Col.Cluster once bubbled...
Butch as I said in my last post and has been mentioned in several posts; I will endeavour to curb my manner. This is not to pee in anyones corn flakes. Below Pufferfish admits to signing off smokers as good to dive. By his actions he is advocating smoking and diving. In the second paragraph he states that GUE is misguided. If they are misguided to restrict smokers then it also implies that smoking and diving is okay. Yes Pufferfish repeatedly back pedals and also throws in that he does not advocated smoking, but as I already stated we are all judged by our actions.
Pufferfish quote
I will continue to see smokers and try and use positive ways to get them to quit to the best of my ability. I will continue to sign off firemen, police, and military candidates who are young and perfectly healthy and who want to dive. And despite that I know over a lifetime smoking is just downright bad and nasty and I could refuse to deal with this unfortunate and serious problem by not seeing people who smoke, I feel this would not be in my or the smoker's best interest.
Yup just like it is okay to train non-smokers at NTD and let them breath air tested by an unaccredited lab which is unable to reliably test for CO, oil, and particulates. And who was talking about tar coated bronchioles and CO filled aveoli
So smoking is bad, GUE can make whatever policies they want even if misguided, and I have beaten this horse to death. End of story.
End quote
Take good care
CC
Ah CC it is nice to see you have come down from upon high on 'top' to chat with us mear mortals again. It must get quite lonely at times up there where no one has any vices or difficulties. But you know what I will take life down here with all its imperfections any day of the week
Listen I didn't want to bring up this smoking and diving issue again but since you seem quite distressed by my comments let me add some clarification. As several respected members on this board have stated from reading my posts at no time did I advocate that smoking was healthy or that diving and smoking was a good idea.
You know CC in this imperfect world of ours I am required to see and treat a lot of medical conditions and problems that while I personally might not agree with what the patient is doing and which has brought on unhealthy state, I still must offer treatment despite my personal belief system. To not do so would violate the Hipocratic oath to do no harm. Just last week I started a twelve year old on birth control with her parents in the office requesting the same. While I might not agree with fact that she was sexually active at twelve (neither did the parents) thankfully the parents were smart enough to realize that aside from locking her up so she couldn't have sex, the best option was to put her on the pill. When the risk and benefits were weighed (and there is lots of data to back this up) both myself and the parents agreed that the risk of a twelve year getting pregnant and delivering a child and then trying to raise that child were far greater than the risks of putting her on the pill. Not an easy decision for myself or the parents but these are the types of risk/benefit analysis decisions we must do on a daily basis. I had to put my personal biases aside take all the data and family wishes into consideration and then help them make a decision that is both scientifically and medically sound and in keeping with the family's moral code. Sometimes being a doc means making difficult decisions or assisting in these decisions.
Which brings me back to the subject of the risk/benefit analysis of signing off a young healthy smoker with no other health problems to go diving. I am not sure why but I see quite a few police and fire recruits who come to me first to get approval to take the fitness assessment and then afterwards for various testing they need done such as a pre diving physical. I always ask whether they smoke and I'm sure the smoking rate in this population (police/firemen) is not as high as the general population but it is still likely in the ten to fifteen percent range. Of these smoking guys and gals they are usually between 18 and 27, very fit, keen, and all of them know smoking is bad for them. I mean how could one not know in this day and age. Despite that knowledge that smoking is bad for them, changing their behavior is a different story. My point to Dan was that by letting these people into his course especially being an ex-smoker he might just be the role model and offer those words of wisdom needed to get the young healthy fit smoking diver to quit. I know I try hard on my end to get folks to quit, but I don't like to use the big stick approach as each person will likely quit in their own time and the initiating event for a person to quit is always different as well. For some it is the death of a friend but for many of the younger smokers it is the role model phenomena. When the young smoker sees people who they respect not smoking that is often (plus the cost of smokes) the impetus to quit. Dan is missing out on this opportunity to influence some of these young divers to quit but that is his perogative.
So CC what do you do when one of these police or fire recruits who smokes comes to your office and says doc I need this PADI/NAUI/Navy Seal/Toronto Police Force/Toronto Fire Department dive physical done so I can learn to dive? Some of them want to learn to dive as a hobby and some as part of their profession. Lets say we go through all the questions on the form, I examine him or her, and the end result of this plus blood work, pulmonary function tests,it is determined this guy or girl could carry a 200 pound unconscious person down a fire ladder from the 30th floor but you know what, HE SMOKES and wants to learn how to dive. Now if I was working for GUE or held a very rigid and narrow view of the world I would have tell the guy sorry, we BELIEVE that all smokers should be barred from ever diving. And according to my Quest article smoking divers might not make responsible dive buddies. I am being somewhat sarcastic here but you get my point. Well thankfully I don't work for GUE (but still am interested in taking a fundamentals course)because I will give the diver in the above scenerio the go ahead to start diving. The data is just not there to say a young healthy fit smoking diver should not dive, just like it is not there to ban a diver with a PFO. Yes we both know smoking is bad but with the absence of any good data to preclude this fellow from diving I can't just say you can't dive becuase my belief is you shouldn't dive and smoke. And you know what CC I can just about guarantee that any doc including the ones doing the physicals for the Navy Seals will sign him off. The reason being is there is no data out there to show this guy especially for recreational diving or taking a GUE fundamentals course is really at risk for any increased problems at this point in his hopefully short smoking career. I may not approve of him smoking and diving and I do inform them of the of longterm risks of smoking but unlike GUE which is free to do what it wants on this issue I must look at the data and put my personal beliefs aside and make a scientific decision on what to do. With that being said, would I sign off a young bad asthmatic who smokes and wants to dive, of course not.
The reality of the situation is this doesn't come up all that frequently and usually if it does in the same visit we can talk about quitting. I have not met one police or firemen recruit who smokes and doesn't want to quit but you know what as I sure Dan can attest one doesn't just wake up and quit. It often takes numerous attempts and various strategies.
So once again that article you presented while full of good info about the longterm risks of smoking which I see the results every day it really doesn't have any good data or references to ban the type of diving candidate mentioned above. It would be interesting to know what percentage of naval divers smoke. My guess is probably about ten percent, the same percentage as doctors who smoke. If the Navy has not started a similar exclusion policy then they must know something GUE doesn't or at least have weighed the evidence for and against allowing a young fit diver to smoke and have come to the same conclusion as I have. Let the smoking recruit in, let him try the tests, and if he passes we will then do our hardest to get him to quit. We will also check him every couple of years physically or if he develops a new health problem (ie. asthma), and if that point in time comes to tell him to hang up his fins we will. The same goes for me. I do not sign off forty year old obese, twenty year old smoker with high blood pressure and cholesterol. I send them to the diving cardiologist to make the decision or in other words pass the buck
CC the message here is each case must be considered individually and having blanket rules and dogmas is not how a person who seeks the truth operates. I know GUE likes their rules and it really does make life much easier at times, but real life has many more nuances and subtleties that require a more critical approach than Rule #1 or Rule #8. Rules work great for driving cars but don't work that well with those of us trying to seek the truth in our day to day work and outside endeavors like diving.
Hope that helps clarify why I do sign off some smokers to dive under certain conditions and this issue can be put to rest.
