17 replies to this topic

[TekDiveGirl]

As you are all aware on June 3, 2006 after surfacing from my second dive on the Hogan when I was too weak to get myself back onto the boat. You all know the story from there.

Right after it happened of course people started asking--- some louder than others---why did this happen? Did she make a mistake? Was it because of her prior diagnosis and subsequennt brain surgery for Chiari Malformation? Could it be a PFO? Bad luck, karma or something else????

I endured bilateral strokes (strokes on both sides of my brain), an arterial gas embolism and bubbles all up and down my spine. The first night in the hospital they had me in the reecompression chamber doing a straight table 6. That is 165' for 9 hours. They put me in for two more 3 hour treatments.

We downloaded my computer, and when comparing the profile I did against several of the most commonly used decompression models my times were spot on. So what exactly happened? At this point I have not had an echocardiogram to find out if I have a PFO or not but I am willing to bet that I do.

After OW dive 4 I ended up in the chamber with DCS symptoms. It was a 30 min. 40' dive. Nobody believed it was DCS (not even me) so I went to the hyperbaric md she checked me out and off I went.

I fell in love with diving and and especially the wrecks. Many of the wrecks are located outside of recational depth limits so that meant getting advanced tecnical training in order to see these wrecks safely. So I followed that path. Back then it was much tougher for females than it is now. I would turn heads when I showed up with my doubles, deco bottles weird gear etc at the docks or dive site.
Sorry to get on a tangent there... so back to the topic... I advanced as far as I could in the technical area staying with open circuit. Advanced trimix advanced wreck... technical divemaster... trimix gas blender. The only place higher to go is instructor and I was in the process of working out a deal with an instructor trainer that I know.

As I said above, I have not had an echocardiogram to find out if I do in fact have a PFO or not. My main focus has been getting better from the accident and not why the accident itself ccured. Although I think I'll be kinda scared to have the PFO test done. What if it turns out that I don't have a PFO? Then what???

Any thoughts?

[finGrabber]

Hmmm,

what's a PFO?

I have an idea but I want to make sure I know what you mean

[TekDiveGirl]

Hmmm,

what's a PFO?

I have an idea but I want to make sure I know what you mean

Simplistic terms ... a hole in the heart. Go to the site below to read more.

http://scuba-doc.com/pfo.htm

[PerroneFord]

Oh boy, not sure if I wanna go here, but Kimber you've been a good friend to me in terms of my diving, so...

When I got word of your accident, I asked if anyone had any details. Things were very tight lipped though we did get word about your AGE and chamber rides.

I wondered about your profiles, but I would have guessed that someone of your experience, and doing the relatively mundane dives you were doing would have been doing pretty safe profiles.

I thought about your previous complaints about being cold in the water which is a known catalyst for some of these kinds of issues.

And I thought about the PFO issue. As you well know, a certain group of divers who routinely do some deep cave dives, requires the PFO test on everyone on their team. I think that it is the safest way to proceed. And I swore I'd do it prior to me diving mix. There is just so much to go wrong.

If it is a PFO, then you'll have to make the tough choice to repair it, or stay out of the water. As no matter how careful you are, you can take a hit. If it's not a PFO, then you are really going to have to do some more searchnig as to the nature of the dive (depth, temps, mix, activity before the dive, physical exertion levels on the boat, etc., to try to find some answers.

But as I am sure you are aware, you're case sounds textbook PFO. Good profile, simple dive, no major factors, major hit, and no PFO test done. It's the first thing I'd go looking for.

Glad to have you back with us. And I truly hope to join you on a wreck dive one day. I'm inching closer.

[annasea]

<snip>
As I said above, I have not had an echocardiogram to find out if I do in fact have a PFO or not. My main focus has been getting better from the accident and not why the accident itself ccured. Although I think I'll be kinda scared to have the PFO test done. What if it turns out that I don't have a PFO? Then what???

Any thoughts?

Would it be safe to assume that you've already put this question to medical professionals, Kimber? Do any of them dive? Have they helped make this decision any easier?

[TekDiveGirl]

Oh boy, not sure if I wanna go here, but Kimber you've been a good friend to me in terms of my diving, so...

Perrone ~~~ you should know this about me by now---I won't ask the questions if I am not willing to hear the answers. I think I said the same thing to you many moons ago.

When I got word of your accident, I asked if anyone had any details. Things were very tight lipped though we did get word about your AGE and chamber rides.

This was at the request of my family and it was to do nothing more than to protect my children. The divig community was in a need to know baasis. My close friends knew of my condition... everybody else could wait. That first week was a hard time for my family and they needed to be protected.

I wondered about your profiles, but I would have guessed that someone of your experience, and doing the relatively mundane dives you were doing would have been doing pretty safe profiles.

The Hogan sits at 130' and my dive time was 30 mins for a run time of 43 mins. using 32% and O2 at 20'. My computer showed me doing the exact dive that I had planned. These were relatively simple dives in the scheme of things. I have done far more complex dives and they turned out fine.

And I thought about the PFO issue. As you well know, a certain group of divers who routinely do some deep cave dives, requires the PFO test on everyone on their team. I think that it is the safest way to proceed. And I swore I'd do it prior to me diving mix. There is just so much to go wrong.

Shulda, woulda, coulda. We can ALL play monday morning quarterback. Yes WKPP does require their divers to get tested for a pfo. I think it' great. I wish I had been tested. At this point I think EVERY diver should be tested for one. A pfo is just a time bomb waiting to go off inside a divers body.

If it is a PFO, then you'll have to make the tough choice to repair it, or stay out of the water. As no matter how careful you are, you can take a hit. If it's not a PFO, then you are really going to have to do some more searchnig as to the nature of the dive (depth, temps, mix, activity before the dive, physical exertion levels on the boat, etc., to try to find some answers.

If it even can be fixed. If it isnt a pfo... then I won't dive at all. If this an unexplainable accident... I just can't take the risk. I only have so many lives left! I have used more than my fair share this lifetime.

But as I am sure you are aware, you're case sounds textbook PFO. Good profile, simple dive, no major factors, major hit, and no PFO test done. It's the first thing I'd go looking for.

Thats what Im thinking too.

Glad to have you back with us. And I truly hope to join you on a wreck dive one day. I'm inching closer.

Thanks! It's good to be back ... good onya and as Dory would say just keep diving...just keep diving...just keep diving! And I will hold you to that ya know!

[TekDiveGirl]

<snip>
As I said above, I have not had an echocardiogram to find out if I do in fact have a PFO or not. My main focus has been getting better from the accident and not why the accident itself ccured. Although I think I'll be kinda scared to have the PFO test done. What if it turns out that I don't have a PFO? Then what???

Any thoughts?

Would it be safe to assume that you've already put this question to medical professionals, Kimber? Do any of them dive? Have they helped make this decision any easier?

Well, whehn my neurologist, who is also the medical director of Scripps Hospital and who I had heard after the fact noboby challenges his authority, told when I was in inpatient rehab no more diving. My reply was we will see. And that is my view right now. When I know more I can make an informed decision. I will withhold judgement.

[ScubaDadMiami]

Probably the first thing to do is to find out if you are, or ever can be, cleared to return to any type of diving by the medical experts based upon your physical condition. We all wish you well from that prospective.

Next, you will have to get tested to see if the PFO was the cause, and just how severe it is. Given that you had an earlier DCI episode in your career from what sounds like a very low risk dive, it would not be surprising to find that the PFO is large, and is the type that would require repair in order to resume diving.

If the cause is not a PFO, you will have to get to the bottom of the cause before being in a position to evaluate whether returning to diving is possible.

Best of luck, and please let us know how it goes.

[drbill]

Kimber, if memory serves me right (and it often doesn't!), 30% of the population may have a PFO. If that is the case, then them's not the greatest of odds. There has been a fair bit of talk on other boards recently (or maybe I'm just tuning into the subject more) about PFO's.

It really has me wondering about my personal risk. I've had some intensive cardio work in the past, and the cardiologist never mentioned anything about one so I'm probably safe (since they did a lot of testing 20 years ago). However, given the increased frequency of my deep diving, I should probably play it on the safe side. The thought of not being able to dive if I do have one would be beyond my ability to accept.

[MNJoe]

The owner/instructor at my LDS took 3 DCS hits before her PFO was discovered. She had it repaired, I belive it was even done as outpatient. She is still diving and teaching. I know most of her dives are when she is teaching, but she has also done some deep dives, 200 feet.

MNJoe

[BeachBunny]

PFO repairs and some ASD repairs (very similar to PFO's just slightly larger) can be repaired using the same technique as a cardiac cath. (Read No open heart surgery or long hospital stay required).

As far as the test goes, a bubble study(injecting agitaited saline through an IV and watching for the bubbles to cross the atrial septum) is typically performed in conjunction with either a transthoracic echo or transesophageal echo. A transthoracic echo can be done in the doctor's office, and the transesophageal is done on an outpatient basis in the hospital with conscious IV sedation (it's similar to having an upper GI done). Both are super easy and can give your doctor a great baseline for your overall heart function.

Before I started diving I had a patient who had taken a DCS hit and came in to be evaluated for a PFO/ASD. He had a teeny tiny PFO....so small it did not create a murmur and under normal circumstances never would affect his quality of life. He was not an avid diver and decided to the best of my knowledge to forego a repair.

I hope you have the echo done and get all of the answers you need Kimber. Once again, I am so glad that you are well.

[finGrabber]

Hmmm,

what's a PFO?

I have an idea but I want to make sure I know what you mean

Simplistic terms ... a hole in the heart. Go to the site below to read more.

http://scuba-doc.com/pfo.htm

Thanks!

I thought it was something to do with the heart valves so this is excellent information!

[TekDiveGirl]

Before I started diving I had a patient who had taken a DCS hit and came in to be evaluated for a PFO/ASD. He had a teeny tiny PFO....so small it did not create a murmur and under normal circumstances never would affect his quality of life. He was not an avid diver and decided to the best of my knowledge to forego a repair.

If I were in his position I would likely do the same thing... but being more in the obsessive diver category makes me considerr the alternatine.

I hope you have the echo done and get all of the answers you need Kimber. Once again, I am so glad that you are well.

That is my plan! And thanks!

[TekDiveGirl]

Probably the first thing to do is to find out if you are, or ever can be, cleared to return to any type of diving by the medical experts based upon your physical condition. We all wish you well from that prospective.

If the cause is not a PFO, you will have to get to the bottom of the cause before being in a position to evaluate whether returning to diving is possible.

Best of luck, and please let us know how it goes.

No medical professional will EVER clear me to dive again. That I am sure of. Nobody would be willing to put their license on the line and say "yes you can safely scuba dive now." Not going to happen. I would be doing it against medical advice. I have a friend who had his pfo fixed. His md said that he couldnt dive. He is out there doing thr big dives.

If its not a pfo--- then I won't dive again. I can't make it through this again. Thanks for the lick, and you know I will let you knoow how it goes.

Kimber, if memory serves me right (and it often doesn't!), 30% of the population may have a PFO. If that is the case, then them's not the greatest of odds. There has been a fair bit of talk on other boards recently (or maybe I'm just tuning into the subject more) about PFO's.

It really has me wondering about my personal risk. I've had some intensive cardio work in the past, and the cardiologist never mentioned anything about one so I'm probably safe (since they did a lot of testing 20 years ago). However, given the increased frequency of my deep diving, I should probably play it on the safe side. The thought of not being able to dive if I do have one would be beyond my ability to accept.

Bill ~~ you are correct it does affect approx 30% of the population. A pfo can strike at ay time--- shallow or deep. I took this hit at 130'

The owner/instructor at my LDS took 3 DCS hits before her PFO was discovered. She had it repaired, I belive it was even done as outpatient. She is still diving and teaching. I know most of her dives are when she is teaching, but she has also done some deep dives, 200 feet.

MNJoe

These are the stories I like to hear! Thanks for sharing.

[Scubatooth]

Kimber

Im in paramedic school and from time to time we do accident anaylsis of what happened and what did it cause. i will precurse this with if you dont wantto answer this thats fine

CM type I? shunts, or just reshaping?

you mentioned bilateral strokes on your first post. Where these strokes the occlusive kind from bubbles in your blood that traveled to the brain or where they caused by the CSF (Cerospinal fluid) coming up from the spine and entering the cerbral ventricles/tonsils and blocking the drainage ducts in the brain?

its good to have you back and continued improvements for you.

Dan

Edited by Scubatooth, 31 January 2007 - 09:06 PM.