A Small Pfo

[IndigoBlue]

In the basic open water scuba class that I began teaching last night, we first had our introductions, and then I moved on to the risk management video and waivers, followed by the medical questionnaires.

I listed the following Big Bad 5 Medical Conditions that we as NAUI instructors consider absolute contraindications to scuba certification:

1) Cerebral palsy

2) Epilepsy

3) Chronic heart disease or PFO

4) Asthma

5) Diabedes

When I finised the discussion of each of these medical conditions, and explained why it was not a good idea for anyone with any of these maladies to scuba dive, a 13 year old student and her mother in the class asked me if "a small PFO" was ok?

I gave her a medical form to take to her heart surgeon, for him to complete and sign whether he believes it is completely ok for the girl to engage in scuba diving.

I have never heard of a "small PFO." I have always been taught that ANY PFO is an absolute contraindication to scuba.

After I get the signed form back from the surgeon, if he approves, then I will need to make a call to D.A.N. myself, and possibly also to NAUI HQ.

Are there any physicians here on Scubaboard with an educated opinion about a "small PFO"???

 

[Saturation]

Very few disease are unconditionally 'safe', such as color blindness or acne, and the like. Most instructors I know, if they see any disease checked in those boxes, will ask for medical opinions.

All your items are not absolute contraindications to dive, they are relative contraindications that is, it depend on the severity of each type of diseases and whether they are active or not.

There are many kinds of cerebral palsy, seizure types beyond epilepsy, 'chronic heart disease', various sizes of PFOs, diabetes and asthma. Its best and easiest to just get a medical sign-off concerning these disease from a dive physician.

You may review each disease here in detail:

http://diversalertnetwork.org/medical/faq/index.asp

 

[miguel sanz]

About 30% of the general population have PFO and they don´t know. Ecocardiography is not required before diving so I don´t think it´s contraindication (even if transthoracic ecocardiography would be performed in every diver, many PFO would not be diagnosed). In the other hand, divers with PFO seem to be at increased risk for type II DCS

 

[miguel sanz]

[Patent foramen ovale: an underrated risk for divers?]
Dtsch Med Wochenschr; 2004 Jan 2; 129(1-2); Lier H, Schroeder S, Hering R; p. 27-30


Abstract (Article Summary)
The foramen ovale which is the fetal connection between the right and left atrium persists in about 30 % of the adult population. In the presence of a persistent foramen ovale (PFO) shunting of blood may occur from the right to the left atrium, and bubbles can reach the systemic circulation during or after the decompression phase of a dive with compressed air. Therefore, divers with PFO may have an increased risk to develop ischemic cerebral lesions and neurologic decompression sickness (DCS). Significant right-to-left shunting may be diagnosed using transcranial doppler ultrasound of the medial cerebral artery and echocardiography with echo contrast media and Valsalva provocation. However, there are no official guidelines concerning PFO screening in medical fitness exams for professional or recreational divers in Germany. Therefore, it remains in the diver's choice to be screened for PFO. Divers with a history of DCS should be monitored for PFO, especially when diving strictly adhered to decompression tables. Divers with PFO who refuse to stop diving after DCS should be advised to adhere to very save dive profiles.

 

[Capt Jim Wyatt]

Many divers dive safely with diabetes also. Type II diabetics very often control blood sugar with diet & exercise only. Diabetic divers who are able to maintain their blood sugar with meds or exercise or a combination of both are fine.

Again as stated above the divers' physician is the best person to ask.

 

[Scubakevdm]

[Patent foramen ovale: an underrated risk for divers?]
Dtsch Med Wochenschr; 2004 Jan 2; 129(1-2); Lier H, Schroeder S, Hering R; p. 27-30


Abstract (Article Summary)
The foramen ovale which is the fetal connection between the right and left atrium persists in about 30 % of the adult population... Divers with PFO who refuse to stop diving after DCS should be advised to adhere to very save dive profiles.

Uwatec markets their "micro-bubble suppression" feature, which causes additional ascent stops at various depths to be dislayed, as being a good idea for PFO.

 

[IndigoBlue]

Thanks to everyone! I appreciate your feedback.

 

[dripdrypoet]

Many divers dive safely with diabetes also. Type II diabetics very often control blood sugar with diet & exercise only. Diabetic divers who are able to maintain their blood sugar with meds or exercise or a combination of both are fine.

Again as stated above the divers' physician is the best person to ask.

I have been diving with Type II for 15 years now, with my physicians whole-hearted support. I constantly run into people who say I am not fit to dive, or some other tripe, simply because of the condition. The only restriction my MD has put on me is I am limited to 300 feet, without his further testing, etc. I surely do wish folks would wake up and realize that anything comes in many different flavors.

Thanks, Capt. Jim for the open mind.

 

[gtxl1200]

I also have type II diabetes and my dr. is a diver. she gave me full permission to dive. I take meds and diet to control mine. I have never had a problem diving with it. I also keep control of mine and check my glucose often. Diving with diabetes might be a problem for someone who doesnt take care of themselves or keep there condition under control.

 

[Greg_Manko]

I think a small PFO would be OK, as blood has to flow between the ventricles through the PFO to do harm (by bypassing the lungs which filter out most of the small bubbles). A small PFO would not allow any(?) blood to flow - there is a hole, but the muscle tissue will keep it pretty much keep it closed. This is why people don't know they have a small PFO - it is asymptomatic.
The students doctor would be the best person to make the decision.