In-Water Recompression, Revisited

[Kay Dee]

Did you mistake this thread as a discussion that only concerns you?

No, but it seems I am one of the few people willing to voice their opnion, and it seems one of the few - but not the only one by any means - that has had fairly extensive real world experience with IWR in remote locations, just not what others tell me it is, or how I should do it, or what they read about how to do it from books.

You too, with all due respect, along with all /any others, can also feel free to overlook my posts, but as long as you continue to make inane comments about IWR, rest assured I may continue to comment on yours.

 

[Wookie]

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A ScubaBoard Staff Message...

Let's take the attitude down a notch. IWR will never be a subject everyone agrees about every time. There is a tremendous amount that is not known, and there are lots of competing theories, all or some of which probably aren't right. We can discuss this like adults, and not sound like third graders on the playground.

Don't make me come back here.

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[cerich]

No, but it seems I am one of the few people willing to voice their opnion, and it seems one of the few - but not the only one by any means - that has had fairly extensive real world experience with IWR in remote locations, just not what others tell me it is, or how I should do it, or what they read about how to do it from books.

You too, with all due respect, along with all /any others, can also feel free to overlook my posts, but as long as you continue to make inane comments about IWR, rest assured I may continue to comment on yours.

comment away.

Which of my posts lacked significance?

I'm also not quite sure how you have come to the conclusion that none of the folks here has "extensive real world experience with IWR in remote locations" except you. I think I covered my real world approach of avoiding the need, but haven't always been successful with avoidance, have been with utilization. Some of the other posters here however have direct involvement and/or consultation with hundreds if not thousands of cases of DCS (including IWR) and their views matter..quite a bit. Their comments are not just academic, because the "just academic" deco wienies aren't gonna be posting here, these folks are passionate active divers.

 

[Kay Dee]

having read your replies in this thread, I am somewhat grateful that I am "out of touch" with YOUR school and experience of expeditionary diving.

Because in my world, I would seriously question my approach if I had to do over 10 IWR's over the years. Just saying.

Just to be very very clear, I myself have suffered two DCS incedents in 30 years. One treated in a chamber, one by IWR. And that was more than 20 odd years ago.

I also said I needed more than two hands to count the IWRs I have witnessed, not that I had 'ran' myself.

That is, I did not say, nor imply, that I conducted all those IWR's, although I did conduct / run a few of them (as felt it my duty of care In the circumstances). Witnesing an IWR is not the same as running (i.e. controlling') one or even being directly involved in the IWR process as it were. I am sure you understand the meaning of wItnessing after all? Still, while I wouldn't wish having seen such a number of bends cases on anbody, I am, in retrospect, 'glad' for / of the experience(s). I feel no shame whatsoever, if thats how you think I should feel.

And as any commercial diver (and am not / never was one) will tell you, its par for the course if you go diving enough times in water, that is geting bent is just something you have to accept may happen to you, even if you think you did 'nothing wrong'. But as John Chatterton says on his blog ' there is no such thing as an unearned hit'. And as we all know, there are many many reasons one might get bent, not neccesarily somthing you 'did' on the dive, or lack of 'experience'. Although some of the cases I have witnessed were from said diver doing someting foolish, but after all we (can) all make mistakes (but hopefully learn not to keep on making the same ones).

Some people feel ashamed to admit the have been bent, which is sad, but after all it is just another sickness, if a rather very serious sickness, hence why its called DCS.

 

[Wookie]

I always considered it akin to catching a cold. There's lots to do to prevent catching a cold, up to and including sitting on the couch. I have certainly been bent my share of times, all resolving on O2 except that one pesky vestibular hit. But you are right, it's just another illness.

 

[Kay Dee]

Simon, interestingly, Kay Dee said earlier that her personal treatment on IWR involved an abbreviated Australian protocol - I'm assuming she stuck with 30 feet. She had worsening spinal DCS and came out relatively asymptomatic. @Kay Dee, please feel free to clarify if I'm incorrect, but I think all the hullabaloo about her doing a 60-foot IWR treatment is hypothetical.

Best regards,
DDM

Hey first, just wait a GD minute now, who ever said I was a woman!!!

And who said anything about being only relatively asmptomatic after my own IWR. I recall being asymptomatic (although I did not say anything one way or the other, which in retrospect I guess I should have been clearer on that point). So please, although it probably wasn't your intent, don't put words in my mouth that I did not utter. There is enough confusion already in some peoples minds about this whole discourse it seems.

As for last question, hyperthetical in as far as not having done it or wtnesed it (i.e. 60ft IWR), but as I have tried to make clear in every post that goes back to this 'scenario', and you make me say it / repeat myself again (much to some readers horror), I (myself that is ) can envisge a situation that I, repeat again I, may be in where it becomes a last resort, that is as opposed to taking the chance of being paralysed for life. But like you yourself said before, lets give this a rest (or words to that effect) shall we? I mean how many times do I have to say the above, we are now just going round and round and round in circles on this one.

Anyway its late here so I am off to bed.

Goodnight to you all!

 

[cerich]

J But as John Chatterton says on his blog ' there is no such thing as an unearned hit'. And as we all know, there are many many reasons one might get bent, not neccesarily somthing you 'did' on the dive, or lack of 'experience'.

I disagree with his choice of words. Earned implies worked towards. It (that article) was headline grabbing but pretty short on substance IMHO

 

[Duke Dive Medicine]

Hey first, just wait a GD minute now, who ever said I was a woman!!!

And who said anything about being only relatively asmptomatic after my own IWR. I recall being asymptomatic (although I did not say anything one way or the other, which in retrospect I guess I should have been clearer on that point). So please, although it probably wasn't your intent, don't put words in my mouth that I did not utter. There is enough confusion already in some peoples minds about this whole discourse it seems.

As for last question, hyperthetical in as far as not having done it or wtnesed it (i.e. 60ft IWR), but as I have tried to make clear in every post that goes back to this 'scenario', and you make me say it / repeat myself again (much to some readers horror), I (myself that is ) can envisge a situation that I, repeat again I, may be in where it becomes a last resort, that is as opposed to taking the chance of being paralysed for life. But like you yourself said before, lets give this a rest (or words to that effect) shall we? I mean how many times do I have to say the above, we are now just going round and round and round in circles on this one.

Anyway its late here so I am off to bed.

Goodnight to you all!

@boulderjohn referred to you as Kathy earlier. My apologies, no offense was intended. If you'll provide your preferred pronoun I'd be happy to use it.

Re the word "asymptomatic", that means something very specific to me, and your description, "Three and a half or so hours later I walked out of the water and other than taking six weeks off diving on a doctor’s subsequent advice (which in retrospect I somewhat regret, as I now think that duration was somewhat excessive) I was not much the worse for wear..." was a little nebulous, thus my fudging of the term. So for clarity, you suffered from severe neurological DCS, underwent IWR on a "modified" Australian table (I'm assuming you stayed with 30 feet, please correct me if I'm wrong), and had complete resolution of your DCS symptoms, yes?

Have a pleasant evening!

Best regards,
DDM

 

[Akimbo]

Doing some catch-up reading here:

Ha! Not at all, with the MD company I keep it's a compliment. Just wanted to make the credentials clear.

Best regards,
DDM

You sir are a master of understatement.

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There are collapsible chambers that can be pressurized to 2.8 ATA with scuba tanks...

Are there any that have a pressure vessel certification that anyone cares about like:

• ASME/PVHO
• DNV
• Lloyds
• ABS
• etc?

No offense to my ancestors but there aren't very many vessels of opportunity under the Italian flag. The only one I can think of is FlexiDec, which is certified by RINA (Registro Italiano Navale) only. We had some RINA-only certified chambers onboard and the vessel's captain (via the owners and insurers) wouldn't let anyone pressurize them. Maybe the different certification agencies and marine insurers are playing nicer these days?

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If you ever want to see a person get frustrated, watch a fully trained hyperbaric doctor try to help a badly bent diver at a remote location even with a chamber but NOT all the tools (drugs and diagnostic tools, multi place chamber) on hand that they know would help.

(discussion and perspective, not argument) The world's navies are the only place I can think of were a hyperbaric doc is onboard during diving operations. The problem is most (not all) get the diver many hours or days after symptoms appear. I can only assume that the much more favorable outcomes that are common in the offshore commercial diving industry are significantly influenced by very short "time to treatment". This is my main motivation behind supporting IWR. As mentioned before, everyone walked out of treatments joking. We had some pretty terrible experimental tables in the early days so one would think that more diver's careers would have ended.

IMHO, even the most conservative and simple IWR, like 20' on an O2 stage bottle, should be done at the first suspicion. You have to over-treat often and early to avoid the much rarer frustration of a hyperbaric doc left to deal with damage that has already been done.

Going below deck and lying down after a dive rather than voicing concerns appears to be a recurring thread in incidence reports.

 

[Wookie]

Are there any that have a pressure vessel certification that anyone cares about like:

• ASME/PVHO
• DNV
• Lloyds
• ABS
• etc?

kind of.

http://www.sosgroup.co/admin/downloads/SOSG Technical Specification Iss01 220914.docm.pdf