Doc Wong's Tech One Reports

[DocWong]

Congrats on the provisional for T1, its definatley a ton of dedication and hard work that goes into it. As for the PFO testing, I went through the whole ordeal of researching it and trying to get answers on which test was the best, which to get, etc. After consulting with my Doc, who turned out to also be a diving Doc for the military, he sent me for the Echo Cardiogram. Basically they probed around the chest with an ultrasound probe, and could see pressure differences on the monitor to see if anything was passing through. Its supposedly the least reliable test, but since I've had no hits or other symptoms, and a diving Doc sent me for it, I'm pretty content.

Yes, from your description you got a TTE or Trans Thoracic Echocariogram. Since I plan on doing deeper dives in the future, I've decided to locate a good source to get a TCD done. Actually my clinic may be getting that capacity, we're looking into a new protocol to improve the brain function of stroke victims and using TCD to monitor blood flow improvement in the brain. What would it take to use that test to check for any shunting is something I'll have to look into.

 

[jjones9527]

I'm also planning heading to Tech 2 in the future. The Doc assured me that if he saw any sign of a PFO, he would refer me back for further testing. Fortunately cost is not an issue for either the Doc or myself, as its all covered by work for me, so I have to believe he has my best interest in mind. I made him fully aware of why I wanted the test done, and the type of diving I was heading for.

 

[rjack321]

If you do some medline searches you'll find that the TTE (trans thoracic echo) is not considered reliable for PFO detection. It only catches about 40-60% of PFOs. Somewhere around 50% of those found by the more advanced methods are missed.

TEE (trans esophageal echo) is the gold standard against which all other methods are compared.

TCD (trans cranial doppler) is about 95% accurate relative to TEE. It may detect pulmonary shunts which the other 2 methods cannot see.

The TTE has fairly low risk, ditto the TCD. The TEE has the highest risks of them damaging your throat etc. So IMO the best combination of accuracy and low proceedural risk is the TCD. It is a newer technology though. Not as many published studies of its accuracy, risks, etc.

Don't forget that a negative PFO result by any test does not mean that one does not exist, says little to nothing about other types of shunts (pulmonary) and also does not mean much of anything about your susceptibility to DCS in general. I think its wise to know if there's something obvious. But the lack of an obvious shunt is not very informative.

I am not an MD but the risks of repair and the question repair longevity seems fairly high relative to the benefits to me. TDS has lots of good discussion about PFO testing. "Saturation" is a sage and wise man, I would start searching his posts for more info.

 

[jjones9527]

Vlada on TDS also went through quite an ordeal with a false negative after taking a couple hits, only to find out she did have a PFO, and eventually got it repaired.

 

[rjack321]

Yeah I heard that story. I prefer mucho deco padding myself, its all diving afterall

 

[limeyx]

The TCD (Trans Cranial Doppler) will show if there is any shunt which can be PFO or pulmonary shunt which I believe is an advantage. It being non-invasive and cheap makes it my choice. If I can find a place to do it in the SF Bay Area for $300, I'll get it done next week just for good measure!

Where did you go to get it done? What specialty did it?

Did it in Seattle on Capitol hill. at the "Swedish" medical group ?
My insurance did not cover it, btu $300 is pretty reasonable for what seems like a pretty accurate test.

I have no idea where else they do it, but I happened to be in seattle so it was easy to just do it there.