Possible PFO- would you still get certified? with what precautions?

[SingingPixie]

I get migraines with auras a couple of times a year, and I've read that this could mean that it's likely that I have a PFO (apparently 20% of the population does). I know that this leaves me more prone to undeserved DCS hits. I'm also on a medication (being weaned off slowly, but could be on for a while) that has tingling/numbness in the extremities as a frequent side effect, which means that I would be less likely to notice that DCS symptom if I were to experience it. Given my situation, would you still get certified? Would you do it, but possibly avoid deep dives to decrease the chances of DCS? I was originally planning to go as far as Rescue, but with the AOW's "Deep Dive" requirement, that may be a bad idea. Any thoughts would be appreciated!

 

[Stoo]

I think I would be inclined to investigate the PFO prior to taking up diving. If it is present, then you might want to re-think your chosen hobby. Why put yourself at additional risk?

 

[ajduplessis]

I expect lots of action after this insert. Flamesuite on!!

Firstly have yourself check by cardiologist. The test for PFO is simple, but rather uncomfortable with the probe down your throat. I am no physician, but would not recommend scuba other than recreational (18m) with limited bottom times, and NO repetitive dives.

Why am I of this opinion........... As pointed out, roughly 20% of the population have PFO in various degrees, some with smaller, and others with larger openings. If this stat is true, then it is safe to say that around 20% of the scuba community might also have PFO's. Very few divers test for this, or even know about this "defect" of the heart and dive on a regular basis.

What I am trying to say is that there are divers, not even knowing they have PFO that complete thousands of RECREATIONAL dives per year without incident. I would definitely not participate in deep, repetitive or extremely long dives if diagnosed with PFO.

If you are still uncomfortable or unsure, HAVE YOURSELF TESTED!!!!!! I would also contact DAN around your medication.

These are my personal views with no medical background or expertises.

PS: PFO can be corrected.

 

[robint]

No, don't get certified right now. Get the PFO confirmed and the surgery. Several people here on SB have had the surgery and were diving again after 3 months. They all found out about their PFO the hard way, after getting DCS hits. You don't want to do that for many reasons.

There is a diver here on SB who is also a cardio doctor and he can give you more specific advice.

robin

 

[Crowley]

I agree with the above: a PFO is one of those things that may never be a problem - on the other hand, if it is a problem, it can be a BIG problem. I know one case where a person with a PFO got bent on a DSD - 6 metres of water, left catatonic and initially the prognosis was severe brain damage. Fortunately, the person made a full recovery.

If you suspect it might be a problem, see a cardiologist and get tested. For many divers it will never be a problem, but it only takes one bubble.

Cheers,

C.

 

[TSandM]

I believe the general recommendation regarding PFOs is that the link between PFO and DCS is too nebulous to recommend that people contemplating recreational diving certification be screened. In fact, there is no recommendation that people contemplating technical diving be screened, either, although some of us have gone ahead and done it anyway.

There is a relatively non-invasive and fairly accurate test for PFO, the transcranial Doppler. If that test is available in your area, and you are concerned, you should look into having it done. It is far less expensive than the transesophageal echocardiogram, and the only risk involved is the risk of an IV start. You may even be able to get your insurance to pay for it, if it is done as part of a workup for recurrent migraines. But you have to think about what you are going to do with the results.

As stated, the prevalence of PFO in the general population is fairly high, which implies it's likely that there are a lot of people out there diving successfully with an untreated PFO. Conservative profiles and careful ascents probably reduce the risk of symptoms significantly, but we also know people vary in how much they tend to bubble after diving. A very brief review of the literature on migraine and PFO closure suggests that you might get a significant improvement in your headache issues with closure, which might be something to swing the pendulum of decision one way or another.

I guess my bottom line would be that, if your migraines are frequent and severe, a PFO study might well be indicated for completely non-diving reasons. Closure might be warranted on that basis, and a successful closure would remove the issue of PFO as a risk factor for DCS.

 

[SingingPixie]

Thanks! I think part of my issue is that my migraines are really rare- maybe a couple a year, most of which I catch during the aura phase and if I take some excedrine and take it easy, don't progress into the full headache. I may get one full-blown one a year, so definitely not bad enough to see anyone about. That said, if I could find a sympathetic doctor I might be able to get him to do a migraine workup on paper, even if he knows my true reason for being interested in the results.

I'm not ready to pay for tests/procedures out of pocket, because I'm already scrimping and saving to pay for the certification process. If I had to pay out of pocket, I think I'd be better off getting the basic OW cert and staying content with that and conservative profiles, and then getting tested when budget allows if I decide I want to take deeper or more frequent dives.

 

[Kilili]

The prevalence of PFO is about 25 percent in the general population, slightly higher for those with migraines. That said, I would Imagine most PFO divers are absolutely clueless about it, and the fatality rate seems pretty low anyway. If you don't mind being in this group, just start your lessons. If you want to absolutely minimise risk potential, get tested, repaired, if needed.

I prefer to know where the risk areas are, and it was easy to find out, no PFO, and test procedure was non-invasive, nothing stuck down my throat. I have the migraines also.

 

[knotical]

Addressing the precautions side of the OPs question: One that comes to mind has to do with equalization techniques.

From: Patent Foramen Ovale

A Valsalva maneuver, used by most divers to equalize their ears during descents and ascents, can increase venous atrial pressure to the point that it forces blood containing bubbles across the PFO into the arterial circulation. Thus the usual filtering process of the lungs is by-passed.

Partly for this reason I suggest everyone practice passive methods of equalizing such as the jaw-thrust and/or the "church yawn".

 

[DaleC]

Our dive club just attended a lecture presented by Dr D Harrison, medical manager of the VGH Hyperbaric chamber and he had some interesting things to say about PFO's.

I hesitate to paraphrase for fear of misquoting but I can say he came down fairly firmly on the side of not seeking a surgical solution for them simply on dive related terms. The risk factors for DCS were much lower than the risk of serious complications arising from the closure surgery.

His suggestion was to evaluate your own tolerance for risk and if the relatively low rate of DCS for PFO's was acceptable then he suggested simply diving more conservative profiles.

He also had some interesting things to say about getting tested to confirm a PFO. He said a positive result does not neccisarily indicate that one will, in fact, be affected by DCS (your risk is higher than non PFO divers but still not that high) while a negative test result may either be:

a.) a false negative or
b.) provoke a individual to dive profiles more likely to induce DCS.

In fact I'm pretty sure he said he suspects that he himself has a PFO but decided not to be tested for it (he is a diver).

One of his suggestions was to simply dive conservative profiles whether one has a PFO or not. To do this he emphasized:

Not diving near or exceeding the NDL's
Not "riding" the computer to milk out extended bottom times
Doing SS's with an O2 rich mix
Pre/post dive breathing O2 rich mixes
Avoiding deep/extended repetitive dives
Taking the third day off on liveaboard/destination dive vacations

He also placed emphasis on the fact that many people take DCS hits within the NDL primarily because they ascend too fast or because they have overall poor fitness/health issues.

I think the gist of his talk, PFO or not, was that most DCS risk can be mitigated by diving conservative profiles and not ascending fast. tech diving was a different story though (that we did not pursue at the time).

I hope I got that right. If any errors were made it was probably because I exceeded deco on our dive just before the lecture and was bubbling while he was talking