Medical News

What is Cancer?

Since many of you don’t seem to understand my problem with Somers and her cancer plan, perhaps a bit of a lesson in what cancer is will help. This is simplified for ease of understanding and for brevity, but you will get the point. Even though simplified for brevity, this is still a much longer post than I usually make. Cancer is a complicated subject.

Normally, your cells do their job. Each cell has a job to do, and they sit there and happily carry out their cellular business 90-96% of the time. During this time, a cell is very busy synthesizing proteins, copying DNA into RNA, engulfing extracellular material, processing signals, whatever its job is. The rest of the time, 4-10% of the time, the cell is busy copying its DNA and dividing to create its own replacement in a process called mitosis. Mitosis happens about once every 24 hours, on average. Some cells like hair follicles do it more often, while other cells like nerve cells, less so.

Your DNA is like a novel contained in the nucleus of your cell. It contains all of the information that your cells need to do their jobs, live their lives, and carry out everything that your body does- from your intelligence, to your looks, your health, and even your behavior. It’s all programmed in there using “words” spelled with chemicals called base pairs. These base pairs are made of four “letters”- G, C, A, and T. There are 3.2 billion of these letters in human DNA. They each must get copied when the cell undergoes mitosis, and they must be copied with complete accuracy.

The process of copying their DNA so the cell can carry out mitosis is incredibly accurate. The error rate during DNA replication is as low as 10^βˆ’9 to 10^βˆ’11 errors per base pair. Errors can be caused by exposure to chemicals that alter the DNA, by certain viruses, by ionizing radiation, or simply a bad chemical reaction. There are “checkpoints” built into the process that detect and correct errors in the DNA replication and will halt the process or even cause the cell to die if correction can’t be done. Cells are programmed through their DNA to only copy themselves a limited number of times before they die off in a process called apoptosis. They will also undergo apoptosis if errors in this DNA copying process happen.

Sometimes, there are errors that slip through. Most of the time, these errors aren’t a big deal. Sometimes they are, and that is what causes cancer. When this happens, there are processes in your body’s immune system that are supposed to locate and destroy these out of control cells, because cells damaged by cancer release a chemical called tumor necrosis factor (TNF). More on that in a future post.

Cancer cells flip the whole mitosis process on its head. They not only fail to undergo apoptosis, they also spend most of their time in mitotic division- making copies of themselves. They multiply out of control, creating tissue that is using more and more of the bodies resources as they multiply out of control.

So cancer is a failure of two parts of the body: the cancerous cells that have lost the ability to undergo apoptosis through a transcription error that appears in their DNA, and the immune system whose job it is to find and eliminate cancerous cells.

There are no magic foods that halt this process, because it is an error in the DNA of the cancerous cells that are causing the problem, and once there is a “spelling” error, there is no way to correct this spelling error in a cancer cell’s DNA. The best you can do is kill off the cancer cell. The “daughter” cells, being an exact copy of the cancerous cell, will also be cancer cells.

The tumors eventually grow large and numerous enough that they use up all of the organism’s resources. This is why cancer patients begin losing weight and looking so sickly. The tumors are spending so much time and energy replicating that there aren’t enough resources remaining.

There are a few ways to get rid of cancer. The main ones are:

Surgery. We use surgery to literally cut tumors out of the body. This doesn’t cure the cancer, it merely lowers the size of the tumor, and thus the energy requirements being used up by the cancer. The issue is that surgery can’t possibly get every cancer cell, so all this does is buy time.

These multiplying cells create their own environment- they cause the body to create new blood vessels to feed the growing tumor in a process called angiogenesis. There are drugs that prevent angiogenesis, and taking these causes the tumors to be starved out.

The growing cells also have one exploitable flaw- they are spending so much time multiplying that they don’t have time to repair damage to themselves. This can be used to our advantage. That’s what chemotherapy and radiation therapy do- they damage all of the cells in your body. The healthy cells then repair themselves in between sessions, the cancer cells do not. The more sessions of chemo or radiation that you undergo, the more unrepaired damage is done to the cancer cells, and the cancer can eventually be killed off this way.

No treatment is 100% effective at eliminating cancer, because no matter how effective, there will always be a cell or two left that the treatment didn’t eliminate. The earlier that a cancer gets detected and treatment begins, the better the results. Although there are no curable cancers, melanoma, Hodgkin lymphoma, and breast, prostate, testicular, cervical, and thyroid cancer have some of the highest 5-year relative survival rates. The 6 cancers with the lowest survival rates are lung cancer, liver cancer, brain cancer, esophageal cancer, stomach cancer, colon and rectal cancer.

Since everyone is different, and so is the DNA error that causes the cancer, each person and each cancer will respond differently to treatment. That’s why one person can get breast cancer and survive, while another does not. This is why people like Suzanne Somers live for twenty years, while someone else doesn’t. Writing a book about how your special diet is the reason why you aren’t dead yet is a complete scam. You are alive because of the random chances of fate and the simple mathematical variances of chance, not because you have the cure for cancer by eating beet roots.

What makes her claims of a cure so despicable is that the people who forego medical advice to try her cure frequently discover the truth that it doesn’t work months or even years down the road, and it is then too late for them to be treated for what may have been a cancer that was easily treatable.

By Divemedic, ago

Government Screws Things Up

When government gets involved in anything, they screw it up. Maybe on purpose, maybe not.

Do you run around and scream that gun stores can’t be trusted? Or do you place the blame where it lies: with that individual, or with the government that made the law that caused the policy? Do you recognize that it is unfair to ask someone to forgo their livelihood so you can circumvent a law with which you disagree?

Do you then blame the pharmacist for not giving you drugs without a prescription?

There are plenty of laws with which I disagree. Some of them even dictate my behavior at work. We all have that happen. A friend who works at the county health department recently had a guy throw used needles at her because she wouldn’t accept them for disposal unless they were in an approved Sharps container. (Even though I happen to agree with that law)

When I was a paramedic and posted on a now defunct gun board, I was accused of being a “jackbooted thug” because I disarmed a patient who had sustained a head injury in a motorcycle accident and was carrying a pistol. I transported him to the hospital with his gun in his backpack, which I put in the cab of the ambulance. Why? Because people with head injuries aren’t in their right mind, and will often get violent because of the “fight or flight” response. It was for everyone’s safety. If I had gotten the cops to take that gun, he likely wouldn’t have seen it again. Believe it or not, I did the guy a favor.

The same accusation was made against me when I said that we occasionally take people to the hospital against their will, for example people who are threatening suicide or who have had a head injury or stroke. Why? The law says that they aren’t in their right mind and don’t have the capacity to make informed decisions. I did a post on that back in 2010. I am a firm believer in patients making their own decisions after being presented with the facts. The only thing that we truly own is our bodies, and we have every right to control them. However, a person who is not able to make an informed decision still has a moral right to receive care.

So why do I bring that up? Because the job that I work in is FAR more regulated than the firearms industry. I don’t make the rules, and neither does anyone else in the hospital. We are dictated to by a lot of agencies: CMS, AHCA, the Joint Commission, state nursing board, DOH, tons of agencies. They run everything from what medications we give to how much we can charge for what we do. If you don’t follow the rules, you lose your license and can be barred from ever working in this field again.

So I disagree when people blame the medical field for what happened in 2020 with COVID. The lockdowns, the vax mandates, all of that nonsense came from the government. Don’t think I am just defending myself and my actions here, because if you will recall, I didn’t return to the health care profession until 2021.

The TikTok dance videos? They were stupid and damaging to the reputation of the medical field, but when you understand that the videos were coming from the outpatient surgery centers that were shut down as a result of COVID mandates, that makes it a bit less shocking. Then consider that surgical nurses aren’t the same as ED or ICU nurses. It takes a year at minimum to train an RN to a basic level of competency in emergency medicine, and that’s a year after licensure, on top of nursing school. It’s a complicated subject that takes years to master. So those nurses who weren’t in fields like the ED, ICU, or ECMO were left with nothing to do and made stupid videos. Still not a damning indictment of all medical professionals.

No, what the people who comment on here about how COVID was the fault of doctors and nurses don’t seem to grasp, is that the lockdowns, the mandates, all of that were the fault of government wannabe dictators getting their tyranny on.

Crying about the way COVID was treated shows a complete lack of understanding of respiratory illness and its treatment. Health professionals were doing what had always worked for respiratory illnesses in the past.

Those treatments worked until COVID came along. Scientists have found that a section of the genetic material that makes up the COVID virus genetic sequence was patented by Moderna for cancer research purposes in February of 2016. The sequence is 19 base pairs long, meaning that there is only a one in three trillion chance that the virus happened naturally. It just so happens that this engineered sequence gave the virus a special affinity for human lung tissue. That makes COVID fall firmly into the category of a biological warfare agent.

Then the shutdown and the turmoil that followed was an engineered crisis that in my opinion was designed to put Joe Biden in the Whitehouse. I have posted on that as well.

So don’t come on here and disparage what the medical professionals did for the COVID outbreak. It isn’t them that caused the problems- it was the people that YOU elected and put in charge. Government receives power with the consent of the governed. What have you done to change what is happening?

Have a problem with it? Get the law changed. You say that you can’t? What makes you think that I can?

By Divemedic, ago

Teens and Consent

I agree with Fenix Ammunition on this one.

The law on this really sucks. If a 12-17 year old comes to the hospital, we are legally not permitted to discuss anything involving reproductive health with anyone that the patient (child) hasn’t permitted, including the patient’s parents.

It gets even more confusing. Let’s say that a 17 year old girl is involved in a car accident. Let’s look at a few scenarios:

  • Being a minor, she legally cannot refuse medical treatment and must be transported to the hospital, even over her own objections.
  • If she is pregnant, she can refuse care because the car accident can affect the unborn child, so she is considered to be an adult
  • If she has a baby in the car but is not pregnant, she can refuse medical care for the baby, because she is the child’s mother, but she cannot refuse care for herself because she is a minor

This is what happens when the government gets involved in anything. They always make it muddier and more screwed up than it needs to be.

By Divemedic, ago

Organ donation

I got an email asking about this, so here is my take:

Whenever a person is about to die, let’s say that they are brain dead but on life support, the hospital will evaluate the patient’s record to see if they are an organ donor. Whether they are or not, the organ donation people will be contacted. That organization will then determine if the person is a candidate for donating organs (not everyone is medically capable of donating their organs.)

If the person has previously agreed to be an organ donor, the person will immediately be screened to see if they are a match for anyone on the recipient list. The transplant team in the recipient’s hospital will be contacted, and they hop on a plane to harvest the organ.

If the person hasn’t indicated either way, the organization will contact the next of kin and attempt to gain consent for organ donation.

No one is taking anyone’s organs without consent. All the organization is doing is acting as a coordinator for the process. If you don’t want to be an organ donor, make sure that you indicate your wishes in your will or living will and make sure that your next of kin is aware of your desires. It’s up to you.

With that being said: No, the hospital doesn’t change your care if you are or are not an organ donor, other than keeping a person that is brain dead on life support a bit longer before “pulling the plug” so as to preserve some of the more sensitive organs like heart or liver. No, it isn’t like signing a DNR.

They aren’t less likely to try and save you for increased profits or anything like that. Chances are, the recipient of your donated organ is hundreds of miles away in another state. As an ED nurse, I work a lot of codes. I do not know, nor do I care, what your organ donation status is before I call your code.

The only thing this is for is to save lives by giving people with defective organs a shot.

A great example of this: A guy comes into the ED by EMS and is brain dead due to some sort of accident. He isn’t savable, his brain is gone, but he is otherwise young and healthy. Why leave his organs to rot when so many people need donations? So the organ donation people get a call, and those people review the record to see if he is an organ donor. If he isn’t, they will try to gain consent of the next of kin. Either way, once they gain consent, they will send out the notifications to the appropriate recipient teams.

Nothing nefarious. It’s all consensual, and it doesn’t change the potential donor’s care one whit.

By Divemedic, ago

So What Are You Doing About It?

Republicans are complaining that nursing schools are teaching nursing students to ask children about their gender orientation. The thing about that is, it’s their own fault. The reason why so many hospitals and other health care institutions are doing this is because…

It’s the law.

Section 1557 of Obamacare prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics). So to the Republicans- if you don’t like it, what are you doing about it?

The Democrats see something that they don’t like, and they fight to change it. The Republicans see something that they don’t like, and they… do nothing but bitch and complain.

It took a maverick like Donald Trump to fix the number one target of Republican ire- abortion, and they hate him for it. The Republicans need to stop being useless power mongering whores and actually do the job they were elected to do.

By Divemedic, ago

How the Sausage is Made

From SocoRuss

Do you think you could do a post about what you see as a medical person and covid. We hear from the govt and CDC we are all going to die and the latest variant will wipe out the world so we should hide and take the next 27 booster shots . We dont get to hear that much from someone like us who who skips the bullshit. But what are you seeing? Are you see large numbers of cases, how severe are the cases, what type of people are coming in? The healthy, the old and weak, the immune compromised? Is the large influx of illegals the cause of the number to rise? The big question would probably be who is getting covid more now, the vaxxed or unvaxxed. there seems to be more and more doctors studies saying the vaxxed are getting covid more now, whats the truth?. Whats you opinion and advice on this? I think a lots of your readers would like to hear this also.

OK. My ED sees between 200 and 300 patients per day. We are seeing about 50 to 60 people who have respiratory complaints each day. The majority of them wind up with cardiac, emphysema, COPD, and other infections like pneumonia and the flu. About 15-25 of those 50-60 wind up being diagnosed with COVID. How does that happen? The following is going to be a bit heavy in technical details, but I will simplify it as much as I can, so that it is more understandable.

We are a protocol driven hospital. Under the law, nurses can’t do anything that they aren’t ordered to do by a doctor. So hospitals using protocols have a set of SOPs that nurses enter into a patient’s chart, and a doctor (or other provider) signs off on it. These protocols can be entered by the nurse that is using their professional judgement, or they can be initiated by the nurse after being alerted by our computerized charting system generating a “best practice advisory.”

Hospitals have something called SIRS criteria, as pretty much every hospital in the nation does. When a patient arrives in the ED, they are initially triaged. The computer (and nurse) looks for the following:

  • Body temperature over 38 or under 36 degrees Celsius.
  • Heart rate greater than 90 beats/minute
  • Respiratory rate greater than 20 breaths/minute
  • partial pressure of CO2 (either end tidal or arterial blood gas) less than 32 mmHg
  • Leukocyte >12000 or <4000 per microliter
  • >10% immature forms or bands

If the patient has two or more of the above, the nurse will enter a standardized set of orders for tests. Those tests include tests for lactic acid, a CBC, CMP, and if appropriate, COVID/Flu tests, urinalysis, and other tests. If the nurse doesn’t enter those orders, the computer will alert them that it is best practice to do so. If the nurse STILL doesn’t do so, the computer requires them to enter a note in the patient’s chart explaining why they didn’t. The system is designed to do this so as to prevent human error from missing something important. Once those orders are entered, a e-note is sent to the provider (doctor, nurse practitioner, or physician assistant) who is in charge of that patient, and they will sign off on those orders. It’s a quick, efficient system that is designed to be safest for the patient.

If any of those tests or a physical exam shows that an infection is also present, the patient is said to be positive for Sepsis criteria. This activates an entire other process. Every attempt is made to identify the particular pathogen involved, but the important thing is to start aggressive treatment at that point, before the patient goes into septic shock. So they get IV fluids and probably antibiotics while we are waiting for the results of testing. Time is of the essence here.

If a patient tests positive for Flu A or B, or COVID, they follow a different path. They don’t get antibiotics. Flu patients get flu drugs like Tamiflu. We check COVID patients to see if their blood is clotting normally (INR, PTT, and other similar tests), they get a chest Xray, and we monitor their oxygen saturation. They get some IV fluids, and oxygen (if indicated) and that’s it.

Does this sound like familiar advice? For decades, we have known that viral respiratory illnesses need fluids and rest. Remember that water is nature’s expectorant. It thins out respiratory secretions so that they are thinned enough to be easy to cough out. If you are sick enough to meet SIRS criteria, you likely haven’t been drinking enough water, so we give you a liter or so of either Normal Saline (0.9% NaCl in water) or Lactated Ringers solution. The vast majority of them get sent home after being monitored for a couple of hours. Occasionally, one will get admitted, maybe one or two a day.

The demographics haven’t changed a whole lot. The ones who are the sickest have underlying conditions like cancer, advanced cases of diabetes, COPD, or other inflammatory or respiratory diseases. My hospital doesn’t see a whole lot of illegals, so I can’t comment there. COVID vaccine status doesn’t seem to matter one way or the other. I really don’t think that the vaccine does anything. That’s why I got the first series back in the spring of ’21, but haven’t gotten anything since. (I had COVID twice just a couple of months after I got vaccinated. I haven’t worn a mask since, yet I have been exposed to COVID at least once every working day, and haven’t gotten shit.)

I haven’t seen a COVID death in at least six months. We admit a few, but the VAST majority are treated and released. I will say that we are getting more cases lately, but I don’t see the cases we are getting now being as severe as the ones from 2020. I think that this is because of a few things:

  • We know how to treat COVID now. That wasn’t true three years ago.
  • COVID already killed off the weakest and sickest.
  • The original strain of COVID was the most virulent, IMO. These new variants are not as deadly as the first one.

We have had a lot of staff testing positive for COVID. We had 15 call ins just in the ED staff on the last day that I worked. It seems to be going around and is more contagious than before, but it seems to be no worse than the flu. I have been beefing up my immune system in the meantime by taking vitamins (especially C, D, and E), calcium, and zinc, trying to be a bit proactive.

Understand that this is the experience of one nurse in one hospital, and we all know that anecdotes are not data.

By Divemedic, ago

Now They Tell Us

I took Ivermectin and HCQ when I got COVID. It sure didn’t hurt. It may have helped, I don’t know. It’s hard to tell when there is an illness with a 99% survival rate.

By Divemedic, ago

Drugs

During the first few weeks of my new ED experience, I can tell you that the community of this new hospital has a larger drug problem than the last. At least a third of my patients have been on Meth or Tranq. Every patient that I have ordered a tox screen for has been positive for one or more of the following: opioids, Benzodiazepines, cannabis, or methamphetamines- in one case, even an 80 year old woman who came in unresponsive and wound up dying- she tested positive for benzodiazepines and cannabis.

In one day alone, I had four different patients come in that were combative because they were on Meth. One of them required 4 nurses, 2 paramedics, and 8 security guards to hold down. We wrestled with him for almost 45 minutes and had to give him 6mg of Ativan, 50 mg of Benadryl, and 10mg of Haldol before he took a nap.

By Divemedic, ago

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