General Category > AN Issues

One Year Post-Op and Personal Decisions on Returning to SCUBA Diving

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Nine5:
This is my first post to this forum.  I am now one year post-translab; but I spent a considerable amount of time in the year before my surgery here absorbing facts, learning, reading about your experiences, considering and reconsidering my options.   So, first, a heartfelt thank you. 

Having little remaining hearing on my right side before the surgery, I had a 1.1cm right-side AN removed with the translab approach at Vanderbilt Medical Center by Drs. Rivas and Thompson of Vanderbilt's Skull Base Center.  I learned about them from this forum and happily make 5 hour trips each way for every visit for their knowledge and experience.  I could not be more pleased with how the pre-surgery consultations, surgery, recovery, and post-op consultations have gone with them and everyone else there involved in my care.

To try to give back a little to this invaluable forum, I've decided to talk about my personal decisions and experiences scuba diving after my translab AN surgery.   I don't intend my post to be contradictory,  nor in any way disrespectful to guidance from DAN (Divers Alert Network) - I have the deepest respect for the diving medical knowledge they bring to the diving activity/vocation.  In fact, the medical factors underlying DANs recommendation to stop diving were critical for me evaluating my personal situation and risk-assessment.  This post is just about my risk/benefit decisions and experiences and is not intended as advice for others.

I am thankful that my AN surgery in July 2015 went very well, and recovery was uncomplicated, and to the expected schedule.  I did not experience CSF leaks nor any other complications.  As I still had some right-side vestibular function remaining before the surgery, I experienced the expected vertigo/spinning sensation post-op.  My physicians emphasized the importance of safely and carefully "getting back out there" and re-establishing normal activities to challenge my brain to adapt to the loss of one vestibular input - I did my part in a local vestibular therapy clinic and going for frequent walks with my wife soon after my discharge.  Yea! for brain plasticity even into my early 50's!  I learned that people who have had normal vestibular function and then had it suddenly disrupted and experienced the resultant vertigo 1) now know what it is like and 2) have witnessed their brains reassert control by shifting some orientation emphasis to visual references. This featured in my scuba risk assessment.

So I began to think about returning to scuba diving after I felt fully recovered and began to research here and elsewhere,  I discovered a broadly  held recommendation that AN patients (especially translab) should not return to scuba diving.  The reasons boiled down to the following:

 1) Risk of CSF leak; 2) impaired or loss of ability to equalize middle ear of the surgical side; 3)  temperature changes during a dive may induce a risk of  'caloric response (vertigo) due to asymmetrical stimulation;'  and 4) risk of barotrauma to my only remaining hearing nerve.

All scuba divers take on unique risks with each dive, but the risk side of the equation is now greater for me.

1) Risk of CSF leaks:  My thinking went as follows.  AN surgery carries a post-op risk of CSF leaks in the weeks following surgery and this drives strict lifting/straining limits for a period of time.  In my own mental risk calculation (right or wrong), I reason that, at 1 year, I'm past the healing window and no longer under weight-lifting /strain limitations.   I feel many of my other physical activities have since placed the healed surgery site under greater strain than I've encountered under recreational diving conditions and proper equalizing practices.  I decided I would accept this risk.

2) Equalizing ear volumes:  I spoke with my surgeon about what my post-operative anatomy was on my right side.  I was a bit inwardly embarrassed to realize I did not know if I still had an ear drum, an intact Eustachian tube, and a volume still identifiable as a middle ear - in all my previous meetings with my surgeons, I had focused my questions in other areas.  Did I still have a sense of feeling in these internal areas?  I learned that answer was yes to the first three, but that the middle ear volume might be packed/congested with the belly fat harvested in my surgery and used to close the surgical area. The fourth one on internal sense of feeling was unknown as of yet.  I was very cautious next.  One year post-op, my wife and I entered the local swimming pool (first full submersion post-op).  We spend quite a bit of time just getting a sense of my single vestibular system floating in water and pressure changes just in the first few feet of water.  Lacking the weight of scuba apparatus and a BCD, my wife stood on my back as I flattened out at the pool's 8' depth. 

When we ascend and descend we experience a sense feedback (discomfort or pain) that our eardrum is straining inward or outward due to unequalized pressure between the outer and middle ear. That was working for me! - my nerve endings (many of which had been numbed for months post-op) were communicating the feeling of my ear drum.  Next to try to equalize using one of several scuba techniques for this.  It was here that experienced the first obstacle.  When we fly or dive, our primary feedback that the Eustachian tube has opened to equalized the middle ear is that we hear it.  I now have SSD on the right side and could hear nothing there when I equalized.  I surfaced and then went back down.  After much practicing I found that when I slowly equalize, I can clearly feel the middle ear volume and ear drum move as the Eustachian tube opens up.  It's very likely that post-op nerve function, middle ear volume, and Eustachian function vary from individual to individual based on tumor size and many other factors; but, in my case, the sense of feel and pain still functioned perfectly on the right side.  Next was a tune-up dive with full scuba gear in a local pool down to 14' with my original instructor.  The experience was the same.  I was able to equalize and detect it.


3) Orientation/Vertigo Risk.   When diving, our sense of orientation is based on a combination of sight and vestibular system since gravity is weakly felt.  Without one of my vestibular nerves, I have a higher dependency on my remaining vestibular system and my eyesight.  Panic is a danger to divers.  A caloric disturbance in my one remaining vestibular system would lead more rapidly and severely to vertigo at depth.  Adding still more risk, in low-visibility situations (low light and/or cloudy water), all that remains is my single vestibular system.  On the plus side, many AN patients now know and know what to expect in that vertigo - more so than others that have not experienced it (my opinion).  Having now experienced truly profound vertigo, I now have a more calm and observational reaction to it.  As a diver, I have other tools for orientation if my own internal systems temporarily fail me.  I have also chosen to set a self-imposed limit for only hi-visibility  dives with a dive buddy.   So I have decided to take this risk for my personal case.

4) Hearing risk.  This is the hardest choice for me.  If I experience barotrauma to my only remaining hearing sense, it will be a severe, life-altering event.  Is recreational diving worth this risk I ask myself each time now.  So far, I have chosen to take the risk.  I feel that, key for me managing the risk is to use gentle equalization methods and to be absolutely, absolutely willing to cancel a dive if I have congestion that interferes with Eustachian tube function, and a  willingness to end a dive if equalization is not going well.

So that's me 1 year after my surgery.  Riding a bicycle again, mountain trail hiking, boating, happy husband to my wife; my experiences, and how I've chosen to approach scuba risk in my life since surgery.  I have since gone on 7 vacation dives ranging from a very slow, deliberate, tentative on at 30' and working up (down?) to 85'.  I hope my experiences are at least interesting, if not informative.

And thanks again to this community for the wealth of shared information and experiences.

rupert:
Sometimes there is no bigger motivation to do things than being told you can't.  By nature,   I think divers are very in tune with the risks and safety concerns of their activity. I think you've got it covered.

Citiview:
The greatest testament to a great treatment result is the patient's ability to return to the occupation and hobbies that they were able to participate in before treatment. Sounds like you had an excellent team and an excellent result. Thanks for posting about it. It helps others to know what team you had and the excellent quality of care that you received.
People who skydive and SCUBA dive were born to do it. You can't stop them. Have fun!

Sheba:
Hi Nine5

Thank you for the very detailed and logical post.

One experienced neurosurgeon told me that people should not scuba dive after any type of brain surgery.  He said that the blood vessels in the area that was treated are more delicate and so the pressure changes of diving can cause a blood vessel to rupture.  I don't know if that actually happened to patients he's treated.  Docs at House also said no scuba diving.

The surgeons who actually removed my AN (July 19) at Keck said it would be OK to dive again.  But all the things you mentioned, plus the idea that blood vessels may be more delicate, are things to consider.  I am now SSD and I don't want to risk my good ear.

I may dive on a special occasion here and there but I think mostly I'll be happy to snorkel instead now, there are some awesome places for that.  I really really loved diving, which is why I may dabble a little still.   I like your story of testing it out in the pool first.

Anyone else out there have some info on this topic?  where is Seahorse?

caryawilson:
My brain surgeon said I could scuba dive 24 months after surgery.  However, before he gave this answer he went to the computer and double checked his surgical notes.  I'm NOT sure what he was looking for and I'll ask him next time.  However, something needed to be done during surgery so I could dive again.  After he checked his notes he said I could dive again in 24 months.  I could start diving down to 1 atmosphere (33 feet) after 9 months from surgery.

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