PFO and still diving?

[MarjoleinBubbles]

Hi,

This is Marjolein and I have a question that is on my mind for a while.

Are there divers amongst us who know they have a pfo but are still diving??

Background: I am a dive-instructor. I have had two Skin Bends (in about two years), they tested me on pfo and found one. That was in january 2006. Since my last deco I didn't dive anyore.

I really want to dive and I am doubting between the operation and just recreational diving once in a while. If recreational diving is possible, I am not going for an operation, unless I really want to work as an instructor again.

With this thread I like to find people who are diving although they have pfo.

Marjolein

[Chris Cherrington]

As about 30% of folk have one I guess many of us dive with a PFO.

The issue is one of risk mamagement. How severe is the opening? What is the likleyhood of severe DCI.

The PFO lets bubbles shunt from one side of the heart to the other. Thus the risk of a gas embolism in the arterial flow to the brain is drastically increased. A brain hit will paralyse or kill you whearas a skin bend or joint bend is easily treated.

If it were me I would get it sorted and go back to doing diving to whatever level you like. The operation is a very easy one - the patch is inserted through the blood system. Its not like open heart surgery or anything like that.

I'm happy to take the risk of regular DCI but AGE is scary. I couldn't trust myself with the diving either. It would be like an alcoholic and "just one beer"... 10 meters max on EAN36... then you think this is OK - I'll do 15m.. then 20...

Chris

[Helen (AKA Hellvet)]

It was never a question for me as to whether to have the hole fixed once i knew it was there. I know several other people with PFO's some of whom have had the septal occluder op, and some have not(though some of these are waiting for the op). All of them are diving, some with a restriction and some with none. The restrictions vary from diving on nitrox, to diving with a max EAD, or a max absolute depth, and some who are back to diving with no restrictions.

I was diving both pre and post op with restrictions, which have been different at different times... Pre-op i was limited to one dive/day, 10m depth (as my EAD was 13.2m for my first bend so Dr Wilmshurst brought my depth limit up to 10m), slow ascents and diving nitrox on air tables, which i stuck to religiously with no problems. Post op i initially started diving on one dive/day, nitrox on air tables etc, and the conditions have varied along the way according to my medical restrictions, but i've stuck to the restrictions of each medical in turn with no problem.

I think you can either cope with diving with restrictions or not - i have coped with diving being restricted to 10m, and not been tempted to go past it - but then i've been for 2 chamber rides due to my PFO and desperately i don't want any more. I found the last one very difficult and would really struggle to go back in the chamber for treatment (I do know the only way to guarantee this is not to dive!). I also am not bothered by diving deep, i just want to be breathing underwater, so if i ever get my health sorted and they ever let me back in the water i'll happily dive to whatever restriction they give me. Lots of people have said to me they couldn't cope with restricted diving, but until the choice is no diving or restricted diving thats a hard call to make!

Helen

[SarahB]

Hi Marjolein

I have just been diagnosed with a large PFO after 13 skin bends. I have been diving for 10 years now and plan to continue diving, albeit with restrictions. I do not intend to have the operation to close the PFO. I was told (Dr P. Wilmshurst) that I could avoid serious DCI by keeping my diving to a max. depth of 15m, no deco, on air tables. If 15m was too restrictive I could use the equivalent air depth on nitrox (i.e. 24m on 40%), also on air tables and no deco. He has never seen any diver present with DCI within those limits.

Given that I have been diving very conservatively for the last 2 years anyway (30m on 32%, air tables, no deco) I find this an acceptable solution for me (those 2 years were relatively DCI free). I am happy to further restrict my diving to 24m on 40%. It means that I need to become even more disciplined (you get used to it!). I find that diving on rich nitrox mixes helps to ensure I am not tempted to break my depth limits (added risk of O2 hit is too much). In addition my diving buddies are usually anxious to ensure no harm comes of me, so if I momentarily forget where I am or how long I've been there they are pretty quick to remind me :)

Best of luck with whatever you decide
Sarah.

[Rhodus Aquanaut]

Hi Marjolein,

I am sure it was a long and hard decision to make to abstain from diving until you PFO gets sorted out, for you and also those you dive with.

I would tend to agree with Chris. Currently as you are with a PFO and the possibility of diving, it is a potential time bomb waiting to go off.

Skin rashes are the warning, push your luck just that once too far and the outcome may not be as lucky.

Diving in general does have its own risks, add to that an increased risk of DCI or worse and time will eventually tell.

In water instructing to students, especially where saw tooth profiles may be expected, ie CBL, AAS Ascents, even just that once too often, could be just enough and too great of a risk to add to trainee students at any level.

My personal advise would be to take whatever advise necessary and consider going for the op. The alternative is to hang up you fins and say a hard goodbye to really enjoying diving to its best, always with the doubt in the back of your mind, is this the time it may not just be a skin bend.

You have taken a hard, but wise decision, you have wayed up the risks involved, not only for you, but also for the others you dive with and are now looking make the best decisions for everyone concerned.


How many others are out there diving and have had the warnings and still dive on time and time again, until the day that it is no longer a skin bend and others around them are left to deal with the aftermath. Never forget DENIAL is the greatest risk with any DCI.

Don't forget that although a skin bend is classed as a minor DCI, it can also be present in more major DCI incidents.


I wish you the very best of luck and a speedy answer to your PFO and a full return back to diving.

[Chris Cherrington]

EAD - equivalent air depth (for the benefit of our BSAC readers..:D)

http://en.wikipedia.org/wiki/Equivalent_air_depth

Chris

[Andy T]

In addition my diving buddies are usually anxious to ensure no harm comes of me, so if I momentarily forget where I am or how long I've been there they are pretty quick to remind me :)

Sarah.

Really? must try and remmebr that the next time I am diving with you! Mental note to self - remember buddy! Bring her back! DOn't do something stupid. Right, that covers everything!

Honestly Sarah, great to hear that you are keeping up the diving. The rumour mill her in Dublin was beginning to fly that you were giving it all up to take up needlepoint!

My opinion pretty much agrees with Sarah on this one. Dive within medical advice. If they say fifteen metres, then stick to fifteen metres. Nitrox 40 means Ntirox 40!

Make sure that your buddy knows that you have a depth/time limit that CANNOT be broken. If they say they never want to dive with you becuase you restrict their depth or other such crap, then you are probably better off not diving with them anyway.

With regard to instructing, fine, you can't teach deeper skills but there is no reason you can't keep teaching. I get a real thrill from teaching novices in 10m of water! The enjoyment on their faces is great. In fact (and yes, it hurts me to say this) Sarah was training officer when I started diving (many years ago now ... ok, six) and was (and is) one of the best instructors that I know.

So don't give up diving, don't give up instructing, just take it easy and obey the best medical advice you can get!

Andy T

[judithbodkin]

There was a guy from my Club went on holiday with 3 other friends. They were
out on one West Indian Islands can't remember which one. This was 2 years ago. Within 20 mins of being back on the dive boat he was unconscious with a spinal bend. Several phone calls later and trip to the local chamber not sure how long for.

But on his return to England he then went to Whipps Cross and had several more
sessions in the chamber with Danny. It turns out this guy had a PFO and since
then has had the operation and also had a full medical and passed to dive.

I don't believe there any restrictions. Plus this guy has dived again. This guy was very lucky it could have been a lot worse.

[Josepherely]

Marjolein
Lots of good advice above. The Question on whether to have the hole closed is a difficult one, although the perceived wisdom in the UK is to go for it, easy & no harm, this is not proven medically. Also it is not a guarantee that the op will close the hole. The long term effects are not known as the op/devices have not been around long enough. Having to be concerned about an infection in your heart for the rest of your life is worrying

I am still diving with a largish PFO, my philosopy is to avoid having bubbles post dive .... easier said than done, however moving over to a closed circuit rebreather is part of this and having long extended deco stops. Also if diving deeper I have switched to using heliox :eek: (which may sound paradoxical, but it is better gas for deco - easier in and easier out...)

Chris highlights the real problem, what sort of person are you, one like Helen who will follow the rules or someone who will push it a bit.

Also although a skin bend may be classed as "benign" you don't know what damage is being done to your brain or bone structures silently. Bubbles bad enough to manifest as a skin bend due to a PFO are all BAD :(

Good luck, but it is a hard decision

Joe

[Steve Summers]

Hi Marjolein,

Some excellent advice above, I find this article very useful http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=70

I may or may not have a PFO, as will 1 in 3 divers apparently, as the above article alludes to, diving with a PFO is a slight risk and the larger the hole presumably the bigger the risk, but it cannot be the 'smoking gun' many divers believe it to be otherwise the chambers would be inundated with bent divers every day.

Last year on my 560th dive with a profile that was classed as 'unprovocative' I suffered a vestbular bend, now according to research, 9 out of 10 divers who get this have a PFO, when I spoke to the chamber about this they said AFATWC a test for PFO would be my choice, but they do not screen their clearence divers and nor do commercial divers AFAIA.

Interestingly they said that if I was tested and found to have one,what would I do? and the choices were give up diving, have the occluder fitted, [and despite people saying that it is a simple proceedure it does have a mortality rate] with no 100% assurance that it would prevent bubble flow, or DCS, or change the way I dive to minimise the risk, I have chosen the latter without having the test, this works for me but I can understand the above posters views.

ATEOTD it is all about personal choice and risk management no one can make a decision for you, but I can say that this year I have undertaken many deeper dives with longer deco' than the one that bent me, without incident [touch wood]

I dive the best nitrox mix possible with dives planned on v-planner + 5 conservatism instead of the +2 default setting, I don't excercise or exert before during and after the dives, and avoid strenous valsalva manouvers, in addition to hydrating with isotonic drinks pre and post dives.

I have taken baby steps and have worked back up to my qualification depth of 50m, although I will say your confidence IME takes longer to heal than your body.

Good luck with whatever decision you make.

ATB,
Steve

[iain aitchison]

Hi Marjolein,

apparently about a third of all of us have a PFO - of some size. Many of these PFO are irrelevant in size.

About a third of all neurologicial DCI cases leave the diver unable to work, about a third are fatal, only one third are recovered to reach freedom from after effects.

If you have a PFO you should inform yourself in detail about the risks and the degree of the PFO you have.

Diving defensively - well hydrated, suitable mixes, ruthless choice of idealised dive profiles, defensive stops, slow ascents, comfortable deco, well slept, warm, fit, focussed, concentrating on buoyancy etc. and you may find that this is enough to be safe. Particularly ascending from the maximum depth and not redescending thereafter and reaching that maximum depth as early in the dive as possible for as little time as possible seems to be beneficial in preventing DCI.

DCI is more serious, more common, less understood, and is more often denied than most divers or indeed instructors will ever admit. Most divers have had at least subclinical DCI and only a few admit it openly. Despite this they often continue to dive.

My personal opinion and I am not a hyperbaric doctor is that the dive profile and the control of the ascent is much more critical to the sucess of the deco - particularly if you have a PFO - than many textbooks suggest. This becomes more critical the higher the gas load becomes. Sloppy buoyancy control and excessively fast final ascents are critical in provoking DCI and these are a common features of many ascents.

One of the most disturbing sides to DCI is that we may realise later that we have had DCI and that since and because we had it has exacerbated or generated injuries which become apparent many years later. These may effect our everyday lives.

A very minor PFO is not in my opinion a reason to stop diving, but it is an opportunity to become very well informed about the risks being taken and to avoid in every dive the other known provocations of DCI as far as can be made possible.

Many only know if they have a PFO because they have been tested for it after a full medical treatment for DCI.

regards
Iain

[Michaela]

Hi, I am totally new to the subject of a 'pfo' as it has only been mentioned to me following a severe skin bend 10 days ago and my repatriation to the UK from Egypt yesterday. All of your comments, experiences and views are great in helping me get my head round it all. I'm off to the London Dive Chamber in the morning and am hoping I will find out more about whether I am a '1 in 3' diver!

I was really surprised today to find that my usually very helpful and positive GP was quite adamant that the only option was to give up diving and that if I do have a pfo the surgery was a risk that was not worth taking. Has anyone else heard of this type of response or have a view on the level of risk associated with treatment?

thanks

Michaela

[Steve Summers]

I was really surprised today to find that my usually very helpful and positive GP was quite adamant that the only option was to give up diving and that if I do have a pfo the surgery was a risk that was not worth taking. Has anyone else heard of this type of response or have a view on the level of risk associated with treatment?

thanks

Michaela

Hi Michaela,

sorry to hear of your bend, as with most things for everyone saying go for it there will be as many saying don't. ATEOTD only you can make that decision.

I seriously doubt I would have a closure as I have had many other surgery's in the past, and would not wish to undergoe any more unless there was an alternative, also I believe not enough is known about the occluders and the long term effects on their recipients health.

I stress that is my choice/opinion only and I am not medically trained, if you have not already looked at it check out the DAN report on my previous post.

Good luck.

ATB,
Steve

[Josepherely]

M I think Steve's advice above is very sound, and Iian's very pertinent.

The trend I have noticed in the UK is to get an occluder inserted and think everything is fine. The risks long term are not known (nor the benefits).

I have over a thousand medical docs work for me in my company, and I certainly am very cautious about letting any of them near my body, let alone my heart, and am sceptical about anything medical that does not have a large study behind it. Having said that if you continue to dive, the risks may be worth taking (even if you don't what they are now).

I would try the controlled diving first and see if the PFO leads to any problems. You know what a skin bend is now, so you will be able to monitor yourself closely. Dive nitrox [high an O2 mix as poss.] (on air computer/settings) be very very careful on the ascents AND MOST IMPORTANTLY about effort post dive, particularly in the first hour. This is when you are most at risk of fizzing in your circulation. Don't lift or put any strain on yourself, particularly for a longer period of time [the duration of the strain increases the size of the shunt]. Get your buddies to do the work (take off tanks, lug them around, etc.). It is suprising how much effort you do post dive without thinking, so you need to be really conscious of this and get your buddies also aware (without frightening them).

You may be OK, you may not, only trying it will let you know. Some docs will tell you NO DIVING, others will say to such and such a depth, but in the end it is your body, and you will have to decide the level of risk you are willing to take for a sport. Following what anyone else does may not be the best way to decide.

I am sure over the coming weeks you will become an expert on this subject, as lots of info on the web, however I have found talking to the really good hyperbaric docs is the best way to understand the risks.


Best of luck
Joe

[IainC]

I was really surprised today to find that my usually very helpful and positive GP was quite adamant that the only option was to give up diving and that if I do have a pfo the surgery was a risk that was not worth taking. Has anyone else heard of this type of response or have a view on the level of risk associated with treatment?

thanks

Michaela


With the greatest respect to your GP, he is a GP, not a heart surgeon, you will need to talk to a specialist to get a proper informed view on whether treatment is worth it or not and which treatment would be best.

A friend of mine has a large PFO (discovered after a bend) and his health authority have been refusing to treat him, principally because they are broke and don't want to pay (they would only do the op if he was a professional diver and his career depended on it), I think he is currently looking at private treatment.