skin bends in Coz.,,

[waldick]

Ok, i met with my cardio doctor and he told me that he would not recommend closure of the PFO, since i had no history of blood clots, family or otherwise. He also did not seem to think my problems in Coz were of a life threatening nature, which i did not understand as Dr. Piccolo was certainly concerned. My doctor here did not know anything about diving or nitrogen loading, etc....so i take that part of his asessment with a grain of salt...my doctor also did not think i would be able to find anyone willing to do the procedure since in his view it was not a medical necessity....

On the up side i did 13 dives over 6 days last November and had the symptoms from about the 2 dive and the sypmtoms never got any worse....of course i thought it was sunburn and bad food....and i ended up thinking i had a heart attack about a week after being home....

This trip i had the same symptoms after the second dive and i quit diving and still had the same symptoms when i got home....

in this liability crazy society my dive instructor refuses to let me do their nitrox course or actually dive with me...

and i have been dry-docked by our sheriff's department dive team...

i suppose i could go back down to Coz., get my nitrox cert. down there and come up with my own dive tables....

what does everyone think ????

 

[Web Monkey]

I think if you don't either get your PFO fixed or stop diving, you're going to kill yourself or end up permanently disabled.

I'd call DAN and see if you can get a consult with a cardiologist who handles divers and see what he/she says about the level of risk involved with the operation compared to the the risk involved with continuing to dive with a PFO.

Terry

Ok, i met with my cardio doctor and he told me that he would not recommend closure of the PFO, since i had no history of blood clots, family or otherwise. He also did not seem to think my problems in Coz were of a life threatening nature, which i did not understand as Dr. Piccolo was certainly concerned. My doctor here did not know anything about diving or nitrogen loading, etc....so i take that part of his asessment with a grain of salt...my doctor also did not think i would be able to find anyone willing to do the procedure since in his view it was not a medical necessity....

On the up side i did 13 dives over 6 days last November and had the symptoms from about the 2 dive and the sypmtoms never got any worse....of course i thought it was sunburn and bad food....and i ended up thinking i had a heart attack about a week after being home....

This trip i had the same symptoms after the second dive and i quit diving and still had the same symptoms when i got home....

in this liability crazy society my dive instructor refuses to let me do their nitrox course or actually dive with me...

and i have been dry-docked by our sheriff's department dive team...

i suppose i could go back down to Coz., get my nitrox cert. down there and come up with my own dive tables....

what does everyone think ????

 

[vladimir]

in this liability crazy society my dive instructor refuses to let me do their nitrox course or actually dive with me...

Maybe he's just sane and it has nothing to do with society?

 

[Rick Inman]

I'd call DAN and see if you can get a consult with a cardiologist who handles divers and see what he/she says about the level of risk involved with the operation compared to the the risk involved with continuing to dive with a PFO.

Terry

That is your best advice.

Be smart. Consult a DAN recommended cardiologist, then really listen to what he/she says.

 

[Saturation]

The ill advised George Irvine recommendation has a lot to do with this PFO craze. Being so, there may be great hesitation in taking such a patient for a course, or even allow you to dive if you fill up the health questionnaire honestly in most resorts.

The simplest approach to this problem is to get an official recommendation and sign-off from a diving med physician nearest you to advise both student and instructor of the next approach. A written report by the dive physician will ease the mind of the instructors or resorts when you fill up the health questionnaire. It also spreads the liability out, and eases the fear of the resorts and instructors.

A PFO patient can still dive once certain precautions are undertaken, and risks understood.

Generally, the theme of therapy is reduction of surfacing inert gas tensions to reduce post dive bubbling [ human studies] and reduction of nuclei generating activities [weaker data]. Besides reduction in bottom times and the use of nitrox, equally vital is improvement in general fitness and weight loss.

With this in mind, there are no immediate issues for dives up to 30' on air but always do safety stops for a full 5 minutes or longer on all dives and ascend no more than 10 fpm from 15' to 0'.

Ok, i met with my cardio doctor and he told me that he would not recommend closure of the PFO, since i had no history of blood clots, family or otherwise. He also did not seem to think my problems in Coz were of a life threatening nature, which i did not understand as Dr. Piccolo was certainly concerned. My doctor here did not know anything about diving or nitrogen loading, etc....so i take that part of his asessment with a grain of salt...my doctor also did not think i would be able to find anyone willing to do the procedure since in his view it was not a medical necessity....

On the up side i did 13 dives over 6 days last November and had the symptoms from about the 2 dive and the sypmtoms never got any worse....of course i thought it was sunburn and bad food....and i ended up thinking i had a heart attack about a week after being home....

This trip i had the same symptoms after the second dive and i quit diving and still had the same symptoms when i got home....

in this liability crazy society my dive instructor refuses to let me do their nitrox course or actually dive with me...

and i have been dry-docked by our sheriff's department dive team...

i suppose i could go back down to Coz., get my nitrox cert. down there and come up with my own dive tables....

what does everyone think ????

 

[Dr Deco]

Hello readers:

PFO?

A perplexing question is, why is the PFO a relatively innocuous entity for scuba divers? It would appear that an opening in the heart wall would allow venous to artery passage of decompression bubbles and result in many divers with neurological DCS.

The fact is this simply does not occur in the great majority of dives. For those interested, references on statistics are below. Thus, believing that you are doomed if you have a PFO is simply incorrect.

What to Do?

You can always help yourself in this regard.

- Naturally, limiting the venous side bubbles in the first place will help considerably. No bubbles equals no entities to do the embolizing. Low gas loadings, safety stops, and reduced exercise levels on the surface will help. Saturation just mentioned this.

- The passage through a PFO is assisted by raising the right atrial pressure over the left atrial. Valsalva-like maneuvers will accomplish his. Coughing and sneezing on the surface are actually more “effective” than a true Valsalva maneuver on the surface.

Dr Deco :doctor:


References :book3:


Germonpre P, Hastir F, Dendale P, Marroni A, Nguyen AF, Balestra C. Evidence for increasing patency of the foramen ovale in divers. Am J Cardiol. 2005 Apr 1;95(7):912-5.

Germonpre P. Patent foramen ovale and diving. Cardiol Clin. 2005 Feb;23(1):97-104. Review.

Cartoni D, De Castro S, Valente G, Costanzo C, Pelliccia A, Beni S, Di
Angelantonio E, Papetti F, Vitali Serdoz L, Fedele F. Identification of professional scuba divers with patent foramen ovale at riskfor decompression illness. Am J Cardiol. 2004 Jul 15;94(2):270-3.

Koch AE, Kampen J, Tetzlaff K, Reuter M, McCormack P, Schnoor PW, Struck N,
Heine L, Prytulla I, Rieckert H. Incidence of abnormal cerebral findings in the MRI of clinically healthydivers: role of a patent foramen ovale.Undersea Hyperb Med. 2004 Summer; 31(2):261-8.

Torti SR, Billinger M, Schwerzmann M, Vogel R, Zbinden R, Windecker S,
Seiler C. Risk of decompression illness among 230 divers in relation to the presence and
size of patent foramen ovale.Eur Heart J. 2004 Jun;25(12):1014-20.

Saary MJ, Gray GW. A review of the relationship between patent foramen ovale and type II decompression sickness.Aviat Space Environ Med. 2001 Dec;72(12):1113-20. Review.

Kerut EK, Norfleet WT, Plotnick GD, Giles TD. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol. 2001 Sep;38(3):613-23. Review.

Bove AA. Risk of decompression sickness with patent foramen ovale.
Undersea Hyperb Med. 1998 Fall;25(3):175-8.

Balestra C, Germonpre P, Marroni A. Intrathoracic pressure changes after Valsalva strain and other maneuvers: implications for divers with patent foramen ovale.
Undersea Hyperb Med. 1998 Fall;25(3):171-4.

Germonpre P, Dendale P, Unger P, Balestra C. Patent foramen ovale and decompression sickness in sports divers. J Appl Physiol. 1998 May;84( 5):1622-6.

 

[waldick]

Thanks for all the responses....i contacted DAN today...i'll keep everyone posted on the outcome, progress or lack thereof...

dry-docked in Ohio!

 

[riddler]

Coughing and sneezing on the surface are actually more “effective” than a true Valsalva maneuver on the surface.

This is forced coughing and sneezing on the surface at the end of the dive, correct? Or do you suggest at the start of the dive as well?

Also, a question about abdominal pain. We are taught that DCS comes in two flavors. The original poster looks like he is exhibiting signs of DCS type 1. Reviewing my manuals, I don't see any reference to abdominal pain for either type 1 or type 2 DCS, except maybe "pain in arms, legs or torso" for type 2.

Is abdominal pain common with DCS? If so, what exactly causes the abdominal pain? I mean, is it an issue of the blood vessels around the intenstinal track becoming blocked by gas bubbles? Or something else?

I am very interested in this, because I have IBS, and usually have ab pain when travelling. I can control it with diet at home, but have trouble finding appropriate food when overseas, so I frequently have mild ab pain when I dive. It's the same as the normal IBS pain I'm used to. And there are no other indications. My concern is that if it's possible to get ab pain from DCS without adjoining symptoms, then I might not be able to tell the difference.

 

[LavaSurfer]

Ok, i met with my cardio doctor and he told me that he would not recommend closure of the PFO, since i had no history of blood clots, family or otherwise. He also did not seem to think my problems in Coz were of a life threatening nature, which i did not understand as Dr. Piccolo was certainly concerned.

what does everyone think ????

Personally, if I got the skin bends every time I dove I would re-evaluate a lot of things.
Having a PFO does not guarantee you will get the bends but, per studies, it is a risk factor.




After a DAN cardiologist examination, I would look at your level of exertion after a dive. This has been mentioned but you should look at it. I don't have a PFO, thank god, but I do my safety stops and, if I have the air, I take a little longer than suggested and when I get to the surface I inflate my BC and just relax. Sometimes I relax for quite awhile. I am usually the last on the boat and if at all possible I take my gear off in the water and hand it up. Not only is this smart for off gassing, it gives me time to reflect on the dive and enjoy the surroundings that much more.

The reason every one is concerned is that right now the bends are showing up as Skin Bends DCS I but are there bubbles making their way to your bones, Brain or heart that are not causing major symptoms. Maybe the next time you take a serious neurological hit and you loose use of a leg, ear or eye, have a stroke, form a clot; Maybe worse.

Going to a DAN Cardiologist is your best bet and secondly, looking at your level of exertion is a good Idea.

Best wishes and be safe.

 

[waldick]

Hi Dr D.

hope all is well on the eve of the arrival of Rita ! i understand you had to evacuate...

i had a question about your response below....

are you saying that a"Valsalve Manuever" will help me keep the PFO shut, to avoid the left to right shunting ?

or will it aggravate the flow across ...?

if it helps to keep the shunt closed, then wouldn't it be a good idea to do it at the safety stop ? while the nitrogen bubbles are still smaller...

thank you for all your time and expertise...

juergen

Hello readers:

PFO?

A perplexing question is, why is the PFO a relatively innocuous entity for scuba divers? It would appear that an opening in the heart wall would allow venous to artery passage of decompression bubbles and result in many divers with neurological DCS.

The fact is this simply does not occur in the great majority of dives. For those interested, references on statistics are below. Thus, believing that you are doomed if you have a PFO is simply incorrect.

What to Do?

You can always help yourself in this regard.

- Naturally, limiting the venous side bubbles in the first place will help considerably. No bubbles equals no entities to do the embolizing. Low gas loadings, safety stops, and reduced exercise levels on the surface will help. Saturation just mentioned this.

- The passage through a PFO is assisted by raising the right atrial pressure over the left atrial. Valsalva-like maneuvers will accomplish his. Coughing and sneezing on the surface are actually more “effective” than a true Valsalva maneuver on the surface.

Dr Deco :doctor:


References :book3:


Germonpre P, Hastir F, Dendale P, Marroni A, Nguyen AF, Balestra C. Evidence for increasing patency of the foramen ovale in divers. Am J Cardiol. 2005 Apr 1;95(7):912-5.

Germonpre P. Patent foramen ovale and diving. Cardiol Clin. 2005 Feb;23(1):97-104. Review.

Cartoni D, De Castro S, Valente G, Costanzo C, Pelliccia A, Beni S, Di
Angelantonio E, Papetti F, Vitali Serdoz L, Fedele F. Identification of professional scuba divers with patent foramen ovale at riskfor decompression illness. Am J Cardiol. 2004 Jul 15;94(2):270-3.

Koch AE, Kampen J, Tetzlaff K, Reuter M, McCormack P, Schnoor PW, Struck N,
Heine L, Prytulla I, Rieckert H. Incidence of abnormal cerebral findings in the MRI of clinically healthydivers: role of a patent foramen ovale.Undersea Hyperb Med. 2004 Summer; 31(2):261-8.

Torti SR, Billinger M, Schwerzmann M, Vogel R, Zbinden R, Windecker S,
Seiler C. Risk of decompression illness among 230 divers in relation to the presence and
size of patent foramen ovale.Eur Heart J. 2004 Jun;25(12):1014-20.

Saary MJ, Gray GW. A review of the relationship between patent foramen ovale and type II decompression sickness.Aviat Space Environ Med. 2001 Dec;72(12):1113-20. Review.

Kerut EK, Norfleet WT, Plotnick GD, Giles TD. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol. 2001 Sep;38(3):613-23. Review.

Bove AA. Risk of decompression sickness with patent foramen ovale.
Undersea Hyperb Med. 1998 Fall;25(3):175-8.

Balestra C, Germonpre P, Marroni A. Intrathoracic pressure changes after Valsalva strain and other maneuvers: implications for divers with patent foramen ovale.
Undersea Hyperb Med. 1998 Fall;25(3):171-4.

Germonpre P, Dendale P, Unger P, Balestra C. Patent foramen ovale and decompression sickness in sports divers. J Appl Physiol. 1998 May;84( 5):1622-6.