TORADOL (ketorolac) linked to Recurrence Prevention
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Great news!
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Solfeo, I am so happy for you! That's excellent news that your sentinel nodes were clear!! I'm so glad you got everything you asked for, and that your pain levels have been low. Sounds like the pectoral block worked great for you (and is still working for you). Thanks for sharing all this with us. I hope the rest of your recovery goes just as well as the surgery went!
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Solfeo, another person here who is very happy to hear the news! Let's hope that more and more surgeons will keep an open mind and do what is best for their patients without worrying about lawsuits( I do understand the need to protect themselves)
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Solfeo, we will give you time to rest and recoup. (What? do I sound like Nurse Ratched?) Please, add any more observations.
Stephy, Rainny, and Solfeo. You have gone through this effectively as a group. I think the next logical thing to do is to look at NSAID as maintenance. Also, completing the form, but the form isn't done yet.
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Congratulations Solfeo!!!
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Great update!0
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Solfeo, ditto to 123
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👐👐👐👐 Solfeo
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Solfeo, hope you get those three drains out tomorrow! That's great that you had no bleeding issues and the pain has been so tolerable. And nice that you have a nice stash, just "in case". Glad to know your healing is going so well!
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Solfeo, DITTO Falls
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Hi all, I hope you don't mind me joining in. I've been a lurker on these boards ever since my aunt was diagnosed with BC 2 years ago and this thread has prompted me to create an account. Everthing I've read on this topic addresses opoid use only in the context of cancer surgery but I'm wondering what the implications are for past and future use of opoids for cancer survivors. My aunt has been taking vicodin on occasion for back pain and this is very concerning to me. She doesn't take it often - maybe every few months her back will flare up and she'll take a couple pills at night to help her sleep, but based on what I can glean from the online articles I've read, even that might be enough to cause any cancer that may be forming to spread. I haven't mentioned this to her yet because I don't want to worry her especially if there is no cause for concern. I tend to worry much more than she does though and maybe I am reading too much into these studies? Can anyone provide additional insight into this?
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Hi Darcy123!
I can relate to your concern for your aunt. My aunt had BC, too. On the one hand you want to protect her, but on the other you don't want to worry her. I've gotten a mixed view of opioids from what I've read so far, but I'm one who follows the precautionary principle, that if there is a question of harm, it is better to avoid it until there is more evidence either way.
Your aunt isn't using vicodin very often, though. I think I'd be more worried if it was an everyday thing. I haven't seen anything specifically linking hydrocodone to cancer recurrence. Most of the concern about opioids seems to be coming out of the use of morphine around the time of surgery or in advanced cancer. But then, that raises concerns about other drugs in that class.
On the other hand, there are plenty of alternatives to vicodin. Maybe you could suggest to your aunt that she talk to her doctor about them. For example, there is ultracet, which is a combination of tramadol and acetaminaphen. Tramadol is a synthetic opioid that seems to lack some of the negative effects of natural opioids. And I've been reading about the use of antiepileptics like gabapentin and pregabalin for back pain. So maybe she could switch to something else, just to be on the safe side.
Hard call! It's difficult to know what is worth making an issue of. Wish I could be of more help....
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Thank you, Falleaves. Futher investigation uncovered the following, which was somewhat reassuring: http://www.ncbi.nlm.nih.gov/pubmed/26207518
Nevertheless, if there are other pain-relieving options available to my aunt that might be safer, it is certainly worth looking into.
There are just so many unknowns out there that I can't help but wonder what other factors come into play that could be increasing the chance of recurrence. It is frustrating and worrying but I think the best thing she (and I) can do is just keep on top of the latest findings making the most sensible decisions based upon what is known now, eat healty, exercise, and above all, live and enjoy life.
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That's good news! Thanks darcy!
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I agree, Darcy, that Danish study is reassuring. I don't know if you saw the thread I started for opioids and BC (I did include the Danish study, too), but here's the link in case you didn't see it: https://community.breastcancer.org/forum/73/topic/...
I absolutely agree with your prescription for avoiding recurrence, especially enjoying life! You do the things you can, and then you let it go and focus on living. Sounds like your aunt is not a worrier, which is probably to her benefit. And she's got you looking out for her!
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Bump
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hello all hope everyone is doing well! I am having my implants and an oopherectomy nov 25 since I had a complete response to chemo and had issues last time with hematoma I'm not going to push for Torodal prior to surgery this go around hope I'm not making a mistake but I don't want any issues to delay healing
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Hi Stephmoen! So glad to see you here. Hope you've been doing great, and the healing has gone well. I think your decision about Toradol makes complete sense.
Good luck with your surgeries on Nov. 25th (guess you won't be cooking on Thanksgiving!) Hope you have a much easier time with those surgeries. I'll be wishing you the very best. Please let us know how they go!
By the way, the Mayo Clinic has developed an enhanced recovery after surgery pathway for breast reconstruction that you might want to take a look at, if you haven't seen it already.
http://newsnetwork.mayoclinic.org/discussion/new-a...
http://journals.lww.com/oncology-times/Fulltext/20...
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Hi ladies,
I am headed for a recon pre-op tomorrow and want to have a stack of studies to show that I want keterolac. Did we have a list posted somewhere?
Thanks!
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Geewhiz, Falls sent me a copy of a letter she wrote to her old doc. I asked that she revise it and post here. I would then erase the old doc letter from page 1 or pg 2. Time is short. Just in case Falls doesn't see your post, I'm reposting part of it. It's really well done
Written by Falleaves November 2015
Summarizing the papers I have read, inhaled anesthetics and opioids should be avoided because of their immunosuppressive effects. Opioids have also been implicated in increasing angiogenesis. Total intravenous anesthesia (TIVA) with propofol (which may reduce postoperative nausea) seems to suppress the inflammatory response to surgery. COX-2 inhibitors and NSAIDS, in particular preoperative ketorolac, could also reduce recurrence due to their anti-inflammatory properties, and their reduction of the need for opioids. Paravertebral nerve block (frequently with propofol) may be particularly valuable in reducing inflammatory cascades and preserving immune function, and reducing recurrence. It also provides better pain control than general anesthesia, reducing the need for opioids post surgery. Local anesthetics such as lidocaine and bupivicaine have been shown to cause apoptosis in breast cancer cells, and liposomal bupivacaine can provide good postsurgical analgesia and reduce the need for opioids. Preoperative gabapentin and pregabalin are effective in reducing postoperative pain and opioid use, and is preventive for chronic post surgical pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615712/
Interestingly, many of the anesthetic choices that appear most likely to reduce recurrence, are also better for overall patient well-being. You may be familiar with enhanced recovery pathways. Johns Hopkins has developed an ERP for colorectal patients: "The goals of the perioperative anesthesiology pathway were achieving superior analgesia, minimizing postoperative nausea and vomiting, facilitating patient recovery, and preserving perioperative immune function...The perioperative anesthetic regimen was tailored to meet the goal of perioperative immune function (in an attempt to decrease surgical site infection and decrease cancer recurrence), in part by minimizing perioperative opioid use." http://www.ncbi.nlm.nih.gov/pubmed/26404073 The Mayo Clinic has created an ERP for breast reconstruction operations, as well. This includes preoperative analgesics and preventive nausea treatment, NSAIDS, liposomal bupivacaine, reduction in opioids post surgery, and resumption of eating and walking soon after surgery. http://newsnetwork.mayoclinic.org/discussion/new-approach-to-breast-reconstruction-surgery-reduces-opioid-painkiller-use-hospital-stays/
It is my thought that if you are talking about a wide range of drugs and techniques that have ALL been tested, approved, and are in wide use, it is wise to favor those that do not promote the growth of cancer. Clearly anesthetics need to be tailored to each patient, but the impact on cancer recurrence should be a factor in the equation. It would be beneficial for breast cancer patients if an enhanced recovery pathway could be developed for them, with particular attention to use of drugs and techniques to reduce the chance of recurrence.
You are a very busy person, and I realize anesthesia is not your area, but as the director of the Breast Center you are in a position to influence every aspect of care. I am linking some of the best studies I have found, and hope that you will share them with your anesthesiologists.
Paravertebral block/Propofol
"Can anesthestic technique for primary breast cancer surgery affect recurrence or metastasis?""Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials."
http://www.ncbi.nlm.nih.gov/pubmed/20947592"Anesthesia technique may reduce breast cancer recurrence, death."
http://www.sciencedaily.com/releases/2013/10/131015191057.htm"Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a controlled randomized multicentre clinical trial"
http://www.ncbi.nlm.nih.gov/pubmed/25480319Ketorolac
"Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery."
http://www.ncbi.nlm.nih.gov/pubmed/24464611/"Reduction of Breast Cancer Relapse with Perioperative Non-Steroidal Anti-Inflammatory Drugs: New Findings and a Review"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831877/Local Anesthesia
"Local anesthetics induce apoptosis in breast cancer cells"
http://www.ncbi.nlm.nih.gov/pubmed/24247230
"Evolving Role of Local Anesthestics in Managing Postsurgical Analgesia."
http://www.ncbi.nlm.nih.gov/pubmed/25866297Gabapentin and Pregabalin
"The Prevention of Chronic Postsurgical Pain Using Gabapentin and Pregabalin: A Combined Systemic Review and Meta-Analysis"
http://www.ncbi.nlm.nih.gov/pubmed/22415535Review articles on Anesthesia and Cancer
"The effects of anesthesia on tumor progression"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601457/#b58"Are we causing the recurrence-impact of perioperative period on long-term cancer prognosis: Review of currrent evidence and practice"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009631/0 -
Good luck Geewhiz. Keep us posted :
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Thank you so much!!! I really appreciate this!
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Once a nurse, always a nurse
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Oops, meant to post that! Thanks, Sassy!
Geewhiz, hope the pre-op appt goes well. Also want to wish Stephmoen well with her day-before-Thanksgiving surgery!
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Falls, did I include the whole thing that needed to be included? Do you want to leave it the way it's posted? Usually I get OP permission before I repost something. I know you understand
Stephy, good luck with surgery
Loverly
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Sassy, looks fine to me. I appreciate your posting it (and you always have my permission, for anything!)
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thanks everyone looking forward with being done with the surgery part of my journey 😊 hope everyone is doing well!
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Hootie Hooo Geewhiz, How did you do with surgery?
Hi, Rainyc, Stephie, Falls, 123, Solfeo, Peace and anyone else I forgot.
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Hi Sas.
Anyone have recent experience with actually getting TIVA approved by yoursurgery team for reconstruction? My ps said it is "very expensive" and outside the comfort zone. I have yet to talk directly to the anesthesiologist.
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Peace, SpeiclaK is the most knowledgeable about TIVA.I think. I haven't studied it even though I worked within it i.e docs using it while I worked in the same OR. It was their thing. How the drugs worked in concept, It was their schitck. BUT and BUT Fallleaves has brought much to the discussion. The links to her threads are in the topic box.
SpecialK, you have knowledge in this area. I remember the setup could run 4 drugs. Didn't care b/c I had no influence. Important now b/c it can influence outcome. ???
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