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Date: Mon, 11 Mar 2002 22:21:12 +0100
From: mat.voss@t-*.de* (Matthias Voss)
To: Simon Naunton <snaunton@ho*.co*>
CC: techdiver@aquanaut.com
Subject: Re: detecting bends
The most simple tool is evidence, as shown in the supect divers
behaviour, how s/he acts, responds, and the neurological quickcheck,
done repeatedly, and kept done/reported continously.

This can be done without tools.
I do not know the tools needed for the cited check, but can imagine that
it implies the use of well maintained binoculars ( not sure about the
degree of magnification needed.

While not questioning the claimed ease of performing this test, I
however see its apparent justification mainly to satisfy curiosity(
sarcastic mode), or being used as a screening tool, for raising
statistical data subject to a future furthergoing analysis( benevolent
mode), in an effort to validate a link between the bubble evidence and
Doppler data, and ! cases of DCS, and! data related to the character of
specific dives.

Since DCS cases are not very frequent, I would like to see the
statistical background of this study, whether it was done in field, or
by test objects ( animals) , since real tests with divers are not
consistent with medical ethics. 

If there is a sufficient number of observed data, there will be no
concern of an alpha error, if not, following guidelines derived from
this study will add accidents to the DCS statistics where divers
received no timely treatment because they did not show a sufficient
number of bubbles in their tear liqid, and this perhaps in spite of
neurologic symptoms.

Matthias

Simon Naunton schrieb:
> 
> I see your point, if you live/dive in Europe or the US. However, if for
> instance you live in Australia or the South Pacific where it may be several
> thousand kms to the nearest chamber, a simple diagnosis tool may be a good
> idea.
> 
> >From: mat.voss@t-*.de* (Matthias Voss)
> >To: Simon Naunton <snaunton@ho*.co*>
> >CC: John.Brett@qu*.co*, techdiver@aquanaut.com
> >Subject: Re: detecting bends
> >Date: Mon, 11 Mar 2002 13:56:24 +0100
> >
> >I did not keep the message refferring to the study, so this is only from
> >my memory:
> >Wasn't it said that Bennett _reported_ on the study ? So , if correct,
> >he would not even need be directly related to this investigation, which
> >seems, to my view, a bit obsolete.
> >  When  a diver shows symptoms, and his history of decompression is
> >known, then next steps/ measures are obvious. No need to treat someone
> >with no symptoms.
> >
> >So , if this study even was on the right track, to what purpose I may
> >question.
> >If a diver showed symptoms, _then_ look into his liquids for bubbles,
> >and, to decide _what exactly_, which would not have to be decided to
> >begin with . Get a Heli _or not_ ? Throttle lLever down the dashboard
> >_or not_ ? Report to the chamber _or not_ ?
> >The mere idea gives me some chills, and a distinct notion to beware of
> >quickshot medical reviews.
> >Matthias
> >
> >Simon Naunton schrieb:
> > >
> > > >From: John.Brett@qu*.co*
> > > >To: snaunton@ho*.co*
> > > >Subject: RE: RE: detecting bends
> > > >Date: Mon, 11 Mar 2002 04:42:19 -0500
> > > >
> > > > > Because this is an forum for the discussion of technical
> > > > > diving and another
> > > > > diver made a statement I happened to disagree with on the
> > > > > basis of the facts presented.
> > > >
> > > >I'm still struggling to work out what basis you have on
> > > >which to express your disagreement. Do you have more
> > > >knowledge than the WKPP about decompression?
> > >
> > > Errmm... no, and I haven't claimed to have.
> > >
> > > >Do you know
> > > >Dr Bennett?
> > >
> > > Not personnally. How, apart from being a leader for you to name drop, is
> > > this relevant?
> > >
> > > >
> > > > > Strictly speaking, we are not talking about
> > > > > decompression, we are
> > > > > talking about the possibility of a simple method of
> > > > > determining whether a diver has DCI or not.
> > > >
> > > >Ugh!  It seems that you haven't understood G's comments.
> > > >Detecting *venous* bubbles isn't the same as detecting
> > > >a bend - a PFO makes a *big* difference to their significance.
> > > >There's also far more going on at the sub-clinical level
> > > >before you get visible symptoms, by which time the damage
> > > >is done.
> > >
> > > So are you saying that once someone is bent then there is no point in
> > > attempting treatment?
> > >
> > > I have sent this in a mail that has yet to appear on the list, but are
> >these
> > > venous bubbles? Could they not have been formed directly from gas in the
> > > divers mask?
> > >
> > > >
> > > > > > > Regardless of
> > > > > > > the achievements you have made with the WKPP, which are
> > > > > > > truly impressive, I
> > > > > > > am more inclined to believe a doctor who specialises in
> > > > > > > hyperbaric medicine than yourself.
> > > > > >
> > > > > >Your loss.
> > > > >
> > > > > Subjective. It could be considered you loss as well.
> > > >
> > > >I know how to deco, thanks to G.
> > >
> > > I too have learned from him. I reiterate that I am in no way challenging
> >his
> > > deco procedures.
> > >
> > > >
> > > > > Not so sure. A prostitute would probably be able to give a
> > > > > trick or two on
> > > > > avoiding the clap, but a doctor would be far more likely to
> > > > > be able to tell
> > > > > you what is going on in the body with some degree of
> > > > > accuracy. Similarly,
> > > > > George and the WKPP are a wealth of information on deco
> > > > > practice, however,
> > > > > AFAIK none of them have spent enough time at med school, if
> > > >
> > > >Bill Mee is a doctor of microbiology (WKPP project engineer)
> > >
> > > Did he attended medical school? BTW I am  not trying not to be
> >provocative.
> > >
> > > >
> > > > > any time at all,
> > > > > to go up to a hyperbaric doctor and tell him he is wrong,
> > > > > particularly with
> > > > > the minute amount of information presented in the email.
> > > >
> > > >Dr Hamilton goes to the WKPP for advice...
> > >
> > > I thought the WKPP acted as test-ish subjects-ish?
> > >
> > > >
> > > > > I read somewhere that George was a stock broker. I believe
> > > > > that Dr Bennett
> > > > > is very active in his field, both treating patients and
> > > > > conducting research, so could hardly be called a theoretician.
> > > >
> > > >So just how much do you know about Dr Michael Bennett?
> > > >Does he actually dive?
> > >
> > > Not much. I don't know. What is the relevence of whether he dives or
> >not?
> > >
> > > >
> > > > > By the same token though, I do not
> > > > > believe that any of the WKPP have ever sold their bodies for
> > > > > the sexual
> > > > > gratification of another party, but I also have never met any
> > > > > of them so
> > > > > that is pure speculation.
> > > >
> > > >Speculation appears to form the basis of your arguments.
> > > >Not the best basis on which to work.
> > > >I've tested G's decompression strategy to the best of
> > > >my ability, so I have a little more basis than speculation
> > > >on which to rate G's opinions over a doctor of whom I've
> > > >never heard.
> > >
> > > As I have already said, I am not challenging G's decompression strategy
> >- I
> > > am not in the position to do that, just his rubbishing of Dr Bennetts
> >study
> > > based on the information contained in one paragraph written by a
> >newspaper
> > > journalist.
> > >
> > > >
> > > > > >Personally, I'd rather listen to someone who bets his
> > > > > >life on the outcome, rather than one who bets a published
> > > > > >paper.
> > > > >
> > > > > True, but this is not really relevant in this context.
> > > > >
> > > > > With apparently 0 incidents of DCI amongst WKPP members, how
> > > > > much experience
> > > > > does the WKPP have with DCI compared with a hyperbaric
> > > > > doctor?
> > > >
> > > >Sigh. You obviously have *no* idea about the WKPP.
> > > >The US Navy come to the WKPP for decompression advice, and
> > > >have sent their hyperbaric doctors to examine WKPP divers
> > > >after diving.
> > >
> > > Your point being? They have loads of experience at DCI avoidence.
> > >
> > > >
> > > > > Bottom line:
> > > > > Have the WKPP studied the formation of bubbles in the tear
> > > > > film of the human
> > > > > eye due to changes in ambient pressure? Probably not. Has Dr
> > > > > Bennett? Yes.
> > > >
> > > >The relevance being...?
> > >
> > > The relevence being that Dr Bennett has studied it and concluded that
> > > subjects with 20-30 bubbles in the tear film of their eyes also had DCI
> >and
> > > those with 2-3 did not. G & the WKPP, AFAIK, have not studied this, so
> >how
> > > can G justify his statement that it is bullshit - but I guess that you
> > > cannot answer that John.
> > >
> > > >
> > > >The issue is not so much whether additional bubbles appear in
> > > >the tear film after diving, but the interpretation & relevance
> > > >of the findings. Just finding bubbles isn't the same as DCI,
> > > >which isn't the same as needing treatment.
> > >
> > > I think that you are looking at this from the wrong angle. I don't
> >believe
> > > that Dr Bennett even implies that these bubbles are the cause or part of
> >the
> > > damaging part of DCI, there are simply 20-30 bubbles with subjects with
> >DCI
> > > and 2-3 with subjects without, therefore, the possiblity exists for an
> >easy
> > > test.
> > >
> > > >
> > > >John
> > >
> > > _________________________________________________________________
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> > >
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> 
> Simon Naunton
> snaunton@ho*.co*
> 
> _________________________________________________________________
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