Experience diving with PFO?

[eschler]

I am a PADI certified rescue diver with 125 dives. I live in Michigan; about half of my dives have been in cold water, some with profiles at 100' or more. The remainder of my dives have been in the Caribbean (Caymans, Bonaire, Playa, Coz, Roatan).

In March, I was on a dive trip in Roatan, scheduled for March 1-March 8. My first 6 dives on Mar 1 and Mar 2 were uneventful, but the dives on Mar 2 were cold. Everyone came up from the dives shivering and cold. Several of us stood under the hot shower on the dock--I let the hot water run into my wet suit.

All of my dives were within limits on my Suunto Cobra 2 computer. About 2 hours after my sixth dive on 3/2, I noted some migraine like symptoms (aura). I get migraines with an aura since the age of 23. Later, I developed superficial pain in the skin of my abdomen with development of some mottling (blue and red). I spent an uncomfortable night and did not sleep weil, but after breakfast on 3/3 I felt very well and decided to dive. The first dive on 3/3 was Mary's place, 88ft, 46 min. The second dive was difficult; we were dropped out of the boat over the blue and had to kick hard into a current for the reef. The entire dive was cold and strenuous. My computer readout indicates that I was in deco as I hit the line at the end of the dive (66 ft, 42 min). I made the usual 3 min safety stop and boarded the boat. I felt OK at that point.

Within one hour after getting out of the water, my abdominal symptoms returned with marked red and blue abdominal mottling (cutis mammarata) and the migraine type aura returned with slight dizziness. No other CNS symptoms were present. I discussed my problems with the instructor who trained me who was also on the trip and the concensus was that I was bent. I did Navy table six on 3/3 about 3 hours after coming out of the water and Navy table 5 on the following day. I was treated at the chamber facility at Anthony's Key, but Dr. Rafael Diaz; I feel that I received excellent treatment.

Subsequently, DAN paid the bill--the system works just as it is intended. I was impressed. Because of my history of migraine, I pursued testing for PFO. A TEE with bubble study disclosed that I have a 2 mm PFO with an associated atrial aneurysm.

It should be noted that I was diving in a group and that no one else got hit. Looking back on the 8 profiles, 2 were squirrelly (i.e. some ascent problems) but at no time was I locked out by the computer.

Consulting with DAN, they suggest that I dive more conservatively, but that I need not necessarily give up diving.

My plan is to dive Nitrox using an air profile and dial up the conservatism on my computer one setting.

Another option would be to have the PFO corrected. My insurance would not pay for this procedure (18K?) and there is a risk of significant complications, although my cardiologist let me know that complications in my case are less likely because my PFO is fairly small (2 mm).

My Question for the group:

Is anyone out there diving with a know PFO? What has been your experience?

For the record, I am 56 years old and in otherwise good health.

Thanks for any input.

Brad Eschler

 

[Dr Deco]

Hi Brad:

Conservative diving is a good plan. Strenuous dives promote blood flow and load tissues with dissolved nitrogen - later released as bubbles into the blood stream. You experienced such a problem.

Actually many divers are diving with a PFO - based on statistical evidence showing that about 20% of the population has this opening. What a surprise.:shocked2:

 

[Lopaka]

Do a search on PFO here. You'll find quite a bit of info, including a few of us that had enough trouble from one to get it fixed. Insurance did pay for mine getting plugged, probably because there was evidence of a small stroke, and both cardiologist and neurologist supported it.

I began suspecting a PFO years ago after getting what I suspected years later was inner ear DCS after dives no one else had problems with, and were within limits. Symptoms all cleared back then and an ENT thought it was probably just barotrauma.

I kept diving, though always watching the limits and later diving Nitrox on longer, warm water dives after doing my own research and reading about PFOs. Too damn cold to stay under long enough in SoCal to cause trouble, but in Hawaii it is easy to run out of bottom time. Over the next few years, I would occasionally get transient bouts of vertigo after diving, very brief, usually when hauling gear up stairs or similar. Kept thinking it was from difficulty clearing earlier, but knew the possible PFO could be at work.

Finally got hit again, vertigo and losing hearing on the right side. Same side I had problems with before. No one else had any problems. Went to an ENT first as I thought barotrauma again, but nothing conclusive. He did an MRI to look for tumor or other reason, and the scan showed small lesions. This time I went after it with a thorough series of checks, including the TEE, and got it fixed. Been almost six months since the fix and am waiting for clearance to dive again.

I suppose my message is maybe I could have dived more conservatively and avoided the (possibly bubble caused) stroke and hearing loss. No one can tell you just how conservatively you need to go. I would also try to be very relaxed and avoid any strain for a few hours after longer dives. Every time I had some symptom, it followed some sort of physical effort. Used to help the crew unload tanks and gear, never realized I was skating on thin ice doing so.

Good luck..............

 

[D_B]

I'm thinking that it would it be wise taking the precaution of getting a TEE done, after having unexplained symptoms several times after diving ?

Edit: Oops, I meant to say bubble study with a ECG

 

[Lopaka]

The TEE I had done was in prep for the Amplazter closure device procedure. It images a lot better than the less invasive echo cardiogram.

It was the less involved ECG with agitated saline solution injected that first showed the PFO. Just lie there with a few sensors stuck on you and they move the source around. IV is in waiting for the bubble solution. Have read that this test does not always show a PFO is there, where a TEE will. Doc Debersole or another cardio guy would have to elaborate on that. My PFO was very evident, with some bubbles migrating across with no straining at all. Told me to stop with the Valsalva almost immediately, guess it looked a bit spooky with the bubbles streaming over.

The ECG is a lot less involved and I think costs a lot less as a first step. Almost no prep compared to the TEE. I'd get hooked up with a good cardiologist to discuss this.