"Undeserved" DCI

[srhein]

I understand that the table is worst case, and doesn't reflect average depth, but the limited information available indicates that they were closer to the limits with their dives than they might have realized. My hope is that they used something (tables, computer, whatever) between their first and second dives.

 

[TSandM]

I agree that Dr. Deco is not the go-to guy for specific cases, but he IS a good person to ask about the research involving pre-dive exercise and DCS.

 

[Karibelle]

There are lots of relatively square profile dive sites on Cozumel... before assumptions about multi-level profiles, it would be good to know which sites were involved on this day.

 

[JTemple]

The dive profile and symptom onset are suspicious for a patent foramen ovale (PFO). It would be very reasonable to have him tested. This typically involves either a transthoracic or transesophageal echocardiogram with bubble contrast.

Being a now ex-PFO diver with an [-]un[/-]explained hit (since I firmly believe the PFO explained it 100%!), it's the first thing that came to my mind when I read the OP!

 

[DandyDon]

The last DAN magazine article on PFOs I read had a number of opinions, and really - they weren't sold on PFO as a common cause, nor a condition to invasively test - much less repair. (Google says I just created a word? ) The jury is still out.

The dive & depth times posted are not exactly conservative for square profiles. I'd really like to see dive computer downloads if possible.

 

[Quero]

Don, I've had two divers with confirmed PFOs after accidents in the past 18 months. Both had the defect repaired on recommendation of their dive medicine and heart specialists after full reviews of their cases. One of these divers stroked, and the other got a bend. Both have returned to diving. You might think that these are isolated cases, but I don't have many divers who get injured, so for whatever reason these two have both been diagnosed with PFO. My own experiences with my divers would therefore lead me to encourage the victim to at least explore the possibility rather than discourage it. In addition, I have had the PFO test myself after the dive doctor here recommended it (skin issues after dives that turned out not to be nitrogen-related, but as I am a migraine sufferer, the doc thought it would be prudent to check anyway). I can say that the procedure for testing for a PFO is not especially invasive though it is uncomfortable to have that camera inserted through the trans-esophogeal path. The decision to close a PFO or not cannot even be considered until a diagnosis has been made. Therefore, I would encourage the victim to bring up the possibility with the medical specialists working on the case and discuss the wisdom of doing the test in light of their analyses.

 

[DandyDon]

I would encourage the victim to bring up the possibility with the medical specialists working on the case and discuss the wisdom of doing the test in light of their analyses.

Sounds like a good approach. Some suggestions do seem more aggressive at times, I think.

For this case as stated tho...

The dives were both around 20 meters, 45 minutes in length, SI of 50 minutes...

Is not conservative diving at all - quite off of the Padi dive chart if I remember how to read one. The divers may have done multi-level dives with dive computers that stayed in green zones, but we just have not been given the info. And I see plenty of Cozumel divers not using computers, never looking at charts, simply following the DM's plan expecting it must be a safe one.

Additionally, with regard to...

slightly elevated blood pressure (is on medication for this)

He might want to discuss not using the med on dive trips. I suspect it is a diuretic, and might encourage dehydration. Not the first time I've heard of such leading to a hit.

 

[Hatul]

deleted

 

[Duke Dive Medicine]

The last DAN magazine article on PFOs I read had a number of opinions, and really - they weren't sold on PFO as a common cause, nor a condition to invasively test - much less repair. (Google says I just created a word?

) The jury is still out.

The dive & depth times posted are not exactly conservative for square profiles. I'd really like to see dive computer downloads if possible.

Don,

It's true that PFO has never been named as a proximate cause of decompression illness, but it is definitely correlated with a few things, some of which are sudden-onset severe neurological decompression illness after dives that were mildly provocative but within the no-stop limits. This description appears to fit these dives. Maybe I'm assuming too much, but if these had been square profiles, I'd think that the original title of the post would have been something like, "We blew our decompression and my husband got bent." I agree that it would be interesting to see the dive profiles, though.

At any rate, I would not categorize the test for PFO as "invasive". In the lectures and presentations given by our own Dr. Richard Moon, he states that a transthoracic echocardiogram with bubble contrast is sufficient to detect a clinically significant PFO. This involves an IV line and an ultrasound probe on the chest. Some cardiologists choose to do a transesophageal echo, which is entirely appropriate and only mildly uncomfortable.

PFO repair is another matter. Depending on where it's done and what type of device is used, the risk of complications can exceed the risk of DCS. For divers with a PFO, the decision to have it repaired should be a well-educated one and should be made in careful consultation with a diving medical specialist and an interventional cardiologist.

He might want to discuss not using the med on dive trips. I suspect it is a diuretic, and might encourage dehydration. Not the first time I've heard of such leading to a hit.

I don't agree with this statement. There are a number of medications that are used to control blood pressure. And among risk factors for which the jury's still out, dehydration is up near the top of the list.

Best,
DDM

 

[Chuckitall]

I'm not a medical person, but a serious diver. Observed experience, my wife had DCS signs (skin bends and headaches) after many dives for several years. I am also acquainted with two other women divers with several DCS problems over several years. All three divers were tested for PFO by Dr Ebersole (Lakeland , Fl) and found to have the condition. All had the PFO repaired by Dr E and returned to diving. All are very serious and do very deep and working dives (hunting). None that I know of have even had a complaint of not feeling well after a dive. Two of them even had chamber rides prior to repairs. MY experience with them is at least get checked for the possible condition. Any one of the divers would be more than happy to talk to your husband for more info.