Future of OC trimix

[Blackcrusader]

I appreciate your concerns, but there's no reason to worry. I go to a cardiologist every six months to one year, to do stress-echo. I consulted several cardiologists and always got clearance for diving. I am free to do whatever I want in terms of scuba

Similar to me I get tested. Just did a PFO test.

Going tech - Patent Foramen Ovale (PFO) testing?

Im not sure that’s accurate. TCD can't separate a pulmonary from a cardiac shunt - except that the injected bubble load is rather small so less likely to pass the lungs unless its a dramatic shunt. But here are some guidelines and discussion on possibly differentiating these two shunt types...

scubaboard.com

I will be doing the TDI ANDP so wanted to check my arteries and heart condition and see if I had a PFO

I am clear for deep dives

 

[crofrog]

Similar to me I get tested. Just did a PFO test.

Going tech - Patent Foramen Ovale (PFO) testing?

Im not sure that’s accurate. TCD can't separate a pulmonary from a cardiac shunt - except that the injected bubble load is rather small so less likely to pass the lungs unless its a dramatic shunt. But here are some guidelines and discussion on possibly differentiating these two shunt types...

scubaboard.com

I will be doing the TDI ANDP so wanted to check my arteries and heart condition and see if I had a PFO

I am clear for deep dives

The number of people diving and even posting here who are over 40, have risk factors for CAD or an arrhythmia and have never had a cardiac calcium score or even ecg is probably extremely high.

 

[ginti]

The number of people diving and even posting here who are over 40, have risk factors for CAD or an arrhythmia and have never had a cardiac calcium score or even ecg is probably extremely high.

Just curious here. Based on what you say it is probably extremely high?

I would actually say the opposite...

 

[boulderjohn]

Whoooaaa!!! Stop right there. You have got to be kidding. You have a heart condition and still think its ok to go down the tech path? Just that right there is a solid "No". Never mind all the rest of the nonsense about not knowing if deep diving is for you, etc, etc. Just stop. You shouldn't do this. Your body and your brain are telling you "No". I'm not sure what part of you is telling you "Yes" but just ignore that. That part is not your friend.

The phrase "heart condition" covers a whole lot, some very serious and some not such a big deal, and most in between those extremes. I am sure a technical instructor and heart surgeon such as @Dr. Doug Ebersole will confirm that many technical divers have heart conditions and still dive with the full blessing of knowledgeable cardiologists.

 

[crofrog]

Just curious here. Based on what you say it is probably extremely high?

I would actually say the opposite...

I think you misunderstood what I was saying the probability of is high. I'm saying the probability of most divers having undergone sufficient (or any) cardiac evaluation prior to the first time they have a cardiac issue is low. I'm not saying the rate of cardiovascular disease is high in the diving population compared the general population overall, but rather I suspect there are many people in diving (as in the general population) that have undiagnosed cardiovascular disease because of lack of screening.

From the research I've seen the average age of divers is increasing, and covid did not do anything to help over the last few years in helping people seek out primary care.

Furthermore diving creates incentives to not seek out cardiac screening because of the chance of being disqualified from diving.

 

[ginti]

@crofrog ok, clear now.

Still, I do not understand why you wrote:

The number of people diving and even posting here who are over 40, have risk factors for CAD or an arrhythmia and have never had a cardiac calcium score or even ecg is probably extremely high.

I think people here tend to be more conscious than outside, although it can be a bias of me.

Two last remarks:

From the research I've seen the average age of divers is increasing, and covid did not do anything to help over the last few years in helping people seek out primary care.

That should bring you to the opposite conclusion. Older people tend to go to cardiologists more often than younger ones, right?

Furthermore diving creates incentives to not seek out cardiac screening because of the chance of being disqualified from diving.

I believe it is quite the opposite: the incentive to stay alive is bigger than the disincentive to be disqualified. Furthermore, I think active people are more attentive to these types of problems than the average.

Anyway, these are just guesses, and without data, we can't say anything.

So, again, back to my question: you are basing your argumentation on your personal experiences and guesses (like I am), or do you actually have real data? If you do, I am VERY curious to read them

 

[broncobowsher]

Helium is still cheaper than Cocaine.
5 grams of Helium is a cubic foot, roughly. So $1 per gram on the high side of retail.
First hit on "street value of coke" is $25 to $200 per gram.

Before researching it I thought the price gap would be closer.

 

[boulderjohn]

I believe it is quite the opposite: the incentive to stay alive is bigger than the disincentive to be disqualified.

I actually wrote about this a while ago--I think I called it the Bob Marley syndrome.

Many people would be surprised to learn that reggae pioneer Bob Marley was something of a physical fitness freak who loved to play soccer. When he was diagnosed with melanoma on his big toe, doctors wanted to amputate, possibly even more than the foot. He wanted nothing to do with that, so he shopped around until he found a doctor who would treat it without amputation. Once the treatment was done, he essentially stopped going to doctors. That is why he died of melanoma as a young man.

As an aging diver, I am well aware of that syndrome--at least as an intellectual concept. Knowing that, I have to be careful to balance my desire to dive with the growing limitations of my age. The problem, of course, is being objective. How can I be sure I am making a truly wise decision when I also know that confirmation bias will naturally affect my decision making?

To what degree is this true in the general population? What percentage will err on the side of caution, and what percentage will throw caution to the winds and ignore key warning signs? I have no idea.

 

[crofrog]

Anyway, these are just guesses, and without data, we can't say anything.

There are piles of data a few pubmed searches away. The lack of people seeking primary care, and addressing modifiable risk factors for CVD is one of the biggest public health issues facing America.

Here are some quick facts:

• a recent study showed that 40% of employees were not aware of the level of at least one of their CVD risk factors (high blood pressure, high cholesterol, and obesity). (1)
• Furthermore, in another study, it is estimated that 36% of the US adult population with uncontrolled blood pressure (about 13 million people) are neither aware of their hypertension nor taking medications to control it. (2)
• The proportion of adult Americans with an identified source of primary care decreased from 77% (95% CI, 76%-78%) in 2002 to 75% (95% CI, 74%-76%) in 2015 (odds ratio, 0.90 [95% CI, 0.82-0.98]). During this period, receipt of primary care decreased for every decade of age except for Americans in their 80s, with statistically significant reductions for those in their 30s, 40s, and 50s (Figure, A). For example, 71% of Americans in their 30s had primary care in 2002 compared with 64% in 2015 (P < .001).

1. Jacobs JC, Burke S, Rouse M, Sarma S, Zaric G. Cardiovascular disease risk awareness and its association with preventive health behaviors. Journal of Occupational and Environmental Medicine. May 2016;58(5):459-465.
2. Wall HK, Hannan JA, Wright JS. Patients with undiagnosed hypertension: hiding in plain sight. Journal of the American Medical Association. 2014;312(19):1973-1974.
3. Levine DM, Linder JA, Landon BE. Characteristics of Americans With Primary Care and Changes Over Time, 2002-2015. JAMA Intern Med. 2020;180(3):463–466. doi:10.1001/jamainternmed.2019.6282

 

[ginti]

There are piles of data a few pubmed searches away. The lack of people seeking primary care, and addressing modifiable risk factors for CVD is one of the biggest public health issues facing America.

Here are some quick facts:

• a recent study showed that 40% of employees were not aware of the level of at least one of their CVD risk factors (high blood pressure, high cholesterol, and obesity). (1)
• Furthermore, in another study, it is estimated that 36% of the US adult population with uncontrolled blood pressure (about 13 million people) are neither aware of their hypertension nor taking medications to control it. (2)
• The proportion of adult Americans with an identified source of primary care decreased from 77% (95% CI, 76%-78%) in 2002 to 75% (95% CI, 74%-76%) in 2015 (odds ratio, 0.90 [95% CI, 0.82-0.98]). During this period, receipt of primary care decreased for every decade of age except for Americans in their 80s, with statistically significant reductions for those in their 30s, 40s, and 50s (Figure, A). For example, 71% of Americans in their 30s had primary care in 2002 compared with 64% in 2015 (P < .001).

1. Jacobs JC, Burke S, Rouse M, Sarma S, Zaric G. Cardiovascular disease risk awareness and its association with preventive health behaviors. Journal of Occupational and Environmental Medicine. May 2016;58(5):459-465.
2. Wall HK, Hannan JA, Wright JS. Patients with undiagnosed hypertension: hiding in plain sight. Journal of the American Medical Association. 2014;312(19):1973-1974.
3. Levine DM, Linder JA, Landon BE. Characteristics of Americans With Primary Care and Changes Over Time, 2002-2015. JAMA Intern Med. 2020;180(3):463–466. doi:10.1001/jamainternmed.2019.6282

These studies are speaking about adult Americans, you are speaking about divers. Two different groups.

If you don't provide a proof that divers (not only American divers!), on average, have the same culture, physical issues, and bias of adult Americans, you just can't use those articles.

I actually wrote about this a while ago--I think I called it the Bob Marley syndrome.

Many people would be surprised to learn that reggae pioneer Bob Marley was something of a physical fitness freak who loved to play soccer. When he was diagnosed with melanoma on his big toe, doctors wanted to amputate, possibly even more than the foot. He wanted nothing to do with that, so he shopped around until he found a doctor who would treat it without amputation. Once the treatment was done, he essentially stopped going to doctors. That is why he died of melanoma as a young man.

As an aging diver, I am well aware of that syndrome--at least as an intellectual concept. Knowing that, I have to be careful to balance my desire to dive with the growing limitations of my age. The problem, of course, is being objective. How can I be sure I am making a truly wise decision when I also know that confirmation bias will naturally affect my decision making?

To what degree is this true in the general population? What percentage will err on the side of caution, and what percentage will throw caution to the winds and ignore key warning signs? I have no idea.

Yes I am aware of that syndrome. It is just my impression that it isn't prevalent among divers. Even more, I have the impression that the situation is improving with time. But since it is my impression, it might well be (strongly) biased.

I am a data guy and I know you like facts too do you know if there is any research that try to understand how much spread this syndrome is? And, even more interesting, if there's a trend in time?