Dive Medicals

[Miyaru]

No, @Scubagermany you wouldn't. Considering the privacy culture in Germany, I wouldn't answer your question.

If you think that your insta-buddy is a diving risk, don't dive with that person.
Suppose your buddy has a doctor-signed dive medical that dates back 6 months. Does that give you any assurance that the diver will act right in a stressful situation 6 months later?

Eventually Mother Nature taps you on your shoulder when your number is up.
(if I tap on your shoulder I just want your attention)

 

[Kenter23]

Should dive medicals be mandatory?

Simple question yes or no, though would be interested in your thoughts if no, if yes when should a dive have a medical? prior to a course, every year, 5 or 10 years etc

I think this is a very important discussion the dive industry needs to have, particularly following a recent high profile death.

People should be getting d-dimer tests prior to diving. It's a test that shows blod clots breaking down, this the presence of clots. Without any recent large bruises this test sets of alarms saying you may have microclots throughout your system.

Should dive medicals be mandatory?

Simple question yes or no, though would be interested in your thoughts if no, if yes when should a dive have a medical? prior to a course, every year, 5 or 10 years etc

I think this is a very important discussion the dive industry needs to have, particularly following a recent high profile death.

 

[lowflyer]

I voted no. First, even if the medical were given by a qualified doctor familiar with diving, there is no assurance that there wouldn’t be a lurking dangerous medical condition. How far is that exam going to go to clear someone? Stress test? CAT scans? Blood tests? I am a medical doctor and will not do a dive medical exam because I know not every medical emergency is foreseeable, and I don’t want my name on a dive medical form in this litigious society.

Also, most physicals would be given by doctors who are not divers, and many would just sign people off without much thought, particularly if the diver is falsifying answers on the medical questionnaire. I have seen that happen.

Maybe the medical report would have to be signed by a qualified "SCUBA Medical Examiner" akin to an Aviation Medical Examiner (AME). Even that cumbersome approach would not be foolproof. I know a retired Captain of a major airline who told me professional pilots know where to go to get an easy First Class medical sign off.

I am unaware of any statistics that suggest that a lot of people are dying because their buddy is not healthy and would have been saved if the buddy had had an intensive medical evaluation.

One of the things taught in the PADI Rescue Course is how to save yourself. If you want to save yourself don’t depend on your buddy having a questionable medical clearance. Just be honest with yourself and your doctor and get checked out.

 

[Duke Dive Medicine]

People should be getting d-dimer tests prior to diving. It's a test that shows blod clots breaking down, this the presence of clots. Without any recent large bruises this test sets of alarms saying you may have microclots throughout your system.

That is an interesting recommendation. Is there a particular circumstance or disorder you have in mind when you mention microclots? An elevated d-dimer can also indicate the presence of larger clots like deep vein thromboses.

Best regards,
DDM

 

[kinoons]

People should be getting d-dimer tests prior to diving. It's a test that shows blod clots breaking down, this the presence of clots. Without any recent large bruises this test sets of alarms saying you may have microclots throughout your system.

d-dimer is a screening test for clotting. I use it in emergency medicine when I have a patient I cannot exclude from a venous thromboembolism based purely on history and physical alone, but my gut says they don’t have a clot. It should not be used as a screening test for someone who has no symptoms and low risk for a clot.

There are many reasons that a d-dimer can be elevated as noted in this link.

D Dimer - StatPearls - NCBI Bookshelf

A positive dimer on someone who has some risk factors for acute clots buys them a CT of the chest and possibly a lower extremity venous ultrasound.

In my experience I see far more negative CT angiograms of the chest and ultrasounds of the lower extremity venous system than I see positive studies after an elevated d-dimer.

I will admit this is likely skewed as if I am really concerned my patient has a DVT or pulmonary embolism I forego the D-dimer and just perform the appropriate imaging study.

 

[kinoons]

That is an interesting recommendation. Is there a particular circumstance or disorder you have in mind when you mention microclots? An elevated d-dimer can also indicate the presence of larger clots like deep vein thromboses.

Best regards,
DDM

And what would be the concern for microclots? I’m not aware of any conditions in which clinically significant microclots develop asymptomatically (I’m open to the notion there could be). This sounds like a diagnosis looking for a problem.

Then someone goes from a healthy individual to a patient, receives a bunch of testing and potentially treatment with little if any benefit, along with all the harm that accompanies that testing and treatment.

 

[Duke Dive Medicine]

And what would be the concern for microclots? I’m not aware of any conditions in which clinically significant microclots develop asymptomatically (I’m open to the notion there could be).

Likewise. There are all sorts of things that COULD be tested for prior to diving and then we'd be making an argument for (excessively) thorough medical screening of divers. I'm interested to hear the rationale for the d-dimer recommendation though.

Best regards,
DDM

 

[lowflyer]

Likewise. There are all sorts of things that COULD be tested for prior to diving and then we'd be making an argument for (excessively) thorough medical screening of divers. I'm interested to hear the rationale for the d-dimer recommendation though.

Best regards,
DDM

Yes, this is an example of how absurd it can get if we set out to impose medical exams on divers, and we still would not have ruled out a life threatening event.

 

[Duke Dive Medicine]

Yes, this is an example of how absurd it can get if we set out to impose medical exams on divers, and we still would not have ruled out a life threatening event.

That's kind of a slippery slope argument. I'm not advocating for or against medical screening of divers, and I don't think it's as simple as "yes" or "no". There are times when screening is reasonable. One analogy might be hypertrophic cardiomyopathy in young athletes. It's something that usually goes undetected until the individual suffers a sudden, difficult-to-reverse cardiac arrest on the field. The screening is a simple ultrasound.

Best regards,
DDM

 

[heftysmurf]

Easy solution to all of this testing -- be a hypochondriac! As a hypochondriac in recovery, I've had more tests in my 45 years than most people get in a lifetime so I think I've examined every avenue of what-if's over the last decade!