Saw a DAN Doc for Asthma Clearance

[Deb In Venice]

Saw the DAN doc today for the "final" okay to dive. I asked for and received copies of my test results. Here they are, "The Good, The Bad and The Confusing": (beware, doctor speak follows)

Echocardiogram

1. BUBBLE STUDY: Probable patent foramen ovalle with a small right to left shunt demonstrated after intravenous injection of agitated saline.
2. LEFT VENTRICULAR EJECTION FRACTION IS VISUALLY ESTIMATED AT 60%. Overall normal left ventricular function.
3. NORMAL LEFT VENTRICULAR CHAMBER SIZE. The left ventricular end diastolic dimension is 5.2 cm., with a left ventricular end diastolic diameter index of 2.8 cm./M sq.
4. NORMAL LEFT ATRIAL SIZE. The left artirial dimension is 4.2 cm
5. THE CARDIAC VALVES APPEAR ANATOMICALLY NORMAL.
6. THE DOPPLER EXAMINATION IS UNREMARKABLE.

Pulmonary Function Tests

Spirometry: Spirometry is within normal limits.
FEV1=2.28 liters (100% of the predicted value) and FVC=2.92 liters (107% of the predicted value). FEV1/FVC ratio is normal.

Flow Volume (FV) Loop: No significant expiratory flow limitation.
Bronchodialator Response: Following the administration of Albuterol by inhalation, there was no significant improvement in the FEV1 or FVC.

Lung Volumes: The lung volumes are within normal limits.

Diffusing Capacity: (DLCO) is within normal limits.

Intrerpretations: Essentially normal pulmonary function tests.

Believe it or not, according to the DAN doc, all that info is good news. My lungs are good and he says I CAN dive with PFO. I have no heart murmur (which I also had my endocrinologist listen for). BUT not shown on the report of my PFT is the fact that my Diffusion Capacity is on the high end of normal and maybe a bit above. This Diffusion Capacity could be an indication of a "Septal Defect" aka a hole in my heart.

To the best of my understanding the difference between PFO and a Septal Defect is this; PFO openings occur when the flap in the septum opens due to a pressure increase that is higher in the right chamber than the left... kind of flaps open and closed; a Septo Defect is all open... all the time.

I'm sure someone will correct my definition if I've gone too far off the mark.

Anyway, I'm seeing a cardiologist on Monday to confirm that I DO NOT have a Septal Defect, if I do, diving will be off the menu for me. So, PFO is okay and Septo is a no go.

These DAN docs don't let anything slip by. The doctor did assure me that after if I clear this next consultation, he will fax a clearance letter to the dive shop of my choice.

So my soap opera saga continues. I'll be back when there is more to tell.

 

[Deb In Venice]

Lucky for you, it sounds like you have very rare attacks. Should you have more, please make sure your primary care physician treats your asthma appropriately.

Jim

Hey Jim,

As an update, the doctor gave me a sample of Advair and a prescription for Albuterol. They are to be used only if I have an attack.

He also wants me to pick up a Peak Flow Meter. I'm to check my flow before a day of diving and if I fall 15% or more below normal, I am to stay out of the water.

See... I'm being good!

 

[Deb In Venice]

ctrl+alt+del

 

[headhunter]

Saw the DAN doc today for the "final" okay to dive. I asked for and received copies of my test results. Here they are, "The Good, The Bad and The Confusing": (beware, doctor speak follows)

Echocardiogram

1. BUBBLE STUDY: Probable patent foramen ovalle with a small right to left shunt demonstrated after intravenous injection of agitated saline.
2. LEFT VENTRICULAR EJECTION FRACTION IS VISUALLY ESTIMATED AT 60%. Overall normal left ventricular function.
3. NORMAL LEFT VENTRICULAR CHAMBER SIZE. The left ventricular end diastolic dimension is 5.2 cm., with a left ventricular end diastolic diameter index of 2.8 cm./M sq.
4. NORMAL LEFT ATRIAL SIZE. The left artirial dimension is 4.2 cm
5. THE CARDIAC VALVES APPEAR ANATOMICALLY NORMAL.
6. THE DOPPLER EXAMINATION IS UNREMARKABLE.

Pulmonary Function Tests

Spirometry: Spirometry is within normal limits.
FEV1=2.28 liters (100% of the predicted value) and FVC=2.92 liters (107% of the predicted value). FEV1/FVC ratio is normal.

Flow Volume (FV) Loop: No significant expiratory flow limitation.
Bronchodialator Response: Following the administration of Albuterol by inhalation, there was no significant improvement in the FEV1 or FVC.

Lung Volumes: The lung volumes are within normal limits.

Diffusing Capacity: (DLCO) is within normal limits.

Intrerpretations: Essentially normal pulmonary function tests.

Believe it or not, according to the DAN doc, all that info is good news. My lungs are good and he says I CAN dive with PFO. I have no heart mummer (which I also had my endocrinologist listen for). BUT not shown on the report of my PFT is the fact that my Diffusion Capacity is on the high end of normal and maybe a bit above. This Diffusion Capacity could be an indication of a "Septo Defect" aka a hole in my heart.

To the best of my understanding the difference between PFO and a Septo Defect is this; PFO openings occur when the flap in the septum opens due to a pressure increase that is higher in the right chamber than the left... kind of flaps open and closed; a Septo Defect is all open... all the time.

I'm sure someone will correct my definition if I've gone too far off the mark.

Anyway, I'm seeing a cardiologist on Monday to confirm that I DO NOT have a Septo Defect, if I do, diving will be off the menu for me. So, PFO is okay and Septo is a no go.

These DAN docs don't let anything slip by. The doctor did assure me that after if I clear this next consultation, he will fax a clearance letter to the dive shop of my choice.

So my soap opera saga continues. I'll be back when there is more to tell.

OK... so no bad news is good news.

We'll look forward to you coming back and telling us that the cardiologist says there is no Septo Defect and then Whoohoo! Look out! Make way! There is a new diver in the ocean!

To quote the words of Jean Luke Picard: Make it so!

Christian

 

[GoBlue!]

Deb-

Glad to hear it. Your test results look great. Good luck with the cardiologist.

Advair is a combination of salmeterol (a long-acting beta-agonist; i.e., a longer-duration albuterol, essentially) & fluticasone, an inhaled steroid. The steroid acts on airway inflammation, which is really the root cause of asthma. To be effective, it has to be taken every day regularly. Since salmeterol is not a fast acting bronchodilator, it's not a "rescue" medication either. So, Advair is the type of an inhaler that should be taken daily (or twice daily) whether symptoms are a problem that day or not.

Now, in your case, you have very few attacks....so, perhaps your doc was suggesting that you only take Advair regularly during the time of year, etc. when you tend to have problems. You may want to clarify that with him next time you meet.

The albuterol, on the other hand, is your "rescue" inhaler. That's the one that you should carry with you; it's fast acting, but may only last a few hours. If you're not familiar with how to use an inhaler, make sure you get taught. One of the most common reasons that I've noticed people have less than adequate asthma control is that they're using the inhaler wrong, OR they're puffing an empty inhaler (you'll see mist even if the drug is gone...the propellant remains... One trick is to pull out the canister & drop it in water; if it sinks, it's full; if it floats, it's empty!). If you find yourself using albuterol more than a couple times a week (without an exertional trigger), your asthma is less than ideally controlled & your other inhalers/meds should be adjusted.

Glad to hear you're on the right track, and I sincerely wish you the best! Hope to hear a good word from the cardiologist!

Jim

 

[Deb In Venice]

I just got back from the cardiologist. He works out of the same facility where I had the echocardiogram that revealed my PFO.

He says that I should NOT dive. It seems I don't have a plain old run of the mill PFO. No... I have a special kind... the kind that is labeled bi-directional. That means instead of the blood ocassionally flowing just from one side to the other through my little PFO hole, it can flow back and forth, which is a very bad thing. Not too bad for my normal day to day living, but made dangerous by diving depths that are deeper than the normal snorkeler would go. Though the odds are still low of having a problem with diving, they are greater for me than someone with a "one-way" PFO and certainly greater than someone without PFO.

The docotor confirmed that the hole is very small and he does not recommend surgery. Other than that, he feels my heart and arteries are in good shape.

I made a promise to myself that I would not endanger my life to dive and I won't (don't want to end up on the "Accidents and Incidents" board ). So I am taking my dive class money and buying myself a new road bike.

Thanks everyone for your support and good wishes. I hope this thread will help someone else in the future.

I'll always be a dive groupie. Everyone, please be safe.

 

[GoBlue!]

Deb-

Sorry to hear the end result, but sounds like you'll enjoy a life of cycling & snorkeling! There are plenty of reefs that can be explored by freediving.

Jim

 

[headhunter]

I just got back from the cardiologist. He works out of the same facility where I had the echocardiogram that revealed my PFO.

He says that I should NOT dive. It seems I don't have a plain old run of the mill PFO. No... I have a special kind... the kind that is labeled bi-directional. That means instead of the blood ocassionally flowing just from one side to the other through my little PFO hole, it can flow back and forth, which is a very bad thing. Not too bad for my normal day to day living, but made dangerous by diving depths that are deeper than the normal snorkeler would go. Though the odds are still low of having a problem with diving, they are greater for me than someone with a "one-way" PFO and certainly greater than someone without PFO.

The docotor confirmed that the hole is very small and he does not recommend surgery. Other than that, he feels my heart and arteries are in good shape.

I made a promise to myself that I would not endanger my life to dive and I won't (don't want to end up on the "Accidents and Incidents" board ). So I am taking my dive class money and buying myself a new road bike.

Thanks everyone for your support and good wishes. I hope this thread will help someone else in the future.

I'll always be a dive groupie. Everyone, please be safe.

I'm very sorry to hear that you won't be able to dive, although I'm very glad to know that you did the research and that you'll be safer as a result.

We look forward to seeing you in the future as a dive groupie!

Take care,

Christian

 

[Kayla]

Better safe then sorry. Sorry to hear that you won't be diving.... but I hope that you continue to post on that boards.

Good luck with everything in the future!


Kayla

 

[Deb In Venice]

Thanks everyone!

This board is addictive, so I will continue to read and maybe post from time to time.

I'm still very interested in the sport even if I can't play.