD by drinking cranberry juice and soaking your junk in hydrogen peroxide a couple of hours. I know God must have invented super glue so we could avoid stitches. Go ahead, your reasoning is perfectly sound to me.

 

[RainPilot]

However, it is not usually recommended for divers carry around a backup O2 cylinder for this purpose.

Even in OW courses, RAID requires that divers be aware of the location of emergency O2 provision and strongly advise against doing any diving where there is reduced/no access to emergency O2. I have never dived anywhere where there wasn't at least an ambulance the other end of a phone call with O2.

"leave it to the professionals" to take care of you, despite that it will necessarily delay your oxygen treatment

All Rescue divers, DMs and instructors are required to be trained in (and keep current in) First Aid and O2 provision. In addition, every commercial dive boat I have been on has had the captain certified in O2.

breathing O2 from a medical O2 tank is not exactly rocket science and could easily be learned by any diver.

Thats one of the many reasons why I recommend Rescue course for ALL divers to do as soon as practical. DAN provides O2 courses worldwide at pretty low costs as well.

So, if a diver blows through a safety stop by accident, wouldn't it make sense to go back down and redo the safety stop? Yet nowhere in my training did they cover "re-doing" missed safety stops.

Omitted deco is NOT the same as IWR. Once there are symptoms, the whole picture changes VERY dramatically. A safety stop is optional not mandatory, if your dive was otherwise clean and you weren't diving "NDL as long as I don't skip the safety stop" type diving, then you shouldn't have to go down again to do a SS.