Continue or stop diving with a PFO?

[Angelo Farina]

I don't understand why fast tissues interact with the presence of a PFO... could you explain the mechanisms you have in mind?

Please note that I am NOT a medical doctor.
My idea is that the PFO allows bubbles to leave the small circle and enter the large circle, where they can cause embolism in various organs.
This happens when a lot of bubbles are released by "fast" tissues which are oversaturated and are off-gassing quickly.
This is typical of what happens in the very last seconds of an ascent close to NDL.
Instead in a long deco dive the critical over-saturated tissues are the slow ones. When they are offgassing, they release nitrogen very slowly, so there are not a lot of bubbles which can go through the PFO.
This hypothesis should be confirmed by performing ecodoppler analysis during the last few minutes before emerging ot just after climbing on the boat.

 

[boulderjohn]

This explains the issue nicely.

Patent foramen ovale and scuba diving: a practical guide for physicians on when to refer for screening - PMC

Divers are taught some basic physiology during their training. There is therefore some underlying knowledge and understandable concern in the diving community about the presence of a patent foramen ovale (PFO) as a cause of decompression illness ...

www.ncbi.nlm.nih.gov

 

[Imla]

Just to clarify the Norwegian/EU system.
A Norwegian/EU citizen has rights for healthcare in the other member countries should the need arise. However, for immediate care, there needs to be an immediate need... If there is no immediate need, you are either transported home to be treated in your home country, or you are released to travel home to start care. OPs PFO is obviously not an "emergency" and hence, medical tourism won't be worth it.
However... if he went diving in the EU (before he knew of the PFO obv.) and did get a hit, he would be entitled to emergency care with the same rights as the countrys own citizens. For eksample hyperbaric treatment and intensive care.
If you are a european citizen, you have the same rights for emergency care as our own inhabitants. If you are not, we will treat you, but we might also ask for an insurance when you are fit to answer...

 

[ginti]

This explains the issue nicely.

Patent foramen ovale and scuba diving: a practical guide for physicians on when to refer for screening - PMC

Divers are taught some basic physiology during their training. There is therefore some underlying knowledge and understandable concern in the diving community about the presence of a patent foramen ovale (PFO) as a cause of decompression illness ...

www.ncbi.nlm.nih.gov

Cool, I have just discovered that I am at increased risk of neurological DCI...

By the way, what are the "reverse profile" mentioned in figure 3? Are those multilevel dives where we go shallow first and then deep?

Also, I only had a quick look, but it seems that this paper addresses the PFO screening issue only within the rec domain. Doing tec, further conservatism is probably recommendable, isn't it? (e.g. preventive screening)

 

[boulderjohn]

By the way, what are the "reverse profile" mentioned in figure 3? Are those multilevel dives where we go shallow first and then deep?

Yes. It is explained in the full text.

 

[ginti]

Please note that I am NOT a medical doctor.
My idea is that the PFO allows bubbles to leave the small circle and enter the large circle, where they can cause embolism in various organs.
This happens when a lot of bubbles are released by "fast" tissues which are oversaturated and are off-gassing quickly.
This is typical of what happens in the very last seconds of an ascent close to NDL.
Instead in a long deco dive the critical over-saturated tissues are the slow ones. When they are offgassing, they release nitrogen very slowly, so there are not a lot of bubbles which can go through the PFO.
This hypothesis should be confirmed by performing ecodoppler analysis during the last few minutes before emerging ot just after climbing on the boat.

Thanks a lot. It would be nice to know what experts think about your explanation - if it's aligned with current scientific knowledge or not

@Duke Dive Medicine @Dr Simon Mitchell

 

[Johnoly]

and did get a hit, he would be entitled to emergency care

YES! Different doctors will give different diagnoses. There are many different levels of a "hit", and there are also many different levels of a "stroke". It's about finding the right doctor that you "like" his diagnosis level of injury. The OP doesn't want to keep looking for another doctor(s) who will describe it as an emergency.

 

[jadairiii]

Interesting dilemma. You go to the doctor due to a "bends" issue, diagnosis, PFO, but they wont fix it, just dont dive. On the other hand, you go to the doctor for a "check up" and they find you have a PFO which puts you at a higher risk of stroke.....but they wont fix that either even if it reduces you risk of stroke.

My point is, maybe you're asking the wrong question. Suppose you went to the doctor and said you had suffered a strange issue the other day when you woke up, slurred speech and your right side of your body felt "numb", but it cleared quickly..............TIA's are hard to diagnose and often dont show up. I'm no doctor and would never suggest insurance fraud to reduce your risk of stroke.......................

Transient ischemic attack (TIA) - Symptoms and causes

www.mayoclinic.org

 

[mcohen1021]

Joining the conversation a little bit late..

But I have a dumb question to ask - why why would the OP be getting skin bends so so often?

That should be enough concern to make him quit I would think

 

[rddvet]

Joining the conversation a little bit late..

But I have a dumb question to ask - why why would the OP be getting skin bends so so often?

That should be enough concern to make him quit I would think

There are multiple factors but I will give you my personal experience. Initially I had 1000 excuses as to why it's not the skin bends and it was something like keeping my drysuit too tight. Often skin bends aren't swollen and painful, they can just arise as lines that look similar to bruising. They really weren't that worrisome. Even when I had some visual disturbances, they weren't bad. No pain or discomfort. I would just get a mild aura like a migraine sufferer might get. I could still drive and do daily tasks. I was able to control my symptoms 90% of the time by adjusting my deco profile. For the past 5 years, I rarely got skin bends for most dives. It was always the piddly little dives, often with minimal or no deco, during which symptoms would occur. My ability to control my symptoms 90% was good enough for me. At the same time, in the back of my head I knew I had a pfo but my first cardiologist just couldn't diagnose it. It took some time to consider finding the right cardiologist. Skin bends are more of an annoyance than anything in most cases. My options were give up diving, or accept the risks. I chose to accept the risks. 99% of my dives are cave dives and my wife and I generally dive every other weekend. I didn't want to give that up, so I modified but kept diving. During the period between when I was finally diagnosed and had it closed I continued to dive, but wouldn't dive with anyone other than my wife. I felt officially knowing I had a pfo made me a bad buddy to people other than my wife. Totally a mental thing since I had dove with multiple people for over 5 years with no issue.