I appreciate the genuine replies, thank you.
If it's warranted, then sure. Suppose that evidence comes out showing, convincingly, that the majority of DCI cases which would otherwise require many hours in a chamber, if reacted to promptly, could instead be resolved by just 10-30 minutes of some IWR protocol, with effectively zero chance of oxygen toxicity, and no need for costly trip to the hospital. If such a finding became mainstream, I imagine that most regular recreational divers would gladly take a few extra classes to get that training and feel safer (I sure would), and that it would not take very long for the general thinking on this subject to change, and before long everyone in the diving community would be criticizing those that opt out of such training, regarding them as negligent and irresponsible "vacation divers" who put a burden on the health care system by opting for "chamber first treatment," due to their own negligence and lack of sufficient training, in the same way that we now think of divers that don't bother to follow basic safety precautions like carrying an octopus or a modern SPG.
In Dr. Mitchell's paper, he said he still wasn't aware of a single incident of oxygen toxicity during IWR (surprising), and only a handful of cases where the patient got worse after starting IWR, and in every single case where the patient got worse during IWR they were attempting IWR on air not oxygen -- and these appeared to be people that did not have formal training on IWR either. That doesn't seem to support the notion that "there's a reasonable chance you'll DIE doing IWR," it makes it sound like fear mongering.
Also, in this thread I've specifically been asking about IWR done for shorter durations that don't exceed oxygen toxicity thresholds, so risk would be further reduced.
They really haven't though. People have given a lot of reasons why IWR isn't always a good option, which seem valid, but none of those reasons seem to apply to the circumstances and use case of IWR I was talking about.
I'm talking about a diver with all requisite training (ie, advanced nitrox, rescue, oxygen therapy, etc), who experiences some mild symptoms of DCI immediately after surfacing. Diver still feels comfortable, feels capable of going back into the water, and no other adverse conditions. It's not clear whether or not a hyperbaric chamber is really needed, or would just be an excessive waste of time and money. Diver could just take O2 on the surface, and hope conditions resolve, but is considering doing a little light IWR as an added measure.
I'm not talking about full on emergency IWR done for hours, pushing way past oxygen toxicity thresholds, wearing full face masks and being monitored with a team of professionals. I'm talking about, say, 5-10 minutes done at 15-25 feet on say 80-100% O2, with a buddy, just to see if it helps to resolve symptoms. I don't think there's a significant risk of toxicity on such a dive, but there seems to be some evidence that short recompressions are enough to provide complete relief in some cases, and it might provide more relief of symptoms that just taking pure O2 on the surface...so why not try it?
To be clear: I'm not advocating for IWR in the above scenario. I'm just saying, I haven't heard a compelling reason given why the person shouldn't try it. It's not an established IWR protocol, it hasn't been studied, the potential benefits haven't been quantified...but it seems to avoid the known risks, and there is some anecdotal evidence to suggest there may be benefits. The primary danger of IWR, oxygen toxicity, doesn't seem relevant because it's so short. Inadequate exposure protection/adverse conditions is a special case scenario that doesn't effect the general case. DCI conditions worsening as a result of IWR doesn't seem to be justified by data.
That's interesting to hear, thank you for sharing. Did you already detail your IWR experience? If so which post # was it? I'd be curious to read about it.
I mentioned type 1 DCI as it was defined in Dr. Mitchell's paper, but really this thread has always and only been about type 1 DCI -- I've been primarily interested in IWR as a potential treatment for minor symptoms of DCS, where some relief might be gained by a short and "light IWR" session, avoiding the risks of O2 toxicity.[/user]
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.
If it's warranted, then sure. Suppose that evidence comes out showing, convincingly, that the majority of DCI cases which would otherwise require many hours in a chamber, if reacted to promptly, could instead be resolved by just 10-30 minutes of some IWR protocol, with effectively zero chance of oxygen toxicity, and no need for costly trip to the hospital. If such a finding became mainstream, I imagine that most regular recreational divers would gladly take a few extra classes to get that training and feel safer (I sure would), and that it would not take very long for the general thinking on this subject to change, and before long everyone in the diving community would be criticizing those that opt out of such training, regarding them as negligent and irresponsible "vacation divers" who put a burden on the health care system by opting for "chamber first treatment," due to their own negligence and lack of sufficient training, in the same way that we now think of divers that don't bother to follow basic safety precautions like carrying an octopus or a modern SPG.
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.
In Dr. Mitchell's paper, he said he still wasn't aware of a single incident of oxygen toxicity during IWR (surprising), and only a handful of cases where the patient got worse after starting IWR, and in every single case where the patient got worse during IWR they were attempting IWR on air not oxygen -- and these appeared to be people that did not have formal training on IWR either. That doesn't seem to support the notion that "there's a reasonable chance you'll DIE doing IWR," it makes it sound like fear mongering.
Also, in this thread I've specifically been asking about IWR done for shorter durations that don't exceed oxygen toxicity thresholds, so risk would be further reduced.
Because it seems like you're not listening. Your questions have been addressed repeatedly and thoroughly, and you ask more. Seems like trolling behavior.
They really haven't though. People have given a lot of reasons why IWR isn't always a good option, which seem valid, but none of those reasons seem to apply to the circumstances and use case of IWR I was talking about.
I'm talking about a diver with all requisite training (ie, advanced nitrox, rescue, oxygen therapy, etc), who experiences some mild symptoms of DCI immediately after surfacing. Diver still feels comfortable, feels capable of going back into the water, and no other adverse conditions. It's not clear whether or not a hyperbaric chamber is really needed, or would just be an excessive waste of time and money. Diver could just take O2 on the surface, and hope conditions resolve, but is considering doing a little light IWR as an added measure.
I'm not talking about full on emergency IWR done for hours, pushing way past oxygen toxicity thresholds, wearing full face masks and being monitored with a team of professionals. I'm talking about, say, 5-10 minutes done at 15-25 feet on say 80-100% O2, with a buddy, just to see if it helps to resolve symptoms. I don't think there's a significant risk of toxicity on such a dive, but there seems to be some evidence that short recompressions are enough to provide complete relief in some cases, and it might provide more relief of symptoms that just taking pure O2 on the surface...so why not try it?
To be clear: I'm not advocating for IWR in the above scenario. I'm just saying, I haven't heard a compelling reason given why the person shouldn't try it. It's not an established IWR protocol, it hasn't been studied, the potential benefits haven't been quantified...but it seems to avoid the known risks, and there is some anecdotal evidence to suggest there may be benefits. The primary danger of IWR, oxygen toxicity, doesn't seem relevant because it's so short. Inadequate exposure protection/adverse conditions is a special case scenario that doesn't effect the general case. DCI conditions worsening as a result of IWR doesn't seem to be justified by data.
That's interesting to hear, thank you for sharing. Did you already detail your IWR experience? If so which post # was it? I'd be curious to read about it.
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 mentioned type 1 DCI as it was defined in Dr. Mitchell's paper, but really this thread has always and only been about type 1 DCI -- I've been primarily interested in IWR as a potential treatment for minor symptoms of DCS, where some relief might be gained by a short and "light IWR" session, avoiding the risks of O2 toxicity.[/user]