Medical News

Vaccine Banned

The CDC has banned the Johnson and Johnson COVID vaccine and ordered all health care providers to destroy all remaining doses. I will say that I remember when claiming this vaccine was bad for you would get you a ban from social media. I’m betting that the friendly folks at the CDC and in government knew this all along, since they gave themselves AND the vaccine manufacturers complete immunity from all legal liability.

I will begin this by saying that I got the Moderna vaccine. I don’t regret getting it, because no one I know suffered ill effects after receiving it. At this point, I will not suggest that anyone take another dose of any of the COVID vaccines.

All of society, all of civilization, relies on trust. You trust that the person behind you won’t shove you onto the subway tracks. You trust that the cars in the oncoming lane won’t swerve into your path. You trust that the person who just cooked your meal in the restaurant didn’t poison your meal, or that the waiter didn’t spit in it.

Like society, the entire scientific community, the entire medical community relies on trust. You trust that the supplies in the package that says “sterile” actually IS sterile. You trust that the vial labelled as “dopamine” doesn’t contain something else, and that it actually will work for its intended use.

Likewise, when other medical professionals tell you that a vaccine is safe and effective, you have no choice but to believe them, because a failure in that trust means that the entire system will fail.

Believe it or not, nearly every medical professional got into the medical field because they want to make a difference. They want to help people. Only a person that is truly psychotic would deliberately harm someone else, but that is exactly what the CDC and the rest of the government has done.

Not only did they make the choice to deliberately harm people, but they did something that is far, far worse. They damaged the trust that underpinned the medical profession, and by extension, all of civilization. This was a deliberate attack. Not just a biological warfare attack, but an attack on the very fabric of our society.

EDIT: Now that Godwin’s law has shown its head, comments are closed.

By Divemedic, ago

The Physics of Manslaughter

Today’s post comes from the UK, and I try not to talk about legal issues in other countries because I just don’t understand the laws in other nations, and don’t want to stick my nose in them. The difference here is that the case involves some technical issues of SCUBA diving and of dive medicine, areas where I feel like I have some level of mastery. This is a technical post, so for those of you who are not interested in physiology and physics of SCUBA, this may or may not be interesting.

A diving instructor in the UK was teaching an experienced recreational diver a course on deep diving. The dive that they did was to 115 feet.

On this dive, they were diving at around 4.5 atmospheres, and this requires some level of care. I don’t see in this account where the instructor messed up, with the exception that I wouldn’t have had a student doing a check dive like this with an 80 cuFt cylinder (which is what the Europeans call 12 liter).

In this case, however, the government brought in a diver from the UK Navy as their expert witness. He testified that the instructor was wrong in three ways- the dive violated the rule of thirds, they were down longer than the dive tables dictated for that depth, and he held his struggling student underwater when the student was attempting to get to the surface, causing his death by drowning.

Let’s start by addressing each of these in turn. The rule of thirds. The rule of thirds is a rule that says you use one third of your air supply to get into the dive, one third coming out, and hold one third in reserve. This rule is generally only used when you are “diving in the overhead,” meaning that there is either a physical or physiological barrier that would prevent you from surfacing. A physical barrier would be diving in a cave, a shipwreck, or diving so deep for so long that you cannot surface because you have a decompression obligation to work through before you can surface. Neither of those was the case here. In that case, the rule is to ensure that you surface with at least 500 psi of gas left in your tank.

The second argument, that the dive tables’ “no decompression” limits for that depth had been exceeded is ridiculous. When you are a new open water diver, you are taught to use tables, but no one, and I mean no one, follows them. The invention of dive computers has rendered them obsolete. The reason for this is that the dive tables assume that you descend at the maximum safe rate from the surface to the maximum depth, then ascend at the maximum safe rate to the safety stop. This is called a “square profile” and no one dives like this in real life. A dive computer monitors your depth every 30 seconds or so, and gives you “credit” for time spent at shallower depths. This has the effect of more than doubling your permissible dive time. Everyone today “dives their computer.”

A great example of this is the standard dive on Florida’s coral reefs. Off the coast of West Palm Beach, there are several reef lines. The most interesting one from a SCUBA perspective is about a mile or so offshore, in 60-100 feet of water. If you were to dive the top of that reef, the tables say that you can spend a maximum of 40 minutes at 70 feet of depth before exceeding the no decompression limit. Most divers will spend a minute or two at that 70 feet, maybe 5 or 10 minutes at 65 feet, then more time at 55 or 60 feet, etc. The result is that divers with computers might well spend 55 to 65 minutes and still not exceed decompression limits. The Commander would have known this, himself being a certified PADI divemaster.

Instead, he contends that the “out of air” situation was so dire that the diver should have been permitted to make an unrestricted surfacing, despite the fact that the student was breathing on the instructor’s plentiful air source. Ridiculous.

I actually did this exact dive here in the states when I got my own extended diving certification some years ago. It is standard practice at the end of any dive that is deeper than 40 feet to stop at a depth between 15 and 20 feet for three minutes. This is called a “safety stop” and is intended to give any gases that have been absorbed in the blood time to diffuse out of the blood and prevent hyperbaric injuries. It’s recommended by each of the three big certification agencies. (NAUI, PADI, and SSI)

Another protocol that some divers follow is to stop for one minute at half of your current depth. So if you had been at 120 feet, a one minute stop at 60 feet is followed by a one minute stop at 30 feet, followed by a one minute stop at 15 feet. No matter how you do it, coming up as slowly as you can is how you avoid hyperbaric injury.

In fact, three of the dive accidents that resulted in injury, and the only diving fatality I have ever been present for was related to a diver ascending too quickly. The physics and physiology of breathing pressurized gases is technically demanding, especially so when diving to depths below 99 feet. Safety stops are VERY important, especially when you are diving at pressures higher than 4 atmospheres of pressure (99 feet).

I myself have had four diving emergencies that required either emergency surfacing or my buddy’s intervention. Three of them were due to equipment failure, and one because I was a moron. One of them required sharing air. We still had time to do our safety stop.

Even so, it’s obvious that the prosecution wanted to railroad this guy. The student in question had a history of high blood pressure, and the autopsy showed that he had alcohol and cocaine in his system. None of this was known to the instructor at the time of the dive.

In this case, the signs of immersive pulmonary edema were there. For those of you who may dive, or who may work in the medical field, pay attention. Immersive pulmonary edema is very similar to the flash pulmonary edema seen with heart failure patients who are suddenly taken off of CPAP. It’s complicated by the changes in pressure caused by depth changes messing with the Renin-Angiotensin-Aldosterone System (RAAS), which regulates blood pressure. Also adding to the complications is the creation of nitric oxide that occurs with sudden pressure changes in SCUBA diving. In patients with hypertension, heart problems, or kidney problems, this combination can be life threatening.

The signs were there: The student was easily winded with mild exertion, he couldn’t perform underwater navigation while at depth (indicating possible mental status changes from hypoxia), and was complaining that he wasn’t getting any air, even though everything was working perfectly ( a sign of shortness of breath). If he was taking an ACE inhibitor for his high blood pressure, this could even make this condition worse.

So how do you treat this? While diving, adopt the rules that I have always followed:

  • Any diver on any given dive can terminate the dive for any reason. This is done by giving any diver in your group a “thumbs up” sign, and is called “thumbing a dive.”
  • Any diver having apparent confusion, disorientation, or an equipment problem should cause the thumbing of the dive.
  • Any diver having shortness of breath should be placed on oxygen as soon as they are on the surface.
  • On the way down, take a few seconds at 65 feet or so to get organized. Look each other in the eye and make sure everyone gives you the “OK” sign.
  • At any dive below 60 feet, make sure that you do your safety stops.
  • Follow other safe practices like ascent rate, NDL limits, and make sure that everyone is diving within the limits of their training and experience.

My Qualifications

My Internet handle has been Divemedic for more than two decades for good reason. I am a certified Master diver, deep diver, mixed gas diver, public safety diver, and Rescue diver. I am certified by all three of the big US recreational SCUBA training agencies at one level or another: NAUI, PADI, and SSI. I have been SCUBA diving for about 30 years. I used to be on a professional dive rescue team. I have been employed at various times as a rescue and salvage diver and had more than 2,000 dives in my logbook, representing more than 900 hours underwater before I stopped bothering to log them, 16 years ago. Enough dives that I have literally worn out a few sets of equipment. I have been present for half a dozen dive casualties, one a fatality. So I understand many of the issues. With that being said, let’s get into the post.

By Divemedic, ago

Teaching Pigs to Sing

A report has come out, showing that math and reading proficiency dropped nationwide during the COVID lockdowns. Maryland students have the lowest test scores in reading and math of any US state or territory, with only 19 percent of Maryland students performing math that is appropriate for their grade level. Some schools in Baltimore had NO students who were proficient in math.

It doesn’t take long to figure out why. The scores are available online. It isn’t that the test is too hard or that teachers in general aren’t doing their jobs- there are schools in Maryland that had 91% of students proficient in math. In general, whites and Asians score higher on standardized tests than do other races, and the more affluent a student is, the higher the test scores.

The 5 cities with the best scores (racial makeup, median household income) were:

  • Bethesda: 88 percent white and Asian, $173K
  • Ellicott City: 83 percent white and Asian, $136K
  • Clarksville: 87 percent white and Asian, $161K
  • Rockville 68 percent white and Asian, $116K
  • Glenelg 88 percent white and Asian $181K

Some would see that and think that there was racism involved. That is what “equity” is all about- looking at outcomes, then trying to make them the same, but that is simply saying that correlation means causation. Instead, let’s look at the correlation and see if we can find the causation.

Parents who make more money do so because they value education, hard work, or some other trait. That doesn’t always mean college- it can mean trade school, learning to run a business, something. Those parents are also clever or intelligent, which is inheritable. The point is, parents who make money tend to impart the values that made them successful upon their children. Parents who are not successful pass their traits on as well. So children in affluent households tend to be successful. The children in poor households tend to be less successful.

How do you fix this? School and teachers can’t. Teachers who are with a student for less than 1100 hours a year can’t fix 18 years bad parenting coupled with the handicap of losing the genetic lottery. All of the programs in the world won’t turn a student with a 75 IQ and no motivation into a scholastically successful person. In that case, you are doing nothing more than trying to teach a pig to sing.

The other thing that I would like to point out is that the response to COVID had an effect on an entire generation of students, who lost learning opportunities that will hurt them in lost learning gains, thereby affecting them for their entire lives. The knowledge gap that they have as a result of missing a year or more of school will cause them to play catchup for years.

By Divemedic, ago

Back Pay

So now the military wants to reinstate those who were kicked out for refusing the vax, complete with back pay. So what happens to those who were kicked out, but whose normal EOAS date has since passed? Do they still get their checks? Or is it only the ones who agree to be reinstated?

But who says that any of them want to serve under the freak show that is their chain of command?

By Divemedic, ago

This One is a Better Example

Everyone who reads this blog knows that I don’t think that the collapse of Damar Hamlin had anything to do with the vax. However, if you want to see a great example of the collapse of a young athlete, look no further than the collapse of Old Dominion sophomore point guard Imo Essien. He collapsed about halfway through the first half a basketball game after having trouble catching his breath.

The team will be sending him to see a cardiologist before allowing him to return to play. Twenty year old collegiate athletes don’t typically collapse from idiopathic cardiac events. Granted, there is no evidence either way as to his vaccine status, but it would certainly be something to keep an eye on.

The pro vaccine folks are already calling it fake news because it isn’t like the collapse of Hamlin, but in my opinion the fact that it isn’t like the collapse of Hamlin is exactly WHY it needs to be looked at.

By Divemedic, ago

What is Commotio Cordis?

Athletes are more prone to sudden cardiac death and arrhythmias than nonathletes. Sudden cardiac death in athletes is rare in the absence of heart disease, with the exception of commotio cordis. It is common enough amongst athletes that commotio cordis should be suspected if an athlete collapses suddenly after a chest impact and is unresponsive. So what is commotio cordis?

The heart is driven by the movement of electrolytes across the cardiac cell membranes. That movement is controlled in part by electrical signals, in part by pressure differences, and in part by small channels in the cell membranes that open and close, called ion channels. This complex dance can be measured by watching the electrical impulses that are caused by the movement of those electrolytes. That organized movement of charges causes organized muscle contraction, causing the heart to pump blood. It looks like this:

In the above diagram, note that each peak is labeled, and each of the small squares in the horizontal plane represents 40 milliseconds. You will note that the normal cardiac cycle lasts about 360 milliseconds in our example.

An impact to the area of the chest that includes the cardiac silhouette during the 10 to 30 milliseconds before the highest peak of the T wave that causes a pressure wave to wash over the heart, if that pressure wave is between 4.8 and 9.6 psi, can stretch some of those ion channels to the point where some will open when they are not supposed to. (Mostly the K+atp channels) That in turn causes some electrolytes to move, creating random movement of electrical charges. It changes a heart rhythm from the organized one we are all familiar with to the one below:

In order for this to happen, the impact has to occur within a narrow timeframe (20 ms wide out of 360 ms total) and within a narrow pressure range. Too low, and nothing happens, too high and you get a cardiac contusion and tissue damage.

With these rather strict parameters, the phenomenon still manages to happen about 20 times per year in the US, usually with fatal results. It’s mechanism is well documented and mostly understood. More than 90 percent of the time, the victims are men. More than 85% of the time, the victims are between the ages of 13 and 20. This is mostly because the vast majority of people who participate in contact sports are males between 13 and 20 years old.

There is a genetic correlation. People with known long QT syndrome in their family history are known to be more susceptible to this- for example, Brugada syndrome. We all have heard of athletes periodically dropping dead during and after practice. It’s one of the reasons why high school and college athletic facilities are equipped with AEDs and why some states require that athletes be screened for long QT before they can compete in school sports.

Look, the vax is certainly causing some unexplained deaths. If you want to be convincing, you have to be able to tell the difference between what is a sudden death and what is normal background. You aren’t going to convince people if you are sounding like an ill informed moron with a political axe to grind. Think of how the anti-gunners look when they start talking about “shoulder things that go up.”

Be informed. Don’t come across like a paranoid moron.

Sources for this post:

Athletes and Arrhythmias. Journal of Cardiovascular Electrophysiology. 2010

Commotio Cordis: Ventricular Fibrillation Triggered by Chest Impact–Induced Abnormalities in Repolarization. ADVANCES IN ARRHYTHMIA AND ELECTROPHYSIOLOGY, the American Heart Association. 2012

Fatalities in High School and College Football Players. The American Journal of Sports Medicine. 2013

Incidence of Sudden Cardiac Death in National Collegiate Athletic Association Athletes. Circulation, the American Heart Association, 2011.

Pathophysiology, Prevention, and Treatment of Commotio Cordis. Current Cardiology Reports. 2014

Sudden Cardiac Death in Athletes. Methodist Debakey Cardiovascular Journal. 2016

By Divemedic, ago

Not the Jab

Not every person who died in 2020 died of COVID. That was ridiculous, and the claims of COVID deaths made those claiming them look stupid. Similarly, not every sudden death happening now is because of the COVID vax.

Yet I have seen many on the right this morning claiming that the collapse of Damar Hamlin was due to the jab. No, it likely wasn’t. For those who aren’t aware, an NFL football player took a hit to the chest in a game last night before collapsing in cardiac arrest.

What likely happened was a phenomenon called commotio cordis. This condition is caused by an athlete taking a blow to the chest while the heart is in its relative refractory period. The heart enters an arrythmia called “ventricular fibrillation” and the person has no pulse. The condition is usually fatal without immediate CPR, followed by immediate access to defibrillation and Advanced Cardiac Life Support. (ACLS)

A similar thing happened in the NHL to Chris Pronger, who collapsed during a 1998 hockey game after taking a blow to the chest from a hockey puck. He went into cardiac arrest. You can see a video of it here (I would embed it, but YouTube doesn’t allow this video to be embedded). Events like this are more common than you would think.

I have been watching tons of conservatives on social media being just as dogmatic as the left was about COVID on this topic. Don’t make yourself look stupid by trying to pontificate on things that you have no knowledge of, simply so you can make a political point. It weakens your argument and makes you look like a tool.

So many people are trying to use this event to springboard their agendas. I saw an NFL player on TV saying that this is why they make millions, because they are putting their lives on the line to play football and this is why the salary cap for the NFL should be raised. He is saying that most players don’t get many years to play, and the risk is high. Keep in mind that the league minimum salary is $705,000 a year, the average player salary is $2.7 million a year, and the highest paid player makes $31 million a year. When you say things like that, you make yourself look stupid.

By Divemedic, ago

RSV, Influenza, and COVID

Joe asks in comments if I have heard anything about this article referencing a “tripledemic” of RSV, COVID, and Influenza.

Respiratory syncytial virus, or RSV, is a common respiratory virus. It usually causes mild, cold-like symptoms. RSV usually strikes children before the age of 2, and is also known to have a severe effect on those over 65 and with weakened immune systems. In the United States, nearly all children have been infected with RSV by age two. This virus has a season, and in the United States, Florida and Hawaii’s season begins in mid September, with the rest of the country’s RSV season beginning by mid-November. The incidence of RSV peaks each year by mid-winter. It is an airborne virus that can also be spread by fomites.

A fomite is a surface that is contaminated because a virus that can live for a time outside of its host is on the fomite’s surface. A person touches the fomite and then touches their face. The average person touches their face 4,000 times a day. Kids even more so. This is why frequent handwashing can be effective in preventing illness.

Influenza also has a season, as we all well know. It also strikes the immunocompromised and the elderly.

Until 2020, patterns for RSV in the United States were predictable. The patterns of RSV and other common respiratory illnesses have been messed up since the lockdowns in 2020. The number of RSV infections began to rise in the spring of 2021 and peaked in July. Why? I mean, this is usually a winter virus.

In 2020 and into 2021, there weren’t many cases of seasonal illnesses because kids were largely kept out of school during the peak RSV and flu seasons during the winter of 2020-2021. In most states not named Florida, the same happened during the 2021-2022 season, so all of the kids who would have brought the virus home to their younger siblings weren’t in school to do so. That means all of the kids born in 2019, 2020, and 2021 have not been exposed to RSV and this will create a heavier than usual RSV and flu season. It makes total sense.

The same is true of the flu. This year, the season appears to be starting a bit earlier than usual, but that is not surprising, considering what I discussed above. The past couple of years have been unusually light for the flu, and I think that we are going to have a rebound year.

So what does this mean? Nothing. Most people who get it have a bit of a cold and then soon recover.

As far as COVID: granted that this is anecdotal, but we don’t seem to be seeing any more COVID than we have been seeing for the past year, at least not in my hospital. It’s just a constant background now. I have had it twice, and I don’t even bother to wear a mask when I treat COVID patients any more. The CDC is not really reporting a high number of COVID cases right now.

I don’t think that there is anything to make a big deal out of right now. That may change, but for now I don’t think it’s anything to get in a lather over.

By Divemedic, ago