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I finally got my doctor to order an echo w/ bubble test and today, I was diagnosed with a "medium sized" PFO. I'm pretty sure I'll go ahead with the closure procedure, but was wondering what to expect. Has anyone had this done? I've done some research, and my doctor has told me what he'll do; but I'm more interested in personal experiences and what to REALLY expect. Any responses (PMs or otherwise) are greatly appreciated.
Thanks,
Bonnie
Just out of curiosity, were you having symptoms of some sort to cause you to request the tests?
is it covered by your insurance? just curious...
I don't think most insurance cover the surgery. The least expensive route is find a doctor that specializes in dive medicine, they give discounts. I overhead someone talking about having it done while I was at the NSS-CDS convention in Marianna and they were happy with it. As for me, I would pass on it if given the choice, well I probably would have it done if I was 20-30 years old.
To each, his or her own.
The most obvious symptom was skin bends, but I can also elevate my heart rate very quickly without too much effort.
I doubt insurance will cover it, but it can't cost more than I have invested in dive gear, right? I'm going to investigate further before I have it done, but cost really isn't the issue. I'll find a way to pay for it. I'm 39 and not ready to quit diving or risk taking a nasty hit.
Bonnie
Bonnie,
I had closure 2/14, was out of the water for ~70 days and returned to active diving. (~100 hours on my meg since...)
Each insurance company will have different policies on coverage. My insurace, Aetna considers closure medically necessary for history of "cryptogenic stroke, transient ischemic attacks, or arterial emboli due to presumed paradoxical embolism through a PFO"
I had multiple type 2 hits, each with full recovery, due to the history it was covered.
By far the hardest part was even finding a doctor to perform the screening tests. Each Hyperbaric Doc DAN sent me to were more interested in running MRI's, Cat scans, Lung Function tests and X-Rays which all came back clean. I eventually got a Doc who dived alot... The procedure is not without risks, Saturation has written extensively on the subject, as someone without any major (beyond skin), I'm not sure if you'd fall into the recommend category.... Simon Mitchell had a pretty good chart at the CDS workshop in Marianna outlining the medical recommendations for screening, not sure if they also had one for closure.
The procedure itself was very straightforward, got at the hospital ~5am, prepped and paperwork for ~10am prcedure, back in my room ~11-12 kinda groggy. They asked me to stand ~1pm, not so good, in bed til 4pm where I was up and about. Overnight stay for observation and discharged the next am, had to take a cab to the motel (Doc was across the state.) where I stayed another night before driving back home. I was able to (and cleared to) workout that afternoon on an eliptical for ~20 minutes before the entry points started to feel a little raw. The next day I was back to an hour, I'm 34, and do cardio regularly.
No swimming or tub baths for a week to allow the entry points to heal up. Plavix and Aspirin for 3 months.
Feel free to PM w/ additional questions.
-Tim
PM Sent with info on how to contact Dr. Simon Mitchell.Quote:
Originally Posted by JSNTP
PM sent.
http://www.pubmedcentral.nih.gov/art...?artid=1336709
http://www.pfodoctor.org/pages/4/index.htm
A couple of good links to articles about PFO.
Sharon
Thanks to everyone - especially Tim - for the responses and PMs. I am doing lots of research and have contacted several diving physicians that were recommended for more information. It's nice to have such a great resource as CDF when you need it. Again, much appreciation to all!
Bonnie
Bonnie...did you have the closure?
I just found out Monday that I have a PFO. I took a hit Aug. 25...see the details here: http://thedecostop.com/forums/showthread.php?t=34294
PM sent with the e-mail address of a friend who recently had a PFO closed.Quote:
Originally Posted by JSNTP
Nathan,
I read your posts on TDS and I find your initial treatment pretty scary. I can also totally sympathize with your feelings of shock and being in a funk. I went through the same thing when they found my PFO.
The short answer to your question is no - I haven't had the closure. There are some extraneous considerations that have complicated things for me, but I intend to proceed with the closure - probably this spring. In the meantime I have been diving recreationally (not too deep & staying within no deco limits) with no issues. I guess I won't be hitting Eagle's Nest this year; but there are plenty of shallow sidemount caves to explore. Also, I'm watching my exertion level after diving. That seemed to be a contributing factor for the issues I experienced.
My PFO has been described as "medium sized" and bubbles shunt mostly with valsalva athough a few did pass at rest. Up until last year I never experienced any problems even after several deep (200'+) dives, so I guess age could be a factor for me. I agree fully with Dr. Mitchell that you shouldn't let PFO paranoia take over your life. Gather the information that you need to make an informed decision and do what makes sense for you. I'll PM you the information for an interventional cardiologist in Florida who was helpful to me.
Good luck,
Bonnie
I'm having a PFO closure done in about a month and a half from now. If anybody would want the doctors names in the Sarasota area PM me. I think they are great. The surgery team are all divers with the same passion for diving as I, and have done quite a few of these for the Navy seals I am told. They also told me a new clam shell device has just become available. Apparently the older ones once closed could not be reopened to reposition over the hole. The new ones can be reopened and repositioned for the best possible closure. As stated earlier I'll only be out of the water for 70 to 90 days.
Also as was stated in an earlier reply, AETNA is taking care of this one for me 100%. A simple note wrote by the heart specialist is all it took. Apparently this cryptogenic stroke thing is sensitive stuff with Aetna. Since I normally solo dive I am actually exicited about getting this procedure as it crosses off one more possible thing that Murphy can screw up.
WB
WOW! Congrats, that's awesome! :)Quote:
Originally Posted by SRQ
Hey Bonnie, Be a little carefull if you are diving in those little caves not to hold your breath and strain. The pfo will open then and you could get hurt even if you are shallow. Micro bubbles can cause damage also. I'm not trying to be a downer but it's something to think about. Cindy
Thanks Cindy! Good advice and I appreciate it. I know that even though I can reduce my risk by being conservative, it can't be totally eliminated. Even with the closure, there's always some risk to this sport.
BTW, I try to take things slowly and not strain too much. It's something I'll be even more aware of with your advice.
I am having my PFO closed today. Insurance is covering it because of a Type 2 Hit requiring table 6 treatment.
Wow. Good luck!Quote:
Originally Posted by Dive Yeti
Dave
Jason Ottinger had one closed a couple of years ago, he is back diving fine. I believe Mark Messersmith had one closed, he is doing fine.
This is an old thread but I just wanted to remind everyone that I am still doing a study with Dr. Denoble of DAN following people with a history of PFO and DCI. We are enrolling both divers who had their PFO closed as well as divers who elected to leave it alone. Any and all are welcome. Information is on the DAN website (www.dan.org) or feel free to email me directly (dgebersole@gmail.com)
Doug
The only problem I had with PFO was finding out IF I had one!
Insurance would not cover test until AFTER something happened.
So... when I had some ulcer pain a few years ago my PMD (who is also a diver) wrote me up as "non specific chest pain on exertion".
Insurace approved an Echo Stress Test (treadmill EKG with ultrasound exam of the heart). Good news- no clogged arteries, valves working fine, and no PFO.
Sent home with Tums & lay off Mexican food.
I think the current cardiology recommendations are to only fix it if you've had symptoms. I certainly wouldn't go looking foer a PFO if you've never had any problems. I had it done a few years ago. Had a couple "wierd" events after deep deco dives then had a full blownTIA at home (arm wouldn't move). Insurance covered it. Total bill was about $30 K so I'd definitely get insurance to cover it. Procedure was piece of cake. To hospital at 7, home at 5, but I'm relatively young and healthy, so everyone may have a different experience. I was working out a couple days later. Took Plavix for 3 months. No events since (been almost 4 years now) with plenty of deco dives during that time. PM me if you have any questions.
We would love to have you in our study. Here is a link to more information:
http://www.diversalertnetwork.org/re...of_pfo_closure
Doug
I had a bubble study covered due to frequent migraines.
Thankfully, no PfO. Very reassuring as I want to start technical training and also because we tend to dive fairly aggressively when on dive trips. 5 dives a day usually, for a week or two. I was a little concerned, given my frequent migraines, that I could have a PFOS causing them.
With due respect to the "land lubber" cardiology community, when I was preparing to upgrade from OW to Tech I felt it was in my OWN best interest to determine my physical status BEFORE ending up in a chamber. My PMD agreed. Ignorance Kills!Quote:
Originally Posted by mgif99
I would be careful recommending closing "asymptomatic" PFOs in divers. In general, the risk of DCI is about 2 per 10,000 dives (at least for recreational diving). It is assumed that having a PFO increases that number by about 5 fold. While that sounds bad, that is still an absolute risk of only 10 per 10,000 dives or 1 per 1000. The risk of significant complications from closing a PFO is probably about 1%. That means you would be taking a 1 in 100 risk of a problem to avoid a problem that only carries a 1 in 1000 risk of occurring. Not the odds I would want to take. And I "walk the walk". I'm a tech diving/cave diving/CCR diving cardiologist who closes PFOs as part of my job yet I've never been tested for a PFO as I've never had an unexpected DCI event.
Closing a PFO is only one option. Being aware of it is number one concern. Other options include (as previously mentioned) avoiding certain stress situations, getting doppler test performed immediately after dive to determine silent bubble gas loading (actual, not theoretical), running dive profile extra conservative, avoiding all but very short deco, staying away from deco, and running all dives non-deco, giving up diving and taking up basket weaving.Quote:
Originally Posted by debersole
Waiting until AFTER an adverse event is reactive, not proactive.