Diving as a lung cancer survivor

[TartanFrog]

Background: Early this summer I scheduled an appointment to have a physical prior to starting the PADI DM path. In case it matters, I've been diving a couple of years and have a little over 70 dives in various quarry and ocean settings and depths. Just prior to that I started experiencing some shortness of breath and some pain between the shoulder blades. So when I saw my primary care physician I informed her of the situation. She had an EKG and X-Rays taken and some additional blood work. As soon as she saw the X-Ray she made a next day appointment with a pulmonary specialist. The specialist did a pulmonary function test and ordered a CT scan. My pulmonary function came up as a 4 out of 8 which said to me that one lung was not operating. As soon as he looked at the X-Rays he made a next day appointment with the oncologist and started talking about the "disease." Pretty easy to figure out what that meant. I had over an hour with the oncologist and at the end he showed me the X-Ray and it was easy to see the tumor that he now definitively called cancer. He ordered an PET Scan and a brain MRI which were all negative except for the right lung. He also immediately ordered chemo and radiation treatments. During this process I sent an email to DAN explaining the situation. Within a couple of days I got a call and spent about a half hour or so discussing specifics of my case. The concern for me was trapped air emobolism because of the location of the tumor. Yeah not being able to expel air coming up from depth would definitely suck. I was told that of course this is America and I could certainly strap on a tank and go diving, although that was not recommended. I have not been in the water since.

Okay fast forward a few weeks. I will have my final cycle of chemo and radiation appointments in a little over a week. My oncologist has said he is going to order a follow-on PET scan and a pulmonary function test. I've already talked with him about discussing the case with DAN. All of the doctors and nursing staff have commented they are amazed at how well I am doing which is attributed to my fitness level and attitude.

Although completely non-scientific, I can breath considerably better than I could prior to treatment. I certainly don't know what the pulmonary function measure is yet but it feels much better than when I was originally tested. And since there were NO indications of other trouble areas with all of the other scans and tests I am anxious to get back in the water!

SO...

Comments!!!

 

[danvolker]

I would go on a zero sugar and low carb diet, and start reading everything on Cancer found on mercola.com ..Start maybe with http://articles.mercola.com/sites/a...tanislaw-and-gregory-burzynski-on-cancer.aspx and then try http://articles.mercola.com/sites/a...y--more-interested-in-wealth-than-health.aspx
And then finally http://articles.mercola.com/sites/articles/archive/2001/07/14/insulin-part-one.aspx .

You asked for comments, I can't help but say this first, for your general well being.


As to diving, it would be safer and still very cool, to begin by concentrating on freediving. It gets you back in the water, it will begin ventilating huge amounts of air through your lungs, and should give you some sense of whether there is a spot or area in your lungs that may not exchange well. Try a trip to Grand Cayman for this, or any one of a the large number of awesome shore diving island destinations that have great snorkeling.

Freedving can be every bit as much fun as diving...you just need to pick the spots carefully where you will be doing it.

Maybe after several months of this, you will have a much better handle on the scuba issue.
Best of luck.

 

[Duke Dive Medicine]

TartanFrog,

It's not clear from your post as to whether you are tumor-free or not. If not, the tumor is probably still affecting your lung anatomy, albeit less than before. Are you receiving chemo and radiation for purposes of shrinking the tumor prior to surgery? Are you a smoker? If so, how much and for how long?

It's good that you're breathing better, but a subjective feeling of improved ventilation isn't enough to base a recommendation on, especially over the internet. A pulmonary function test is a good objective measure of your lung capacity and airway patency but doesn't have the sensitivity to detect isolated areas of potential air trapping.

Best regards,
DDM

 

[HIGHwing]

DDM -

What circumstances or clinical parameters are necessary to have an acceptably safe diving/decompression outcome? Based on my [limited] understanding there are basically three approaches 1) Go for it and report the results, 2) Achieve a clinical threshold, 3) Hang up your fins.

Is there a defined clinical threshold of what makes a diver medcially eligible (as it pertains to this discussion)?

 

[DocVikingo]

Hi TartanFrog,

There are a number of issues:

1. Certain anticancer drugs (e.g., Blenoxane (bleomycin), Cytoxan (cyclophosphamide)) and treatments (e.g., radiation) can damage lung tissue.

2. The side effects of many antineoplastic agents include lethary, fatigue and lack of stamnia, bleeding, infection and headache. You will want to be finished with these agents and free of such adverse effects before considering a return to diving.

3. Post-treatment range of motion and strength in the arms and upper body 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.

It is good that your treating oncologist has ordered PFTs and a PET-scan. Apropos of DDM's caution regarding the detection of isolated areas of potential air trapping, you may also wish to consider a spiral/helical CT of the lungs. When all results are in, if there are any notable abnormalities pulmonary medicine clearance to dive would be prudent.

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.

 

[tracydr]

TartanFrog,

It's not clear from your post as to whether you are tumor-free or not. If not, the tumor is probably still affecting your lung anatomy, albeit less than before. Are you receiving chemo and radiation for purposes of shrinking the tumor prior to surgery? Are you a smoker? If so, how much and for how long?

It's good that you're breathing better, but a subjective feeling of improved ventilation isn't enough to base a recommendation on, especially over the internet. A pulmonary function test is a good objective measure of your lung capacity and airway patency but doesn't have the sensitivity to detect isolated areas of potential air trapping.

Best regards,
DDM

Is there any test that has the sensitivity to detect areas of potential air trapping? I wonder this for people with COPD and asthma. Perhaps an MRI or radial CT?

 

[DocVikingo]

Is there any test that has the sensitivity to detect areas of potential air trapping? I wonder this for people with COPD and asthma. Perhaps an MRI or radial CT?

Inspiratory (at functional residual capacity) followed by expiratory (at residual volume) helical CT thin-section can shed some light.

Regards,

DocVikingo

 

[Duke Dive Medicine]

DDM -

What circumstances or clinical parameters are necessary to have an acceptably safe diving/decompression outcome? Based on my [limited] understanding there are basically three approaches 1) Go for it and report the results, 2) Achieve a clinical threshold, 3) Hang up your fins.

Is there a defined clinical threshold of what makes a diver medcially eligible (as it pertains to this discussion)?

We have sometimes used approach #1 in patients with very poor prognoses with the philosophy that they deserve to have their remaining time be as fulfilling as possible. Re the clinical threshold, so to speak, I don't have much to add to what DocV said above. Most modern CT scanners are helical/spiral scanners and have a high enough resolution to enable a good radiologist to detect areas of potential air trapping, which is probably the biggest long-term hazard in cases like the OP's.

 

[HIGHwing]

Most modern CT scanners are helical/spiral scanners and have a high enough resolution to enable a good radiologist to detect areas of potential air trapping, which is probably the biggest long-term hazard in cases like the OP's.

I guess you just have to figure out how to get a "good radiologist". I'm hazarding a guess that most Doctors (especially non-diving) aren't going to be in the frame of reference that submerging one's self is a proper idea from the start. I can see defensive medicine playing a large part in the doctor-patient conversation.

Perhaps a drive down to Duke is recommended for the OP post-treatment?

 

[Rhone Man]

Lots of good advice above, but I'll throw in a couple more comments as a non-doctor.

- Once you complete your treatments you have to go through an absolutely agonising period before they run fresh PET scans to try and determine whether the disease is in remission. You just need to think a little bit about doing anything which may impact your ability to receive further treatment quickly if, God forbid, that is necessary.

- Remember that chemo significantly dampens your immune system and it takes a while to bounce back. If you do resume diving (and I say: live life to the fullest, but you probably know that better than me), have a care not to expose yourself more than necessary to "conventional" illnesses, as your ability to resist them is going to be impaired for a while.

I wish you all the very best with it. Battles with cancer are dark days. Whatever the medical advice is, it is nice to be able to remind yourself that the sun shines, and diving is as good a way to do that as I know of.