Dr. Doug Ebersole, an interventional cardiologist in Lakeland and an avid diver, is getting increasingly known in the diving community for repairing a heart defect that about 25 percent of Americans have. Called a patent foramen ovale, or PFO, many people don’t even know they have it.
About one-fourth of us walk around with a specific heart defect, two little flaps between the upper heart chambers that didn’t fuse together in infancy.
Few who have the hole in their heart know it’s there. Most won’t need to know.
They aren’t launching into outer space, pressing the limits of the atmosphere as military pilots or making deep, frequent underwater dives.
But, for the select number involved in such activities, a patent foramen ovale — PFO for short — can be dangerous.
Not always, but sometimes. Even to skilled divers like Deana Fraser, who make a point of following all the safety procedures.
A diver since 2004, the Washington state resident had her first experience with the bends, decompression illness, in 2018. Divers call it getting bent.
This can happen when divers have too rapid a reduction in air pressure as they surface or when a high-altitude aircraft loses its cabin pressurization.
Nitrogen bubbles escape into the tissues of the body. If someone has a PFO, nitrogen bubbles can travel through that hole between chambers into the left side of the heart, said Dr. Doug Ebersole, a Watson Clinic interventional cardiologist and an avid diver.
Even when a diver follows all the proper protocols.
Decompression sickness occurs about two times in every 10,000 dives for the general population. The likelihood is five times greater, 10 times in every 10,000, if the diver has a PFO, Ebersole said.
His medical specialty, his work as a volunteer consultant for Divers Alert Network and his affinity for diving led to his becoming known for repairing the PFO defect in divers like Fraser who develop decompression illness.
“It’s a little niche I’ve developed,” said Ebersole, 60, who dives about 100 times a year.
He does the corrective repair more often on young people who have strokes associated with having a PFO and no other discernable cause.
Within the diving community, however, he’s known as one of the specialists doing that heart repair for them.
Fraser, a registered nurse for more than 25 years and a breast cancer survivor, was one of his patients.
She’s devoted to diving, starting as a recreational diver and last year completing a Global Underwater Explorers technical course. Tech training lets her do deeper dives in her quest to explore.
“The things you love the most make up who you are,” said Fraser, 50, a wound care nurse.
She flew from Washington in mid-December to have Ebersole close the hole in her heart in an outpatient procedure at Lakeland Regional Health Medical Center.
There are doctors capable of doing it much closer to her home, but location wasn’t her main consideration.
“I had to find that person who could do it who had done a number of them,” she said.
“He had the numbers to show how good he was,” she said of Ebersole, and the diving experience to know how much diving meant to her.
Along with her came a family friend, Bert Brezicha, a diver for 30 years, who suspected he had PFO but didn’t get tested to confirm it until Fraser did.
“Deana and I were flirting with disaster,” he said.
Brezicha’s test disclosed he had a large PFO. Ebersole repaired his heart right after he fixed Fraser’s.
His decompression illness developed after he had gotten certified for “tech dives” of deeper than 100 feet. Deeper dives put more pressure on the body, although the bends can occur at shallower depths.
“Every once in a while, I would get skin bends (a mild form of decompression illness),” said Brezicha, who is 55. “I was very tired compared to other people who were doing the same dives.”
He began taking it easy on how much diving he did.
Fraser’s decompression illness surfaced in April 2018. She and her husband, James, 50, also a veteran diver, were on a diving trip to the Maldives, islands in the Indian Ocean.
After a dive of less than 100 feet, Fraser told her husband she’d somehow been stung on the abdomen. A Benadryl and some sleep cleared it up, James Fraser said, and they dismissed the occurrence.
They now suspect it was a minor case of skin bends.
One year and many dives later, Fraser had skin bends while diving in the Red Sea at Hurghada, Egypt.
She had stinging, itching and pressure on her thighs and abdomen. Those and other symptoms went away after she got 100 percent oxygen for a few hours.
Six months later, on another diving trip, things got worse.
She and James were in the Leeward Antilles in Caribbean. Two hours after the last of several dives over a two-day period, the skin on her hips and abdomen felt like “itchy stinging needles.”
Oxygen cleared it up that day but, on a subsequent dive, the skin pain was similar and went down to her thighs. Oxygen stopped the stinging but not her tissue pain or swelling from excess fluid.
The couple called Divers Alert Network, which told them Ebersole was on the same trip they were as a speaker. He assessed her, said she had signs of lymphatic decompression illness and should be checked at a local hospital.
This decompression illness was more serious than skin bends.
When they returned home, testing disclosed she had a PFO.
Doctors in Washington discussed some standard options:
Give up diving.
Take shallower and less frequent dives.
Fraser didn’t like either of those options, she said, but she didn’t want to risk having a stroke or other neurological damage.
There was a third option: Get her PFO fixed.
Brezicha, meanwhile, wasn’t pleased with the restrictions he’d adopted for himself.
When Deana Fraser arranged her surgery for Dec. 12, Brezicha got his scheduled then too. Fraser praised Ebersole’s nurse, Ana Liz Green, for handling the arrangements to make it possible within her time frame.
Timing was tight. They flew from Seattle to Tampa on a red-eye flight.
Her sister, Jessica Mitchell, flew to Tampa from Dallas and brought them to LRMC. James arrived later that day from a business trip in Australia.
James Fraser and Brezicha are diving instructors as well as diving enthusiasts.
The device used to close the hole in the heart is the Amplatzer PFO occluder, tiny discs made of Nitinol, a nickel and titanium alloy that can be stretched out and spring back into shape. The discs are guided into the heart through a catheter and put over the flaps.
Looking like little clam shells, they sandwich the flaps together. The larger of the two is about an inch in diameter, Ebersole said.
Scar tissue grows over them within about three months. Patients are on Plavix and baby aspirin during that time to prevent clotting.
Divers are encouraged to refrain from diving until the tissue grows in.
Both patients now are back to diving and having no difficulties.
“It’s been wonderful,” Deana Fraser said.
Brezicha also called the feeling wonderful, adding “It’s nice to feel safe.”
Robin Williams Adams can be reached at firstname.lastname@example.org