Patent foramen ovale

[The Iceni]

Hi beche de mere,

It is now a year since I had my nasty incident I discussed on this thread which I believe was all because I have a PFO which I did not know about (not yet fixed).

I believe it is a certainty that there is a greatly increased risk of neurological DCI in those 30% of divers who do have a PFO.

In a nutshell I see it thus;

1) In the ascent phase of all dives bubbles form in the venous
tree

2) These are normally mopped up by the lungs so are asymptomatic

3) If the diver has a PFO AND the flow is reversed by a Valsalva-like manoeuvre, a shower of bubbles reaches the left atrium.

4) They then spread throughout the arterial tree and under the influence of gravity most rise to the highest part of the body - the brain.

5) If they can expand enough, on ascent they cause DCI.

Please note that what happened to me is VERY rare indeed and was just a combination of unfortunate circumstances.

However, if you suffer migraines after diving it might be wise to have it checked out.

Hope this very basic discussion helps. :doctor:

 

[beche de mer]

The Iceni once bubbled...


It is now a year since I had my nasty incident I discussed on this thread which I believe was all because I have a PFO which I did not know about (not yet fixed).

In a nutshell I see it thus;


:doctor:

Thanks for your reply Paul. That sounds like a nasty incident and you were lucky to survive. From reading the thread, I gather that it was a loss of consciousness on ascent followed by near drowning.

A couple of questions. After your loss of consciousness, you were on the bottom for 14 minutes. How come? Didn't your buddy see you go back down? Did you have a full face mask or did your reg just happen to stay in your mouth? What's the next thing you recall after your loss of consciousness?

A year down the line, what do you think happened? I presume you are thinking CAGE, related to the PFO. But is this likely to occur between 22 metres and 12 metres?

 

[The Iceni]

beche de mer once bubbled...
you were lucky to survive.

Don't I know it!

A year down the line, what do you think happened? I presume you are thinking CAGE, related to the PFO. But is this likely to occur between 22 metres and 12 metres?

I cannot really think of another reasonable explanantion. It was a very long thread I referenced but towards the end I discuss the possibilities and concluded exactly that.

The last thing I remember is performing the CBL and then waking up on ITU. I confidently believe my initial survival was due to;

1) Nitrox (marginally elevated reserves of oxygen)

2) Early ventilation with 100% oxygen given immediately by my rescue divers.

3) Hypothermia (my core temp was below 35 degrees on admission)

I don't want to make too much of this but if I am right and it can happen to me such a "shallow water blackout" can happen to anyone else with a PFO.

As you know the greatest pressure changes are close to the surface.

Kind regards,

 

[jknight]

I'm scheduled to have my PFO closed in about 3 weeks. Does anyone out there have any idea what I should expect in the form of side effects? I've heard mirgraines might be an issue. Is there anything to that?

 

[detroit diver]

I'm scheduled to have my PFO closed in about 3 weeks. Does anyone out there have any idea what I should expect in the form of side effects? I've heard mirgraines might be an issue. Is there anything to that?

Well, mine's on the 4 of March. Send me a Pm on the 5th or 6th and I'll let you know!!

 

[jknight]

Well, mine's on the 4 of March. Send me a Pm on the 5th or 6th and I'll let you know!!

Mines on the 4th too. Let's stay in touch.

 

[fins wake]

I don't want to make too much of this but if I am right and it can happen to me such a "shallow water blackout" can happen to anyone else with a PFO.

If this were universally true, we'd very likely see a lot more unexplained scuba diver incidents and fatalities, given the probable prevalence of PFO in the general scuba diving population.

I feel bad questioning Paul's assumption above as I know the issue has a very personal resonance for him, and I can understand the rationale behind wanting to know any and all possible causes of that particular incident. Yet, having followed the threads on this incident from the start, I think that the only firm conclusion possible is that there can be no firm conclusion as to the original cause of that incident ... (I know I sound like Sir Humphrey, sorry).

There might well be a correlation between increased risk - however small - of neurological DCS and the presence of a PFO, but the jury is still out, I believe. There certainly appears to be no major cause for alarm for the general diving population. There is ongoing research on this in Belgium at present.

Incidentally, I also agree with all others Paul's escape was miraculous, and I'm very grateful for it.

 

[detroit diver]

Mines on the 4th too. Let's stay in touch.

Good luck to you.

The 4th must be National Fix Your PFO day!

 

[detroit diver]

If this were universally true, we'd very likely see a lot more unexplained scuba diver incidents and fatalities, given the probable prevalence of PFO in the general scuba diving population.

I feel bad questioning Paul's assumption above as I know the issue has a very personal resonance for him, and I can understand the rationale behind wanting to know any and all possible causes of that particular incident. Yet, having followed the threads on this incident from the start, I think that the only firm conclusion possible is that there can be no firm conclusion as to the original cause of that incident ... (I know I sound like Sir Humphrey, sorry).

There might well be a correlation between increased risk - however small - of neurological DCS and the presence of a PFO, but the jury is still out, I believe. There certainly appears to be no major cause for alarm for the general diving population. There is ongoing research on this in Belgium at present.


Incidentally, I also agree with all others Paul's escape was miraculous, and I'm very grateful for it.

You have to wonder how many of the deaths attributed to "unknown causes" or "heart attacks" are actually PFO issues.

 

[The Iceni]

You have to wonder how many of the deaths attributed to "unknown causes" or "heart attacks" are actually PFO issues.

I have the greatest respect for fins awake but tend to agree with Detroit diver on this one.

It is difficult to be entirely dispassionate when one has nearly been been a statistic but I think it was Sherlock Holmes who said something like "If you exclude the impossible the answer can only be what is possible." (No doubt someone will correct me).

Now I do not believe in miracles. My intact survival was, I believe, entirely due to the fact that I was breathing Nitrox (so had a marginally elevated oxygen reserve), hypothermia and immediate effective BLS - I was ventilated with 100% oxygen on scene by an ex-army medic.

I was also very lucky indeed that there was a ITU bed available at the local hospital.

Now as to the cause. I discussed this with a recognised UK diving doctor expert who, like fins awake, completely dismissed AGE as the cause because
I did not suffer from pulmonary baraotrauma. (It is quite possible that I did and it was missed!)

Perhaps I should list the possible causes of the incident?

My buddy described me a losing consciousness and then I appeared to fit.

1) equipment failure - No
2) out of gas - No (the rescuers found me from my bubbles)
3) C02 retention - on OC?
4) CO or other gas poisoning - same set as on first dive so no
4) CNS oxygen toxicity - my ppO2 at 21M (EAN32) was 1 bar - possible I admit but is is as likely?
5) AGE - from PFO or PB is possible and would produce the effects witnessed.

Now. Does this mean I think every diver recruit should be screened and treated for a PFO? Not at all. I had been diving for over 30 years - on and off -without incident. The difference on this occassion was that it was the second of two shore dives and I had carrried very heavy kit on the cliff ascent immediately following the first dive. I provoked it!!!

The other clue is that I have a history of cluster migraines.

It will take a lot to convince me that I did not suffer from an AGE.

(As an aside DCI was not even considered in the differential diagnoses. If I am right I would have recovered much quicker if I had been recompressed.)