Dive Medicals

[kinoons]

Of course. I never said anything like that.

No, you didn’t (regarding a yearly exam for all adults). Your statement was basically do I believe there is harm in treating DM or HTN.

none the less, it boils down to this.

The research shows that at a population level a yearly exam did not extend the population’s life. That means either…

A) finding and treating the undiagnosed chronic diseases did not help.

Or

B) there is a competing harm related to the visits that cancels out the benefit.

I don’t know which is true, and I’m willing to entertain another hypothesis to explain the outcomes.

So as to the question is it better to find and treat undiagnosed HTN and DM (on the individual level) via yearly physicals the answer is yes. However, any accompanying harms related to these yearly visits (on a population level) must be mitigated.

 

[tursiops]

The research shows that at a population level a yearly exam did not extend the population’s life.

Why do you think this applies to divers?

 

[kinoons]

Why do you think this applies to divers?

Given that I believe that overall divers are roughly as healthy as the general population, if not perhaps somewhat more healthy, yes I think this holds true for divers.

 

[Scubagermany]

No, you didn’t (regarding a yearly exam for all adults). Your statement was basically do I believe there is harm in treating DM or HTN.

none the less, it boils down to this.

The research shows that at a population level a yearly exam did not extend the population’s life. That means either…

A) finding and treating the undiagnosed chronic diseases did not help.

Or

B) there is a competing harm related to the visits that cancels out the benefit.

I don’t know which is true, and I’m willing to entertain another hypothesis to explain the outcomes.

So as to the question is it better to find and treat undiagnosed HTN and DM (on the individual level) via yearly physicals the answer is yes. However, any accompanying harms related to these yearly visits (on a population level) must be mitigated.

In Germany where everything is paid for by your medical insurance the insurances recommend a check for all diabetics every three (3!) month, e.g. four times per year. This is done because we want to make sure the secondary ilnesses associated with diabetes do not occur or occur later. The same goes for coronary heart disease, asthma, COPD and lately others such an hypertension, high cholesterol, pAVK and chronic renal disease (for the last ones yearly to biyearly checks)
Do you think the government regulated insurances would recommend these checks if they cost them more money?
For them, it is all a calculation whether its cheaper to spend money now or to spend it later on the secondary ilnesses.

 

[Scubagermany]

Given that I believe that overall divers are roughly as healthy as the general population, if not perhaps somewhat more healthy, yes I think this holds true for divers.

Please note that many cardiovascular events do have good survival rates if treated quickly. A heart attack that is treated properly has excellent statistics nowadays. Untreated or treated to late (because you are under water when it occurs) mortality goes up to 80%.

So for divers These things should be much more important.

 

[dmaziuk]

Please note that many cardiovascular events do have good survival rates if treated quickly. A heart attack that is treated properly has excellent statistics nowadays. Untreated or treated to late (because you are under water when it occurs) mortality goes up to 80%.

So for divers These things should be much more important.

Sure, and during a routine medical you can diagnose a heart attack that will happen on a dive next year. Or maybe you can look at their lipid panel and prescribe a statin that, according to some naysaysers, may reduce their risk of that heart attack by a whooping 1%.

 

[tursiops]

Sure, and during a routine medical you can diagnose a heart attack that will happen on a dive next year. Or maybe you can look at their lipid panel and prescribe a statin that, according to some naysaysers, may reduce their risk of that heart attack by a whooping 1%.

That same article you quote also says:
"being overweight, smoking and having high blood pressure can increase a person's risk for heart disease, heart attack or stroke"
Nice job of selectively quoting to denigrate getting an exam.

 

[Scubagermany]

Sure, and during a routine medical you can diagnose a heart attack that will happen on a dive next year. Or maybe you can look at their lipid panel and prescribe a statin that, according to some naysaysers, may reduce their risk of that heart attack by a whooping 1%.

You sound bitter. Did you have bad experiences during a medical?

What you write in your quoted post does not reflect what the summary of your linked article says.

Do you want to share with us what troubles you?

 

[kinoons]

In Germany where everything is paid for by your medical insurance the insurances recommend a check for all diabetics every three (3!) month, e.g. four times per year. This is done because we want to make sure the secondary ilnesses associated with diabetes do not occur or occur later. The same goes for coronary Do you think the government regulated insurances would recommend these checks if they cFor them, it is all a calculation whether its Yes, but this is not what we are discussing here. We are discussing a screening exam or yearly physical, not routine follow up on patients with known disease.

But that is not was is in question here. The question is does a yearly physical (or a routine dive screening exam) improve outcomes. We’re not discussing does routine follow up on chronic conditions improve outcomes.

Please note that many cardiovascular events do have good survival rates if treated quickly. A heart attack that is treated properly has excellent statistics nowadays. Untreated or treated to late (because you are under water when it occurs) mortality goes up to 80%.

So for divers These things should be much more important.

My primary employment is emergency medicine, which I have done for over 20 years, so I am quite familiar with the bad outcomes associated with cardiac arrest.

Yet in studies to date performing a yearly physical did not reduce the rate of death from ACS, so performing the yearly visit for this reason does not pass muster.

Again we must be clear; The question is who would benefit from a yearly physical (or dive screening exam). The statement earlier in the thread (not by yourself) was that a yearly physical was something we should be doing and I contend that this is not true for everyone.

Sure, and during a routine medical you can diagnose a heart attack that will happen on a dive next year. Or maybe you can look at their lipid panel and prescribe a statin that, according to some naysaysers, may reduce their risk of that heart attack by a whooping 1%.

That same article you quote also says:
"being overweight, smoking and having high blood pressure can increase a person's risk for heart disease, heart attack or stroke"
Nice job of selectively quoting to denigrate getting an exam.

I think the point in question is that a statin is not necessarily right for everyone. Taking a statin but not addressing the other multiple risk factors can only go so far. Both mitigating/improving risk factors and taking a statin is greatly beneficial. OTOH someone with minimal risk factors for ACS but has elevated cholesterol may not benefit much at all by adding a statin.

 

[CG43]

Again we must be clear; The question is who would benefit from a yearly physical (or dive screening exam).

No , this is not the original question and thus the limitation to one point does not make sense.

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