PFO-An open letter of thanks to George Irvine (long)

[Groundhog246]

Great names for this! There was a foot doctor a block from my office who's name was Smellsy!!

DD: Get well soon. Off Topic (who me :54: ) there's an oral surgeon not far from me who sign is Dr. Pus. Makes you want to book an appt right away. Much funnier, we have a local Dr. Nurse. It's hilarious watching peoples faces in the hospital when they page "Doctor Nurse, please call ....." .

 

[LUBOLD8431]

Yeah, your posts on this subject have got me a little worried. My sister is a Doc, and last year, she had surgery to repair a heart murmur, and an arythmia. She has a PFO also. I dont know if it is hereditary, or not, but I had some tests when I was alot younger, because my doc thought I had something wrong. I am looking into getting tested for this.

 

[Snowbear]

I dont know if it is hereditary, or not..

From what I've read - the thinking is there may well be a heredetary component.

 

[Scuba]

Thanks for sharing DD. Let us know if you feel any different in your future dives. Possibly less fatigue or other symptoms of subclinical DCS you may have experienced before. Has anyone who has gone through this procedure noticed any such differences?

I agree with you this subject should be covered in OW dive instruction. The increasing body of knowledge continues to point towards the importance and impact a PFO can have on divers, specially a large one.

Here is a link to a brief article on this subject claiming a dramatic risk increase for those with a PFO.
http://www.divernet.com/news/stories/pfo260204.shtml

Few details about the study listed, so if anyone can add more info maybe they can share it or start a thread in the medical section.

 

[JohnF]

Thanks everyone. Actually, I feel great. No strenuous excersize for 2 days, and then back to normal life.

Glad to hear it went well. I knew we were past the scheduled date so I've been watching for a post from you. See you at Gilboa.

JohnF

 

[ABQdiver]

Jack, I want to thank you (again) for your help and guidance! You help me about a year or so ago with my assimilation into the backplate and wing. For that I am grateful. Now with this information I will get myself check out for this as well.

Actually had an appointment set up for a physical next week. I'm going to ask to add the test for PFO onto the standard set of tests.

Thanks again :sappy:

 

[detroit diver]

Excellent post. I actually just read it over on Quest but decided to respond over here. So, how long till you can make a full recovery and get back to diving?

Actually, other than a bit of a headache this morning, I'm good to go. Just have to take it easy for 2 days. They want to make sure the artery that they entered thru doesn't open up and start bleeding.

There is a small area around the PFO that is still open. It will close in about 6-8 weeks. Then I'll have a follow-up echocardiogram to verify that it is closed.

 

[glbirch]

An interesting post. But it doesn't make sense. If 30% of the population had an open PFO, and stressful diving caused the nitrogen laden blood to bypass to the brain without offgassing, we should be experiencing a much greater incidence of DCS II. But we're not.

I wish I had access to more DCI studies. But one study of the incidence of DCI, The Abacus Study done in British Columbia from Oct 1, 1999 to Nov 30, 2000 reported 14 cases of DCI from 146,291 tank fills (i.e.) , an incidence of only 0.010%. And you know, with the cold water in B.C. requiring dry suits, and the strong tidal currents, there must be plenty of exertion required in B.C. diving. There were only 3 fatalities.
If PFO was a "clear and present danger" then many more people would be suffering stroke like embolisms from diving. It just ain't happening.

I think the military would also have data on this subject, given the strenuous dive training recruits must perform. All in all, I think quoting 30% of divers might be at risk of neurological DCS just does not agree with the empirical evidence that I'm aware of.

I certainly am not one to immediately reject any hypothesis, or go into denial. If the agencies are asleep, let's wake them up. But let's see some evidence this is a problem before we start frightening potential and new divers over a hypothetical danger. And, yes, I have lots of respect for George Irvine.

I'm not sure you are looking at the data correctly. Somewhere between 25% and 30% of people may have PFO's (now I'm considering having myself checked as well) but there are many types and size of them. It is likely that the vast majority are so minor as to not make a noticeable difference in the normal diver. (Personally, I've never met a normal diver.)

What the studies seem to be indicating is that a larger percentage of divers who have suffered from decompression illness are found to have PFO's than random chance would suggest. If 30% of people have them in general, but half of the divers who check in with problems have them, that would suggest a link that should be looked at closely as a possible causal factor. It doesn't mean that 30% of divers are going to keel over after a strenuous dive.

Hmmm. Mabye I can propose a study and get a big government grant?

 

[Rick Inman]

Jack,
Great post. Glad you're doing well!
If 30% have a PFO and suddenly everyone is getting checked... where do I buy stock in the thing they use to fix it?? There's gonna' be a lot of PFO surgery goin' on.
If the risk for DCS is only 0.010, what is the risk for the surgery? Even minor surgery has some risk to it. Maybe it's less than 0.010, in which case we may have another one of those, "The most dangerous part is the DRIVE" things going on here. Out of the relative few scuba deaths each year, only SOME of these are unexplained, and maybe SOME of these are PFO related, but it sounds like we're into Lottery odds here, and I'm not sure if having someone poking around in my heart is worth it.
But then, this could just be my over developed denial mechanism kicking in...

 

[ckharlan66]

Jack,
Great post. Glad you're doing well!
If 30% have a PFO and suddenly everyone is getting checked... where do I buy stock in the thing they use to fix it?? There's gonna' be a lot of PFO surgery goin' on.
If the risk for DCS is only 0.010, what is the risk for the surgery? Even minor surgery has some risk to it. Maybe it's less than 0.010, in which case we may have another one of those, "The most dangerous part is the DRIVE" things going on here. Out of the relative few scuba deaths each year, only SOME of these are unexplained, and maybe SOME of these are PFO related, but it sounds like we're into Lottery odds here, and I'm not sure if having someone poking around in my heart is worth it.
But then, this could just be my over developed denial mechanism kicking in...

I can't say what others think. But for me, after reading Dr. Paul's report, if I had found that I had a PFO the risk of diving without having it repaired would have been too great. If I had found that the surgery was too risky and I did not really need it unless I wanted to continue to dive I might have chose just to not dive anymore, but, I definately would not have dove any longer without repairing the PFO.

Chad