Continue or stop diving with a PFO?

[JonG1]

This is worth a read, there was also an article in Wet Notes that I'll try and find for you.

Everything You wanted To Know About PFOs and Decompression Illness, But Were Too Busy Decompressing to Ask

Though your chances of getting bent are relatively low, your risk increases five to 13-fold in the presence of a patent foramen ovale (PFO), which may enlarge and become problematic with age. Skin bends anyone? Here cardiologist and rebreather instructor Doug Ebersole explains the latest...

gue.com

 

[JonG1]

Ausgabe 29 (Oktober 2018)

Inhalt: Ausbildung: Toddy-Style 2.0, Tauchen managen Technik: Scaleo Infinity, Big Betty Physiologie: PFO – Neueste Erkenntnisse Wracks: Burdigala, Elida, Gunilda, Dutch Harbor, Geisternetze …

www.wetnotes.eu

 

[SixtyFeetUnder]

OP, it certainly sounds like medical tourism may be your best option given your country's medical insurance situation.

On a related note, I don't recall my basic open water training mentioning just how prevalent PFOs are in the population. This link (and we all know the internet is always 100% reliable, right?? ) says that 25% of the population have a PFO. If true, the engineer in me now wonders what percent of PFO-bearing divers never get bent--probably due to a combination of the size of the hole and the conservatism of their diving. RGBM suddenly isn't sounding so bad...

 

[rddvet]

I had my pfo closed about 6 months ago and am just getting back to diving. Best money spent on diving thus far. I’m still in the stage where I’m slowly punching my deco longer and longer in order to ensure I won’t get bent. Totally unnecessary but being cautious. The biggest thing I’ve noticed is through my entire 30 years of diving, I was always dead tired after a day of diving. Now I feel energized amd great after a dive. It’s amazing the little problems I didn’t notice before closure.
My surgeon sees patients from all over the world for pfo closures specifically for diving.

 

[JonG1]

I had mine closed too, wasn't diving at the time, it showed up because of diving, but I gave up with the diagnosis.

I got it fixed due to concerns about a stroke but was lucky to get it closed on NHS (UK). So glad I did I hadn't realised how important a part of my life diving was and now is.

I think it does make you cautious about deco though, I had a helicopter ride after my worst hit but was asymptomatic on arrival at the pot but wasn't recompressed.

 

[ginti]

Hi @Frogman82, keep in mind that different countries have different attitudes to health problems. I have experience with Italian, French and Belgian health systems because of a heart condition, and it took a while to find the right solution for me.

In my experience, if a patient has a specific problem, different European national health systems will:
(1) find the *same* problem consistently;
(2) evaluate the problem in the same way, reaching consistently the same conclusions;
(3) give systematically different recommendations and options to solve it.

Point (1) and (2) are just to say that we are lucky with our national health systems - they work well

But you should focus on point (3). @Angelo Farina already provided with a good option - Italy is way better than other countries in {A} prevention of and {B} solving *certain* issues. I know nothing about Norway, but I wouldn't be surprised to find that Italy is more developed in this regard.

I will try to add some other pieces.

First, contact DAN and explain to them your problem; they should be able to find the most appropriate physician.

Secondly, I'll mention another excellent option in Italy: Alberto Maria Lanzone, close to Milan, who is also a DAN doctor:

https://bianalisi.it/mappa-collaboratore/186

He has experience with any kind of divers (from recreational to deep-sea explorers). I personally tested the PFO with him, but I don't need to close it - so no direct experience about it, but many people recommended him.

Lastly, keep in mind that if you close your PFO abroad, you may have problems later on in obtaining medical clearance in your country because doctors might not be familiar with patients like you. It means that you may need in the future to go abroad for a paper signed by a doctor, even if just to go to the gym. So be sure that you discuss it with your family doctor before doing anything.

 

[doctormike]

The biggest thing I’ve noticed is through my entire 30 years of diving, I was always dead tired after a day of diving. Now I feel energized amd great after a dive. It’s amazing the little problems I didn’t notice before closure.
My surgeon sees patients from all over the world for pfo closures specifically for diving.

This is a very important point that shouldn't be lost. We think about being bent as being a binary thing - you either take a chamber ride or you are fine. But EVERY dive involves decompression stress, and while it's hard to quantitatively measure "being tired", I wouldn't be surprised if a small amount of bubbles in the arterial circulation (i.e. CNS perfusion) was enough to cause symptoms without being enough to cause a stroke.

Remember, the PFO does not do anything to change your decompression stress. That's dependent on depth, time, mix and ascent profile. And there is a bell curve for everything, so a given level of decompression stress will cause different people to get different symptoms. There are people who blew off significant deco and never had symptoms.

PFO closure doesn't change venous side bubble formation. All it does is prevents those bubbles from bypassing the pulmonary filter and reaching the arterial side, where they can cause AGE or possibly other subclinical symptoms. For example, one theory of inner ear decompression sickness is that it's an arterial side phenomenon due to small end arteries in the ear.

 

[J-Vo]

Similar story for me. A couple skin bends and a shoulder bend over the last few years. All on 200+ foot dives. No official diagnoses or chamber rides. Self treated with in water and surface O2. Lots of subclinical signs over 25 years of diving. Eco showes small PFO with shunting at rest, but after the TEE my doc refered to it as "significant". Both my doc and Dr. Doug think I should get it closed, but insurance has so far denied to cover it. My doc said he has never seen a denial, and he currently even has stroke patients that have been denied. General consensus is the insurance company is trying to make up for COVID losses.

I had always dove GF 50/80 until the shoulder bend After that I played around a lot and landed on 60/75, but soon got the first skin bend. Went down to 55/70 and it took two years and around 200 dives before I got the second skin bend. Then reduced it to 50/65 and started pursueing the PFO. I haven't had any issues since and only one instance of subclinical symptoms. It's probably been ~250 dives.

As I was expecting to get the PFO closed this last fall, I bit the bullet and bought a breather. That makes a big case for not giving up the sport in my mind. We'll continue to work on the insurance company, while I add some padding to that last deco stop. At this point I'm not sure I would relaxed my GF even after getting it fixed.

 

[J-Vo]

Also, since it has been mentioned, my DOC estimated $80k-$120k for the procedure without insurance coverage. He wasn't totally sure as most of the charges wouldn't come from his office. That's a bit out of my range of possibility.

 

[JonG1]

Yeah I've had a shoulder hit post closure, with relatively aggressive GFs, repetitive diving and a bit of swell.

But the diagnosis and closure give you confidence about the more troubling neurological hits out of nowhere.

In the back of my mind, probably literally, is the possibility that I acquired lesions through the diving pre- diagnosis, which keeps me focused on DCS stress minimization.

I am considering an O Dive to fine tune things in the New Year.