PFO Decision

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Karen Cleveland

Contributor
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Location
Phoenix, AZ/wherever I happen to be working
# of dives
After reading the PFO diagnosis thread, I thought I would my post my experience.

3 weeks ago I had a PFO closed (Amplatzer device) at the Arizona Heart Hospital.

The decision to be tested was made about a year ago based on more frequent occurance of skin bends and what I called "the eye thing" after my deep dives. The eye thing is this http://www.eyeguys.net/ocularmigraineThe first time this occurred after diving was after a 260 ft dive about 6 or 7 years ago and then maybe once or twice a year on deep dives but over the last 2 years it was happening more frequently.....I am not going into the details of each one of these dives because it would make an already long post unbearable :)

Anyway, I finally decided after much research that I wanted to get tested for a PFO (I had already had a brain MRI years earlier trying to figure out the eye thing)...I opted for the easy echocariogram with color doppler study...none invasive, cost me $100 after insurance. The hard part was convincing the resident at my family medicine clinic to prescibe the test. So I had the test and 3 weeks later after they found the results (they had misplaced them) I had tested positive for a PFO (the report read: sm. left to right shunt probably there since birth; bubble study needed to determine if right to left exists).

Now the real decision needs to be made and a referral to a cardiologist...when asked about my options and that I possibly wanted to have it closed the response was "it's not our thing" and that is a direct quote. So now the research begins for a cardiologist.

I ended up at the AZ Heart Institute and they did another echo test and confirmed the PFO and also did a bubble study (no right to left shunt was seen on that) and they gave me the results right then and I made an appointment to talk to the Dr Robert Strumpf who does all the PFO closures....he happened to be on vacation and I knew he was who I wanted to speak with. All the techs that did my tests were facinated by the the whole deep diving thing and told me I should just get it closed because the procedure wasn't a big deal and Dr. Strumpf did them all the time for stroke patients.

So I talked with Dr Strumpf asked tons of questions and decided to have the procedure done and would try to schedule it in Oct 2006. Well, then they recalled a piece of equipment they use to implant the device and due to work projects on my part and the recall, the Dr and I both decided it would be best to wait until Jan.

I finally had the procedure done on Jan 19th at 3:30pm and walked out the next day at 10am. They implanted an Amplatzer device to close the hole by going into femoral vein or artery at the groin. The worst part of the whole thing was that I agreed to let the student nurses start my IV's....bad idea. And the other unpleasant part was after the procedure (I may have been awake but do not remember any of it) you have to lie flat for 6-8 hours to make sure you do not bleed out of the femoral vein or artery where they went through to implant the device. Oh, and the use the TEE to place the device or something because my throat hurt for 3 days... And I have to be on blood thinners (Plavix) for 6 months.

On my follow up apt. last week, I am cleared to do recreational diving on Mar 1, but no deep dives. I go back in April and we will talk about when I can do any deep dives then.

Will this fix, my skin bends....don't know, but the piece of mind that it is closed was worth it to me to get it fixed. Also the Dr said that having this closed may prevent a stroke later in my life and may cure any headaches...these are big MAYS.

I have not gotten a bill yet so I can't comment on what the cost of the whole thing is. I do know the closure device is around $3600 alone. But having to sit out on the over 200ft dives (a limit I set for myself after the PFO discovery)while everyone else was seeing cool stuff was driving me insane.... So far I am glad I had the procedure.

Karen
 
Thanks for posting.
I have more interest in PFO's since finding a diver I know may have one and also that they are more prevalent than I thought

Glad your OK and getting back in the swim of things :)
 
Karen,
Thank you very much for sharing your experience and insight.

-Ben
 
Karen, thanks for sharing. I know someone who stopped diving because of a PFO. It's a shame he didn't research it more.

Did insurance cover any of the procedure?

Maybe we'll see you out at the lake sometime in March.
 
Since this thread is here I thought I would share my experience. I have done about 50 dive all with the deepest being a little over 100 feet. Our dive profiles were conservative and never did any deco deco dives. I don't recall ever having problems after diving. In October of last year I had a TIA (mini stroke). I am 30 years old and in decent shape. I had a echocardiogram and they found a PFO. They did a MRI and there was no damage. Then had a TEE to get an up close look to decide if it should be fixed. From the TEE they determined the hole was fairly large and there was constant blood flow through it. In December, my cardiologist used the Cardioseal implant to repair the hole. According to him the hole was the size of a quarter. For those of you wondering about cost here it is.
Doctors (surgeons and anesthesia, etc) approx. $5000
Hospital (medicines, approx. 24 hour stay, cardioseal and other stuff) approx. $25,000

Cardioseal device was around $8000 and device used to insert was over $1000. (these were included in the 25,000)

Insurance has covered the doctors (other than my percentage) and they are still reviewing the hospital bill.

From what I was told the general rule is if you have had one TIA, then you go on blood thinners. If you have second TIA, then they do the repair. I was taking baby aspirin everyday when I had my first TIA and after the doctor saw how large the hole was they said it needed to be repaired now.

My wife and I have decided to quit diving for now. I know that I could dive now, but my wife had a blood clot in each lung last year after giving birth to our son. We have decided it is best just to quit for now, especially since we have a child now.
 
Great posts.

As far as insurance coverage, make sure and "explore" and consider your options how the case is presented to them in the physician's notes.

Sometimes wording makes a huge difference.

being more "proactive" about assigning symptoms vs a purely prophylactic closure?
 
Karen, thanks. There are quite a few divers out there with PFO's that wrestle with idea of having it fixed, hopefully you're experience can shed some much needed light on the situation.

Please keep us posted as time progresses.
 
I'm a cardiologist who does PFO closures as well as an avid recreation/technical/rebreather diver. As mentioned above, thanks for sharing your story. Most people don't realize that PFO is very common -- probably upwards of 25% of the general population. Therefore, probably about 25% of divers have one as well. Most divers with PFO never get DCS just like most individuals with PFO never have a stroke or TIA. The time to consider fixing one is when you've had a problem. The classic indication for closing a PFO is after an aspirin or coumadin failure from a recurrent stroke. That is because in the days before percutaneous closure the only other option was surgical closure. Given the risk of surgery it was felt best to treat the first stroke medically and reserve surgery for a recurrent event. Percutaneous closure has really changed the playing field. Usually, if an implanting cardiologist and a neurologist both recommend the procedure most insurance companies roll over and pay for it but it's always best to check. The implanting cardiologist's office will usually get pre-authorization for the procedure from the insurance company, but it's never a bad idea to check with them yourself as well.

Feel free to PM me with questions.

Doug
 
https://www.shearwater.com/products/swift/

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