TORADOL (ketorolac) linked to Recurrence Prevention

Hi Sassy - We weren't talking about the Toradol for the entire time, but we did spend a good amount of time on it. Her objections were the usual ones - risk of bleeding and hematoma. When she did finally say she would be willing to do it, she said (I paraphrase) "As long as you understand it can cause bleeding and hematoma, which can lead to a seroma and other complications." She did mention that a lot of other surgeons won't use it at all, but that she did have some experience operating on people who had been given Toradol in the ER and then had to be rushed into the OR, so she had no choice, and it usually worked out OK. But that she had also seen the bleeding problems at times. I guess not in planned breast surgery because she hasn't been using it.

She said she was already aware of the studies, but that they were small studies that were not reliable because of the way they were done. I wish I could remember exactly what she said here, but it was something about an unusual number of recurrences in the non-Toradol group ("There was something else going on in the original study"), and that the other studies have only been in a laboratory or with animals.

I did use your Dear Doctor, lightly edited, in my original email to her. I left out the "You do not have permission to refuse my request" part, because I personally think that kind of direct statement can cause the recipient of the information to resist. It could be received as confrontational and cause them to put up walls before the conversation even starts. Eventually I did have to actually firmly refuse to take any opiates whether she agreed to the Toradol or not. She thought it shouldn't be an issue for the SNB, or maybe even the mastectomy alone, but for the MX with TE (I'm still not decided) she said she would be very surprised if anyone could do it without the narcotics due to the level of pain. I told her women here are already doing it, but I couldn't remember exact circumstances so I couldn't tell her with certainty that no one is having issues with regard to MX with TE. I guess that is probably an individual thing.

I do wonder if suffering through unrelieved severe pain just to avoid opiates may create its own issues with inflammation and suppression of the immune system, which is why I have said (not to her but elsewhere on these boards) that I probably would be willing to take something stronger if the pain was that bad. In that case, I would try to take as little as possible and continue to address the inflammation in other ways. I think the original surgeon's idea of alternating the Toradol with the Tylenol 3 if necessary, would be a good way to do that. I already have the Tylenol w/codeine prescription if I need it.

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.

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

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.

sas-schatzi wrote:

"Please, a balance between opiods and Toradol should be the goal. Sorry, I missed that in your post"

That's a good example of something I was totally confused about, and I did tell the surgeon I was refusing all opiates before/during/after surgery. I wrote earlier that I would probably give in to a little something post-op if the pain is too bad, alternating with the Toradol, but I didn't know we should be allowing opioids in surgery AT ALL.

So now I'm afraid I have requested something that could make my situation worse, out of misunderstanding what we are supposed to be asking for.

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.

Sassy - See how misunderstandings occur in online communications, because I didn't mean my misunderstanding originated from you. I obviously did read your last post because I quoted it. My confusion is the culmination of conflicting information I've run across throughout researching the issue: hearing what other women are asking for; a personal difficulty with processing scientific jargon, etc. Just not knowing specifically what to ask for. Thus my original question.

I have read this whole thread, and other related individual posts, but it's a lot of information to process and some of it conflicts. Just as another example, some have said they are asking for thoracic epidurals. But I think you said that's a bad idea if I understood your last post that addressed the issue (a few days ago I think). Conflicting info. Not making any judgments just never clear what/how to choose.

Hope this clears things up about my struggle. Has nothing to do with anyone else. I'm just seeking clarification and guidance.

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.