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From: "Paltz, Art" <Art.Paltz@R2*.CO*>
To: techdiver <techdiver@aquanaut.com>
Subject: RE: oxygen exposure
Date: Wed, 5 Jan 2000 14:04:46 -0500
Wow, great post!  Thanks, lots of information in there.  My comment about it
being BS (or rather George saying that) I think after reading was in the
strict following of belief in the numbers.  I think you summed it up when
you equated it to deco.  It's basically an average that is conservative for
most, a guide line.  I typically get a kick out of that argument about 80%.
I remember a long time ago asking about the CNS clock and long dives and the
clock getting blown out.  The response was use 80% and you'll keep the clock
down.  This didn't really make sense to me.  Sacrifice my optimal gas
selection because of a clock?  Anyway, just wanted to say thanks for the
response and hope that others find it informative too.

Art.


	-----Original Message-----
	From:	Jarrod Jablonski [SMTP:jjcave@ib*.ne*]
	Sent:	Wednesday, January 05, 2000 3:36 AM
	To:	Paltz, Art; kirvine@sa*.ne*; Shimell, David (shimell)
	Cc:	QUEST@GU*.CO*; techdiver
	Subject:	oxygen exposure

	At 09:10 AM 12/30/99 -0500, Paltz, Art wrote:
	>Can you elaborate on Oxygen Exposure?  I remember you saying many
times that
	>OTU's and CNS clock's are BS.  How do you track this?  What about
repetitive
	>dives?
	>>
	Art,

	This question requires a far longer response than would be practical
right
	now. I will see what I can put together in the near future but lets
start
	with this general outline. Oxygen Exposure is problematic for
several
	reasons including:
	1) High degree of variability in oxygen tolerance
	2) Inconsistent measurements and difficulty assessing oxygen
tolerance
	3) Poor understanding of oxygen toxicity mechanisms

	In general the biggest problem with oxygen relates to the
significant
	variability between individuals and within one individual over time.
Plots
	of PO2 and time look more like a wide bore shotgun blast than
sensible
	graph. Subjects would often manage huge tolerances (sometimes
several
	hours) one day and then tox in a matter of minutes the next day.
	Unfortunately tolerances would vary so dramatically that there was
not any
	notable success in establishing a trend such as increased or
decreased
	tolerance. 

	Most oxygen tolerance testing was done with pure oxygen commonly at
30,60,
	and 90'. Many individuals managed amazing tolerances that make
current
	limits seem ridiculously conservative. However, other individuals
	experienced problems very early in the tolerance time limits.
Actually
	measuring tolerance proved to be a significant problem with exposure
	testing while early tests often used time limits based upon actual
toxic
	events (ie seizures) and later studies limited time to what has
become the
	commonly recognized "symptoms" known by the acronym VENTID. As a
result
	some individuals that managed significant times when pushed to
seizure were
	then limited by the occurrence of a symptom perhaps prematurely. The
	occurrence of symptoms did seem to at least loosely relate to
toxicity
	incidence but unreliably and with many complications. This
complication in
	the measuring process further skews what one might refer to as the
"actual"
	toxicity time limits


	Furthermore, our inability to get a handle on the mechanisms behind
oxygen
	toxicity confuse limiting its impact and/or measuring the time
limits. For
	example, consider immersion in water and its role in the development
in
	oxygen toxicity. Merely being immersed (as opposed to being in a dry
	chamber) increases the risk of oxygen toxicity. Being immersed in
hot or
	cold water (either pole is similar in impact) decreases tolerance.
Numerous
	factors affect one's likelihood of succumbing to toxicity but our
	understanding of these mechanisms and our ability to manipulate them
is a
	very inexact process and highly problematic

	The preceding issues are important in considering oxygen toxicity
	manifestations and in discussing the "oxygen clock". This clock
"works" by
	relating the chosen maximum time at a given PO2 (ie 45@1.6) to a
percentage
	of accumulated time at this PO2. Of course, the success or failure
of this
	clock relates to the accuracy of the time limit which is confused by
	susceptibility. The 100% (ie 45min at 1.6) limit suggests that as
you
	exceed this parameter your risk of oxygen toxicity markedly
increases.
	Actually it is a bit more complicated than this but in general this
is the
	idea. However, on our dives we regularly exceed several thousand
percent
	and have pushed into the 10,000% range leaving these numbers to seem
	meaningless. While they are not meaningless and are in fact a good
but very
	general rule of thumb it is important to see these "limits" for what
they
	are- a forced best guess based on highly variable and conflicting
data.
	Realistically it seems that these limits are probably overly
conservative
	for the vast majority, good for some, and not enough for a very few.
	However, given the risk (ie seizure and likely drowning) it is
prudent for
	most people to stay near the limits. These "limits" are really more
of a
	range that should be used as a generally sensible guideline. 

	The problem in technical diving is that an ardent belief in these
numbers
	leads people to assume that they must save the extra 5 or 10% off
their
	clock by using odd gas mixtures. It is very likely that divers are
best
	served by regular breaks from oxygen (for deco benefit and extended
O2
	tolerance) and the conservative use of PO2 (such as 1.4 or less for
	diving). Oxygen tolerance limits are in many ways similar to
Decompression
	limits in that they are likely too conservative for many and highly
	variable for most individuals. Furthermore, violating these "limits"
may
	increase the risk of an unpleasant outcome or more likely will
produce no
	noticeable impact. However, the risk of violation (which includes
pain and
	death) is likely not worthwhile for the vast majority of divers.
These
	ranges should be viewed with respect but also an understanding of
their
	history and an appreciation for the variation that leads some divers
to
	reevaluate their role in technical diving.

	Safe diving,
	JJ






	ent:	Wednesday, December 29, 1999 2:26 PM
	>	To:	Shimell, David (shimell)
	>	Cc:	QUEST@GU*.CO*; techdiver
	>	Subject:	Re: SAMPLE DECO DIVE - 220 FOR 25

	>
	>	I ignore the first dive - in this case you have mushed the
bubbles
	>	anyway. After enough time, I ignore any first dive other
than as
	>regards
	>	the oxygen exposure - that is where the risk lies. 
	>
	>	Shimell, David (shimell) wrote:
	>	> 
	>	> George
	>	> 
	>	> Here's another question.
	>	> 
	>	> Say you do your 220' for 25 and then ascend to do a
multi-level
	>dive to say
	>	> 90' for 25.  How would you calculate the deco for this?  I
recall
	>you once
	>	> talked about superimposing one table on another but I had
it on my
	>list of
	>	> things to look at.
	>	> 
	>	> David Shimell
	>	> Email: shimell@se*.co* <mailto:shimell@se*.co*>
	>	> Project Manager, IBM NUMA-Q, Sequent Computer Systems
Limited,
	>	> Weybridge Business Park, Addlestone Road, Weybridge,
Surrey, KT15
	>2UF, UK
	>	> registered in England and Wales under company number:
1999363,
	>registered
	>	> office as above
	>	> 
	>	> -----Original Message-----
	>	> From:   kirvine@sa*.ne* [SMTP:kirvine@sa*.ne*]
	>	> Sent:   Friday, December 24, 1999 12:43 PM
	>	> To:     QUEST@GU*.CO*
	>	> Cc:     techdiver
	>	> Subject:        SAMPLE DECO DIVE - 220 FOR 25
	>	> 
	>	> Let's run through a sample dive. I will throw out the
parameters
	>and
	>	> the standeard deco on one side, and my changes and why on
the
	>other ,and
	>	> then we can discuss it.
	>	> 
	>	>  We can then build the dive into a longer dive, a deeper
dive and
	>we can
	>	> add more gasses and more stituations, and then the
equipment to do
	>it.
	>	> 
	>	>  Let's start with this and get the discussion going that
way. I
	>need all
	>	> questions, no matter how sophisticated, so we can get out
the
	>rock.
	>	> 
	>	> ***PROFILE 220 FOR 25                   CHANGES
	>	> ***GAS 16% OXYGEN  50% HELIUM   1.2 PPO2
	>	>                                 85 AED
	>	> 
	>	>          REASON FOR GAS CHOICE: the more heluim, the
better . It
	>is
	>	> easier to breathe at depth, and it is easier to decompress
from,
	>	> contrary to what you have been told elsewhere. The reduced
narc is
	>	> obvious. I chose the 50% heliuum for this , but the more
the
	>better. The
	>	> oxygen ppo2 should be kept intentionally low. The reason
is that
	>you do
	>	> not want to unnecessarily deplete brain chemistry to pick
up
	>"perceived"
	>	> deco advantage, expescially in light of the fact that we
have
	>boosted
	>	> the helium which reduces the nitrogen damage and loading,
and thus
	>the
	>	> deco requirement. While inert gas is inert gas for
purposes of
	>this
	>	> discussion ( or said another way, the oxygen window is the
oxygen
	>	> window) the reality is that helium changes the
physiological
	>factors
	>	> that are as real in deco as the straight compartment
loading and
	>	> unloading factors. Very important to us in our diving, and
more so
	>as
	>	> the dives get more severe or repetitive. We also do not
want to
	>burn the
	>	> shit out of our lungs with high PPO2's either, and keep in
mind
	>that
	>	> depending on the bottom time, we are going to be forced to
expose
	>	> ourselves ot elevated oxygen to decompress.
	>	> 
	>	> It is critical in multiday exposure that you reduce the
oxygen
	>dose, and

	>	> we will show how to do that in each decompression.
	>	> 
	>	> STANDARD DECO FROM A PROGRAM            REAL LIFE DECO
	>	> 
	>	> DEPTH   TIME    GAS                     DEPTH   TIME
GAS
	>	>                                         160-120 1 MINUTE
EACH ON
	>BG
	>	> 110     1       16/50                   110     1
	>	> 100     3                               100     1
	>	> 90      4                               90      1
	>	> 80      5                               80      1
	>	> 70      3       50/50                   70      5
50/50
	>	> 60      4                               60      2
	>	> 50      5                               50      3
	>	> 40      9                               40      5
	>	> 30      11                              30      8
	>	> 20      17      OXYGEN                  20      13
OXYGEN
	>	> 10      26                              20-0    8
	>	> 
	>	> TOTAL 88                                TOTAL   60
	>	> 
	>	>                     REASONS FOR CHANGES
	>	> 
	>	> 1) we start our deco at 80% of the profile in atmospheres,
or in
	>this
	>	> case , around 160 feet. We are not changing gases yet, so
no
	>reason to
	>	> sit on these stops. The ascent rate is 30 fpm, or the
equivalent
	>of a 20
	>	> second stop every ten feet from the bottom, so we are
really only
	>adding
	>	> 40 seconds per "stop" from 80% of the profile. This
actually
	>"maxes out"
	>	> at about 5 minutes per "deep stop" in anything approaching
	>saturations,
	>	> which I call 150 minutes for the purposes of decomprssion
reality
	>as
	>	> opposed to trying to decompress a whale. In a long dive,
we also
	>use the
	>	> first deco gas at 80% of the profile . Not in play here.
	>	> 
	>	> 2) moving up we do not extend these stops per Bulhmann,
since we
	>have
	>	> already moved the "ceiling" quite a long ways above us,
and are
	>not yet
	>	> really pressing the gradient ( in percentage or relative
terms, ie
	>the
	>	> ratio of the atmospheric change deep a opposed to
shallow). We
	>need to
	>	> get to a deco gas first and spend some time, so......
	>	> 
	>	> 3) we "SIT" on the 70 foot stop for quite a bit longer
than is
	>suggested
	>	> by theory. The reason is we want to use that wide open
oxygen
	>window for
	>	> all it is worth down there to both clear the slate as much
as
	>possible,
	>	> and to move that ceiling again quite a bit so that we can
	>abbreviate the
	>	> stops above as their ppo2 declines, rather than
lengthening them
	>as
	>	> either Bulhmann or bubble mechanics would indicate - real
life
	>says we
	>	> are correct. In fact, I have SKIPPED up to 100 minutes of
our 40
	>foot
	>	> stops with no repercussions, and Lucy Ho can vouch for me
on this
	>( and
	>	> the doppler says so). The other reason is that we want to
give the
	>blood
	>	> a chance to totally circulate with the new gas. While it
hits the
	>key
	>	> body parts immediately ( spine, heart, brain), it takes a
couple
	>of
	>	> minutes to get to everything properly. We do not want to
hammer
	>high
	>	> popo2's, we want to use them to our advanntage.
	>	> 
	>	> 3) since we have done our deep stops and our high ppo2's,
both
	>moving

	>	> our ceiling and shortening our upper time, we can go ahead
and
	>press the
	>	> gradient as it condenses, and shorten the next few stops
and get
	>to that
	>	> oxygen.
	>	> 
	>	> 4) the oxygen does not have to be hit too ahrd. I like
12-13
	>minute
	>	> stints with 6-8 minutes off. The reasons are that it takes
almost
	>no
	>	> time to saturate with oxygen at any ppo2 once the
immediate
	>offgassing
	>	> slows - a few minutes - and the damage starts to accrue
after
	>about
	>	> 16-20 minutes in our experience, depending of course on
the
	>dosages
	>	> already taken on the way up to this point.  The swelling
of the
	>lung
	>	> tissue picks up after a few minutes, and the gas transfer
process
	>is
	>	> severely hampered. Vasoconstriction gets worse, and you
are
	>pissing in
	>	> the wind honking on the oxygen. You need to break to back
gas, or
	>in
	>	> this case , just move up and get out.
	>	> 
	>	> 5) slow final ascent - the last move up to the surface is
one of
	>the
	>	> most critical. No matter how long you sit on a stop with
the
	>window wide
	>	> open, there will still be gas that will not be displaced
by this
	>method.
	>	> When you increase the gradient by trying to surface, the
last of
	>the gas
	>	> comes out rapidly and does so in bubble form. You must do
a slow
	>ascent
	>	> to reduce the risk of this, and for long dive it is one
foot per
	>minute
	>	> to the surface, for this dive it is more like 2.5 - 3 fpm.
	>	> 
	>	> 6) at the surface, sit still for a bit and try not to
exert for
	>about 30
	>	> minutes thereafter. Bubbles forming at this time will now
grow as
	>they
	>	> pick up offgassing nitrogen ( the helium is long gone) and
will
	>become
	>	> problematic later, and severely so if you have a shunt
that can
	>then be
	>	> opened by the in increasing pressure on the cappillary
beds of the
	>	> lungs.
	>	> 
	>	> OK - let's take it from here and get the discusion going.
Please
	>do not
	>	> copy back the whole message or it will become a mail bonb
- just
	>cut and
	>	> paste the parts you want to discuss, and lets discuss one
item per
	>	> email, SVP. When we expand this to a long dive, then I
will cross
	>copy
	>	> it to WKPP@eg*.co*, and we will bring in the big guns
( Rose,
	>Mee
	>	> ,et al).
	>	> 
	>	> Let's go .
	>	> 
	>	> --
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