Medical questionaire

[shakeybrainsurgeon]

I have really enjoyed reading this thread as it pertains to me now.

Here is my history. I am 55 and I have always wanted to dive. I have been diving for 3 years now under some pretty adverse conditions. Fast current, cold water, low VIS. I am COLD WATER certified. (It's required is some places here). Everyone I dive with says I am a great dive buddy, not a risk taker, by the book.. I never get sick, only 2 sick days in the last 18 years. I have never smoked, not obese (190 lbs & 6'1" tall ) (BP 118 / 70), I eat well watch my trans fats and cholesteral (3.9). I dive twice each week. My last dive was a long drift dive where I had to walk back 1/2 mile to my car with all my gear on (cold water diver here) I sound pretty healthy.

Oct 10 2006, weather is getting colder, we had an early snow fall. I experience angina pain climfing a small hill. I get it checked out and was sent to emergency. No heart attack and all looks normal. Still suffering angina and was put on beta blockers and carried a Nitro spray. I went for the stress test and scored a -10. I went for an angiogram and the left main coronary artery was 90% blocked. Angioplasty and a stent were not possible so I had to go for a triple bypass on Dec 18th 2006. Because of my good physical health, I was discharged 4 days after the operation. I am at home recuperating now but I think my diving days are done. My Cardiac Surgeon says "NO WAY", you'll be diving again in the fall of 2007. I am not a foolish person as I work the medical field and I wont dive again until I get a great score on future stress tests.

I know Coronary Artery Disease (CAD) takes decades to form but something changed rapidly in my condition. Maybe some plaque broke loose and increasd the stenosis. I am lucky to be alive, they say. I will wait and see how the dive ops repond to health history in a couple of years.
It used to be patients in there 60's & 70's coming in with CAD. Now patients in their 50's are coming in with it. My Cardiologist said that he is concerned that in the future in North America, it will be patients in their 40's because of all the junk food out there.

I really like Catherine's views on this topic but in reality, which DM or Dive Op is going to allow me to dive with them. We don't sue very quickly here in Canada and I have told my family, if I die while diving, I would die doing what I love. There will be no law suits on my side. I never even thought of a DM or dive buddy getting injured trying to save me and this concerns me.

I am afraid my diving days are over and I am sad.

This has been a great thread. Any comments ?

There was an interesting article in the New England Journal of Medicine a few years back that showed that people over 50 or 55 with CAD live LONGER than people without CAD! Why?

Simple... there is no one in that age range who DOESN'T have CAD, only people who don't know aabout it yet. Treatments are so good now (bypass, bp and statin drugs) that those diagnosed with CAD do well, better than their counterparts who have yet to be diagnosed.

Anecdotally --- my father got angina at 48, had two heart attacks and a bypass by 54, another bypass at 58...he's now 79, has no pain, golfs every day and his cath lasst summer was clean... even arteries blocked ten years ago are now open. thanks Lipitor.

I believe you will dive again some day.

 

[DI_Guy]

There was an interesting article in the New England Journal of Medicine a few years back that showed that people over 50 or 55 with CAD live LONGER than people without CAD! Why?

Simple... there is no one in that age range who DOESN'T have CAD, only people who don't know aabout it yet. Treatments are so good now (bypass, bp and statin drugs) that those diagnosed with CAD do well, better than their counterparts who have yet to be diagnosed.

Anecdotally --- my father got angina at 48, had two heart attacks and a bypass by 54, another bypass at 58...he's now 79, has no pain, golfs every day and his cath lasst summer was clean... even arteries blocked ten years ago are now open. thanks Lipitor.

I believe you will dive again some day.

Thanks for your comments and I agree with you ( I am not selling my gear yet ). I think many people have CAD and don't know ( ie: me ). I will be healthier in the future as my eating habits weren't bad before but they will be even better in the future.

This thread interested me because of the two sided discussion over the "legal forms" and the honesty of diver's answers. It's great to hear about your dad.

Thank you so much for your comment. Much appreciated.

 

[redrover]

I think your diving days are over when you want them to be, whatever your reasons.

I have really enjoyed reading this thread as it pertains to me now.

Here is my history. I am 55 and I have always wanted to dive. I have been diving for 3 years now under some pretty adverse conditions. Fast current, cold water, low VIS. I am COLD WATER certified. (It's required is some places here). Everyone I dive with says I am a great dive buddy, not a risk taker, by the book.. I never get sick, only 2 sick days in the last 18 years. I have never smoked, not obese (190 lbs & 6'1" tall ) (BP 118 / 70), I eat well watch my trans fats and cholesteral (3.9). I dive twice each week. My last dive was a long drift dive where I had to walk back 1/2 mile to my car with all my gear on (cold water diver here) I sound pretty healthy.

Oct 10 2006, weather is getting colder, we had an early snow fall. I experience angina pain climfing a small hill. I get it checked out and was sent to emergency. No heart attack and all looks normal. Still suffering angina and was put on beta blockers and carried a Nitro spray. I went for the stress test and scored a -10. I went for an angiogram and the left main coronary artery was 90% blocked. Angioplasty and a stent were not possible so I had to go for a triple bypass on Dec 18th 2006. Because of my good physical health, I was discharged 4 days after the operation. I am at home recuperating now but I think my diving days are done. My Cardiac Surgeon says "NO WAY", you'll be diving again in the fall of 2007. I am not a foolish person as I work the medical field and I wont dive again until I get a great score on future stress tests.

I know Coronary Artery Disease (CAD) takes decades to form but something changed rapidly in my condition. Maybe some plaque broke loose and increasd the stenosis. I am lucky to be alive, they say. I will wait and see how the dive ops repond to health history in a couple of years.
It used to be patients in there 60's & 70's coming in with CAD. Now patients in their 50's are coming in with it. My Cardiologist said that he is concerned that in the future in North America, it will be patients in their 40's because of all the junk food out there.

I really like Catherine's views on this topic but in reality, which DM or Dive Op is going to allow me to dive with them. We don't sue very quickly here in Canada and I have told my family, if I die while diving, I would die doing what I love. There will be no law suits on my side. I never even thought of a DM or dive buddy getting injured trying to save me and this concerns me.

I am afraid my diving days are over and I am sad.

This has been a great thread. Any comments ?

 

[redrover]

Too bad Biscuit7 has said her piece and doesn’t want to participate in this thread as I think her opinions as an OP have value.

Biscuit7 is not clear about what she, as an OP allows.
“First of all, if a diver has a known medical condition and carries copies of the PADI/RSTC medical that is current (within the past year) I can't think of a single shop that would refuse to let that person dive.”
Then
“I should be able to decide what level of personal risk is acceptable to me. The only way I know if you, the diver, are putting ME at higher risk from UNSEEN conditions is through the medical. I can see the smoker, I can see the grossly obese diver, I can see the diver who has no stamina. I CAN'T see the diabetic or the asthmatic.”

Is having a medical ok to dive with her even if there are medical Y’s or she would cancel that once seeing the form and noting it had a Y.

Concerning both diver and OP decisions, I think it is good there is room for individual determination, freedom of choice. The OP can set a specific limit of acceptable risk reducing or increasing business. A potential customer may disregard that OP as too stringent or, choose it feeling the strictness provides less chance of having another visitor cause a problem. Although, it might be impossible for the latter to make their arrangements with full knowledge such as no stamina and a smoker is a personal judgment call (ones smoking habits can be disguised and I think no stamina would preclude passing a medical.)

I don’t see why a universal Medical form is impossible. Doesn’t it state the person has been cleared by a physician to dive - then the OP or whomever makes further judgment if acceptable risks for them?

I have a real problem with other people viewed as having undeniable right to discuss my medical history. Examples are that I may be willing to discuss it with a buddy but not everyone on a dive boat or people that make no determination of allowed or not such as the person that pulls faxes off the machine.
Those who think it is unethical to not disclose medical history; do you really want to attend a week of disclosure prior to a dive so everyone, including you, present every detail of history to everyone else so they may make an informed decision if they are willing to dive with one another? Possibly just several hours would be sufficient for everyone to provide updates from dive 1 prior to Dive 2.

I disagree with Saturation on what might be a slight misstatement.
"a document reflecting the diver's general health, its valuable if it contains accurate information from the time of the examination to the time of the dive."
Considering many things can happen in a year I think that should be accurate information at the time of the examination. And once again reinforces individual risk assessment in that each person makes it for themselves. An OP my disallow anyone they choose to and may offer to discuss each situation they are concerned with.

As far as needing to get a separate physician opinion than the one I have, that is a real turn off and smacks of just greasing the local economy more than looking for my safety.

I seriously doubt the vast majority of persons who die in any diving related activity have hoped this will be the dive they die, and the more strangers, or friends, the better. I would not be surprised if that vast majority would if they could, personally apologize to those strangers or friends for their untimely death upsetting them.

Ethics?
Is it ethical or unethical for one person to look down on another, the sole breadwinner who feels it is too risky to take any risk of contracting a disease they may die from or can pass onto others?
Is it ethical or unethical to be willing to take those risks?
Is it ethical or unethical for a person to choose whom they dive with and/or choose to be willing to assist?
Is it ethical or unethical to demand I share private information, that I feel I have the right to remain private?
Is it ethical or unethical for me to not feel I need, nor want to know someone else’s private medical information?
Is it ethical or unethical for me to desire privacy or choose to respect another’s privacy?
Is it ethical or unethical to ask and expect a person with a condition that may hasten their death remove themselves from your presence?
Ok, what you really mean is you just want people with known diving risks to tell you about them so you can choose if you want them to be anywhere near you, correct? Does that mean you will leave if they want to dive? Or, do you mean you want them to go away so you can dive?


I imagine there is a fair amount of personal level of risk considered acceptable or not acceptable, I think of it as lines drawn, at some point a line exists between ok and not ok. The key word is personal. Right off the bat; we have operators that will allow a traveling visitor to book, yet refuse them boarding after reviewing a medical questionnaire. And operators who wink wink, nudge, nudge to complete the questionnaire so all can enjoy the business of diving. Individual divers have stated they will only dive with someone they know and trust, I’ve never understood how they got to know and trust them. But anyway…there are those that admit they will dive with just about anybody.
Is there one correct ethical line placement for everyone in the world? If a majority of people agree, will you change your ethics to match?

Back to Henriville’s original statement and request for other perspectives.
"Because of these potentially negative consequences for others, I think it is ethically wrong to dive while under a medical condition that is broadly accepted as an absolute contraindication to diving."
How about we set some ground rules? Just what exactly are broadly accepted contraindications? I have a hard time lining up the words broadly and known in the same sentence as a straight line between yes and no. Is there a specific exact yes you can and no you can’t list?
I’m just asking, because looking at the Guidelines for Recreational Scuba Diver’s Physical Examination I was provided prior to BOW I am not finding absolutes. I see the words relative, imply, may, believed, might, recommended, can, possibility. Accessed according to the degree of compromise…moderate increase in risk…the consultants involved in drafting this document would generally discourage…base their judgment on an assessment of the individual patient…some medical problems which may preclude diving are temporary in nature or responsive to treatment, allowing the student to dive safely after they have resolved.
Certainly the several pages are not the end all last word and final authority. But I’d be willing to bet it is a broadly summarized compilation of known factors. I could not find “they will die.”

 

[TSandM]

A couple of times a month, I see someone in the ER who presents with an acute complaint that drives them to the doctor. This person hasn't seen a physician in twenty or more YEARS. When I ask them if they have any medical problems, they say, "No!"

Then we start examining and testing. The diabetes that hasn't been diagnosed shows up, as well as the mild renal failure as a result. The untreated hypertension shows up, and the electrocardiogram has the unmistakable marks of a past myocardial infarction.

In other words, this is one sick dude who hasn't a clue.

This is the issue with medical forms, releases, or clearances. I'm not sick -- I haven't seen a doctor in years! All that means is that whatever is wrong with me hasn't been diagnosed. Whereas the poor fellow who has HAD his treadmill, angio, and CABG is shunned by a dive operator because he has coronary artery disease he not only knows about, but has DONE something about.

The person who has severe, poorly controlled asthma and chooses to dive on a boat without informing the crew is being unfair, just as biscuit7 says. He's putting the crew at significant risk without letting them decide if they're willing to do that (although anyone who crews on a tour boat should at least have a suspicion that they are volunteering to save the knowingly unfit). The person with well-controlled hypertension probably isn't putting the dive op at any increased risk. And the healthy 38 year old who spends the time he doesn't spend diving doing meth is probably at higher risk than either of the other two, and NOBODY dealing with him knows it.

There just isn't any good answer until human beings start being both honest and responsible for themselves, and I'm not holding my breath.

 

[redrover]

A couple of times a month, I see someone in the ER who presents with an acute complaint that drives them to the doctor. This person hasn't seen a physician in twenty or more YEARS. When I ask them if they have any medical problems, they say, "No!"

Then we start examining and testing. The diabetes that hasn't been diagnosed shows up, as well as the mild renal failure as a result. The untreated hypertension shows up, and the electrocardiogram has the unmistakable marks of a past myocardial infarction.

In other words, this is one sick dude who hasn't a clue.

This is the issue with medical forms, releases, or clearances. I'm not sick -- I haven't seen a doctor in years! All that means is that whatever is wrong with me hasn't been diagnosed. Whereas the poor fellow who has HAD his treadmill, angio, and CABG is shunned by a dive operator because he has coronary artery disease he not only knows about, but has DONE something about.

The person who has severe, poorly controlled asthma and chooses to dive on a boat without informing the crew is being unfair, just as biscuit7 says. He's putting the crew at significant risk without letting them decide if they're willing to do that (although anyone who crews on a tour boat should at least have a suspicion that they are volunteering to save the knowingly unfit). The person with well-controlled hypertension probably isn't putting the dive op at any increased risk. And the healthy 38 year old who spends the time he doesn't spend diving doing meth is probably at higher risk than either of the other two, and NOBODY dealing with him knows it.

There just isn't any good answer until human beings start being both honest and responsible for themselves, and I'm not holding my breath.

Lynn, I think you present affirmation of my thoughts, and suspect you don’t meant to LOL.

Heck a person can just forge a physician signature, any scribble will do. (Now Lynn, I’m willing to bet I could read yours.) The medical clearance form is really just an opportunity to be forthright.

If asked, I’d say I was willing to dive with anybody. But I know of someone’s medical history and was quite surprised they were OK to dive. I would stay as far away from them as I could diving.
Who is wrong or unethical: Me for not taking all effort to publicly make other divers aware? His physician? He for abiding his physician’s instructions?
Or, considering the enormous variances and degrees of risk regarding medical fitness added to the general risk of diving (not to mention some peoples perception of risk associated with length of a piece of gear) doesn’t the whole thing boil down to opinions? Personal opinions made to choose to dive or with whom? At this point we can make those choices and cannot control ethics for the entire human race.

The question of ethics and moral duty is a far greater wave spread out from the submersion of a diver. I like choosing my own ethics and would resent greatly being forced to adopt different. Ergo, I must allow others to make their choice.
And just think of the economic ruin resulting from there being no cheats, liars and thieves. Sick yes, but then I tend to agree with the survival of the fittest faction.
I say; feel free to stay within your (the broad ‘you all’) comfortable level of risk and let me stay within mine. Both freedom and constraint have risk.

 

[DI_Guy]

I am really enjoying this thread. The comments are giving me lots to think about. A bit more of my history... I did the annual physical with my GP faithfully. Always good health and no problems was the conclusion. I am afraid the "at rest" ECG they do, doesn't show the early stages of CAD. I guess we men have to be more honest with our replies during the physical examinations. (was that pain "angina" or just "heartburn"). We do tend to be in denial sometimes.

Regarding my diving, I do an organized dive every week with a group of people (maybe 16) and most of us know each other on a dive related basis. Usually we have the same buddy each week, maybe not. I will inform the dive club of my condition as I would never put them in a position of risk or liability. They had asked me to help lead the dives next year but I am not a DM so I can't. I am sure I can be surface support until I am cleared to dive again.

It's the other dive ops that I utilize will on vacation that concern me. They must protect themselves. In April 2006, I was diving in Honolulu and loved it. The DM's commented that I was a very competent diver and a pleasure to dive with. What would they say if they now saw this 13" scar on my chest ? It's going to be interesting to see how 2007 is going to be ?

As for a unknown "dive buddy", you can measure someone up pretty quickly on the surface and within the first 40' of depth. That will determine if I am willing to go to 130' with them. I hope they do the same scutiny on me. I am looking forward to what is to come. ;-)

 

[Walter]

I am COLD WATER certified. (It's required is some places here).

I've never heard of that one. Who offers it? What's included? What's the definition of "cold water?"

 

[beautybelow]

What's the definition of "cold water?"

Ha....anything below 80F

 

[tedtim]

Think of analogous situations in society...there really aren't any. The funny thing is,

diving is really only risking yourself, as compared to 95% of other activities. Do they

do this to you if you rent a plane?...which you could fly into a building and kill

hundreds? No....Scuba Industry is a bit full of itself, taking this one on if you ask me.

Catherine, this is not a fair comparison. Anyone who flys an airplane has a licence; we have C-cards. They don't ask for a medical waiver when you rent an aircraft because you have to have a valid medical exam for your licence to be valid. So, there really is no comparison, unless you want divers to have a licence.

In other words, this is one sick dude who hasn't a clue.

This is the issue with medical forms, releases, or clearances. I'm not sick -- I haven't seen a doctor in years! All that means is that whatever is wrong with me hasn't been diagnosed. Whereas the poor fellow who has HAD his treadmill, angio, and CABG is shunned by a dive operator because he has coronary artery disease he not only knows about, but has DONE something about.....There just isn't any good answer until human beings start being both honest and responsible for themselves, and I'm not holding my breath.

To me, this is a real challenge to the SCUBA industry. Once you complete your training with your LDS, you don't have to sign any forms with them again. So, when you go for a fill they don't ask, even years later. I agree with you Lynn that there are not any good answers here. You can't legislate common sense either.