Continue or stop diving with a PFO?
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Satrekker
Contributor
I'm 56 and have recently discovered that I have a PFO. My most active, recent diving years were 2016-2021. I averaged 125+ dives/yr, all recreational, during this time period and never had any issues that I was aware of at the time; however, in hindsight I realize that I had been exhausted on several occasions after a day of 2 tank dives. As a relatively fit individual, I thought this was a bit odd but possibly just due to overactive swimming during a drift dive. Also, I have some tinnitus.
I had intended to have an echocardiogram with a bubble study performed to test for a PFO the last couple of years, since I was aware of potential medical issues diving if one were present, but after the birth of my son and the following societal disruptions due to the restrictions from the COVID-19 pandemic, the PFO testing got put on the backburner as my diving activities precipitously declined.
Earlier this year, March 31, 2023, I suffered a retinal arterial occlusion in my left eye (stroke) which was diagnosed by a retinal surgeon 6 days after the event. He recommended strongly that I go through a full stroke work up ASAP due to the increased risk of another event within 12 months of this event. I immediately contacted my cardiologist via phone and had his office schedule the recommended tests immediately rather than wait 5 weeks for an appointment in person.
I had a carotid ultrasound and an echocardiogram with a bubble study ordered amongst other tests - ekg, blood work, et al. The carotid ultrasound came back with very mild plaque buildup, and the echo with bubble study detected a PFO. My cardiologist followed this up with an order for a 30-day cardiac event monitor to check for arrythmia after the echo results came back positive for a PFO. I was told that a PFO closure has additional risks with the presence of arrythmia, so it was important to complete the 30-day monitoring process first before moving forward with treatment.
At this point, I was also informed about the PFO closure procedure and device - Amplatzer Talisman occluder and that I would need to find an interventional cardiologist to perform the PFO closure. He also suggested that I have a TEE - transesophageal echocardiogram; however, I decided to hold off on the TEE until I had decided on an interventional cardiologist for the procedure.
Dr. Ebersole of Watson Clinic in Lakeland, Florida is who I finally decided on to perform my PFO closure. Many people here on Scubaboard.com will recognize his name. He is a DAN medical advisor as well as an active CCR instructor and avid diver. He is highly qualifed, and people travel from all over the world in order to have him perform their PFO closure procedure. I consider myself fortunate that he practices less than 70 miles from my front door.
After contacting the Watson clinic, I was able to set up an appointment with Dr. Ebersole the following week. He reviewed all of my medical records and test results prior to our appointment, and after meeting with him in person, the decision to move forward as soon as my 30-day monitoring results came back negative for arrythmia became much easier. Dr. Ebersole took the time to personally go over the procedure as well as the device. Also, since he images the procedure while implanting the Amplatzer Talisman occluder device, it was not necessary to have a TEE performed prior to PFO closure. It was nice to hear I was able to eliminate an unnecessary, additional procedure.
My PFO closure was scheduled for June 22, 2023. I arrived at 6am at Lakeland Regional Health for check-in, and was shortly directed to the interventional catheterization area to prep for the procedure which was scheduled for 8:30 am. The procedure was performed while under sedation, NOT anasthesia. I was in a somewhat sleeping state during the procedure. There was no pain during the procedure and no disorientation or confusion post-procedure. A vein in each leg was utilized - one for the occluder device and one for the imaging device. The incisions were very small, and the procedure took about an hour. Post-procedure recovery was fairly easy. The only issue that I had was a tightening in my chest which I was concerned with initially; however, when I mentioned this to the nurses, they informed me that the sensation was due to the administration of a somewhat large (600mg?) initial dosage of Plavix - an anti-platelet medication, since I was not taking it prior to the procedure, on an empty stomach due to required fasting since 8pm the previous day.
After having a light salad at lunch, the sensation abated, and then I only had a 2pm ekg followed by additional monitoring until 4pm before I was cleared for discharged and prescribed 90 days of Plavix.
Upon discharge, I was able to walk, but was wheeled via wheelchair to my vehicle, after which, my wife drove us home. Dressings were removed about 30 hours later, and I was able to shower. Both legs were slightly tender near the groin area due to the incisions, and I was instructed to take it easy and not lift anything heavy. I did have and still have a less than quarter-sized nodule on my right groin near incision site. It was tender and something normal that should resolve in 4-8 weeks iirc.
I took things very carefully and limited my activity and walking for the first 2 days. I felt really good, and aside from limiting my walking and not wanting to overdo things, I was amazed that I had just had a heart procedure. Incisions were ridiculously small, and I mainly only had tenderness on near my right groin due to nodule. I am now 11 days post-procedure and feel really good. I have been given the clear to return to the gym in 3 more days - 2 weeks post-procedure, at which time I will begin slowly working my way back to full activity.
As far as follow up, in approximately 30 days post-procedure, I'll meet again with Dr. Ebersole, since I'm local, for a follow up, and then 2 months after that, I'll have another echocardiogram with a bubble study (90 days post-procedure) in order to confirm closure of the PFO. At that time, if all looks good, I will be off the Plavix and be cleared to dive. Yay!
The entire staff at Lakeland Regional Health whom I dealt with were outstanding. I couldn't have been more pleased with the people and the process which was a welcome, positive experience. Of course, Dr. Ebersol was outstanding, congenial, and very efficient. I would highly recommend anybody in need of a PFO closure to consider Dr. Ebersole and his staff, even if it's necessary to travel.
I had intended to have an echocardiogram with a bubble study performed to test for a PFO the last couple of years, since I was aware of potential medical issues diving if one were present, but after the birth of my son and the following societal disruptions due to the restrictions from the COVID-19 pandemic, the PFO testing got put on the backburner as my diving activities precipitously declined.
Earlier this year, March 31, 2023, I suffered a retinal arterial occlusion in my left eye (stroke) which was diagnosed by a retinal surgeon 6 days after the event. He recommended strongly that I go through a full stroke work up ASAP due to the increased risk of another event within 12 months of this event. I immediately contacted my cardiologist via phone and had his office schedule the recommended tests immediately rather than wait 5 weeks for an appointment in person.
I had a carotid ultrasound and an echocardiogram with a bubble study ordered amongst other tests - ekg, blood work, et al. The carotid ultrasound came back with very mild plaque buildup, and the echo with bubble study detected a PFO. My cardiologist followed this up with an order for a 30-day cardiac event monitor to check for arrythmia after the echo results came back positive for a PFO. I was told that a PFO closure has additional risks with the presence of arrythmia, so it was important to complete the 30-day monitoring process first before moving forward with treatment.
At this point, I was also informed about the PFO closure procedure and device - Amplatzer Talisman occluder and that I would need to find an interventional cardiologist to perform the PFO closure. He also suggested that I have a TEE - transesophageal echocardiogram; however, I decided to hold off on the TEE until I had decided on an interventional cardiologist for the procedure.
Dr. Ebersole of Watson Clinic in Lakeland, Florida is who I finally decided on to perform my PFO closure. Many people here on Scubaboard.com will recognize his name. He is a DAN medical advisor as well as an active CCR instructor and avid diver. He is highly qualifed, and people travel from all over the world in order to have him perform their PFO closure procedure. I consider myself fortunate that he practices less than 70 miles from my front door.
After contacting the Watson clinic, I was able to set up an appointment with Dr. Ebersole the following week. He reviewed all of my medical records and test results prior to our appointment, and after meeting with him in person, the decision to move forward as soon as my 30-day monitoring results came back negative for arrythmia became much easier. Dr. Ebersole took the time to personally go over the procedure as well as the device. Also, since he images the procedure while implanting the Amplatzer Talisman occluder device, it was not necessary to have a TEE performed prior to PFO closure. It was nice to hear I was able to eliminate an unnecessary, additional procedure.
My PFO closure was scheduled for June 22, 2023. I arrived at 6am at Lakeland Regional Health for check-in, and was shortly directed to the interventional catheterization area to prep for the procedure which was scheduled for 8:30 am. The procedure was performed while under sedation, NOT anasthesia. I was in a somewhat sleeping state during the procedure. There was no pain during the procedure and no disorientation or confusion post-procedure. A vein in each leg was utilized - one for the occluder device and one for the imaging device. The incisions were very small, and the procedure took about an hour. Post-procedure recovery was fairly easy. The only issue that I had was a tightening in my chest which I was concerned with initially; however, when I mentioned this to the nurses, they informed me that the sensation was due to the administration of a somewhat large (600mg?) initial dosage of Plavix - an anti-platelet medication, since I was not taking it prior to the procedure, on an empty stomach due to required fasting since 8pm the previous day.
After having a light salad at lunch, the sensation abated, and then I only had a 2pm ekg followed by additional monitoring until 4pm before I was cleared for discharged and prescribed 90 days of Plavix.
Upon discharge, I was able to walk, but was wheeled via wheelchair to my vehicle, after which, my wife drove us home. Dressings were removed about 30 hours later, and I was able to shower. Both legs were slightly tender near the groin area due to the incisions, and I was instructed to take it easy and not lift anything heavy. I did have and still have a less than quarter-sized nodule on my right groin near incision site. It was tender and something normal that should resolve in 4-8 weeks iirc.
I took things very carefully and limited my activity and walking for the first 2 days. I felt really good, and aside from limiting my walking and not wanting to overdo things, I was amazed that I had just had a heart procedure. Incisions were ridiculously small, and I mainly only had tenderness on near my right groin due to nodule. I am now 11 days post-procedure and feel really good. I have been given the clear to return to the gym in 3 more days - 2 weeks post-procedure, at which time I will begin slowly working my way back to full activity.
As far as follow up, in approximately 30 days post-procedure, I'll meet again with Dr. Ebersole, since I'm local, for a follow up, and then 2 months after that, I'll have another echocardiogram with a bubble study (90 days post-procedure) in order to confirm closure of the PFO. At that time, if all looks good, I will be off the Plavix and be cleared to dive. Yay!
The entire staff at Lakeland Regional Health whom I dealt with were outstanding. I couldn't have been more pleased with the people and the process which was a welcome, positive experience. Of course, Dr. Ebersol was outstanding, congenial, and very efficient. I would highly recommend anybody in need of a PFO closure to consider Dr. Ebersole and his staff, even if it's necessary to travel.
@Satrekker Good to hear. And glad you went with Dr Ebersole. I've posted my experience here previously. One thing I hadn't brought up since I hadn't seen anyone else say the same thing was the TEE. When I was first diagnosed my insurance didn't cover Dr Ebersole's hospital and I went to Gainesville to see a cardiologist who's done quite a few divers (but definitely not nearly as many as Dr Ebersole). That cardiologist was adamant he wouldn't perform the closure without a TEE. I was scheduled for one and my insurance was good to go, but the day before the admissions at the hospital called to say I'd need to pay $4500 for the TEE which made no sense based on what my insurer told me. It ended up being a blessing in disguise. I canceled the TEE and decided to push it off for a while because my wife was looking for a new job and I knew her government job would have awesome insurance. After a 5 month wait I was able to see Dr Ebersole because of my wife's insurance. He did not require a TEE which I appreciate because it meant one more day out of work. The rest of the story was great and everyone at the hospital was awesome. For once an insurance snafu worked in my favor.
The reason I said I hadn't previously said that Dr Ebersole didn't require a TEE is because I hadn't seen anyone else say that. Imo (I'm in a medical field as well) sometimes Drs get stuck behind their protocols. Most other cardiologists I know of doing divers' pfos absolutely require a TEE and its become part of their required protocol. I believe with Dr Ebersole he decides on a case by case basis whether its necessary or not. I respect that alot. He's not bound by ironclad protocols.
The reason I said I hadn't previously said that Dr Ebersole didn't require a TEE is because I hadn't seen anyone else say that. Imo (I'm in a medical field as well) sometimes Drs get stuck behind their protocols. Most other cardiologists I know of doing divers' pfos absolutely require a TEE and its become part of their required protocol. I believe with Dr Ebersole he decides on a case by case basis whether its necessary or not. I respect that alot. He's not bound by ironclad protocols.
Satrekker
Contributor
@rddvet I'm happy to hear things worked out for you. When the TEE was recommended to me by my cardiologist after the PFO diagnosis, I decided to not move forward with it mainly because he was not going to be the one performing the PFO closure. Call me a cynic, but I didn't see the need for him to order and perform another procedure prior to the interventional cardiologist determining whether or not it was even necessary.
The end result of my decision was the elimination of an unnecessary procedure and the accompanying unnecessary bill from a doctor who wouldn't even be performing the PFO closure. I'll just leave it at that.
Also, I'll add that my insurance is a HSA with a $10k deductible with Golden Rule, so I have to spend $10k before my insurance picks up a dime. IIRC, the total for Dr. Ebersole and Lakeland Regional Health was less than $7k in total.
The cost was less than some good rebreathers new, so while it's not an insignificant amount of money, it's not some $50k - $100k+ bill that other heart procedures cost, and it turned out to not be near the financial hurdle I expected it to be, and Dr. Ebersole made it feel like a relatively easy procedure. It sure feels that way afterwards. :-D
Thank you, guys, for the kind words. I'm just glad you are doing well. That is what is most important.
And from a page or so back, I would never disagree with Simon Mitchell. In my opinion, when it comes to decompression physiology he is the ultimate authority. (OK, maybe Neal Pollock is up there too).
And from a page or so back, I would never disagree with Simon Mitchell. In my opinion, when it comes to decompression physiology he is the ultimate authority. (OK, maybe Neal Pollock is up there too).
J-Vo
Contributor
Had mine done in June 14th. I'm amazed at how easy it was in me. I felt like I could have walked out or the OR. I was cleared for full activity 5 days after the procedure.
I did enjoy cracking jokes while watching the doctor rooting around in my heart on the screen.
I did enjoy cracking jokes while watching the doctor rooting around in my heart on the screen.
J-Vo
Contributor
@Dr. Doug Ebersole
Thanks for the consultations along the way. It really helped me navigate getting this done in my local area.
Thanks for the consultations along the way. It really helped me navigate getting this done in my local area.
Hi Dr. Ebersole, it's been a while. I hope everything is going well with you.Thank you, guys, for the kind words. I'm just glad you are doing well. That is what is most important.
And from a page or so back, I would never disagree with Simon Mitchell. In my opinion, when it comes to decompression physiology he is the ultimate authority. (OK, maybe Neal Pollock is up there too).
So, I couldn't help but chime in (my apologies)... what about David Doulette? ;-)
Yes, David Doulette is part of that group!!! Sorry, David. I meant no disrespect!
Macfod
Registered
I had done hundreds of dives and deep until over a few years I had a rash on my abdomen a few times and never thought of PFO..then one dive which was torrid I came out and had no appetite and blurred vision..rang DAN and off to hospital to have oxygen..short and tall is I got tested back in NZ and yes PFO. I dive still with no issues and with advise from DAN and a professor limit my diving…nitrox on air profile..20m max, no currents and longer surface interval..plus important no lugging gear onto boat after a dive and sit and rest once on boat…no issues for 6 years…BUT…last month stupidly my guide asked me to switch my computer so we could do a longer dive at 20m…I got a skin bend! PLAN THE DIVE AND STICK TO THE PLAN…lesson learnt
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