TORADOL (ketorolac) linked to Recurrence Prevention
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Stephy yes re' Morphine. Ask nurse to total amount of milligrams you've had of Tylenol since first does. Remember Norco has Tylenol in it
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Stephy you could ask for dilaudid. Great pain control
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Wow, Steph, sounds like you've been through the wringer a few times already! Glad to hear your bleeding has stopped, and I hope your blood numbers come back quickly. That's pretty spectacular that your scans showed the cancer is gone! Hope your path results are great, too. I'm wishing you much smoother sailing from here on out!
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Sassy and Steph, this paper, "Morphine Use in Cancer Surgery" ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151591/ ) offers some alternatives to morphine: tramadol, buprenorphine, and gabapentin among others. Don't know if any of those is appropriate for you Steph, but just wanted to pass along the info.
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Okay Steph there you have some alternatives. Just b/c Morphine on your list , doesn't mean nurse can't call for an alternative. It's done all the time. Tramadol is best choice
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Stephy, please, ask them as a nursing measure since you are acutely anemic, to either put you on or getan order for 2 liters of oxygen
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Solfeo, today i'm reaching brain dead. But perhaps I can call Forget. Called Retsky, why not?
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Steph, you doing okay? my butt is getting numb and body parts are yelling at me
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Wonder how Rainy's doing?0 -
doing well drainage is way less incision site looks good just saw my plastic surgeon he said blood work is good may send me home tomorrow on bactrium and iron pills feeling good don't really like urinary catheters though can't wait to get that out thinking about asking for sleeping pills
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Stephy, Did he change your pain med? Tramadol is a non-opiod., Heck I've used it for the last 9 months. Particularly, b/c it wasn't an opiod.
Rainny logged in updated her bio for rt < mast. Didn't post anywhere. I sent her a PM.
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OFF now have to pick up DBF from work. Hope everyone has a good night. I'll check on you before I got to bed. Bless you sassy
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Steph, heads up about iron pills- take with orange juice or anything with vit C to help with absorption. Take with food to help prevent upset stomach. Poop will be black so don't be scared. Get colace or docusate sodium for constipation prevention as both Norco and iron can slow everything down. Tramadol is a good option for pain. Careful if you are on antidepressant at the same time.
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Solfeo I asked Retsky about you question re delaying recon. He located this article and made this comment
Retsky "There is a paper noting that reconstruction after a long delay from primary
surgery produced a noticeable number of relapses. Definitely left me the
impression that ketorolac should be used in reconstruction and probably any
surgery during the period of risk of relapse."Isern et al recurrence and reconstruction, BJSurg 2011.pdf
See abstract a few boxes below
Homemom this likely applies to further surgery after the initial tumor removal. I haven't looked at it yet.
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hemoglobin is 7.2 thinking I will bd getting a transfusion today
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looking through this thread I now see blood transfusions can cause reoccurance feel like I'm in a no win situation here toradol caused bleeding now I'm having to do more things to my body I didn't realize the study was done on all trip neg cancers as well wonder if it has to do with the fact they don't have ongoing treatment
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Steph - I just read some of the recent posts. Sas stated earlier about platelet transfusion in addition to blood transfusions. Good advice! Feel better!!
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what would platet I fusion do?
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stephy not platlet transfusion. I wanted to know what your platlets preop and post op. Yes, yo do need a transfusion. not quite awake yet
This is very important Tell the nurse the blood has to be LEUKOPOOR packed red blood cells. Call her right now. Refuce it if it's no LEUKOPOOR.
It's pretty well the standard of care., but just to be sure.
I'll explain the rest latter.
Rainey did okay, but tired she'll post later.
Solfeo, I'll get it figured out, but at least you have his answer
.
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stephy please, very important truly get the preop and all the postop platlet numbers. toradol stopped working 24 hours ago. you are bleeding from something else. low clotting ability, or astitch was missed. I need to know your platlet counts
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my platlet count is at 112 not so much bleeding anymore I will ask nurse about leukopoor does that mean low wbcin in?
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just popping up to say that I'm okay and will post more when I'm home and have access to my laptop. Steph, hope you're feeling better
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Okay, all the chicks are in the hen house
All is right with the world againStephy your statement " looking through this thread I now see blood transfusions can cause reoccurance feel like I'm in a no win situation here toradol caused bleeding now I'm having to do more things to my body I didn't realize the study was done on all trip neg cancers as well wonder if it has to do with the fact they don't have ongoing treatment" They're two parts to your statement
1. "transfusions can cause recurrence" What we learned from articles/ study brought to us by either 123 or Falls, is a transfusion of our OWN blood(autologous) can cause a recurrence because of the actual circulating cancer cells are being given back to us in the transfusion of our own blood. Therefore, a contraindication(absolute no no) of an autologous(our own) blood transfusion should be know by every cancer patient. We can't depend, at this point in time, that the wider medical community knows this.
In regard to receiving a blood transfusion from another person. The blood must be treated so that it is Leukopoor. Leuk is the root word for white. The blood is treated so that the white bloods cells are removed. The reason the white blood cells are removed is once in the body they would activate the immune response. The immune response starts the inflammatory chain of events. As cancer patients we know inflammation is our enemy. Inflammation encourages. the growth of cancer cells either dormant, circulating, or in the original tumor bed . Leukopoor blood is generally the standard of care in the USA. If you are reading this from another country, you would need to demand only leukopoor blood be transfused.
Now before I move to the next portion of Stephy's concern, I need all my team mates to tell me if this is clear information. Remember what we write here is being read in many countries.
2." I didn't realize the study was done on all trip neg cancers". Stephy (and all ) this is from the post(page9) Re: Dr Retsky grant application in Nigeria. In Retsky's conclusion of his study, he posited/suggested that the fastest way to prove the theory that Toradol prevents recurrence was to do a study of TNBC patients because they have the shortest time to recurrence. The reason he mentioned Nigeria, is BC is at an advanced level at diagnosis b/c they don't use mammography. Plus, as a population they have a high number of TNBC hormone status patients. Which as a community we know, is the most difficult to treat. The Nigerian Government is interested in preventing recurrence. So, if a study is done on the Nigerian BC TNBC patients it will 1. prove or disprove the theory in a relatively short time as studies go. 2. It will help the Nigerian women that have limited access to cancercare resources. A two for one win.
Again my friends, please, let me know if this is clear.
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Dr Retsky I think another area of study re: Nigeria would be to identify genetically why they're is a high rate of TNBC in the population. If I remember the stat right in the USA population TNBC occurrence is 12%. This would benefit the world if the link was identified.
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note: if someone (nurse) doesn't understand the term Leukopoor - they may be more familiar as referred to WASHED PACKED cells. Same blood product where the red blood cells are flushed/washed with saline to remove the majority of WBC, platelets, proteins.
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This is the abstract. The PDF file that Retsky sent. is of the entire study. I was able to see the study, but I can't get it to hyperlink to here. It's from The British Journal of Surgery. They charge for access. Retsky apparently had paid for it. Now if someone can explain how I can get the link from my documents to here the whole study would be available.
Risk of recurrence following delayed large flap reconstruction after mastectomy for breast cancer
- A. E. Isern1,5,*,
- J. Manjer2,
- J. Malina3,
- N. Loman4,
- T. Mårtensson1,
- A. Bofin6,
- A. I. Hagen6,
- I. Tengrup2,
- G. Landberg3,7 and
- A. Ringberg1
Article first published online: 10 FEB 2011
DOI: 10.1002/bjs.7399
Abstract
Background:
The aim of this retrospective matched cohort study was to evaluate the rate of recurrence among women with delayed large flap breast reconstruction after mastectomy for breast cancer. The recurrence rate among women treated at a single hospital was compared with that in an individually matched control group of women with breast cancer who did not have reconstruction after mastectomy.
Methods:
Between 1982 and 2001, 125 women with previous invasive breast carcinoma underwent delayed large flap breast reconstruction with pedicled musculocutaneous or microvascular flaps (a median of 32 months after mastectomy). They were matched individually with 182 women with breast cancer who had a mastectomy but did not undergo breast reconstruction. Matching criteria were year of diagnosis, age at diagnosis and treating hospital. Medical records were evaluated until October 2007. Histopathological specimens for all included women were re-evaluated. The endpoint was locoregional or distant breast cancer recurrence. The risk of recurrent disease was calculated using a Cox proportional hazards analysis, adjusted for established prognostic factors.
Results:
Median follow-up for the entire cohort was 146 months. The reconstruction group had a 2·08 (95 per cent confidence interval 1·07 to 4·06) times higher risk of recurrent disease than the mastectomy only group.
Conclusion:
Women with breast cancer who had delayed reconstruction with a large flap in this study had a higher risk of recurrent disease than those with mastectomy alone. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Cp418 Thank you for jumping in to help in my absence. As you probably have already read, what I've been asking Stephy for are her platelet lab values preop and postop. If her platelet levels were below a certain lab value then a platelet transfusion would be the treatment
Now this brought a buried memory back which is of benefit to us in the BC community. Platelet transfusion can stimulate an immune response. Immune response stimulates an inflammatory response. Inflammation is the enemy of the cancer patient. SO, IF YOU ARE EVER IN NEED OF A PLATLET TRANSFUSION, THE WAY TO LIMIT THE INFLAMMATORY RESPONSE IS TO DEMAND A PLATELET TRANSFUSION FROM A SINGLE DONOR.
If you need a definition further than this statement , please, google it or ask your practitioner to explain. We have so much already here to remember, I don't want to muddy the waters.
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Stephy, Sorry I missed your question " what would platet I fusion do?" Platelets are involved in the clotting cascade. I just saw your platelet count is 112. BINGO. You are bleeding b/c your platelet level has dropped. Normal is between 150-450.
Cp418 thank you for adding the other descriptions for leukopoor. I didn't add them to my definition b/c it is was new learning. New learning I try to limit the writing to "need to know info" to keep it simple. BUT once new learning is accomplished, adding other new information becomes easier. WELL TIMED.
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recieving blood transfusion now thanks for explaining some things I was pretty out of it earlier today feeling better now
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Stephy, please, would you agree to giving me permission to talk to your nurse about your medical information? If so, the way it's done is you tell here I have permission. You get a phone number for me to call and I ask all the questions to organize the info.
You are bleeding b/c of a low platelet count. Everything is relative. I need to know the numbers. You could have been allot lower and are now coming up. If tha's true, waiting a bit won't hurt and you may be able to avoid a transfusion. They aren't being forth coming with you about the info.
ALSO, you are acutely anemic. I previously asked you to get them to put you on oxygen. You are Low red blood cells, with low hemoglobin. can't do all that teaching now. BUT tell them you want to be on 2 liters of oxygen. It doesn't matter what your oxygen saturation says(long teaching story). and you don't need a chest xray. The reason for the Oxygen is acute Anemia. They obviously don't understand the physiology or they would already have you on oxygen.
TRUST ME___
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