Help Finding a Physician, Please

[wetagain]

My brother in law is heavy guy, maybe in the 550 to 600 Lb. range. He has recently dealt with some seriously wicked cancer, and other health issues.

Last month he felt that he had moved beyond the most of his major problems, and expressed interest toward me, in getting involved in scuba diving (OW). I thought, great!, as this would be fun, and probably good exercise for him. We got him set up with some gear, and even went like 10ft. in a spring so he could see if he really liked it or not. Well, he LOVED it, and was very excited.

Heres the catch. Due to his size, and history, the people set to certify him, have requested a doctor to asses him for diving, before commencing. So, he got ahold of his doctor thismorning and they said ABSOLUTELY NOT!!!

I have the suspition that he is dealing with people who know ABSOLUTELY nothing about diving, and are just generalising it, as some sort of extreme sport, or something. I mean, he even got a cart for hauling his tank, so he dosn't overexert himself and everything.

IF the doctor said something to us like "I am seriously concerned about the tissue loading and unloading characteristics of his body type." I would buy it........ BUT when we contacted them again this afternoon as to the specifics of thier decision the reply was that he was considered "morbidly obese, and at too high a risk to dive."

I truly believe that he needs a second opinion from some sort of DIVING physician. Any thoughts on this would be much appreciated, or direction towards the right people. Until then I guess things are just on hold, poor guy, he was SO exited!! :(

[J_glenn06]

Man thst sucks i'm no doctor but i hope everything works out

[sskasser]

Contact DAN and ask for a referral.

[aainslie]

I suspect that doctor is onto something. Have a look through dive death statistics. It's unbelievable how many are a mix of causes, BUT - and here's the key issue - with heart failure as one of the most frequent issues. It caused me to go out and buy a defibrillator which I take everywhere with me when diving. Also it's amazing how many fatalities are overweight 40+ men - and I'm not talking the 500 lb range either. I view myself as mildly overweight at 205 lbs and 6 ft 2 - and I view myself as at mild risk of dive related heart failure.

Your friend will have a far higher than average risk in this regard. I suspect that he doesn't need yet another thing to reduce his lifespan at this point.

Of course I'm not even a medical doctor, let a lone a dive specialist, but seriously, why place himself at further risk than he is already at?

There are other recreational options that might be better for him.

[guru caver]

My brother in law is heavy guy, maybe in the 550 to 600 Lb. range. He has recently dealt with some seriously wicked cancer, and other health issues.

Last month he felt that he had moved beyond the most of his major problems, and expressed interest toward me, in getting involved in scuba diving (OW). I thought, great!, as this would be fun, and probably good exercise for him. We got him set up with some gear, and even went like 10ft. in a spring so he could see if he really liked it or not. Well, he LOVED it, and was very excited.

Heres the catch. Due to his size, and history, the people set to certify him, have requested a doctor to asses him for diving, before commencing. So, he got ahold of his doctor thismorning and they said ABSOLUTELY NOT!!!

I have the suspition that he is dealing with people who know ABSOLUTELY nothing about diving, and are just generalising it, as some sort of extreme sport, or something. I mean, he even got a cart for hauling his tank, so he dosn't overexert himself and everything.

IF the doctor said something to us like "I am seriously concerned about the tissue loading and unloading characteristics of his body type." I would buy it........ BUT when we contacted them again this afternoon as to the specifics of thier decision the reply was that he was considered "morbidly obese, and at too high a risk to dive."

I truly believe that he needs a second opinion from some sort of DIVING physician. Any thoughts on this would be much appreciated, or direction towards the right people. Until then I guess things are just on hold, poor guy, we was SO exited!! :(

I am NOT A PHYSICIAN, but I believe that when a doctor tells you that you are 'morbidly obese' he's not kidding. Diving is still a lot more strenuous UNDER the water than people think. I mean, your body is surrounded by lbs. and lbs. of pressure (varying depending on your depth). I for one, strongly urge you to not encourage diving for your brother in law until his doctor says it's okay.

[wetagain]

I for one, strongly urge you to not encourage diving for your brother in law until his doctor says it's okay.

Did you read the last lines of my post or what?

[wetagain]

Thanks sskasser, for an actual suggestion. He is doing this as we speak.

[guru caver]

yes, read all of your post (twice) and thought about my advice to you carefully.

[wetagain]

Thats ok sometimes I read crap 3 times and forget what it said LOL

[skip]

second opinions are always a good thing. never believe one doctor, unless you just want to. they rarely agree on anything (like most of us). i dive with friends in the 300-400 lb range (not in caves cause they are not cave/cavern) and although i do worry a bit about health issues, etc., they have been diving with no problems for 8 years now. It could change any minute and death could result, but hey, it could happen to any of us at any time. had a friend in a car wreck, and in the hospital they discovered cancer and he died a month later. not a hint of cancer to his knowledge and if not for the car wreck, he would have never gone to the doctor! Heck I even sky dive with a 500 lb buddy and believe me we get a few odd looks trying to find a plane big enough! we sometimes have to pay a bit extra.

if you want to dive, dive. if you die, well, you knew the risks and decided it was worth it.

-skip

[wetagain]

Thanks, I agree. This guy has been through some serious hell, and been close to death a couple of times from the cancer, and subsequent operations. The real clincher here is his risk for dcs. Possibly he could dive profiles that keps him WAY out in the clear, I don't know. Thats why we wanted to find a guy knowledgable on this as well as medicine. I think dan is helping him find someone. Thanks all!

[Squirrel Girl]

Thanks, I agree. This guy has been through some serious hell, and been close to death a couple of times from the cancer, and subsequent operations. The real clincher here is his risk for dcs. Possibly he could dive profiles that keps him WAY out in the clear, I don't know. Thats why we wanted to find a guy knowledgable on this as well as medicine. I think dan is helping him find someone. Thanks all!

Let us know how it turns out. I hope it works out that he can dive in some capacity.

[Deep-Thief]

This just might be the sport or love that would push him over the edge to start dieting. If you want something bad enough, you will make it happen. I would definately contact a diving specialist and see what they say. Sorry I can't give any advice other than to try someone else and don't give up yet.

[aainslie]

Oh bugger it. Withdrawn.

[RN]

The real concern here is not DCS. The real concern is the exertion and the effect it will have on his body while diving. If your friend needs a cart to haul his gear to the water, then he shouldn't be diving. Personally, with or without a physician's release, I would not train your friend. I require my students, both recreational and technical, to be able to carry their gear to the water. If they can't do that, then they don't need to be getting in the water with. Yes, there are handicapped associations for diving and that's a whole other story. Your friend is not handicapped. He's overweight. Actually, he's morbidly obese. This also brings up the question of how much weight he would need to become neutrally bouyant. How is he going to put this weight on? How will he perform some of the skills that are required during the class? I would not want to have to rescue and perform CPR on him. I'm not trying to be harsh, just realistic. I've been in the healthcare business for almost 20 years and have seen lots of people your friend's size. I've taken care of them outside and inside hospitals. There are several health issues to consider here, not just DCS. I would question any physician, dive specialist or not, who is willing to sign off on this guy. Sorry, but he needs to lose some weight before he does this.

[cavediver256]

I have to agree with RN, I too have been in healthcare for 10+ years, and there are several issues to look at. Several have already been listed here, so I won't rehash them.

If your friend is that excited about diving, maybe he should drop some weight and improve his overall health before attempting diving. Diving is a strenuous sport, even if it is OW, and his risk for DCS begins the moment he breaths compressed air below the surface regardless of the conservativeness of his profile.

[BobK]

The real concern here is not DCS. The real concern is the exertion and the effect it will have on his body while diving. If your friend needs a cart to haul his gear to the water, then he shouldn't be diving. Personally, with or without a physician's release, I would not train your friend. I require my students, both recreational and technical, to be able to carry their gear to the water. If they can't do that, then they don't need to be getting in the water with.

Assuming you mean not due to back issues ? There are lots of good divers who can't carry all their gear to the water due to back problems, but are great once they are in the water.

[Squirrel Girl]

RobN, I don't have a medical background, and I don't presume to disagree with your opinion. It sounds like you've got very good reasons for saying that.

But I wonder if there isn't a bigger picture. The guy could be dead tomorrow from cancer. Doesn't there ever come a time when it's worth some risk? I AM NOT SAYING HE SHOULD BE OKED TO ENROLL IN A CLASS AND BE TREATED LIKE ANY OTHER DIVER!!!!!!!!!

But clearly, he did dive and didn't die. Is it possible that some conditions be created where he could do some very limited diving while he hopefully loses some weight to get to where he could be able to do "normal" diving? I could see where giving him a more regular "taste" of diving would be good incentive to encourage the weight loss. I struggle terribly with weight myself, so I feel his pain!

I could see him saying, "I'll never lose enough weight" and give up. But if he gets to go in the water on a very limited basis, I could see that that minimal activity would both assist in physical activity and encourage more.

I guess what I'm suggesting is perhaps not what the OP was asking. I guess they're asking for a blanket OK, and I'm suggesting some sort of toe dipping instead. I can certainly understand where both medical and diving professionals would be wary and know the consequences of failure.

There's a guy in my office who nearly died of Typhoid. He was in his 20s, hadn't travel anywhere, and who in Virginia gets Typhoid? It took his doctors FOREVER to figure it out. So now he has a very different outlook on life. Why's he saving money? Why doesn't he go out and enjoy life? You never know when you're going to lose it.

So while I am very encouraging of being safe, including in this case, I also think that having this guy who could die any day of cancer or heart related problems, shouldn't be told, later, later.

Far be it from me saying he *should* dive. But maybe there are other options.

[wetagain]

well you got to die somehow, he is talking to the right people now, thankyou all, I will post more, when I hear more.

[cavemark]

It could change any minute and death could result, but hey, it could happen to any of us at any time.
-skip

The Lord can call any life at any time for any reason.


This just might be the sport or love that would push him over the edge to start dieting.

I'm not morbidly obese or even obese, but from the time I started OW to the time I had finished Full Cave I had lost 25lbs (approx 14%). As soon as I started losing I started noticing differences in trim and total weight needed on my belt. The better I felt in the water the more incentive I had to lose the extra weight I had put on. If he starts losing weight now, then since he is used to carrying the extra weight, his frame won't feel the difference as he adds the weight of the gear as his training progresses. By the time he has lost 20% he'll have lost the weight of a small set of doubles and be in much better shape to carry the gear.

I have a great concern for the obese. I have friends in the 400-500lb range and am trying to start a ministry to help them. I'm in the research phase. The main motivator for true and permanent change doesn't come from others wanting you to change for yourself or them, it comes from you wanting to change for yourself and others. Being told "You can't do that because your obese" doesn't provide the motivator, it only causes frustration and anger. The motivator would be your friend wanting to dive with you for one or both of two reasons:
1) If he wants to participate in an activity with you that he has discovered that he enjoys;
2) If he wants to enhance your opinion of him and your friendship knowing that you would enjoy it if he lost weight in order to dive with you.

Mark

[RN]

Assuming you mean not due to back issues ? There are lots of good divers who can't carry all their gear to the water due to back problems, but are great once they are in the water.

No, I'm talking exertion issues due to decreased cardiac and pulmonary function. Once in the water, these are still issues.



RobN, I don't have a medical background, and I don't presume to disagree with your opinion. It sounds like you've got very good reasons for saying that.

But I wonder if there isn't a bigger picture. The guy could be dead tomorrow from cancer. Doesn't there ever come a time when it's worth some risk? I AM NOT SAYING HE SHOULD BE OKED TO ENROLL IN A CLASS AND BE TREATED LIKE ANY OTHER DIVER!!!!!!!!!

But clearly, he did dive and didn't die. Is it possible that some conditions be created where he could do some very limited diving while he hopefully loses some weight to get to where he could be able to do "normal" diving? I could see where giving him a more regular "taste" of diving would be good incentive to encourage the weight loss. I struggle terribly with weight myself, so I feel his pain!

I could see him saying, "I'll never lose enough weight" and give up. But if he gets to go in the water on a very limited basis, I could see that that minimal activity would both assist in physical activity and encourage more.

I guess what I'm suggesting is perhaps not what the OP was asking. I guess they're asking for a blanket OK, and I'm suggesting some sort of toe dipping instead. I can certainly understand where both medical and diving professionals would be wary and know the consequences of failure.

There's a guy in my office who nearly died of Typhoid. He was in his 20s, hadn't travel anywhere, and who in Virginia gets Typhoid? It took his doctors FOREVER to figure it out. So now he has a very different outlook on life. Why's he saving money? Why doesn't he go out and enjoy life? You never know when you're going to lose it.

So while I am very encouraging of being safe, including in this case, I also think that having this guy who could die any day of cancer or heart related problems, shouldn't be told, later, later.

Far be it from me saying he *should* dive. But maybe there are other options.

I understand what you're saying. And if this is a risk he's willing to take knowing he may die, then it's his choice. However, there's really no way to do this. He needs the medical release. I doubt any reasonable doctor would sign off on it. No reasonable instructor would take him in the water without it. I really doubt at his current weight he could complete all the skills required to pass an OW course without overexerting himself and risking serious injury. He could possibly do a bunch of Discover/Try Scubas, but he still needs the medical release for those. And if something happens, even with the liability release signed, the instructor guiding him would most likely be sued by some lawyer representing the family. The liability release doesn't prevent anyone from suing.

[wetagain]

RN I have a few close friends that haul gear to the water with carts, due to medical reasons. PM me for thier e-mails, and you can send them all e-mails explaining why they shouldnt dive.

Im NOT saying you have prejudices, but telling a fat person they are not handicapped, just fat, is the equivalant to telling a slow person he's not a retard, just slow. DCS IS the primary issue here, as the exertion problems have been talked about between us extensively, and can be managed by picking the right sites, with relatively easy acess, and shallow depth. The DCS is the unknown. That's why we are looking for someone with explicit knowledge in this field.

The reason for the cart in the first place, is the operation made, to remove the tumor that was growing on his lower spinal cord, left him with alot less walking mobility than he had before, not because he is just so big he can't walk to the water. Personally I am quite offended for him, when I hear statements like "you just need to lose some weight"..... This is not an acceptable awnser, it'a akin to your mom telling you "because I said so", and who likes that explanation. Irregaurdless, he knows he needs to lose some weight, of course.

I have spent quite a bit of time with this guy over the last year, and my eyes are being opened by the interactions others have with him, and how his condition affects all of those, and to be honest, it makes me sick, and angry sometimes. Sorry if this shows. Remember, we are seeking knowledgable medical advise before proceeding with anything at all. If a diving physician says no, then so will I.

p.s. He says he dosn't want you performing cpr on him either. oh and he says he found a good spot for the weights too.

[wetagain]

The Lord can call any life at any time for any reason.



I'm not morbidly obese or even obese, but from the time I started OW to the time I had finished Full Cave I had lost 25lbs (approx 14%). As soon as I started losing I started noticing differences in trim and total weight needed on my belt. The better I felt in the water the more incentive I had to lose the extra weight I had put on. If he starts losing weight now, then since he is used to carrying the extra weight, his frame won't feel the difference as he adds the weight of the gear as his training progresses. By the time he has lost 20% he'll have lost the weight of a small set of doubles and be in much better shape to carry the gear.

I have a great concern for the obese. I have friends in the 400-500lb range and am trying to start a ministry to help them. I'm in the research phase. The main motivator for true and permanent change doesn't come from others wanting you to change for yourself or them, it comes from you wanting to change for yourself and others. Being told "You can't do that because your obese" doesn't provide the motivator, it only causes frustration and anger. The motivator would be your friend wanting to dive with you for one or both of two reasons:
1) If he wants to participate in an activity with you that he has discovered that he enjoys;
2) If he wants to enhance your opinion of him and your friendship knowing that you would enjoy it if he lost weight in order to dive with you.

Mark

Thankyou mark! Bj says you are a fine gentleman. :) He's here with me today.

[wetagain]

One more thought, this guy has been going to the fitness center and walking treadmills and stuff TWICE a day, just to try to get into better shape to get his feet wet. Before his spine was compromised, this guy (even heavier then) would walk around sea world with us ALL DAY. I think that says something about his cardiovascular system, what.... hmmmm, don't know.

Squrrel girl, yes, this is exactly what he want's to do, get his "toes wet" to a very limited degree. The need for a blanket statement comes from needing a card, to acess sites, and getting fills. Thankyou again for the direction toward DAN.

[Squirrel Girl]

I understand what you're saying. And if this is a risk he's willing to take knowing he may die, then it's his choice. However, there's really no way to do this. He needs the medical release. I doubt any reasonable doctor would sign off on it. No reasonable instructor would take him in the water without it. I really doubt at his current weight he could complete all the skills required to pass an OW course without overexerting himself and risking serious injury. He could possibly do a bunch of Discover/Try Scubas, but he still needs the medical release for those. And if something happens, even with the liability release signed, the instructor guiding him would most likely be sued by some lawyer representing the family. The liability release doesn't prevent anyone from suing.
Yes, I'm sure you're right. If I were a doctor or instructor, I would be very reticent about OKing him even with a liability waiver. I also recognize that if this is an extreme case and if you let him slip through the rules, why not let everyone slip through the rules?

But I still think it would be great thing to find a way.

[OneBrightGator]

RN I have a few close friends that haul gear to the water with carts, due to medical reasons. PM me for thier e-mails, and you can send them all e-mails explaining why they shouldnt dive.
Might want to scale back the attitude there chief, because if you really...


are seeking knowledgable medical advise before proceeding with anything at all.
Then you found it in Rob. He is knowledgable in the medical and diving fields. Just because he's not the "YES" man you seem to be looking for certainly doesn't give you the right denigrate him.

You really need to consider situations beyond the ideal diving conditions. What will happen if you have an issue, above or below the water, what is his ability to render aid? What if he cannot render sufficient aid, how will that effect him should you be injured or killed? Consider the converse also, what is your ability to render aid for him? What if you cannot render sufficient aid, how will that effect you should he be injured or killed? These are questions that need to considered honestly with every buddy you intend to dive with.

[wetagain]

Yes you are right, I am quite enthused about sticking up for him, sorry about that. To be honest, he lives literally one mile from Blue spring's and want's only to drift from the head ramp to the parking lot ramp, looking for shark teeth, and what not. And I can honestly say that is probably going to be the extent of his diving, oh, and he wants to do alexander once and a while. Not looking for a yes man, btw, looking for a diving physician. We are also not looking for only-negative thoughts and comments, from someone "knowledgable in the medical and diving fields", off the net who has not even met the guy. He got a list from DAN today, thankyou again sskasser.

[Cindy]

My thought on this are: Can your Brother swim the laps in a pool that he would have to do to even finish an open water class? I think your putting the cart before the horse. If he can physically do the things he needs to do for certification then try snorkeling and then scuba. I think that any MD in the universe would say that swimming in a pool is OK. If he can do what he needs to do then take him to an open water class, if he passes then worry about spring diving. Take baby steps.
If you don't want to be rational and you just want to go on a cavern dive before he dies then Screw The Doc and toss him in the spring with a regulator. He will most likely die but it's better doing it there with the people he loves in a pretty place instead of hooked up to a vent in some ICU. Cindy
ps don't do it at Ginnie please.

[wetagain]

He accompanied me to a dive shop today to drop some tanks off to hydro, and the instructor say's "Iv'e certified bigger" and acted like it was no big deal, and then gave us his story on dropping 100 Lbs. last year, and gave him some suggestions. He's by no means putting any stock into this, as he, and his wife both still want to talk with the proper specialists. Also, ty Cindy, beautifully put. - Phill p.s. yes he snorkels and swims at blue springs all the time & loves it. :) I bet it feels good to be in the water when you are used to carrying 500Lbs!

[DeepSea]

is the equivalant to telling a slow person he's not a retard, just slow.

For someone that is so offended by the comments of others I am surprised by your ignorant comment. You have actually offended me by using the term "retard". Personally, I hope you never post on here again.

[RN]

RN I have a few close friends that haul gear to the water with carts, due to medical reasons. PM me for thier e-mails, and you can send them all e-mails explaining why they shouldnt dive.

Im NOT saying you have prejudices, but telling a fat person they are not handicapped, just fat, is the equivalant to telling a slow person he's not a retard, just slow. DCS IS the primary issue here, as the exertion problems have been talked about between us extensively, and can be managed by picking the right sites, with relatively easy acess, and shallow depth. The DCS is the unknown. That's why we are looking for someone with explicit knowledge in this field.

The reason for the cart in the first place, is the operation made, to remove the tumor that was growing on his lower spinal cord, left him with alot less walking mobility than he had before, not because he is just so big he can't walk to the water. Personally I am quite offended for him, when I hear statements like "you just need to lose some weight"..... This is not an acceptable awnser, it'a akin to your mom telling you "because I said so", and who likes that explanation. Irregaurdless, he knows he needs to lose some weight, of course.

I have spent quite a bit of time with this guy over the last year, and my eyes are being opened by the interactions others have with him, and how his condition affects all of those, and to be honest, it makes me sick, and angry sometimes. Sorry if this shows. Remember, we are seeking knowledgable medical advise before proceeding with anything at all. If a diving physician says no, then so will I.

p.s. He says he dosn't want you performing cpr on him either. oh and he says he found a good spot for the weights too.

wetagain, first, I'm not prejudiced against people who are overweight. I'm a registered nurse who has several years of experience in cardiovascular intensive care and emergency medicine. I'm also a recreational, technical, and cave instructor. The information I'm posting here is based on that experience and the information you posted in your original post. I have real concerns about someone that large being able to handle issues underwater. You never mentioned anything about him snorkeling or walking treadmills until yesterday. Even with that, I would be hesitant to bring someone down 60 or even 30 feet underwater. Remember, part of the OW skills that need to be completed are removing and replacing weights underwater and on the surface. I think that alone would create overexertion for someone that size. It creates overexertion for some who are not overweight! It's not about where to place the weights, it's about taking them off and putting them back on in the water. I did not say he just needs to lose some weight. I said he needs to lose some weight before doing this. I understand about the weightlessness underwater, but there's so much more to it. And my comment about not wanting to rescue and perform CPR on someone his size was in regards to having to get him out of the water in an unconscious state. It's not likely to happen in time. I'm performed CPR well over 100 people in my career and even run advanced codes including administering meds and defibrillation, with many of them surviving. I'm not trying to be a jerk about this. I am expressing real concerns. Believe me, if I could think of a way for him to safely do this right now I would tell you. I am a big supporter of Matt Johnston (http://www.scubadivingdream.com/). Yes, people have to bring his gear to the water for him. They even have to bring him to the water. But he has a team of experts that he is depending his life on to get the few dives in that he has done. There were years of research and trials to get him to the point of being able to spend a few minutes underwater in the Keys. He is on the extreme end. There are other disabled folks out there who dive and need help to the water, but cardiovascular-wise, they are fit. While your friend may be able to walk a treadmill, I am still concerned about his cardiovascular fitness. The weight alone decreases it. Has he ever had a cardiac catheterization or tranesophogeal echocardiogram? What's his ejection fraction? Has he ever done a cardiovascular treadmill test? I would expect any physician who even considers signing off his medical form for diving would at the very minimum get these results. And, unfortunately, your friend's insurance will probably not pay for the tests, so he'll end up having to pay out of pocket. Okay, enough rambling. I'm just trying to paint a better picture for you about where I'm coming from. It's not the weight that concerns me. It's the effects the weight has on his cardiovascular system. I'm sure for basic recreational dives his body can handle the increased pressures without him taking a DCS hit. What I'm not so sure about is whether it can handle the exertion necessary to perform the skills required to get OW certified. Have your friend do the 200 yard swim in a pool or spring without stopping (as required by standards). Have him get on the surface and remove and replace a weight belt with the proper amount of weight required to make him neutrally buoyancy. Have him get on the surface with a BCD and tank and remove and replace this with the weight on. If he can do these things without overexerting himself and getting out of breath, then maybe he could get signed off. But then he's also not the typical 550 lb person. Please keep us updated on what happens. I'm am genuinely interested in the outcome of this. I'll even provide his training if he gets cleared after a treadmill and echo and can perform the 3 skills I mentioned without any major issues.

[wetagain]

Yes, you are right, sorry about that, you have some very good points there. I guess if I was just looking for the people he needs to contact, I shouldn't have explained the situation in the first place :( ima big hairy chest beater for some apparent reason

[wetagain]

For someone that is so offended by the comments of others I am surprised by your ignorant comment. You have actually offended me by using the term "retard". Personally, I hope you never post on here again.
it's your lucky day then! :clapper