TORADOL (ketorolac) linked to Recurrence Prevention
Comments
-
Dr. Retsky, WOW what fun you are here. Let me get over the breathlessness LOL. The biggest thing I would like to know is are we going in the right direction. They're members that post here, and they're members that lurk. I won't explain lurkers as I know you are familiar with on-line forums. We know that other members that have upcoming surgery, are being told by others that have read here, that they may want to check out the Toradol thread.
This thread well be here as long as BCO. Our words have to be right. Lives and quality of life is at stake.
When I meet aresearcher or inventor, I always like to know what sparked their interest in a particular thing. How did you see the connection between Toradol, inflammation, and recurrence?. Was it before or after Forget's work?
More to come, but that's a start
0 -
Dr Retsky will you be reading from the beginning? Generally, on a thread like this a member seeking information before surgery will read from the beginning to pick up on the whole discussion. If you find anything that is not true, could you make a note and we will fix it. We have the ability to edit our posts.
Could you give and overview of where you believe the research is going?
Have you lectured to or have you had any feed back from ASCO? American College of Surgeons? Anesthehsia folks?
Do you see a movement to use the drug without the definitive prospective study not being done yet?
A few pages back I put together a DEAR DOCTOR letter that has your's and Forget's studies. Plus, some studies on bleeding. I should make the lead statement less confrontational. But It was before coffee, and someone had trouble with their doc. For those that have posted, it's a mixed bag as to response from their MO/anesthesia/PS/ BS. From never heard of the studies, to much risk of bleeding, to simple "NO, we don't do that." Suggesstion?
More questions coming. Variability as to who shows up and when. No two days are alike
0 -
Dr. Retsky, I sent a PM to all that have posted here. Tea or coffee?
Friends post your questions. I'm sure that Dr.Retsky will be around for awhile. I hope. The ability to question an expert in a field so close to our hearts, is beyond exciting. I originally put "close to our boobs", but he doesn't know our humor yet.
0 -
Dr Retsky, Is pre-incision the most opportune time to give Toradol? My reading said pre-incision, but second guessed myself when someone recently asked the direct question. My intent was to go back and find it. Well....you are here
0 -
I gave a talk to the Angiogenesis Foundation in 2012 that is on their website. Here is link: https://www.angio.org/ I am in the "hear from the experts" between the two females.
I was just in Nigeria in July and gave three talks to clinical and surgical staffs. They liked the idea and we jointly submitted a grant proposal
to do a clinical trial. Amt requested is $2.6 million. They have high incidence of triple negative and don't use mammography so patients have
poor prognosis. That's bad for them but good if we want to demonstrate reduced early relapses.
I understand you and your fellow members are concerned about bleeding. I hear that often. However Patrice Forget tells me
that it does not happen in Brussels. They have been using ketorolac for years. By the way, Patrice is a young guy with a nice
family. His name is pronounced in French as Forzhay. I have told many friends and others who have contacted me that I would
use ketorolac if I or my wife needed surgery for cancer.
I would probably make sure your anesthesiologist is doing it just as Forget uses it. I would put them in touch just to make sure
there is no communication problem.
Michael
0 -
Dr. Retsky, thank you for coming here and sharing information.
I've already had a bi-lateral mx in 2013and received Toradol after surgery...wish I would have known about the research for using it pre-incision. My question is: I'm considering breast reconstruction, would you recommend Toradol pre-incision? And post reconstruction?
Thank you.
0 -
I do understand humor among cancer patients in patient forums. I am a 20 year survivor of stage IIIc colon cancer. I am a founder and
on board of directors of the Colon Cancer Alliance (www.ccalliance.org). I was on forums for a long time.
0 -
Rainey, Opiates has been discussed very little here, Falleaves is into that research. I have not read everything she brought. I apologize for that.
But with the current, past research, and working in the operating room for 12 years, these are my comments. A certain amount of opiods have to be used during surgery b/c otherwise the depth of anesthesia needed for cutting can't be achieved. The patient will feel it. The body does not like being cut. If adequate pain control is not used, the bodies "fright or flight" mechanisms kick in. The whole body will react. The technical---it activates the Sympathetic portion of the Autonomic Nervous System. To keep the body happy during surgery we make sure that we don't alert that system.
What the studies related to pain show is that when Toradol is used, not as much opiod has to be used. They hit different receptor sites. The total pain control is improved for this reason. If you refer to one of my earliest post about anesthesia can be compared to a smorgasboard i.e. a little of this and a little of that. anesthesia can be achieved with a lesser amount of each drug. But each drug is an important part of the buffet. An amnesic--Versed, opiod-- sufentanil, aparalyzer--ketamine, a centrally acting vasoactive blood pressure med--like clonidine, and as in the case of this discussion Toradol. This is a balanced meal from the buffett of drugs available.---this is a balanced plan.
Please, a balance between opiods and Toradol should be the goal. Sorry, I missed that in your post.
Rainey, I will get to Falleaves studies and figure out what she meant.
0 -
The amount recommended by Patrice Forget is 20 mg preincisional in patients under
60 kg, and 30 mg in patients over 60 kg. He is quite available by email. Phone call
is not best way to contact him.
0 -
Solfeo, Hmmmm Read my last post. AND You just tell your anesthesia doc that his/her standard use of opiates is okay. I have never said anywhere that opiates shouldn't be used.
A usual operating room standard is, Versed given in pre-op, Then in the OR suite. an anesthesia person administers. Drugs in sequence in a fairly short time. An opiod, a drug to block the cardiovascular system sympathetic response--i.e clonidine, a paralyser--usualy ketamine. Toradol when used acts on a different set of pain receptors than opiod receptors.
Post op pain control is best managed by a combination of Toradol(if used) and an opiod.
I promise I will go and look at Falls studies. Plus, if you believe I have said not to use an opiod, point it out. So, I can figure out what's up.
0 -
Thanks, what you have said about the balance is so helpful. I sent the Retzky and Forget studies to the surgeon but received only the response that I can talk to the anesthesiologist the day of surgery (tomorrow). I doubt very much that the surgeon passed the studies along, so I will be starting from scratch. I have a lot to do to get ready, but I'm at least going to skim them again tonight so they are fresh in my mind for tomorrow.
Will report back at some point, hoping that it might help others.
0 -
Solfeo, tell me where you got confused-----I don't want to assume anything
0 -
Solfeo, I get you, Bummed. Okay, you know the way I work. I find the source, then to the best of my ability find and answer that is understandable. i.e asking Dr Retsky to come help.
Thoracic epidurals------must be in Falls literature. It's not something I've studied. But until I did, I would stick with what I stated earlier. Don't use Toradol with epidurals. Maybe that's a wrong answer, but not treading where I don't have a clue. Bleeding into an epidural space can be trouble.
So, define for me what you are confused about by number and we will work it out.
0 -
Hi everybody, just wanted to weigh in a bit on the opioids. I've been away awhile, and it looks like I've missed a lot! Amazing to see Dr. Retsky posting here! (Thanks for the heads up, Sassy). I hope bringing up the negative effects of opioids doesn't freak anyone out. I have read mixed things about opioids. On the one hand pain itself is very immunosuppressive. So anything that aids in pain management, including opioids, is helpful. But opioids can, in higher doses, be immunosuppressive themselves, and there are some papers I've read that indicate opioid exposure promotes tumor growth in SOME animal models. So if you can use alternatives to opioids, that would be the best thing.
The other drug I would avoid, if possible, is ketamine, which is VERY immunosuppressive (unless given with a beta-adrenergic antagonist).
On the other hand paravertebral nerve blocks, propofol, and tramadol all have very beneficial effects for cancer patients.
But, I am NOT an expert by any means. I just think if there are choices to be made, we should take the opportunity to ask for what might benefit us the most. We're not talking about experimental drugs, just choosing among drugs that have all been in use a long time.
0 -
Falleaves, YAY your back. I knew you had a handle on what you studied. Whew, you were here to save the DAY. Okay Ketamine and clonidine(beta adrenergic antagonist). Propofol(diprivan) and paravertebral blocks. Did you have anything in your materials about thoracic epidurals?
0 -
Falls, Just so happy you are back, felt like I was on a ledge. I knew I hadn't said anything, didn't want to sound Like I was dumping on you. Retsky was here. Kilroy left before he got here. I'm hoping he takes a look at the rest and tells us if we were off track anywhere. Solfeo was rightly upset and we are still working out her concerns, trying to figure if it's something from here. So stick close okay
0 -
Falls, Okay, I think it's melding. Let's watch for solfeo's questions/concerns. Rainy has Retsky's response on dose. Which his dosing schedule is in both Forget's study and is referenced in Retsky's. The dosing schedule by Forget is very specific. It is different than the product labeling. Then going to call it a brain day.
Need to find out how Forget came to figure out the dosing.
Please, watch for Solfeo.
0 -
The thing is, paravertebral nerve blocks may be great, but not that many anesthesiologists are comfortable doing them, so you probably have a better chance of getting ketorolac/toradol if it is requested. If you are getting either one, you're at an advantage.
I saw my oncologist a few weeks ago, and mentioned the drastic reduction in recurrence for patients getting ketorolac in the Forget study, which piqued her curiosity, but she didn't know whether they were using it during surgery at her center. I gave her a bunch of studies about anesthesia and recurrence to pass along to the head of anesthesiology, but she gave me a bit of an eye roll, so I don't know if she ever did.
0 -
Solfeo, Excellent suggestion. I will add the dosing schedule to the topic box and the DEAR DOCTOR letter.. The page turned. I added to my last post that the dosing schedule that Forget uses, is very different than the package insert of the 1/2 dozen brands I looked at for IV dosing. In particular the 20 mg.
Solfeo, thanks off the ledge. If you see any other things you think should be added let me know and we can talk around.
Falls, Been meaning to say on the block thing. Blocks and spinals. I've worked in two perioperative settings. One a teaching hospital and the other a community hospital. Docs were good at the blocks needed for childbirth and lumbar spinals. Beyond that there were few. Regionals for arm surgery. Even that not all of them did them.
0 -
Sassy, I just want to say that was pretty exciting seeing Dr. Retsky post on this thread---I feel like I've been in the same room as a rock star! Nice work getting him here!!
I posted a bunch of studies on the paravertebral nerve blocks on a separate thread but I'll put a link here for anyone who is interested:
https://community.breastcancer.org/forum/73/topic/...
0 -
I just listened to Dr. Retsky' presentation at the Angiogenesis conference. Very interesting.
I hope one day there are studies on early stage node negative breast cancer and recurrence. There has to be something out there that can prevent it......0 -
Mates, I've been thinking that it would be possibly better that we take the discussion about the other NSAIDS off here to another thread. I was going to suggest that we think about for a week. This thread will be around a long time. Mixing apples and oranges, might not be a good thing when we aren't here to clarify.
What do you think?
Falleaves, please look at the material back aways on blocks and move that their too. Thanks. Falls, I felt the same way about Dr.Retsky. I hope he comes back. What I do know is I feel great he answered about timing and dosing. They're were some other questions, but it's okay. I have no hesitation about calling him again. Nice guy.
Officially brain dead
0 -
Thank you Dr Retsky...................you made our day. Wine?
0 -
Lol, I'll have some of that wine, Sassy!
I did a post awhile back with a bunch of papers about anesthesia and cancer in general. I think I'll pull them out and put them in a separate thread, too. I think it's good to keep this thread focused.
0 -
Sassy - Sorry I had to miss Retsky but really appreciate his responsiveness.
Reading through all the above it looks as though Ketamine is standard but not a good idea?? Wish I'd known that before.
Also don't understand why Versed is used so freely. I HATE the stuff and finally had to tell them I'm allergic (not true but I don't ever want to have it again.)
Not that this is relevant but just curious about some of these protocols.
0 -
Rainnyc,
Just wanted to wish you all the best tomorrow! I hope the anesthesiologist does exactly what you ask. And I hope your surgery is smooth, and your recovery as fast and as easy as possible.
0 -
Well.Falls.................I agree on the wine , but I don't have any. It used to be that I could juggle it all. AND remember all............ not anymore. I just reread the article about Forget's study. . Chit. I forgot so much and it's not been that long ago I read it the last time. ChitChitChit I hate getting old. makes me sick at my stomach.
0 -
Hopeful, they'd use Diprivan if Versed can't be used.
0 -
just had surgery I recieved my Torodal pre op I tried to get no opioids but the anesthesiologist said my bp would be way too high during surgery to not get anything he discussed an epidural but I ended up getting a paravertebral block to lower the amounts I would recieve when I woke up I was in a lot of pain so I recieved dilaudid I'm recieving toradol no
0 -
Steph congratulations. I do so hope. you have a better experience.
Toradol preop. & Paravetebral block & toradol postop. Your the poster child of this thread.
Ask for Voltaren for postop continuation after toradol done. Be back with the reference.
0
