"Undeserved" DCI

[pensacolaracer]

I noticed you mentioned your husband has slightly elevated blood pressure and is on medication for this.

FWIW, Tobin (cool-hardware52) on the Deco Stop was kind enough to give a VERY detailed recount of his recent unanticipated DCS hit. And although it has been a while since I have read through his entire post, I seem to recall he thinks the high blood pressure medication (Diovan) had a lot to do with taking the hit. Not sure what your spouse is on, but might be worth taking a look.

Link below, but I think you need to be a member to see it. Not sure if we are allowed to cross post from other forums, so if you can't see it and a mod gives me the go ahead, I will copy and paste.

The Deco Stop

 

[bleeb]

I noticed you mentioned your husband has slightly elevated blood pressure and is on medication for this.

FWIW, Tobin (cool-hardware52) on the Deco Stop was kind enough to give a VERY detailed recount of his recent unanticipated DCS hit. And although it has been a while since I have read through his entire post, I seem to recall he thinks the high blood pressure medication (Diovan) had a lot to do with taking the hit. Not sure what your spouse is on, but might be worth taking a look.

Link below, but I think you need to be a member to see it. Not sure if we are allowed to cross post from other forums, so if you can't see it and a mod gives me the go ahead, I will copy and paste.

The Deco Stop

I haven't seen the Deco Stop thread, but Tobin posted one incident here on SB in the Accidents & Incidents forum, which might be the hit you're talking about: Bent!

 

[pensacolaracer]

Yup, thats it. Thanks. I guess its obvious where I spend most of my time.

 

[Johnoly]

... Keep in mind that stroke kills one third of victims, so the potential complications associated with PFO repair versus the mortality rates of stroke victims makes for an entirely different argument than repairing a PFO only to be able to continue diving..

Excellent post Quero !! And just one more thing to add is that in almost all cases where a PFO is present, the opening(s) tend to get larger with age. Thus increasing the chances of stroke as you mentioned. PFO is not just about a diving concern, it's much more about a stroke concern and a major loss of mobility. After 3 of my dive friends had their PFO's repaired by SB's Debersole, I had myself checked for PFO also(negative)

 

[DandyDon]

Excellent post Quero !! And just one more thing to add is that in almost all cases where a PFO is present, the opening(s) tend to get larger with age. Thus increasing the chances of stroke as you mentioned. PFO is not just about a diving concern, it's much more about a stroke concern and a major loss of mobility. After 3 of my dive friends had their PFO's repaired by SB's Debersole, I had myself checked for PFO also(negative)

So, since 25% of the population has PFOs, would you support testing everyone - and repairing all found?

Or would you at least test every diver who has had DCS...?

 

[Quero]

So, since 25% of the population has PFOs, would you support testing everyone - and repairing all found?

Or would you at least test every diver who has had DCS...?

I am in no position to make such recommendations nor to discourage such testing. My point is simply that if during the course of the investigation of a diving accident for which the presence of a PFO might be a factor, testing for this defect is a logical option to consider. And if one is found, making a decision about whether or not to repair the defect would likely weigh factors beyond the effect on future diving. A doctor and a patient may decide that the incidence of stroke as a result of PFO is so small in the general (non-diving) population that testing is unneccesary. Or a doctor and a patient may decide that the lifestyle of the patient warrants testing. Testing was recommended for me as an individual, but a different patient could receive an entirely opposite recommendation.

 

[DandyDon]

There does seem to be a PFO bandwagon on SB at times. It may well be a good idea in some cases to test, or maybe talk with different specialists about the idea. The case that started this thread looks more like violating NDLs.

For anyone considering a PFO test, I think it'd be good to read the most recent DAN magazine article in its entirety. Alert Diver | PFO and Decompression Illness in Recreational Divers One excerpt for example...

Bove: I would not recommend PFO closure in any sport diver, whether or not the diver had a DCS incident. The noted incidence of DCS in recreational divers is between two and five cases per 10,000 dives (0.02 percent to 0.05 percent). The serious complication rate for PFO closure, as noted in Dr. Douglas Ebersole's comments, is 3-4 percent, more than 100 times the risk of experiencing a DCS event. It is clear that the risk-benefit ratio for PFO closure in divers strongly favors not closing the PFO. Further, the presence of a residual PFO after closure is significant, up to 30 percent in some studies.

 

[Johnoly]

....Or would you at least test every diver who has had DCS...?

Insurance companies won't pay tests on everyone, even with a confirmed DCS hit. But an educated diver who has had red blotchy skin bends, migrane with aura, and even a chamber ride, should seriously consider having a T.E.E. even if they have to pay for it out of their own pocket like I did. If a diver does take a hit, at a minimum I think they should do a T.T.E. I dive every weekend, but many people are once a year vacation divers who could give up diving. Knowing the results, in my opinion is worth the out of pocket costs.

 

[Ayisha]

I think the point that a few people have been trying to make is that it is between the doctor and patient how to proceed once a PFO is suspected. PFO testing or closure is not something that should be recommended or dissuaded here. It is a medical decision that should be made in consultation with a physician.

 

[BubbleBlocker]

I think the point that a few people have been trying to make is that it is between the doctor and patient how to proceed once a PFO is suspected. PFO testing or closure is not something that should be recommended or dissuaded here. It is a medical decision that should be made in consultation with a physician.

Very much agreed. I'm one of the 3 divers Chuckitall and Johnoly referenced. You can see my whole account (from progressively worse symptoms over my 20 years of diving, to investigating PFO, to chamber rides, to closure) here: http://www.scubaboard.com/forums/ma...s-other-adventures-dcs-pfo-migraine-aura.html .

After years of relatively mild symptoms that I kept ignoring (migraines with aura, mottled skin (aka skin bends) and pain in my upper arms that would subside over a period of days) I finally went to see a cardiologist to request a TEE back in 2008. The cardiologist was unfamiliar with diving/DCS but agreed that what I was suggesting regarding the cause of my symptoms was a reasonable possibility. However, he discouraged me from having the TEE, telling me 1. it was invasive (as others have said, it's a stretch to consider it as such), and 2. there was no point in knowing whether I had a PFO unless I planned to stop diving since my insurance would not cover me to fix it unless I had 2 strokes. As it turned out, that initial cardiologist was wrong on both counts. My insurance paid for pretty much every penny of my surgery. And even if it hadn't, I still don't think I would have hesitated on the closure - not just because I wanted to continue diving, but because I felt like a ticking time bomb waiting for a premature stroke. As it turned out, I was very lucky to be a diver. Otherwise I might never have known just what bad shape my heart wall was in (Dr. Ebersole described it as 'swiss cheese').

I'm not a proponent of testing every single diver, but I think PFO/ASD is something worth investigating when there's no explanation for a hit, particularly when there are repeated hits. In hindsight, I waited much too long. I was lucky my years of denial didn't ultimately lead to my death, and all of my symptoms from the hit immediately prior to the closure were resolved with multiple chamber rides.

These days I spend part of my time diving the walls off East End in Cayman, doing deep dives daily sometimes for periods of several weeks at a stretch. Despite hundreds of dives since the closure I've never had a single instance of the symptoms that used to be so routine for me: no migraines with aura, no vertigo, no pain in my shoulders, breasts or upper arms.