All drugs have consequenses, I've started the discussion with the Black box warning re: Toradol (ketrolac). Always important to understand everything you can about a drug when you are considering using it. Safe approach.

ketorolac

generic

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Black Box Warnings .

Appropriate Use

for short term (<5 days in adults) tx of moderately severe acute pain requiring opioid-level analgesia and only as continuation of parenteral tx, if necessary; total combined duration should not exceed 5 days; not indicated for minor or chronic pain; oral tx not indicated in peds; max recommended total daily dose 40 mg PO and 120 mg IV/IM; doses above label recommendations incr. serious adverse event risk w/o improved efficacy

GI Risk

incr. serious GI adverse event risk, incl. bleeding, ulcer, and stomach or intestine perforation, which can be fatal; may occur at any time during use and w/o warning sx; elderly pts at greater risk for serious GI events; contraindicated in active PUD, recent GI bleeding or perforation, and PUD or GI bleeding hx

Cardiovascular Risk

may incr. risk of serious and potentially fatal cardiovascular thrombotic events, MI, and stroke; risk may incr. w/ duration of use; possible incr. risk if cardiovascular dz or cardiovascular dz risk factors; contraindicated for CABG peri-operative pain

Renal Risk

contraindicated if adv. renal impairment or if renal failure risk due to volume depletion

Bleeding Risk

contraindicated if suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high bleeding risk because inhibits platelet fxn; contraindicated as prophylactic analgesic before major surgery

Labor/Delivery Risk

contraindicated in labor/delivery because may adversely effect fetal circulation and inhibit uterine contractions; contraindicated in nursing mothers due to potential adverse effects of prostaglandin-inhibiting drugs on neonates

Concomitant NSAID Use

contraindicated in combo w/ ASA or NSAIDs due to cumulative risk of serious NSAID-related side effects

Intrathecal/Epidural Use

contraindicated due to alcohol content

Hypersensitivity Rxn

hypersensitivity rxns range from bronchospasm to anaphylactic shock, have appropriate tx available; contraindicated if previous ketorolac, ASA, or other NSAID hypersensitivity rxn

Special Populations

max total daily dose 60 mg IV/IM if pts 65 yo and older, wt <50 kg, and moderately elevated Cr; max single dose 30 mg IM and 15 mg IV in peds pts

BUT and it's a big BUT........ I will not have surgery again without the discussion. At present time I do know that I have no contraindication for the drug limited to one time use. Toradol is used IV up to 6 doses post-op /6hrs. Toradol is rare to be given my mouth in the hospital setting. Rare outside of the hospital as a prescription b/c of the GI problems. Great drug for short term use. It's an old drug that has stood the test of time, roughly two decades.

What I'm going to do is get the anesthesia record from Medical records to see if Toradol was used. Hopefully it hasn't been expunged. Toradol was part in parcel of almost every surgery at the hospital I had my surgery.

Anesthesia folks are as obsessive compulsive as many others are. In the Forget study, two docs. essentially used the same plan. The plan is pretty universal. People that administer drugs on the anesthesi level know that drug so well, the a small change in the patient under anathesia, they got it. Clonidine is a centrally acting vasoactive blocker drug. Ketamine--paralyser, sufentanil, think fentanyls burley strong dad, for pain control. Hmmm no Versed. None of the 4 have amnesic qualities. Is frequently given technically outside of the operating room doors i.e pre-op,so, it's considered a pre-op drug. If you remember the OR, they gave it in the room or to late in pre-op

With this new(to me) information added to my understanding of anesthesia folks, I can make some observations. Anesthesia takes the history of the patient and determines the score. They're is a pretty cook book approach to basic anethesia. Each level has quidelines. Anesthesia won't take risks, unless the patients life is at risk. Anesthesia folks are excellent at keeping abreast of changes in the field and publications that have anything to do with their field. Guess, but a good guess based on knowledge of anesthesia doc and CRNA's, they know this potential of Toradol is out there. It's already being used with this in mind.

I predict that in 2016 forward we will start to see a drop in 10-12 month recurrence and the pattern described by Retsky, will be observed. The a retrospective analysis will be done to look at numbers.

What I don't agree with Retsky is that the first trial be done on triple Neg BC patients. Per his statement that this would be the fastest way to determine if the drug worked b/c of the statistical recurrence is short. Nope. Anyone in their right mind that would withhold a drug, that costs a few bucks, routinely used worldwide, one time to max usage 6 doses, that person would be criminal. I know the laws prevent that in trials. But anything less than Toradol right now the risks are to great for a negative outcome.

EDIT: 9/28/2015. Allot more study and allot more understanding has occurred since writing this, my soapbox stand on a triple negative study is not well reasoned. The learning continues.

Enough pontificating, going to play. sassy

Loverly, the exciting answer is best presented in Retsky's study. The theory is there, if it pans out. It changes the paradigm

Hi, 123J Thanks for posting. Interesting that they gave you a list of drugs inclusive of OR drugs. I'm impressed. You should have some fun with reading the studies b/c you are in the group that may have been protected from recurrence. Again it won't be solidly known for several years. Would love to have you look back years from now and say "I was in the early days"

Hopeful, I'll do a sight search and bring that topic forward if I can. If you find it tell me . I'll link it to this topic by a link in the topic box. That gal was very on top of the info. I happened on the studies when I was helping a gal on the port thread that I monitor. It was a "No chit' moment. You know me Hopeful, once I get on a bandwagon, I ride it. LOL

Immensely happy you 'gotter done'. So, cool for you. Was the Toradol issue the only reason you didn't go with the first surgeon? Did you take the study material? Was the surgeon familiar with it or was it she was honoring your request?

 My  pathology was so bad, right there in front of me was 'unfavorable outcome'. No clue why, I'm here. According to Retsky's hazard/chaos analysis I've passed the first two trouble times. I still have hopes of retrieving the OR/anesthesia record to see if it was used.

YAY HOPEFUL--you done good.

123J, Retsky suggested at the end of his study that the quickest way to determine if the connection between recurrence and Toradol was to do a trial using Triple Negative BC patient's b/c  they have the fastest time to recurrence. I love his research, but that took my breath away. In print it was so cold. Can't imagine being in that trial.

The two of them are building such a compelling case for Toradol. No idea how this is dealt with? I'm a post polio kid of 1952. Trials went on from 1936 till my time. Salk vaccinated his kids in June 1952. I and 3 siblings had polio in September that year. I only know this b/c it was in his obit. I looked at the obit. Tears. Polio negatively affected my entire families life. To be so close yet so far away. FDA didn't approve it until 1954.

The studies will be done, but we have some control. Just like Hopeful did with her doc. Present it. If you believe the studies are valid. Don't settle for less than receiving the drug.

The drug is 20 years old. Routinely used in many surgeries world wide. They're specified black box warning situations that it shouldn't be used in. If you don't fit the scenario for a black box warning issue. How can the drug be withheld?

123, google keyword crp and cancer, then crp and breast cancer, then crp and heart.

On the trials, preapproval. Ibuprofen was the first  bbl still want to play

Has to do with the whole inflammatory response thing. Bad for all body parts and function. I wrote some stuff on Vita d, I'll get the link. It's an inactive thread that I store drug info on.

https://community.breastcancer.org/forum/102/topic/826526?page=4#idx_102

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a693001.html

Toradol info. If considering asking your doc to use in surgery. Review this monograph.