“You know it’s something, but you want to keep doing what you’re doing,” Wolbrecht explained. “You don’t want it to end. You just don’t want to think something could stand in the way of your passion.”

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After falling in love with diving in her early 20s, she put the pursuit on hold to raise her family, before picking it up again when she became an empty nester. This time, Wolbrecht, 55, also recruited her husband, David, to join her in the adventure.

Before long, diving was a regular feature in their lives, and the Wolbrechts’ backyard pool became a scuba diving training site.

The couple planned two trips a year, often traveling to Roatán, an island off the coast of Honduras, where blue water beckoned.

Initially, Wolbrecht tried to hide and push through her feelings of fatigue and dizziness. Her symptoms matched a type of decompression sickness (DCS) known as “skin bends,” which also causes red or marbled skin.

Decompression sickness is caused when nitrogen dissolved in the blood forms bubbles as pressure decreases, going from different depths while scuba diving.

“I kind of ignored it,” Wolbrecht admitted. “I still hadn’t connected all of the dots.”

Then, in 2019, a shelter-in-place warning went out to residents of Deer Park after a fire at a local refinery caused an emission of the dangerous chemical benzene.

Again, Wolbrecht’s skin reacted. She described “bubbles” forming on the bends of her elbows.

A couple of months later, during a multiday dive trip, she noticed symptoms after her first dive.

“I thought maybe it was a heat rash,” Wolbrecht said.

She went on one more dive; as she carried the equipment back, she was struck with dizziness.

“I felt queasy,” she said. “I looked down and had some marbling going down my legs and onto my belly.”

Wolbrecht headed to the resort’s medical clinic.

“I took a couple steps to the door and I just crumbled,” she said.

Wolbrecht learned from the on-site doctor that she developed Type II decompression sickness, a more severe form of the illness that results in numbness, tingling and weakness. She received oxygen treatments to counteract the nitrogen in her system.

The doctor then issued a directive: No more diving for the rest of the trip.

Wolbrecht pleaded with him. She had not gone too deep or stayed out too long. She couldn’t understand how she could have developed decompression sickness.

“He said that some things can’t be explained,” she recalled. “And then he told me, ‘You can either stop diving or severely limit it.’”

“I left the island crying,” Wolbrecht said.

But she refused to accept the ultimatum. After returning to Houston, Wolbrecht, who works as a program manager at UTHealth, dove into research.

“I just couldn’t accept that there isn’t a reason for this,” she said.

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She found an article about a woman who also had decompression sickness, with the same cranberry marbling on her leg. A comment on the story online stopped Wolbrecht in her tracks: Another person said they had similar symptoms, which were determined to be caused by a patent foramen ovale (PFO) — a small opening between the right and left atrium of the heart.

Normally, a thin wall develops to separate the chambers, preventing blood flow between them. But for patients with a PFO, the flow can continue.

“I had never heard of it,” Wolbrecht said.

She made an appointment with Dr. Konstantinos Charitakis at

UTHealth, who specializes in internal medicine, cardiovascular disease and interventional cardiology.

He ordered a transthoracic echocardiogram (TTE) with a bubble study, which calls for agitated saline bubbles to be injected into the vein. Normally, lungs can filter out the bubbles. With a PFO, however, the opening allows the bubbles to move through the hole and then pop up on the left side of the heart. The test confirmed that Wolbrecht had a PFO.

“I had mixed feelings,” Wolbrecht said. “I was relieved I had found a reason. But then I was bummed. I didn’t know what to do about it.”

Charitakis gave her three options: Stop diving altogether; limit her diving; or get the PFO closed.

If Wolbrecht decided to have the procedure to close the PFO, he recommended his colleague Dr. Abhijeet Dhoble, associate professor of cardiovascular medicine and director of Structural Heart Interventions at UTHealth’s McGovern Medical School. She called Dhoble.

“Everyone is born with a PFO,” he said. “It’s natural.”

In utero, the hole is a necessary part of circulation. Then, for about 75 percent of the population, the hole closes as children develop. Dhoble said that for the remaining 25 percent of individuals, the PFO remains open.

“We don’t know why it stays open or closes,” he added.

Regardless, for most people, the opening is not a problem. There are often no symptoms.

“It is, however, considered a risk factor of strokes in younger folks,” Dhoble said.

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He explained that the PFO allows blood clots to travel from the right to left atrium of the heart, without being filtered in the lungs, which can result in a stroke.

Still, Dhoble said that a PFO should be closed only if a patient has had a stroke.

“But Caroline’s story is a little different,” he explained. “She didn’t have a stroke, but she had other issues.”

Her risk involved nitrogen bubbles, resulting from the dives, crossing from one side of her heart to the other.

“If air bubbles stay on the right side, it’s not a big deal, because they are filtered by the lungs and then exhaled out,” Dhoble said. “If it crosses to the left side, that’s when it becomes a problem.”

He is able toclose the PFO by performing a procedure called a transcatheter PFO closure, which begins through an incision in the groin. Doctors then move a PFO occluder device through the vein to the heart, placing it on the location of the defect. The out-patient operation takes less than an hour.

Wolbrecht’s PFO was closed in October 2019, and a follow-up bubble study showed her closure was complete. Wolbrecht was ready to get back into the water, but COVID-19 postponed her first dive.

In May 2021, she was finally able to head back to Roatán and test out her fully-functional heart.

“It was the perfect trip,” Wolbrecht said. “I always appreciate it, but this time, I appreciated it 1,000 percent. I had this overwhelming feeling of gratefulness.”

There were no signs of dizziness, weakness or rash. Upon returning, she emailed a thank you to Dhoble.

“She sent me pictures from the dive, and it was good to see,” he said. “I’m glad it worked out. This was a big part of her life.”

He believes that all divers should be screened for PFO to reduce the risk.

Wolbrecht agrees. “It might help someone,” she said. “They might not delay as much as I did or deny their symptoms.”

Wolbrecht looks back and now recognizes the many signs of the PFO, had she only known what to look for.

“There are so many reasons to be thankful,” she said. “I’m thankful I get to keep doing something I love. And I’m also thankful to live a healthier life.”

“I feel like I got a second chance,” she added.

Lindsay Peyton is a Houston-based freelance writer.