Patent foramen ovale

[DocVikingo]

(nt)

 

[The Iceni]

Hi Arctic Diver,

It really is a matter of clinical judgement and risk:benefit analysis, I suppose. A stroke caused by the patient's new heart valve would not be such a good outcome.

Certainly in the case of metal heart valves long term anticoagulation is pretty well standard practice.

 

[ArcticDiver]

Boy, isn't that a fact!

As I said my main question had to do with the folow on lifestyle imposed by a PFO repair patch. From what you are saying it appears that, unlike some types of valve and stent surgery, once healing is complete there would be no dimunation of life quality.

So, then, the next question. Should, in your opinion, a TEE be elevated to the level of a routine test for all divers? If not, what about a specific age group? Only if certain symptoms?

 

[The Iceni]

So,should, in your opinion, a TEE be elevated to the level of a routine test for all divers? If not, what about a specific age group? Only if certain symptoms?

Hail Oh cold one!

Such atrial septal defects are mostly symptom free and do not have a major effect on an individual's physical fitness (Despite my PFO I was passed fit for RAF aircrew and I completed British Parachute Regiment selection twice, on the second occassion I was 32 years of age)

So I do feel that all diver recruits should be offered screening for a PFO, particulartly if they intend to do technical diving even thoiugh my little incident occurred on a short, shallow no stop dive.

However there are not enough cardiologists to do so many TEEs which is why I asked DocVikingo about the DAN trial of carotid doppler.

 

[ArcticDiver]

Thanks. While I certainly believe in prompt treatment once injured; it is best to do everything reasonable to prevent the injury in the first place. From this discussion it seems reasonable to have a TEE if available.

 

[DocVikingo]

Do be aware that a TEE is not inexpensive & that your HMO or other medical coverage will not pay for it unless it is clearly medically indicated.

Best regards.

DocVikingo

 

[ArcticDiver]

Yep, I'm familiar with the TEE. Also familiar with the insurance issue.

But even without insurance, in the scheme of things the cost of one is far less than the cost of the consequences if there is a problem. An imperfect analogy, but applicable I think, is the person who buys a small car for fuel cost savings and spends far more on the ER visit and treatment after the accident when they could have bought a bigger vehicle and in the long run both saved money and avoided pain and suffering. Here a person could spend money on the test and avoid all the larger cost of an injury that could have been avoided.

Plus, there are some symptoms that can indicate that PFO is a possibility, or so the specialists tell me. Screening then might very well be covered by insurance.

 

[DocVikingo]

"Plus, there are some symptoms that can indicate that PFO is a possibility, or so the specialists tell me. Screening then might very well be covered by insurance."


If as the result of complaints of symptoms or discovery of suggestive signs your physician recommends procedures for the detection of PFO, then such follow up may be considered "medically indicated" by your health plan. However, a diver without symptoms or signs of PFO who wants echocardiography would surely end up paying for it himself.

In the vast majority of PFO there are no symptoms under normal circumstances, nor is it likely that signs would inadvertently be discovered during medical examinations not specifically focussed on PFO.

Best regards.

DocVikingo

 

[ArcticDiver]

"Plus, there are some symptoms that can indicate that PFO is a possibility, or so the specialists tell me. Screening then might very well be covered by insurance."


If as the result of complaints of symptoms or discovery of suggestive signs your physician recommends procedures for the detection of PFO, then such follow up may be considered "medically indicated" by your health plan. However, a diver without symptoms or signs of PFO who wants echocardiography would surely end up paying for it himself.

In the vast majority of PFO there are no symptoms under normal circumstances, nor is it likely that signs would inadvertently be discovered during medical examinations not specifically focussed on PFO.

Best regards.

DocVikingo

This is different than prior posts in this thread how?

 

[DocVikingo]

Agreed it is a repetition in slightly altered words of things that I've said in prior posts, but its focus is different.

In it I'm addressing the matter of "medical necessity" & the notion that health coverage might somehow pay for diagnostic tests for PFO in an individual without any signs or symptoms of the disorder. It will not.

If dive training agencies or gov't regulations elevated such screening to the level of a routine test for all divers, HMOs/insurance plans still would not pay for it.

Even in the diver with unexplained Type II DCS, where PFO becomes a potential issue to be ruled out, almost no health coverage is going to pay for any cardiac work up in the absence of more compelling signs/symptoms.

Your statement, "Plus, there are some symptoms that can indicate that PFO is a possibility, or so the specialists tell me. Screening then might very well be covered by insurance" could be misleading. In the vast majority of those with PFO there are no symptoms. Ergo, no reimbursement.

I just wanted you & others following this thread to be aware of these facts & their implications regarding payment.

Best regards.

DocVikingo