[Question] UK Divers - Experiences with PFO testing and repair with NHS and private insurance

[LivR95]

Hi there,

I’m looking for some advice in terms of getting a PFO test (transoesophageal echocardiogram) after my recent diving trip to the Maldives and experience of decompression sickness.

I’m a diver from the UK! I was diving in Fuvahmulah (absolutely incredible diving!) last month and was on day three and my seventh dive when I surfaced (I did everything correctly in terms of deco stops etc) and started feeling tingling in my left hand.

It wasn’t severe but I mentioned it to my dive master who said I was probably just a bit dehydrated and was told to drink more water before my eighth dive. I went down again and on surfacing the tingling had move to both hands and travelled up to my elbows, with numbness too.

I alerted the dive shop and was taken to the local hospital where I was put on emergency oxygen for 18 hours. The tingling moved to my feet and I had cramping in my hands. I also had pain in my chest, and upper and lower back.

As I was in such a remote location, it took them three days to evacuate me by seaplane to another island for decompression chamber treatment. The tingling was still there but perhaps not as acute after my time in the hospital.

I ended up having 20 hours of treatment in the decompression chamber (5 hours on the first day, 5 hours on the second and then 2 hour bursts after that). I was discharged with some residual symptoms. I now have intermittent tingling but don’t really notice it.

Prior to the trip, I had done about 15 dives (so have now done 23 in total) and am qualified to advanced level. We were frequently doing deep dives (30m) each day, as well as diving at different depths. I was also diving with more experienced divers so felt more pressure to get down quickly, which was challenging as I often struggle to equalise.

I am also a red head and sensitive to the sun, so believe I was likely dehydrated when this happened.

My decompression doctor said I would be clear to dive again after three months as long as I saw a diving specialist, but recommended that I be checked for PFO using the above procedure. I have done a bit of reading on it and it sounds a bit of an unpleasant procedure, but a fairly good way to find out whether I have an open flap in my heart.

I asked for a referral to a cardiologist through my NHS GP, who initially referred me but he has heard back and the cardiology team has explicitly said that I would not qualify for a PFO check through the NHS, and that I would have to pay for this treatment privately.

Has anyone else been knocked back for a check through the NHS and successfully pushed back, or is it not worth me pursuing this route? Is there an affordable way of having this checked privately? And if I do have a PFO, would the costs of surgery be astronomical? I also have private health insurance through my boyfriend’s work – has anyone managed to claim for these checks through private work health insurance?

Thanks in advance for any advice you can give – and apologies for the long message! It has been quite a journey. I would love to be able to return to diving at some point in the future but feel I need some answers first on why this may have happened.

Thanks,

Liv

 

[Marie13]

While SB is international, we have a mostly North American membership. Highly recommend you check out UK forums/FB groups with your NHS question as they’ll probably have more information for you.

 

[LivR95]

While SB is international, we have a mostly North American membership. Highly recommend you check out UK forums/FB groups with your NHS question as they’ll probably have more information for you.

Thanks Marie - I'll do that

 

[-JD-]

I agree with @Marie13 , but if you want to catch the eyes of the UK crowd, maybe edit your title (you should be able to do this if you do it quickly) to better reflect your distilled question ... ex:

"[Question] UK Divers - Experiences with PFO testing and repair with NHS and private insurance"



There is also a UK specific sub-forum on SB: British Isles

I don't know if you'd necessarily get better visibility there as it is relaitvely low traffic, but some of your target audience may have a "watch" on it. If you want it moved, click the "Report" button (lower left of your initial post) and just ask the moderators to move it.

 

[JonG1]

Give me a shout if you like uk based pfo "survivor"

DM me and we can sort mobile nos

 

[Duke Dive Medicine]

Hi there,

I’m looking for some advice in terms of getting a PFO test (transoesophageal echocardiogram) after my recent diving trip to the Maldives and experience of decompression sickness.

I’m a diver from the UK! I was diving in Fuvahmulah (absolutely incredible diving!) last month and was on day three and my seventh dive when I surfaced (I did everything correctly in terms of deco stops etc) and started feeling tingling in my left hand.

It wasn’t severe but I mentioned it to my dive master who said I was probably just a bit dehydrated and was told to drink more water before my eighth dive. I went down again and on surfacing the tingling had move to both hands and travelled up to my elbows, with numbness too.

I alerted the dive shop and was taken to the local hospital where I was put on emergency oxygen for 18 hours. The tingling moved to my feet and I had cramping in my hands. I also had pain in my chest, and upper and lower back.

As I was in such a remote location, it took them three days to evacuate me by seaplane to another island for decompression chamber treatment. The tingling was still there but perhaps not as acute after my time in the hospital.

I ended up having 20 hours of treatment in the decompression chamber (5 hours on the first day, 5 hours on the second and then 2 hour bursts after that). I was discharged with some residual symptoms. I now have intermittent tingling but don’t really notice it.

Prior to the trip, I had done about 15 dives (so have now done 23 in total) and am qualified to advanced level. We were frequently doing deep dives (30m) each day, as well as diving at different depths. I was also diving with more experienced divers so felt more pressure to get down quickly, which was challenging as I often struggle to equalise.

I am also a red head and sensitive to the sun, so believe I was likely dehydrated when this happened.

My decompression doctor said I would be clear to dive again after three months as long as I saw a diving specialist, but recommended that I be checked for PFO using the above procedure. I have done a bit of reading on it and it sounds a bit of an unpleasant procedure, but a fairly good way to find out whether I have an open flap in my heart.

I asked for a referral to a cardiologist through my NHS GP, who initially referred me but he has heard back and the cardiology team has explicitly said that I would not qualify for a PFO check through the NHS, and that I would have to pay for this treatment privately.

Has anyone else been knocked back for a check through the NHS and successfully pushed back, or is it not worth me pursuing this route? Is there an affordable way of having this checked privately? And if I do have a PFO, would the costs of surgery be astronomical? I also have private health insurance through my boyfriend’s work – has anyone managed to claim for these checks through private work health insurance?

Thanks in advance for any advice you can give – and apologies for the long message! It has been quite a journey. I would love to be able to return to diving at some point in the future but feel I need some answers first on why this may have happened.

Thanks,

Liv

Liv,

This is an interesting case. In general, PFO is associated with sudden-onset severe neurological DCS (think paralysis or other stroke-like symptoms), inner ear DCS (vertigo, tinnitus and hearing loss), and a skin-marbling type rash, and you didn't mention any of those. You may want to consult with a diving physician in the UK before deciding on a PFO test. Below is a link to a map with contact information for UK-based diving referees:

Medical Referees - UKDMC

UKDMC,

www.ukdmc.org

Best regards,
DDM

 

[LivR95]

Liv,

This is an interesting case. In general, PFO is associated with sudden-onset severe neurological DCS (think paralysis or other stroke-like symptoms), inner ear DCS (vertigo, tinnitus and hearing loss), and a skin-marbling type rash, and you didn't mention any of those. You may want to consult with a diving physician in the UK before deciding on a PFO test. Below is a link to a map with contact information for UK-based diving referees:

Medical Referees - UKDMC

UKDMC,

www.ukdmc.org

Best regards,
DDM

Thanks so much for this information. So my deco doctor said that I had some marbling on my feet and legs but that this was unusual and it would usually present on my stomach. I don’t remember seeing any marbling there but he said the 18 hours on oxygen could’ve masked it? I also had some slight dizziness, but the main issue was the tingling and numbness.

 

[Duke Dive Medicine]

Thanks so much for this information. So my deco doctor said that I had some marbling on my feet and legs but that this was unusual and it would usually present on my stomach. I don’t remember seeing any marbling there but he said the 18 hours on oxygen could’ve masked it? I also had some slight dizziness, but the main issue was the tingling and numbness.

Of course! That's interesting, and yes, O2 can help some symptoms resolve, at least temporarily. I'm glad they decided to treat you in the chamber.

Best regards,
DDM

 

[Edward3c]

@LivR95 The UKDMC is the place to start, as mentioned above. Contact one of the diving medical referees for a clear diagnosis and a way forward.

 

[noserider]

There is a divers emergency centre at Whips Cross Hospital in NE london along with a help line, might be worth giving them a call

LHM Healthcare – Hyperbaric Oxygen Therapy Provider