Patent foramen ovale

[DrMike]

Some good info here guys - thanks.

From what Im seeing is it only type 2 DCS that results from a PFO?

If a diver gets an undeserved type 1 - could that indicate a possible PFO?

Thanks
Mike

 

[The Iceni]

. . . 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. . . .
In the vast majority of those with PFO there are no symptoms. Ergo, no reimbursement.

Best regards.

DocVikingo

Interesting how funding affects management, Dr Vikingo.

I must again repeat that my position holds considerable bias but, if I knew earlier what I know now, I would have happliy paid of the $1,000 or so for a TEE. On reflection, I might have been satisfied with the carotid doppler promoted by DAN, even though it is less sensitive.

TEE is far too expensive as a screening tool but as a PFO is so common and does increase the risks of DCI, it seems sensible for a screening programme - of some sort - to be available to those who can afford it.

 

[DocVikingo]

Based on my reading of the literature, I personally would not spend the money as long as I was free of signs, symptoms, unexplained DCS, etc.

However, I certainly can respect the diver who feels that screening for PFO is a prudent investment. As you know, some respected researchers do suggest the wisdom of such.

It very likely would have made a big difference in your life.

Glad to see that you are doing so well.

Best regards.

DocVikingo

 

[ArcticDiver]

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

While I would not encourage anyone or their physician to falsify a diagnosis code, there are often ways to code a treatment that results in insurance paying while another, equally valid code, would not. That is all part of the warfare the medical and insurance communities are routinely involved in.

That said, thanks for the warning. Certainly a person considering such a test should take a close look at the financial impact prior to having the test.

Even so, the cost of the TEE is less than a week aboard a Liveaboard and can save a great deal of trouble and cost. So, I think it is a wise expenditure, IF a diver is going to do more than plain vanilla dives.

 

[The Iceni]

If a diver gets an undeserved type 1 - could that indicate a possible PFO?

Mike

Hi Mike,

As you know there is no such animal as an "underserved" DCI hit. An incident may indeed be unexpected but there is usually an explanation, whether it is dehydration or simply statistical. (Every table has a measurable margin of error.)

I, for one, would suggest that it is only the more severe, rapid onset, deteriorating neurological DCI incidents that are likely to have arisen from the presence of a significant right to left shunt.

However, is this not like sudden cardiac death?

Your very first DCI may be your last.