Scuba diving with an unseen injury.
It’s pretty safe to say that 2020 wasn’t the year anyone was expecting.
You might have read on my social media a couple of weeks ago, I have been cleared to dive! This has come about after my concussion from a surfing accident six months ago. It’s been a long (and at times really frustrating) recovery as I learnt how to let myself rest, things I didn’t realise and probably one of my biggest questions was “how would it affect my diving?”
So I thought I would share with you my journey over the last six months, including my injury, my rehabilitation and things to be aware of when returning to diving.
Here in New Zealand, we had a quick government response toward COVID, going into an immediate one-month lockdown and another further three weeks in tight restrictions – New Zealand successfully stamped out the virus initially. The first weekend out after restrictions eased, there was an awesome east coast swell and I was dying to get back in the water. My boyfriend Josh and I met one of my best friends up north before heading out to the coast to catch some waves.
I will be the first to admit they were quite steep and bigger than I was used to. As I stood up on my first wave, I fell forward over my board and into the water. As the wave crashed over me, the water slammed my head into the seafloor below, catching the sand bottom beneath my chin. At the same time my board had flung around, and the rail of the board hit the back of my head, breaking the fibreglass.
Despite this, I was feeling quite relaxed knowing I could hold my breath for over 3minutes, I thought to myself ‘ouch that hurt’ but then waited patiently for the wave to pass before coming to the surface. As I stood up in the surf, I felt slightly dizzy but nothing to put me off surfing. I signaled to Josh to keep an eye on me and I went back out to catch the next wave. Learning my lesson from before, I stayed in the white water, enjoying the freedom of being in the ocean. An hour later, we returned to the beach for a hot shower and headed home. It wasn’t until woke the next morning I realised something was wrong.
It felt like I had the worse hangover. My head felt like it was in a clamp crushing my brain. The room was spinning around me and I struggled to walk, using the walls to support me. Later that day, after a phone call with one of my best friends Marion about what I should do, she urged me to go to A&E, where the doctors diagnosed a concussion.
After a week off work, the vertigo and the clamp crushing stopped, but I still had a constant headache and found my heartrate was all over the place. I walked to the top of my driveway and my heartrate peaked at 180bpm. I realised then that this wasn’t going to be an overnight fix and unlike a broken leg, having a head injury is more difficult for people to see and understand.
What is a concussion?
A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
The following months after the injury, despite not having any alcohol – I felt like I had a constant hangover. I had a team from APM take on my case to help me recover while easing back to work. The biggest shock was my initial assessment at the physio. The first test, walk across the room and on your way, pick up a pen on the ground. Easy right? Well as soon as I tried to pick the pen up and change levels, I instantly fell over. The second test reminded me of the movies when the patient has to follow the doctors pen with my eyes. Also easy right? Although I didn’t realise, my physio said I was blinking constantly as I was trying to follow the pen. This was because my brain couldn’t process all the information and this is a coping mechanism to give my brain a break.
Through these tests I found I had lost all my balance, eye tracking was difficult and the ability to process information decreased significantly. I couldn’t articulate my thoughts and had trouble speaking, my hearing was impacted as I couldn’t tolerate any loud sounds or multiple people speaking and I wasn’t able to regulate my heartrate – all a result from the concussion. Being in a car at night-time when it was raining was my worst nightmare - moving bright lights and fast window wipers were not a good combination.
To assist my recovery, the team at APM gave me some fancy earplugs, blue light glasses and exercises to do. The hardest part was to get the balance right between rest and activity, while letting my brain recover. If you know me, you will know I am not great at prioritising rest. I eased back into work starting with 2hours, then 4hours and slowly getting to half days in schools. Loud classrooms and VR headsets proved a challenging setting but was counteracted by the fantastic support I had from the BLAKE team. I also found afternoon naps to be amazing!
Four months after the injury I was able to work a full day and my headaches were intermittent, only increasing if I did too much exercise or didn’t get enough rest. So now I wanted to see if I was able to get back in the water. This had been the longest time out of the water since learning to dive in 2013.
Implications of Scuba Diving after a concussion?
I am no doctor and to be honest, really had no idea about the risks associated with scuba diving after a concussion so I reached out to Simon Mitchell to hear his thoughts.
For those who don’t know Simon Mitchell, he is an incredible physician specialising in occupational medicine, hyperbaric medicine and anaesthesiology as well as someone who is hugely respected in the diving community around the world. He has a Wikipedia page and received the Rolex Diver of the Year Award in 2015. I felt so honoured that he emailed back and agreed to catch up. Trying not to be a fan girl, I was grateful for my facemask hiding my massive smile and excitement as I meet Simon outside Auckland Hospital.
We discussed my injury and my symptoms associated with my concussion. I had not lost consciousness or experienced any amnesia and therefore my injury was classified as a mild concussion. Injuries with a loss of consciousness for 30mins to 24hours or a skull fracture were considered moderate; and severe concussions were injuries that included loss of consciousness or amnesia for more than 24hours, subdural hematoma or brain contusion. I consider myself very lucky that I was only mild.
There is little known about concussions and research in this area is difficult as every injury is so different. Although Simon discussed one of the major risks for scuba diving after a concussion was an increased risk of seizures. For non-divers the primary concern is that a loss of consciousness underwater is likely to result in death by drowning.
This risk varies greatly according to the severity of the traumatic brain injury and is reflected in the percentage ratio as it increases significantly in comparison.
We did a couple of tests, focusing on my balance by standing one foot in front of the other, with my hands on my shoulders and my eyes closed for one minute. I had been practicing my physio exercises every day and was stoked that I completed the one minute without falling over!
Although having a mild concussion, there is still a small increased risk of a seizure. Simon acknowledged that no one can ever guarantee that there will be no problems therefore I accepted the unknown (but almost certainly small) degree of increased risk and Simon advised some cautions to help me ease back into diving.
The first caution was to understand which gas I was breathing. With increased partial pressures of oxygen, this can be known to increase the risk of seizures and therefore instead of diving nitrox, diving with Air, 21% oxygen while I eased back into diving was highly recommended. Avoiding physical exertion and task loading on dive was also suggested, like avoid swimming into a strong current, instructing and guiding diving; or any activities that would raise my heart rate and increase symptoms. And finally, Simon’s last piece of advice was not to push depth and for the first couple of months sticking to open water dives (above 18m).
But this meant I could dive again!!! And I was very, very excited about this. We concluded our catch up with epic diving stories and some amazing photos that Simon had taken on his incredible journeys on different diving expeditions.
Back to basics
Being cleared to dive, I eagerly called up a couple of my friends and asked if they would be happy to join me for my first dive back. We chose to dive at Goat Island, New Zealand’s first marine reserve, and where my open water course was held.
We hit a maximum depth of 5m for an hour as I enjoyed being back in the water, chasing fish, looking for crayfish and following Steph’s trusty navigation. It was so good to get back in the water and I am super excited for the summer ahead.
This is my own personal account of my injury. I wanted to share my experience and some of the cautions around scuba diving after a concussion. If you have had a traumatic brain injury, be sure to seek medical advice and clearance before returning back to diving.
Little bit about me...
Born and raised in New Zealand, I grew up around the ocean. I want to share my passion and inspire others to explore, love and protect our underwater environment.