Brain Tumors and Diving

[rcoltura]

Hello all,
I'm trying to do a bit of research for my father who has just got out of a succesful surgery to remove a brain tumor. He had been experiencing dizzy spells for a couple of months and the doctors passed it off as vertigo. He then began feeling nauseous all the time and was having difficulty eating. With some persistence he was able to go in for a CAT scan which revealed a tumor (hemangioblastoma) on the back of his brain. The next day he went in for an MRI and four days later they were operating. He is doing quite well now and is working towards making a full recovery. A little over a year ago my dad became a scuba diving fanatic and when told about the impending surgery questioned the surgeon about whether he would be able to dive again. The surgeon said that eventually most likely he would be able to. I performed a search on the board and found one thread relating to this but I'm just curious if anyone has any other information or research articles regarding the topic of brain tumors/surgery and diving. If so they would be greatly appreciated. Thanks and happy holidays!

Coltura

 

[ckharlan66]

I can't help with your question but wish him the best with his recovery from me.

Chad

 

[scubadoc]

Hello Coltura:

We hope your father continues to do well. It would be good to know whether or not he is taking anti convulsant medicine It would be difficult to provide your with any advice other than generalities.

Brain surgery generally poses two main problems with diving: post-operative epilepsy and changes in cognitive status. You do not describe seizure activity post operatively or if he is taking medication. In addition, some feel that scarring from the surgery would predispose him to DCS.

Anticonvulsants (Dilantin) should not be used with diving as they are all sedating and potentiate the effect of nitrogen narcosis, leading to disorientation at unexpectedly shallow depths. There is an apparent risk for seizures requiring the medication - another contra indication to diving.

You Dad may be able to dive if he has the approval of his physician, has not had seizures and has had no reduction in his ability to perform the task-loading required in safe diving, self-rescue and rescue of his buddy and has been off medication as described above. Dr. John Parker, writing in the Sports Diving Medical feels that he should wait 3 years before diving. [The Sports Diving Medical, p. 118].

Hope this helps!

 

[rcoltura]

Thanks Chad and Doc,
I appreciate the replies. My dad is not on any anti convulsant medication and there are no apparent cognitive changes. Although my dad is anxious to be diving as soon as possible he is patient enough to research the articles and allow for adequate recovery time in order to ensure his safety and the safety of those he dives with. Thanks again and if you come across any other relevant reading material be sure to pass it along. Have a great day!

Coltura

 

[AllenG]

First off, I am pleased to learn that your father (perhaps you?) persisted and finally got him in to be appropriately evaluated. As one in the medical business (there's no more "care" in health care, it's just a business!), I see far too many people held at bay by (mis)managed care with adverse and sometimes life-threatening consequences. Some docs on this board may shrug their shoulders at these statements, but, hey, I have no need to watch people suffer or perhaps even die because the practice of medicine has been reduced to a commodity no different than white bread (except that the quality control procedures and public health oversight for baking of white bread are far more rigorous!).

Second, I am even more pleased that your father is doing well. Recovery and rehabilitation after a tumor like this can be complex.

And, so now, to the matter of your question: the issue of brain tumors and surgery did appear once before and can be found at www.scubaboard.com/showthread.php?s=&threadid=10607

Research on the issue? I haven't seen any. Helpful information? I've seen even less of that - just lot's of parrot-like repetition of well-intended, but not necessarily factually based recommendations. In that regard, I would like to reiterate two points from my previous post:

"(C)onsiderations may include the nature and location of the tumor, along with the functions controlled by that area of the brain. In addition, consideration needs to be given to the possibility of continuing, but more subtle effects from the tumor or the surgery. Some of our patients who have had a mild brain injury will seem to be doing okay, but over time, the patient, his/her family, co-workers, or friends will notice that some functional areas "seem a little bit off." In these cases, a neuropsychological evaluation (i.e., aimed at neuro issues impacting functioning, rather than psychiatric symptoms) may identify things that other methods have not."

"(A)ssuming that everything is going great, who should you work with re evaluating the risks associated with a return to diving given your medical history and your current condition? Notice the words - not "is it okay to dive?"; rather "what are the specific risk issues that your particular constellation of history and current functioning represent relative to diving?". On the one hand, a neurologist/ neurosurgeon with no expertise in diving medicine will be (WARNING: inexcusably cheap aquatic reference is about to happen) like "a fish out of water" trying to consider what diving-related issues will be critical for you. On the other hand, many diving docs are more focused on pulmonary medicine and, knowledgeable as they may indeed be, won't have sufficient expertise to speak to the neurological nuances that may be important. (At this point, you may be hoping to find a one-armed physician who therefore cannot say "on the other hand" - sorry, I like bad jokes, what can I say?) If it is at all possible, you may need to bring together experts from the two disciplines. And please don't assume that an MRI or an EEG is going to give a definitive answer. These tools can only help guide the assessment process and the ensuing discussion."

Notwithstanding the usual caveats and disclaimers (see below), I would be glad to provide by PM questions that may help guide you and your father to secure information to better guide him in making decisions re whether or not to return to diving, or, if returning, time frames and considerations. Again, I haven't seen the patient, I can't/wouldn't offer you answers - rather, I would be offering questions you/your Dad would want to ask specialists in diving medicine and neurosurgery from which an informed opinion can be derived.

Best wishes to your Dad.

Allen


(and now the usual disclaimers - none of the above is intended to serve as medical consultation or in place of your seeking medical consultation or treatment. Only a physician who has personally evaluated or treated you can provide you with the guidance that you need. The information provided above merely documents issues associated with the treatment of certain medical conditions, in the hope that you will be able to more effectively participate in your own treatment and consultation with such physician)

 

[r9tucker]

I am a brain tumor survivor having it removed at Duke Univ. on 4/25/02. Unfortunately, my prior symptoms included seizures that are not going to help me much as I attempt to continue diving that started in the late 60's. I currently take anti-seizure medication which is why I feel somewhat comfortable even thinking about diving. I am currently debating the possibility of diving with my doctor who is naturally reluctant to give me the OK. The key here is that doctors will probably never sign off on any of us stricken with this unfortunate disease. Their legal obligation prevents them from doing so. And diving operations will not fill your tank if they know about the surgery and do not have a doctor's permission from you. So the impasse is mostly addressed by finding dive operations that will accept a waiver that you would sign relieving them of any risk. There was an article recently in a dive magazine that evaluated their legal value. Either way, you will have to find an dive operation or someone that just fills your tank that will accept them. If you decide not to disclose the medical information , then you obviously are breaking the trust given to you. Your choice.
Rob Tucker

 

[NurseShark]

there isn't much that directly pertains to diving post brain tumor surgery. I work in pediatric neurosciences (including brain tumors), but even though we see teens, I don't have any experience with any of them wanting to dive post surgery. My best suggestion would be to have your father speak with his neurosurgeon about the diving. If the neurosurgeon doesn't have any experience with risk factors associated with diving, it would be far easier for your father to bring him articles about DCS & what physical requirements are needed to dive safely & then the neurosurgeon can make a recomendation based on his direct personal experience with your father, rather than trying to find articles that discuss diving after a brain tumor that may not have any relevance to your father's situation. I'm sure DAN would have pertinent information your father could take to his doctor.

It bodes well that the doctor already said your father could most likely return to diving. As Scubadoc already stated, the biggest concerns in general are seizures & cognitive changes. You sound like you & your dad are being cautious about his return to diving & using sound judgement. The only other concerns you might want to discuss with your dad's doctor would be any other treatments (you don't say if he needs chemo. or radiation) as these can change the picture, and whether there are any vascular effects from the tumor itself (hemangioblstomas are clumps of blood vessels and their removal can sometimes release excess blood cells into circulation, leaving you at risk for thrombus formation or other vascular damage, which could increase the risk for DCS).

And now, of course for the usual disclaimer as Allen put it so well:
(and now the usual disclaimers - none of the above is intended to serve as medical consultation or in place of your seeking medical consultation or treatment. Only a physician who has personally evaluated or treated you can provide you with the guidance that you need. The information provided above merely documents issues associated with the treatment of certain medical conditions, in the hope that you will be able to more effectively participate in your own treatment and consultation with such physician)

Good luck & hope to see you in the water soon!

 

[Blackbeard]

I'm glad to see this subject has come up again since my original post (was feeling mighty lonely). With the limited knowlege/experience there seems to be with this topic, it's good to share info.

I've had a lot of time to think about this and have decided the best thing is to take it slow. r9tucker you say:

r9tucker once bubbled...
I currently take anti-seizure medication which is why I feel somewhat comfortable even thinking about diving.

:wacko: Well not sure what your taking but dilantin still wipes me out, slows me down, which at times feels like drunkeness and there's no way I would dive on that. From what I've read, it's an absolute NO as effects can increase underwater. IF I'm able to wean off dilantin at 1-yr, I still won't even think about pursuing diving for at MINIMUM 1 seizure-free year after that. At that point, and I'm still hopeful, I would begin to explore the subject further with the right folks (as suggested by AlenG) and a combo of things like the followup MRI's etc. I still haven't even asked the question as I know it's too soon to tell and I don't want to hear a NO.

If I can get to the point of feeling comfortable myself with diving, as well as having the best medical opinion, I could see spending a lot of time an experimentation in the deep end of the pool. I really miss diving but there's no way I'll consider putting myself or a buddy at risk . I'm now adjusted to thinking in neurologic time which I hope is a little quicker than geologic.

r9tucker: Would like to hear about your experience as we're almost on the same timeline.