Diving with Medical Condition PFO

[dhkalb]

I am open certified diver (advanced open wtaer) with a recent diagnosis of a PFO.

See medical desciption:

The foramen ovale is a small hole located in the atrial septum that is used during fetal circulation to speed up the travel of blood through the heart. When in the womb,a baby does not use it's own lungs for oxygen-rich blood, it relies on the mother to provide oxygen rich blood from the placenta through the umbilical cord to the fetus. Therefore, blood can travel from the veins to the right side of the baby's heart and cross to the left side of the heart through the foramen ovale and skip the trip to the baby's lungs.

My doctor say I should not dive - does anyone else have the same experience?

 

[knotical]

Discussion of PFO, including diving at:
DAN Divers Alert Network : Patent Foramen Ovale - Is It Important to Divers?

And here's a thread started by someone who might like to communicate with you.
http://www.scubaboard.com/forums/diving-medicine/314201-looking-divers-pfo-research-study.html

 

[Doubler]

It is fixable. See the "Other Board" and read Amazz's post on her PFO. There is hope. I wouldn't dive with it until I got it fixed as it makes you susceptible to DCS.

 

[Dr. Doug Ebersole]

Check out my multiple posts on this subject. I am an interventional cardiologist who closes PFOs as a part of my practice (including several people who are on this board). I'm also a CCR trimix instructor and cave diver.

In general, a PFO increases your risk of DCS by about 5 fold. While this sounds bad, the baseline risk of DCS is about 2 in 10, 000 so a 5 fold increase puts your risk up to 1 in 1000. The risk of the procedure is around 1% or so. In general, it doesn't make sense for someone who has never suffered DCS (and may never have an episode) to take a 1% complication risk to avoid something that may happen 1 in 1000 times.

As PFOs are present in 25% of the population, it makes sense to assume that about 25% of the divers out there also have one, but very few people get bent.

There is no reason to give up diving (or never start) because you have a PFO.

As mentioned above, I am coordinating a study of divers of divers with PFO who have suffered DCS. There is lots of PFO info on the DAN website. If you have specific questions about your case, PM me.

Doug

 

[pasley]

I am open certified diver (advanced open wtaer) with a recent diagnosis of a PFO.....My doctor say I should not dive - does anyone else have the same experience?

You have some expert advice here in the form of a doctor who specialises in PFO and of course the DAN website. I am not such an expert, just a diver The following is IMHO. Readers digest or translation of what you said about a PFO: blood from your body with all the disolved nitrogen and microbubbles or maybe bigger bubbles of nitogen in a person without a PFO goes to the heart, then to the lungs where the bubbles (particularly the larger ones) are filtered out then is returned to the heart and disbributed to the brain and the rest of the body. In a PFO the blood with the nitrogen bubbles enters the heart and then some of the blood (with bubbles perhaps) crosses over and then goes directly to the brain, and that is not a good thing. Depending on the serverity of the PFO you are in at a higher risk (Doc Debersol puts it at 5x) than divers without a PFO of having a very bad day that could be fatale.:shocked2: So you tell me, is diving worth it?

IMHO Follow your doctors advice stop diving for now and get it fixed then go back to diving.

 

[TSandM]

I think Dr. Ebersole has put it perfectly. You have perhaps a 1 in 1000 chance of a DCS event -- and that may well be able to be reduced by avoiding risky behaviors like pushing your NDLs or poor ascent practices. You have a 1% incidence of complications from closing the PFO -- that's ten times higher. We are virtually certain that many people dive for years with a PFO without incident (looking at the frequency of occurrence in the general population and extrapolating that to divers).

I would spend some extra time learning good buoyancy control before attempting any ambitious dives, and I would definitely monitor for any DCS symptoms. But in their absence, I don't think you either shouldn't dive, or should have a PFO closure.

Note that the advice from Dr. Ebersole is coming from someone who makes his living doing these sorts of procedures . . . if he says not to do it, he is definitely working from good medical judgment, and not personal gain.

 

[Dr. Doug Ebersole]

Thanks, Lynn. There is a lot of misunderstanding out there in terms of ABSOLUTE vs. RELATIVE risks of various conditions and procedures. PFO has become a very hot topic of late, and while it is very reasonable for some divers who have had DCS despite conservative dive practices to have PFO closure, most people should follow basic common sense dive practices and not worry about it. Like I've said before, I'm a trimix rebreather diver/instructor and cave diver. I do lots of decompression diving. I've never personally been checked for a PFO because I've not been bent. I try to practice what I preach.

The best we can do to try to get more information with research. If anyone knows a diver with a PFO who has sufferred DCS, please direct them to DAN: Divers Alert Network - Scuba Diving and Dive Safety Association to get information on the study we are doing. Thanks!

Doug

 

[5cmdiver]

Check out my multiple posts on this subject. I am an interventional cardiologist who closes PFOs as a part of my practice (including several people who are on this board). I'm also a CCR trimix instructor and cave diver.

In general, a PFO increases your risk of DCS by about 5 fold. While this sounds bad, the baseline risk of DCS is about 2 in 10, 000 so a 5 fold increase puts your risk up to 1 in 1000. The risk of the procedure is around 1% or so. In general, it doesn't make sense for someone who has never suffered DCS (and may never have an episode) to take a 1% complication risk to avoid something that may happen 1 in 1000 times.

As PFOs are present in 25% of the population, it makes sense to assume that about 25% of the divers out there also have one, but very few people get bent.

There is no reason to give up diving (or never start) because you have a PFO.

As mentioned above, I am coordinating a study of divers of divers with PFO who have suffered DCS. There is lots of PFO info on the DAN website. If you have specific questions about your case, PM me.

Doug

Hi Doug, I'm so desperate for some answers. Just saw this thread, hope it's not too late to write here. I hope you can help.

Quick background of myself
- Just been confirmed 3 weeks ago that I've a PFO, and during the bubble test, it shows it's open at rest as well. (awaiting to get a TOE done)
- 6 DCS logged within the last 1 year and a half (all DCS dives were within limits according to the dive computer, all on AIR)
- Last DCS was back in Oct 12, (worst one I recorded, with very bad chest pain, sharp lower abdominal pain, the usual deep purple rashes, shortness of breathe, weak, shoulder and back pain)
- never had any problems with NITROX dives

OK, my question is, before I go further and do the PFO closure, can I still go diving? I understand I'm at very high risk of getting ANOTHER DCS as it's been such a frequent thing to me, I dont even find it rare anymore. Sadly to say, it's rather normal to me, and I know the figures of DCS in recreational divers, I'm just one of those 0.xxx % diver who's DCS keep on coming. Ridiculously sad!

I am going back to the Red Sea for a week next week, been there few times, always using nitrox, never had any problems.

But back then, didn't know I have PFO, now, I'm just a worry rat! especially after the last DCS, I got scared finally. I know there's divers out there chose not to close their PFO, and still dive. I know the extra care I have to do if I do choose to dive, nitrox, longer and multi stops, shallower dives, shorter dives.. etc. Read all about it.

Have I missed anything out? and from your professional point of view, based on my frequent DCS episodes, will my body be at even higher risk of getting another DCS because of the past DCS episodes or they were all individual cases?! I know my body obviously doesn't take the nitrogen bubbles so well.

Would you also tell me not to dive until my PFO is closed? or can I be one of those divers with a PFO out there still can dive? But I don't know if they've that many DCS attacks like I had.

P.S I'm happy to provide you with any info for your research if you still looking for divers had DCS. I might probably be 1 of the interesting one who still survived after so many episodes. lol

 

[Dr. Doug Ebersole]

5cmdiver:

Thanks for your post. First of all, we would love to have you in our research trial. You can find the link at Scuba Diving Medical Safety Advice ? DAN | Divers Alert Network. If you can't find it, email Petar Denoble (pdenoble@dan.org) directly.

As far as your case goes, six cases of "unexpected" DCS cases in the past year is quite alarming. While we don't know if your PFO was the reason you suffered DCS, it is quite concerning and I personally would recommend closing it if you want to continue diving. Please know, however, that this is just my opinion. PFO closure for DCS is still controversial.

Yes, you can return to diving after PFO closure. Actually, that is why a large number of people elect to have it closed. They hope (expect) that having it closed will decrease their future risk of DCS events.

With six episodes of DCS within a year and a resting shunt on echo, I would recommend you not dive until you have the TEE and probably have it closed. Again, just my opinion and based only on what information you have given me above.

If you have any other questions, email me at dgebersole@gmail.com or call my cell (863--602-3410)

Doug

 

[uncfnp]

Check out my multiple posts on this subject. I am an interventional cardiologist who closes PFOs as a part of my practice (including several people who are on this board). I'm also a CCR trimix instructor and cave diver.

In general, a PFO increases your risk of DCS by about 5 fold. While this sounds bad, the baseline risk of DCS is about 2 in 10, 000 so a 5 fold increase puts your risk up to 1 in 1000. The risk of the procedure is around 1% or so. In general, it doesn't make sense for someone who has never suffered DCS (and may never have an episode) to take a 1% complication risk to avoid something that may happen 1 in 1000 times.

As PFOs are present in 25% of the population, it makes sense to assume that about 25% of the divers out there also have one, but very few people get bent.

There is no reason to give up diving (or never start) because you have a PFO.

As mentioned above, I am coordinating a study of divers of divers with PFO who have suffered DCS. There is lots of PFO info on the DAN website. If you have specific questions about your case, PM me.

Doug

Dr Ebersole, since this thread has resurfaced, I wonder if the 2+ years has made any changes in your recommendations to the OP. Thanks