PFO testing

jeroen73 · November 19th, 2007, 04:15 PM

I would like to know what the general opinion is whether to be tested if you have PFO or not

.

On the one hand if you are tested and do not have a PFO you have excluded a problem which might cause DCS. On the other hand a lot is still unclear and loads of people are not tested even people who make technical dives and have not experienced problems until now.

From the DIR point of view I will say that you have to be tested but even GUE does not demand a PFO test for tech courses if I am right.

Please your comments.
gr. Jeroen

Gene_Hobbs · November 19th, 2007, 05:57 PM

Quote: (Originally Posted by Southerland)

There is no need to consider an additional PFO policy for deep diving unless it is known that the deep diving decompression schedules will give divers significantly higher venous bubble loads.

Southerland DG. Medical Fitness at 300 FSW. In: Lang, MA and Smith, NE (eds.). Proceedings of Advanced Scientific Diving Workshop: February 23-24, 2006, Smithsonian Institution, Washington, DC. RRR ID: 4659

I find Dave's comment above a pretty significant step forward from the usual established diving medical opinions.

DIR Quest had an older article by Neal Pollock that summed things up nicely and Simon Mitchell gives an update on this topic in the next issue.

More general information worth looking over can be found here

**Alastair** · November 20th, 2007, 12:35 AM

Tough question. As we all know a PFO doesn't necessarily equal DCS. I dived for 6 years with no issues before getting a bend on a profile I considered sensible. With something that really couldn't be explained (other than by accepting deco is in-exact) I went for the test.

If we start blanket testing divers then the diving industry would struggle. And to be fair the incidence rate of DCS is very low so this would seem to be un-necessary.

I reckon an unexplained bend should result in a PFO test. If you've had no issues then it comes down to how much deco you are doing and your own personal risk assessment. My guess is that most people would rather live in ignorance. I'd be interested if anyone here has actually had the test just for their peace of mind?

Cheers
Al

limeyx · November 20th, 2007, 12:55 AM

Quote: (Originally Posted by Alastair)

Tough question. As we all know a PFO doesn't necessarily equal DCS. I dived for 6 years with no issues before getting a bend on a profile I considered sensible. With something that really couldn't be explained (other than by accepting deco is in-exact) I went for the test.

If we start blanket testing divers then the diving industry would struggle. And to be fair the incidence rate of DCS is very low so this would seem to be un-necessary.

I reckon an unexplained bend should result in a PFO test. If you've had no issues then it comes down to how much deco you are doing and your own personal risk assessment. My guess is that most people would rather live in ignorance. I'd be interested if anyone here has actually had the test just for their peace of mind?

Cheers
Al

For me, it was always a hard choice as I would have to pay for it myself.
The "accurate" test (TEE) I think is about $4000 USD here, and pretty invasive.

Then I heard about the TCD test (Trans Cranial Doppler) which is supposed to be 95% as accurate as the TEE which is supposed to be 93% accurate, and it is non-invasive and only $300

Apparently the inaccuracies of the TCD are also more due to the test not being executed precisely rather than any inherent inaccuracy in the methodology.

At that price, for me it was a no-brainer even though I didnt have any real symptoms of hits on other dives.

jeroen73 · November 20th, 2007, 09:59 AM

Quote: (Originally Posted by Alastair)

Tough question. As we all know a PFO doesn't necessarily equal DCS. I dived for 6 years with no issues before getting a bend on a profile I considered sensible. With something that really couldn't be explained (other than by accepting deco is in-exact) I went for the test.

If we start blanket testing divers then the diving industry would struggle. And to be fair the incidence rate of DCS is very low so this would seem to be un-necessary.

I reckon an unexplained bend should result in a PFO test. If you've had no issues then it comes down to how much deco you are doing and your own personal risk assessment. My guess is that most people would rather live in ignorance. I'd be interested if anyone here has actually had the test just for their peace of mind?

Cheers
Al

That is what I mean. I do not want to stick my head in the sand but there are loads of (technical)divers doing dives without being tested on PFO and having no problems of DCS. If you do not have any problems and are tested on PFO and you have one not matter how small. Your diving career is more or less over as you will not get a medical approvel. Unless you have it fixed.

I also heard that a PFO can occur at an older age. If this is true at what sequence do you have to be tested?
I can understand if you experience a DCS which you can not explain you will take the test but until then it is a difficult matter.

By the way Al was your accident due to having a PFO or was it just a bad day, time place etc. the grey area of DCS

MonkSeal · November 20th, 2007, 10:21 AM

Quote: (Originally Posted by Alastair)

I'd be interested if anyone here has actually had the test just for their peace of mind?

Yes, I did after your incident. And I know few others from DIR Italia that performed testing because peace of mind.

ogobara2000 · November 20th, 2007, 11:21 AM

Quote:

I'd be interested if anyone here has actually had the test just for their peace of mind?

I did. I had a full TEE test several years ago even before doing mix/deco diving. I used to work in the red sea madhouse of diving with doing quite often four dives a day with mutliple ascents etc and especially as i started doing longer and deeper dives I simply wanted to eliminate the risk of having a PFO without knowing.
Of course a PFO test won't safeguard you against a hit but i do not see any reason why not to do it. IMHO it is the wrong way to find out afterwards.

Oh yeah and testing positive does not necessarily mean that you have to give up diving.

Marijn · November 20th, 2007, 12:51 PM

Quote: (Originally Posted by ogobara2000)

I did. I had a full TEE test several years ago even before doing mix/deco diving. I used to work in the red sea madhouse of diving with doing quite often four dives a day with mutliple ascents etc and especially as i started doing longer and deeper dives I simply wanted to eliminate the risk of having a PFO without knowing.
Of course a PFO test won't safeguard you against a hit but i do not see any reason why not to do it. IMHO it is the wrong way to find out afterwards.

Oh yeah and testing positive does not necessarily mean that you have to give up diving.

You'd "just" have to make your ascents more conservative to further prevent the forming of bubbles?

ogobara2000 · November 20th, 2007, 02:19 PM

Quote:

You'd "just" have to make your ascents more conservative to further prevent the forming of bubbles?

Sure thing. Actually there is a lot of things I would not do these days anymore.

My point was rather more that I think it is a good idea for people to do a PFO test especially when they start doing more "aggressive" dives. However I further think it would be quite unpractical for GUE or other dive agencies to require a test for their students.

jeroen73 · November 20th, 2007, 02:29 PM

Quote: (Originally Posted by ogobara2000)

I did. I had a full TEE test several years ago even before doing mix/deco diving. I used to work in the red sea madhouse of diving with doing quite often four dives a day with mutliple ascents etc and especially as i started doing longer and deeper dives I simply wanted to eliminate the risk of having a PFO without knowing.
Of course a PFO test won't safeguard you against a hit but i do not see any reason why not to do it. IMHO it is the wrong way to find out afterwards.

Oh yeah and testing positive does not necessarily mean that you have to give up diving.

Hi Ogobara,

Do you know if there is real medical evidence that PFO is causing DCS. I mean I read a lot of stories positive and negative. The link below even speaks about the growth of a PFO and people who are tested and were negative can be positive now.
Then the questions rises how often do you need to be tested to be safe.

Primary Care Diving Medicine

Do not get me wrong I can totally understand your point of view.
I just want to know what the general opinion is and why/when people want to be tested and not

gr. Jeroen

November 19th, 2007, 04:15 PM	#1 (permalink)
jeroen73 (Online) New Member Join Date: Aug 2007 Location: Culemborg, Holland Posts: 59	PFO testing I would like to know what the general opinion is whether to be tested if you have PFO or not . On the one hand if you are tested and do not have a PFO you have excluded a problem which might cause DCS. On the other hand a lot is still unclear and loads of people are not tested even people who make technical dives and have not experienced problems until now. From the DIR point of view I will say that you have to be tested but even GUE does not demand a PFO test for tech courses if I am right. Please your comments. gr. Jeroen

November 19th, 2007, 05:57 PM	#2 (permalink)
Gene_Hobbs(Offline) WKPP Join Date: Sep 2006 Location: Durham, NC, USA Posts: 57	Quote: (Originally Posted by Southerland) There is no need to consider an additional PFO policy for deep diving unless it is known that the deep diving decompression schedules will give divers significantly higher venous bubble loads. Southerland DG. Medical Fitness at 300 FSW. In: Lang, MA and Smith, NE (eds.). Proceedings of Advanced Scientific Diving Workshop: February 23-24, 2006, Smithsonian Institution, Washington, DC. RRR ID: 4659 I find Dave's comment above a pretty significant step forward from the usual established diving medical opinions. DIR Quest had an older article by Neal Pollock that summed things up nicely and Simon Mitchell gives an update on this topic in the next issue. More general information worth looking over can be found here __________________ http://rubicon-foundation.org/ Home of the Rubicon Research Repository. For help getting started with the Repository, please visit our FAQ page. PLEASE support our work. "Oxygen is addictive and deadly. Everyone who uses it will eventually die" --RW Hamilton, PhD 1991

November 20th, 2007, 12:35 AM	#3 (permalink)
Alastair(Offline) DIRX Supporter Join Date: Nov 2005 Location: UK Posts: 693	Tough question. As we all know a PFO doesn't necessarily equal DCS. I dived for 6 years with no issues before getting a bend on a profile I considered sensible. With something that really couldn't be explained (other than by accepting deco is in-exact) I went for the test. If we start blanket testing divers then the diving industry would struggle. And to be fair the incidence rate of DCS is very low so this would seem to be un-necessary. I reckon an unexplained bend should result in a PFO test. If you've had no issues then it comes down to how much deco you are doing and your own personal risk assessment. My guess is that most people would rather live in ignorance. I'd be interested if anyone here has actually had the test just for their peace of mind? Cheers Al __________________ Helium is our friend - GI3

November 20th, 2007, 12:55 AM	#4 (permalink)
limeyx(Offline) New Member Join Date: Nov 2005 Location: Los Angeles, CA Posts: 707	Quote: (Originally Posted by Alastair) Tough question. As we all know a PFO doesn't necessarily equal DCS. I dived for 6 years with no issues before getting a bend on a profile I considered sensible. With something that really couldn't be explained (other than by accepting deco is in-exact) I went for the test. If we start blanket testing divers then the diving industry would struggle. And to be fair the incidence rate of DCS is very low so this would seem to be un-necessary. I reckon an unexplained bend should result in a PFO test. If you've had no issues then it comes down to how much deco you are doing and your own personal risk assessment. My guess is that most people would rather live in ignorance. I'd be interested if anyone here has actually had the test just for their peace of mind? Cheers Al For me, it was always a hard choice as I would have to pay for it myself. The "accurate" test (TEE) I think is about $4000 USD here, and pretty invasive. Then I heard about the TCD test (Trans Cranial Doppler) which is supposed to be 95% as accurate as the TEE which is supposed to be 93% accurate, and it is non-invasive and only $300 Apparently the inaccuracies of the TCD are also more due to the test not being executed precisely rather than any inherent inaccuracy in the methodology. At that price, for me it was a no-brainer even though I didnt have any real symptoms of hits on other dives. __________________ my divelog: http://www.mydivinglife.com/limeyx

November 20th, 2007, 11:21 AM	#7 (permalink)
ogobara2000(Offline) New Member Join Date: Dec 2005 Location: Plymouth UK :) Posts: 99	Quote: I'd be interested if anyone here has actually had the test just for their peace of mind? I did. I had a full TEE test several years ago even before doing mix/deco diving. I used to work in the red sea madhouse of diving with doing quite often four dives a day with mutliple ascents etc and especially as i started doing longer and deeper dives I simply wanted to eliminate the risk of having a PFO without knowing. Of course a PFO test won't safeguard you against a hit but i do not see any reason why not to do it. IMHO it is the wrong way to find out afterwards. Oh yeah and testing positive does not necessarily mean that you have to give up diving. __________________ You are free....to do as you are told

November 20th, 2007, 09:59 AM	#5 (permalink)
jeroen73 (Online) New Member Join Date: Aug 2007 Location: Culemborg, Holland Posts: 59	Quote: (Originally Posted by Alastair) Tough question. As we all know a PFO doesn't necessarily equal DCS. I dived for 6 years with no issues before getting a bend on a profile I considered sensible. With something that really couldn't be explained (other than by accepting deco is in-exact) I went for the test. If we start blanket testing divers then the diving industry would struggle. And to be fair the incidence rate of DCS is very low so this would seem to be un-necessary. I reckon an unexplained bend should result in a PFO test. If you've had no issues then it comes down to how much deco you are doing and your own personal risk assessment. My guess is that most people would rather live in ignorance. I'd be interested if anyone here has actually had the test just for their peace of mind? Cheers Al That is what I mean. I do not want to stick my head in the sand but there are loads of (technical)divers doing dives without being tested on PFO and having no problems of DCS. If you do not have any problems and are tested on PFO and you have one not matter how small. Your diving career is more or less over as you will not get a medical approvel. Unless you have it fixed. I also heard that a PFO can occur at an older age. If this is true at what sequence do you have to be tested? I can understand if you experience a DCS which you can not explain you will take the test but until then it is a difficult matter. By the way Al was your accident due to having a PFO or was it just a bad day, time place etc. the grey area of DCS

November 20th, 2007, 10:21 AM	#6 (permalink)
MonkSeal(Offline) Old Member Join Date: Feb 2006 Location: Zagreb, Croatia Posts: 472	Quote: (Originally Posted by Alastair) I'd be interested if anyone here has actually had the test just for their peace of mind? Yes, I did after your incident. And I know few others from DIR Italia that performed testing because peace of mind.

November 20th, 2007, 12:51 PM	#8 (permalink)
Marijn (Online) Smurf #1 Join Date: Aug 2007 Location: Papendrecht, The Netherlands Posts: 379	Quote: (Originally Posted by ogobara2000) I did. I had a full TEE test several years ago even before doing mix/deco diving. I used to work in the red sea madhouse of diving with doing quite often four dives a day with mutliple ascents etc and especially as i started doing longer and deeper dives I simply wanted to eliminate the risk of having a PFO without knowing. Of course a PFO test won't safeguard you against a hit but i do not see any reason why not to do it. IMHO it is the wrong way to find out afterwards. Oh yeah and testing positive does not necessarily mean that you have to give up diving. You'd "just" have to make your ascents more conservative to further prevent the forming of bubbles? __________________ Its a fact that the humans can't go without water for more than 3 days

November 20th, 2007, 02:19 PM	#9 (permalink)
ogobara2000(Offline) New Member Join Date: Dec 2005 Location: Plymouth UK :) Posts: 99	Quote: You'd "just" have to make your ascents more conservative to further prevent the forming of bubbles? Sure thing. Actually there is a lot of things I would not do these days anymore. My point was rather more that I think it is a good idea for people to do a PFO test especially when they start doing more "aggressive" dives. However I further think it would be quite unpractical for GUE or other dive agencies to require a test for their students. __________________ You are free....to do as you are told

November 20th, 2007, 02:29 PM	#10 (permalink)
jeroen73 (Online) New Member Join Date: Aug 2007 Location: Culemborg, Holland Posts: 59	Quote: (Originally Posted by ogobara2000) I did. I had a full TEE test several years ago even before doing mix/deco diving. I used to work in the red sea madhouse of diving with doing quite often four dives a day with mutliple ascents etc and especially as i started doing longer and deeper dives I simply wanted to eliminate the risk of having a PFO without knowing. Of course a PFO test won't safeguard you against a hit but i do not see any reason why not to do it. IMHO it is the wrong way to find out afterwards. Oh yeah and testing positive does not necessarily mean that you have to give up diving. Hi Ogobara, Do you know if there is real medical evidence that PFO is causing DCS. I mean I read a lot of stories positive and negative. The link below even speaks about the growth of a PFO and people who are tested and were negative can be positive now. Then the questions rises how often do you need to be tested to be safe. Primary Care Diving Medicine Do not get me wrong I can totally understand your point of view. I just want to know what the general opinion is and why/when people want to be tested and not gr. Jeroen