Return to Diving After Moderate TBI

[BFRedrocks]

My 16-yr old son fell down a flight of stairs and sustained a fractured skull and had some small bleeds in his brain (classed as a moderate TBI) back before Christmas. My emails with DAN suggests a moderate TBI should stay out of the water and away from diving for 1 year. My question is once he is cleared by a doctor to dive (probably by a neurologist and family physician who are not dive medicine trained), how should we approach his return to diving? First dive in a pool to 8/10 feet, then migrate to shallow OW (<20/30 feet), and then to "normal" diving? After a year of no symptoms (he is currently asymptomatic as is typical of moderate TBIs), should his return be more regular (straight to OW, but easy dives)?

Of course this also requires re-familiarizing him with diving in general after being away for a year, but I'm referring to dealing with his return from the TBI.

 

[Duke Dive Medicine]

Hello @BFRedrocks ,

Your son needs an evaluation by a physician trained in diving medicine. Unfortunately there seems to be a dearth of physicians in Phoenix who do that. You might contact the UCSD hyperbaric unit and see if anyone there is willing to do a telemedicine consult with your son's neurologist and PCP.

Best regards,
DDM

 

[BFRedrocks]

Hello @BFRedrocks ,

Your son needs an evaluation by a physician trained in diving medicine. Unfortunately there seems to be a dearth of physicians in Phoenix who do that. You might contact the UCSD hyperbaric unit and see if anyone there is willing to do a telemedicine consult with your son's neurologist and PCP.

Best regards,
DDM

Thank you...DAN provided me with a "referral" to the Scottsdale (AZ) Healthcare - Osborn Baromedical Department, so I was going to start there, unless you've heard that they do not do consults or have someone trained in diving medicine. My next option would be to contact UCSD per your suggestion.

Maybe the answer to my specific question is it depends on what the doctor trained in diving medicine suggests as far as how to return him to diving, but I was assuming (with my question) that he'd be cleared to dive again...so specifically, would it be a slow return (pool, shallow, normal) or just return to normal diving once cleared?

 

[Duke Dive Medicine]

Thank you...DAN provided me with a "referral" to the Scottsdale (AZ) Healthcare - Osborn Baromedical Department, so I was going to start there, unless you've heard that they do not do consults or have someone trained in diving medicine. My next option would be to contact UCSD per your suggestion.

Maybe the answer to my specific question is it depends on what the doctor trained in diving medicine suggests as far as how to return him to diving, but I was assuming (with my question) that he'd be cleared to dive again...so specifically, would it be a slow return (pool, shallow, normal) or just return to normal diving once cleared?

I don't know that I'd assume anything at this point. He could be at increased risk of seizure so I'd leave it up to the examining physician to make specific recommendations.

Best regards,
DDM

 

[BFRedrocks]

I don't know that I'd assume anything at this point. He could be at increased risk of seizure so I'd leave it up to the examining physician to make specific recommendations.

Best regards,
DDM

Thank you, I understand. If I can't get a hold of someone at UCSD, does your department/group do telemedicine consults as well?

 

[Duke Dive Medicine]

Yes, you're more than welcome to have your son's neurologist and/or PCP contact us. Did you get hold of the folks in Scottsdale?

Best regards,
DDM

 

[BFRedrocks]

Yes, you're more than welcome to have your son's neurologist and/or PCP contact us. Did you get hold of the folks in Scottsdale?

Best regards,
DDM

Thank you! Scottsdale has not returned my calls yet. I will keep trying, but I also recognize that we're at least 8 months away from him being close to being cleared to dive.

 

[Duke Dive Medicine]

Thank you! Scottsdale has not returned my calls yet. I will keep trying, but I also recognize that we're at least 8 months away from him being close to being cleared to dive.

Kudos for thinking ahead!

 

[BFRedrocks]

Yes, you're more than welcome to have your son's neurologist and/or PCP contact us. Did you get hold of the folks in Scottsdale?

Best regards,
DDM

Hi,

It's now been about 8 months or so since my 16 yo son's moderate TBI (see above for what happened). He has been evaluated by a couple of neurologists (including one of the leading neuro docs at the MC Scottsdale), and had a couple of comprehensive neurocognitive tests conducted as well as a follow up MRI approximately 6 months post injury. There were three very small areas of encephalomalacia identified on the scan, consistent with his injury.

The neurologist has cleared my son to return to most activities, with the caveat that he should not (and will not) engage in competitive football, ice hockey, or lacrosse in the future. From the neurologist's point of view, he should be fine returning to scuba diving, although I have already told him we will wait until later in the year to consider getting him back in the water.

My question to you is whether or not you think it's necessary (or recommended) for you to have a phone consult with his neurologist to discuss him diving (we are planning a trip in January), or whether you think his neurologist clearance is sufficient for him to return to diving at the end of the year?

Thank you! (feel free to move this to a DM if necessary)

 

[flyboy08]

To get their attention...

@Duke Dive Medicine