PFO Testing in Canada
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dylanfromwinnipeg
Contributor
So she's a pioneer - very cool! How is she doing now? Does she still dive?
Yes she does. We are semi -retired from teaching but still recreationally. We moved from Minnesota to Texas so our wetsuit diving season is 10 months of the year as opposed to 0 months of the year up North. She is in a long term study with the Mayo Clinic , she hasn't had an issue with her plug.
Yes she does. We are semi -retired from teaching but still recreationally. We moved from Minnesota to Texas so our wetsuit diving season is 10 months of the year as opposed to 0 months of the year up North. She is in a long term study with the Mayo Clinic , she hasn't had an issue with her plug.
ontdiver
Contributor
Well, that's not good. There are some contact numbers on this page Contact - Diver Certification Board of Canada . Perhaps they have someone new for Manitoba. Good luck!
Are you experiencing symptoms leading you to investigating this?
OP
dylanfromwinnipeg
Contributor
Nope. But I’d rather not wait until I get an undeserved hit only to later learn I had a medical condition that could have been easily diagnosed and treated earlier.
Recommend that you and whatever cardiologist you end up speaking with have a good conversation about the risk of DCS vs. the risk of complications with PFO closure. Closure itself is not without risk.
Tagging @Dr. Doug Ebersole, an interventional cardiologist and very active diver for more information.
Best regards,
DDM
Agreed. While the risk of PFO closure is quite small, it is not zero.
The FDA approved indication for PFO closure in the USA is cryptogemic stroke in patients 18-65 years of age. This is basically a stroke with no other etiology found other than the PFO and closure is only performed after consensus by the patient, neurologist, and cardiologist. Insurance coverage for PFO closure in divers can sometimes be difficult. Often, it will be approved for neurologic DCS as this often has "stroke like" symptoms. I would imagine, though I cannot guarantee, that the Canadian system would be similar as this is what has been studied in the medical literature.
There is no indication for PFO closure simply because you have been found to have a PFO. Yes, a diver with PFO is probably about 5 times more likely to suffer DCS than a diver without one, but the ABSOLUTE risk of DCS is quite small. For recreational diving, this would be approximately an increase in DCS from about 2 episodes per 10,000 dives to about 10 per 10,000 dives, or 1 in a thousand. PFO closure complications are very low, but they are higher than 0.1% ( one in a thousand).
While the risk of DCS in technical diving is obviously higher than with recreational diving, the absolute risk of DCS in technical diving even with a PFO is quite small. For that reason, the recommendation is only to close PFOs in divers who have had one or more episodes of DCS of the types associated with PFO -- cerebral, spinal, inner ear, or skin bends.
The FDA approved indication for PFO closure in the USA is cryptogemic stroke in patients 18-65 years of age. This is basically a stroke with no other etiology found other than the PFO and closure is only performed after consensus by the patient, neurologist, and cardiologist. Insurance coverage for PFO closure in divers can sometimes be difficult. Often, it will be approved for neurologic DCS as this often has "stroke like" symptoms. I would imagine, though I cannot guarantee, that the Canadian system would be similar as this is what has been studied in the medical literature.
There is no indication for PFO closure simply because you have been found to have a PFO. Yes, a diver with PFO is probably about 5 times more likely to suffer DCS than a diver without one, but the ABSOLUTE risk of DCS is quite small. For recreational diving, this would be approximately an increase in DCS from about 2 episodes per 10,000 dives to about 10 per 10,000 dives, or 1 in a thousand. PFO closure complications are very low, but they are higher than 0.1% ( one in a thousand).
While the risk of DCS in technical diving is obviously higher than with recreational diving, the absolute risk of DCS in technical diving even with a PFO is quite small. For that reason, the recommendation is only to close PFOs in divers who have had one or more episodes of DCS of the types associated with PFO -- cerebral, spinal, inner ear, or skin bends.
It’s also worth noting that while generally quite safe, a TEE is not 100% without possible complications as well.
If a patient of mine has any degree of symptoms indicating the need for the test I wouldn’t hesitate to recommend one.
OTOH simply wanting to look for the sake of looking (even with what the patient believes to be justification) quickly runs into a risk vs benefit discussion of the evaluation itself, followed by what to do with the answers once you have them.
I went to my GP who got me a referral to a cardiologist. I didn't get the full TEE so I didn't need sedation and have the thing down my throat. I had the less invasive procedure; TTE (?). A buddy of mine also got a referral from his GP, etc. He did do the full TEE. Both of us showed negative. Neither one of us had ever been bent. I don't remember what excuse I gave in order to get the test done.
I also know 2 others who had a history of skin bends and they did the same. GP to the cardiologist who did the full TEE. As suspected they both had PFO's and both got them fixed.
All of us were covered by Alberta Health Care so no cost.
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