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

[underwater daphne]

since i have migraines a doctor advised me to get checked for pfo. belief is that there is some connection between migraines and pfo. this was a dive doctor/doctor for internal organs in a nearby hospital, whom i went to see after a diving incident (which turned out not to be a diving incident).

if you have no signs then i wouldn't get the test done. or put it this way, if i had had no signs, i wouldn't have gotten it done.

you get an iv and lay on a bed where they use ultrasound to "see" your heart. then they pump blood and maybe something else into your arteries to see how it passes through your heart. as explained better above by others.

the doctor said that he didn't see enough to be 100% sure, so he also, i don't know how to say this in english, gave me a shot of dormicum through the iv and stuffed a hose the size of a garden hose down my throat to get a better look. then repeated the process with the blood pumping like above but using the hose to "see" my heart. absolutely disgusting.

not something i would have done without a doctors recommendation.

i don't have pfo, but the doctor told me if i did, i would have to dive more conservatively and follow some other points. i was probably too high on dormicum to ask him more questions after the tests.

i'm glad i'm healthy.

 

[Saturation]

since i have migraines a doctor advised me to get checked for pfo. belief is that there is some connection between migraines and pfo. this was a dive doctor/doctor for internal organs in a nearby hospital, whom i went to see after a diving incident (which turned out not to be a diving incident).

if you have no signs then i wouldn't get the test done. or put it this way, if i had had no signs, i wouldn't have gotten it done.

you get an iv and lay on a bed where they use ultrasound to "see" your heart. then they pump blood and maybe something else into your arteries to see how it passes through your heart. as explained better above by others.

the doctor said that he didn't see enough to be 100% sure, so he also, i don't know how to say this in english, gave me a shot of dormicum through the iv and stuffed a hose the size of a garden hose down my throat to get a better look. then repeated the process with the blood pumping like above but using the hose to "see" my heart. absolutely disgusting.

not something i would have done without a doctors recommendation.

i don't have pfo, but the doctor told me if i did, i would have to dive more conservatively and follow some other points. i was probably too high on dormicum to ask him more questions after the tests.

i'm glad i'm healthy.

I'm happy for you. What the doc did was insert an esophageal probe, but why its so big I don't know. The test you endured was a transesophageal echocardiogram, TEE, the definitive test to date, to diagnose a PFO. He initially tried to see the PFO without the probe.

As the test you describe indicates, its not pleasant and there is a slight chance of rupturing the esophagus, which can be very bad.

Most of the folks who speak in favor of testing for PFO in divers are unrealistic about the dangers of making a diagnosis of a PFO via a TEE, and the treatment of it later on. In the end, your final paragraph is best done by all divers, as shunts other than a PFO can exits in the lungs or develop later in life.

 

[Keysdrifter454]

Could anyone give me the following:

1. Exact Results of the BC study
2. Real chance of having PFO

I want to make some calculations to maybe calm the fears of some people. At first read I was pretty scared, but after running some stats with aprox numbers I am not to worried. Hoping maybe to calm some nerves.

No/maybe, but he's some food for thought, and some calculations already made.

http://makeashorterlink.com/?R27921E69

 

[underwater daphne]

I'm happy for you. What the doc did was insert an esophageal probe, but why its so big I don't know. The test you endured was a transesophageal echocardiogram, TEE, the definitive test to date, to diagnose a PFO. He initially tried to see the PFO without the probe.

As the test you describe indicates, its not pleasant and there is a slight chance of rupturing the esophagus, which can be very bad.

Most of the folks who speak in favor of testing for PFO in divers are unrealistic about the dangers of making a diagnosis of a PFO via a TEE, and the treatment of it later on. In the end, your final paragraph is best done by all divers, as shunts other than a PFO can exits in the lungs or develop later in life.

thank you. and thanks for the info.
maybe i exagerated a bit on the size, but it was really big. i always thought it would be a thin tube, but it was almost the size of a garden hose, without exageration. i guess it has to be because the doc really has to push it down as you automatically have the urge to vomit or better said, can't stop the reflex of vomiting, that's why i had to go early morning without breakfast. and my throat hurt a bit 1-2 days after when laughing, eating, etc. i can imagine that things could go wrong during these tests, but also think chances are small that this happens. all the same, once is enough.

 

[dweeb]

BTW, I did call DAN to see what they had to say about it. I asked if they thought I should get tested and told them what kind of dives I was doing (a little deeper and longer than some). They asked if I'd ever had any trouble and I said no. They said I probably didn't need to worry then.

I had an email exchange with Dan Volker, an associate and training partner of GI. He asked me what my best 10K time was (around 43 minutes) and said that I didn't need to worry. He said that a PFO limits your maximum aerobic capacity, and I couldn't run like that if I had a PFO.

 

[The Chairman]

Thanks for the letter... now go get well!

 

[detroit diver]

Could anyone give me the following:

1. Exact Results of the BC study
2. Real chance of having PFO

I want to make some calculations to maybe calm the fears of some people. At first read I was pretty scared, but after running some stats with aprox numbers I am not to worried. Hoping maybe to calm some nerves.

The answer to #2 is approx 30-35 percent of the population.

 

[Saturation]

I had an email exchange with Dan Volker, an associate and training partner of GI. He asked me what my best 10K time was (around 43 minutes) and said that I didn't need to worry. He said that a PFO limits your maximum aerobic capacity, and I couldn't run like that if I had a PFO.

A VSD or ASD defect other than a PFO may limit exercise capacity but this depends on how big the shunt is. A substantial number of them do not impede exercise capacity.

Many PFO do not provide _any_ limitation because:

of variable size shunts;
the presence of a flap that keeps the opening closed except in reverse flows;
the need for flow reversal of flow to cause significant problems;

For something close to home among the DIR set, an exceedingly athletic former WKPP diver { I am told he left recently} has been very open in discussing his experiences with his PFO. It remained completed unknown until just the past few years. GUE or WKPP folks maybe able to fill you in to his identity.

 

[Hootis]

DD,

What's the follow-up? Are you back in the water, yet? Notice any differences?

I got bent in Grand Cayman a month ago, and upon returning had a PFO test--positive. Pretty good size one, too. I meet with the Cardiologist tomorrow for another visit after the bubble study test the week before last.

I have 1000 or more dives...14 years recreational, 2 years working as a dive master, 4 years tech and rebreather. I really didn't think I could have a PFO...I thought I would have already been dead by now. Turns out I have been ignoring symptoms for years...and probably have done some damage to tissues and organs...very likely including my brain. (Which explains a lot... ;-) )

On days with many recreational dives (4-5 dives of 60-80') or decompression dives below 200', I will sometimes get skin bends (just light pain--not visible cuteous mamorata) or headaches. On several occasions, I have had a visual disturbance that I describe as "a dozen golf ball sized blobs of blurriness swarming through my field of vision." This can also be accompanied by general malaise and/or very light flu like symptoms. The first time I encountered this visual disturbance, was an hour after diving my rebreather. I had always thought this was oxygen myopia. Now I hear it was more likely a stroke.... maybe that's what GI3 means when he calls me a stroke. ;-)

After a dive to 250' on 20/30 trimix in GC last month with a conservative decompression profile, I surfaced and within 10 min on the boat was experiencing numbness in my right arm, starting at my hand and creeping up my arm. I sat down next to my rebreather, fired it up, and started breathing +-100% O2.... within 5 min I was feeling fine. After stopping O2, symptoms reoccurred after 5 mins. Later symptoms included trembling in the knees, lack of coordination, etc. I treated my symptoms with O2 because I didn't want to go to the chamber (I know...mistake) After I could move well (1-1/2 hours on O2), a subsequent dive with a high setpoint seemed to clear up most all of my remaining symptoms.

Later review of the incident with Kevin Gurr and Joe Radomski (who were also on the trip) by analyzing the profile on my VR3, showed that it was probably an underserved hit. After hearing some of my other symptoms (described above) they suggested PFO check. Thanks go out to those guys.... they were right.

Now I've done a lot of research...sounds pretty treatable, but very unsafe to continue diving without having it repaired. BTW, one of the other symptoms I have is killer migraine headaches 5-6 times a year...not associated with diving. Migraines are also associated with PFO.

Thanks for starting this thread, DD. Hopefully, if anyone is having any of these symptoms, they’ll get checked out. My insurance covered the tests no problem....don't know if they'll cover the surgeryyet or knoe

DD, how about a post op, follow-up? Feeling good now?

Later,
Ryan

 

[detroit diver]

Hi Ryan,

First of all, I'm sorry to hear that you took those hits. That could not have been a pleasant experience.

I've been back in the water since late May. I feel great, but I didn't have any symptoms before I found out that I had the PFO. For about 3 weeks after my surgery, I had some PFC's. These are heart palpitations that I was told were normal after this type of procedure. It did go away after a while.

I finally did a follow-up bubble study about 2 weeks ago. It was clean. I should have done it before diving, but, well, you know...!!!

Dive safe.

DD,

What's the follow-up? Are you back in the water, yet? Notice any differences?

I got bent in Grand Cayman a month ago, and upon returning had a PFO test--positive. Pretty good size one, too. I meet with the Cardiologist tomorrow for another visit after the bubble study test the week before last.

I have 1000 or more dives...14 years recreational, 2 years working as a dive master, 4 years tech and rebreather. I really didn't think I could have a PFO...I thought I would have already been dead by now. Turns out I have been ignoring symptoms for years...and probably have done some damage to tissues and organs...very likely including my brain. (Which explains a lot... ;-) )

On days with many recreational dives (4-5 dives of 60-80') or decompression dives below 200', I will sometimes get skin bends (just light pain--not visible cuteous mamorata) or headaches. On several occasions, I have had a visual disturbance that I describe as "a dozen golf ball sized blobs of blurriness swarming through my field of vision." This can also be accompanied by general malaise and/or very light flu like symptoms. The first time I encountered this visual disturbance, was an hour after diving my rebreather. I had always thought this was oxygen myopia. Now I hear it was more likely a stroke.... maybe that's what GI3 means when he calls me a stroke. ;-)

After a dive to 250' on 20/30 trimix in GC last month with a conservative decompression profile, I surfaced and within 10 min on the boat was experiencing numbness in my right arm, starting at my hand and creeping up my arm. I sat down next to my rebreather, fired it up, and started breathing +-100% O2.... within 5 min I was feeling fine. After stopping O2, symptoms reoccurred after 5 mins. Later symptoms included trembling in the knees, lack of coordination, etc. I treated my symptoms with O2 because I didn't want to go to the chamber (I know...mistake) After I could move well (1-1/2 hours on O2), a subsequent dive with a high setpoint seemed to clear up most all of my remaining symptoms.

Later review of the incident with Kevin Gurr and Joe Radomski (who were also on the trip) by analyzing the profile on my VR3, showed that it was probably an underserved hit. After hearing some of my other symptoms (described above) they suggested PFO check. Thanks go out to those guys.... they were right.

Now I've done a lot of research...sounds pretty treatable, but very unsafe to continue diving without having it repaired. BTW, one of the other symptoms I have is killer migraine headaches 5-6 times a year...not associated with diving. Migraines are also associated with PFO.

Thanks for starting this thread, DD. Hopefully, if anyone is having any of these symptoms, they’ll get checked out. My insurance covered the tests no problem....don't know if they'll cover the surgeryyet or knoe

DD, how about a post op, follow-up? Feeling good now?

Later,
Ryan