Catalina Island death info?

[browntrout]

I'm sorry if this sounds high and mighty, I am generally a very low key easy going person. I apologize if these sounds condescending, it is certainly not my intention to sound as if I am talking down to someone. I listed my occupation in my profile as self employed because it make me uncomfortable to advertise that I am a physcician. I am an MD with over 12 years experience.

I never said BMI was an indicator of health. I said a BMI is measure of how much overweight a person is relative to their height. A BMI calculator takes into account wheter or not a person's weight is appropriate for their height. That's it. A whole host of experts who are far smarter than me have determined the BMI charts. The National Institute Health and World Health Organization have set up these criteria.

Now, the reason why they are used is because they are screening test for the average population. As a person's BMI increases there is a direct correlation between being overweight, being obese, and a linear increase in hypertension, heart disease, and diabetes. Also, there is a directe correlation to obstructive sleep apnea which has its own risk for sudden death. These risks are also directly correlated to waist size which is a marker for central obesity.. There is a significant correlation to a person's waist and the above health problems.

Let's be clear, I am not saying it is a marker of general fitness and heatlh. There are multiple factors in health. One that is not apparent to the naked eye is cholesterol levels. Remember the pitcher for the St. Lous Cardinals Darryl Kyle? He ahd a sudden death heart attack in his early 30's. Turns out he had a significant family history in which his dad and paternal uncle both died in their 40's of heart attacks. You can be thin and still have high cholesterol, heck you can have diabetes and hypertension for that matter as well. I see it every day. The BMI is simply one of a number of different factors that determine health and risk for heart disease.

Getting back to this thread, this particular diver was estimated by witnesses to be around 300 lbs. This puts him in the obese weight or above unless he is over 7 feet tall. And while we can speculate about if he had a scuba related accident like AGE, witnesses describe a sudden death event. See my previous post regarding possible causes. Statistically, he has at least a 2 fold increase over general population for undiagnosed coronary disease. I also looked at the DAN 2008 report on diver fatalities. Of the reported deaths, 76% (thanks Bob) were either significantly overweight or obese. In regards to NIH and WHO data with a direct linear correlation with incidence heart disease/heart attacks and either increasing BMI or increase waist circumference (which is just as significant a predictor) a sudden death event in this setting is not as big a mystery. Also, DAN data indicates that fatal heart attack account for 38% of diving fatalities, far more than AGE or DCS.

Those are the numbers. Please tell me that I'm not getting it in regards to BMI. And by the way, I would make you cite your references if you were a medical student.

Well I'm not a medical student so you'll have to save that one for your peeps at the clinic. As is evidenced by your uncalled for post below on the Tampa death your obviously on a rant to tie BMI with dive accidents and some for us, MD's or not, it doesn't hold water so to speak. I'll take a dive buddy that's a muscle bound athelete in supreme shape over a chain smoking emaciated person with a BMI of 15 anyday.

 

[freewillie]

Before this thread degenerates, lets make this clear. We are talking about a specific diver in a specific instance. And please, lets not forget a 13 year old boy saw his father die in front of his eyes participating in a sport that we all love but has inherent and potential life threatening dangers. We are here on SB to learn from others and their experiences so we can all become safer divers.

To that end we shouldn't speculate on things like maybe the diver had AGE or DCI, however I am trying to offer a medical opinion based on my training and knowledge. Facts, the diver is significantly overweight. Someone in this thread mentioned that he weighed around 300 lbs. Also, by the time the diver was brought to the surface his eyes were fixed and dilated and his lips were blue. Unless these are wrong, I can make certain opinions as to a probable cause of death due to my background. This is speculation based on these current facts.

Fixed and dilated pupils generally indicate that the person has very significant brain injury and is often a sign doctors look for to indicate brain death or something very similar. Also, if the lips were blue then the victim is suffereing from severe hypoxia. In addition to the obvious ov drowning, the real question is how did he die so fast? I am telling you as a physician only sudden death events happen this quickly. The most common of these is a sudden death heart attacks, and if this person is truly 300 lbs this would be a clinically relevant clue that he could have had multiple risk factors for previously undiagnosed or unknown coronary arter disease. In this very specific situation with this particular diver a significantly high BMI certainly sheds some light on the possible cause of this particular event.

I am also hoping that the 13 year doesn't have ongoing guilt about causing his father's death. As Ken pointed out his actions were comendable under the situation. If his father did indeed have a heart attack or other similar sudden medical catastrophe it is my hope that he can forgive himself and know that he did everything right in this situation and he himself bears no blame for his father's death.

I was trying to shed light on a very tragic situation, and the father's BMI in this situation makes the sudden death event less of a mystery to me as a doctor. I am not extrapolating a BMI as a marker of fitness to the general population as even in my practice this is only one of many tools I use to determine overall health. I never use it without other information to assess health.

BTW a BMI of 15 is grossly underweight as well and in the anorexic range and not considered normal or healthy as well. A 18.5 is lower limit of healthy weight.

 

[alibi 2]

We often teach children to dive..as NAUI they have to do basic rescue skills and rescue breathing to get certified..it is distressing when we see people obese diving ...and over 300 would be obese..my son is 6-5 and very active but was obese at 295..he dropped his weight to 220 and his BP is much better and so is his endurance and heartrate...he is only 24...I do think that most football players who are defense are obese...i know kids in high school who play defense and they eat a lot and intentionally "bulk" up for the season...it broke my heart to see my friends son get so fat his thighs rubbed and his legs bowed ..and they rows of soft fat and man "boobs" couldnt have been good for his health, but he did get his football scholarship!..

Kens points on how this tragic event affected the young son has given me a lot to think about when teaching..we do tell the parents and child that the child may need these skills to rescue the parent..but maybe there should be more discussion with the parent..

 

[donhealy]

When I started diving at age 35 I had no idea of the stress or strain it could put on a body. I weighed close to 300 lbs. at the time. I read DAN every month and was lucky enough to be surrounded by highly trained medical professionals who constantly counciled me on the need for proper fitness. I am now 54 and weigh 200 lbs with a body fat of 14% and have a VO2 of 43.5. I intend to dive until I'm in my 60's and it is that goal that helps to keep me in physical shape. Overweight and out of shape is a recipe for an unfortunate event.

I got my son certified when he was 13 and agonized over the same issues discussed in the thread. I can tell you that it was one of the best decisions that I have made. The time spent with him was and is priceless. I can also tell you that I never wanted him to experience what happened to this young man and that was one more reason to drop the weight and get in shape.

I too have pulled someone unconscious and not breathing from the waters off Anacapa. Its an experience I'll never forget. We (and especially the diver) were lucky that we had a great boat captain, highly trained Coast Guard on duty and an ER Dr. on board. It was a sobering experience and made me a much better diver because of it.

Ken. I haven't written on any posts with you for a while but I respect you as a highly trained professional that others would be wise to read and an listen to.

 

[DandyDon]

Dang it would be nice if the boy could get involved with some top quality local divers who would help him deal with his anguish in time and get back into diving, but maybe that's wishful thinking. If I was local, I'd offer to help altho I'm not the quality of diver needed.

 

[seaducer]

BMI is a population statistic, not a personal statistic. It doesn't measure body fat, it is a simple formula and is not an indicator of health by any means. This is a classic case of correlation equals causation when BMI is linked to health issues caused by obesity.

To measure health you need to run a series of other tests, of which a tape test or caliper test to measure body fat % (an actual stat you can apply to your self) can be done at home. The rest require labs and needles, typically.

BMI abuse is yet anotehr fallout from "weight loss companies" who are trying to sound scientific in their marketing schemes, and even MD's have fallen for it.

As for the subject of teh OP...I hope a COD is found soon and can be posted here so we have something concrete from which to learn from...

 

[freewillie]

I'm beginning to sound like broken record. I never said BMI is a marker of health. I said you can be thin and out of shape as well. I'm begiining to wonder how well some of you read and how well you interperet what you've read.

A BMI is SCREENING tool to assess body weight relative to height. Before you contradict this, please give medically relevant facts. You have to state something that is at least part of a medical textbook. I do not want to hear that this is an opinion.

The tape test and caliper test will measure percent body fat, but medical studies show that this is not any more sensitive or specific than the BMI. And yes, the BMI is a approximate measure of body fat.

No, it was not developed by 'weight loss companies' It was developed by the World Health Organization and the National Institute for Health. It does have a direct correlation to health. As a person's BMI increases then there is a directe correlation to the RISK of heart disease, hypertension, sleep apnea, and diabetes. Please don't state as if it is medical fact that there is no correlation between being overweight and risk for developing diabetes or heart disease.

To clarify the difference, correlation means there is an association. It does not mean cause and effect. An increased BMI does not cause heart disease and diabetes. It is a risk factor. It is like driving in the rain. Speeding does not cause a car accident by itself, but speeding in the rain increases your odds or chances for a car accident.

It is also a SCREENING test. By definition it will screen patients at risk for heart disease, hypertension, diabetes, etc. but some patients will have FALSE positive. Body builders for example, BMI not accurate assesment of weight. But that is a very specific exception. So, unless you can fall into an exception it is applicable to the population. From there is is an INDIVIDUAL determination of health with OTHER parameters of cardiovascular endurance, cholesterol levels, fasting glucose levels, and blood pressure.

Please limit the comments to whether or no you personally agree/disagree with BMI. Just don't state facts that are actually false.

 

[Jax]

Maybe a halpful mod could break this into a separate thread? Does this BMI argument have anything to do with the scuba death?

 

[freewillie]

Maybe a halpful mod could break this into a separate thread? Does this BMI argument have anything to do with the scuba death?

Depends on cause of death. If scuba related death then no. But cardiac disease contributes for nearly 40% deaths related scuba diving. If this particular diver's autopsy reveals coronary disease then yes it is relevant

 

[Kevrumbo]

Some stats from the Catalina Hyperbaric Chamber Volunteer Crew Training Class:

Initial Reported or Observed Problem of Divers Brought to the Catalina Hyperbaric Chamber (1995 - 2000):

Buoyancy Problem: 12%
Air Supply Problem: 11%
Buddy Problems: 10%
Decompression Problem: 6%
Equalizing Problem: 6%
Pain: 6%
Uncomfortable: 5%
Environmental Problem: 4%
Equipment Problem: 3%
Medical Problem: 3%
Regulator Problem: 3%
Rapid Ascent: 2%
Fatigue: 2%
Rebreather Problem: 2%
Mask Problem: 2%
Aspiration (water): 1%
Panic: 1%
No Problems Noted: approx. 10% occurrence

Quote: Divers Brought to the Catalina Chamber
--Did They Panic During the Dive?
Panicked: 33%
Did not Panic: 42%
Unknown: 25%

Quote: Divers Brought to the Catalina Chamber and
Suffering From AGE/Drowning/Near Drowning
--Did They Panic During the Dive?
Panicked: 51%
Did not Panic: 19%
Unknown: 30%

Quote:Cases from 1995 thru 2000
Of 154 Divers Brought to the Chamber:
76 (49%) Recompressed:
43 (57%) of which were DCS related
33 (43%) of which were Air Embolism related

78 (51%) Not Recompressed:
23 (29%) Rule Out AGE
23 (29%) Rule Out DCS
19 (24%) Near Drowning
9 (12%) Drowning
4 (5%) AGE/DCS Refused Treatment Against Medical Advice

19 (12%) Full Arrest --Fatalities