On a side note…link to report on grounding of Star Princess linked to sleep apnea.
I see a lot of CPAP machines onboard.
The USCG physical should be a real thorough physical that meets international standards and more.
It should test for everything that needs to be tested to be sure that mariners are truely fit enough to do the job.
The employer physicals are not about fitness to do the job, or seamen’s health needs, they are about liability avoidance and keeping health insurance costs low. This should not be allowed. Carried to its logical extremes employers will be doing genetic testing and screening people out on the basis that their unborn children may have expensive medical problems.
If this occupational physical business continues to grow in the broad US labor force, taxes will have to skyrocket to support all the people unable to work because of employer screening. What happened to medical privacy.
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Well, I actually lost more (I basically was so sick that I hadn’t eaten in a month) and have gained a couple back. . . .
Sure…and I see that coming via IMO Treaty Law.
But I’m more concerned with the backend of that…we need to meet a higher standard even to walk aboard a ship.
Once we cannot,(and it’ll happen to all of us sooner or later), we need to make sure that we are not just thrown out on the street and…hope…that our Disability isn’t stuck in Limbo at the whims of some Social Security bureaucrat.
How are we ever going to attract people to this indiustry,(supposedly that’s an Official Policy Thing), when we are but one physical away from living under a bridge for our Golden Years?
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If you can work steadily at any job, in any field, you are not disabled for purpose of Social Security. I’ve been through this and they make it extremely clear that this is the case.
^^I’m sure that [cough]scumbag[cough] lawyers sometimes (often?) get people awards that they’re not actually eligible for. This is of course a crime and subject to penalties if it’s discovered.
Also there are strict limits to the amount of useful (paid or unpaid) work you can do without losing the award. In practice that mostly means paid work. Basically you have to report any paid work by month. You are allowed a total of nine months of work/income over some trivial amount like ?$125? in the month. After the ninth such month you lose the award as you are no longer considered disabled. If you really are still disabled you can wait out the six month eligibility period and apply for a new award starting from scratch.
They offer various training and other programs to help people transition to working again. Unfortunately however that abrupt nine-month limit is a considerable disincentive for people who had high income before being disabled and thus had fairly high awards.
For context, I’m quite well paid in Social Security terms and I’m presently getting $21,600/year, with slight cost-of-living increases most years. I aged off the disability system last year at age 66. I now get the same money from "regular’ Social Security, and I may do any amount of work without affecting it.
Ten,
It’s a real condition. What happens is that the person literally stops breathing for brief periods. Then the body senses oxygen deprivation and carbon dioxide building up, the urge to breathe kicks in hard and the person then takes a large, gulping or snoring breath. Maybe you’ve heard it- soft snoring, then nothing, then a big snort a moment later, rinse and repeat.
Weight is a big contributing factor. Some people with certain anatomical structure issues- overbite, sinus issues, etc can be prone, too
It can cause serious problems because the sleep cycle is interrupted by the fits and starts in breathing, but the sufferer is generally unaware of it. It can contribute not only to poor quality sleep, but hypertension and even diabetes. Or make those worse.
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In a healthy person oxygen deprivation is such a tiny signal compared to excess CO2 (or actually excess carbonic acid in the blood which is exhaled as CO2 – this is known as respiratory acidosis) that it has no effect on breathing.
This is a source of danger to free divers who hyperventilate before diving so as to stay under longer – this action increases oxygen saturation** but also decreases carbonic acid in the blood to the point that oxygen starvation occurs before the CO2 breathing reflex is triggered. Divers have died through simply not recognizing that they needed air.
The opposite situation affects the people we used to call “chronic lungers” – the polite term is now COPD, or Chronic Obstructive Pulmonary Disease.
These folks always have excessive CO2, to the point that it no longer triggers the breathing reflex; so they breathe based on oxygen need only. It was around the seventies when I was a Hospital Corpsman that it was realized that giving pure oxygen to such a patient could kill him; because he would breathe less often than needed to keep the CO2 somewhat within bounds, go into severe respiratory acidosis and quite possibly die.
There are something like 25 different mechanisms that serve to control blood pH; but by far the most important is the carbonic acid/bicarbonate balance. The great danger arises because the homeostatic (self-regulatiing) feedback only function when blood pH is very close to the normal limits of pH 7.35 +/- 0.05. Outside those limits the feedback loops make things worse instead of better; and the patient will surely die without outside intervention by doctors actively interfering with the pH to try to get it back inside the homeostatic region.
I’m sure that computers have made this much easier; in my time they used nomograms and special-purpose slide rules to try to determine how much of what to put in the patient’s IV to try to get them to the right range long enough for the body mechanisms to take over. It was tense and grueling, and not uncommonly failed.
Thanks for your reply. If those are the SSDI guidelines, then that’s a pretty strong incentive NOT to take employment in a field where the government mandates a level of physical fitness, ain’t it?
Go work in a muffler shop and you never need to worry about mandated physicals and such. Just work until you fall down and hurt your back or have a heart attack.
As to scumbag lawyers…yep, we’ve all heard of or personally known Case Artists…but I’d posit that scumbag lawyers can only get purchase from unreasonable or unfair laws,(likely written by OTHER scumbag lawyers precisely for that purpose).
Your own history, if I’m following you correctly, rather makes the point. You were disabled from the time of your award until you turned 66, and then all of a sudden, you were “calendar cured” and can now work and make as much as you want…have I got that right?
That’s kind of retarded and unreasonable to make you “wear a paper hat and a plastic name tag” (part-time, to be sure),for however many years until your 66th birthday.
I’m assuming that you were a bona-fide working seaman with decades on the steel, and you obviously paid your 40 quarters into SS. And so effectively you got “punished” for actually working as a merchant mariner.
Like I said…if we had chosen a field WITHOUT the requirements to pass regularly scheduled physicals, we would never even face this problem, would we?
I wonder how pilots and train engineers and truckers manage this…they have to go to vet regularly also.
[quote=“Bilgeman, post:32, topic:48760”]
Your own history, if I’m following you correctly, rather makes the point. You were disabled from the time of your award until you turned 66, and then all of a sudden, you were “calendar cured” and can now work and make as much as you want…have I got that right?[/quote]
It’s not that I’m cured (I wish!) but that the SSDI system only operates to that age, after which you are transitioned to the regular Social Security system exactly as though you had retired at 66.
That’s kind of retarded and unreasonable to make you “wear a paper hat and a plastic name tag” (part-time, to be sure),for however many years until your 66th birthday.
Even for a paper hat and plastic name tag, you can only work for a total of nine months -->or parts of months<-- while receiving SSDI. I think there’s some special allowance for getting paid during participation in some of their retraining programs, but I’m not sure as it was not a possibility for me.
I’m assuming that you were a bona-fide working seaman with decades on the steel, and you obviously paid your 40 quarters into SS. And so effectively you got “punished” for actually working as a merchant mariner.
No, sorry – I’m a WAFI, or was between '69 and '05 or so when my condition deteriorated to where I couldn’t do it any more. The Navy trained me as a Corpsman and medical lab tech; and later on I worked in electronics and computers.
Thanks for a review of the acid-base balance. We use end-tidal capnography (in the ambulance) to monitor if a patient is experiencing hypercarbia. We do provide oxygen for our COPD patients only if they already use it, or if they are experiencing respiratory distress.
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Back in the early seventies when this little tidbit was big news, if you the doctor wanted to know O2 sat or other blood gases you’d call me in the lab half an hour ahead of time so I could warm up and calibrate the cranky, hateful blood gas machine. When I called back that it was on line and ok, you’d do an artery stick with a glass syringe (possibly rinsed with heparin first? – been a very long time), and bury it minus needle in cracked ice in a kidney basin, which is how it would come to me. The injection port on the machine had a Luer-lok fitting to take the syringe.
Also, the closest thing we had to an infusion pump was a “Harvard Pump” aka a 50 cc glass syringe mounted on top of a box with a variable-speed plunger shoving it home. It was rarely used. Normal gravity-based IVs were regulated by counting drops and checking against the level in the bottle (no bags then) every half hour or so.
And other than straight needles, the only things available for IVs were butterflies and a very rudimentary version of the Intracath – ours was a tapered (to accept the IV line) plastic cannula with a sharp obturator that you’d withdraw and discard before connecting the line.
Different times…
I’m pretty new to medicine. I’m just an EMT basic when not working offshore. I can see how things have changed and are always changing and evolving as more is known. That’s one of the things that got me interested.
Friend of mine is a retired medic who ran back in the day when they still used Cadillac ambulances. I’ll bet he’d love to chat with you.
Our Navy “Gray Elephants” were Pontiacs, with the high beam indicator (red in those days) in the form of an Indian chief.
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Have no first or second hand familiarity with the malady but use common sense; for the love of god, keep your mouth shut and try to manage it w/o triggering any red flags such as medical providers in states with electronic records sharing. Big brother is out of control, don’t hand him an excuse to ruin your career.
The Coast Guard is replacing NVIC 04-08 with a merchant mariner medical manual. A draft is available online and the Coast Guard is seeking public comment on the proposed document: https://www.federalregister.gov/documents/2018/11/13/2018-24502/draft-merchant-mariner-medical-manual
Here’s your chance. Best way to access is go to regulations.gov and search “USCG-2018-0041” That will bring you to the docket where you can submit comments. A link to the draft is under supporting documents in the docket.