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

[Uncle Pug]

I'm certainly glad that DD made it through the surgery just fine... he was in my prayers ahead of time concerning this surgery and I thank God that he was not among the small percent that do end up going sideways.

Three or so years ago I had a complete physical by diving Doc. Ed Kay and at the time asked him about getting tested for a PFO. He advised against it since there is at least a small risk associated with the TEE itself as well as a risk associated with any repair proceedure should a PFO be detected.

While there is also a risk asscociated with having a PFO and scuba diving... even if all incidence of DCI were related to a PFO the percentage is still smaller than the risk asscociated with testing for and then repairing a PFO.

I really appreciate Dr. Deco's continued insistence that post dive exertion is to be avoided. I wouldn't be surprised if following his advice would prove more effective in eliminating DCI than having everyone's PFO fixed.

All that said, I got to thinking about all of the strenuous exercise I have done over the years after some dives... and realized that I have given myself field PFO tests hundreds of times. So... I have to agree with I.G. if it ain't broke don't fix it.

 

[crispos]

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.)

No doubt you are correct about the small, albeit statistically significant linkage between PFO and DCI. As to the data I was looking at, I wasn't really referring to any as I haven't seen any. I was just responding to the rather dire statement of the original poster. My intent was to make sure we didn't turn off potential divers from taking a dive course.

This past week any new diver on SB might have read about 1) a person dying in Cozumel 2) a person almost dying at Ginnie Springs and I just didn't want to finish off any interest in diving by readijng about a 1 in 3 chance of dying of a PFO related embolism. Do you see where I am coming from?

Glad you made it over your surgery DetroitDiver, that took guts to have someone mess with your heart. All the best but please do not scare divers away without checking the facts.

 

[detroit diver]

Scare them away from diving? Not my intent. But should we bury the information so that they don't know about it?

In addition, maybe some of those folks with unexplained hits can follow thru on a fairly simple (echocardiogram) procedure to at least rule out a possiblity. The ones that are dead don't have that choice.

The facts are fairly simple.

1. Approx. 30 percent of the population has a PFO.
2. Coughing, and certain strenuous activities can cause the blood flow to pass thru the PFO into the chamber that feeds your brain.
3. Nitrogen bubbles accumulate in your bloodstream during a dive.
4. Nitrogen bubbles in your brain are not good.

You can quote lack of statistics all that you want. Common sense tells me that the above is not a good scenario for the 30 percent of us that have this feature.

One more thing. You stated a 1 in 3 chance of dying of a PFO. That is not what I said at all.

No doubt you are correct about the small, albeit statistically significant linkage between PFO and DCI. As to the data I was looking at, I wasn't really referring to any as I haven't seen any. I was just responding to the rather dire statement of the original poster. My intent was to make sure we didn't turn off potential divers from taking a dive course.

This past week any new diver on SB might have read about 1) a person dying in Cozumel 2) a person almost dying at Ginnie Springs and I just didn't want to finish off any interest in diving by readijng about a 1 in 3 chance of dying of a PFO related embolism. Do you see where I am coming from?

Glad you made it over your surgery DetroitDiver, that took guts to have someone mess with your heart. All the best but please do not scare divers away without checking the facts.

 

[Uncle Pug]

1. Approx. 30 percent of the population has a PFO.
2. Coughing, and certain strenuous activities can cause the blood flow to pass thru the PFO into the chamber that feeds your brain.
3. Nitrogen bubbles accumulate in your bloodstream during a dive.
4. Nitrogen bubbles in your brain are not good.

Generalized statements to follow... there are exceptions but lets not make them the focus:
1. Can be repaired but with risk.
2. Can be avoided without risk.
3. Can be avoided without risk.
4. Can be avoided by avoiding 2 and 3.

Now the scary thing is that even though 30% of the divers have a PFO of one degree or another a great many don't pay attention to avoiding 2 and 3 and therefore risk 4.

Posting all the facts surrounding PFOs is largely beneficial in my opinion.

Rather than scare new divers off we just might educate them to the risk/benefits involved.

And rather than having everyone rush out to get tested for PFOs and having them repaired if found we also need to assess the risk/benefit involved.

 

[Scuba]

Although statistically the risk of DCS is very small for the average diver, the risk for those with a substantial PFO is much greater.

What is the risk of DCS if one has an X type PFO? Again we are diving in ignorance.

A diver with knowledge of a PFO can choose to dive more conservatively depending on diagnosis. He does not necessarily need to incur the extra risk of treatment.

And yes, we can all dive more conservatively. But how much? Is it necessary?

It comes down to this decision: Do you take your chances underwater experimenting on yourself due to ignorance? Do you take a minor risk to inform yourself in the Dr's office and reduce your risk underwater?

Just pointing out a different perspective.

Perhaps DAN could get a Dr's network to provide the tests for divers at lower cost. I beleive they run about $700 in this area, it varies. Unless one has a medical condition in which the test will be covered by insurance.

DD,

IG,

Thank you, as always, for your learned and scholarly input. We have a desperate need in our sport for people who have an education and training such as yours, who are experienced divers, and are willing to freely share such hard-earned information. Again, thank you!

BJD

Absolutely! And kudos to DD and all the other average divers who do their share. (no offence meant by average DD, I'm one)

 

[Uncle Pug]

Note: I am not disagreeing with DD, especially considering the reason he had the test done... he is progressing into decompression diving where the risk factor for those with a PFO goes up substantially.

 

[detroit diver]

.........
Absolutely! And kudos to DD and all the other average divers who do their share. (no offence meant by average DD, I'm one)

No offense taken. I'm as average as they get!!

 

[Uncle Pug]

BTW: there is a risk factor associated with eating geoduck as well.

 

[detroit diver]

BTW: there is a risk factor associated with eating geoduck as well.

The only risk factor there is the desire to move to Seattle....!!

 

[Uncle Pug]

Yeah... that's risky alright. Have you told your wife you are moving yet?