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Thread: What medical testing should RB divers get?

  1. #31
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    Re: What medical testing should RB divers get?

    Simon,

    I don't suggest or recommend a PFO test unless you are a) planning some serious diving or b) like me was getting bent for no obvious reason, given my last bend was neurological and cost me my eyesight allbeit very temporarily. To me not getting tested and taking positive action was not an option.

    The problem with highly educated people is IMO, they sometimes let their education and stats get in the way of good old common sense. You may only get one hit in a thousand dives, but if that one hit could be debilitating, positive action is a no brainer.

    So given the diving I was doing and given my recent bend history, how was my Consultant wrong?

    I just can't agree with your 'opinion' that the pre op and post op stats don't offer any info regardless of the number of dives. Everyone I know who was tested positively for the PFO was getting bent before the op - guess what, no bends after the op. Simon, you don't need to have a PHD to understand the reward for getting the hole fixed?

    I still don't understand your stance, you seem to intimate the knowledge of a PFO would cause the diver anguish? More so than bends and not knowing?

    DrM, like you I dived without incident for a long time while mates got bent and fixed - Like you I didn't get tested as nothing was wrong. When post dive started going tits up - I got tested.

    I'd rather have the knowledge than bury my head under a pile of stats.

    Dive safe.
    Last edited by Jim; 2nd September 2008 at 09:54.

  2. #32
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    Re: What medical testing should RB divers get?

    Quote Originally Posted by Scubascooby  View Original Post
    IMO it was dropped because the NHS started asking too much money for the medical and other agencies only required self cert.
    It was because it wasn't very effective, most GP's didn't understand diving issues. The NHS never paid, i allways had to pay my GP for it. New questionaire approach with referal to specialist diving doctors is reported to be working better, generating more referals.

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    Re: What medical testing should RB divers get?

    Quote Originally Posted by jptaylor9  View Original Post
    It was because it wasn't very effective, most GP's didn't understand diving issues. The NHS never paid, i allways had to pay my GP for it. New questionaire approach with referal to specialist diving doctors is reported to be working better, generating more referals.
    Many years ago, I didn't pay for my first one, just for the X-ray which was extortionate.

    When I had my second the governement had told the NHS to charge fixed rate fees for sports medicals and they were asking £60+ so I used a private doctor, who had done a diving medical course in Aberdeen, who was cheaper !

    Do you mean more referrals from filling in the form or more from seeing a specialist diving doctor ?

  4. #34
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    Re: What medical testing should RB divers get?

    Quote Originally Posted by Scubascooby  View Original Post
    Many years ago, I didn't pay for my first one, just for the X-ray which was extortionate.

    When I had my second the governement had told the NHS to charge fixed rate fees for sports medicals and they were asking £60+ so I used a private doctor, who had done a diving medical course in Aberdeen, who was cheaper !

    Do you mean more referrals from filling in the form or more from seeing a specialist diving doctor ?
    Privately at a London Clinic £900 - On NHS with no referral (long story) £150 to cover Trust costs.

  5. #35
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    Re: What medical testing should RB divers get?

    Quote Originally Posted by Jim  View Original Post
    Simon,

    I don't suggest or recommend a PFO test unless you are a) planning some serious diving or b) like me was getting bent for no obvious reason, given my last bend was neurological and cost me my eyesight allbeit very temporarily. To me not getting tested and taking positive action was not an option.

    The problem with highly educated people is IMO, they sometimes let their education and stats get in the way of good old common sense. You may only get one hit in a thousand dives, but if that one hit could be debilitating, positive action is a no brainer.

    So given the diving I was doing and given my recent bend history, how was my Consultant wrong?
    Jim,

    Apart from the "use of legs" comment, he wasn't wrong. You are not reading my posts. Try this bit from post #20 again.....

    "Look, screening for PFO has its place for properly informed divers who understand the issues, and when supervised by clinicians who also understand the issues and who can discuss them objectively with the "patient". It also has its place in the investigation of unusual DCS events or event sequences. But the matter is treated too flippantly by internet commentators who like to provide advice on matters well beyond their level of training or expertise."

    I think "unusual DCS events or event sequences" sums up your personal situation quite nicely. I also think that "properly informed divers who understand the issues" can embrace anyone who is "planning some serious diving" provided they have the right information given to them. My objection (as previously stated multiple times) is the manner in which the process is advocated on the internet. Getting tested for a PFO is rapidly and inappropriately becoming a de facto "standard" for safe practice in technical diving.

    Quote Originally Posted by Jim  View Original Post
    I just can't agree with your 'opinion' that the pre op and post op stats don't offer any info regardless of the number of dives. Everyone I know who was tested positively for the PFO was getting bent before the op - guess what, no bends after the op. Simon, you don't need to have a PHD to understand the reward for getting the hole fixed?
    I'm well aware there are divers (some my own patients) who have suffered recurrent DCS events because of right to left shunting of bubbles across a PFO, and who have it closed, and who then suffer no further episodes. Fixing the PFO probably fixed the problem. There's no question about that. It can happen. But the typical story is that a diver suffers DCS once, gets tested, has a PFO (just like 30% of the population), gets it fixed, doesn't suffer DCS over their next (insert number) of dives. In terms of evidence for efficacy of PFO closure in preventing DCS the point about these cases is this: A diver suffers a rare event, has a PFO closed, then doesn't suffer the rare event again. How can this be evidence of efficacy? You are trying to draw conclusions of efficacy based on the fact that an event we wouldn't expect to occur (because it is rare) doesn't occur. If you can't see that, I can't do anything more to help.

    Quote Originally Posted by Jim  View Original Post
    I still don't understand your stance, you seem to intimate the knowledge of a PFO would cause the diver anguish? More so than bends and not knowing?
    Here you illustrate the reason for my stance in the same sentence you question it. You essentially imply that PFO = BENDS. My stance is all about injudicious internet commentary. PFO does not = bends. Read my earlier posts again. 30% of divers have a PFO, yet those variants of DCS associated with PFO remain rare. PFO is another risk factor. I am not against getting tested for a PFO or even getting one repaired if there is a good reason to do so, and the diver fully understands all the implications of each step of the process. My objection is that the issue is misrepresented all the time on the internet. It has got to the stage where every time a diver reports a case of DCS on a forum, there is an army of amateur physicians lining up to tell him or her to get a PFO test. This happens even after episodes of pain only DCS; a variant that has never been associated with a PFO in any of the studies that have looked at the issue. The process is being driven off course by misinformation, and you can read one of my earlier posts again on the potential implications of that for diving and the diving industry in the longer term.

    Regards,

    Simon M
    Last edited by Simon Mitchell; 2nd September 2008 at 12:34.

  6. #36
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    Re: What medical testing should RB divers get?

    Quote Originally Posted by Simon Mitchell  View Original Post
    Jim,

    Apart from the "use of legs" comment, he wasn't wrong. You are not reading my posts. Try this bit from post #20 again.....

    "Look, screening for PFO has its place for properly informed divers who understand the issues, and when supervised by clinicians who also understand the issues and who can discuss them objectively with the "patient". It also has its place in the investigation of unusual DCS events or event sequences. But the matter is treated too flippantly by internet commentators who like to provide advice on matters well beyond their level of training or expertise."

    I think "unusual DCS events or event sequences" sums up your personal situation quite nicely. I also think that "properly informed divers who understand the issues" can embrace anyone who is "planning some serious diving" provided they have the right information given to them. My objection (as previously stated multiple times) is the manner in which the process is advocated on the internet. Getting tested for a PFO is rapidly and inappropriately becoming a de facto "standard" for safe practice in technical diving.



    I'm well aware there are divers (some my own patients) who have suffered recurrent DCS events because of right to left shunting of bubbles across a PFO, and who have it closed, and who then suffer no further episodes. Fixing the PFO probably fixed the problem. There's no question about that. It can happen. But the typical story is that a diver suffers DCS once, gets tested, has a PFO (just like 30% of the population), gets it fixed, doesn't suffer DCS over their next (insert number) of dives. In terms of evidence for efficacy of PFO closure in preventing DCS the point about these cases is this: A diver suffers a rare event, has a PFO closed, then doesn't suffer the rare event again. How can this be evidence of efficacy? You are trying to draw conclusions of efficacy based on the fact that an event we wouldn't expect to occur (because it is rare) doesn't occur. If you can't see that, I can't do anything more to help.



    Here you illustrate the reason for my stance in the same sentence you question it. You essentially imply that PFO = BENDS. My stance is all about injudicious internet commentary. PFO does not = bends. Read my earlier posts again. 30% of divers have a PFO, yet those variants of DCS associated with PFO remain rare. PFO is another risk factor. I am not against getting tested for a PFO or even getting one repaired if there is a good reason to do so, and the diver fully understands all the implications of each step of the process. My objection is that the issue is misrepresented all the time on the internet. It has got to the stage where every time a diver reports a case of DCS on a forum, there is an army of amateur physicians lining up to tell him or her to get a PFO test. This happens even after episodes of pain only DCS; a variant that has never been associated with a PFO in any of the studies that have looked at the issue. The process is being driven off course by misinformation, and you can read one of my earlier posts again on the potential implications of that for diving and the diving industry in the longer term.

    Regards,

    Simon M
    Simon,

    That's a very long reply to basically say you agree with the vast majority of what I say as an informed diver, but get hacked off with people second guessing you as a medical professional.

    From previous posts on this very site, the only time I've seen a test recommended by any other informed divers (most of whom have had the test and the op, or a bud who has) is when someone comes on the site with an unexplained hit or series of hits and ask the FORUM for advice.

    Don't worry mate, we don't want your job and I do respect your profession and years of education. Just allow us to discuss the topic and use our own common sense with experience in deciding a way forward and the free speach to give our thoughts and opinion. I don't believe anybody would take any post as a diagnosis .......

    All the best.

  7. #37
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    Re: What medical testing should RB divers get?

    Quote Originally Posted by Jim  View Original Post
    Simon,

    That's a very long reply to basically say you agree with the vast majority of what I say as an informed diver, but get hacked off with people second guessing you as a medical professional.
    I must admit to having a bit of a chuckle over this. Let's agree that a lot of what you say can be true. But as is typical of many complex issues in medicine, to be strictly accurate the information needs to be heavily qualified and contextualised to avoid imparting unhelpful or inappropriate beliefs. That is what is missing on the internet, particularly in respect of the PFO issue. Its not people second guessing me that "hacks me off".

    Quote Originally Posted by Jim  View Original Post
    Don't worry mate, we don't want your job and I do respect your profession and years of education. Just allow us to discuss the topic and use our own common sense with experience in deciding a way forward and the free speach to give our thoughts and opinion. I don't believe anybody would take any post as a diagnosis .......

    All the best.
    Yes, it disturbs me that these PFO debates inevitably make me look like a pompous intolerant physician. I'm not like that at all. In fact, I have no problem with "common sense" "free speech" discussions on the internet even if they go way off track so long as it doesn't result in an inaccurate message that is potentially damaging to divers or diving itself. The PFO issue frequently ventures into this territory, and on the internet this can mushroom into widespread disinformation or at least "partial" disinformation very quickly. I have no desire to discourage discussion of medical issues, but commentators and readers should always remember that the best sources of information are experts in their respective fields.

    If you are interested and you pm me with an email address, I will send you a review of the PFO issue I wrote recently for a textbook chapter.

    Regards,

    Simon M

  8. #38
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    Re: What medical testing should RB divers get?

    There are far more prevalent issues that should concern us that would predispose us to a higher incidence of DCS. Some with far better scientific evidence: choice of deco algorithms, dehydration, overweight, lack of fitness, age, alcohol, etc.

    If the theory that a PFO is the cause of people getting bent gains credence then the next move will be for the government to legislate the compulsory testing (and repair) of PFOs for all divers. Where will this lead?

    Before we say that governments would not take this position - I have just been through 3 years of hell as a result of over enthusiastic bureaucrats pursuing the theory that a small reverse dive profile caused the death of a diver. The outcome if they had been successful would have been that to do any dive even slightly deeper than a previous dive would have been ‘illegal’

    It was only the argument of some very capable legal and medical experts that were able to demonstrate that the evidence did not support this hard line position.

    To perpetrate the theory that everybody should have a PFO test will give credence to the government taking a stand and effectively stop 30% of the population from diving unless they have major surgery.

    If all this sounds like a bit of a stretch: the outcome in the case I mentioned above was that the dive shop was successfully prosecuted for failure to ensure that the diver’s personal depth gauge was calibrated... Now dive shops are responsible for ensuring divers personal equipment is working and accurate. Give the government a little power and a half cooked idea and it will get out of hand.

  9. #39
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    Re: What medical testing should RB divers get?

    Quote Originally Posted by 01RMB  View Original Post
    If all this sounds like a bit of a stretch: the outcome in the case I mentioned above was that the dive shop was successfully prosecuted for failure to ensure that the diver’s personal depth gauge was calibrated... Now dive shops are responsible for ensuring divers personal equipment is working and accurate. Give the government a little power and a half cooked idea and it will get out of hand.
    Ha ha. Calibrated in what ? Sea water, fresh water, custard ?

    Getting a gauge calibrated would cost more than the gauge.

    Even if the gauge wasn't calibrated it would still indicate a greater depth unless it was completely duff and showed less depth as you got deeper.

    If you get stopped for speeding, prosecute the Police for failing to calibrate your speedo.

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    Re: What medical testing should RB divers get?

    Quote Originally Posted by 01RMB  View Original Post
    Give the government a little power and a half cooked idea and it will get out of hand.
    Australia leads the world in production of politian's half cooked ideas.

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