Asthmatic with a possible PFO

[porg]

Hey guys.

This is a real question from the heart (pardon the pun).

I am an asthmatic, i have been since i was a child. It is very well controlled, and i have my medical cert to dive and have completed 40 dives now.

Unfortunatley on one dive, my buddy got his SMB caught in his octopus and had a rapid ascent. I surfaced following a normal no warnings ascent to find him not there!:wacko:
I signalled the boat and by the time it had got there he had surfaced. He was put on 100% o2 and we headed back to base. on takeing off my drysuit (north sea diving, bloooody cold) i had a rash over my chest and back.
I was then put on 100% o2 and we were both taken to hospital to be checked out. The doctor had never seen a bent diver before and hadnt got a clue. I had to get a chest x-ray and full neuro obs done, but was told i was fine.

My question revolves around - i was told i might have damaged my lungs- a barotrauma from my asthma. Consequently the bubbles were able to get to my skin via a PFO in my heart. Is this treatable? And should i insist on being tested for the PFO? I have just spent £1500 on a twinset to go to 50m+.

Please, any input would be greatly appreciated.

porgie

 

[Drew Sailbum]

I won't get into the entire asthma issue except to say that it is a serious issue to be evaluated by you and your doctor. But I'd suggest that a PFO on top of asthma would be an even greater concern. You might be better off not diving if that is the case. Get yourself checked out.

That said, from your description I'm not clear if you experienced a skin bend or subcutaneous emphysema. A DCS hit which manifests in the skin may cause a rash, but I'm not sure how that would relate to asthma. However, asthma may result in air trapping within the lung resulting in a pulmonary barotrauma leading to subcutaneous emphysema.

Note: I'm no doctor, and have never played one on TV

 

[DocVikingo]

As your question is of a medical nature rather than directly concerning the scientific aspects of decompression, I have taken the liberty of moving it to the Diving Medicine forum. Dr. Deco will still see it.

Best regards.

DocVikingo

 

[MikeFerrara]

Maybe it was just a rash. Were you using argon for suit inflation? If so what grade? I have heard of argon containing traces of other gasses (I think carbon dioxide is the main concern) causing rashes.

A pfo is thought to potentially predispose you to decompression sickness. I have never heard it implicated in a lung overexpansion injury.

 

[porg]

Hey guys, thanks for the reply.

I wasnt using argon for my suit inflation, just bog standard air from my tank. I have been told it could have been a million other things appart from a bend, and i do like to consider them to be true - rash from washing powder in my undersuit, suit squeeze, even just a plain allergy to something pre-dive. However i do have asthma, which i do know makes me much more likley to damage my lungs (bronchospasam traps air in the lungs and pop!), but these bubbles can get to my skin and make me itch like i have fleas! ( i work in a vets now, but not then).

Thanks guys.

I am just waiting to hear back from the DDRC about if i should be tested for this.

Porgie:newbie:

 

[Dr Deco]

Dear porg:

A lot at once - - -

This question sounds more like an exam question where they throw in a bunch of stuff to see if you can figure out what is important and what is a “red herring.” I will believe that there will be many respondents to this query [or I will be the only one].

Asthma

This is an issue concerning clinical medicine, and, as such, I see that the thread has been moved. Unless you had breathing difficulties (exhaling) when ascending, I doubt that asthma would have played a role in this instance . Asthma and diving is a general topic to be discussed with a physician familiar with your case (as is always mentioned on these FORUMS. You do mention that you have this issue under control and have received a certification to dive.

Did the PFO cause the rash?

I do not know. Dr Peter Wilmshurst at the Department of Cardiology, Royal Shrewsbury Hospital in Shrewsbury (England) has reported his impression that skin rashes (cutis marmorata) are often indicators of the passage of gas bubbles through a PFO. The relationship is statistical; he has never observed this in real time.

Should I get checked for a PFO

The general recommendation by physicians and researchers who have made an analysis of the risk of DCS with and without a PFO are that the risk does not warrant the test. That is, the risk of DCS is very low in the first place and the presence of a PFO does not really seem to increase it much. This is the statistical answer .

On the basis of what I have observed in the laboratory and gleaned from publications, I would certainly avoid any Valsalva-like maneuvers following a dive. This includes such things as huffing and puffing as one climbs the ladder back into the boat. Coughing, breath-holding while straining and the like are all Valsalva-like procedures. These procedures can increase pressure in the heart and pulmonary artery and lead to arterialization – even when a PFO is absent (bubbles pass through pulmonary shunts).

Should I get a closure device surgically inserted?

When I last heard Dr Wilmshurst speak about this (at a NASA conference), he indicated that he might recommend this in some cases for professional divers. I do not believe that he would recommend this for the recreational diver.

Dr Deco :doctor: