debersole

Hi Dr. Debersol - I have a question if you may. I thank you kindly in advance. Bottom line question is - is it possible that a TEE would NOT find a small PFO? Is it possible that a small PFO would open under a full breath at 20 feet, and that this pressure situation is not easily mimicked while a person is getting a TEE and could have been missed? And if so what arer the best next steps for testing or evaluation? Do you have a trusted colleague in Phoenix?

Now the background. I had DCS in February that required two trips to the chamber. My dive profile was 2 dives a day, 7 days in a row, max depth 45ft, average 25-30 feet. I was taking 40-90 minute surface intervals, and I was ascending very slowly with a lot of time (10-20 minutes) at 20-15 feet before surfacing. On the last dive I felt a sharp painful tweek in my chest in the heart area. I have felt this many times when taking a full breath at depths of 20 feet or more. I thought it it was my fascia stretching from the stretching posture of diving. My DCS involved my brain and I ended up with mild brain trauma like a head injury person. (All healed now!) My cardiologist heard the symptoms and believed it was a air embolism from a PFO causing a stroke and heart attack. He did the TEE and couldn't see a hole. At the end of the procedure he said that the next step was to send me in for a scope, but 2 weeks later he reevaluated and decided that it was a simple DCS. I am not sure. After 3 months I dove again, and at 15 feet on the safety stop I took a full breath (not huge, just the slow deep breath I was trained to take), and twange, the pain again. I can't create this pain on land or in the pool. I have often gotten mild DCS symptoms in the left shoulder area after diving, and didn't realize it until this big hit where I got to experience the pain full bore. So I am ultra suspicious, but not sure where to go next for further evaluation.