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All TopicsForum: Clinical Trials, Research News, Podcasts, Study Results → Topic: Ways to Reduce Occurrence Risk: Ketorolac, Blocks, Opiods

Topic: Ways to Reduce Occurrence Risk: Ketorolac, Blocks, Opiods

Forum: Clinical Trials, Research News, Podcasts, Study Results —

Share your research articles, interpretations and experiences here. Let us know how these studies affect you and your decisions.

Posted on: Apr 12, 2016 09:51AM - edited Jun 3, 2016 10:18PM by sas-schatzi

sas-schatzi wrote:

Hello, glad you have come. Hope you find this information helpful. In 2014 and 2015, there were several threads that looked at 1. specific drugs i.e. ketorolac, opiods, propofol, and other NSAIDS, and 2. surgical anesthesia interventions i.e. paravertebral blocks that may affect breast cancer recurrence either local or metastatic. All the information is Evidence Based Research with links. The intent of this thread is to provide you with links and info that you can take to your surgeon and anesthesiologist for discussion pre-op.

A great starting point is this presentation by Dr. Vikas Sukhatme who is Academic Dean at Beth Israel Deaconess Medical Center at Harvard. Published on Jan 21, 2016. Presented by Dr. Vikas P. Sukhatme on December 8, 2015 at MIT in Cambridge, MA.

"A Simple, One-Time, Inexpensive and Non-Toxic Intervention to Improve Cancer Survival"

https://www.youtube.com/watch?v=H8zVrYEW8vE&feature=youtu.be

The first two posts are a synopsis of info that can be printed off to take to your docs

The third post there will be an attempt to be posted to each surgical group

The fourth post incorporates all the links to the individual threads. Each of those threads incorporate all the links that were researched by everyone involved.

The fifth post are topics I did in the past to help you get through this

The sixth post is pep talk :)

A special thanks to Falleaves, 123JustMe, Solfeo, Rainnyc, Stephmom. for all their dedicated work in the 2014 and 2015.

sassy


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Apr 12, 2016 09:52AM - edited Apr 12, 2016 10:00AM by sas-schatzi

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.

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?"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615712/

"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/25480319

Ketorolac

"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/25866297

Gabapentin 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/22415535

Review 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/


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Apr 12, 2016 09:53AM - edited Aug 17, 2017 08:17AM by sas-schatzi

TORADOL/KETOROLAC

Dear Doctor, I request that you consider the use of Toradol pre-incision for my upcoming surgery. Below are the relevant studies.

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The amount and timing recommended by Dr.Patrice Forget is 20 mg pre-incision in patients under 60 kg, and 30 mg in patients over 60 kg.

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There has been ongoing research that is looking at the specific use of Torodal/ketorolac in the perioperative(preincision) phase of breast surgery. The initial study was from Belgium. This study is known as the Forget study published in 2010. A particular isolated group of patients that had an unusually low rate of breast cancer recurrence. All had the same breast surgeon and one of two anesthesiologist. The anesthesiologists had a common approach to drugs used for surgery. Toradol was identified as the common drug given intraoperative.

This link is to an article about the Dr. Forget study, 2010. Patient cohort 327.

http://www.medscape.com/viewarticle/723293

Dr. Forget' s study. This is benchmark original research.

http://www.ncbi.nlm.nih.gov/pubmed/20435950

Dr. Forget' s study 2014. Follow up retrospective study of the 2010 retrospective study. Patient cohort 720.

http://bja.oxfordjournals.org/content/early/2014/01/23/bja.aet464.full.pdf

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Dr. Retsky' s study is a broader based analysis of Dr. Forget' s

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831877/

Curr Med Chem. 2013 Nov; 20(33): 4163–4176.

Published online 2013 Nov. doi: 10.2174/09298673113209990250

Reduction of Breast Cancer Relapses with Perioperative Non-Steroidal Anti-Inflammatory Drugs: New Findings and a Review

Michael Retsky,1,2,* Romano Demicheli,3 William J.M Hrushesky,4 Patrice Forget,5 Marc De Kock,5 Isaac Gukas,6 Rick A Rogers,1 Michael Baum,7 Vikas Sukhatme,8 and Jayant S Vaidya7

Quotes and graphs from Dr. Retsky's study.

"Using Computer Simulation to Analyze Bimodal Relapse Pattern

Based on computer simulation, to explain the 10 month peak we postulated that induction of angiogenesis at the time of surgery provoked sudden exits from dormant avascular phases to active growth and then to detection. That mode is quite sharp and most often seen among premenopausal patients with axillary lymph node involvement (N+). We suggested the remainder of relapses within the first 40 or so months to be surgery-induced growth of previously dormant single malignant cells. We proposed that the broad late peak relapses result from steady stochastic progressions from single dormant malignant cells to avascular micro-metastases and then on to growing deposits with no apparent synchronization to the time of surgery.

Most Important Finding – Early Relapses are the Result of Something that Happens at Surgery

The most important finding of this early work is that something happens at or about the time of surgery to accelerate or induce metastatic activity that results in early relapses. These early relapses comprise over half of all relapses. Surgery-induced angiogenesis of dormant avascular micrometastases and surgery-induced activity of single malignant cells are implicated. Late relapses are apparently not accelerated by surgery but the shallow peak at 5 years occurs as a result of shedding from primary ceasing after primary removal. We have been vigilantly looking for new data with which we can learn more about surgery-induced tumor activity and that perhaps will also lead to improved outcomes. As we describe here, there has been an important development."


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Forget et al. [40] data from Universite catholique de Louvain in Brussels, Belgium. Relapse hazard is shown for mastectomy patients given ketorolac or not. Data are smoothed as indicated for fig. fig.11.


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Object name is CMC-20-4163_F8.jpg

Forget et al. data were updated September 2011 and shown in hazard form but not smoothed as in fig. fig.7.7. Patient data are presented in the table. Patients included in this figure were less than 80 years of age, tumor less than 9 cm diameter and disease free survival greater than 2 months. It can be seen that relapses in months 9 -18 accounted for the major difference between ketorolac and non-ketorolac patients.

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Very often the excuse to not use Toradol is because of concern about postop bleeding. Here are links and abstracts related to studies re: Toradol and postop bleeding.

http://www.ncbi.nlm.nih.gov/pubmed/24572864

2014 Mar;133(3):741-55. doi: 10.1097/01.prs.0000438459.60474.b5.

Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials.

Gobble RM1, Hoang HL, Kachniarz B, Orgill DP.

Abstract:

BACKGROUND:

Postoperative pain control is essential for optimal patient outcomes. Ketorolac is an attractive alternative for achieving pain control postoperatively, but concerns over postoperative bleeding have limited its use.

METHODS:

Computer searches of the MEDLINE, EMBASE, and Cochrane Library databases were performed. Twenty-seven double-blind, randomized, controlled studies were reviewed by two independent investigators for the incidence of adverse events, including postoperative bleeding. Comprehensive meta-analysis software was used to evaluate the differences between ketorolac and control groups.

RESULTS:

Twenty-seven studies with 2314 patients were analyzed. Postoperative bleeding occurred in 33 of 1304 patients (2.5 percent) in the ketorolac group compared with 21 of 1010 (2.1 percent) in the control group (OR, 1.1; 95 percent CI, 0.61 to 2.06; p = 0.72). Adverse events were similar in the groups, 31.7 percent in the control group and 27.9 percent in the ketorolac group (OR, 0.64; 95 percent CI, 0.41 to 1.01; p = 0.06). There was a lower incidence of adverse effects with low-dose ketorolac (OR, 0.49; 95 percent CI, 0.27 to 0.91; p = 0.02). Pain control with ketorolac was superior to controls and equivalent to opioids.

CONCLUSIONS:

This is the first meta-analysis of randomized controlled trials examining whether there is increased postoperative bleeding with ketorolac. Postoperative bleeding was not significantly increased with ketorolac compared with controls, and adverse effects were not statistically different between the groups. Pain control was found to be superior with ketorolac compared with controls. Ketorolac should be considered for postoperative pain control, especially to limit the use of opioid pain medications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.

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The data presented in this study suggest that the use of intravenous ketorolac does reduce the need for narcotics administration in patients undergoing TRAM flap breast reconstruction, without significantly increasing the risk of hematoma.

http://www.ncbi.nlm.nih.gov/pubmed/11214049

Plast Reconstr Surg. 2001 Feb;107(2):352-5.

Incidence of hematoma associated with ketorolac after TRAM flap breast reconstruction.

Sharma S1, Chang DW, Koutz C, Evans GR, Robb GL, Langstein HN, Kroll SS.

Abstract:

Ketorolac is frequently used as an adjunct for postoperative pain relief, especially by anesthesiologists during the immediate postoperative period. It can be used alone as an analgesic but is more often used to potentiate the actions of narcotics such as morphine or meperidine in an attempt to reduce the total dose and side effects of those drugs. The manufacturer of ketorolac cautions against its use in patients who have a high risk of postoperative bleeding, for fear of increasing the risk of hematoma, but the risk in transverse rectus abdominis musculocutaneous (TRAM) flap patients has never been reported. In a study of 215 patients who had undergone TRAM flap breast reconstruction, it was determined that patients who received intravenous ketorolac (n = 65) as an adjunct to their treatment with morphine administered by use of a patient-controlled analgesia device required less morphine (mean cumulative dose, 1.39 mg/kg) than did patients who did not receive ketorolac (n = 150; mean cumulative dose, 1.75 mg/kg; p = 0.02). There was no increase in the incidence of hematoma in patients who were treated with ketorolac. The data presented in this study suggest that the use of intravenous ketorolac does reduce the need for narcotics administration in patients undergoing TRAM flap breast reconstruction, without significantly increasing the risk of hematoma.

///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////This study states a three fold increase in hematoma formation after a reduction mammoplasty. if you evaluate the numbers sited in the study, they are small in actual occurrence, but when the phrase "three fold increase" is used in the conclusion of the actual study and then repeated in the abstract, the implication is the numbers are ominous. Another way the authors of the study describe the risk is a 1:16 ratio. When the risk of recurrence is balanced against the hematoma risk, the reduction in recurrence should be weighted in favor of disease free survival(opinion)

http://www.ncbi.nlm.nih.gov/pubmed/22434401

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty.

Abstract:

PURPOSE:

We conducted a retrospective review following concerns involving a suspected increase in the requirement for surgical re-exploration for hematoma evacuation when ketorolac was administered perioperatively in patients undergoing reduction mammoplasty.

METHODS:

Following ethics approval, a retrospective chart review was conducted of all patients who underwent reduction mammoplasty at our two institutions from the time ketorolac became available in 2004 until surgeons requested its use discontinued in 2007. The data we collected included patient demographics, ketorolac administration, requirement for surgical re-exploration, documented hematoma formation not requiring surgical re-exploration, and excessive bleeding in the perioperative period. Three hundred and seventy-nine patient records were reviewed; 127 of the patients received a single intravenous dose of ketorolac (15 or 30 mg), and 252 of the patients did not receive ketorolac.

RESULTS:

Patients who received ketorolac were at an increased risk of requiring surgical re-exploration for hematoma evacuation (relative risk [RR] = 3.6; 95% confidence interval [CI], 1.4 to 9.6) and hematoma formation not requiring re-exploration (RR = 2.2; 95% CI, 1.3 to 3.6).

CONCLUSIONS:

A single perioperative intravenous dose of ketorolac was associated with a greater than three-fold increase in the likelihood of requirement for surgical hematoma evacuation. Our data suggest that it may be prudent to consider carefully whether the potential risks associated with the use of ketorolac outweigh the potential benefits of using ketorolac in patients undergoing reduction mammoplasty.

//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

thank you for consideration of this information.


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Apr 12, 2016 10:02AM - edited May 19, 2016 07:54AM by sas-schatzi

An attempt will be made to post this for each BCO surgical group.

"Hope you find this information helpful. In 2014 and 2015, there were several threads that looked at 1. specific drugs i.e. ketorolac, opiods, propofol, and other NSAIDS, and 2. surgical anesthesia interventions i.e. paravertebral blocks that may affect breast cancer recurrence either local or metastatic. All the information is Evidence Based Research with links. The intent of this post is to provide you with a link to information that you can study and in turn take to your surgeon and anesthesiologist for discussion pre-op, if you feel it has value in your breast cancer care.

https://community.breastcancer.org/forum/73/topics/843381?page=1#post_4691613

A great starting point is this presentation by Dr. Vikas Sukhatme who is academic dean at Beth Israel Deaconess Medical Center at Harvard. Published on Jan 21, 2016. Presented by Dr. Vikas P. Sukhatme on December 8, 2015 at MIT in Cambridge, MA.

"A Simple, One-Time, Inexpensive and Non-Toxic Intervention to Improve Cancer Survival"

https://www.youtube.com/watch?v=H8zVrYEW8vE&feature=youtu.be

This is a post and run. I'm 7years out and on with life and other things, I'm not monitoring or mentoring this thread. Particular questions re: the research, please, post on each individual thread . Good luck and blessings -sassy"


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Apr 12, 2016 10:02AM - edited Apr 23, 2016 04:57PM by sas-schatzi

Links to BCO threads that are related to this topic. These links discuss Evidence Based Research studies and articles related to preventing recurrence of BC.

Topic: TORADOL (ketorolac) linked to Recurrence Prevention. 2015, by sas-schatzi et all

https://community.breastcancer.org/forum/73/topics/833612?page=7

Topic: Paravertebral Nerve Block and Propofol Sept. 2015, by Falleaves

https://community.breastcancer.org/forum/73/topic/834546?page=1#idx_15

Topic: Effects of opioids on cancer progression Sept. 2015, by Falleaves

https://community.breastcancer.org/forum/73/topic/835291?page=1#idx_

Topic: ketorolac to reduce recurrence Mar. 2014, by Falleaves

https://community.breastcancer.org/forum/91/topic/818961?page=1#post_3936891

Topic: Anesthesia and recurrence of cancer Sept. 2015, by Fallleaves

https://community.breastcancer.org/forum/73/topic/835244

Topic: NSAIDS and Breast Cancer Sept. 2015, by 123JustMe

https://community.breastcancer.org/forum/73/topic/835343


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May 19, 2016 08:11AM - edited May 19, 2016 08:13AM by sas-schatzi

These are topics which I've started in the past. The intent is to help you get through this chit. Thought I'd group them and pass on. sassy

Just Diagnosed- Get Prepared

Re: Evidence Based Research (EBR)Sites

STEAM ROOM FOR ANGER

Warm & fuzzy owls, goats, kitties, dogs, birds ETC. PICS &LINKS

Drugs that can cause Mouth Problems

CONSTIPATION--problem with so many of our drugs

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May 30, 2016 09:39AM - edited Jun 1, 2016 07:30AM by sas-schatzi

I think I will repost this to each surgery group:

Thought I'd drop this post here. It was written to the June 2016 surgery group:

To all. check back to the post on Toradol and NSAIDS. Please, view Dr. V's video. He explains about the use of Ketorolac/toradol pre-incision. That's just the intro. If you follow all the links you will find the definitive studies and the work we all did last summer......................On the lumpectomy & rads versus mx and adjuvant. Is the most controversial of any subject. I think it's the SEER study that says the lumpectomy & Rads group do well, BUT it's how the MBC group fits into the story gets murky. Please, view Dr. V's study and then read my Toradol thread from last summer.

They're many elements that are the bases for consideration at the time of surgery time. It is known that the act of surgery causes the body's response of inflammation. That cascade of chemicals that are produced in the inflammatory response can cause 1. circulating tumor cells that are released from the tumor site to lodge at a distant point an stimulated to grow, and 2. cells that were released earlier that were dormant at a distant site are stimulated to grow.

This is the idea behind the interruption of the inflammatory cascade by the use of ketorolac/ Toradol. Not sure when inflammation was seen to be such a problem i.e what year, but Dr. Patrice Forget's first retrospective study done in 2010, looked at the drugs that were used at the time of surgery to see if the any connection could be found.

This was a highly unique situation of 325 patients at one hospital that had the same group of anesthesia docs and same surgeon(s). The finding was that ketorolac was the common drug in the group that had the longest time to reoccurrence or no recurrence. Dr. Forget then did a second retrospective study on a cohort of 725. The same finding. This was remarkable. It's earthmoving. Then Dr. Retsky did a study that looked at what was being done worldwide. There was more data worldwide supporting Forget's study in recognizing interference with the inflammatory cascade was a key connection. Though the connection to ketorolac was made by Dr.Forget, Dr. Retsky saw the immense meaning. Dr. Retsky 's study is a wild ride in the science behind Forget's discovery.

Dr. V from the video, was a co-author with Dr. Retsky. All the data that Dr. V uses in his video is from their study and Dr. Forget's study.

Dr. Forget has a prospective(double blinded) study going on in Brussels now. Dr Retsky is trying to get one going in Africa now.

The reason Dr. Retsky is in Africa is that blacks have a higher incidence(nearly exclusive) rate of triple negative patients. If ketorolac does in fact reduce reoccurrence it will be known pretty quickly b/c TNBC has the highest early reoccurrence rate. For Africa this would be revolutionary( the world too) b/c they don't have the medical resources that the developed world has. Ketorolac cost less than 10$.

I could go on for a very long time. I'm hoping this is enough to convince you of the importance of studying yourself, and then talking with your docs about ketorolac pre-incision. In the link to the topic box i have described how to use the info there. There are two posts that pull all the need to consider info & links to take to your docs. Our team from last summer did some very very intense work to put it all together to make it simpler for anyone reading this.

It has become my mission to try and make people aware of this research. If you and your physician choose not to do it b/c this is retrospective research, I get that. But the research is so compelling, don't discard it without a serious look.

Plus, there is compelling research about blocks,NSAIDS, and proporfol/Dipravan. are, also, instrumental in reducing inflammation at the time of surgery. All the links are there.

I'm going to send this off to Dr. Retsky and Dr. Forget and see if they agree as to how I've stated this. Always like to check the facts :) I'll post back if they have any comments.

Okay, off the soap box :)

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Jun 25, 2016 11:58AM __asher__ wrote:

Hi,

I just happened to stumble upon this thread not having been to the boards since diagnosis. It's kismet. I am so grateful for all the research and effort you have put into this. I have surgery for a double mastectomy and axillary node dissection scheduled for the 5th and I will certainly be bringing this information to my next preop appointment.

Tina Dx 2/9/2016, IDC, Right, 4cm, Stage IIB, Grade 3, ER+/PR+, HER2+ (IHC) Targeted Therapy 2/23/2016 Perjeta (pertuzumab) Chemotherapy 2/23/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/23/2016 Herceptin (trastuzumab) Surgery Mastectomy: Right; Prophylactic mastectomy: Left Surgery Prophylactic ovary removal Radiation Therapy Whole-breast: Breast, Lymph nodes Targeted Therapy Herceptin (trastuzumab) Hormonal Therapy Arimidex (anastrozole)
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Jun 26, 2016 07:04AM sas-schatzi wrote:

Hi, Asher. The topic box with dr. V's video and an explanation of how to use the first few posts for info for your docs is all here with links to all the other research.

How did you happen upon this thread? Important may be a clue as to how to get the info out there. None of the Toradol, Blocks, Opioids, NSAIDS, Beta Blockers use is proven YET. But if we can use a therapy that does 'no harm', it might give us the needed edge to defeat cancers return.

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Jun 26, 2016 12:43PM __asher__ wrote:

I happened upon the thread because I was browsing the sub-board Clinical Trials, Research Studies, etc. I initially saw the discussion thread TORADOL (ketorolac) linked to Recurrence Prevention. I'm slowly working my way through the thread. It just so happens that I'll have my surgery next week, so I'm curious to see if the doctors have heard about the study.


Tina Dx 2/9/2016, IDC, Right, 4cm, Stage IIB, Grade 3, ER+/PR+, HER2+ (IHC) Targeted Therapy 2/23/2016 Perjeta (pertuzumab) Chemotherapy 2/23/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/23/2016 Herceptin (trastuzumab) Surgery Mastectomy: Right; Prophylactic mastectomy: Left Surgery Prophylactic ovary removal Radiation Therapy Whole-breast: Breast, Lymph nodes Targeted Therapy Herceptin (trastuzumab) Hormonal Therapy Arimidex (anastrozole)
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Aug 6, 2016 03:26PM sas-schatzi wrote:

Bump

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Aug 19, 2016 12:59AM sas-schatzi wrote:

Bump folks, this is one of those things that may save you from recurrence, follow the links

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May 2, 2017 08:19PM sas-schatzi wrote:

Bump


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Jun 10, 2017 05:14PM sas-schatzi wrote:

Bump


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Jun 29, 2017 02:24PM sas-schatzi wrote:

Bump


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Jun 29, 2017 08:25PM - edited Jul 1, 2017 04:51PM by TectonicShift

I think this topic is very important.

I had to have my port replaced recently. I had gotten my measurable CTCs down to zero before the surgery (down from a pretty high number). I had the surgery and I had gas anesthesia and I did not ask for Torodol beforehand.

Immediately after the surgery, my CTCs shot back up to a positive double digit number - forget what exactly but enough to make me very nervous after six months of zero CTCs. My doctor said he wasn't surprised - that surgery and infection and wounds cause the release of nasty hormones that send cells into hyperdrive and the proliferation of new CTCs didn't surprise him. We worked hard to get the CTCs back down to zero after that surgery and did so successfully.

About four months later I had to have the new port removed. For this second surgery I asked for a shot of Torodol before the surgeon did anything at all. Also there was no anesthesia, just topical Lidocaine. I was awake during the procedure. But I was "cut" to get the hardware out of me. It was definitely a surgery, albeit small. This time, after the surgery, my CTCs did not go up. The first test after the port removal the CTCs were still zero.

I believe that possibly the lack of opioid anesthesia and the Torodol shot may have made a difference. Maybe not, maybe a coincidence. But I'm glad I had the Torodol shot before the second surgery. I will try to never have surgery of any kind again without it.

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Jul 1, 2017 09:17AM sas-schatzi wrote:

Techtonic, thank you for posting. Your post is very important.

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Jul 1, 2017 04:53PM - edited Jul 1, 2017 06:37PM by TectonicShift

Thank you, sas-schatzi, for all the hard work you put into this thread. I really believe it is extremely important information. I hope everyone who visits this forum sees this thread and reads it carefully.

Dear everyone, if all the data makes your eyes glaze over, just watch the youtube video in the OP to get an idea of what this is all about.

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Aug 1, 2017 12:43PM sas-schatzi wrote:

up

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Aug 10, 2017 11:44PM sas-schatzi wrote:

ump

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Aug 17, 2017 09:22AM sas-schatzi wrote:

bump


Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Aug 23, 2017 02:48PM sas-schatzi wrote:

bump


Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Sep 15, 2017 07:45PM sas-schatzi wrote:

bump


Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Oct 28, 2017 09:26AM sas-schatzi wrote:

Bump

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".
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Nov 14, 2017 07:13AM sas-schatzi wrote:

Bump

Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride".

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