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Returning To Diving After A Concussion

When and how should you return to diving following a traumatic brain injury? GUE’s NextGen Scholar, Kiwi water woman Annika Andressen spent eight months figuring out the answers to those questions with the help of Dr. Simon Mitchell, after suffering a concussion while surfing. Here is her tale of sloggin’ the noggin.

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by Annika Andresen
Header image courtesy of Jack Austin, Dive Tutukaka . Other photos courtesy of A. Andresen unless noted.

It’s pretty safe to say that 2020 wasn’t the year anyone was expecting.

You might have read on my social media recently that I have been cleared to dive! Eight months ago I experienced a concussion from a surfing accident. It’s been a long (and, at times, really frustrating) recovery as I learned how to let myself rest, but one of my biggest questions was, “How will this affect my diving?”

​So I thought I would share my journey over the last eight months, including my injury, my rehabilitation, and things to be aware of when returning to diving. 

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Surfing along the coast of New Zealand that resulted in my concussion. Photo by Josh Fretwell.

Here in New Zealand, we had a quick government response toward COVID, going into an immediate one-month lockdown and another further three weeks under tight restrictions, and initially, New Zealand successfully stamped out the virus. 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 that the waves 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 fiberglass.

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East Coast Surfing. Photo by Cole Johnston.

Despite this, I was feeling quite relaxed knowing I could hold my breath for over three minutes. 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 not bad enough to put me off surfing. I signalled 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 I woke the next morning that I realized something was wrong. 

​It felt like I had the worst hangover. My head felt like it was in a clamp that was crushing my brain. The room was spinning, and I struggled to walk, using the walls to support me. Later that day, I called one of my best friends to ask what I should do, and she urged me to go to the A&E (accident and emergency facility). There, the doctors diagnosed a concussion. 

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Where my head made contact with my board on the rail. Ouch!
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The impact broke the fiberglass on the rail above and below.

After a week off work, the vertigo and the clamp-crushing head pain had stopped, but I still had a constant headache, and my heart rate was all over the place. I walked to the top of my driveway and my heart rate peaked at 180bpm. I realized then that this wasn’t going to be an overnight fix. 

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. 

​In the months following the injury, despite not having any alcohol, I felt like I had a constant hangover. A team from Advanced Personnel Management (APM) took on my case to help me recover while easing back into work. The biggest shock was my initial assessment at the physio. The first test: walk across the room and pick up a pen on the floor on the way. Easy right? Well, as soon as I tried to pick the pen up and stand up, I immediately fell over. The second test involved my having to follow the doctor’s pen with my gaze as he moved it back and forth in front of my eyes.  Also easy right? I didn’t realise it, but my physio said I blinked constantly as I tried to follow the pen. This was because my brain couldn’t process all the information, and the blinking was a coping mechanism to give my brain a break.

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Practicing my eye tracking with a pen.

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 as a result of a concussion. Being in a car at night-time when it was raining was my worst nightmare—moving bright lights and fast windshield wipers were not a good combination.

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Enjoying my sparkling grape juice!

​To assist my recovery, the team at APM gave me a pair of fancy earplugs, blue light glasses, and some 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 my work as an educator, starting with two hours, then four hours, and slowly getting to half days in schools. Loud classrooms and VR headsets proved a challenging setting, but the struggles were balanced 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. But then I wanted to see if I was able to get back in the water. This period had been my longest time out of the water since I learned to dive in 2013. 

Diving After A Concussion? 

​I am no doctor and, to be honest, I really had no idea about the risks associated with scuba diving after a concussion, so I reached out to Dr. Simon Mitchell to hear his thoughts. For those who don’t know him, Dr. Mitchell, is an incredible physician specialising in occupational medicine, hyperbaric medicine, and anaesthesiology, as well as being someone who is highly respected in the global diving community. 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 fangirl, I was grateful for the facemask hiding my massive smile and excitement as I met Simon outside Auckland Hospital. 

​We discussed my injury and the symptoms associated with my concussion. I had not lost consciousness nor had I  experienced any amnesia; therefore, my injury was classified as a mild concussion. Injuries with a loss of consciousness for 30 minutes to 24 hours or a skull fracture are considered moderate. Severe concussions are injuries that include loss of consciousness or amnesia for more than 24 hours, subdural hematoma, or brain contusion. I consider myself very lucky that my concussion was only mild.


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​There is little known about concussions, and research in this area is difficult, as every injury is so different. Although Simon explained that  one of the major risks for scuba diving after a concussion was an increased risk of seizures, this risk varies according to the severity of the traumatic brain injury and is reflected in the correlation between trauma and seizures. 

​We did a couple of tests, focusing on my balance by standing with one foot in front of the other, with my hands on my shoulders, and with 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! 

Despite having only a mild concussion, there was still a small increased risk of a seizure. Simon acknowledged that no one can ever guarantee that there will be no problems, so I accepted the unknown (but almost certainly small) degree of increased risk, and Simon gave me some advice to help me ease back into diving.

The first precaution was to understand which gas I was breathing. Increased partial pressures of oxygen can be known to increase the risk of seizures;  therefore instead of diving nitrox, diving with air at 21% oxygen was recommended while I eased back into diving. Avoiding physical exertion and task loading on a dive—swimming into a strong current, instructing and guiding diving, or any activities that would raise my heart rate and increase symptoms—was also suggested. And finally, Simon’s last piece of advice was not to push depth for the first couple of months; instead to stick to open water dives (shallower than 18 m/60 ft). 

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One very happy diver. Photo by Steph Haden.

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.  

Cleared to Dive!

​Being cleared to dive, I eagerly called a couple of my friends and asked if they would 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 5 m/16 ft 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, just in time for summer. 

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Finishing my first dive since the concussion.

It has been three months since my first dive back in the water. If you follow my social media, you will know that over the summer, every spare minute I have is normally spent being on or in the water. I have been very lucky to have two weeks off work where I got to explore unfamiliar territory in the cooler waters of Waihau Bay, the most eastern part of New Zealand. And, although I wasn’t scuba diving there, it was great for freediving practice and just being back in the water. The second week of my holidays was spent in my favourite place up north in the sunny Tutukaka, where I have been able to scuba dive as much as I can while sticking to Simon’s advice and slowly increasing my depth. 

A person smiling on a boat

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Heading home after a weekend of amazing diving at the Mokohinau Islands. Photo by Steph Haden.

For the first couple of months, I limited my dives to a maximum depth of 18 m/60 ft, avoiding physical excursion. During the last couple of weeks I have been increasing my depth limit to 30 m/98 ft, constantly monitoring how I am feeling and if any symptoms recur. I have been ensuring as well to make sure I drink plenty of water and allow for more rest and sleep than usual, both before and after diving. 

Last weekend was a great test to see how I was after a full weekend of diving at the Mokohinau Islands. I completed four dives, my longest being 71 minutes, and loved every moment of it! We saw bronze whaler sharks, pilot whales, dolphins, a baby octopus, a little blue cod (unusual for this area), hundreds of schooling koheru, and a silver and yellow bait fish. The excitement I felt and the smiles on my face didn’t stop the whole weekend. 

My next step in the next couple of months is to start diving with nitrox  and work towards more technical diving later on in the year. Hopefully, by that stage, I will be able to travel and will be ready to take Global Underwater Explorers (GUE) Tech 1 and Cave 1 courses.

This is my own personal account of my injury. I wanted to share my experience and some scuba diving precautions after a concussion. If you have had a traumatic brain injury, no matter how slight, be sure to seek medical advice and clearance before returning to diving. 

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InDepth: Jumping into the Deep End by Annika Andresen

InDepth: Meet GUE’s NextGen Scholarship Winner


GUE’s first NEXTGen scholar, Annika Andresen is a virtual reality environmental educator for BLAKE NZ, connecting thousands of young Kiwis with their marine environment. Annika holds a Master of Architecture degree, where her thesis investigated the role architecture plays on the connection people have with their environment. During her studies, Annika worked as a dive instructor for Dive! Tutukaka, and was the President of the Auckland University Underwater Club. Annika has just been awarded the New Zealand Women of Influence Youth Award for 2019. Using her natural enthusiasm and infectious personality, Annika hopes to educate others to understand and cherish our unique environment and to better protect it for the years to come.

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Hal Watts: Plan Your Dive

Known for his deep air diving exploits back in the day, 86-year-old Hal Watts, aka “Mr. Scuba,” is one of the pioneers of early scuba and credited with coining the motto, “Plan Your Dive. Dive Your Plan.” He founded the Professional Scuba Instructors Association International (PSAI) in 1962, which eventually embraced tech diving, but never relinquished its deep air “Narcosis Management” training. Italian explorer and instructor Andrea Murdock Alpini caught up with Watts and teased out a few stories from the training graybeard.

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Interview by Andrea Murdock Alpini 
English text by Vincenza Croce

Hal Watts, Terrence Tysall, and Bill Stone in March of 1993.  This was the last stop in the U.S. for a test dive of the Cis-Lunar Mk-4 rebreather prior to Stone’s San Agustin expedition (1994) for its first real sump dive.

“Plan your dive, dive your plan,” is a common refrain in diving, but it’s easy to forget the meaning of this phrase has changed over time.

The underwater explorers of the early days learned to plan their dives with watches, depth gauges, and US Navy tables. Back then, decompression tables were the Bible for divers—something miraculous, halfway between alchemy and physiology. Those trail-blazing divers defined what it meant to “plan” a dive.

But, at the time, the term “technical diving” did not exist; divers breathed air on the bottom as well as during decompression. Only after many years was oxygen added, followed by the famous jump into the hyperbaric chamber.  

Later came new innovations after a few decades of experiments: hyperoxygenated binary mixtures, the NOAA tables, Heli-air (i.e. the addition of helium in tanks loaded with air), the change in the speed of ascent, new molecules to be studied, new physiological and narcotic effects, and their consequent impacts on humans and their psyches.

In a very short time, diving traditions underwent a metamorphosis. The spool and the coral tank became a proper reel, the ascent bin and the plastic bag disappeared in favor of the buoyancy control device (BCD), the surface marker buoy appeared—and then, even later on, wrists were adorned with underwater computers instead of decompression slates.

Divers later renewed and revolutionized a niche discipline, transforming it into a sporting phenomenon and a vocation. Faced with imminent change, there is often nothing that can be done when an anomalous wave arrives; you cannot stop its irresistible force with the wave of a hand. And thus was the American revolution of underwater technique, where the means of exploration—read mixed gas and scooters—have become the end.

The self-proclaimed originator of the “plan your dive, dive your plan” motto was 86-year old Hal Watts, the founder of American didactic Professional Scuba Association International (PSAI) and a diving pioneer who once held the Guinness Book of World records for deep diving. Though the use of trimix grew in popularity, Hal continued to believe in deep air, in the ancient technique of coral fishermen. He supported wreck and cave diving—with decompressive mixtures and new configurations through PSAI; but, above all, he believed (and continues to believe) that deep air, if properly practiced, is a discipline with unique logistics, hidden dangers, and irresistible charms that can take you to a parallel world.

Hal Watts speaking at aquaCORPS tek.93 Conference

First of all, Hal, what was the dive that changed your way of seeing scuba diving? I mean, a dive that was like an epiphany, a dive which changed your point of view on a technical matter?

Hal Watts: Wow, you sure are really trying to test my old man memory. Now I’ll have to review some of my old logbook entries. 

The first scuba dive that really got my attention as to just how serious and dangerous scuba diving can be was on December 2, 1962. I was diving with Bob Brown, co-owner of Florida State Skindiving School in Orlando, Florida. I was a member of a dive club in Orlando known as Orlando Sport Diving Club. Bob and I had heard of a sinkhole in Ocala known locally as Zuber Sink as well as Blue Sink. Years later, I later leased the property and renamed it as Hal Watts’s 40 Fathom Grotto, and I eventually purchased the Grotto in mid-1979.

We had never talked to anyone about the sinkhole; therefore, we had no idea about the visibility or the depth. Up to this point, I had constructed my favorite BCD, using a large white Clorox plastic jug, which we tied to our twin tank system. We put air into the BCD from our “Safe Second Stage” mouthpieces. 

Bob and I tied our safety line to a tree on the bank of the sink and reviewed our dive plan. I am reminded of the motto I came up with, many moons ago—Plan your dive, dive your plan. 

We all know that motto. I didn’t realize that it was you who coined it.

It was back in the 1960s when I was writing course manuals for NASDS [National Association of Scuba Diving Schools] and opened up my Mr. Scuba dive shop.

Mr. Scuba’s Magic Bus!

But back to the dive at Zuber. I’ve failed to mention the fact that neither of us had been doing any dives below 30 m/100 ft. We followed the cave line down slowly, not paying enough attention to our depth. Before we realized it, we had hit the bottom, stirred it up, and had no clear water.

Lucky for us, I kept the cave diving reel in my hand, and Bob kept his hand on the line. I couldn’t see; however, I could feel Bob’s hand, squeeze his fingers tight on the line, grab his thumb, and give it the “thumbs up” signal. I don’t know how we managed it, but we were both able to use our NASDS safe second stages and add air into the Clorox “BCDs.” We were actually fated to begin an uncontrolled, too-rapid ascent. All of a sudden, we hit an overhead wall, which stopped our ascent at a depth of 9 m/30 ft. 

We looked at each other, and gave the OK hand signal. While decompressing, following the old Scubapro SOS mechanical computer, I started to pull up the loose line until the dive reel appeared. Wow, we sure had an awful lot of loose line floating around us. Were we extremely lucky? Of course, we were. Our problem was that we never planned our dive, and consequently, were unable to dive a plan.

After that dive, I worked with Scuba Pro and Sportsways to create the “Octopus,” or “safe second.” A while later, the octopus appeared for the first time in Scuba Pro catalogs. I was also the first to add a pressure gauge along with the Octopus.

Hal Watts set the world deep air record to 120m/390 ft in 1967

Ah yes, the “Safe Second.” That’s what NASDS called backup second stages, right? Sheck Exley (1949-1994), the legendary cave explorer with whom you were friends, was also credited with fitting a redundant second stage reg with a necklace. I want to ask you more about Exley, but first, I want to know: What are the best wrecks you ever dived?

This is really very hard to answer. I’ll have to list four, in the order that I dived them: the USS Monitor, Andrea Doria, Japanese wrecks located in Truk Lagoon, and the Lusitania in Ireland.

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The most important would have to be the USS Monitor, a submarine used during the Civil War. A group of well-known USA divers applied to the National Oceanic and Atmospheric Administration (NOAA) for a permit to dive the Monitor, as she was located in protected waters. In addition to myself, the group consisted of: Gary Gentile, attorney Peter Hess, and several other well-known expert divers. At first, NOAA refused. Then, Peter Hess filed proper papers asking that we get the NOAA permit. To that end, we presented my Deep Air training material to the concerned NOAA group. I appeared as an expert witness and provided NOAA staff and their legal representatives with my internationally accepted training material and my record of training several world record deep air divers. Our deep air training has been accepted worldwide with zero diving deaths. After that, we received the permit. 

Other than the Monitor, my favorite deep wreck dive would be the Lusitania, which is a very personal and proud story for me. The main reason is because venture capitalist Gregg Bemis owned the diving rights to the Lucey at the time. Gregg had contacted me requesting that I train him on PSAI Narcosis Management Level V, on air—which is 73 m/240 ft—and then train him on trimix so he and I could dive to 91 m/300 ft on the Lusitania lying off the coast of Ireland. 

When word got out that I had enrolled Gregg in my Narcosis Management Course, a well-known international course director (a personal friend of mine) called and told me, “Hal, do not teach Gregg deep diving.” 

PSAI’s ad in aquaCORPS Journal circa 1994 offering deep air training.

He told me that he had been training Gregg at his facility, and that he was a “train wreck.” “He is from a very well-off family in Texas, and if you cause him any injuries, you will be sued and put out of business,” my friend said. Well, guess what? Gregg completed the 240 Level V Deep Air course, then our PSAI Trimix course. My wife, Jan Watts, Gregg, and I went to Ireland to dive the Lusitania. He and I made an awesome 91 m/300 ft trimix dive to the deck.

Diving on the Andrea Doria with Tom Mount, Peter Hess, and several great wreck divers was also an awesome dive. Last but not least was a great trip to Truk to dive on some of the Japanese wrecks.

Please tell us about Sheck.  What was your relationship with him like?

Sheck and I became friends and made several dives together, and one of my favorites happened when Sheck, his Mary Ellen, my wife Jan, and I were diving at 40 Fathoms. Sheck wanted to practice gas switches during descents. Sheck was practicing, getting ready for a planned very deep dive (I think in Mexico with Jim Bowden). The four of us swam to the east side of The Grotto, slowly following the wall during our controlled descent, watching Sheck practice gas switching. 

Sheck Exley and Hal Watts at a NSS-CDS conference

After reaching our planned depth of 73 m/240 ft, we began our controlled ascent up to our first planned deco stop. During our last deco stop on our 4.5 m/15 ft platforms, I noticed that Sheck had a funny look on his face and was messing with his drysuit between his legs. I remembered then that he had told me that he had an attachment installed in the drysuit that would allow him to pee underwater. He was clearly in a bit of discomfort and Mary Ellen, Jan and I just floated nearby and watched.

I’ve heard that Sheck later used diapers, or just cut it loose in one of his old neoprene drysuits on his big dives, so evidently he didn’t get that early p-valve to work. What about your friendship and job collaboration with Gary Taylor, your brother-in-arms and a co-owner of PSAI?

Andrea, get comfortable, since this question will take some time to properly answer.

I first met Gary in Miami, which is where we became friends when I was staying in his home and taking Tom Mount’s nitrox course.  I have a photo of Tom, Gary, and me gas blending on the floor of Tom’s garage. During the course, Tom was still using his worn-out hand written paper flip charts as his notes.

Gary was impressed with my deep air program and offered to put together an updated slideshow presentation for me to teach with. PSAI still uses an updated version of this system to date. Gary stayed with Tom until Tom thought he had sold IANTD [International Association of Nitrox and Technical Divers] to another individual. After that sale came about, Gary contacted me wanting to get more involved with PSAI. Being smarter than folks thought I was, I jumped at the chance to have Gary on the PSAI Team. Tom’s deal fell through, but Gary was totally involved with PSAI, and now is a partner and president of our agency. Thanks to Gary and Tom. 

Many, many years ago I was still taking some type of classes—I think regarding mixed gasses, maybe with Rebreathers—at Tom’s house. In fact, I was one of Tom’s instructors who did the final proofreading of one of Kevin Gurr’s manuals. Too far back to recall much about this mixed gas stuff—remember my reputation for being a deep air diver.

Tom Mount and Gary Taylor mixing up some trimix in the garage.

Speaking of the people with whom you’ve dived, was the aim of The Forty Fathom Scubapros Club?

Before I invested in a sinkhole in the Ocala, Florida, area—which was locally referred to as Blue Sink or Zuber Sink, and is now referred to as 40 Fathom Grotto—several diving buddies whom I had dived with and trained for extreme deep air diving—as well as cave exploring—got together and planned to dive The Grotto at least one Friday night per month. Within a short period of time, several other buddies joined our group, which eventually became known as The 40 Fathom Scubapro’s dive club. Each diver had to meet my requirements of training. 

Forty Fathom Grotto aka Zuber Sink
An early Sheck Exley mix course at Forty Fathom Grotto
An Eric Hutcheson drawing of Forty Fathom Grotto

Eventually, our group set specific personal requirements—being a good person, supporting our club safety rules, and making at least one 40 Fathom Grotto dive per month. We set a limit of 14 or 15 members. Three 40 Fathom members eventually set World Records for deep air: I was one, A. J. Muns, and Herb Johnson set ocean records, and later I set the air depth record for cave diving. Naturally, as time passed and we got older, our membership got smaller. It is notable that none of our club members have died during any scuba dive.

Finally, what led you to create the iconic motto, “Plan Your Dive. Dive Your Plan?” 

I used to be a private pilot, and we used to say, “Plan your flight, fly your plan.” This was back in probably 1961 when I had just started diving and there were so many instances where all the other divers would get in the water without saying anything. I’ve seen so many incidents and fatalities that could have been avoided through proper planning.

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Dive Deeper

ScubaGuru: LXD 029 : Hal Watts – Record Deep Diver & Technical Diving Pioneer

Netdoc: Netdoc chats with Mr Scuba, Hal Watts

InDEPTH: The First Helium-based Mix Dives Conducted by Pre-Tech Explorers (1967-1988) by Chris Werner

Alert Diver.Eu: Rapture of the Tech: Depth, Narcosis and Training Agencies

Professional Scuba Association International: PSAI History


Andrea Murdock Alpini is a TDI and PSAI technical trimix and advanced wreck-overhead instructor based in Italy. He is fascinated by deep wrecks, historical research, decompression studies, caves, filming, and writing. He holds a Master’s degree in Architecture and an MBA in Economics for The Arts. Andrea is also the founder of PHY Diving Equipment. His life revolves around teaching open circuit scuba diving, conducting expeditions, developing gear, and writing essays about his philosophy of wreck and cave diving. He published his first book, Deep Blue: storie di relitti e luoghi insoliti (2018) and IMMERSIONI SELVAGGE, the new one is on the way, out on fall 2022. 

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