freewillie
Contributor
One of the reasons I have gravitated to SB is to learn how to be a better and safer diver. Even before I was certified I would go to the Lessons for Life section of Scuba Diving Magazine and read through the article. They're basically stories of divers who made mistakes and died. At the end of the article the experts discuss what went wrong and how to avoid them. One month the article specifically included a diver who had a heart attack while diving.
Well, there is only a limited number of monthly magazines. So I started going to the Accidents and Incidents forum here. Lots more posts to go over and maybe learn some pearls. There were two accidents in particular that struck a chord.
Both involved sudden death incidents while diving and ironically both divers as it turns out were significantly overweight. One thread in particular started going off on a tangent on whether or not a Body Mass Index is an accurate measure of health.
Just for background, I am a general internal medicine MD and am board certified. The following is my opinion on health and is an amalgamation of accepted medical practice, standard recommendations for diet and exercise, and my own personl beliefs on diet and exercise. And just because this is a litigious nation the following is not intended to diagnose or treat any condition, and is intended for the sole purpose of education in general.
My normal assessment for health is a general health history. Basically do you have any underlying medical illnesses and what medications are you taking? In that section patients will indicate if they exercise or not. I will assume that all of you have had your medical waivers signed by your doctors and have been medically cleared to dive. If has been several years since then, please keep reading.
The next part is the physical exam. For new patients and complete physicals these always include blood pressure, height, and weight. I actually have a electronic medical record and can click a box that will give me a Body Mass Index, or BMI. Please, this is not to discuss the validity or accuracy of a BMI on health. This is only one of many factors we will discuss. Then I listen heart, lungs, etc. BTW I also look for skin lesions especially melanoma so wear sunscreen and cover up.
The last part of the evaluation will be the blood test. Specifically I am concerned about fasting blood sugar since it screens for pre-diabetes or diabetes itself and a cholesterol panel since it screens for risk of cardiovascular disease.
Please note that none of these parameters by themselves is a measure of health. They are markers for risk factors and have an association for other medical conditions. Being overweight does not mean you will develop diabetes but you have and increased risk of developing diabetes. High cholesterol and or high blood pressure does not mean you will have a heart attack or stroke, but your risk is higher the higher your levels respectively.
More important, I generally look at your BMI and your exercise capacity. If you are overweight I recommend losing weight. Generally this only takes place in the setting of both diet modifications and exercise. For exercise I make a generic recommendation referred to as a walk talk sweat test. You want to walk fast enough to develop a light sweat but not so strenuous you can't carry on a conversation comfortably at the same time for 20-30 minutes. This equates simply to moderate level exercise and you should to attempt to exercise 3-4 times a week. I know we are all busy and this may not possible for everybody but even once a day is better than no exercise at all.
As for diet, please be honest with yourself. It is a calorie issue and you need to match you calories in to your calories out. It is not my purpose to get into the advantages or disadvantages of specific diets. Find a daily calorie calculator, figure out how many calories you need per day based on age, sex, and activity and target your intake to that level. More calories you will gain weight, less calories you will lose weight.
How does all this related to scuba? Well, as it turns out both the divers I mentioned were significantly overweight in the 300 lbs range. By any means they were overweight. Using DAN numbers, being either overweight or actually obese was associated nearly 75% deaths. In addition, cardiac causes of death was about 26% of fatalities. So if you are overweight and out of shape you have a higher risk of a diving fatality. Also, the month of July has the highest fatality rate. I found this very interesting, and my own $0.02 is that this is when the highest number of out of shape divers are getting in the water. They haven't exercised for a while and underestimated the physical exertion of scuba and suffered a cardiac event. Also, a higher number of divers not having dived for a while and increased risk dive accident.
Now, nothing I've said is specific to dive related medicine. If you are on medications you will need to clear them with you own MD. However, as good general medical recommendations please diet, exercise, and maintain a healthy body weight. Never underestimate the value of a good nights sleep. Laugh often and with others. Hug your spouse and your kids or pet. Don't forget to smile.
If it has been a while since you had your medical waiver signed, or if it has been a long time since you went diving, please plan for your dive vacation by starting an exercise regiment several weeks before your trip to ensure you are healthy enough to participate and think about a refresher course. These may actually make your trip more enjoyable.
Wishing all of you good health. Have fun, and safe diving to all.
Well, there is only a limited number of monthly magazines. So I started going to the Accidents and Incidents forum here. Lots more posts to go over and maybe learn some pearls. There were two accidents in particular that struck a chord.
Both involved sudden death incidents while diving and ironically both divers as it turns out were significantly overweight. One thread in particular started going off on a tangent on whether or not a Body Mass Index is an accurate measure of health.
Just for background, I am a general internal medicine MD and am board certified. The following is my opinion on health and is an amalgamation of accepted medical practice, standard recommendations for diet and exercise, and my own personl beliefs on diet and exercise. And just because this is a litigious nation the following is not intended to diagnose or treat any condition, and is intended for the sole purpose of education in general.
My normal assessment for health is a general health history. Basically do you have any underlying medical illnesses and what medications are you taking? In that section patients will indicate if they exercise or not. I will assume that all of you have had your medical waivers signed by your doctors and have been medically cleared to dive. If has been several years since then, please keep reading.
The next part is the physical exam. For new patients and complete physicals these always include blood pressure, height, and weight. I actually have a electronic medical record and can click a box that will give me a Body Mass Index, or BMI. Please, this is not to discuss the validity or accuracy of a BMI on health. This is only one of many factors we will discuss. Then I listen heart, lungs, etc. BTW I also look for skin lesions especially melanoma so wear sunscreen and cover up.
The last part of the evaluation will be the blood test. Specifically I am concerned about fasting blood sugar since it screens for pre-diabetes or diabetes itself and a cholesterol panel since it screens for risk of cardiovascular disease.
Please note that none of these parameters by themselves is a measure of health. They are markers for risk factors and have an association for other medical conditions. Being overweight does not mean you will develop diabetes but you have and increased risk of developing diabetes. High cholesterol and or high blood pressure does not mean you will have a heart attack or stroke, but your risk is higher the higher your levels respectively.
More important, I generally look at your BMI and your exercise capacity. If you are overweight I recommend losing weight. Generally this only takes place in the setting of both diet modifications and exercise. For exercise I make a generic recommendation referred to as a walk talk sweat test. You want to walk fast enough to develop a light sweat but not so strenuous you can't carry on a conversation comfortably at the same time for 20-30 minutes. This equates simply to moderate level exercise and you should to attempt to exercise 3-4 times a week. I know we are all busy and this may not possible for everybody but even once a day is better than no exercise at all.
As for diet, please be honest with yourself. It is a calorie issue and you need to match you calories in to your calories out. It is not my purpose to get into the advantages or disadvantages of specific diets. Find a daily calorie calculator, figure out how many calories you need per day based on age, sex, and activity and target your intake to that level. More calories you will gain weight, less calories you will lose weight.
How does all this related to scuba? Well, as it turns out both the divers I mentioned were significantly overweight in the 300 lbs range. By any means they were overweight. Using DAN numbers, being either overweight or actually obese was associated nearly 75% deaths. In addition, cardiac causes of death was about 26% of fatalities. So if you are overweight and out of shape you have a higher risk of a diving fatality. Also, the month of July has the highest fatality rate. I found this very interesting, and my own $0.02 is that this is when the highest number of out of shape divers are getting in the water. They haven't exercised for a while and underestimated the physical exertion of scuba and suffered a cardiac event. Also, a higher number of divers not having dived for a while and increased risk dive accident.
Now, nothing I've said is specific to dive related medicine. If you are on medications you will need to clear them with you own MD. However, as good general medical recommendations please diet, exercise, and maintain a healthy body weight. Never underestimate the value of a good nights sleep. Laugh often and with others. Hug your spouse and your kids or pet. Don't forget to smile.
If it has been a while since you had your medical waiver signed, or if it has been a long time since you went diving, please plan for your dive vacation by starting an exercise regiment several weeks before your trip to ensure you are healthy enough to participate and think about a refresher course. These may actually make your trip more enjoyable.
Wishing all of you good health. Have fun, and safe diving to all.
