Scuba Diving after Bleomycin…With the right precautions


The objective of this post is to add my experience to the growing body of evidence that supports people treated with bleomycin safely returning to scuba diving under the right circumstances.

I was diagnosed with testicular cancer in October of 2005.

I was lucky.  Friends and family supported me during the diagnosis, and I was fortunate enough to live in Vancouver just blocks away from the BC Cancer Agency.   The BCCA is one of the finest clinical care facilities in North America.  3 years after a recurrence that was treated with 3 cycles of BEP (Bleomycin, Etopisode, Cisplatin) chemotherapy in 2007 I feel confident that we’ve beaten it.  I know I have a great number of people to thank, and will remain grateful for as long as I live.

I should note that I’m not a doctor and you should rely on the advice of your physician. 

That said, I’ve returned to scuba diving having obtained the endorsement of my physician and in the past 3 months have enjoyed some of the most thrilling diving of my life.  If you’re a diver and reading this, check out Pescadore Island, Malapascua and Apo Reef.  Whoa.

Getting here involved a great deal of research and talking to people and I’m hoping this post will help people in a similar situation to me.

If you’ve been prescribed bleomycin,  you know that one of its contra-indications is breathing compressed oxygen.  The sheet I was given by my oncologist specifically said that I would not be able to scuba dive again.

Period.

If you read Lance Armstrong’s book “It’s not about the bike” you may remember that there is a point where Lance is prescribed 3 cycles of BEP, but his doctors step in to say they have an alternative series of drugs that would not endanger his lungs, and therefore give him a better chance to return to cycling.  The drug they were avoiding is Bleomycin (the B in BEP).

The Path Back for Divers: Here’s what I found out in a nutshell. You should wait at least 2 years (3 on the most conservative side) post chemo-therapy before considering returning to diving.   You can then complete a pulmonary function test and see a specialist in hyper-baric medicine to present your case and get the go-ahead.

The thing is that even after completing the above with a specialist in hyperbaric medicine, he still felt constrained by the published authorities on the matter.  That’s where it gets frustrating.  After considering my test results and determining that there was no lung injury resulting from my exposure to bleomycin, his review of published research still suggested to him he must take the most conservative approach and support the ban on scuba.

In order to tip the scales, he asked me to get the advice of the Divers Alert Network, (DAN) who are closest to the issue.  If DAN gave the green light, then he would be able to as well.

Here is a thread of the email that I had with the Divers Alert Network DAN, including their contact info if you’d like to approach them too:

Subject: DAN Bleomycin
Date: Tue, 6 Apr 2010 11:56:32 -0400
To: Andrew Gregory

 
Dear Mr. Gregory,

Thank you for your message.

The medication of Bleomycin has been getting more and more attention lately.

Bleomycin may cause pulmonary pneumonitis in about 10% of patients resulting with pulmonary fibrosis in 1% cases. The therapy has many faces and various evolution paths and thus there is no one answer regarding return to diving. The issue has to be discussed with the treating physician who is most familiar with your condition. The final decision will depend on your general condition, i.e. tolerance for exercise, your pulmonary functions and absence of other possible complications that may compromise safety.  And by safely we mean at least the ability to rescue your self and your buddy without hesitation.

It sounds as if you have done everything we would normally recommend in this situation:

PFT, read by a dive medicine physician, approved by a dive medicine physician for diving, and then approval by your treating physician.  The one pre condition being that you are not currently on the medication.

Thank you again for your email and your interest in DAN.

If you have any questions or require further information please do not hesitate to contact DAN.

Have a great day.

Divers Alert Network

Phone:    919-684-2948 ext 238

Toll Free: 800-446-2671 ext 238

Fax:        919-493-3040

________________

Name: andrew gregory

 

RE: Diving after Bleomycin for Cancer Survivors

I am a PADI advanced diver, and cancer survivor who was treated for testicular cancer with 3 cycles of BEP chemotherapy: Bleomycin, Etopiside and Cisplatin.  I completed treatment 3 years ago, and am happy to say that my oncologist has every reason to believe that I am cured.  I return every 4 months for regular checkups.

I have had 3 pulmonary function tests at Vancouver General Hospital and have consulted with specialists in hyperbaric medicine.

The pulmonary function tests results have shown that my lungs were not adversely affected by the exposure to bleomycin.  The doctor has indicated that nothing in my test results would suggest that I should not return to diving.

I have seen varying opinions about whether a person can return to diving after exposure to bleomycin, and under what conditions.  I would greatly appreciate some advice as to whether I can return to diving now that I am over 3 years post chemotherapy and have completed pulmonary function tests that are negative for damage.

I love to dive and the ocean is a passion of mine.

Thank you for your kind attention. Let me know if you require me to become a member of DAN before you can consider my question.

After reviewing this note from DAN, and considering my medical results, the physician was finally able to attest that there is no added risk to me returning to scuba diving than there would be for some other person with the same fitness who had not been treated with bleomycin.

So there you go. If you want to scuba dive, you can.

I’d be very interested to hear any comments from other scuba-divers who have  had this question, who have returned to diving, or who are still wondering if it is safe.   Please feel free to post to this blog if you have any questions.

Post Script: If you or a loved one is diagnosed with testicular cancer, I recommend you do as I did and find the Testicular Cancer Resource Centre (TCRC) and pore through it to prepare yourself to tackle the treatment.   The information, advice and stories there were invaluable to me in getting my mind right and gaining a sense of control.

More Resources:

Here’s another citation I came across after the fact.  More and more are being written each month which leads me to believe that the outright ban on diving will soon be a thing of history:

“…We strongly believe that resuming scuba diving 6—12 months after an uncomplicated series of three or four cycles of BEP is completely acceptable. Caution should only remain for patients who develop clinical signs of pulmonary-function impairment during or shortly after bleomycin treatment. We deem the conservative opinions of many physicians and diving organisations about recreational diving after bleomycin treatment as unnecessary—opinions that we hope to change. Young men affected by testicular cancer should be able to undertake their normal daily life as fully as possibly after treatment with bleomycin.”

The Lancet Oncology, Volume 8, Issue 11, Pages 954 – 955, November 2007 – Bleomycin and scuba diving: where is the harm?

Original Text Ronald de Wit a, Stefan Sleijfer a, Stan B Kaye b, Alan Horwich b, Ben Mead c, Dirk T Sleijfer d, Gerrit Stoter a

Paul Balfour talks about Progress in Cancer Research


I just read the following blog post from Paul Balfour.  Paul captains the Phillips Hager & North team that raised a total of $292,000 for cancer research at the BC Cancer Foundation last year.  This year Paul has already raised over $60,000 personally, and his team will surpass $350,000 raised.

On the evening before our Ride to Conquer Cancer, this strikes at the heart of why we Ride.  Thanks for the inspiration Paul!

Progress

by Paul Balfour on Fri, Jun 18, 2010 @ 3:41 PM

I think one thing that we in the fundraising community hasn’t done a very good job of is communicating just how much great progress is being made in fighting, and in many cases, curing cancer.

Typically, we set out to fundraise by talking about how awful the disease is (and it is, make no mistake about that) and how incidence rates are rising etc. and but I think perhaps by doing that people get the impression that little progress is being made or that cancer is starting to rage out of control.

Incidence rates for the population as a whole have been increasing but for mostly the simple reason that we are living longer and we have gotten much, much better at preventing deaths in other areas. Far fewer people are dying from heart attacks and strokes, far fewer are dying in car crashes in fact the decline in mortality rates for just about everything is quite remarkable. So, in a sort of good news/bad news story, the increase in incidence rates is concentrated in the older segment of the population living longer and having the chance to develop cancer in the first place and the drop in mortality rates in just about everything else.

But progress in cancer treatment is being made, year in and year out. It’s indisputable. Consider a few observations.

Childhood leukemia used to be fatal 90% of the time. Now it’s a 90% survival rate. Because of research. Testicular cancer (Lance Armstrong) used to be a very serious disease. It still is, but the survival rate is now 96%. Due to research.

Outcomes in breast and prostate cancer have improved in recent years to close to the 90% level. Thanks to research.

There is a disease called CML (Chronic myelogenous leukemia) that used to be pretty much fatal. Scientists knew it was caused by a mutated gene and one day (okay over a period of a couple of years) a drug was discovered called Gleevec and further refined to a pill form. So, you used to die from this cancer and now … as long as you take a pill every day, you’re fine. Cool. All due to research.

What’s also neat is that this same drug works like a charm on a type of nasty stomach cancer. Here’s where it gets really interesting: the two cancers’ cells look absolutely different under the microscope but the same drug “cures” them. Why is that? Well, these two cancers have that same genetic mutation in common.

So, what if we could do a better job of analyzing the genome of the patient for clues as to the causes for cancer and come up with other breakthroughs?

Well guess what the BC Cancer Agency is doing? Exactly that! In fact the Genome Science Centre here in Vancouver is a leader (many say the leader) in this area. Ask a scientist you know sometime how hard it is to get published in the science journal Nature. It’s unbelievably hard. Three significant breakthroughs by the BC Cancer Agency and the Genome Science Centre have been published in Nature in the past twelve months. How many other centres have had three major findings in that period of time? Um, none actually. Two? None.

Pretty impressive I say, right here in little ol’ Vancouver. Also, it’s an open book here we share that research with the rest of Canada and the world, make no mistake about that.

But it takes money. It takes a lot of money to keep this progress going. There are also plenty of patients who are on the wrong side of those survivorship rates and they really need help. There are some tumour groups where we have made very little progress for decades (brain and pancreatic in particular) using conventional therapies my guess is the genome will prove to be the key here. It will take money to do that though.

Please support me if you can, by donating here or at the link below. No donation is too small … and as my friend Michael likes to say, no donation is to big!

Thanks for reading this.

…and thank you Paul!  Here’s a link to his Ride page should you want to make a donation.

http://www.conquercancer.ca/site/TR/Events/Vancouver2010/1742352005?px=1759724&pg=personal&fr_id=1331

Alberto European Extreme Style, $1,250 Conquer Cancer Sponsorship


Extreme Style Cycling Team lines up
Extreme Style Cycling Team at the start of the 2009 Ride to Conquer Cancer

Our cycling team has been just blowing the doors off in fundraising.  I can’t say enough about the hard work of everyone on the Extreme Style cycling team, and the over 600 generous sponsors who have given to battle this terrible disease.   By next Sunday we will be well on our way to beating last year’s total of $90,000 raised for the Ride to Conquer Cancer.  We have over 25 riders and generous sponsorship from the wonderful people at Alberto European Extreme Style.

Because everyone is rocking the fundraising so well, we have the ability to share with someone who may not have the connections or resources that we do.  We were thinking of all the people affected by cancer here in BC, and the hundreds of people who had committed themselves to the Ride and to raising funds for the BC Cancer Agency and the groundbreaking research they do.

So here’s our idea…Alberto European Extreme Style is going to match funds to enable someone to ride that wouldn’t have been able to otherwise, despite their best efforts to meet the minimum fundraising threshold.

The Offer

If you know an inspiring person in Vancouver who is registered for the Ride to Conquer Cancer, please nominate them for this award.  Our sponsor is offering up to $1,250 matching funds for the Ride to Conquer Cancer for one deserving cancer survivor or caregiver who has been unable to raise their minimum.

To nominate, please go to our Extreme Style Cycling Team facebook page and post the nomination to the Wall, providing a link to their Ride page in the post.  We’ll decide on Tuesday June 15th next week. 

Here’s our Facebook Page:

 http://www.facebook.com/#!/pages/Extreme-Style-Cycling-Team/318451084264

 Hope to see you on the ride, and please spread this around to everyone you know who is registered, inspiring, struggling to meet their fundraising goal, and is ready to Ride down to Seattle!

Explaining the Team Give’r Logo


Our Team Give'r Cycling Logo

This is the story of Team Give’r and our wicked mean logo.

In 2009 our Give’r Cycling Team was sponsored by Alberto European Extreme Style for the Ride to Conquer Cancer.   Last year we raised over $90,000 and this year we are already at $65,000 and growing every day.

Our super-talented designer in residence Dean put together a beautiful blue and red kit (shown below) to represent for the brand, and we found room for the Team Give’r logo on the shoulder. 

To go back to the beginning, our group of friends had dubbed ourselves “Team Give’r “ after we had lazed our way through the first few days of the Juan de Fuca trek.  We awoke late on the final morning with the realization that we were in danger of missing our lift out of the bush.  When asked how the hell we were going to make it in time, the answer came pretty easily…Just Give’r.  The name stuck.

Since we have some new riders and countless new supporters on the team this year, I thought it made sense to explain the genesis of the logo and what it means…beyond the fact that it just looks mean and cool, of course.

The logo is an original cancer survivor symbol that I explained to Dean in the form of a story, which he then built. 

The skull and crossbones, commonly found on your household cleansers, represents the life-saving poison of chemotherapy.  It’s also been used for centuries as a symbol of resurrection, with the crossed bones being a nod to the cross of Christian origin. The eye patch is a symbol of Wisdom from legend, coming from the old tale of the Norse God Odin who is said to have plucked out an eye in return for a sip from the well of knowledge  (you’ll have to come up with your own conclusions for why it is over the left eye…that’s a tightly held secret that I will only share over several drinks).  The eyepatch is there because my own experience with survivorship is that it forces wisdom on you…pushing aside the things that just don’t matter and bringing priorities into focus.

And finally the wings.  I could say that they represent freedom, or the soaring feeling of surviving a deadly threat…but the truth is that Dean thought they looked cool.  And that’s hard to argue with.

Team Give’r was made to channel the athletic, creative and compassionate energies of our wonderful network of friends into a way to give back.  We’re in year 2 now and as of this writing the team has raised $160,000 for the BC Cancer Foundation and the Ride to Conquer Cancer.  Not bad.

Thanks to everyone who has supported us…our caregivers, family, friends and sponsors.  We ride so that some day no one need fear death from a cancer diagnosis.

For more info on the Ride and our ride from Vancouver to Seattle, check out my Ride page here:  http://bit.ly/AndrewRidePage  and the Team Page here: http://bit.ly/extremestyle 

Team Extreme Style at the finish line in Seattle

Hope to see you on the roads!

Sophie is Clean!


Congratulations to everyone on Team Alberto European Extreme Style, who rode 260km over 2 days from Vancouver to Seattle this past weekend.   All in all our team 

Our Team, Riding to Conquer Cancer
Our Team, Riding to Conquer Cancer

had 25 riders and raised over $90,000 for Cancer Research!

The Ride to Conquer Cancer in its first year in BC had 1701 riders and raised over $6.9MM for the BC Cancer Foundation.  This is a record for this kind of event in BC, and sets the stage for even more success next year.  Congratulations everyone!

I’ve shared with you the heart-rending story of my friend Marcel’s 4-year old daughter and her bout with brain cancer. I dedicated my RIDE to her battle this year, and just 5 minutes ago I received this wonderful email…after 2 surgeries and more than 5 cycles of chemotherapy Sophie is clean!

“Hi Andrew and Jim,

Sophie had a (scheduled) MRI and CT scan and a lumbar puncture yesterday. The purpose of these procedures was to see if the tumor has returned or not.

Minutes ago we received the results of the tests. Sophie is clean! I don’t know the details yet but it seems that there are no traces of malignant cells in the brain nor spinal fluid.

This is very, VERY important and good news which I wanted to share with you all immediately. Because, the longer the malignant tumor stays away, the lower the probability that it will return.

In the mean time Sophie is doing amazingly well. She had her stem cell transplant a couple of weeks ago and she’s still in isolation. Most kids would be a wreck right now but she has never looked better and she is more happy and cheerful than she has ever been before!
She’s truly amazing. And I am so proud to be her father…

I actually want to shout from the rooftops that cancer research is SOOOO important. Sophie is doing remarkably well because she’s having experimental chemo. A treatment that didn’t exist 10 years ago.

10 years ago she would have died!

Thanks for your support in our fight against cancer my friend. Thanks so much.”

If you are dedicated to the ambitious goal of seeing an end to cancer, successes like this is why we do it…have a great weekend!

Week 3 Training Blog, Ride to Conquer Cancer


Here we are 2 months out from the longest ride in my life, and training is going great.  Team Alberto European Extreme Style is coming together well on both the riding and fundraising fronts.  We are up to 25 riders now and with another $7,000 coming in from sponsors via mail we should be in the top 10 teams in total money raised.

Right on Track: We’re almost 80% of the way to our goal of raising over $50,000 as a team!

Riding

Saturday we did the ride out to Horseshoe Bay again under some beautiful sunshine.  It’s a rolling ride that should be quite similar to the trip down to Seattle so it is an appropriate test that we will be completing a couple times a month.  Rode with Dean, Kathy and Eilleen and felt strong as an ox on the climbs.  The 50k ride took us over 2 hours but we were pretty leisurely. 

The team has a pretty wide range of ability so we’re a pretty good cross-section of the people who will be on the Ride with us…from enthusiastic non-riders all the way up to the super-fit triathlete.  This is good because everyone should have someone to ride with all the way to Seattle.

We’re using the La Bicicletta Sunday morning rides as our team get-togethers.  This is a solid group for people who want a regular opportunity to ride in a pack at a moderate speed.  They leave at 9:30 sharp from the store at Broadway and Alberta each week (be there by 9:15 ready to go).

I’ve been riding to work through the midweek rains as well to keep my fitness up during the less than ideal weather and playing hockey where I can to keep the training up.

Fundraising

For a number of people on the team last week seemed to be the time to start fundraising in earnest.  There is still plenty of time, and we have some fun events planned in addition to everyone’s personal efforts.  In addition to Mike Scholten’s successful Burger and Beer at one20 pub in Surrey on Saturday, Kathy, Sue and Sarah have a great event planned at Red Square Tapas Lounge on the 30th:

Thursday April 30th at 7pm
Red Square Tapas Lounge, downtown Vancouver 1216 Granville street (near Davie).
We have collected some great swag for prizes – yoga membership, salon products and professional services, Lacoste bags, GC’s, bike gear…
$5 at the door directly to donation, gives you $5 off food/drinks.

Contact me at awg_home@hotmail.com if you want to support the event.

We are also planning a gala event at our restaurant sponsor Hapa Izakaya in Kitsilano in June.  More on that later.

Monday-Thursday: Bike to work, 30 minutes round trip

Friday: Off

Saturday:  50km ride, 2:20:17 (frequent stops)

Kitsilano to Horseshoe Bay.  Great rolling ride.  Nice opportunity to climb in the big ring to build power and practice going downhill. 

We’re beginning to work out in our heads how long it will take to get down to Seattle.  Judging from our experience at the Tour of Courage in 2007 riding with Axel Merckx and Alex Stieda, we should be able to hold a pretty good speed without too much effort in a pack.

Just have to be fit enough to stay with the Pack!

Week 2 Training Blog


After an absolutely fantastic weekend last week, we’ve had a typical Vancouver week of rain.  Threw a wet blanket over outdoor activity.  Thankfully the sun returned today (Easter Monday) and Anita, Dean, Kathy and I jumped on our bikes for a most excellent 2 hour ride to Iona Beach and down by UBC.

Team Alberto is kicking into a higher gear with 2 months to go until the Ride to Conquer Cancer.   Lots of people putting renewed effort in, and Colleen just completed her goal of raising over $2,500. 

We’ve had a new joiner, Sid Segal, who completed a 500 mile ride in September where he and his daughter raised over $8,000.  They’ll fit right in.  I’ll be in Toronto next week and will be visiting Alberto Culver to thank the company for their sponsorship and do a presentation on the BC Cancer Foundation.  We’re going to totally blow away the goal of $50,000.

A week into my training blog and while I wasn’t able to shed any weight, I did lose 1% body fat.  Hoping that building muscle should pay dividends in the summer racing season. 

Was chatting on the bike with Dean about my goal of setting a personal best in both the Olympic Tri and the 10k this year.  I think the 10k goal is going to be the tougher of the 2, but am up for the challenge.

Monday: Walk to work; 45 minutes each way. 

Tuesday: Bike to work; 15 minutes each way. 

Wednesday: Off

Thursday: Hockey, 90 minutes. Scored a goal and we pulled out an 11-9 win in a pick up game

Friday: 3 hour walk around Vancouver, The Seawall to Chinatown and around. Doing the tour-guide thing with Myrna’s friend Pam.

Saturday: Cycling 60 Minutes on the trainer in-doors

Sunday: Church, and Easter Pot-Luck Dinner.

Monday: 49.20 km Ride,  Time 1:57:44, top speed 63km/hr, ave speed 25.1 km/hr

Beautiful day to ride. Out to Iona Beach and back along UBC.  With a bit of a tailwind we were able to hold 40km/hr on the flat. I was a little bit wiped out afterwards, but it was Easter Monday so a day of rest was in order.