Have you (or someone you know) had a pfo mended on the NHS?

[Divemouse]

Just getting round to replying to my 'feck off!' letter from an NHS consultant and one of his reasons for replying in such a cheery manner was that 'No divers get a pfo repaired on the NHS'. I'm pretty sure that's not true, so I'd like to reply with a list of names and the local hospital that did it. If you, or someone you know, are one of those people and you don't mind being named as part of a basically pointless rant at a jobsworth, please reply with full name and where you had it done by pm. There's no reward, other than knowing you'll be fuelling my self-righteous rage.

[Chrisch]

Kelly had a test and one of the twats there said "waste of money". I think there might be quite a few such people to overcome. The doc in charge who refered her was the dive specialist - I think Wilmslow? - who was the top cheese in the field. At the time she had migranes. I guess he has retired now and so the priority has slipped down even further.

You could write to your MP ( ) she is some sort of cigar smoking health nut I think (sorry )

[Tel]

Just getting round to replying to my 'feck off!' letter from an NHS consultant and one of his reasons for replying in such a cheery manner was that 'No divers get a pfo repaired on the NHS'. I'm pretty sure that's not true, so I'd like to reply with a list of names and the local hospital that did it. If you, or someone you know, are one of those people and you don't mind being named as part of a basically pointless rant at a jobsworth, please reply with full name and where you had it done by pm. There's no reward, other than knowing you'll be fuelling my self-righteous rage.

Guy you want to speak to is Dr Peter Wilmshurst

[Iain Smith]

I have a memory that prophylactic NHS percutaneous PFO occlusion was withdrawn a few years ago, so did some internet digging.

There was a programme called "Commissioning for Evaluation" through which patient with PFOs who had yet to suffer any adverse events could have them fixed. I believe a number of divers here or on YD did have these repaired, though I forget how many had them without first suffering a bend.

The 2019 NHS commissioning document which followed that study sets out criteria for performing the procedure which are, in essence, for prevention of a further ischaemic stroke in a younger adult (age 18-60) who has already had a TIA or stroke attributable to an identified PFO.

Insertion of of occlusive devices for primary prevention (ie preventing the first TIA or stroke) was found in the "real world" Commissioning for Evaluation study to have neurological events somewhat more than twice the rates reported in previous randomised controlled trials (a "gold standard" research study which, though I have not read the specific studies in question, often enrol highly selected patients whose results then don't translate to normal clinical practice). This event rate was comparable to "best medical therapy", thus the actual value of undergoing the procedure was less than previously believed, hence its restriction to patients who had already suffered a first event.

I suspect that a diver with a PFO who has not suffered an unprovoked CNS bend will struggle to persuade the NHS to fund this intervention. If one had already suffered a bend, there might be a argument that the patient has suffered an ischaemic event from paradoxical embolism and would continue to be at risk (from "normal" venous thromboembolic events, never mind bubble embolism) if the PFO is not repaired. Whether that would persuade the cardiologist and/or local commissioners, I would not want to say.

Dr Wilmshurst is/was, as Tel suggests, the "go to" person for the definitive answer (or as close to such as exists). The UK Diving Medical Committee still lists him as working at the Royal Stoke University Hospital, though he does not appear in the Trust's current Consultant Directory...then again, I don't appear in my hospital's, and I've only been there four years!

[wibble32]

I suspect that a diver with a PFO who has not suffered an unprovoked CNS bend will struggle to persuade the NHS to fund this intervention. If one had already suffered a bend, there might be a argument that the patient has suffered an ischaemic event from paradoxical embolism and would continue to be at risk (from "normal" venous thromboembolic events, never mind bubble embolism) if the PFO is not repaired. Whether that would persuade the cardiologist and/or local commissioners, I would not want to say.

Thank you for posting. Appreciated
Rgds

[Tim Digger]

The problem you are facing is that you have an expensive proceedure which has been invented more or less in the nineties and was promoted (by enthusiasts (and manufacturers) for all sorts of conditions related or postulated as related to PFO. The powers that be running the NHS got the wind up at the thought of the thousands of migraine sufferers all wanting closure. Leaving divers out of it as the numbers were too small to matter, there was quite a lot of work done looking at benefit of stroke prevention and migraine treatment from closure. I did not keep up with it but as usual I guess there are papers for and against it. And opinions as to its value in different situations will have varied and changed across the decades. I don't believe there is a blanket ban across the NHS but commissioning bodies will as always tend to discourage borderline benefit expenditures divers and dive medicine get caught up in this, as I said the numbers of them are too small to matter unless its you! But that's how it is. Relatively local to you was a chamber at James Paget Hospital Gt Yarmouth (it may have closed) it may be worth talking to a Consultant there as they may have much more knowledge of the local situation and routes of referral.

[JonG]

I had mine done at Liverpool via a referral from Peter Wilmshurst, I'd have to check the date was a few years ago now.

Talking to a recent implantee 2 months ago she tried lots of angles but ended up spewing around 10k to get one closed

[witchieblackcat]

A friend of mine had his closed and then closed again when it wasn't 100% successful.
He's a diver but never had a bend but did suffer migraines after diving.
Used to be pretty active at the other place.

[Tim Digger]

It would be helpful in view of changing medical views and financial NHS leanings to have a date of closure and encouragement of those directly involved to just stick a brief resume on the forum.

[1st Ade]

It would be helpful in view of changing medical views and financial NHS leanings to have a date of closure and encouragement of those directly involved to just stick a brief resume on the forum.

So - a sanitised version of what I sent DiveMouse

Adrian *******
DoB ********
NHS Number *******
Gained BSAC 1st Class and BSAC Advanced instructor - 1,700 or so dives prior to incident

Bent 20th August 2006 - 2nd Dive of the day - 20 metre drift off Weymouth - no mandatory deco but did safety stop at 6M on 32% "because you can"
Airlifted to Poole - "Classic Skin Bend" (to quote the chamber operator) - Back to B&B late that night, drove home next morning

September 2006 Private PFO Test - "Yep, that's a PFO alright, about 10mm"

March 2007 - NHS Operation at St Mary's hospital, Paddington, under Dr Malik to perform closure. Went home (although very groggy!) that night.

Eventually resumed diving although given up now for other reasons.

Hope that helps get yours fixed... If you need more details please shout