2 DCS hits and a PFO closure

[Anny Art]

Not that I'm jealous or out, but how comes with the type of diving you do you haven't had more hits?
I mean I don't do nowhere near as much deco and I still get hit even doing way and above what is required.
Maybe my closure wasn't as successful as I thought?

 

[uncfnp]

Pure speculation...

There has got to be some as yet undefined factor or factors that make some individuals more prone to bubble then others under identical dive conditions, raising their risk of DCS, with or without a PFO. Of course if these divers also have a PFO the risk will be even greater.

I started getting type 1 bends at dive 118. After several more episodes I used my resources and got a local cardiologist to do a bubble study. As noted previously it was positive. After consulation with several authorities I decided to dive very conservatively. I still rashed or had lymphedema at least once every dive trip except for Bonaire. Bonaire dives are repetitive, average of 4 per day, but about half the dive is at 20 to 30 feet making a very long safety stop.

So for Florida dives I started using 100% O2 at safety stops plus adding additional time at the stops. I would still rash or swell or both about once in 15 dives. And these are very benign dives. And honestly, breathing O2 after the symptoms start seems of little benefit. I can't tell you how fustrating this was. This is when I went back for a more formal cardiac evaluation and they wanted a TTE that was negative.

I am left with the suspicion that my bends are not PFO related at all but that I am definitely one of those divers that just seem prone to bubbles. But I also think these bubbles may not be vascular at all but a purely a soft tissue reaction at this point.

 

[kensuf]

KenSuf -- That is very odd in that a TEE is MUCH better at seeing the interatrial septum and much better at imaging the bubbles in the left atrium than a TTE. However, these flaps are dynamic and volume status, etc can cause them to be more likely to shunt on one day versus another I suppose. There is also a great deal of operator dependency. You really need to look for shunting at rest, with Valsalva, "sniffing", ...... before saying there is not a PFO present. That is not usually the case in a "standard" TEE for other diagnoses, but should be when looking for PFO in the setting of DCS.

@debersole The first TEE I ever had was done in '98. I was not having problems back then, and was a fairly active cave diver including a bunch of deep diving with the WKPP. I took a break from cave diving in '01 but when I came back to it a decade later, that's when I started getting bent with regular frequency.

In August '14 I had a TTE, which tested positive. My cardiologist then scheduled me for a follow-up TEE, and that tested negative. My surgeon, Arthur Lee up here in Gainesville, said he thought that the anesthetic I was under inhibited my ability to do a deep Valsalva during the TEE but he was willing to do a closure based on the TTE.

There are a lot of weird things for me. One is that although I had been bent three or four times in the 90s, that was not that uncommon among the crowd I was diving with, the deco schedules we were using, and for the dives we were doing, but when I came back a decade later I was getting hit with alarming frequency. I did spend six of those ten break years as a bike racer, riding up to 950 hours a year, and I can't help but wonder if that changed the nature of my PFO...

 

[Anny Art]

Anny Art, are you saying that you're getting "skin bends" from diving to a depth of 15 meters? Is the photo that you posted representative of that?

Best regards,
DDM

No that was from 2 dives to 20 meters in cold water keeping within Rdp limits doing all safety stops and some.

I have only come onto this forum for some more information, but Pfo seems to be the reason people get bent.
I just want to know of other reasons.
I have also been checked for lung shunt and this is negative thankfully.

Last ditch attempt to stay diving.

 

[Anny Art]

As previously stated by Dr. Ebersole and DDM, it's not the PFO causing the DCS. Hopefully I'm saying this right but it is due to the bubble load and especially for a decompression diver the off gassing is inefficient as the oxygen cannot oxygenate the blood in order to reduce the bubble load as it should. I think that's right. If your getting bent regularly at 15m I would first of all quit diving altogether until you can figure out what's going on. I'm no Hyperbaric Physician but I can confidently say that having DCS symptoms as many times as you've had and not seeking medical treatment that your causing severe and possibly irreparable damage to your body. Having DCS symptoms on a regular basis and just letting them wear off over a few days is not the way to handle it imo.

Just looking for answers to carry on diving.
I know of several people that have had twinges in what I call irrelevant body parts that is so minor like fingers that have had hyperbaric treatment. Why?
The body can put up with so much more and I know that I am pushing the limits. Hence why I am looking for answers on here.
Oh yes, thought so many times to give it up.

 

[Anny Art]

Pure speculation...

There has got to be some as yet undefined factor or factors that make some individuals more prone to bubble then others under identical dive conditions, raising their risk of DCS, with or without a PFO. Of course if these divers also have a PFO the risk will be even greater.

I started getting type 1 bends at dive 118. After several more episodes I used my resources and got a local cardiologist to do a bubble study. As noted previously it was positive. After consulation with several authorities I decided to dive very conservatively. I still rashed or had lymphedema at least once every dive trip except for Bonaire. Bonaire dives are repetitive, average of 4 per day, but about half the dive is at 20 to 30 feet making a very long safety stop.

So for Florida dives I started using 100% O2 at safety stops plus adding additional time at the stops. I would still rash or swell or both about once in 15 dives. And these are very benign dives. And honestly, breathing O2 after the symptoms start seems of little benefit. I can't tell you how fustrating this was. This is when I went back for a more formal cardiac evaluation and they wanted a TTE that was negative.

I am left with the suspicion that my bends are not PFO related at all but that I am definitely one of those divers that just seem prone to bubbles. But I also think these bubbles may not be vascular at all but a purely a soft tissue reaction at this point.

 

[kensuf]

Not that I'm jealous or out, but how comes with the type of diving you do you haven't had more hits?
I mean I don't do nowhere near as much deco and I still get hit even doing way and above what is required.
Maybe my closure wasn't as successful as I thought?

I'm sorry, but I don't have an answer for you. I'm not particularly conservative on deco (I run anywhere from an 85 to a 95 Hi GF), and at 210#, I'm not particularly lean (I carry a spare tire). I'm also going to be 48 in two weeks, so it's not like I'm young either.

I will say that I do regularly work-out and I do cardio between 3 and 5 times each week for at least 45 minutes a stint. My job also involves a lot of walking around campus to attend meetings, and I get in anywhere between 8000 and 15000 steps each day, M-F (that doesn't include my workout time).

 

[Anny Art]

Finally someone who seems to be in the same boat, although I don't think I'll be supping anything more than 80% on my stops.

Thank you.

 

[Duke Dive Medicine]

No that was from 2 dives to 20 meters in cold water keeping within Rdp limits doing all safety stops and some.

I have only come onto this forum for some more information, but Pfo seems to be the reason people get bent.
I just want to know of other reasons.
I have also been checked for lung shunt and this is negative thankfully.

Last ditch attempt to stay diving.

Have you been tested for cold-induced urticaria? We had a diver with that some years ago who had multiple incidents of post-dive rash, was tested for PFO (he had one) and told he couldn't dive any more. He came to us for a second opinion. One of our attending physicians placed a bag of ice on his abdomen and removed it after a few minutes, and a rash just like the one you posted appeared. We advised him to stay warmer and sent him back to diving.

Best regards,
DDM

 

[Duke Dive Medicine]

Pure speculation...

There has got to be some as yet undefined factor or factors that make some individuals more prone to bubble then others under identical dive conditions, raising their risk of DCS, with or without a PFO. Of course if these divers also have a PFO the risk will be even greater.

I started getting type 1 bends at dive 118. After several more episodes I used my resources and got a local cardiologist to do a bubble study. As noted previously it was positive. After consulation with several authorities I decided to dive very conservatively. I still rashed or had lymphedema at least once every dive trip except for Bonaire. Bonaire dives are repetitive, average of 4 per day, but about half the dive is at 20 to 30 feet making a very long safety stop.

So for Florida dives I started using 100% O2 at safety stops plus adding additional time at the stops. I would still rash or swell or both about once in 15 dives. And these are very benign dives. And honestly, breathing O2 after the symptoms start seems of little benefit. I can't tell you how fustrating this was. This is when I went back for a more formal cardiac evaluation and they wanted a TTE that was negative.

I am left with the suspicion that my bends are not PFO related at all but that I am definitely one of those divers that just seem prone to bubbles. But I also think these bubbles may not be vascular at all but a purely a soft tissue reaction at this point.

We had a chamber operator who was like this. He got skin bends practically every time he dove.

Best regards,
DDM