TORADOL (ketorolac) linked to Recurrence Prevention
Comments
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Dr Forget, Thanks for coming here. It's appreciated. Immensely. Did you get a chance to read Rainy's post about Sloan Kettering.......The ripples are flowing
.......One of our gals is waiting to have surgery scheduled. Doc refuses to use Toradol. Perhaps not a question for you. But any ideas as to approach? I don't think she's in a scenario she can change docs.Is it out of bounds asking if you are into another study?
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Decided to take a relook at the thread. Read all the posts on page 1 & 2. We had a nice start. Solid in identifying why we were interested, bleeding risks, where the research was headed. I came across the link that Falleaves about Opiods and paravertebral blocks.(pg 2). I think I will continue till I'm at the end. I did make a reference about Dr Forget being a woman i.e Patrice...........For the record he's a man.
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Sassy, I'm in awe that you've brought both Dr. Retsky and Dr. Forget to this thread! Wow.
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It is very neat. It would be fun to try and get them here at one time in the future. Q.A. They can't give specific advice, but we should be able to come with thingd to discuss
Yes, it's very nice they are here. VERY -
I am so close to success. The surgeon has agreed to pre-incision injection of Toradol, with Toradol prescription post-op, and minimal opiate use only if needed. She also agreed to the paravertebral block with propofol, and minimal general anesthesia only if necessary. She is going to speak to the anesthesiologist today, and I'm going to meet with him tomorrow, with my clothes on, to discuss it. He could still say no but BS said she thinks she can find someone else in the department to do it.
I'm still going to get the 2nd opinion from another plastic surgeon on Friday, just for information gathering purposes, but unless he says something so brilliant I can't refuse immediate reconstruction, the plan is BMX w/sentinel node biopsy with possible limited ALND next week Wednesday. With delayed reconstruction, if any. BS is still optimistic that my nodes are clear, so hoping to avoid the ALND but we had a nice talk about it and I trust her to be be as conservative as she can based on what she finds once she is in there.
She said her notes are going to be all full of the disclaimers we discussed, but the bottom line is that she is just a really open minded, nice and accommodating kind of surgeon who is willing to give the patient what she wants when it is reasonable to do so. So if anyone wants to know the big secret for talking your surgeon into this stuff - some are going to be flexible and some are not, and you can usually tell pretty quickly which is which. I will note that it was the younger of the two surgeons who was the more flexible one. Don't get me wrong though, I did still have to do quite a bit of persuading, so it's good to go in there prepared with your answers to your surgeon's every possible objection. Thanks to Sassy and Fallleaves for making that part easier.
Cross-posting this in the paravertebral block/propofol thread since it covers both.
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Good work, Solfeo! I'm so glad your BS was willing to accede to your wishes, and I hope your meeting with the anesthesiologist goes just as well. Keep us posted on how things go. I'm wishing the best for you, and hoping your surgery goes like clockwork (and minus the ALND)! I'm sure you're looking forward to when this is all in your rear-view mirror.
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Solfeo, Ditto to what Fallleaves said. I'm working on bladder stone shards passing. This is the 6 time. Ugh. Don't know what's responsible for this learning experience. All the different ologists stare blankly or shrug their shoulders. Scans,scopes, and labs negative. I'm into what I call White Knuckle Syndrome.
Go girl--getter'done.
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Ms. Sas, what dose of vitamin D are you currently on?
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Sorry you are having to deal with that kind of recurrent pain, Sassy. Hope you can find somebody who knows what's causing it, so you don't have to keep white knuckling it! And I hope you're feeling better VERY soon.
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Success all around! The Toradol was already approved, so not much more to say about that. I found out I was not being a PITA by requesting the meeting with the anesthesiologist. These pre-surgery meetings are a free service the hospital offers to all patients having surgery. Between the nurse getting the preliminaries done and speaking with the anesthesiologist, they spent a full hour and a half with me. Felt like I really got to know them, and I liked them.
The anesthesiologist sounded pretty excited to be bringing these new procedures to the hospital. He said I will be the first, and probably the first in my entire state to get everything. I believe I will be paving the way for women who come after me to have safer surgeries that do not increase risk of recurrence. Women who wouldn't even know to ask. Makes me feel pretty good. He gratefully accepted Fallleaves research and I believe he is actually going to read it! He said he wanted to do more research and I handed him the packet, "Here, this should get you started."
He was going to let me do it awake with just the block and propofol, but even though my fear of general anesthesia makes me like that idea, I told him just to knock me out so I don't have to lay there for 3 hours. It will be over faster in my perception. They will use the propofol as the general. He's going to shoot for no opiates, but I gave my OK if it turns out to be necessary.
He actually offered me a few different options and all of them sounded good. He wants to continue his research over the next week to decide which combination of procedures will give us the best pain control during and after surgery, so I won't know until the morning of surgery exactly what will be done, but it will be a combination of things we already discussed.
He seems to prefer thoracic epidural (I believe he said it is more effective, or lasts longer or something - sorry I can't remember every detail) over paravertebral block for during the surgery - said shouldn't be any problem with the Toradol. But after speaking to one of his colleagues he was thinking that a pectoral block in addition to the epidural might get us everything we want, during and after surgery (he mentioned pain control for 12-30 hours, possibly eliminating the need for opiates completely). They know I am willing to take narcotics if the pain is bad, but they are trying their best to figure out how to make this happen without any. Going out of their way to do so, in fact. I feel pretty good about these people because they really seem to want to make this work as much as I do. You know what I mean? Much better than pushing for something the doctors are not enthusiastic to try, because they might not do their best work.So I won't be able to tell you exactly what I'm getting until after the surgery, but it will be some combination of block(s) and propofol, with minimal opiates only if necessary.
Gonna cross-post this one to the paravertebral block and propofol thread as well, so it gets seen by everyone who needs it.
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that's amazing solfeo congratulations!
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Thanks Steph - as much as I hated all the waiting, it was worth it because I never would have had time to learn everything I needed to learn otherwise. I really do hope that in some small way it will help other breast cancer patients in the future.
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Solfeo Execellent!!!
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Thank you Loveroflife.
Another thing they told me was that my BS was in there today doing surgeries, and she was talking about my case to everyone. She went out of her way too, to find me the best anesthesiologist for the job. Then when the anesthesiologist left the room, the nurse said, "I'm not supposed to say this, but he really is the best, and so is your surgeon. So I feel like I'm in really good hands.
Still, realizing anyone can have complications even when everything is done right so I won't be regretting my choices regardless. I do still have that worry that if something goes wrong it will discourage them from trying again for anyone else. That would be the opposite of what I want to come from this. What I hope will happen is that if there are problems, that they learn from them and think of ways to avoid them in the future, without giving up on the idea completely. I plan to have that conversation with both of them before the surgery.
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You are truly blessed to have good doctors in your team. So happy for you. Hoping for smooth surgery.
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Wow, Solfeo, it sounds like your meeting with your anesthesiologist could not have gone better! I'm so glad that your whole team is supportive of you and willing to fulfill your requests in the best possible way. Sounds like they are definitely going the extra mile. I love how enthusiastic your anesthesiologist is about putting this together for you, and hopefully other patients. How cool that you have gotten them to look at all this! (I have a feeling you have pretty good powers of persuasion) I hope your surgery goes seamlessly, and the mix the anesthesiologist puts together for you works really well. I think it is so great that you are blazing a trail that may end up helping many other women, too!
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Fallleaves - I just don't let them leave until they give me what I want. Persuasion or hostage situation? You decide. Just kidding people! No taking your surgeon hostage! haha
Sassy - Somehow I missed the post about your stones. Hope you feel better soon.
Now it's really countdown to surgery. Wonder when that's gonna hit me since it seemed like it would never come.
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Lol! Good one, Solfeo. But if I ever need a patient advocate, I'm hiring you!
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I would like to repost Dr. Retsky's talk at The Angiogenesis Foundation, which is a must watch for anyone interested in this research. Would love to see this in the top post so everyone who comes here has a chance to see it. He explains everything so clearly, in plain language that anyone can understand.
Oh cool, posting the link embedded the YouTube video. Nice feature BCO! (Oh wait, it's showing up in the editor but not in the preview - must experiment to see if it actually works. Let me know if you can see the video or not). If you can't see it in the post, try this.
Awhile ago I mentioned the oncogene testing I had done on my circulating tumor cells in Greece. Besides a general high risk of recurrence, it also determined high risk of angiogenesis (they go together). That is where my determination to do everything possible to prevent those things came from. Thank goodness someone directed me to this thread when I began asking questions about BC surgery when I first came here (Shout-out to SP!).
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Solder, can't see it. Great idea!
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Solfeo, that's warrior negotiations! YAY for everyone here. These are changes that will pave a way for a better future for all. I'm having some cosmetic surgery later this month and just asked my surgeon his thoughts on a block. I thought he'd pass out. But he uses the anesthesiologist group I used for my mastectomy. Based on this info, I just requested a premeeting. Don't care what it costs. We never know who we are teaching. Goodness knows I've learned thanks to these threads....and warriors
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I've had my final consultation and I have a solid plan for surgery. The 2nd opinion PS did not change my mind about delaying reconstruction, so skin-sparing BMX next week with possible recon when my treatment is done. My reason for making this choice is because I want to try out the Toradol and block w/propofol on a less complicated, shorter, and less painful surgery to see how my body handles the Torodol and the pain. That will tell me if I want to go through more than one more surgery to do the recon. If I choose against it he said we can tighten up the skin that was spared in the BMX for the recon. That should be a fairly simple procedure that I can get through without opiates if I can't have more Toradol.
I'm happy with this plan because I think it covers all the bases, and I'm sad that most women don't have as much time as I have had to make these decisions, because it wasn't easy and it did take time. Hopefully my experience will make the choices easier for others.
If I have time I'll try to share the things I have done to lower my risk of complications, but I have a feeling I'm gonna pass out all weekend from exhaustion.
Have a good weekend everyone and thanks again for the support!
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Hi folks, I think this stone/shard experience is over for this event. YAY, Thanks for the nice thoughts.
Solfeo, it sounds like the whole plan came together. Looking forward to your report. Are you doing nipple sparing? I have a personal preset against it, simply b/c my BC extended up to and including the nipple. The MRI didn't pick it up. It was indicated in the final pathology report. For me, it would have been an extra sx. I worry when I hear folks doing nipple sparing. NOT based on research, just worry
Your experience with the pre-op anesthesia interview is what I have experienced for 18 years. That's why I was surprised by Rainny's experience of not being able to meet with anesthesia beforehand. But she had a good experience nonetheless. Gawd, I forget what Stteph's experience was with hers already.
Yes I agree I will get Dr Retsky's. Video in the topic box.
I posted earlier, that I was doing a reread of the entire thread. Only have done the first two pages. In a do over, I would have done a surgery schedule in the first or second box after the topic box. First, it would have avoided being caught short by not knowing Stephy's sx date. Second, tracking who had sx trying to follow these new ways. It would allow for follow up down the road. We could always do a box anywhere and I link the page. I've done that on other threads. Any suggestions on how to manage it now?
Stephy, glad to see you post
How are you doing? Rainny?
Fallleaves and 123 I will link to your threads in the topic box too.
Have a great weekend
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Falls and 123 check your topics ---did I get it right?
Solfeo, I added Dr Retsky's youtube angiogenesis link as well as the link he sent us.
Still need to add the PDF file that dr. Retsky sent, but need to go for the rest of the day
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Sassy, I'm so relieved you are feeling better! The topic box looks great. It's good that you added Dr. Retsky's talk. I do have one other thread you might want to add, which summarized some of the general review papers on anesthesia and cancer recurrence: https://community.breastcancer.org/forum/73/topic/...
Glad you are back!
Solfeo, I hope you can just relax and rest up this weekend! You've done a lot of work getting to this point, and now that you have done everything you possibly could to improve your odds and put a great plan in place, I hope you'll be able to just veg-out and recharge your batteries. I think what you've posted (and what Stephmoen and Rainnyc have shared) will be very helpful to many other women down the line!
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falls--done
Thanks, the stone thing is just getting old. Only 5% of women get them. I'm sure it's do to something related to all this chit. BC or Thyroid or drugs. Regretfully, can help someone on this subject too. Real and book.123 & Falls, link each other all round. That way if any fall off the first page of the science forum, they don't get lost in time. Cut and paste from my box to respective opposite boxes. Me to both of yours, 123 to Falls, and Falls to 123. Then the circle is complete.
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Glad you are feeling better Sassy!
I have had two surgeries as an adult. The first time I didn't get to meet the anesthesiologist at all until I was on the operating table, and he was in the process of putting me out. That was about 20 years ago. The second time I got 10 minutes the morning of the surgery in my cubicle in my hospital gown. That was in 2009. All he said repeatedly was that he had some really good drugs for me, without being specific, and I was too discombobulated to ask any questions. Then I went and had a panic attack in the bathroom. Definitely a better experience this time and now I know to always insist on a pre-op meeting.
About the only thing all of the surgeons agreed on was that nipple-sparing wasn't a good idea for me. The cancer is too close to the right nipple, and my breasts are too large to make the nipple on my left breast match unless they are both reconstructed. The PS I chose has a reputation as the best cosmetic guy, and the photos they showed me of his recons were amazing. Of course they don't pull out the botched ones, if any, but I was impressed.
Speaking of the very large breast issue, it occurs to me that it could put me at higher risk of bleeding problems due to the larger surface area being cut. A B-cup probably wouldn't have the same risk. Something for everyone to consider when assessing their own risks.
I love the idea of tracking who is having these procedures and their results. Although Steph probably doesn't think of it this way, her experience was a real gift to me in terms of preparation, as was rainnyc's. What about a separate survey-type thread (with standard questions) on the Surgery board that can be linked to from here? I thought of starting one myself but I'm not well known like you, Sassy, and I probably wouldn't get as good of a response. Apologies in advance for volunteering you for another job when you are already doing so much.
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Sassy, O.K., I added links!
Solfeo, I love your idea for a survey thread to track peoples' experiences with the anesthesia process (requesting it, getting it, and the outcomes).
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Add link?! Seriously?
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goodness, solfeo and falls, you gals sent your message by ESP. I got it about two hours ago LOL. Yes, another thread strictly for tracking. Form style. I'll start it. I've been thinking for a couple hours. Then we can link it where needed. Plus, I'll ask Retsky and Forget to give a last look for suggestions. this is a long term type concept. it will have questions re: recurrence. That can be filled in at a future time OR NEVER...... or something like 'still clear'.
Frankly, I never understood why BCO never developed a questionnaire that covered all the same material as the Nurse's study. Even though we already have cancer, trends could be found. Then it would be interesting to compare to existing info that has been accumulated form the nurses study.
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