Diving on chemo?

[kathywynne]

I am looking for info about diving while on chemo and post-mastectomy and reconstruction. One of my goals is to get back to diving. It is my love. Any experience out there? In particular, any oncollogists out there who would know about Avastin?

 

[SelkieDVM]

Greetings Kathy and welcome to ScubaBoard. I will ask a Moderator to move this thread to the Diving Medicine subforum, where I think you have the best chance of getting some useful answers to your questions. I wish you the best in your recovery and hope you can get back to diving soon!

Cheers,
Lilla

Whoa that was fast - moved before I even finished the PM - thank you!

 

[TSandM]

Hi, Kathy!

I am not an oncologist, but a brief review of materials on Avastin indicates that one of the biggest risks of the drug is significant bleeding at any of a variety of sites. The risk appears to be in the 2 to 5 percent range, and can include gastrointestinal bleeding, nosebleeds, or bleeding into the brain. I do not know whether the risk of this goes down if you have tolerated the drug for a period of time without problems, or whether it goes up as the duration of treatment increases. These would be questions to ask your oncologist.

In addition, my brief review indicates that Avastin is not usually used as a sole agent. Bleeding risk may be affected by other drugs used concomitantly.

Has your oncologist indicated the expected duration of therapy? If it's brief, you might consider a hiatus from diving. If prolonged, you have to do a risk analysis and prioritize things.

 

[DocVikingo]

Hi kathywynne,

There are a number of issues:

1. Were other drugs (e.g., Blenoxane (bleomycin), Cytoxan (cyclophosphamide)) or treatments (e.g., radiation) used? If so, these can damage lung tissue and pulmonary clearance to dive is prudent.

2. Avastin (bevacizumab) side effects include lethary, fatigue and lack of stamnia, bleeding, pain (especially abdominal pain) infection and headache. As TSandM mentions, it is commonly used in combination with other drugs, like Taxol (paclitaxel). Such treatment can result in a tendency to bleed quite easily. Given that divers are prone to barotrauma of air containing areas of the body (middle ears, sinuses, lungs, gut) such drugs could complicate these occurrences. Another consideration is the risk for trauma such as from falling on the boat, being bumped by a cylinder or other gear, and cuts from wrecks or other objects. Finally, some have speculated that drugs with this property may worsen the effects of spinal DCI.

3. Post-surgical range of motion and strength of the affected arm(s) should be appropriate to safe SCUBA.

4. The diver should be taking no narcotic pain relievers or other medications that could adversely impact cognitive performance, mood or behavioral modulation.

5. The diver should feel physically and psychologically up for the activity.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[kathywynne]

I have stage 4 breast cancer. Bone mets in spine, pelvis, sternum, and also liver. In 5th of 6 months regimen of Avastin, Taxol, Zometa. Then month off, then surgery(ies.) Then most likely Avastin for ?????? Maybe ever, as long as I tolerate it. I have a Bard Power Port. Quite frankly, I cannot be at peace with the thought that I can never dive again. It is my first love. I have denied thinking about this issue, but the winter and snow have started my thinking of our hopefully future dive trip when I am able. I am 52, in great shape, still working full-time as RN in outpatient surgery. I like to pray that my physicality and spirit can facilitate my doing what I want with the rest of my life. I do have some headaches, ringing in the ears, nosebleeds, slight elevation of BP. But all tolerable. Please let me dive at some point, I need to dream it!!!

 

[wve]

Please let me dive at some point, I need to dream it!!!

Hi Kathy,

I am a hematologist/oncologist. Among other things, I treat breast cancer, and I use Avastin (bevacizumab) all the time.

As a diver myself, I certainly understand your desire to get back into the water, and I have returned patients with stage IV cancers to diving. However, I do not think it is a good idea to try to do so while on active chemotherapy, especially Avastin.

Avastin (bevacizumab) is a drug which specifically targets the circulatory system. There is no telling what it might do -- not only to your risk for bleeding, but also the risk for decompression sickness. Unfortunately, life-threatening bleeding can occur without any warning. Should something happen, you don't want to be far from help, especially in some remote location out of the country.

The other drugs you mentioned can also have adverse effects, the Taxol more than the Zometa. Taxol can cause peripheral neuropathy, and that could make it difficult, if not impossible, to distinguish symptoms of DCS from the drug itself. Rarely Taxol can also cause lung damage, so I wouldn't risk diving while on the drug. In fact, it might be advisable to have pulmonary function tests with DLCO done prior to re-entering the water.

Finish your treatment, make sure your disease is controlled, that you are symptom-free, that your blood counts have returned to normal, that you have regained your strength and stamina (this can take weeks or months), then ask your oncologist whether it is okay to get wet again.

I have several patients with stage IV breast cancer who have been very stable and living a normal life for years. So while there are prohibitive risks with diving while on treatment, there is definitely hope for later on.

 

[EGad]

Kathy,

I am not a doctor, my medical training is rather remedial. For that matter, I'm not even a certified diver. That being said, I would suggest staying positive and focusing on getting well as soon as possible. I would get some diving DVDs and DVR episodes of any diving related show I could find to watch while you recover. Also, you could use the eDiving simulator to get a more hands on diving experience. I know it's not the real thing, but I would minimize risk and feed my "diving jones" as safely as possible.

Here are some diving video links:
Sea Hunt Season 1 Complete (download torrent) - TPB
That's a link to 39 episodes of Sea Hunt on a torrent. Good if you're interested in vintage diving, great if you want to see Lloyd Bridges fight underwater.

Then you can always read through Dr. Bill's posts. He has a show, but I don't think it's available online. However his posts are very informative on the subject of marine life. (I have a good friend who's about to get his phD in marine biology, but Dr. Bill's more entertaining. Sorry, Kevin!)
ScubaBoard - View Profile: drbill

And there's always one of the shows featuring diving on television (these are shows from the USA, as that's where I live right now, so it's my base of reference.)
Deep Sea Detectives - History.Com

And here is a link to the eDiving simulator
Virtual Diving - Explore your Ocean

Hope this helps, I'd link more, but it's my birthday and I seem to have gotten a little intoxicated.

Please post a picture from your first dive after you get well.

Best wishes,

Eric

 

[kathywynne]

Thank you for the reply. I know you are right. But it just doesn't make it any easier. I will be on Avastin for a long time, as long as I tolerate it due to the liver mets. While I am a very grateful person, losing diving sucks. How about world class snorkling from the surface? The new boobs I am planning on getting will keep me afloat!!! Peace, Kathy

 

[wve]

Thank you for the reply. I know you are right. But it just doesn't make it any easier. I will be on Avastin for a long time, as long as I tolerate it due to the liver mets. While I am a very grateful person, losing diving sucks. How about world class snorkling from the surface? The new boobs I am planning on getting will keep me afloat!!! Peace, Kathy

I had forgotten to comment on the implanted port. That thing might hurt at depth. I have had several patients complain over the years about their car's shoulder harness pressing on it, causing discomfort. If the pressure of a shoulder harness hurts, then one has to wonder what it would feel like to put on a tight wetsuit, a BCD, then dive to 2-3 atmospheres of pressure.

If you have tissue expanders in place in anticipation of breast reconstruction, then I would also worry about the impact of pressure upon those. (Good question for the surgeon.)

But I don't see any problem with either of those from snorkeling -- other than possibly being in a remote location.

 

[InTheDrink]

Thank you for the reply. I know you are right. But it just doesn't make it any easier. I will be on Avastin for a long time, as long as I tolerate it due to the liver mets. While I am a very grateful person, losing diving sucks. How about world class snorkling from the surface? The new boobs I am planning on getting will keep me afloat!!! Peace, Kathy

Probably not very much use to you, but at least know there are people here that are dreaming your dream with you and when you do manage to descend down into the water just think of how many people will be so pleased for you too.

Get well and when you do, savour those first sweet, saline & special moments

J