Possible PFO- would you still get certified? with what precautions?

[cram]

I think the gist of his talk, PFO or not, was that most DCS risk can be mitigated by diving conservative profiles and not ascending fast. tech diving was a different story though (that we did not pursue at the time).

I attended the same lecture presented by Dr. Harrison as DaleC this past weekend, and his summary fits with what I recall except on one point. (With the same disclaimer that any errors should be attributed to me, not to Dr. Harrison!)

As I recall it was not technical diving that was considered a "different story", but commercial diving. Even then I got the impression that he recommended the surgery only in cases where the employer/government required it for the diver to keep his job. The statistics he presented suggested that the risks of the surgery were simply that much higher than the risks of diving with a PFO.

The take-home message for me was that a PFO is one many factors that can increase an individual's susceptibility to DCS, and just like being a bit out of shape, or a bit older, can, in most cases, be dealt with by diving conservatively.

 

[Puffer Fish]

I'm somewhat surprised here.

I've not known a lot of divers that have died or been permanently crippled diving...4 to be exact.

One was someone that should not have been diving and the other three had PFO's.

I understand that there are different types of PFO.. different risks.... and different types of diving can raise or lower this.

I also understand that lots of people have PFO's, and many must be divers and have no issue.

I would also say the odds must be pretty low.... except I am not sure if some of the other diving deaths were not PFO's, and just not checked for.

However, I can think of no other similar condition where reasonable people would say... well, just go dive and find out.

How about having your arteries plugged say 70+%... would bet there are thousands of divers that don't know they have that, that are diving, so would anyone say that is just a risk, and tell them to go diving and see if they have an issue?

Perhaps they would.

 

[Dr. Doug Ebersole]

As an interventional cardiologist, I close PFOs for a living. I definitely would NOT be checked for a PFO just because you are thinking about getting certified. And I practice what I preach. I am a CCR trimix diver and routinely do decompression dives to 300 fsw. I have never been checked for a PFO. Now if I ever have recurrent "undeserved" DCS I'll probably get a TEE.

The reason for this is that the incidence of PFO in the general population (and probably in the diving population) is 25%. However, the incidence of DCS is probably around 2-5 episodes per 10,000 dives. It is felt that a PFO increases your risk of DCS by 2-5 fold. While this is a significant increase in the "relative" risk, the absolute risk is still very small -- maybe increasing to 1 in 1000. This risk is less than the 1-2% complication rate for PFO closure.

Now, for technical divers who want to continue technical diving and have had multiple episodes of "undeserved" DCS the risk-benefit MAY swing towards closing the PFO, but this is definitely not proven and is extremely controversial.

Petar Denoble of DAN and I are currently performing a research study following divers who have a PFO and have suffered DCS -- irregardless of whether the opted to have the defect closed or to have it left alone. WE welcome any interested divers out there!

Doug

 

[DaleC]

Thanks Dustin, you jogged my memory with the commercial diver part and that is correct (as I remember it).

Doug, that is along the lines of what Dr Harrison said. He said he would not check pre DCS incidence but might/would (not exactly sure) if someone took an undeserved hit and wanted to continue diving afterwards. He also indicated that PFO's were often associated with DCS hits but that, as stated, the incidence of DCS is so low that pre screening wouldn't statistically skew the results as much as common sense conservative diving would.

Dustin, feel free to correct me if I'm wrong on any of that; I really should have taken notes.

 

[Dr. Doug Ebersole]

Agreed. The best is advice is to stay hydrated, dive conservatively, and don't push your computer. If, despite that, you end up with MULTIPLE undeserved DCS events, THEN maybe worry about a PFO.

 

[D_B]

I think (for me) that one undeserved DCS event, one that can not be traced to me diving right at the edge of envelope .. would make me want to get tested, and if I have a PFO, to get it closed
.. I've seen what a possible consequence could be from having one and that's enough to prompt me to find out and fix it, or stop diving

 

[Dr. Doug Ebersole]

I understand your concern but that is not the standard of care at the moment. And the procedure does have complicatons -- not common, but definitely there. That having been said, I have closed them after one undeserved episode but after a long discussion with the patient.

 

[eschler]

I took a skin hit on March 3, 2009 while diving in Roatan. The rest of my group dove very similar profiles and no one else got hurt. The hit occurred on the day the I logged dives #123-125. I have dove in the great lakes, Bonne Terre mine, midwest quarries and the Carribean with profiles to 100' without a previous problem. I have had migraines with an aura for 35 years and I suspected that I had a PFO. I got the transesophageal echocardiogram done (TEE) and found that I have a PFO. My first impulse was to give up diving, but I consulted with a physician recommended by DAN, Dr. Rick Hodgson, at Spectrum Health in Grand Rapids, MI.

Dr. Hodgson pointed out that the incidence of DCS is low to begin with and that up to 30% of the population has a PFO. It is true that divers with PFO are over-represented in the population of divers who take a skin or type II hit. As an alternative to giving up diving Dr. Hodgson suggested that I dive more conservatively and gave me some suggestions. These are my personal guidelines for diving now that I know I have a PFO and have been bent:

1. Dive nitrox for all dives with my computer set for air plus one extra level of conservatism (Suunto Cobra II).
2. Despite using a computer set up as above, I essentially dive air tables; my computer is a backup.
3. My self-imposed depth limit for the first dive of the day is 60 feet.
4. For my second dive, I limit my depth to 40'
5. I pay very close attention to ascent rate.
6. I limit myself to 2 dives/day and when diving for a week (Sunday to Saturday) I take Wednesday off.
7. When in doubt about whether I can stay within my limits on a given dive, I don't dive.

Since resuming diving, I have made 14 dives using the guidelines above and have not encountered any additional difficulties. I intend to continue to dive, but more conservatively. I recognize that all diving carries risk. I accept that risk under these circumstances.

In retrospect, after examining my profiles from the 8 dives I made in Roatan over the three diving days culminating in my hit, my problems were exacerbated by rapid ascents on 2 dives, inadequate exposure protection and being cold, dehydration, and deep, square profiles that took me to the NDL on my computer (air). Also, I cannot say enough about the help and support that I got from the Fantasy Island Resort on Roatan and the Chamber facility. The resort was very gracious and helpful about arranging transport to facilitate my treatment. Also, DAN was very helpful to me, both during the incident, paying for needed treatment and in providing support and advice after the incident.

 

[LeadTurn_SD]

Excellent thread that needs a

Best wishes.

 

[dhkalb]

I expect lots of action after this insert. Flamesuite on!!

Firstly have yourself check by cardiologist. The test for PFO is simple, but rather uncomfortable with the probe down your throat. I am no physician, but would not recommend scuba other than recreational (18m) with limited bottom times, and NO repetitive dives.

Why am I of this opinion........... As pointed out, roughly 20% of the population have PFO in various degrees, some with smaller, and others with larger openings. If this stat is true, then it is safe to say that around 20% of the scuba community might also have PFO's. Very few divers test for this, or even know about this "defect" of the heart and dive on a regular basis.

What I am trying to say is that there are divers, not even knowing they have PFO that complete thousands of RECREATIONAL dives per year without incident. I would definitely not participate in deep, repetitive or extremely long dives if diagnosed with PFO.

If you are still uncomfortable or unsure, HAVE YOURSELF TESTED!!!!!! I would also contact DAN around your medication.

These are my personal views with no medical background or expertises.

PS: PFO can be corrected.

There are other doppler related examinations to recognize PFO. As noted above either a cardiologist or neurologist can provide the examination.