Patent Foramen Ovale and Undeserved DCI

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pasley

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Scuba Instructor
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Location
Lakewood, CA
# of dives
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My physician has restricted my diving to 33 feet until I get a test to eliminate the possibility that I may have a Patent Foramen Ovale.

I had a stress test a year ago and did very well. Doctor said somthing about a level 13 or somthing. I can't afford the quoted $1,800 for the test (Stress Test followed by Echo of heart) on my own. Is there another test to confirm or deny this condition that may be lest costly?

My History:
I went diving with two buddiesfor my 12th lifetime dive, Certified June 3, 2001). We found the sand bottom in about 84 feet of water. So far so good, not 70 feet, but still ok.

19 Minute total dive time, max depth 110 ft. I did proceed rather rapidly to 80 feet to get more air time. From there I rode my DataMax computer hard all the way up. looking at it the entire time. I kept my assent rate in the green, and I made a deliberate effort to stop at 80, 60, 40, and 20 feet until the DataMax Pro computer indicated I was in the green to ascend to the next level. Yet I still got DCI.

The next day, I felt a vague, barely there discomfort in my ankle. By Friday, I was noticing a little more ache in my ankle. So I called DAN and they said they doubted it would be DCI too, but for me to contact the Decompression Chamber.

I was told to come back the next day for a second treatment. I, still did not believe I had DCI told them I did not think that was necessary and they said fine. No argument, I figure it could not have been important. I was also told no diving for 7 days.

7 days to the day later, still having a little discomfort, I went diving. Depth 40 feet, but spent most of the time at 20 on the first dive. Second dive two hours latter max depth of 20 feet with most of the dive at the 10-15 foot level.

Saturday when I drove to a town at 1,400 feet elevation. I noticed an increase in discomfort in my legs. I then drove straight to the hospital for an additional two treatments over two days. I had pins and needles in my feet (like a leg that has been asleep and is waking up) for two weeks following the treatments. I was diagnosed with level II DCI.
 
A standard echocardiogram (cost here about $600) should do it. Some cardiologist will inject some bubles into a vein and watch where they go if there is any question.

A dive medicine authority you may know and respect has written an article at http://www.scuba-doc.com/pfo.htm

HTH
 
Dammit! I sure wouldn't dive with some DCI indications. Not even after seven day's!! Definitely not after getting bent after one of my first dives.

One of my buddies got bent. Really worse! He had trouble speaking etc. After a normal dive and going into the mountains. It took him years to get rid of all the itches. He only dives shallow dives now.

My advise: respect the bends!

Jorgen
 
Having recently been diagnosed with a PFO I can give you certain opinions.
1-Until I had my contrast echocardiography I didn`t continue diving. There are some things more important than getting wet.
2- On recieving the results I then found out everything I could about the condition. Having a PFO doesn`t stop you from diving but you have to understand the added associated risks .
3- I have decided to have my PFO closed as I wish to continue diving in the future. I do not believe that prolonged future diving with this condition is , in my circumstances, responsible.
4- Now that I have had this condition found, in a way, I am at an advantage over most other divers. I know what my exact limits are - in the UK it is advised that you don`t go deeper than 15m (approx 50ft); never go into deco and dive very conservatively using the DCIEM tables.

Please if it is advised you have the check, then you owe it to yourself and those around you to do so. This is surely better than the other possible results if you don`t.

Cheers Martin.S
 
Becareful with your life man. There is nothing more important than protecting your life. Your friends and family need you. Diving is a fun and SAFE sport.(the best in my opinion) My suggestion would be to take the advise of your doc., and get a check-up.
(Just my .02 worth)
Scott
 
Dr Campbell's site indeed has good info regarding DCS and PFO.

It is difficult to be certain what your exact risk is.

Some episodes of DCS will occur within the No-Decompression-Limits whether by table or computer, and they will occur with or without a PFO.

A PFO increases the risk of DCS, but it's not a simple all-or-nothing risk factor.

The Rodale's Scuba Test Labs show the Oceanic as a somewhat liberal computer (allows more freedom, but therefore also somewhat more risk) This is not to malign the Oceanic.. I dive one myself. It does make sense to know and monitor your risks.

If you wished to dive without the test, you should consider yourself as probably at increased risk of repeated DCS, and should discuss your risks very carefully with a knowledgeable diving Doc. Some docs would endorse very conservative diving and some would recommend not diving.

If you get an echo study, it should be done with what is referred to as "bubble contrast" and many physicians feel should be done as a trans-esophageal echo study. DAN could direct you to physicians experienced in this study.

It is somewhat specialized and not every ultrasonographer or cardiologist is experienced at performing or interpreting the results, so pick someone with diving knowledge or expertise.

With that said, there are two possible outcomes of the study..
Either you have a PFO or you don't.

If you have a PFO and you get it fixed, that does NOT guarantee you will not have another episode. It probably improves your odds somewhat, but the degree of protection it provides is not a clear medical certainty.

If you have a PFO and don't get it fixed, and have had one episode of DCS, your risk of recurrent DCS is higher, but the degree of increased risk is unclear.
Some physicians would endorse diving with very conservative profiles and some would disqualify the diver.

If you don't have a PFO but have had a "undeserved" hit, many docs would still advise a very conservative profile in any future diving.

Be aware that there are other ways besides a PFO for bubbles to get over to the arterial side and cause neurologic DCS.

In a perfect world, the answers would be clear and simple. That is not the case with this particular issue, and there is no easy answer.

I might also recommend SCUBAMED.COM as a website with relevant info here.
Good luck.. and dive safe.

John
 
https://www.shearwater.com/products/peregrine/

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