It took a while, but I am diving again. I am depth limited, due to the likely PFO, but at least I am diving. I will see if I can get fixed at not too high a cost.
It takes me a while to sort medical things...
I do have a PFO. I've not had it closed yet, but I may get it done after a Farnes trip this autumn. One key consideration is whether my insurance will pay - it looks difficult to get it done on the NHS.
Just a bit more theory and physiology. It is not an uncommon history that someone with years of uneventful diving and hundreds of dives should get a bend, that is "undeserved" within tables no rapid ascent etc. And then can be shown to have a PFO with bubble shunting IE probably a significant PFO. It begs the question why after so long and probably many more potentially DCI causing dives in the past should this occur now? I once advised someone on YD to get a PFO check after he appeared to become allergic to neoprene the rash he was getting were skin bends and he had a large PFO later closed.
A PFO is a hole between the two atria of the heart. These are the low pressure chambers, the first stage pump into the ventricles that do the serious pumping, the pressure in these two chambers is low in young healthy people about 3/0 on the right and 5/2 on the left. While in theory any bubbles (or more seriously clots of blood) can pass from R to L ac4ross a PFO in practice they usually do not, largely due to the pressure in the left being very slightly higher. As one gets older the resistance to blood flow through the lungs increases (this is a normal effect of ageing and may well be one of the factors limiting maximal exercise as one ages), the back pressure on the right side of the heart that this increased resistance causes will increase slightly the pressures on the Right of the PFO and thus predispose to bubbles being more likely to shunt across to the left and hence round the rest of the body causing DCI. The solution is either closure or stop diving or minimise the risks not only by depth limitation but by severely limiting nitrogen loading. Anyone who doesn't know what I mean by severely limiting should try the P1 or 2 setting on a Suunto computer which will effectively limit you to one <20m dive and maybe a second <10m dive a day. With long surface intervals and no lifting carrying gear post dive.
I should say the above theory re ageing is my own I have never read it anywhere and the "normal" increase in Pulmonary vascular resistance that occurs with ageing has only relatively recently been appreciated.
Evolution is great at solving problems. It's the methods that concern me.
Cheers, Tim. That makes sense to me. I had been diving for 15 years, with around 1000 dives before in my 50's I started with DCI symptoms. I was found to have a 10mm PFO. If anything my dives were much more conservative than in the past.
I'm reminded of a talk given by Dr Wilmshurst at a Diving Officer's Conference a fair few years ago now about the link between migraines and PFO.
Mate who was sat next to me said afterwards that he indeed got migraines after diving and had for some time. He got checked out and yes he did
have a PFO.
I was at that talk. And Mrs T was as well. She told me to get myself looked at by Dr Wilmshurst as I exactly fitted in with the symptoms he had described. So I did, and I had, and I now don't.
First: Read the German magazine from october 2018 about not closing a pfo and still do technical diving without problems. It is possible. There is NO reason to quit diving, no reason to get it closed, and no reason not to do technical diving. Read it. There is group of hyperbaric diving doctors that found out that taking oxygen at surface after a technical dive will help more to prevent dcs then get a pfo closed. Read it, it is worth it. contact them. The reason that they did such research is that we don't get a pfo closed by the healthinsurance as it is not needed to life. So they found a better and safer way not to get bend again. They write that after a fist episode NO pfo check is adviced, only if you got bend more than once. And even if they find it, no reason to close it, but take the surface oxygen. Only if this not helps quit or another way of diving is adviced. They really understand that staying shallow and within ndl is for some divers only boring and not real diving. They think in what the diver wants to do and hear. They do technical dives themselves also. Really good stuff by that doctors. Contact them if needed.
But do you really believe you had dcs? As Neuritis Vestibularis has almost the same symptoms, but then no strength loss in limbs or other strange feelings in skin or lymbs. And this is completely harmless, only it can take 2 till 2 weeks to get fit again. It is just a cold virus. And if you have neuritis vestibularis, diving is adviced to do. Sadly I have experienced it once and after contacting a doctor the advice was seek your limits till vomitting and do what is possible, even diving was a good thing if I was not dizzy when floating (had planned a diving holiday with technical diving). So after the sudden onset and 1.5 day in bed I was able to walk again, but still got seasick in a car, a friend drove me to the divesite for our 5 day diving holiday and we did 2 dives of 90-120 minutes. As soon as I was floating in the water, my dizzyness was gone. The 5 days of 2 long deep decompression dives each day was making me fit again. After the first day of diving I was also able to drive myself again. Ok, here it was no dcs, but what you describe about being dizzy sounds exactly what I experienced with the cold virus. Only no other coordination or strenght loss with neuritis vestibularis. It took 2.5 week to get completely fit again as before with the same coordination like standing on 1 leg and doing showjumping on my horse again. Before the onset I had no hunger, so that was in my case a sign that I was not completely fit. But never had a cold or so. I was just unlucky they said, 1:200 get once in his life this illness. I was unlucky. So the sudden onset of neuritis vestibularis can also happen after a dive. Then you think about dcs, but it isn't. So you get a wrong stamp.
How can you see or feel the difference? Doctor told me with dcs you loose also strength in muscles. Did you experienced that? Did you experience other lost of coordination? You talk about you bladder, did you lost control over it?
What happens with inner ear dcs if you do not treat it? Will dizzyness and vomitting heal by itself? And over what period? Or will it getting worse and worse?
About conservative diving, remember: an air sportsdive within NDL to 30m can give more bubbles than a trimixdive to 100m.
I took the diagnosis from the diving docs at the chamber, who were certain it was a bend. Each treatment improved me , which is a pretty good indicator.
I have no idea what would happen if it was as left untreated. This strikes me as a really bad idea to test out. It was apparently pretty close to a major neurological bend, and these can have really bad consequences.
I do definitely have a PFO - the bubble test proved it. I do not want to risk another bend, because I wouldn't wish it on my worst enemy. So I will dive within the constraints of my sign off until (if) I get it closed. It may only be 15 metres, but at least it's diving. Seal dives always were amongst my favourites anyway.