O2 Toxicity

[JoePSU]

Vaughn told me that after my 3x BEP, that I should advise all future surgeons not to give me Oxygen, and never go scuba diving...

The problem here, is that I have ALWAYS, ALWAYS, wanted to go scuba diving. As a young guy, I've just never had the money or the opportunity to go before I was diagnosed.

What could happen to me if I went scuba diving? Can't I get a breathing tank that has the regular atmospheric mix of N, O2, and CO2 that we breath normally anyway? What is it exactly, about scuba gear that causes problems for people who had BEP?

Also, wouldn't it be possible to get tested to see if I had any lung damage? Would my risk to O2 toxicity come up on a physical exam, stress test, or scan?

[Scott]

Hey, Joe, this topic was discussed recently in this thread and previously in this thread.

Divers Alert Network was recommended as a resource.

[dadmo]

I'm going to get in touch with some of the top dive centers and put something together. This question comes up more then I ever thought it would. Don't give up your dive dreams but you do need to be checked by a pulomonologist who understands that you want to go scuba diving. You need to be out of treatment for a minimum of 2 years before even thinking about it and 3 would be better. If you want send me a pm with your address and I can send you some of the books you will need to study to get certified.

[Already Bald]

Joe,
Surely you were aware of the potential side effects of Bleo prior to starting treatment.
I don't know why someone with your education level would question someone like Dr. Vaughn- and virtually every other expert in the field, on such a commonly known condition relating to BEP.
Didn't you talk to him about 4XEP to preserve your scuba diving dreams?

[dadmo]

Scuba diving and mountain climbing are why we requestion Jaymo get EP.

[JoePSU]

Joe,
Surely you were aware of the potential side effects of Bleo prior to starting treatment.
I don't know why someone with your education level would question someone like Dr. Vaughn- and virtually every other expert in the field, on such a commonly known condition relating to BEP.
Didn't you talk to him about 4XEP to preserve your scuba diving dreams?

I was much more concerned, and still prioritize, getting the most proven method of care to address the immediate problem than to change my cancer treatment around a hobby I would like to do someday.

I'm not questioning Vaughn's methods, but I do know that a lot of what docs tell you is based on "standard care" policies. The same way why you have to individually ask for specific tests if you want them, like testosterone tests, or others (I regret not getting this done before my orchiectomy).
If it's not "standard care", you won't get it unless you ask. Similarly, the docs will only feel comfortable telling you what has been shown statistically through studies and research to the "average" patient. If I want to know something more about my individual patient status, I'm going to have to ask for more tests.

[Scott]

I'm with you, JoePSU. I completely understand possible future plans to go scuba diving wouldn't have been top of mind while you were discussing treatment options. It does often seem to fall to patients to know what questions to ask.

[Russell's Mom]

Hi, Russell has Bleomycin Toxicity and as I have said before, you don't want it. Previously I posted a document from Micromedex, a highly recognized drug database that is updated every three months. This describes the drug +++. From the information that I have gathered and according to the Pulmonologist that treated/is treating Russell, the risk stays un-predictable. As Russell was treated, the Pumonologist shared that there is not a person in the world who understands it. They treat with high dose steroids because there has been "some success." People have been know to flip into the toxic reaction, long after their treatment. Sorry for the news. We were told that even if they had discovered the toxicity early, they probably would have continued on with the treatment in order to kill the cancer. I have my thoughts about that one and that would be an entirely different topic that would take some time. Overall, I would say be very carefull. Our Pumonologist shared that if someone tried to put O2 on Russell during his RPLND and he became aware, he was to rip it off of his face. He had a 7 1/2 hour surgery on room air level O2!!! Already he has lost about 30% of his original lung capacity. It is a ucky reality to face. But...you should see him snowboard and play the heck out of the drums.!! Sharon

[Fed]

I can't resist explaining the reason behind the contraindication of scuba diving after treatment with bleomycin (sorry, it's the geek in me). Bleomycin is a glycopeptide, meaning that it is made up of sugars and amino acids. Glycopeptides are degraded by esterases, and these enzymes are all over the body except in two places, the skin and the lungs. In order for bleo to work as a chemotherapeutic and cleave the DNA of cancer cells, it needs a mixture that, as a chemical reaction looks like:

bleo + DNA + O2 + metal (Fe or Cu) ---> chopped up DNA

In order for the reaction to work, there needs to be oxygen around, and normal O2 concentrations in a cell are sufficient for this to work. Bleo has a long residence time in the lung for the reason I mentioned above, and in the presence of high concentrations of O2, like those you would find in an O2 tank while scuba diving or during surgery while receiving anesthesia, any residual bleo will get activated and wreak havoc in your lungs, hence the contraindication.

OK, I'll stop with the geek talk .

[Mom]

OK, so what happens if you need surgery? What happens if you are in an accident and no one is around to tell the EMTs no oxygen? I can see living without scuba diving, but now you have me nervous about surgery, etc. Dianne

[Already Bald]

If it's not "standard care", you won't get it unless you ask.

You may be right- you will probably get the standard answer from Vaughn, and most every other doctor, unless you ask educated questions.
My concern with your thread, (and I'm not saying that this would happen with You- JoePSU), is a patient that was treated with BEP can start asking pulomonologists to be tested for scuba. If one doc gives scuba the green light- and you go dive and something terrible happens- you will be the one left to deal with the consequences. You and your care taker that is.

As long as I stare at this thread, I just can't convince myself that the risk is worth it.

I guess it's "Standard care" for a reason.

Hey, look at the upside Joe- you were cured with BEP rather than EP.
That means you were exposed to less Etoposide and Cisplatin than I was- (Considering our weight is the same and dosages were the same and so on.)
This quote from www.tcrc.com:

Etoposide can cause leukemia many years down the road (at the levels given during standard chemo, the risk is less than 1 percent.) and Cisplatin can cause neuropathy and hearing loss, so there is some impetus to reduce the number of cycles of these drugs.

So BEP was good for you, and it got you to your wedding quicker.
(I went EP because I had a chest cold going into chemo- a day care virus my toddler brought home. Vaughn was concerned that he would not be able to tell if my cough was related to that or BleoTox).
My suggestion about scuba, get a fishtank.

As far as Mom's concern- is it common to wear a Med-Alert bracelet in the event of an emergency? Something I would ask the prescribing onclogist.

[dbo]

Some counterweight

I am going to put some counterweight on this thread.

On the tcrc website under chemo there is a line where the question on bleomycin was discussed with dr. Nichols and dr. Einhorn.

I quote what is written there:

We have also asked Dr Lawrence Einhorn at Indiana University about the same thing, and his position is that the a good part of bleomycin toxicity issue is overstated and the negative aura has grown over time without any medical evidence.

My story:

I received 4 BEP, 2 EP, 2 VIP, RPNLD and 3 chest surgeries..
After that I also received HD salvage chemo.

About 9 months after the HD chemo I booked a trip to the Red Sea and got my PADI open water.
I dived there various times, mostly about 10-15 meter. max. <20 meter.

......... I am glad I did it, because I am still strugling with my health.

Also worth mentioning, you can dive, and dive deep.
If you do this for recreation, the nicest things can be seen <15 meters.

The problem is related to the depth you dive, because the volume of air you consume increases exponentialy with the depth.
I believe the number was something like the volume of air you consume doubles every 10 meters?

Regards,

[dadmo]

dbo:
Your numbers are close enough. That's why I always recommend that bleo patients stay above 60 ft.
My major concern is this question. How does a pulmonolgist know if you will suffer from residual bleo toxicity? Do they only measure lung function or is there something else they do. I plan on contacting Divers Alert Network this week and some pulmonolgists to try and sort this out.

[Russell's Mom]

If you have the toxicity, it is visible as opacities on the CT scan. They use a high resolution CT to watch it. As well, the pulmonary function tests for lung capacity. I will hope to see some answers here, but what I have learned so far is that no one knows exactly what is happening or even if the steroids are stopping the reaction. The Pumonologist that we saw shared that if the toxicity returns, to expect that the steroids will "not" work again. There are no other known treatments. Well lung transplant I suppose. We have another year and a half or so to decrease the percentages of the pulmonary fibrosis returning. Not particularly fun while waiting for two years to pass for the cancer as well. But.....you should see him play with his dog and swim in the lake near his house!!! So he will go wide, not deep! Sharon

[RTC]

I was quite concerned about this too . . .

I had been coughing for 3 weeks or soon after first round of BEP . .
My Onco wasn't concerned . . . I thought given the dosage
in the first round . . it would be too early to worry about it. . . .

Then I emailed and expert in Vancouver . . He suggests me to drink as much
as I can when I get Bleomycin as outpatient . . . because usually
not much IV fluid is given during Belomycin outpatient injection . .

Now I just returned home from my last dosage of Bleomycin for my round 3
dosage was reduced due to my low platelet count . . . and I start to cough
a bit after getting my Bleomycin . . . . . hmmmmmm . . .