Diving after an Aneurysm Coiling

[BobArnold8265]

Hi,

I had a 5mm subarachnoid hemorrhage (aneurysm) this past February. It was repaired though a technique know as coiling and I have made a full recovery. I have been told by my doctor that because of a lack of data about aneursyms and diving that he recommends that I don't return to diving. I have no other restrictions and have returned to running (currently 5 miles/day 4 times a week). I was wondering if there are any divers or doctors on this forum who have any experience with this. Considering the very small number of divers who have had aneurysms I don't think an official study will ever be done so I would like to "collect" my own data so I can make an informed decision whether or not to return to diving.

Please share any of your thoughts or experiences on this subject. Thank you.

Bob

 

[TSandM]

There are several things that theoretically MIGHT affect an aneurysm while diving . . . the big ones are centralization of blood volume, with perhaps increased cardiac output or blood pressure; vasoconstriction due to cold, which could raise blood pressure, and exertion, which could raise blood pressure.

With the exception of centralization of blood volume, they all pertain to on-land exercise as well.

I personally don't see much that would make diving particularly risky after aneurysm coiling, but I'm quite sure there is no literature on the subject, as the intersection of the sets of people who have had aneurysms treated and those who dive is likely to be a small set, indeed.

 

[Doubler]

Why do we go to doctors for healing and advice if we are just going to go to a Internet board and question the same advice?

 

[blue sky]

My mother had a subarachnoid hemorrhage. The family Doc was frank and honest. Some of what he said was "Doc speak" to me. Fortunately I fished and drank with an anesthesiologist that translated for me. The mortality of the affliction is shocking. Consider yourself very lucky. Live life to the fullest and enjoy diving. Hopefully everything will be fine. And if it's not, at least you'll go in the saddle so to speak.

 

[TSandM]

Doubler, I understand the frustration of people who come here and say, "I don't think my doctor knows very much about diving, but he's said "x"; does anybody know if there is any validity to it?"

Liability is a huge fear for physicians, and we are fundamentally risk-averse. If we don't KNOW that something is okay -- in other words, if we can't find literature to prove it -- we're going to advise against it, because if someone goes and DOES it and has a bad outcome, guess who is found responsible for the advice? And if we know nothing about the activity except that we think it's risky, it's all too easy to say, "Just don't do it." Nobody will ever sue you for telling them to stay out of the water . . .

So I don't blame people at all, for coming here and asking for medical opinions from people who have at least enough interest in diving to be on this board; or from other patients who have been through the same thing. The plural of anecdote is not data -- but sometimes a collection of anecdotes is the best data you can find.

 

[Doubler]

I still say medical advice that is contrary to that of the attending physician should not be given out on a Internet chat site. It can only lead to bad things.

 

[Dr. Doug Ebersole]

Doubler, I would have to disagree with you. I stand with Lynn (TSandM) on this one. I don't know you, but I assume you are not a physician. Please correct me if I am wrong. Lynn is exactly correct in that we physicians are "risk averse" to use her term. There is very little good data with regards to diving medicine though DAN and UHMS are trying to change that. Medical students get basically NO training in dive medicine and extremely few physicians have any knowledge whatsoever about dive medicine. As Lynn points out, every physician believes in the motto of "above all, do no harm" so if they don't know the answer or can't find data, they are going to (appropriately) advise the most conservative approach. This board (and others) have a group of physicians with an interest and expertise in dive medicine and I feel the opinions here can help patients discuss their situation with their private physician to make more educated decisions about their care.

Unfortunately, Lynn as an Emergency Physician and me as a Cardiologist are not experts in the field of interventional neurology -- though I do sleep with an interventional radiologist who deals with intracranial aneurysms on a daily basis.

Hopefully, there is a neurosurgeon on the board here that could provide some insight. Like Lynn, I can't think of any physiological reason why diving would be particularly harmful this long after a coiled aneurysm, but I would appreciate any thoughts from other physicians.

Doug

 

[John C. Ratliff]

Bob, if this were my decision on my own body, I'd give myself a year before thinking about diving again. If after a year everything is looking good, and there have been no effects at all, then I'd re-evaluate. For instance, I have had bicycle injuries that took about a year to get back to "normal".

You say you have recovered, but complete healing may take time and not be easily sensed. Diving is a bit different than running. In running, if you feel something you can stop. In diving, if you stop you may not make it to the surface. There is also the physiology of diving, with dissolved gases in the blood stream. So take it conservatively.

Diving can be very easy, and should not tax you physiologically; but this is not predictable in open water. I am not a physician, but have some background in professional safety and industrial hygiene.

SeaRat

John C. Ratliff, CSP, CIH, MSPH
(CSP is Certified Safety Professional; CIH is Certified Industrial Hygienist)

 

[BobArnold8265]

Everyone, thank you so much for your input.

John - I agree with you fully. I had my first angiogram (where they run a fiber optic in to look at the repair) earlier in the week and was told that the coiling was a complete success and everything had healed properly. If I do return to diving, it will not be any earlier than 6 months from now which would give my body a full year to heal. During that time I will also evaluate how well I am doing with surfice activities. If I do dive, I plan on going very slowly. Diving to a max depth of 10 meters for a while and then maybe slowly exploring a little deeper. Fortunately, my wife and I enjoy diving at Bonaire and there is plenty o see at the more shallow depths

Doubler - It is not that I am second guessing my surgeon. I have actually gotten conflicting advice from two doctors. My surgeon told me 2 months after my surgery that I had no restrictions including diving. I waited until my first check up at 6 months (an angiogram) and asked my doctor to consult with DAN about diving. After consulting with DAN, I was told that there is not enough data available, so they recommended that I not dive. This is a very conservative approach and I certainly understand it considering current medical liabilities. Unfortunately, none of the doctors have given me any reason why diving for me would be any more risky than it is for a "normal" person. They simply don't have the data. I posted on this board to gather some of my own data. Then I can access the risk and make an informed decision. I hope to hear from other divers who have had aneurysms and returned to diving.

Blue Sky - Yes, I am very blessed. The odds of making a full recovery after an aneurysm is very small. For one of the few times in life, I did the smart thing and went to the hospital right away. I was also extremely lucky to find myself in the hands of a very skilled surgeon. I was actually out of the hospital in just 3 weeks, returned to work on week 5 and started running again on week 8. I have no more headaches, am not taking any meds and have resumed my "normal" life. Now all I need to to figure out whether I should get back into the water or not


Thanks again everyone for your input.

---------- Post Merged on September 26th, 2012 at 07:15 PM ---------- Previous Post was on September 25th, 2012 at 12:58 PM ----------

Just another couple of thoughts about my current condition.

1. It's kind of ironic when you think about. I was likely born with my aneurysm and have been diving for years at risk of it bursting. Obviously I was not aware that I had the condition but none the less I was at risk. In theory, now that I have had the repair, it may actually be safer for me to dive than ever.

2. Since I have had a CAT scan and it has been determined that I have no other aneurysms, I may actually be at less risk diving than the general population considering that there is a percentage of diver's out there who are diving right now with aneurysms that have not burst.

This is all true if the repair (coiling) is as strong as a normal blood vessel.