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Lung cancer to dive for

In 2006, financial planner Teresa Rainier and business owner Leni White met on a “liveaboard” holiday in the Red Sea. They had lots in common. They were both mothers, both lived in Port Elizabeth and they both loved diving, the reason for their trip to Egypt. (Liveaboards are scuba diving boats for tourists who spend their holiday on the boat.)
Lung cancer to dive forTeresa had lung cancer, Leni was healthy. Teresa was diagnosed in 2004, and took up diving as a way to lose weight after chemotherapy.

“With the medication and everything I sort of expanded, and I needed to lose the weight. I was diagnosed with cancer in July 2004 and I had surgery and treatment. In December I finished my treatment and at my first check-up in March 2005 I said to my oncologist: ‘I need to lose this weight.' I felt like an elephant.

“He said: ‘Yes you can exercise, just don't go overboard, and please don't run.' And I then went and actually did my open water and advanced diving course, because my husband dived.

“I did it because I thought: ‘Will I survive or won't I?' And I thought: ‘Well, if I kick the bucket then the least I can do for him - we weren't married at the time, we'd only been living together for six months when I was diagnosed - is actually take him on a trip to the Red Sea. So at the end of July we went to the Red Sea and that's where we met Bob and Leni on a liveaboard.”

(Teresa got engaged to Rob Rainier under water, 20 metres below the surface to be exact.) At the time, she was in remission, but in July last year, Teresa was re-diagnosed with lung cancer.

An open-lung biopsy was performed. More tumours were found and chemotherapy was again scheduled. By April this year Teresa had spent a few days of just about every week in hospital.

She's not on any treatment at the moment, because of her body's response to earlier treatment, including experimental treatment. “So, once again I could kick the bucket. In January I will be tested again and they'll decide whether its chemo or what they're going to do. They throw around words like bone-marrow transplant. So we'll wait, but in the meantime we dive!”

To raise awareness of lung cancer (November is Lung Cancer Awareness Month) Leni and Teresa undertook a dive in the shark tank at the Two Oceans Aquarium, Cape Town.

Teresa says she dives because it relaxes her. “It's the most relaxing thing on earth. There's no stress, your husband carries your tanks, you sit on the boat, you put your BC (buoyancy compensator) on, you drop over the side and you're weightless and you just sit and stare.”

She is, however, petrified of sharks, “I'm petrified of sharks, absolutely petrified. I watch them on TV and I always say to my husband: ‘Listen, if ever we dive and you see a shark, you do not tell me, no hand signs, you can put your hands in front of my mask. I just don't want to see it.' So this is actually quite a giggle for me, it will get me over my fear of sharks.”

Eight months before her diagnosis, Teresa developed a wet cough. She thought it was the flu. On a ski trip the coughing had gotten to the point where she couldn't lie down anymore. “I couldn't lie in bed anymore, we brought a couch into the room, and I had to lie, elevated from the hips up because I couldn't lie on my side, it felt like my ribs were broken on both sides.”

She eventually saw a specialist, who sent her for a CT (computerised tomography) scan, which threw up an unidentifiable mass in her lung. “When the specialist that sent me for all the different tests said to me: ‘Give me a family history, what's your mom's health like?' I said: ‘You know she died just after I finished matric.' What did she die of? I said lung cancer. Your dad? I said well he died nine years later. What did he die of? I just got as far as the word lung and I looked at him and he said: ‘You know what the possibility is.

“I must be honest, I never shed a tear. I just said OK fine, where do we go from here, because that's the type of person I am.”

A biopsy confirmed the diagnosis. She didn't tell her children. Her eldest son was in matric. “I thought I've got two kids who are still at school and nothing is going to get me down. And I must be honest, I also believed in my faith. For me it was a case of: just give me another five years, to get my kids through school through varsity and settled then if it's time up, it's time up.

“I can't say I didn't have the odd tear at home, I know I had two panic attacks in hospital but I think that was more a case of nerves for the children.”

Leni and her husband Bob came to South African in 1983, intending to head for Australia after two years. Instead, Port Elizabeth became their home.

“In 1998, my husband decided he would like to try scuba diving, and I said well, good luck to you because I'm not going to carry weights and tanks and stuff, I'm quite happy snorkelling.

“But he wouldn't do it without me so I was forced into it, and I didn't like the course at all. Well, the minute I had my certificate and we dived on our own out here, I was a hook-line-and-sinker diver.”

The couple have since dived all over the world, including in Fiji and the Maldvives.

“We met Teresa on the dive trip in 2006 and I couldn't believe it when I heard her story. I was healthy and I didn't know anything about cancer.”
By 2007 Leni had also developed what she thought was a persistent case of the ‘flu. “It was more of an irritating cough than a bad painful cough and I had had pneumonia before. I knew it wasn't pneumonia because it wasn't painful.”

A GP insisted she had asthma, but Leni wasn't convinced. She and her husband had booked a sailing and diving trip to the Caribbean and when she checked with her GP whether she could dive with asthma she was told she could not.

“I said well don't you think it's time I saw a specialist or had X-rays or something. I forced myself to have X-rays and it was a big tumour on the bottom of my right lung, four-and-a half centimetres across.”

She underwent a CT scan, and was called in by the specialist, who informed her she had lung cancer. “It came out of the blue. There's no cancer in my family whatsoever. I didn't expect it but luckily I knew Teresa, I knew that people actually can live after lung cancer.

“My husband was as white as a sheet. He couldn't say anything. I was in total shock and all I said: Well at least it's picked up early. And he (the specialist) said: ‘No, no no. It must have been coming for about five years, It's in your lymph nodes as well.”

Leni underwent a needle biopsy and her oncologist was blunt. “He said: ‘All we can do is put you on a low chemo and try to prolong your life, because it's stage 3b, it's in the lymph nodes, you'd better get your thoughts around that.'”

On the drive home her husband was beside himself. “I said: You know what? We're actually driving home. I didn't die in a car accident. There's hope! We're going home.”

They got onto the Internet and researched their options. As it turned out, a surgeon in Cape Town was her best bet. However, there was nothing the surgeon could do. “I said OK, but please tell the guys in PE I want full-on chemo. Lance Armstrong made it, I'll tell them when to stop. I don't want slow mixtures.” (Armstrong is a cyclist who won the Tour de France seven times, and survived testicular cancer that spread to his brain and lungs after extensive chemotherapy.)

Back in Port Elizabeth she was told that even with strong chemo, the chances of stopping the growth were minimal - maybe 15% - and the chances of it shrinking were even slimmer.

“After three months of chemo they scanned me and it had actually shrunk almost by half. They couldn't believe it, so I got back in the car, back to Cape Town, and the surgeon said: ‘Tomorrow morning I'll take the rest out of you, and they took part of my lung out.

“Four or five days after the operation the surgeon woke me up early and said: ‘You've hit the jackpot! I said: ‘What? And he said … (the lab) couldn't find a trace of cancer!” The surgeon called it a miracle.

Leni is a Christian, but not an active one. When she was first diagnosed, Teresa had taken her to a healing session at her church. “That was the only time I broke down in tears. They put the hand on me and I said: ‘I'm not ready, my children are not ready for me to go. That's all I was worried about. I said: ‘Give me more time.' I've been back many times since. I strongly believe today's medication is really great, and the surgeons are great but there's more to it.”

Her ordeal still wasn't over. She had to undergo another three months of chemotherapy. “I was told it is an aggressive cancer and it will want to come back and that of course was very hard because you think that now you are all over it but then I thought ah well, at least I'm alive, it's fine.

“Like Teresa I also put on a lot of weight, 10, 12 kilos and I'm still sitting on it, but doesn't worry me anymore, stuff like that doesn't worry me anymore. I felt miserable, and not much excitement and then from one day to the next, I woke up and everything's done. It's just like a bad dream.

“I felt totally on top of the world and then I went on a shopping trip of note. I said to my husband I want to go diving again, because that's when I'll know I'm fully alive. In March I went to the Maldives, and I dived again.”

Teresa knows the shark tank at Two Oceans. Her husband used to clean it. “He used to be a rescue diver and their club used to volunteer and take turns to actually clean the tank and he told me all about the sharks.

“I'm using Leni as bait. I've decided we're going to dive back to back so if they come for me I'm going to duck and they'll get Leni, and if they come from behind they'll still get Leni.”

Leni and Teresa undertook the dive at the Two Oceans Aquarium in Cape Town in aid of Lung Cancer awareness. Leni was overjoyed with the result of her dive. No butterflies in the stomach for her.

“It was absolutely awesome. Everybody made us feel really welcome and special. It's just that I felt a little like a monkey in a cage with all those people watching. But I really enjoyed the dive. I said to my husband he's got to do it. It was so stunning, not only the sharks, but the other game fish as well, like the tuna. It was amazing how big they actually are.”

Approaching the shark tank, Teresa was anxious. “I must be honest, when I first got in the pool I couldn't think of the sharks. I hadn't dived for a year-and-a-half. I told our dive master - we called him Santa because he looked like Father Christmas and was so wonderful - that I didn't want to look down because I knew what was down there and I felt like I was hyperventilating.

“He held my hand and said: ‘Just put your DV (it's a breathing device) in your mouth and put your face in the water.' I looked down for about 30 seconds and it was OK. There were no sharks below me, just fish.

“So I said: ‘OK, I'm ready.' We descended slowly down the wall and it was amazing. It was a completely relaxing and wonderful experience. Unless I see a Great White I don't think I'm going to be scared of sharks in the sea anymore.”

Warning signals had been pre-arranged, but only once did Teresa have to be nudged out of a shark's way.

“There was a shark directly behind me and I was wriggling a bit, so he pulled me down and I saw it go over my head. It was absolutely amazing.”

The experience has filled Teresa with new resolve. “It's made me feel like I can now dive again. Even though I'm not in remission, I can dive again, I'm going to dive again. It's amazing.”

Lung cancer is characterised by the uncontrolled growth of abnormal cells inside the lung. There are two main forms of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer.

NSCLC is the most common form of lung cancer, accounting for approximately 80% of all cases. Generally symptoms do not manifest until the disease has progressed, making lung cancer difficult to treat.

Risk factors include smoking, a family history of lung cancer and exposure to asbestos and radon gas.

Symptoms include shortness of breath and/or wheezing, a chronic cough and/or repeated bouts of bronchitis, hoarseness, chest pain and loss of weight and appetite for no known reason.

Treatment options vary in accordance with the type and stage of the cancer - its size, position and whether it has spread and the physical condition of the patient. In general, the treatment options for NSCLC are:

Surgery and radiotherapy: Early stage, localised NSCLC (that is, cancer that has not spread to any surrounding tissue) may be successfully treated using surgery and radiation. Up to 70% of patients with NSCLC survive for at least 5 years after diagnosis if treated at this stage, with a proportion of these patients being cured1.
Chemotherapy: The majority of NSCLC cases are diagnosed at an advanced stage1 when the cancer has already spread to another part of the body and can no longer be successfully removed by surgery and therefore chemotherapy is used to treat patients. In spite of the use of chemotherapy as the first-line treatment option, less than 5% of advanced NSCLC patients survive for 5 years and most die within 6 months.
New treatments for NSCLC: Patients and doctors now have newer treatment options for advanced stage NSCLC. Innovative therapies such as EGFR TKI (Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor) Therapy - and anti-VEGF (Vascular Endothelial Growth Factor therapy have shown a significant survival benefit in patients suffering from advanced NSCLC.
• Anti-VEGF is the first anti-cancer therapy to prolong the lives of patients with NSCLC that have not been treated for advanced disease. It is an anti-angiogenic agent that blocks the activity of vascular endothelial growth factor (VEGF), a protein that stimulates the growth, survival, and repair of blood vessels in and around a tumor. By inhibiting the actions of VEGF, it starves tumors of the blood supply that is critical to their growth and spread throughout the body.
• EGFR TKI Therapy with a proven and significant survival and symptom benefit in a broad range of patients with advanced NSCLC, is an oral targeted agent without the toxic side effects of chemotherapy. Indicated for use in the second line, it delivers comparable efficacy to chemotherapy without compromising tolerability and overall quality of life. EGFR TKI Therapy is conveniently dosed in a once-daily oral pill and, unlike chemotherapy, specifically targets and blocks EGFR only in tumour cells without harming normal cells. EGFR is one of the molecular pathways found in abnormally high levels on the surface of many types of cancer cells and is essential to the growth and spread of cancer cells.

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