TORADOL (ketorolac) linked to Recurrence Prevention
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1 Not yet recruiting Perioperative Inflammation and Breast Cancer Outcome
Condition: Breast Neoplasms
Intervention: Drug: NSAIDS (ketorolac and ibuprofen)
I found this one but it is in Korea! LOL!
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The one I found is in Egypt. I won't speculate. I have a thought, but it would not be nice.
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LOL!0
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Ineresting. Will keep in mind should I ever need surgery again. Hoping against hope that I am DONE.
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Hi Jen, keep this in your Favs and check back. They're is more research re: NSAIDS that will be posted. Because of the influence of NSAIDS on inflammation and inflammations influence on disease, we will see NSAIDS more often being considered as an adjunct to care.
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This was posted on this forum by Besa. Meta-analysis looking at ovarian cancer.
https://community.breastcancer.org/forum/73/topic/833770
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SAS, finally looked through my med records. Didn't have toradol with bmx. The PS specially wrote no toradol for my TEs and the implants. Don't have any info yet from the Dec SX
SAS, is any sx regarding breast with toradol or only with lumpectomy and bmx
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Smarrty, what was the question again. Didn,t quite get it.
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SAS.... I have bi MX in 2012. I don't have the anesthesiologist report but I was deathly ill afterwards and had to,stay an extra day for the vomiting. Dr. attributed it to reaction to anesthesia. With implant surgery, the anesthesiologist said he would use a combination of drugs to keep the reaction at bay. He said, you won't remember them, but next time you have surgery tell them you need to have ......(and I may not have the initials correct but I do remember it started with a "T"... And sounded like TEVA or TEBA. I said I would remember because it sounded like my favorite hiking sandles. Do you think I may have been given Toradol ?
Thank you so much for the time you take to keep us informed ! Knowledge is power
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SAS.....for decades, Toradol has been my drug of choice. I, too, can't tolerate other pain meds. I have used it via IV and by mouth. Whenever I have surgery, I have the script filled before surgery because the med isn't readily available.....it is really sad that most doctors don't prescribe it because it really is a great drug!!
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Hi Obxf, The best thing you can do is go to the Medical Records department of the facility you were in and get the copy of the anesthesia records. The next best thing rather than you trying to figure it out is contact the anesthesia department and request that the doc that gave you a second anesthesia review the record to determine which drug. By you taking and giving them a copy, the whole thing will work faster. Ask up front if they're is a charge for his/her review. Describe for them the same thing you described for me.
I've always described anesthesia as a smorgasbord. A little of this, little of that. Drug action and drug side effects are dose dependent. A higher dose of a single drug can cause unwanted side effects. By the use of drugs that are complementary (lay term) to each other, a lesser amount of each drug can be used.
Please, when you get the answer let us know. You've got me curious
They're were several very good studies since 2005 looking at post op nausea and vomiting in kids having tonsillectomies and adenoids(ectomy). with the use of Ibuprofen post op. The conclusion was they're was less vomiting in the ibuprofen group. But kids are special in regard to drug use. They react very differently to opiods and antiemetics. The primary concern of the study was bleeding and pain control. They're was no statistically significant increase in bleeding. Pain was controlled which lead to less vomiting. The effect on vomiting was indirect.
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obx - TIVA anesthesia, which is by IV not inhaled - here is a blurb:
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Hi Special, Thanks, Lol, we never used the proper name when it was introduced to our OR. The docs just referred to it as that machine. They are amazing.
Also, thanks for that other thing
Special have you had a chance to read the Toradol studies?
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No, haven't looked at them yet, but I will. I have experienced both inhaled and TIVA with the many surgeries I have had through treatment and definitely prefer the TIVA - I am much sharper waking up and have less nausea, but one of the anesthesiologists I spoke with pre-op indicated they can't always use it and it is dependent on the nature of the surgery and how deeply the surgeon needs you to be anesthetized. I had not previously had issues with nausea upon waking until surgery last year - I don't process anti-emetics well - Zofran and Reglan don't work, this was an issue during chemo. Compazine works for me but they don't like to use it in a surgical setting I guess, but the scope patch helps. I had a fat graft in Nov with intubation and I ended up with an impinged lingual nerve - my tongue was numb for three months. Just had surgery in May and they used a mouth contained type (no intubation) and it went well - no numbness. I was pretty drugged as I don't remember much from post-op but my DH and DD said I was having trouble with eating my saltines and drinking my gingerale. I apparently instructed them to advise the staff that saltines should be outlawed for post-op because they stick to the roof of your mouth. It seems I was quite insistent about this - DH and DD just found it comedic, lol!
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I had keterolac with my surgery based on some of these studies which had been out a few years back. I also requested it with followup recon and had to battle. The PS said that it increased the chances of bleeding during surgery. I ended up getting it every time except one. I learned that I always had to request a pre-op consult with the attending anesthesiologist.
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SAS, my question is other surgeries beside the bmx or lumpectomy for the toradol to do any good. If it's used during TE or Implant sx is there still a benefit?
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torodal for pain I had that in hospital for my port removal due to an infection hope it did me some good lol
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Smarrty, I don't think that link has been looked at, but it will be considered. Retsky describes how Toradol interferes with the inflammatory sequence in two ways 1. By freed circulating cancer cells being destroyed. 2. distant dormant cancer cells deprived of stimulus for angiogenesis(growth of blood supply). If any of this is true, then in any subsequent surgery it may help to interfere with inflammation to do the same. Particularly, dormant cells. Now that and 10 cents won't buy a cup of coffee. It sounds wonderful, but hasn't been proven. If you read back a few posts, I made a statement that I wouldn't have sx again without Toradol being used if not contraindicated by a condition change. My rationale is if it can prevent a recurrence and the drug isn't going to hurt me, and it's been in routine use for 20 years, I will request it's use.
Hi geewhiz, thanks for posting. Yes, Forget's study was published in 2010. Did you see another study predating that or do you think her study is the one you saw awhile ago? I came upon it only a few weeks ago. Forget now has two studies completed for just over a 1000 (325 & 700+)patients. Retsky published shortly after that and has published several times since expanding on the same base. I think the area has become central to their research, which is not unusual. It takes so long for a new concept to be proved and then accepted. I was dismayed at Retsky's conclusion as how to prove the hypothesis. Double blind study on triple negative BC patients b/c they have the shortest time to recurrence. I cringed at that for obvious reasons.
The pediatric studies done since 2005 specifically looked at bleeding and pain with the use of Ibuprofen for tonsillectomy/adenoidectomy patients. T&A's if bleeding occurs can be terrible to try to control b/c of location. Those studies were very important b/c the fear/concern for bleeding was interfering with the use. They were solid studies. How much they have influenced wider thought on intraoperative and postop bleeding for other surgeries, I don't know.
In the BC group, a PS and BS are involved. Beyond the removal of cancer, the focus is on excellent cosmetic(medical usage) outcome. When blood is in a wound it triggers an inflammatory response causing scar tissue and adhesions. We as patients are involved in reducing this scar tissue/adhesion formation when we do foob massage. The BS's & PS's at this time that are limiting the use of Toradol preincision or up to 48 hrs postop, and the use of other NSAIDS postop are doing this b/c of the bleeding concern for the creation of scar tissue and adhesions, and hematomas.
If this research on the prevention of recurrence either locally or distant bears out, management will have to change. Guidelines will be written. Best drugs will be determined. I see Toradol being the first, to be settled into it's role. The other NSAIDS will have to be studied.
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SpeciaL, I hated the gases. In recovering patients, I'd always forget about getting to close until I'd get lightheaded. The use of Diprivan was just way better for the patients. No clue about how much gases are used anymore. Usage changed in the places I worked pretty early b/c of the negative impact on the patient plus staff. When Sublimaze(stronger than Fentanyl )became available in the 70's the use of the gases decreased. Then in the 90's when I returned to a surgery center, the use was much lower again. YAY. But the patients at the sx center were ASA 1&2's. Haven't worked with ASA's 4&5's in the OR since the 70's.
Sorry, you had the tongue impingement. A wayward injection when my wisdom teeth were removed caused a permanent paresthesia on the left half of the tongue. Feels like when lidocaine is wearing off--tingly all the time.
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Steph did you ask for it, or were they on auto?
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Hi Sas-
Yes there must be other studies out there. I had my surgery in 2009 and I had googled enough by then to ask for it at my BMX in late 2009. I seem to recall it might have had been noted with another cancer? I will hit pubmed later on and see.
I had 3 different surgeons. The first was at a major NIH hospital, and he was familiar but the next one was not. He argued with me that it caused bleeding during surgery.
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geewhiz, Any chance you might locate it? We posted the same time LOL. I think I should bring the T&A peds studies here. Maybe I have them here and forgot LOL
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Sure thing! I will post if I come across it for sure!
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Oh my gosh Sas-...so many studies in there, eh?
I remember what sent me down this rabbit hole initially...it was about morphine and opiate based drugs being used in surgery. There is quite a bit out there about that too.
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Here's one dated 2006... it doesn't mention keterolac...but the thought process is there.
http://www.ncbi.nlm.nih.gov/pubmed?term=17006061
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geewhiz, they're quite a few in that same vein. They were headed in the right direction. Just the wrong question.
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Hi Sassy, thank you for bringing up ketorolac again! I started a thread about ketorolac in March of 2014 ( https://community.breastcancer.org/forum/91/topic/...) Right around the same time amoc1973 wrote another thread about the benefit of ketorolac AND paravertebral nerve blocks (https://community.breastcancer.org/forum/91/topic/...)
Both the Retsky and Forget studies blew my mind, and I have no idea why there aren't large scale retrospective and prospective studies being done in the U.S. right now! The one caveat I ran across was that ketorolac was thought to increase post-surgical bleeding, but this study shows that it does not (http://www.ncbi.nlm.nih.gov/pubmed/24572864) and that it provides superior post-operative pain control, which reduces the need for opioids (opioids may suppress immunity and cause cancer cells to proliferate).
My mother-in-law is going to have surgery soon for DCIS and I will be recommending both ketorolac and paravertebral nerve block to her!
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Thanks, Special K! Clears up the confusion.
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Falleaves, Excellent! Many reasons
1. We can join forces and become Toradols standard bearers. If you've read my posts I have a "Why not use it" attitude. I wrote this today and something similar earlier. "I made a statement that I wouldn't have sx again without Toradol being used if not contraindicated by a condition change. My rationale is if it can prevent a recurrence and the drug isn't going to hurt me, and it's been in routine use for 20 years, I will request it's use.(unsaid it's stood the test of time--very important with a drug)
2. The metanlysis study re: bleeding is a significant tool in our arsenal to get physician cooperation. (thank you immensely for bringing it. Combined with the pediatric studies, it shows that the risk is statistical not there. YAY
3. You love Retsky. I love Retsky.
I haven't been able to talk with anyone about his study from 2013. When I first read it two or three weeks ago, I so enjoyed the history. I enjoyed the intergration of the different types of science description. He was building towards something exciting. His writing style is unusual for a researcher. He is so engaging. As I progressed through the study the first time, I found myself breathing different. As if in a theater during a 'who done it'. My heart was increasingly fast. He laid the groundwork so well I knew where he was headed. Part of me kept saying "Can he do it". I think he has. Yes, it has to be confirmed. But his hypothesis is strong.
Tell me what your thoughts were when you first read it?
EDIT 9/28/2015 none, thought I saw something that needed correction.
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What I find concerning is this is a transition time. Nothing worse than a major shift occurring and not being on the right side of the shift.
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