Question So I'm 65 and on medicare which will not cover a physical. What do older divers do for the required physical? How extensive should it be?

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Then 5-10 years later
The paralysis of analysis.

If I had waited another 10 years for studies to be done on either the PPP or the CPap machine, I could very well have died. The PPP was the preferred method back then because so many patients could not deal with a CPap machine. When the PPP didn't work, I immediately went on CPap which really had been invented only a few years earlier. Insurance didn't want to cover it at first. While, I'm not sure I would refer to myself as a pioneer, I was definitely ahead of the curve, and soon my right shoulder was able to heal. I love science and research, but every now and then, somone's got to be the rat in the maze. Fortunes, and cures favor the bold.
 
Sorry to hear that. That has not been a viable alternative for your problem for at least 25 years.
Well, it's been around 30, I reckon. A few years one way or the other. It wasn't a pleasant experience on any level and my shoulder still hurt.
 
I was talking about the PPP :)
I was too. My then wife kept punching me in the shoulder whenever she noticed I wasn't breathing. She was a NICU nurse, so was really clued in on that. They stopped my sleep test at one point when O2 saturation dropped to dangerous levels. I'm remembering 60%, but that doesn't seem right somehow. I distinctly remember the pain in my shoulder subsiding considerably after the CPap. I want to get the travel one so I can sleep on planes.
 
The paralysis of analysis.

If I had waited another 10 years for studies to be done on either the PPP or the CPap machine, I could very well have died. The PPP was the preferred method back then because so many patients could not deal with a CPap machine. When the PPP didn't work, I immediately went on CPap which really had been invented only a few years earlier. Insurance didn't want to cover it at first. While, I'm not sure I would refer to myself as a pioneer, I was definitely ahead of the curve, and soon my right shoulder was able to heal. I love science and research, but every now and then, somone's got to be the rat in the maze. Fortunes, and cures favor the bold.


I don’t know how you were consented for your PPP, but often times patients are told “this is what we do for this, we think it will help”. However, if the clinician was truly honest (with themselves, and the patient) they would admit that we really don’t know.

It’s one thing to be part of a trial and know full well that what we are doing we are studying to see if it works (and often these studies can be completed in a few short years) vs being told this is what we do because it works.
 
I don’t know how you were consented
I asked the doctor what he would recommend... I am a bit more reticent now. :D FWIW, they gave me an on-demand pain killer. I pushed a button and got relief. I did once and immediately knew it was Demorol and I'm allergic to it. So, as miserable as I was, I never used that button again. In the morning, the nurse remarked on this and I told him I thought it was Demorol and that I was allergic. He wanted to know WHY I didn't tell them earlier. I pointed out that the allergy was on my file. You don't think clearly when you're in that much pain. Later that morning when he pulled the packing out of my nose, I had a deviate septum fixed too, I was overwhelmed with nausea and vomited on his shoes. :D
It’s one thing to be part of a trial
I trust my doctors to do the best they can that's in agreement with the science as we currently understand it. Sometimes the operation is a success, but the patient still dies. It's why we call them "practicing" physicians.
 
I asked the doctor what he would recommend... I am a bit more reticent now. :D FWIW, they gave me an on-demand pain killer. I pushed a button and got relief. I did once and immediately knew it was Demorol and I'm allergic to it. So, as miserable as I was, I never used that button again. In the morning, the nurse remarked on this and I told him I thought it was Demorol and that I was allergic. He wanted to know WHY I didn't tell them earlier. I pointed out that the allergy was on my file. You don't think clearly when you're in that much pain. Later that morning when he pulled the packing out of my nose, I had a deviate septum fixed too, I was overwhelmed with nausea and vomited on his shoes. :D

I trust my doctors to do the best they can that's in agreement with the science as we currently understand it. Sometimes the operation is a success, but the patient still dies. It's why we call them "practicing" physicians.

You’re still missing my point. Frequently the science that is used to support a particular medication, procedure, or product is crap. Like total crap. Medications are often tested against a placebo when a better standard of care is available, or tested against a deficient medication to get an easy win for approval.

Many surgeries and procedures have never been tested against a sham procedure. It has been shown that cardiac stenting for stable heart disease has absolutely no benefit over a sham procedure. In spite of this many cardiologists still perform stenting of stable heart disease.


Arthroscopic procedures on knee meniscus is also often advocated for by orthopedics in spite of evidence that for the average person they have no benefit.


Thankfully the need for proper RCTs to truly establish causal links for any medical intervention is becoming much more widely accepted than in the past, but still anyone with a finiancial interest in whatever medication, procedure, or product can come up with a million excuses why their pet intervention either is better than the studies show or why a study isn’t practical.
 
You’re still missing my point.
No, I disagree with your point.
Frequently the science that is used to support a particular medication, procedure, or product is crap
Let's be clear. Science is a constant. It never changes.

Our understanding of science is a rollercoaster. It always has been and always will be.

We observe. We hypothesize. We test. We keep repeating until we get it right. Mistakes are a huge part of the process. No one wants to make mistakes, but Murphy is an a-hole. Mistakes happen and are mostly unavoidable. Like rain, you can hate it, rail against it, and yell at the meteorologist when it ruins your parade. It's still going to rain. We observe our mistakes. We modify our hypothesis. We keep testing. Science never changes, but hopefully our understanding will more closely align with actual science. Yes, it's frustrating because it seems we take two steps forward and one step back. Progress is often painful.
Arthroscopic procedures on knee meniscus is also often advocated for by orthopedics in spite of evidence that for the average person they have no benefit.
My partial meniscectomy was an absolute success. That was 40 years or so ago. So were all the wrist and hand surgeries, the rotator cuff, the plates to fix my broken leg, the initial back surgery and I know I'm forgetting some.

Of all the procedures and surgeries I've had, only the PPP and my heart cath were a bust. There were some benefits to the ppp, in that it resolved a deviated septum and got rid of my tonsils. I used to get all sorts of respiratory infections, but those are now history. The heart cath was indeed needless. Other than losing my high tenor, I suffer no long-lasting side effects from either of those procedures. Medical science will continue to evolve. I'm fine with that. If you don't like the current results, don't yell at the researchers. Get off your butt and make a difference, instead. Do some real research in a lab. Yes, it will take time, money and resolve.

Me? I trust in the Hippocratic oath. Doctors spend their lives learning to cure what ails us. The CDC has more resources and is collectively smarter than all the 'experts' on the internet. I'm working through back issues at the moment. At my last procedure, the Doc was completely candid. He said they were guessing. There's no way they can know for sure which nerve is causing my pain. It's obvious that they need to try another area. There's a bit of relief, but I still have quite a bit of pain. I still trust the process of elimination here, as frustrating as it might be. Why? There is no other process. It's the best we have at the moment. Getting mad and casting aspersions at the doctors' genealogy won't make it any better. There aren't any conspiracies here. There are only successes and mistakes. There are misunderstandings as well as breakthroughs. But science remains constant. We just need a better understanding of it. Time, patience, and resources will help us in that endeavor.

Caveat: some drug companies put profits ahead of cures. These are outliers, even though they consume more than their share of media coverage. The vast majority of scientists and doctors want to make things better.
 
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