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?

[The Chairman]

Why do you think that? Now you know that a coronar heart disease did not cause your heart issues.

I don't have any 'heart issues'. My bradycardia has been well documented over my entire life. During one of my wrist surgeries, the anesthesiologist concluded that I have ischemia, where the heart muscles are large on one side. This is from being an athlete at one point in my life. Racing canoes is a whole-body workout. To date, I have 4,600 miles in the seat of a canoe. My resting pulse used to be in the mid-thirties. Currently it's in the mid-fifties. Two cardiologists have concluded that I will die one day, but probably not from any heart condition.

Our bodies are mostly a result of all the choices we've made in our lifetime, good or bad. Diet, exercise, and habits all contribute positively or negatively to our quality of life. There's nothing we can do about our genetics, but so much we can do about all the rest. Right now, my Garmin watch says to "MOVE!". I think that's a great decision to make on my part. I'm going to head over to LifeSouth in Lake City and give my weekly donation of platelets. No, it won't help me, but it will help someone. It's worth the two hours I spend every Monday. TTFN.

 

[kinoons]

No, I disagree with your point.

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.

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.

I like your optimism, and I am also glad the majority of your procedures were successful. Unfortunately I don’t share your optimism. You are correct that science does not change; our understanding of the results evolve. Unfortunately when prestige and money are involved that understanding is easily manipulated for personal or institutional gain.

Today I read about the longer term (one year outcomes) using a device to occlude the left appendage of the left atria of the heart. Basically the thought is by doing this procedure with a device the risk of stroke from A-Fib can be reduced and the pt can come off anticoagulant meds.

Historically this was done via a surgical procedure that was quite complicated and the pt remained on anticoagulant meds. Therefor it was not very common.

Now many cardiologists use a device that is much easier to place.

In the initial trial, measuring device success after 45 days, there was a trend towards more strokes, but the result was not statistically significant. Because of this study widespread use was approved.

The rare few (Drs. Mandrill, Foy, Naccarelli) argued that this device should not be used as it is not better than the standard of care (anticoagulant usage) and costs more. They asked for longer term results to confirm safety and effectiveness.

Inspite of this, use of a LAA devices has skyrocketed.

Now the one year results are out. LAA devices leak about 1/2 of the time. A leaking LAA device increases the risk for stroke. There was a signal in the initial study, and the “longer” term study (only one year) confirmed this.

I believe that usage of a LAA device shouldn’t have been approved off the initial study. With the results trending toward harm longer term studies should have been required. Instead it was approved and usage skyrocketed. Now the genie needs to be put back in the bottle. I don’t doubt the overwhelming majority believe they are doing the right thing, but that belief is hard to shake when it is reinforced by cold, hard, cash. I fear it will take years, maybe decades, for this practice to stop.

https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.123.067599?utm_source=substack&utm_medium=email

https://www.heartrhythmjournal.com/article/S1547-5271(17)31200-6/fulltext

I wish this was an isolated example, but similar occurances are rampant. Dr. Vanay Prasad wrote an entire book on it.

 

[Scubagermany]

I don't have any 'heart issues'

I dont mean to be mean (no pun intended),
But from this post alone I would recapitulate that you are a 60 plus grossly overweight male with hypertension and bradykardia.
The bradycardia itself is a "heart condition" . Not to mention the diabetes (do not know if that applies to you) that is rampant in the US und in the most important risk factor for chd except.for smoking.
Every sensible general practitioner would have recommended a cath with your risk profile. It would have been neglectful not to do so.

 

[The Chairman]

I was more bradycardic when I was thinner and had stupid low BP. Up until I broke my leg, and then had to take care of my sister, I was quite active and had no issues with normal BP much less a high BP. Today, while giving platelets it was 120/70. When I'm in pain, it will go up to 140. How many doctors do I need to tell me that my heart is fine? While he might have felt the need to recommend it, I don't think I needed it.

It's incredibly important for each of us to know our personal baselines and to follow them throughout our lives. They will change with age, activity, and disease. While I am bradycardic, my sister was tachycardic. My base temperature is usually 96.8 hers was right at 99. I'm not against doctors, quite the contrary. I am against overusing doctors and not taking care of yourself instead. Know thyself begins with knowing your body.

I think we are way, way off of the initial theme of this thread in. I've never been asked for a physical to dive... just if I have had a dive within the last year. Taking a class might be different, especially if your instructor has doubts.

 

[Scubagermany]

I did post my recommendations regarding the question posed by the TO a few posts earlier.

 

[eelpout]

From the point of view of a Hyperbaric facility employee, because of your smoking history, a good Diving doctor would request at least a chest X-ray to find "Blebs" that heavy smoking can cause. I have a younger brother who smoked for 40 years who at dinner party in 2016 had a "Spontaneous Pneumothorax" occur. He was an avid diver because of his profession, Marine Biology Professor, had to quit. He is lucky that it did not happen underwater or else he would have had a very serious problem. I am 65 and Have type 2 Diabetes. My doctor knows my health issues and how I am maintaining it. I have had two Diving Medical Forms that she has signed for me. I had a stress test 4 years ago and it seems my heart is in pretty good shape. The underwater world is a "hostile environment" and divers have to be capable of dealing with their physical stress and be able to assist with their buddy's issues if needed. If we do treat patients with "Blebs" in the chamber, we have to modify the ascent based on the patient's condition and history.

 

[kinoons]

From the point of view of a Hyperbaric facility employee, because of your smoking history, a good Diving doctor would request at least a chest X-ray to find "Blebs" that heavy smoking can cause. I have a younger brother who smoked for 40 years who at dinner party in 2016 had a "Spontaneous Pneumothorax" occur. He was an avid diver because of his profession, Marine Biology Professor, had to quit. He is lucky that it did not happen underwater or else he would have had a very serious problem. I am 65 and Have type 2 Diabetes. My doctor knows my health issues and how I am maintaining it. I have had two Diving Medical Forms that she has signed for me. I had a stress test 4 years ago and it seems my heart is in pretty good shape. The underwater world is a "hostile environment" and divers have to be capable of dealing with their physical stress and be able to assist with their buddy's issues if needed. If we do treat patients with "Blebs" in the chamber, we have to modify the ascent based on the patient's condition and history.

Chest x-rays are a very poor screening exam. The sensitivity of a chest x-ray for something like blebs isn’t near good enough to trust that a normal CXR means you’re okay.

I’d start with pulmonary function tests to diagnose COPD/emphysema. Lacking a diagnosis of COPD or asthma is reassuring. Additionally not having a body type that lends itself to spontaneous pneumothorax is also reassuring.

It appears that the rate of spontaneous pneumothorax in the population may be somewhere around 14 per 100,000 per year

“In 2016, there were 14.1 spontaneous pneumothorax admissions per 100 000 population 15 years and older (95% CI, 13.7-14.4), a significant increase compared with earlier years, up from 9.1 (95% CI, 8.1-10.1) in 1968.”

Trends in the Incidence and Recurrence of Spontaneous Pneumothorax, 1968-2016

This population epidemiological study uses English national hospital data sets to characterize trends in the incidence and recurrence of hospital admissions for spontaneous pneumothorax to identify risk factors for recurrence.

jamanetwork.com

The question becomes can routine asymptomatic screening of divers reduce the likelihood of a spontaneous pneumothorax on surfacing. Honestly I don’t know the answer to that question, but my WAG is that you’d have to screen a metric **** ton of divers to prevent one pnuemo. Even if you narrow that screening to only high risk individuals I’m not convinced as I’d be willing to bet dollars to donuts many tens of thousands of “at risk” divers do so every day without injury.

But, I’d be open to being proven wrong via a well designed RCT. Although given the rarity of pneumothorax or air embolism associated with diving I think you’d have a hard time powering your study to get reliable results.

 

[1fspeed]

If your insurance won't cover the physical, just check the boxes like you're a 20yo Jacques Cousteau.
In the end, everyone runs out of air.
Dive more, worry less.

 

[FishWatcher747]

From the point of view of a Hyperbaric facility employee, because of your smoking history, a good Diving doctor would request at least a chest X-ray to find "Blebs" that heavy smoking can cause. I have a younger brother who smoked for 40 years who at dinner party in 2016 had a "Spontaneous Pneumothorax" occur. He was an avid diver because of his profession, Marine Biology Professor, had to quit. He is lucky that it did not happen underwater or else he would have had a very serious problem. I am 65 and Have type 2 Diabetes. My doctor knows my health issues and how I am maintaining it. I have had two Diving Medical Forms that she has signed for me. I had a stress test 4 years ago and it seems my heart is in pretty good shape. The underwater world is a "hostile environment" and divers have to be capable of dealing with their physical stress and be able to assist with their buddy's issues if needed. If we do treat patients with "Blebs" in the chamber, we have to modify the ascent based on the patient's condition and history.

If only medical screening was as easy as you would hope. Chest Xray is not a reliable screening tool for blebs. Should we do a chest cat scan on every diver who shows up for a medical visit?

 

[WeRtheOcean]

Our bodies are mostly a result of all the choices we've made in our lifetime, good or bad. Diet, exercise, and habits all contribute positively or negatively to our quality of life.

That doesn't seem to be a PC thing to say anymore.

I'm very much of the opinionThat people are too Paralyzed by what insurance will or will not pay for.

For the love of Pete, if I need a physical And insurance won't pay for it I'll pay for it Out-of-pocket if I really want that physical.


We really need to stop abdicating our own responsibilities to somebody else just because they offer pay for it.

I was surprised that there were no comments on this. Think about other types of insurance. Car insurance, for instance. Your car insurance will not pay for oil changes, tire rotation, tune ups, or things of that nature; that basic maintenance is on you. Car insurance is there for when there is an accident and a major repair is needed. What if we (as a culture) were willing to own our health the way we own our cars?