My personal experience getting bent...

[WetRocks]

2. Aside from the ECG with bubble test or the presenting of symptoms, do you know of any other ways to test for a PFO? (I had an ECG done a few years ago, but without the bubble test. The doc had no reason to request a bubble test, I suppose.)

3. Do you know of other people with a PFO who didn't find out until later in life as well? If so, did any of them serve in the armed forces (US)?

4. It is now 2016. Have you gone diving yet?

I'm not John but I can respond to a few of these...

2) an ECG (electrocardiograph) will not show a PFO. Perhaps you are think of an echocardiogram? Either a trans-esophageal (TEE) or trans thoracic (TTE) with bubble study would be done to diagnose the PFO.

3) I was diagnosed at 35...had no prior symptoms until experiencing skin bends 3 out of 9 dives.

4) got back in the water right at 3-months post-op. Doing the same dives that resulted in skin bends previously with no troubles at all.

 

[Rich Keller]

I don't know who told you that in 6 months you would be diving again but based on what I heard in your video you are done diving forever. GET a second opinion! If they tell you it is OK get a third opinion. Given what happened at the time and the fact that you were still having these kinds of issues months after tells me not only is this NOT going away if it happens again it will be in those same areas but FAR worse. The problems you are still having now from the CNS hit are NEVER going to go away, you will be lucky if they just stay the same. Get used to them, they are your new normal. BTW you weren't going by the book you were going by three computers. I know it is pointless to even say this but, if you had used the Navy tables during your dives you would not have ended up on the Navy tables in the chamber.

 

[CuzzA]

I don't know who told you that in 6 months you would be diving again but based on what I heard in your video you are done diving forever. GET a second opinion! If they tell you it is OK get a third opinion. Given what happened at the time and the fact that you were still having these kinds of issues months after tells me not only is this NOT going away if it happens again it will be in those same areas but FAR worse. The problems you are still having now from the CNS hit are NEVER going to go away, you will be lucky if they just stay the same. Get used to them, they are your new normal. BTW you weren't going by the book you were going by three computers. I know it is pointless to even say this but, if you had used the Navy tables during your dives you would not have ended up on the Navy tables in the chamber.

I don't believe that's necessarily true. I would say diving will never be the same as the thought will always be in the back of his mind. He may also experience feelings due to the residual damage from being bent, but have a read of Richard Pyle's story. He continued to dive after some agonizing rehabilitation. If one is willing to accept the risk post severe DCS, then who are we to stop them.

Confessions of a Mortal Diver

 

[ZephyrNYC]

I'm not John but I can respond to a few of these...

2) an ECG (electrocardiograph) will not show a PFO. Perhaps you are think of an echocardiogram?...

4) got back in the water right at 3-months post-op. Doing the same dives that resulted in skin bends previously with no troubles at all.

That's exactly what I meant-- echocardiogram. I had one done a few years ago. Thanks. And I'm glad you're ok

 

[Freak*Flag*Flyer]

On July 4, 2015 (as in a few months ago) I was down in north central Florida in the middle of MOD2 and full CCR Cave training on my rEvo.

I've done many high profile dives in terrible conditions and under high duress as the dive went all pear shaped. And I've luckily always been fine.

Not on July 4th. Not by a long shot. Rather than describe the event, I think it easier to share a YouTube link of the presentation I gave to my coworkers at the New England Aquarium a week or so ago.

After watching it, I'd be happy to answer any questions, as I feel theres some good information in there for us all...

https://www.youtube.com/watch?v=0t8djdervQw

John Hanzl
Author
john h hanzl (author) | official site

Thank you for sharing this. I hope your recovery is going well.

wishing you all the best!!
D

 

[NYCNaiad]

I'm glad you're ok and it was interesting to hear your story. One of the other things to mention is there are different grades of PFOs. I have a small one. One that doesn't seem to require the operation you did and one that drs seem to agree is ok to dive with as long as I stay conservative. I've never had any symptoms and the PFO was found during a separate test. The test turned out to be benign, but when I mentioned I was a diver they did additional tests and found the small PFO.

 

[JohnnyH]

Good morning, John.

Happy 2016. Thank you for sharing your video and your experience for us to learn from it. And thank you for being strong enough to live through this. You are a lucky man. Please answer the following:

1. Was this the first time in your life that any symptoms of your PFO presented?

2. Aside from the ECG with bubble test or the presenting of symptoms, do you know of any other ways to test for a PFO? (I had an ECG done a few years ago, but without the bubble test. The doc had no reason to request a bubble test, I suppose.)

3. Do you know of other people with a PFO who didn't find out until later in life as well? If so, did any of them serve in the armed forces (US)?

4. It is now 2016. Have you gone diving yet?

5. Aside from the PFO, would you say that the next major factor leading to your DCS was dehydration?

Btw, I noticed a couple misspellings in the video: "optometrist" and "medevac" (MEDical EVACuation). I think that the way you spelled the latter is slowly becoming accepted, but I think it's another new Americanism or corrupted spelling lol.


Sincerely,
Frank

Hey Frank -

Good questions - let's see...

1) Yes - first time. I've had some very mild skin-bend type issues many many years ago but that's about all. And I've done many much more challenging dives - and one in particular that went horribly wrong, and that at the time I was confident I was going to get bent - but never had any issues.

2) I believe the Trans Esophageal Echocardiogram (TEE) with bubble study is the gold standard, followed by the Trans Thoracic Echocardiogram (TTE) with bubble study. The TEE uses a transducer inserted down the throat so doesn't have to contend with muscle etc interfering, but is more of a "thing" to do. I believe there's a cranial doppler study as well, but that doesn't pinpoint the source of shunting. But regardless of TTE or TEE, you have to have the bubble study - that's imperative.

3) I have spoken with some very well placed individuals in the dive industry and dive world who have discovered they had a PFO that was possibly causing DCS issues, and who subsequent to closure have not had a one. None AFAIK were in the military.

4) Not yet - I had to wait three months post closure for proper healing then do another TTE with bubble study. This I had done last week - the results look great - and I am now just waiting to see my diving physician on the 22nd to get final clearance. Which is good, because I have to teach NAUI Advanced Rescue Diving on March 4th!

5) Yes - I happen to believe that dehydration was the second biggest straw that broke this camel's back.

Finally, thanks for catching those spelling mistakes. That kind of thing drives me nuts!

Regards,
John

 

[JohnnyH]

Wow! I'm so glad you are OK! Great job presenting your story and the learning points in such a gripping way! I'm a big believer in learning through story-telling.

I am a PCP and a recreational diver (and I take HCTZ!) and I'm giddy with questions. But mostly just glad you are OK. I can totally see how the denial would happen.

- Would it have been safe for you to fly to Georgia for treatment rather than drive?

- Did they fill you up with IV fluids before putting you in the chamber? How did you hydrate in there? (Sippy cup?)

- HCTZ is a diuretic, but it is so super mild... I wonder if there is any medical literature about not using it in divers? Or anyone else who might be at risk for dehydration? We don't use it in people with low potassium, but we don't always consider lifestyle when prescribing, and lots of providers know nothing about diving in particular. I guess there are plenty of alternatives so why even take a chance (with pro divers), but I never even considered that as a risk factor and I take the drug myself! Although I only do like 30 dives a year (if I'm lucky).

And if I may share a story... I was in a very remote part of the south pacific on a trip and the staff approached me to look at a "rash" one of the guests had. At this place we only dove 2x/day at 10am and 2pm, and this day both dives were quite conservative. The "rash" was a weird marbled looking discoloration on her thighs. She also described feeling "weird" and having tingling fingers. Once she said "tingling fingers" we all looked at each other and ran for 02. There was no chamber for thousands of miles, and she felt totally better after a few hours on 02. Over the next few days she was fine. We were chasing after her with 02 for 2 days. No diving of course. We couldn't understand why she would get a (albeit very mild) hit until she remembered she had a PFO!

I hope your procedure went OK and thanks again for sharing this!

Hey - thanks for the questions!

No, flying was out of the question (well, in an airplane. I would have been okay in a MEDEVAC chopper as it would have been low flying).

Yes - I was actively being loaded with IV saline from the time I entered the ER of the first hospital until after three days at South Georgia Medical Center (including the hyperbaric chamber). If I recall, the IV line was fed through a bulkhead connector in the door of the chamber. And yes - I also had a sippy cup, which is now sitting on my desk at the Aquarium...!

DAN does mention diuretics with diving: Diver Diving Diuretics (water pills) — Medical Dive Article — DAN | Divers Alert Network Net - recommendation is to reduce or not take (after review with physician) day of diving. For me, luckily I am currently off all hypertension meds. Also, the hospital tried to "sneak" potassium into my IV one night while I was asleep. Not a great idea - I woke up to see a chain of bubbles disappearing into my arm and my arm burning and in a ton of pain...!

It's amazing - and your story underscores it well - just how unpredictable your body is with regards to DCS. We're all one great science experiment!

Closure went very well and I am looking forward to getting back in the water within a few weeks - finally! It's been almost seven months!

Regards,
John

 

[JohnnyH]

I'm glad you're ok and it was interesting to hear your story. One of the other things to mention is there are different grades of PFOs. I have a small one. One that doesn't seem to require the operation you did and one that drs seem to agree is ok to dive with as long as I stay conservative. I've never had any symptoms and the PFO was found during a separate test. The test turned out to be benign, but when I mentioned I was a diver they did additional tests and found the small PFO.

Very good point - and I know that PFO tests aren't currently recommended for divers. However, there is a growing belief that perhaps PFOs should be tested for in divers undertaking dives outside of conservative profiles (decompression diving, helium mixes, etc). As it turns out in my case, my cardiologist told me after the closure that my PFO was "wide open". Guess I am grateful that it was found when it was...

Regards,
John

 

[JohnnyH]

I'm not John but I can respond to a few of these...

2) an ECG (electrocardiograph) will not show a PFO. Perhaps you are think of an echocardiogram? Either a trans-esophageal (TEE) or trans thoracic (TTE) with bubble study would be done to diagnose the PFO.

3) I was diagnosed at 35...had no prior symptoms until experiencing skin bends 3 out of 9 dives.

4) got back in the water right at 3-months post-op. Doing the same dives that resulted in skin bends previously with no troubles at all.

LOL - have been catching up on these posts and had just responded along the same lines! Thanks!

John