Saw a DAN Doc for Asthma Clearance

[sgj]

PFO=PATENT foramen ovale.

You can read about the condition in my post to Deb above.

Best regards.

DocVikingo

Ooops, I didn't see Doc's quote!

My concern would be, rather, the incidence of spontaneous pneumothoraces in persons with Asthma. Especially, in those who have a body habitus of tall and lanky.

I assume the incidence of PFO is the same in Asthmatics as compared to the general population. Also, her PFT's may be entirely normal at the time of testing, and Asthma being a variable disease may not rear its head till dive time. I guess the key is to stay on top of the controller medications...

Now back to the Pneumothorax question... How would you adequately assess someones risk for this? (MRI vs CT)? If I were suffering from Asthma, this would be the question I would ask...

Sal

 

[babar]

Ooops, I didn't see Doc's quote!

My concern would be, rather, the incidence of spontaneous pneumothoraces in persons with Asthma. Especially, in those who have a body habitus of tall and lanky.

I assume the incidence of PFO is the same in Asthmatics as compared to the general population. Also, her PFT's may be entirely normal at the time of testing, and Asthma being a variable disease may not rear its head till dive time. I guess the key is to stay on top of the controller medications...

Now back to the Pneumothorax question... How would you adequately assess someones risk for this? (MRI vs CT)? If I were suffering from Asthma, this would be the question I would ask...

Sal

At our chamber, we use a xenon washout scan. This is the V part of the VQ scan. In a patient with COPD, or bullous disease, this study can be used to quantify the degree of air trapping which MAY corelate to the degree of ventilation, if there is adequete and equal ventilation, there should be no delayed areas of uptake, and the contrast gas should washout evenly.
We have a form that we use to tell the radiologists specifically what we want to know when ordering this study, otherwise they just do a VQ, and interpret it as that. Of course if you just what to know about the presence of bullae or blebs, then a ct would probobly be better, and easier to get.

Cheers
babar

 

[DCROOK]

Like Deb, I also have asthma. I just passed a medical today. He asked me all the same questions that Deb posted. Basically, he said it is a personal thing that affects people differently. His big thing is if I was hospitalized over night because of asthma in the past 10 years. My case is somewhat mild. I only ever get tight if I'm doing strenous excercise for some period of time. His last piece of advice was to avoid diving if I had to use the puffer the same day of the dive. I did not need to go through all of the tests though...

 

[Deb In Venice]

Like Deb, I also have asthma. I just passed a medical today. He asked me all the same questions that Deb posted. Basically, he said it is a personal thing that affects people differently. His big thing is if I was hospitalized over night because of asthma in the past 10 years. My case is somewhat mild. I only ever get tight if I'm doing strenous excercise for some period of time. His last piece of advice was to avoid diving if I had to use the puffer the same day of the dive. I did not need to go through all of the tests though...

Congratulations on passing your medical! I'm glad to know the "grilling" is pretty standard.

I think that I am having the tests because 1) I've never seen this doctor before and he has not had access to my medical records 2) I have not been treated for my asthma on a regular basis since I was in elementary school in the 60's when I had allergy shots twice a week for about 2 years... ick! [the desert is my enemy] 3) I've never been on a regular medication like and inhaler. I take an OTC med for the few (usually cat related) attacks I have per year and he wants to make sure that's the right thing for me to continue to do and 4) since I specifically stated that I was asking for clearance to dive, he wants to make sure all the "t's" are crossed and the "i's" are dotted.

I go in for my electrocardiogram on Thrusday. I hope to schedule my PFT for the same day.

 

[Deb In Venice]

Well, today was Hoop #2 aka Echocardiogram with Bubble Study to R/O (PFO) bla bla bla bla bla

This is one of those flimsy paper gowns open to the front kinds of tests. After the paper gown, a saline IV was started in my right arm (their preference for this test). Then 3 electrodes were attached. I was told to lay on my left side, facing the technician, with my head resting on my left arm which was stretched above my head. The tech then began an ultrasound test in 3 locations on my chest. This was the only uncomfortable part of the test because she used a lot of pressure with the "probe" on some areas that were particularly tender for me. From time to time the tech would turn up the sound and I could hear my heartbeat. It works!

About half way through the ultrasound a doctor came in to perform the Bubble Study. He used a device that looked like 2 syringes connected together on a 90 degree angle. It appeared that he would draw a mixture of my blood and some of the saline into one of the syringes then he would aerate the mixture by passing it between the two syringes. He would have me exhale all my air and then bear down as hard as I could while he injected the mixture into my IV. We did this four times.

The Bubble Study was recorded on a VHS tape, so the doctor had the tech play all four tests back to see what happened. Of, course, I watched. He was looking to see if the bubbles would migrate from the right chamber into the left, which should not happen. If the bubbles migrate it means there is a hole that did not close when it should have in infancy. It seems that I fall into the category of the 15% of the population who do have that hole. The doctor said the hole did not appear to be very large but some bubbles did migrate so I do have one.

The doctor asked me why I was referred for the test and I told him that I wanted to scuba dive. He told me that as far as diving was concerned, if I should get the bends, it would probably be more severe than in someone who did not have a hole (very much what DocVikingo said in one of the links he gave me). He said I would really have to talk to my DAN doc, to find out exactly what the implications would be for me personally.

I asked the doctor how this hole effects my everyday non-diving life. He said very little, if at all. The reason they know that 85% of the population don't have this hole and 15% do, is mostly through autopsies. The one situation that could be dangerous is if I developed a blood clot that traveled from my leg to my heart. Depending on it's size it could pass through that hole (instead of going to my lungs) and cause a heart attack.

So, the bottom line is I have to meet with my DAN doc to discuss the test in detail. If he says, "Sorry Deb, diving is too dangerous for you", I'll live and be happy to just snorkel. If tells me I can dive but I'm limited to a certain max depth, I'll follow his instructions.

I still have one more hoop with my PFT (Pulmonary Function Test) to go through. I'll be back when I know more.

 

[GoBlue!]

...The one situation that could be dangerous is if I developed a blood clot that traveled from my leg to my heart. Depending on it's size it could pass through that hole (instead of going to my lungs) and cause a heart attack.

Nice description, Deb, of what a contrast echo is like. One point I'd like to make is that while you had it exactly right that depending on a PFO's size, a potential blood clot could travel from the venous side (usually the legs) to the arterial circulation, this usually won't cause a heart attack. It could cause a stroke or death of other tissues (e.g., gut, kidney, fingertips, etc.). It's pretty unusual for a clot to slip through a PFO & then slip down one of the coronary arteries coming off the root of the aorta. Instead, they usually fly up through the aorta to the carotids (feeding the brain), mesenteric arteries (feeding the gut), etc. Air bubbles, of course, can take that exact same path & cause the exact same ischemic damage...and that's why your DAN physician will need to review the echo results with you & help advise you for your future in the water (whether it be snorkeling or scuba!).

Best of luck,
Jim

 

[Deb In Venice]

Nice description, Deb, of what a contrast echo is like. One point I'd like to make is that while you had it exactly right that depending on a PFO's size, a potential blood clot could travel from the venous side (usually the legs) to the arterial circulation, this usually won't cause a heart attack. It could cause a stroke or death of other tissues (e.g., gut, kidney, fingertips, etc.). It's pretty unusual for a clot to slip through a PFO & then slip down one of the coronary arteries coming off the root of the aorta. Instead, they usually fly up through the aorta to the carotids (feeding the brain), mesenteric arteries (feeding the gut), etc. Air bubbles, of course, can take that exact same path & cause the exact same ischemic damage...and that's why your DAN physician will need to review the echo results with you & help advise you for your future in the water (whether it be snorkeling or scuba!).

Best of luck,
Jim

Hi Jim,

You are right about the stroke instead of heart attack. I was trying to write my experience from memory since I couldn't take notes and I'm sure I confused the results. Thanks for the correction!

And thanks for the good luck wishes.

 

[headhunter]

Hey Deb,

I'm sorry to hear about the PFO and hope that it doesn't keep you from being able to dive.

Of course, if it is something that would keep you from diving, then I'm glad you found out about it now. I don't think testing for PFOs is typical for clearing someone to dive for most of the major dive agencies, but I'm not entirely sure about that. Maybe it should be, but I don't really know.

Anyway, the important thing is to be safe above all else.

Do they ever repair PFOs? Just curious.

I'll keep monitoring this thread with great interest.

Take care.

Christian

 

[Deb In Venice]

Hey Deb,

I'm sorry to hear about the PFO and hope that it doesn't keep you from being able to dive.

Of course, if it is something that would keep you from diving, then I'm glad you found out about it now. I don't think testing for PFOs is typical for clearing someone to dive for most of the major dive agencies, but I'm not entirely sure about that. Maybe it should be, but I don't really know.

Anyway, the important thing is to be safe above all else.

Do they ever repair PFOs? Just curious.

I'll keep monitoring this thread with great interest.

Take care.

Christian

Thanks for your concern Christian,

I did some googling and some searching of the DAN archives and seems that PFO is not necessarily a contraindication for diving. DAN has done some preliminary research. Here is part of an article I found at this link: http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=50

We have examined with a two-dimensional echocardiogram 91 patients evaluated and/or treated for decompression sickness at Duke University Medical Center. Of these 91, 39 had PFO. Sixty-four of the 91 patients had more serious symptoms (weakness, dizziness or symptoms of brain abnormalities) and 32 of these 64 had patent foramen ovale (50 percent). This percentage is higher than one would expect in a normal population (10 to 20 percent).

Does this mean that the presence of patent foramen ovale may cause decompression illness? No, it does not. The data we have are merely suggestive. The number of patients we have checked is too small to draw any firm conclusions. One issue which needs explanation is that whereas 10 to 20 percent of the normal population may have patent foramen ovale, less than 0.1 percent of divers get the bends. In order to form firm conclusions, we must examine many more patients.

Also, the normal populations with which we are comparing our data have been obtained from other laboratories. In order to be absolutely certain of the relationship between patent foramen ovale and the bends, we must investigate many more patients with decompression sickness and also a group of normal volunteers in the same age range as our divers.

What should be done in the meantime? Nothing yet. Diving is a relatively safe sport. We recommend safe diving practices to make the sport even safer. If specific recommendations need to be made about testing divers for patent foramen ovale, we will make this known to you as soon as possible.

This article was from 1995. I haven't found anything more current (I'm still googling). My hopes are not yet dashed but I am a realist and if the DAN doc says "No" then away I go.

I'm not sure if this is the type of thing people have repaired if it is not causing problems in their everyday lives. I know I would NOT have surgery on my heart just so I could dive. Since, I haven't done ANY diving, the addiction has not yet taken hold.

I will keep everyone posted.

 

[Deb In Venice]

Today, I was finally able to have my PFT (Pulmonary Function Test).

If anyone is interested in the details of how the test is administered, please click here. This is not where I had my test but a great description of what the test involves.

I will not be able to go over the results with my DAN doc until Thursday the 19th but the tech said my lungs performed really well. He said, that in his opinion, based on the results, I could get by without letting the Scuba instructor know that I am asthmatic. Of course, I stated that even though my asthma is produced by allergens, I was afraid to be off diving somewhere where those allergens were more plentiful (L. A. is very good for me) and end up having a problem. He agreed with me.

BTW, I performed some of the tests before and after using an inhaler, which I've never used before, and didn't really notice any difference in my lung function.

So, I'll be back next week to report on the PFO and the PTF final results. Wish me luck!