Tamoxifen after DCIS

[reefsong]

I was diagnosed with DCIS recently, lumpectomy only with no nodal dissection, and am currently in radiation treatment. Because the path report showed 93% positive receptors for estrogen, I am assuming that when I meet with the medical oncologist next week, there will be a recommendation to take a five year course of tamoxifen.
Does anyone out there have any thoughts on the use of tamoxifen and diving?
I am otherwise a very healthy, active, and fit 50 year old, with no history of blood disorders, DVT or superficial thrombophlebitis and no family history of same.

 

[DocVikingo]

I really don't know much about this issue, and a search of customary medical sources revealed no studies on the subject, but I didn't want your inquiry to go without response.

I suspect that you know tamoxifen can have a range of side effects, some of them quite worrisome. I'll limit my reply to some of those having potential implications for scuba. There may be others:

1. As you seem to be aware, blood clots (thrombosis) is one of the more serious, documented adverse reactions. Given the plane rides, sometimes long, that many dive trips involve, and the venous gas emboli often formed during ascent from a dive, even recreational dives where safe decompression guidelines are observed, one could be at increased risk.

Any swelling, redness, discomfort or warmth in the legs, breathing difficulty, sharp chest pain or other unusual developments should be brought to immediate medical attention.

2. A tendency to cause nausea & vomiting could by itself, or combined with boat rides & u/w surge, interfere with diving.

3. Mood swings/depression are not uncommon. To the extent that these may impair attention/concentration, decision-making, ability to tolerate routine aggravations, impulse control, or even bring on suicidal thought, the risk to scuba is obvious.

4. Loss of energy also is not uncommon. To the extent that this may impede ability to respond to the possible rigors of scuba, such as dealing with heavy currents, unexpected downwellings, buddy rescue & the like, this would be problematic.

5. Memory loss. This has yet be to solidly confirmed, but one should be on the look out for any significant changes in this function.

An adequate topside trial on the medication prior to scuba should reveal much about what enduring side effects, if any, one is going to experience.

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.

Best regards.

DocVikingo

 

[reefsong]

Dear Doc V,

Thanks for your well informed response. All these, and other, considerations, come to mind when I am contemplating what I will do with the inevitable advise I will get from the oncologist, and have already been getting from all the other health care persons thus far involved in my care.

One of the things I do know is that statistically. my odds of no reoccurence of Ca are so greatly enhanced by taking the tamoxifen that I would probably be foolish not to go along with the advise to do so.

However, what I am currently thinking about as my own solution to this problem is to temporarily remove the tamoxifen from my system for a short period of time just before any future dive trip and during the trip so as to avoid these problems in the first place.

I already know as well that the doctors will have to tell me that they disapprove of this action only because it is not an approved "method" of treating my disease, there are no studies out there to back up any opinion on this course of action. They absolutely have to take this point of view and I understand it and fully support them in saying so.

I will not be starting the tamoxifen until near the end of October (plenty of time to research the half life of tamoxifen and to take my previously planned trip to Fiji at the conclusion of radiation therapy!)

I'm only able to get away ~ twice a year on dive trips as it is. The entire course of tamoxifen therapy is 5 years. I'm still researching this approach as an option, but I am perfectly willing to carry the small percentage of lessened tamoxifen protection to allow me to continue my life in as normal a fashion as I am able.

I am simply not willing to give up those two dive trips a year for the next 5 years of my life. Life is already too short and I'm just not willing to give up something that gives me so much pleasure, that I and my husband look forward to so much.

I will be completely honest with my doctors and discuss my thought process with them, but when I weigh the "risk/benefit" ratio, this seems like my probable course of action.

Thanks for a forum that allows all of us who regularly read this website a place to honestly discuss our diving issues.

reefsong

 

[DocVikingo]

My pleasure.

I endorse being completely honest with one's doctors, discussing with them one's thoughts on options for approaching safe diving, and then arriving at a course of action with which all parties can agree, even if grudgingly.

Best of luck.

DocVikingo

 

[GoBlue!]

Also a reminder that skin exposed to radiation therapy has some of its defenses weakened, and can be more prone to infection (cellulitis). If going to be diving, make sure to wash well after diving and dry thoroughly.

 

[lavieafond]

Hello reefsong,
This is quite an old thread but I am researching the same questions as you here in 2019. How did you get along? Did you end up with the Tamoxifen and did you keep diving? I'm thinking of avoiding all need for radiation and tamoxifen by a double mastectomy and hoping that extends both my life and my dive career for decades to come. Such horrible decisions. I hope you are well today and have been able to move on from this disease.
Big hugs and thanks for posting this question in 2003.
Kim