PFO Closure - Medical Tourism, Cost, Locations/Doctor Recs (Outside USA)

[thecutestdiver]

Hi all!

My husband and I are new divers. We learned that he has a PFO through an unfortunate DCS incident. He is ok but would like it closed to get cleared to dive again.

Insurance is not covering the closure. We were quoted $69,000 for out of pocket. We are interested in potential travel to have it covered (Canada is what comes to mind, but open to other places ). I am not familiar with medical tourism and was hoping someone here may:

1) live in another country and have had their pfo closed there and have somewhere to recommend

Or

2) be familiar with medical tourism in general outside the USA

Or

3) have any idea how much a PFO closure costs where it is not $69k

 

[Capt Jim Wyatt]

@Dr. Doug Ebersole

 

[Duke Dive Medicine]

Hi all!

My husband and I are new divers. We learned that he has a PFO through an unfortunate DCS incident. He is ok but would like it closed to get cleared to dive again.

Insurance is not covering the closure. We were quoted $69,000 for out of pocket. We are interested in potential travel to have it covered (Canada is what comes to mind, but open to other places ). I am not familiar with medical tourism and was hoping someone here may:

1) live in another country and have had their pfo closed there and have somewhere to recommend

Or

2) be familiar with medical tourism in general outside the USA

Or

3) have any idea how much a PFO closure costs where it is not $69k

Hi! What made you decide on closure as opposed to diving more conservatively? Were you told by a provider that he couldn't dive again with a PFO? What were his DCS symptoms?

Best regards,
DDM

 

[thecutestdiver]

Hi!

He was told by cardiology (who diagnosed the PFO) to not dive until it was repaired.

Hoping to get a second opinion from the dive medicine doctor we saw at the hyperbaric chamber about the option to dive conservatively.

He had Type I DCS with joint aches, pains, and numbness, in the shoulders and upper arms after a normal dive profile, but it was his deepest dive to date. Has no issues prior to hitting eighty feet.

 

[Endler's]

You should also appeal the insurance company's decision.

 

[thecutestdiver]

We did an appeal and a peer to peer review. Unfortunately, it was still denied.

 

[Duke Dive Medicine]

Hi!

He was told by cardiology (who diagnosed the PFO) to not dive until it was repaired.

Hoping to get a second opinion from the dive medicine doctor we saw at the hyperbaric chamber about the option to dive conservatively.

He had Type I DCS with joint aches, pains, and numbness, in the shoulders and upper arms after a normal dive profile, but it was his deepest dive to date. Has no issues prior to hitting eighty feet.

Interesting. Is that how they characterized it, Type I DCS? Was the numbness localized to the shoulders and upper arms? Was there any swelling in those areas? You said he had a normal dive profile, can you be more specific? Depth, bottom time? How long did it take for the sypmtoms to appear after he surfaced? What was he doing when he became symptomatic?

I'm asking because PFO is associated with severe, sudden-onset neurological DCS (think unconsciousness, paralysis, widespread numbness, severe weakness), inner ear DCS (vertigo, tinnitus, hearing loss), and cutis marmorata (a marbling type of skin rash). It is not associated with Type I DCS.

Best regards,
DDM

 

[thecutestdiver]

It's been a while, so I have to check the records to see if Type I DCS was specified or that's just how I'm remembering it. I'll check the records and let you know!

​

I believe onset was about 24 hours after, definitely not sudden. I wasn't there but I've been in the same spot and it was about 80 feet. I don't have log handy for bottom time.

When he became symptomatic he was just sitting at home with me. No swelling that I recall. Numbness was started at shoulders and spread to arm. I don't remember if it was one or both.

​

The PFO was confirmed by a transesophageal echocardiogram late last year.

​

And thank you! That is good information to know about what types of DCS are associated with PFO.

 

[Duke Dive Medicine]

It's been a while, so I have to check the records to see if Type I DCS was specified or that's just how I'm remembering it. I'll check the records and let you know!

​

I believe onset was about 24 hours after, definitely not sudden. I wasn't there but I've been in the same spot and it was about 80 feet. I don't have log handy for bottom time.

When he became symptomatic he was just sitting at home with me. No swelling that I recall. Numbness was started at shoulders and spread to arm. I don't remember if it was one or both.

​

The PFO was confirmed by a transesophageal echocardiogram late last year.

​

And thank you! That is good information to know about what types of DCS are associated with PFO.

It's very rare for DCS symptoms to appear that far out from a dive, which makes him an outlier in that sense even without a PFO in the picture. If he flew in an airplane or drove over some mountains in between it might make me think twice, but you didn't mention that. It's also a bit of a stretch to attribute DCS-related localized numbness to a PFO, though not impossible under the right circumstances. Given the information you've provided, I don't know that I'd be rushing to get a closure if I were your husband. Did he have any spinal imaging done at the time? Where in New York are you, and what facility were you treated at?

Best regards,
DDM

 

[thecutestdiver]

That's good to know. No spinal imaging was done.

No airplane, but I don't know if he drove over a mountain on his way back from Lake Hydra.

We're on Long Island and he was (eventually) treated at Mather Hospital with Dr. Joseph White.