Suffered DCS for the first time and terrified to dive again

[Duke Dive Medicine]

Thanks, Dr. Powell. That's our normal recommendation as well, i.e. don't have the PFO closed because the risk of complications related to the procedure is higher than the risk for DCS related to the PFO. I'm interested in farsidefan's procedure simply because we don't encounter too many divers who've had a PFO closed (though it sounds like that wasn't technically his diagnosis).
We once had a test subject in the Flying After Diving study arterialize some bubbles at altitude through a previously-unknown PFO. The inside tender happened to have the TTE probe in place and saw the bubbles cross, so the operator took the chamber back to sea level right away and the subject remained asymptomatic. It's interesting that these cases are some of the few instances in which we've actually seen bubbles cross a septal defect in an "operational" (vs. clinical examination) setting.

 

[FritzCat66]

I've played rugby, sailed, mountain biked, and even played D&D!

Well then, you should know real risk firsthand then, and understand that even the best and toughest of us roll a 00 now and again...

 

[FritzCat66]

In patients with global amnesia in whom Valsalva-like activities immediately preceded the onset of TGA, frequency of PFO was 55%, and 47% of these reported a precipitating activity (e.g., lifting heavy furniture, digging out the roots of a tree, strenuous defecation, filling a concrete mixer, and pumping bicycle tires) immediately before the TGA occurred.

Summary: PFO + Valsalva + Warhammer Maneuver = DCS very likely.

 

[Duke Dive Medicine]

Summary: PFO + Valsalva + Warhammer Maneuver = DCS very likely.

That's just wrong!

 

[farsidefan1]

You are correct, it was an ASD (aterial septum defect or whatever I have a card I now carry which identifies me as having this device. It is a Non-ferromagnetic/mri compatible to 3.0 OT manufactured by AGA Medical Corporation. The product family is Cribriform. If you need more description let me know.

 

[Dr Deco]

Hello Readers, mgmonk and FritzCat66:

TGA is short-term amnesia. It is a small stroke [although nothing is small if it happens to you]. It is caused by blood clots and DCS is caused by gas bubbles. The concept is related but bubbles have the characteristic of dissolving, something a blood clot is slow to do.

I do not know what the Warhammer maneuver is.

The formula is more likely:

Many bubbles in the venous return [and right heart] + Valsalva maneuver + PFO = possible arterialization.

Arterialization does not necessarily mean bubbles occluding the blood vessels of the brain and thus causing DCS. It is dose dependent. Most likely, the bubbles will [mercifully] pass over to the venous side if they are in a small volume.

Dr Deco :doctor:

 

[DandyDon]

The Warhammer maneuver is a dumb, sick joke. You're not missing any humor worth reviewing.

 

[bvanant]

I do not know what the Warhammer maneuver is.

You just don't remember. Your comments 10 years ago suggest that you just don't want to go there (and rightly so).
Bill:shocked2:

 

[Dr Deco]

Hi bvanant:

OK.... NOW I remember!

Do not want to go there....

 

[DandyDon]

It's called "potty humor" among elementary school teachers. Childish and good to forget. Bears crap in the woods, fish in the water, and people wherever needed. That some use the latter for shock value is so lame...