TORADOL (ketorolac) linked to Recurrence Prevention
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Have read the original Forget study. Leaving in 3 hours for BS appointment. Will report back.
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Solfeo, I am pretty sure that it DOES NOT need to be Toradol post op but could be ibuprofen, Tylenol, etc
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FWIW - I used Toradol post-op as well. It can only be used for (I think) five or eight days and must be taken with food. I did NOT need all that was prescribed and did fine/well, post lumpectomy/SNB. I could have used Tylenol as well but chose not to. Since it's not an opiod there were fewer GI issues and I wasn't foggy or groggy. I've used it in the past after oral surgery and, for myself, strongly prefer it over other RX pain-relievers.
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Reporting back with the hope that it may help others: I did bring this up during my conversation with the BS yesterday. Was very glad to hear that he already uses Toradol, though post surgery rather than pre-incision. He was quite dubious about the use of spinal anesthesia. Of course I was intimidated and tongue-tied in advocating for myself and this was in the context of a long conversation about the surgery and what will happen. Followed up today by sending four of the articles (forget x2, retsky, and the one on how disease free time is affected by anesthesia) to the surgeon and nurse with a note saying that I was most interested in how these affect the possibility of metastasis. I'll abide by their decision but am hoping that by sending these and making it clear that I have read them, no matter how imperfectly, they will take my concerns seriously. Of course I will not meet the anesthesiologist until I'm actually in the operating room.
Anyway, I've said my piece as respectfully as I can and we'll see what happens. Off to buy pillows.
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Rainnyc great job on being a patient advocate for yourself! Glad to hear your surgeon has heard of Toradol at least.
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I will soon be calling Retsky. A couple of weeks. I would like everyone to post your questions, please.
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Have a spot with surgeon today I get the toradol being given before to reduce inflammation but with the anesthetic why are we asking for thoracicepidural I do not see any articals discussing that
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Stephy, Fallleaves is doing the research on that. Send her a PM. Her Mom's ill, so she may be off caring for her. Check when she last logged in? I haven't researched anything on the blocks.
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Stephy, Falleaves did a pervious Toradol thread. She then joined us here. She has links re: the blocks in her first post on Page 2 here. I C&P'd the entire post
Aug 6, 2015 07:10PM , edited Aug 6, 2015 07:12PM by Fallleaves
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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123 could you put all the links to asa, ibuprofen in one box(other than Toradol). With a 1-3 sentence about the study. Keep adding to that one box as you find things. It will make for easier study I think. Is that doable?
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Stephy, she's been off since Aug26th. Her Mom had BC sx recently. She's likely with her.
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reading these studies also reminds me of other studies I have read regarding beast cancer in post partum women spreading faster due to inflammation of breasts and the wound healing process how I wish j knew I had bReast cancer and something as simple as an NSAID could prevent spread
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that was easy surgeon said ok about toradol and the block is already an option for me to use justhave to ok if with the plastic surgeon!
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Stephmoen, that is GREAT news!0
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Sol from yay! Baby steps! Hope everything works out re: Toradol. I wish they would do a study using NSAIDS and the rate of recurrence for breast cancer!0
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Solfeo and Steph----this is not mainstream, not ASCO approved. The docs are all reading to see if they're is any way it could hurt you. It' will generate alllot of talk.
Solfeo and Steph. We will know shortly what they think.
Someone raised the question as to if it needs to be used with each sx. The initial sx they're is the concern for tumor bed cells, circulating cells, and distant dormant tumor cells. If the cells are dormant by denying them stimulation in a subsequent sx when the inflammatory response is again activated by cutting. Seems logical, but it will be a question for Retsky.
I plan to soon call Retsky. We are at a turn in the road to now have him come here and give us an opinion. We are a breastcancer group. That's is his focus for several years now. Doesn't seem unusual to me to say "Hey, are we interpreting what you have written correctly". Before I go on with this it's what I strongly believe needs to be done.
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To everyone the discussion of the one time or short term use of Toradol (NSAID) compared to the other NSAIDS for routine daily use are two separate studies. Please, do no mix info from between the two.
Rather then make a new topic I think we can keep them separate. But if it seems that we are mixing the info too much we may have too. Thoughts are evolving. Drop in with your thoughts. Did any of that make sense? If not we need to a grape dance all over till we have wine.
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I'm up in the middle of the night xanax must be wearing off lol I do have some questions for resky..so I am in a different category than many others I recieved neoadjuvant chemo the hope is I killed any of those floating cells in my body I wonder if he has any thoughts on that also this is not my first true surgery I did have my port implanted it was short simple and no pain meds wereused I winder if toradol should have been used prior to that buuuut here is my last question if those cells are awakened after surgery wouldn't the chemo you recieve shortly after kill them? Ok back to bed for me!
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Please, DO NOT take this discussion to a new thread. We are in this together. Every bit of discussion needs to be here. These are big decisions and big discussions. Stories allow us to see ourselves in others and them in us. Also, from these stories we raise more questions for Retsky.
Solfeo, please, if you have time and can remember why your BS was against it? Could you tell if she really had read the studies? Sometimes in my past life in similar situations. I'd pick an important point that wasn't in the abstract, introduction, or conclusion. Then I'd bring that into the conversation. If the person had really read whatever we were talking about, I could tell if the read the thing.
Toradol is a tool. It may change history, We don't know. I push heavy that each know the studies chapter and verse, to make a decision. By knowing the material a personal decision can be made. This is not mainstream. We are taking a risk. But we are doing it with some very good science to back us. Each that chooses to fight for the use of Toradol is taking a risk. Risk based on knowledge. This is not a situation where someones's saying " Oh I think it is a good idea.". World's of difference. For those like Stephie, that have read enough that they want to use Toradol, but b/c of extenuating circumstances i.e having an active one year old. I put together the "Dear Doctor" package with the studies and the studies on bleeding. This, I believe, should force the doc to pay attention to our concerns by making them responsible to read.
Solfeo and Stephie your hormone status says there are many tools available. The fact that you had sx already, yes, it's a strong question for Retsky---Will Toradol have any impact now?
Based on my knowledge of the inflammation cascade, with each inflammation occurrence can we prevent more inflammation and reduce the potential for angioneogenesis --the growing of new blood vessels that supply distant dormant cells that were either present before the initial sx or since the initial sx.? Can't be proved yet, in the situation where sx has occurred, but if they're is a CHANCE, I'd say go for it. This statement is empirical at this point with allot of good science behind it as I stated before. This, also, is a question for Retsky.
What's unique here is the drug is not an absolute contraindicated drug for this surgery. If Hematoma does develop, it can be dealt with. Toradol is an absolute contraindicated drug for joint and heart surgery, or history of certain GI conditions, allergy, and nasal polyps. That is not what we are dealing with.
A story: Maybe a bad analogy, but in September,1952 as a 26 month old, my twin, my 4 y/o brother, and I had Polio. The vaccine was approved in 1954. When Salk died, I read his obituary. There was this quote " Salk so believed in his vaccine that he had inoculated his children in June 1952". Just a few months apart, his kids were safe. My family was devastated. In the initial phase, it was unknown how we would come out. I was a few hours away from being put in a lung. Mom and Dad eventually lost everything i.e. home and hearth. I sat and stared, maybe cried. Our whole life was negatively impacted(still is). We were on the wrong side of the shift. My whole life has been spent trying to be on the right side of the shift.
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BTW Solfeo, I do respect that your surgeon took such great time to talk with you. That doesn't happen often. Good woman. Every concern of her's is important for our discussion here. Looking at all her concerns, allows to look at our beliefs /ideas/data to either validate what we see as true OR invalidate, OR modify.
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I will raise something here that interests me very much: the nature of how we communicate with our doctors and the response we get from them. I have posted elsewhere about the power dynamic that exists, necessarily, between doctor (knowledgable, in professional context complete with white coat uniform) and patient (ill, half-naked, scared, not knowledgable, pulled out of our everyday lives). It is very hard to bridge this divide when we feel strongly that we have information that they must consider.
The other night, I went to a presentation at Sloan Kettering about doctor-patient communication. Well, it turned out to be mostly about how doctors are trained in this area. But I think they actually could focus a bit more on training patients to communicate with the medical staff: whom to ask which questions, how to get the best response from a doctor about questions. It was interesting that they did not deny the fact that they simply don't have much time to answer our questions and that wasn't likely to change.
You guys are amazing on the level of medical research that you're pulling out of the medscape world. This is not my world, and while I have now read these studies, I just don't have the background to form a deep understanding of them in the short time remaining before my surgery next week. But I do think that we also have to consider how we approach our doctors and if there are ways that can be more or less helpful in convincing them of the legitimacy of these studies, even if they go against protocol.
One of the things I have felt in the 4 months since my diagnosis is that it takes some real effort to be considered a partner in my care. Too often things are not explained, or the dr/nurse/patient communication of largely about side effects. Too often I have been reassured that my doctors are communicating with one another--and yet I have not been informed about something that seems important to me. That's something I'd like to work on and hope that others are thinking about this, too. Thanks for listening to my non-scientific two cents!
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I didn't do a good job with this statement " To everyone the discussion of the one time or short term use of Toradol (NSAID) compared to the other NSAIDS for routine daily use are two separate studies. Please, do no mix info from between the two". I will try now.
They're two terms we can use to make it clearer between the two. Acute and Chronic. Both are determined by time. Acute as it applies here is peri-operatively. It incorporates preop, intraop, and postop. Chronic as it applies here, indicates indefinite duration not connected with surgery.
The acute phase: Time encompassing the peri-operative phase. The compelling data produced by the published studies of Forget and Retsky is retrospective i.e. looking back. It specifically identifies the use of Toradol in the perioperative phase of breast tumor surgery. In the end, what we want is a plan that tells us what to do and how to do it in the peri-operative phase. A prospective clinical trial studies have to be done to prove the hypothesis that Toradol can prevent recurrence. That won't happen for awhile. We are still on the wrong side of the curve. Research may have already started and we aren't aware.
Chronic phase: Time after the peri-operative phase. We are BC patients forever. What we want is a plan developed from prospective studies that tells us whether the use of some form of NSAID on a scheduled basis as an inflammatory prevention will stop, limit, delay recurrence. We still are on the wrong side of the curve. But research is being produced.
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Rainny, your non-scientific two cents makes perfect sense. I suggest when you are on the other side of the major stuff and have your life back to it's new normal, that you take these establishment folks and work on them. As you go through all this stuff, jot down notes of the good , the bad, and the ugly. You may decide in the end that you want nothing to do with it. There again, you may want to write a book. The future isn't written. Take me. I'm retired, I spend hours here each week. The goal is to make change. I'm on the other side of the troubled time. I could go do something else. My hobby lifelong has been learning. This is the perfect fit. They're many here on BCO that do the same. An underlying reason to stay here and do what I do, is my reality is heavily weighted for cancer in my future (bad gene). I'm not waiting for it by sitting on the sidelines. I'm working, enjoying life as it is, and happy.
Studies can make us crazy in reading them. Some suggestions 1. Have two browsers open, maybe more. 2. split screen--one with the study, the other with and open google box. When you run into a word that you don't know, flip to the open window and type define _____________. Use the open browser how ever you need. When I was working on the Microbiome, I had a whole lower screen of browsers open. I was working fast and furious between them. Great fun. Computer got confused LOL. Took hours for my tech service to get it back in working order.. When it comes to statistics, over read them. I, also, find two things. I read and reread a paragraph until I understand it , then I move on. OR if that doesn't work, I move on and see if latter info defines what I couldn't understand. Then the best thing I learned as a young one is to reread something I was done with. Everytime I reread something a little pearl or many little pearls jump off the page. I learn more. I'm on my third time of reading Retsky and have read Forget twice. I intend to read each even more.--hope some of this helped.
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FWIW - One surgeon I spoke to also belittled the studies and expressed huge concern over bleeding. (Really? I'd rather bleed than recur.) She then triumphantly said 'and besides that, there's a nationwide shortage due to a recall and we don't have any.'
That was just one of several reasons I cancelled that surgery and found another - and MUCH better - surgeon who was willing to consider, and then order, the use of Toradol.0 -
I am so surprised that some have had such a difficult time getting this approved I asked about it had prepared a speech and had articles printed out and my surgeon and plastic surgeon both simply said ok...my surgeon said she hasn't heard of using it before surgery but said she would do it and told me I am so cute because of all my research..I am 30 and have 2 young kids I want to do everything possible to keep this cancer from coming back. Both my plastic surgeon and surgeon said the only concern was bleeding but felt that it wouldn't be an issue.
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Hopeful, that doc was gradeFK Asshole, who probably hasn't opened a book in years and graduated bottom in his class...............hmm what else awful can I say about him. Thank God, you found a reasonable doc. Did you have any bleeding problems? Was it pre-incision? How many doses? What did you think of the pain relief? What did the surgeon say after? What did the anesthesia person say? Did they know of the studies? What was the surgeons comments about the study? Details, details,details? What do you think now? How do you feel about working the problem? Everything about your point of view? Yes, I'm asking for a dissertation LOL.
Stephy, I'll try and look at Forget's. The injection is given in the OR pre-incision, but I'll verify. When is your sx? Some where I got it drilled into my brain pre-incision. Read Solfeo's & Hopeful's experience with the doc or maybe it was Rainny. All the questions I asked Hopeful, when all is said and done, please, the same for you.
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Rainey nix on spinal anesthesia. I bypassed that. What Falleaves was advocating for was a paravertebral block. Way different than spinal. ANYTHING that even has the hint of causing bleeding should NEVER be used if the spinal area is entered. Posting this now and continuing to read your posts
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"Hopeful, that doc was gradeFK Asshole, who probably hasn't opened a book in years and graduated bottom in his class...............hmm what else awful can I say about him. Thank God, you found a reasonable doc. Did you have any bleeding problems? Was it pre-incision? How many doses? What did you think of the pain relief? What did the surgeon say after? What did the anesthesia person say? Did they know of the studies? What was the surgeons comments about the study? Details, details,details? What do you think now? How do you feel about working the problem? Everything about your point of view? Yes, I'm asking for a dissertation LOL."
Sassy - sadly, that surgeon was a woman - and a real btch; not a word I use lightly. She is very high up in the breast care health program at the hospital where my imaging was done, which is really sad. What's just as bad is that the MO (another woman) she recommended is another real witch. I had provided the surgeon with copies of the studies - she was incredibly dismissive.
The anesthetist had no problems using Toradol although she was careful to check that it wouldn't be contraindicated by other drug interactions. I'd have to read through the surgical report to be sure that it was pre-incision but from what my surgeon said I believe it was. Ditto on the number of doses.
I'm going to have a follow up conversation eventually with my surgeon's NP and with the anesthesiologist to make sure they have copies of the studies, understand the potential and can incorporate it into their surgical planning rather than women needing to stumble on it themselves.
I had no bleeding issues and the pain relief was fine. The oral Toradol that I used post-surgery did a great job.
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He's coming.........................................
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Hello friends,
What can I do to help?
Michael Retsky
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