Possible PFO

[Helen Butcher]

Having just got back from the chamber, after frightening myself (and the rest of my club!) silly after getting bent 2 hours after surfacing this sunday (diving to 18.6m for 35min on 36% nitrox with a 5 min stop at 6m), i have been told that i may have a PFO.

Obviously i won't be diving until the doctors say its safe (minimum 3 months, and i need a full diving medical before they will let me loose again) and i will be filling in an incident report form, etc etc.

I am keen however to get worked up for a PFO asap, and would appreciate any recommendations as to how to go about this - so does anyone know what tests do i need to get done? do they have to be done by a diving doc? How do i go about getting at least the workup done asap - privately if necessary?
Any advice on how they fix these? How invasive/risky is surgery?

Any advice would be great as my club are slightly concerned that I might drive them all mad by the end of 3 months let alone 6-9months! I am going to continue training for the sports diver qualification and at least complete the theory, think i might try to persuade them to let me do the first aid and o2 admin courses within the club too(quite relevant now!) and they have threatened to make me boat handler for the next 3 months, and run a boat handling course, but I am going to run out of stuff to keep me occupied way too soon I think!

BTW my DO and TO were great - listened to my concerns, told me to ring the DDRC direct and drove me up to plymouth on 02 and 80% nitrox for assessment and recompression. Thanks to their solid training,confidence, and calmness in a stressful situation i got to the chamber having improved a great deal, and with a comprehensive summary of my symptoms and treatment, for which the doctor had nothing but praise!

[David Tombs]

Having just got back from the chamber, after frightening myself (and the rest of my club!) silly after getting bent 2 hours after surfacing this sunday (diving to 18.6m for 35min on 36% nitrox with a 5 min stop at 6m), i have been told that i may have a PFO.

Obviously i won't be diving until the doctors say its safe (minimum 3 months, and i need a full diving medical before they will let me loose again) and i will be filling in an incident report form, etc etc.

I am keen however to get worked up for a PFO asap, and would appreciate any recommendations as to how to go about this - so does anyone know what tests do i need to get done? do they have to be done by a diving doc? How do i go about getting at least the workup done asap - privately if necessary?
Any advice on how they fix these? How invasive/risky is surgery?

Any advice would be great as my club are slightly concerned that I might drive them all mad by the end of 3 months let alone 6-9months! I am going to continue training for the sports diver qualification and at least complete the theory, think i might try to persuade them to let me do the first aid and o2 admin courses within the club too(quite relevant now!) and they have threatened to make me boat handler for the next 3 months, and run a boat handling course, but I am going to run out of stuff to keep me occupied way too soon I think!

BTW my DO and TO were great - listened to my concerns, told me to ring the DDRC direct and drove me up to plymouth on 02 and 80% nitrox for assessment and recompression. Thanks to their solid training,confidence, and calmness in a stressful situation i got to the chamber having improved a great deal, and with a comprehensive summary of my symptoms and treatment, for which the doctor had nothing but praise!


I am in a similar situation. I developed a skin bend 8 hours after diving and am awaiting an Contrast EchoCardiogram to exclude a pfo. Its not just a matter of getting the test,it has to be interpreted properly to give a diving opinion. The most cited expert is Dr Wilmshurst in Shrewsbury. But you will have a long wait,as everyone goes to him.What may be possible is to get a n Echo done locally , privately, and see what the result is,and contact Dr W with the result. I am sure that the best thing to do is phone him,the number is in the list of medical refs on this site. Given the nature of what happened to you,it is better to get checked,rather than dive and not be able to walk. I am just as frustrated. I am a medic,with lots of info on this,if you wish e mail me.

[Helen Butcher]

I am in a similar situation. I developed a skin bend 8 hours after diving and am awaiting an Contrast EchoCardiogram to exclude a pfo. Its not just a matter of getting the test,it has to be interpreted properly to give a diving opinion. The most cited expert is Dr Wilmshurst in Shrewsbury. But you will have a long wait,as everyone goes to him.What may be possible is to get a n Echo done locally , privately, and see what the result is,and contact Dr W with the result. I am sure that the best thing to do is phone him,the number is in the list of medical refs on this site. Given the nature of what happened to you,it is better to get checked,rather than dive and not be able to walk. I am just as frustrated. I am a medic,with lots of info on this,if you wish e mail me.

Thanks for your reply - my club have been great and everyone has been really supportive, but no one else has been bent, had to sit in a pot for 3 sessions, or been stopped from diving - so its good to hear from someone who is in the same position. Fortunately our club has a really good safety record, and therefore unfortunately we don't have much experience of bends and where to go from here...
Any info would be great - i am a vet so kinda understand the whole pfo thing at least a bit but am just unsure of whats needed to make a diagnosis etc, and how to go about contacting Dr Wilmshurst! I will try and contact him through the site now - thanks.
As you say i am happy to be relatively unscathed after my bend though it was scary at the time, and don't want to be going diving yet if it will knowingly be putting either myself or my buddy at risk. i am keen to get the referral sorted asap purely because as you say i am probably going to have to wait a while to get the appointment and the sooner i can get things moving the better.

[Lynn Jackson]

After being poleaxed by a gas embolism in August (and waiting for the obligatory PFO test...)- are there any views on my wanting to go skiing in the New Year? My 3 months will be up by then - is it applicable to 'going up' as it is to 'going down'?

(Thanks to every every one from RRSAC btw; the hyperbaric Doc said that because of improved First Aid management of dive clubs he now gets to see either 'improving' or 'very serious' casualties, not that many in-between...)

[Helen Butcher]

my hyperbaric docs said the same - improved first aid by dive clubs, as well as good record keeping of first aid measures administered is making their decision making and treatment a lot easier...

I was told apart from not diving for 3 months i am also not allowed to fly, or climb mountains - made my TO laugh out loud when i said that didn't number among my hobbies! ~However, as far as i know it does apply to going up as well as down!

If in any doubt give your chamber a call they are always happy to give advice rather than treatment!

Helen

[Hannah Thompson]

Check out January '05's issue of dive. There's a really interesting and informative article on PFO's and aparently 1 in 3 divers has one!! That's a little scary and the bad news which i really don't want to tell you is that it can take up to a year if not longer to get the surgery required to put it right!! sorry.

But boat handling is really good fun - it's a great course - i drenched our boat under a massive wave when i did it, no one told me to slow slightly on the top of a wave!! oh, and i crashed it into the harbour wall!!

How about training for your rescue specialist!!

Good luck and i hope you get it all sorted out soon and are back to diving before you know it.

H

[Helen Butcher]

Check out January '05's issue of dive. There's a really interesting and informative article on PFO's and aparently 1 in 3 divers has one!! That's a little scary and the bad news which i really don't want to tell you is that it can take up to a year if not longer to get the surgery required to put it right!! sorry.
:
I found it very weird that this issue had such a spread on PFO's! It arrived on my doorstep along with a flurry of text messages from the rest of my club. Didn't contain anything we hadn't already found out, but it was nice to have this issue to back me up. At least I'm fashionably up to date!
I had gradually been picking up the long time frame this is likely to take as i went along - probably a good job they didn't tell me that at the time cos my bottom lip started to wobble when they told me i was booked off for 3 months let alone 12months! I've actually been told that the worst case scenario might be up to 6 months to get referred for the tests and up to 2 1/2 years to wait for the op if i have a PFO, depending on its size!

But boat handling is really good fun - it's a great course - i drenched our boat under a massive wave when i did it, no one told me to slow slightly on the top of a wave!! oh, and i crashed it into the harbour wall!!

looking to do my course in July, as there's one organised locally for then, but as we have a boat handling instructor in the club i've managed to get him to agree to give me tuition beforehand...sneaky!

How about training for your rescue specialist!!

Am already doing all the courses in rescue and first aid that i'm allowed to do, can't do practical rescue management and some of the others as you have to be a qualifed sports diver and i'm only a sports diver trainee!

Good luck and i hope you get it all sorted out soon and are back to diving before you know it.

Thanks - i'll keep this thread updated as soon as anything changes - the main hold-up at the moment is whether my primary care trust will pay for the tests - until they've made a decision i can't even be referred! If i've got to pay for it privately i'm going to be shafted! Can't afford the ?11,000 quoted in the BSAC article thats for sure ;-)

Helen

[Helen Butcher]

My primary care trust have just written to me to tell me they will not pay for me (?120) to go to have a pulmonary function test and echo with DR P Wilmshurst. Even though he is an acknowledged expert in PFO's in divers they say he cannot offer me any more than my local cardiologist.

Luckily i have managed to get BUPA cover because it was a single episode of DCI and is completely resolved. This covers me for DCI and associated predisposing factors ( at a cost of ?15 extra/month) because i do not have a diagnosis yet though i am statistically a lot more likely to have a PFO.

I am off to have a ruck with my doctor on friday, as i need a GP referral for my BUPA cover - ill let you know how it goes...!

In the meantime if you have the ability to get private health cover i would recommend it!

Helen

[Helen Butcher]

Had my NHS heart scan on friday, but as they had omitted to book the contrast bit of the contrast echo it was of very little use - being as this was their cock-up they have sent me through an appointment for monday 28th, so we'll see.

I went for my 3 month check at DDRC today and have been allowed back in the water(finally!), but been told to take it steady, cos there's still no definite reason as to why i got bent, until i get a answer on the pfo possibility!

I have to dive nitrox on air tables, and have as slow an ascent rate as possible, limited on depth to 20m, and 1 dive/day. i'm quite happy with this and am not planning on going any deeper than 10m anyway, I'M BACK IN THE WATER, and thats the important bit!

got my cylinder of 40%, and my instructors were on standby - so some pool time coming up on friday! Taking my instructors with me cos it'll help boost my confidence, and they're my good friends too!

[Helen Butcher]

PFO confirmed!

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At last a diagnosis - i have (and i quote) a "large" resting right to left shunt, and a "very large" shunt under valsalva provocation.
In some ways i'm really happy - at least there's a reason why i got bent on such a benign dive, and it's something i can get fixed, especially as i have BUPA cover ...however it's quite a mindblower to find out you have a hole in your heart which is shunting all the time even at rest, and not have had it picked up before, but only because i went diving - i've even had 2 general anaesthetics and nothing been queried!
The doctor wouldn't let me watch the scan cos i'm a vet and it might have affected how well i did what he asked me, cos i would have been watching the results rather than concentrating on what he was asking me to do...but he did let me watch the video afterwards, and gave me a pretty picture of all the bubbles in my heart(!) I feel like an expectant mother with a picture of her unborn baby on a scan - i keep pulling it out for people (mainly my dive buddies obviously) to have a look.
I knew there was a hole when he injected my fizzed up blood and said "oooh, thats impressive", at this point i turned and looked at him and said "so there's a hole then?!", and he replied "yep, pretty much".
Got an appointment with Wilmshurst this month sometime, he rang me at home on sunday evening (while the cave diving programme was on - he really does ring at odd times) , and it was reassuring that he asked me questions about my diving - everyone else so far has said "oh, you're a diver then" and not asked anything else - i feel like someone is finally relating my symptom(my bend) to my diagnosis...
allowed back in the water in the meantime, one dive/day, very slow ascent rates, diving richest nitrox mix possible on air tables, 20m max. Medical done by DDRC last tuesday - they didn't even ask if i wanted to dive again - Dr Bryson just said that i knew enough about physiology to decide whether i wanted to take the risk, said i needed to get the PFO angle checked and then said they'd be there for me when i need them! Nice people!
I've told my DO and TO (luckily they've been through this before with another club member) and we are currently deciding on a strategy for any future club diving, before any diving takes place with a view to ensuring i don't carry my own kit, safety checks with buddies a few hours after the event, etc etc, any suggestions gratefully received!

Helen