Medical risks for the ageing diver

[billt4sf]

OK, we are all ageing (hopefully) and I am just over 60, in good shape and exercise regularly. Anyway I don't intend this to be about me per se.

I have noted that often dive accidents are related to per-existing medical conditions that just happen to occur while diving. It's easy to imagine that a heart attack while diving could much more easily be catastrophic than at home, with 911 nearby.

My question then, is what other age-related medical conditions might end up being a proximate cause to a dive fatality? As far as I know, strokes are much more common during sleep than during activity. (I had a TIA "minor stroke" and have been cleared to dive).

The second question is: How can older divers mitigate the likelihood they might occur? Other than regular exercise and weight control, keep dive profiles conservative, keep hydrated, and actually practice the skills we supposedly have.

Thanks,

Bill

 

[divingpyrate]

i turn 56 on march 9 and will celebrate diving in coz
Yearly physicals full blood work and my doctor knows that I dive and advises accordingly
I have a fused c6.c7 neck injury. And my surgeon and PTS knew about my diving and also advise

there is no cure for ageing, and people die sitting at desks allthe time. All you can do is due diligence. I will dive until my health stops me or my doctor says stop
that will be a sad day

Sent from my A500 using Tapatalk 2

 

[JoeSpirit]

I have to differ with you divingpyrate. There is one cure for ageing...

On a more serious note we rarely know when our time is at hand. The best I think we can do is try to maintain our physical, and mental, condition as best we can. And it sounds like you're working on that Bill.

One thing to be sure of is how you feel before you enter the water. Often your body warns you whether you should do something or not.

 

[billt4sf]

​I'm hoping with this thread to get responses from some medical people that can tell us what specific conditions are most likely to cause problems.

 

[TSandM]

Well, if you look at the physiology of diving, the big deals are going to be exertion, cold, and pulmonary function. I think what probably brings on heart attacks in older divers is the adrenaline rush, either of getting into cold water, or of exertion in swimming against current, or swimming period, if the person is otherwise rather inactive. Adrenaline could also precipitate arrhythmias in somebody with a predisposition to them.

Most pulmonary issues which are likely to kill you are going to be symptomatic on land to some degree that would probably preclude diving.

Immersion pulmonary edema is an interesting entity which has been tenuously linked to hypertension, which is more likely to exist in older divers.

Other than controlling one's weight and staying generally fit, I don't think there is anything specific you can do to avoid the risks. You can have silent coronary disease, and when your plaque ruptures, that is the first you know of it. Even a yearly treadmill won't rule out the risk of a heart attack.

 

[billt4sf]

Even a yearly treadmill won't rule out the risk of a heart attack.

Can it help to identify incipient coronary disease in a number of cases? (I assume here, you mean a treadmill test with EKG attached or some such.)

Because otherwise it seems that older (> 60) divers are taking a substantial risk. Having a cardiac event at home with 911 around is one thing, but having it 60 feet underwater is an entirely different animal. One could easily cut 20 years off one's life. I would really like to have whatever tests are even somewhat likely to indicate issues.

 

[DocVikingo]

Can it help to identify incipient coronary disease in a number of cases? (I assume here, you mean a treadmill test with EKG attached or some such.). I would really like to have whatever tests are even somewhat likely to indicate issues.

Hi Bill,

Cardiac/exercise stress testing (aka exercise tolerance testing or ETT) can help to identify incipient cardiovascular disease in a few cases. However, in persons already at low risk for coronary artery disease (CAD) (e.g., no family history, no history of smoking, obesity, diabetes mellitus, hypertension, low HDL cholesterol), it’s detection rate is so low as to render it generally inadvisable.

Of course there are other techniques available to image & measure coronary circulation (e.g., coronary catheterization, radionuclide stress testing, stress echocardiography). However, it is important to appreciate that other & more sensitive techniques cost money and that your insurance carrier/health system is very unlikely to pay for them in the absence of any direct indication for their use (e.g., signs/symptoms such as chest pain (angina)). They almost certainly will not do so just to put an individual at ease. Also, none of these procedures is without risk although some have much higher risk than others.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

---------- Post added February 19th, 2013 at 08:19 AM ----------

As far as I know, strokes are much more common during sleep than during activity. Thanks,
Bill

Hi Bill,

I don't believe that the bulk of the published research on this topic supports that statement:

- Transient Ischemic Attacks and Minor Stroke During Sleep

- Population-based study of wake-up strokes

Regards,

DocVikingo

 

[billt4sf]

Hi Bill,

I don't believe that the bulk of the published research on this topic supports that statement:

- Transient Ischemic Attacks and Minor Stroke During Sleep

- Population-based study of wake-up strokes

Regards,

DocVikingo

Thanks Doc. I sit corrected! Good articles. The first is especially good for my wife who snores.

 

[zugbug99]

Hi Bill,
The most common causes of death for the aging have changed in the past 100 years. The CDC has a nice publication at: http://www.cdc.gov/nchs/data/ahcd/agingtrends/01death.pdf
Cardiovascular disease is still the number one cause of death as a whole, and likely the biggest concern in diving due to distant locations and conditions that make access to advanced emergency medical services difficult if not impossible.
I hope to have my first cardiovascular event on the doorsteps of the Mayo Hospital, and not at Truk Lagoon.
DocVikingo is spot on about his comments of cardiovascular risk stratification and the ability, and lack thereof to detect early vascular disease before the event occurs.
Ultrafast coronary artery CT scans with calcium scoring looked promising 10 years ago, (the so called $99 HeartScan offered by a host of facilities across the country) but have not been able to give much reassurance than old Harvard Step Test, Bruce protocol on a treadmill stress test etc.
Now 2 day cardiac perfusion scans (MUGA , Persantine scans) are the standard which cardiologists are using short of the left heart catheterization with angiography at the local heart hospital.
Unfortunantly most cardiac disease is found after the first event (your first TIA) and the rest of our lives we try to slow the progression of the disease and extend our lives enabling us to enjoy activities we love (diving).

New implementation of the Affordable Healthcare Act (ObamaCare) is going to rapidly change the "standard of care" for the treatment of atherosclerotic vascular disease. The ability to have 4-5 stents placed in multiple arteries over multiple events will soon be a thing of the past. The emphasis will be on preventative care, and there may be little choices available after a first heart attack, stroke, or other vascular event.

The old standbys of risk reduction by maintaining a healthy lifestyle (weight manegment, lipid control, tobacco cessation, active lifestyle, stress control) can certainly help. Genetics is a strong predictor of future disease risks, something the human genome product has shown.

So when it really comes down to it, enjoy everyday that live has to offer. Don't keep a bucket list, but enjoy what life has to offer now! And keep doing the great things you already mentioned, exercise, healthy diet, and not pushing ourselves to keep up with the 20 year olds.

Best Wishes!
Mike

 

[raftingtigger]

To put into plain old English what the Docs above are saying: Tests aren't infallible and have their own set of risks.

In addition to finding a real problem that you can do something about, a test can

1. Miss a problem and give you a false sense of security (false negative)
2. Find a problem that isn't really there (false positive), which then leads to treatments that aren't needed and some can even have substantial risks.
3. Cause harm itself

In ordering a test the provider tries to balance the potential benefit of the test vs. the potential harm it may do. This generally isn't a cut and dried, but depends on multiple variables (person's age, over all health, problem at hand, risks of the test...).