Hi all, thanks for the many responses. And sorry for the delayed response, I'm in the process of relocating out of the Cayman Islands, so last days have been a bit busy.
I'm in a very similar condition. I have had one serious case of skin & pulmonary bends that required 2 chamber rides. Since then I have definitely had a few minor cases of skin bends that have been treated with O2 and rest.
You and I have a common friend who you should definitely speak to. Doug Ebersole spoke at InnerSpace about PFO and technical diving. He gave us some great advice to consider. Some of what he recommended:
Adjust your gradient factors to a more conservative profile.
Extend your decompression stops.
Spend extra time after your last stop and allow your body to continue to off-gas.
Consider changing your diving habits.
Doug & I have talked at length about my specific issues. In addition to the extra time off-gassing at depth, consider staying on the loop even after you surface for a while. Keep O2 handy and don't hesitate to use it if needed. None of these are as a substitute for proper treatment, but the sooner you're on O2 if you think you're bent, the better change for recovery you'll have.
Anthony, first of all sorry to hear of your DCS episodes. Being through the same it really knocks your confidence quite a bit.
I'm doing exactly that. My GF is set to a conservative 40/70 and looking at setting the GF low higher. I'm doing a 6 min safety stop after any deeper/longer dives. If on CCR, or even OC recreational Nitrox, I take 5 min on the surface after the dive to breath down some higher O2 gas available to me.
I have not done any decompression diving since my last bend.
As
@Dr. Doug Ebersole already mentioned, Doug has been extremely helpful and kind in discussing my case.
And sorry to have not been able to meet you at Innerspace this year, I was on Grand helping in running the shop there.
Hello Menno,
In respect to your TTE, are you SURE this was done with bubble contrast AND provocative maneuvers like valsalva and sniffing at the point of maximum opacification of the right heart?
Thanks,
Simon M
Hi
@Dr Simon Mitchell thanks for your comments. I was asked the question about the valsava, and I really can not recall if it was done yes or no during the procedure. There was a lot going on of course during the test, and I just can't recall. I assume so, they have had more divers in so should be experienced. They showed me the film of a diver with PFO they have had and I could clearly see the bubbles coming through.
I have the bubble study report attached to this post. I also have the video images, but it requires to install some proprietary GE Healthcare software to be installed, which in turn requires a (almost antique) Windows 7 computer that I haven't found yet.
Anthony -- I've spoken with Menno about his episodes and reviewed his dive profiles
Simon -- I agree. A transthoracic echo with "bubbles" AND with provocative maneuvers are needed to look for PFO.
Menno -- If a good quality transthoracic echo study is truly NORMAL, it is unlikely that you are missing a significant PFO that would be picked up on TEE. However, if the images are of poor quality, a TEE with bubble study and provocative maneuvers would be the next step. If bubbles are seen "late" on the left side of the heart (defined as later than 3-5 heart beats), you would need to consider an intrapulmonary shunt from a pulmonary AVM (arteriovenous malformation). These can be confirmed on a CT angiogram of the chest and are often able to be closed percutaneously (non-surgically) by an interventional radiologist.
Just my 2 cents.
Douglas Ebersole, MD
Interventional Cardiology, Watson Clinic LLP
Director, Structural Heart Program Lakeland Regional Health
Cardiology Consultant, Divers Alert Network
IANTD and TDI CCR Trimix Instructor
Hi Doug, thanks for pitching in, next to all your help you have already provided me in our e-mail conversations as well over a beverage on Grand Cayman.
Also I hope you do not regard me posting my case here as not trusting your view, or me trying to find a different answer. I just want to soak up as much insights and knowledge as there is on this subject, so I can figure out the best way forward for me.
I am considering doing a TEE. As you have explained, the chance of any large PFO being picked up there is very small. My main reasoning for doing it would be as sort of an 'insurance' in case the TTE was not done correctly.
