DGriffin
Registered
From the FWIW department, I just spoke with DAN. As they have said there isn't a lot of research and concrete proof on the subject, they recommend waiting a solid 12 months before diving again. I wish I hadn't called them.
Cerebral Aneurysm - how long to dive again?
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shakeybrainsurgeon
Contributor
Not to second guess DAN, but there is no evidence to suggest that a person is any safer six months post bleed than three months, or twelve months post bleed than six months. They are just being extraordinarily conservative, which isn't necessarily a bad thing regarding a recreational activity with some risk, I guess.
However, what are they worried about? Seizure? Re-bleed? There is no evidence or even common wisdom to suggest that the risk of either of these is lower at 12 months versus 6.
Let's put it this way...consider another activity that, if one had a hemorrhage or seizure while doing it, there would be disastrous consequnces: driving. Presuming someone has not had a seizure, is there any neurosurgeon or neurologist who is restricting a patient, after an uncomplicated aneuyrsm obliteration, from driving FOR A WHOLE YEAR??? That's nuts. In Pennsylvania, even after a grand mal seizure, the license to drive may be suspended for only six months (provided the patient remains seizure-free the whole time). Of course, driving is a more essential activity than diving, re: work, school, etc. That said, however, a seizing or bleeding driver can kill many people, a diver with similar distress will likely kill only himself. I see no reason to be more conservative with diving than with operating a car.
I am not saying to go against DAN; it's just that I don't personally understand that recommendation. If you can't dive at, say, six months, you aren't going to be any safer at 12, or 24. They might as well restrict all SAH or aneurysm patients permanently. Too often we in medicine pull a time frame out of our you-know-whats with no real rationale other than tradition. In the case of post-aneurysm patients, however, the data are pretty clear regarding the risk of vasospasm, bleeding and seizure (the only things that are likely going to get you into trouble). In the case of the first two, the risk goes to nearly zero after three months, certainly after six. The seizure risk never goes away completely, perhaps, but certainly it is as low as it is going to be by six months.
It would be interesting to see what other physicians on the board think about a one year ban in this circumstance. Have you asked your treating doctors about medical clearance? I am going to contact a friend of mine who is a very experienced brain aneurysm surgeon and a very experienced diver (he has been diving for decades and works in his sparetime as a diver for our local zoo and aquarium, both maintaining the sealife and going in the wild to procure specimens). I would be curious about his opinion of DAN's position.
Just my opinion, not official medical advice of course...
However, what are they worried about? Seizure? Re-bleed? There is no evidence or even common wisdom to suggest that the risk of either of these is lower at 12 months versus 6.
Let's put it this way...consider another activity that, if one had a hemorrhage or seizure while doing it, there would be disastrous consequnces: driving. Presuming someone has not had a seizure, is there any neurosurgeon or neurologist who is restricting a patient, after an uncomplicated aneuyrsm obliteration, from driving FOR A WHOLE YEAR??? That's nuts. In Pennsylvania, even after a grand mal seizure, the license to drive may be suspended for only six months (provided the patient remains seizure-free the whole time). Of course, driving is a more essential activity than diving, re: work, school, etc. That said, however, a seizing or bleeding driver can kill many people, a diver with similar distress will likely kill only himself. I see no reason to be more conservative with diving than with operating a car.
I am not saying to go against DAN; it's just that I don't personally understand that recommendation. If you can't dive at, say, six months, you aren't going to be any safer at 12, or 24. They might as well restrict all SAH or aneurysm patients permanently. Too often we in medicine pull a time frame out of our you-know-whats with no real rationale other than tradition. In the case of post-aneurysm patients, however, the data are pretty clear regarding the risk of vasospasm, bleeding and seizure (the only things that are likely going to get you into trouble). In the case of the first two, the risk goes to nearly zero after three months, certainly after six. The seizure risk never goes away completely, perhaps, but certainly it is as low as it is going to be by six months.
It would be interesting to see what other physicians on the board think about a one year ban in this circumstance. Have you asked your treating doctors about medical clearance? I am going to contact a friend of mine who is a very experienced brain aneurysm surgeon and a very experienced diver (he has been diving for decades and works in his sparetime as a diver for our local zoo and aquarium, both maintaining the sealife and going in the wild to procure specimens). I would be curious about his opinion of DAN's position.
Just my opinion, not official medical advice of course...
I thought I'd give an update on my wife's situation as there is so little information out there on diving after an aneurysm.
This weekend my wife was really happy to be able to get back into the water after her clipping in April 2007. The delay was not the result of the aneurysm itself but due to the extended DVT that formed in her legs during the long period of inactivity. Her neuro surgeon liberated her almost a year ago but her vasco only liberated her recently after a lot of tests.
Anyway, on Saturday we did a couple of easy shallow dives at 20-25ft just to get her back into practice - after all her last dive was in Coz in Feb 2007 - and then on Sunday we went a little deeper to around 60ft. She felt nothing from the surgery - just very happy to be back in the water.
So she's living proof that there is still diving after a major bleed and I'm happy to get my regular buddy back after 18 months suffering with insta-buddies.
This weekend my wife was really happy to be able to get back into the water after her clipping in April 2007. The delay was not the result of the aneurysm itself but due to the extended DVT that formed in her legs during the long period of inactivity. Her neuro surgeon liberated her almost a year ago but her vasco only liberated her recently after a lot of tests.
Anyway, on Saturday we did a couple of easy shallow dives at 20-25ft just to get her back into practice - after all her last dive was in Coz in Feb 2007 - and then on Sunday we went a little deeper to around 60ft. She felt nothing from the surgery - just very happy to be back in the water.
So she's living proof that there is still diving after a major bleed and I'm happy to get my regular buddy back after 18 months suffering with insta-buddies.
Great outcome, Mike!
HBO MD
Contributor
I appreciate Shakey's very thoughtful response and would support him in his overall assessment( medical disclaimer inserted in bold here). In a situation where the patient has been treated in the absence of ongoing/recurrent symptoms I would consider 12 months to be quite conservative.
However, medicine is always somewhat contemplative : you know, 2 doctors, 3 opinions sort of thing.
But does that translate to diving as usual? I'm not sure from the above if any parenchymal ( brain tissue) damage was present on CT or MR? If so, in the absence of symptoms, I'm not sure I would alter the time to return, but I would consider altering your profiles in the presence of tissue changes on scan in light of changes in gas uptake and off loading in an area of injury.
Additionally, I would consider sticking to air diving rather than mixed gas?......
.....Which brings me to another point of discussion in this clinical scenario. Shakey, what would be your recommendation in the previous situations in terms of mixed gas diving, in light of the potential CNS effects.
What are your thoughts?
However, medicine is always somewhat contemplative : you know, 2 doctors, 3 opinions sort of thing.
But does that translate to diving as usual? I'm not sure from the above if any parenchymal ( brain tissue) damage was present on CT or MR? If so, in the absence of symptoms, I'm not sure I would alter the time to return, but I would consider altering your profiles in the presence of tissue changes on scan in light of changes in gas uptake and off loading in an area of injury.
Additionally, I would consider sticking to air diving rather than mixed gas?......
.....Which brings me to another point of discussion in this clinical scenario. Shakey, what would be your recommendation in the previous situations in terms of mixed gas diving, in light of the potential CNS effects.
What are your thoughts?
pickledxb
New
Hi everyone,
I am so glad to find this thread. I had a very aggressive aneurysm which originally measured 22mm. I had it coiled (stem assisted) in Dubai (13 coils). Unfortunately, it continued to grow to a crazy 29mm. Luckily I was in Greece at the time. To cut a looong story short, I had a new surgery (still the only person in the world) where I had a newly invented smaller stent inserted into my previous stent. It was a crazy operation - The equipment, stent and technicians were flown over from Paris, and the Doctor (who poineered the procedure) was flown in from Milan. Anyway, my 2nd procedure was done in August 2010. My current amazing doctor in Greece isn't sure whether to allow me to dive again. For one, I cannot have an MRI again because this new stent (and ''set-up'') that I have has never been tested. So, I guess I am in a real pickle because of how unique my case is. Any advice? What is the main concern about diving with aneurysms? Is it related to the pressure? Or gasses in the blood? Or highered blood pressure? I know I am not allowed to run excessively again because of the way it raises your heart rate and pressure so quickly. Any advice?
I am so glad to find this thread. I had a very aggressive aneurysm which originally measured 22mm. I had it coiled (stem assisted) in Dubai (13 coils). Unfortunately, it continued to grow to a crazy 29mm. Luckily I was in Greece at the time. To cut a looong story short, I had a new surgery (still the only person in the world) where I had a newly invented smaller stent inserted into my previous stent. It was a crazy operation - The equipment, stent and technicians were flown over from Paris, and the Doctor (who poineered the procedure) was flown in from Milan. Anyway, my 2nd procedure was done in August 2010. My current amazing doctor in Greece isn't sure whether to allow me to dive again. For one, I cannot have an MRI again because this new stent (and ''set-up'') that I have has never been tested. So, I guess I am in a real pickle because of how unique my case is. Any advice? What is the main concern about diving with aneurysms? Is it related to the pressure? Or gasses in the blood? Or highered blood pressure? I know I am not allowed to run excessively again because of the way it raises your heart rate and pressure so quickly. Any advice?
Hi Pickled,
If your care team is concerned that running would increase your BP and heart rate excessively, it's a pretty good bet that you should not be cleared for diving either. The decision should ultimately be up to the physician who performed the procedure, though.
Best regards,
DDM
If your care team is concerned that running would increase your BP and heart rate excessively, it's a pretty good bet that you should not be cleared for diving either. The decision should ultimately be up to the physician who performed the procedure, though.
Best regards,
DDM
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Hi pickledxb,
Wow, sounds like you were the recipient of real first class surgery and medical treatment, with an excellent outcome.
In my opinion, given the nature of your condition and treatment, it might be wisest to pass on scuba. In short, this opinion is based on the inability to image the operative site via MRI, the increases in intracranial pressure secondary to pressurization equalization techniques, the increase in intracranial pressure that can occur with increased ppCO2, and the increase in BP that occurs due to the immersion-related shift of the blood into the thorax & constriction of peripheral vasculature. BP also may be increased by the exertional demands of some scuba.
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
Wow, sounds like you were the recipient of real first class surgery and medical treatment, with an excellent outcome.
In my opinion, given the nature of your condition and treatment, it might be wisest to pass on scuba. In short, this opinion is based on the inability to image the operative site via MRI, the increases in intracranial pressure secondary to pressurization equalization techniques, the increase in intracranial pressure that can occur with increased ppCO2, and the increase in BP that occurs due to the immersion-related shift of the blood into the thorax & constriction of peripheral vasculature. BP also may be increased by the exertional demands of some scuba.
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
I recently had a brain aneurysm (6 weeks ago) and I am fine. Got really lucky because the diagnosis was fast, the coiling went well, and other than a little light headed and lower energy, I feel 100% normal. My follow up appts are next week, but I'm really worried about not being able to dive again soon enough for our planned dive trip at the end of the year.
I got some comfort from miketsp's story but I don't see anything about an EVD. Because of the pressure building up a couple days after the coiling, they had to put a 'brain drain' in. So, how long does the hole drilled into my head take to heal, and does it impact my ability to dive differently than the aneurysm?
I got some comfort from miketsp's story but I don't see anything about an EVD. Because of the pressure building up a couple days after the coiling, they had to put a 'brain drain' in. So, how long does the hole drilled into my head take to heal, and does it impact my ability to dive differently than the aneurysm?
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diver 85
Contributor
OP, Glad she's doing well......But, I'd listen to the attending docs along with DAN's input---& not someone in cyberspace---ie someone you can look eyeball to eyeball @....
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