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Hi all, I'm posting this for a buddy who got hit, and does not have net access. I have a buddy who got bent last year but, because of no reason to suspect a hit and an existing soft tissue injury to the affected shoulder, didn't realize it until weeks after the fact. The incident hasn't been positively identified as it occurred during a month of active deep diving. Believed probably occurred after the second of two 42metre dives. First for 12 minutes, 4 deco, second 4 hours later. Diving modified Buhlmann. Second dive of the day again to 42metres. Surfaced in Table E after six minutes deco. Blazing hot Summer day, peeled off dry-suit and went for a swim. (vigorous exercise?) Coming back to port 30 minutes later itch across shoulders, checked immediately by buddy -no blotches. Checked again 30 minutes later by buddy and again by diving officer, all clear. Sore shoulder nagged for a further two weeks before being diagnosed as a bend, one two hour period of slight numbness/tingling in left leg provided the prompt for medical evaluation. Chamber treatment for 2.5 hours on O2 resolved symptoms. What caused it? The swimming after the dive or a PFO. Very few manuals/books/instructors think to warn about avoiding excercise after diving, especially deeper stuff but they should. To try narrow things down, he went for the test and finds a big PFO. But the PFO was always there and never caused problems in the previous 100 dives. So now what to do? The easy and only guaranteed safe decision is to quit but there have to be a lot of people who have experience of this and can answer some questions. Who rejects confirmed PFOs? Why? Reconcile this with medical proof of 30% PFO incidence in normal population? With 30% of the pop affected, why aren't divers tested and 30% rejected? The heart pumps both sides simultaneously and as the freshly oxygenated supply is to the whole body, the pressure will be higher on that side than the other, hence the cross-flow will be just to recirculate. The 'victim' saw this clearly on the enhanced U/S Doppler image. PFO under normal situations cross-flows from the newly oxygenated lungs back into the CO2 and N2 rich feed to the lungs so no increased risk there. Experiments to reverse PFO cross-flow are very difficult to effect and are transitory. One theories relating to divers is: Valsalva-ing can change the pressure differential from side-side momentarily changing the cross-flow. This is only going to present a potential risk when outgassing, ie ascending+decompressing and again is transitory. So why can anyone justify how PFOs increase risk and are reason to disqualify and if so why aren't 100% of trainees tested and 30% rejected? The cardiologist who did the test did not agree a PFO should cause DCS or be grounds for rejecting a diver. He did know what divers are and the mechanism of DCS and quoted an article in The Lancet, supporting this position. Anyone reading this been or know anyone else in this position: been bent with no obvious reason, subsequently found to have a PFO? What about anyone who's confirmed a PFO but continued diving? So thats it - he's in a sitaution where info is hard to find, and hopefully some of you out there can offer useful advice, or better, personal experience. Email to me directly, or the group if you wish. Thanks, Olly
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