Fentanyl and anti-depressants - what works?

I bumped into this. New area of study. Very early, but has promise. Sometimes when something this exciting comes along it spurs allot of research wide and far.

New research identifies promising drug therapy target for breast cancer

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I also bumped into this re: Vitamin D. I posted it on Insomniacs too. We had a discussion  re: dose. This satisfies my need to know what are the current recommendations. I was having difficulty finding Evidence Based Research on Google. Love it when research falls into my lap.

"YAY Hootie Hoo- I was researching something else and happened upon an article that referenced research that says current recommendations re: Vita D was WRONG by a factor of ten. This is the statement made by the lead researchers

"Researchers at UC San Diego and Creighton University have challenged the intake of vitamin D recommended by the National Academy of Sciences (NAS) Institute of Medicine (IOM), stating that their Recommended Dietary Allowance (RDA) for vitamin D underestimates the need by a factor of ten."

"Both these studies suggest that the IOM underestimated the requirement substantially," said Garland. "The error has broad implications for public health regarding disease prevention and achieving the stated goal of ensuring that the whole population has enough vitamin D to maintain bone health."

'Robert Heaney, M.D., of Creighton University wrote: "We call for the NAS-IOM and all public health authorities concerned with transmitting accurate nutritional information to the public to designate, as the RDA, a value of approximately 7,000 IU/day from all sources."

Full article  http://www.news-medical.net/news/20150318/Recommended-intake-of-vitamin-D-miscalculated-by-IOM-experts-say.aspx

6 hours ago        , edited 6 hours ago        by sas-schatzi    

WOW Dr. Heaney answered my email the same day, I didn't open email till today. LOL Now I wish asked lot's more questions.

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Is there a contraindication to Vitamin D3 supplementation by breast cancer survivors?  No

What amount of Vitamin D3 should a breast cancer patient/survivor take?  Whatever it takes to get serum 25(OH)D above 40 ng/mL – typically 4000–6000 IU/d from all sources.

What amount of Vitamin D3 should a Breast cancer patient/survivor that has been previously diagnosed as deficient? ( pre BC-I was originally < 4 not detectable)  Same as everyone else.  See answer above.

Do cancer patients differ in the amount of Vitamin D3 needed versus the rest of the population?  No

What is D2 a role with cancer patients?  None.  D3 does it all – better and cheaper than D2

Is there a link between Vitamin D deficiency and BC?  Probably.  Adequate vitamin D status helps our bodies recognize and throw off cancers in their earliest stages.  Probably works better for some cancers than for others.  We don’t know for sure which are protected and which are not.

Vitamin D3 deficiency and Thyroid cancer?  See above.  The link is clearter for breast cancer than for thyroid cancer

Recommendation on dose of Vitamin D3 for Metastatic Breast Cancer (MBC), specifically but not limited to, bone mets?  Same as above.  But no harm in pushing to a higher level, such as 60–80 ng/mL.  (But don’t go above 200 ng/mL.)

Robert P. Heaney, M.D.
John A. Creighton University Professor Emeritus
Creighton University
2500 California Plaza
Omaha, NE 68178
Tel: 402 280 4029
Blog: <http://blogs.creighton.edu/heaney/>

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About Dr. Heaney

Robert P. Heaney, BS’47, MD’51, is a clinical endocrinologist specializing in nutrition. Until 2014 He held the John A. Creighton University Professorship. He is world-renowned for providing nearly 50 years of advancements in our understanding of bone biology, osteoporosis, and human calcium and vitamin D physiology.

Hit the motherload in D research. Not sure why all this didn't pop before, but really happy it has. Probably b/c these are articles quoting other researchers versus direct articles. Haven't looked at everything, but happy nonetheless. Anyone, finding anything of concern let me know Thanks sass

http://www.grassrootshealth.net/press/156-grh-robert-heaney-md-research-director

Hi all, I'm reposting this email I sent to my brother. It's in regard to Proton Pump Inhibitors PPI's. Also, known as Proton Pump blockers. This class of drugs is way overused incorrectly. DB is going to have open heart sx in the near future. We have been in a "discussion" re: the misuse of this drug for some time.

PPI's can contribute either directly or indirectly to Osteoporosis, Acute interstitial nephritis, hypomagnesia,, Thrombocytopenia, Pre disposition to Clostridium Difficle (C-diff).

"In preparation for your upcoming surgery, a relook at your medications is an important step to take now. This link is to Medscape. All articles on Medscape are Evidence Based. The article is mostly layperson readable if you consciously ignore the statistics. Trying to absorb the message of the article can be lost when the numbers get in the way.

With the major surgery that you will be having, consideration of the PPI as a potential contributor to surgical complications is a concern. This article nicely addresses the major problems associated with PPI's. There is much in the literature addressing the same problems identified in this one article. These problems are also identified in the drugs monograph.

If you decide to pursue a change in Prevacid use after studying, discontinuation of a PPI should be done by weaning over 3 weeks. PPI's were never meant for long term use.  Consideration of switching to an H2 blocker in the near future is important. This would allow for the bodies adjustment without undue direct and indirect side effects. If this were attempted during the surgical phase it will just be a problem as the gastric cells are regenerating and the gastric environment is coming back into equilibrium.

I will review Medscape for a similar study on H2 blockers and hopefully identify the least problematic drug of the class. At this time Pepcid is in the forefront, but I will be looking at the class with particular interest related to your scenario.

Use of a PPI or H2 blocker in the operative period and postop has been the standard of care since the 80's. This occurred because of the recognition of the Surgical Stress Response. This response involves many body systems. Without getting into a dissertation, gastric ulcers are a problem during this time. Hence, the use of PPI's and H2 blockers. My goal is that you become knowledgeable enough to say to your docs that you want an H2 blocker because of the reduced risk of complications over a PPI.

I will forward information on H2 blockers when I find them.

http://www.medscape.com/viewarticle/809193

Procrastination is my middle name!

Bump