Continue or stop diving with a PFO?

[ginti]

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.

I would be really surprised of a price like this one in the EU

 

[tridacna]

I would be really surprised of a price like this one in the EU

True but OP is not in the EU.

 

[J-Vo]

I would be really surprised of a price like this one in the EU

List price in the US is based on a feedback loop of insurance underpaying and providers jacking up the price in attempt to get insurance to pay more.

 

[ginti]

True but OP is not in the EU.

He is in Norway, which has prices closer to the EU than US, and he has the possibility to travel to the EU (he may be obliged actually, depending on where he finds a good doctor)

List price in the US is based on a feedback loop of insurance underpaying and providers jacking up the price in attempt to get insurance to pay more.

Well, I know that the situation and the prices are quite different, even if I am not aware of the mechanisms behind; anyway, I just wanted to point out that for the OP it might be cheaper, that's it

 

[DiveProKoko]

The price of getting a PFO closed notwithstanding, I read a recent DAN article that stated 25% of the population has a PFO. So, I have to think there are options for ya. I have a friend who recently got bent and they discovered......a PFO! The doctor told him it's more common than you might think and basically treated him like any other DCS patient. I understand every patient is different, but that doctor is a diver.....Diving docs seem to look at these things through a clearer lens since they know the science of both general medicine and diving.

 

[SubseaSports]

Even IF you could get your PFO closed, this procedure is not without risk.
I am no expert but from the devices I know of, I am not sure I want that in my ticker (looks more like a double sided check valve that you would find on some of my gear).
I also believe there is more data needed to show real success rate. Maybe that has changed since I looked into it.
With your history, I would be very cautious either way. If you choose to continue to dive in your current state, maybe develop an over cautious off gassing stop on your rec dives (50%?). Dive nitrox using air data. There are options. There is also risk as you know.
It all boils down to how bad you want to dive.
Good luck and be well.

 

[rddvet]

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.

I definitely was never bad enough for a chamber ride (though Dan recommended it once). Much like the op I would get skin bends and visual aura. It’s very easy to convince yourself you’re not bent when the symptoms are mild. A few times I tried convincing myself my skin lesions were from my dry suit when I knew they weren’t. Your points are great ones. For me, I got bent typically doing non-deco ow dives and short, 10 minute or less deco cave dives. If I did a long 30+ minute of deco dive I rarely got bent. Likely because I was more aware and cautious of the risks and padded my deco obligation and slowed my final ascent from 20 ft to the surface.
My closure was done by Dr Ebersole. As Pete said earlier, he’s one of the leading cardiologists when it comes to diving and pfo closure. People from all over the world seek his treatment.
I won’t lie, when I looked at what my insurance was charged, it was insane. But with our messed up US medical/insurance system, someone from out of the country would have a much smaller bill than what my insurance paid.
The ridiculousness of our insurance system is insane.

 

[rddvet]

Even IF you could get your PFO closed, this procedure is not without risk.
I am no expert but from the devices I know of, I am not sure I want that in my ticker (looks more like a double sided check valve that you would find on some of my gear).
I also believe there is more data needed to show real success rate. Maybe that has changed since I looked into it.

For me the procedure was easy as pie. It was after that sucked. I had a severe allergic reaction the the Plavix you have to be on. I’d never had a medication reaction before. It sucks. Took me a month to 6 weeks to recover from it.
As far as success rate, there is a ton of quality data. You just need to find it and understand it or have someone in the know break it down for you(aka a highly skilled cardiologist who is extremely familiar with diving and pfo’s)

 

[Frogman82]

Really appreciate the replies from all of you. I think now, with the current status of covid and everything, going abroad to get it fixed isn’t really an option. At least not for me. Maybe I’ll look into it when things calm down a bit. In the meantime I think I have to carefully decide on what to do. Maybe I’ll be my own guinea pig and see how a very conservative approach to normal ndl diving would work out.

 

[uncfnp]

I have had skin bends in Florida, Cozumel and Grand Cayman (even diving “conservatively”) but in more than 300 dives there I have never had any problems in Bonaire. The difference? Shore dives where, for me, my average depth is less than 40 feet vs 50’s and 60’s. And prolonged time at end of dive at 30 feet or less. My surfacing GF is rarely more than 30 even after 3 to 4 dives a day and up to 10 days diving.

Of course this is just my experience.