TORADOL (ketorolac) linked to Recurrence Prevention
Comments
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123, just the URL and name of thread. Look how I linked your thread. Falls has more. You can just Cut and paste from my box to yours. I'm thinking you thought the whole box? was that why you reacted... Seriously?!..........
or are you pulling my leg?
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Solfeo what does the research say about Ultram/tramadol. Decent drug. Non opiod. I think needs a bit of adjustment to get used to it. First contact a few years ago, I said this was not a drug for me. But this year I was just tired of the pain. I have used it intermittently and a two month period of daily. Gave up on the daily. Constipation. I lost part of my colon to Celebrex. Wasn't willing to loose anymore.
I process meds differently. Two cytochrome450 enzyme abnormalities. Teeny percent of population. LOL I'm special........
Falls, Rainey,Stephy, 123 comments on Tramadol research? Any other pain control drug suggestions.
I still haven't read your thread Falls, concentration is not at it's finest.
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Sassy, glad you're back in fighting form. Where are the references to the Tramadol research? Sorry if I'm being dense (always a possibility).
I did go back to the surgeon Friday and received the very good news that my pathology report showed no evidence of disease anywhere. Lymph nodes clear on both sides. Got the drains out, too. So all in all, a good visit--though of course with that news and the fact that the surgeon was telling me while picking steri-strips off my chest I didn't ask him more about Toradol, which I'd meant to do.
Don't get me wrong; I'm overjoyed with the path report. And I truly think this surgeon is a nice guy; he seemed as happy with the news as I was, and I'm sure they love to deliver the good news, in a field where the opposite is more often the case. I just wish that the patient/doctor relationship wasn't fraught with such inequality: he, in surgical coat, standing over me, on my back on a table, wincing from the (minor) pain. Sigh. Still, I will take the news.
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Rainnyc, WOW excellent news. Incredible entering the next phase with that kind of report. (Just got happy shivers). .....Yes, they're is a power dynamic. It's difficult to describe the shift over the decades. In the 70's few had the idea that they wouldn't just do what the doc said. Fewer still had the idea of searching for information. If one chose to search, getting access to more than general info through the public library was all the general population could expect. Access to medical libraries was limited to medical and nursing.
Really wasn't till the 1990's with the PC and Internet that searching started to influence the doctor patient dynamic. In that time, it was interesting listening to docs reactions re: patients that came in with info found on the net. Some dealt well with it. Others were threatened. Then into the 2000's and now, docs have to be prepared for patients presenting as we all here do. Prepared.
With office visits the list of what you want to discuss is important. It's so easy to get diverted by what's occurring during the visit. If I go without a list, I always forget something I wanted to chat about. If I've forgotten the list, I write my questions on the white paper on the exam table. The first time I did that, the docs reaction was very interesting. I even have taken to doing it from my prepared list. Then before I let them out of the room, I say something about checking off my list. Then saying"'Okay, I'm done". I shift the dynamic. I'm letting them go, they aren't letting me go. I haven't actually put this into words this way before, but in mulling it while writing, it's true. I feel a sense of comfortable closure of the visit.
If you really want to even the playing field, buy a white warm up jacket at the local uniform store. Please do, LOL. If the doc has a white jacket on, you put yours on. If they don't have one on, don't wear it. Or if you really want to change the dynamic, you have yours on when they don't. Some peoples reaction would be that this wouldn't influence the situation. It does. All medical students and many nursing students are directed from day one to have a jacket for patient contacts. It's a subliminal thing. Also, if they are standing, you stand. Seated, you sit. Laying on your back always shifts the dynamic in favor of the standing person.
A couple of books on dynamics, I read as a young one are as good today as first written. "Games People Play", and "I'm Okay, You're Okay". I gave both books to DS when he was in law school.
On the Tramadol. I haven't been able to get to the opiod research. I know all of you have (Falls, 123 , Solfeo, Stephy, you). Tramadol is a good drug. I am guesstimating that it's been looked at in light of the opiod research.
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Okey dokey-----------got started
Topic: Discussion Topic: Record of Surgical Managemet, and Recurrence
https://community.breastcancer.org/forum/73/topic/835528
Topic: Record of Surgical Managemet, and Recurrence
https://community.breastcancer.org/forum/73/topic/835525?page=1#post_4516040
I put them in the topic box here, Suggest you put them in your respective topic threads.
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taking a break LOL always a good idea when confused about what it was you were doing
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Hi Sassy, that's great that you've gotten the ball rolling on the new thread!
I'm trying to remember where I read things about tramadol...but I definitely put it in the "good" anesthesia column.
Here are two mentions of tramadol I could find again:
"Morphine Use in Cancer Surgery"
"Tramadol is a low-affinity mu opioid receptor agonist with complementary central inhibition of serotonin and noradrenaline reuptake (Leppert, 2009). Tramadol not only improved immune function in animals (Sacerdote et al., 1999; Tsai and Won, 2001) but also reduced postoperative immunosuppression in patients undergoing surgery for uterine carcinoma, while providing analgesic efficacy comparable to that of morphine (Vickers and Paravicini, 1995; Stamer et al., 1997; Hopkins et al., 1998; Sacerdote et al., 2000; Hadi et al., 2006)."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC315159...
(Afsharimani, 2011)
and
"Are we causing the recurrence-impact of perioperative period on long-term cancer prognosis:Review of current evidence and practice"
"Mild MOR agonist tramadol also has noradrenergic and serotonergic activity. It stimulates NK cell activity. In a rat model, tramadol has been shown to block the enhancement of lung metastasis induced by surgery.[41] Morphine (10 mg) and tramadol (100 mg) were compared in hysterectomy patients for uterine carcinoma. T-lymphocyte proliferation was found to be depressed in both the groups, but remained so only in the morphine group.[42]"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC400963...
(Das, 2014)
I did read that tramadol can cause more nausea than other anesthesia, but I imagine you already know whether it affects you that way!
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Hmmm sounds like a question for Forget
Re: Tramadol with it agonist on " "Mild MOR agonist tramadol also has noradrenergic and serotonergic activity" That aspect acts similarly to SNRI's. It's why I gave it a chance for every day pain control. ----------My counselor and I explored it. We laughed. I said it made me mellow and great pain control, if I took it in the am. Then b/c of my weird metabolism, it was good till the next am. He also, Identified that it had an effect of reducing OCD. We laughed again.
So wish I could take it daily....................won't......................wish,,,,,,,,,,,,,,,,,,won't
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Surgery Weds. morning. Ran out of time to say more! I'll update as soon as I can.
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Solfeo is that next wed, or yesterday, when yesterday was today?
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I think Solfeo is having her surgery today! Hope it goes flawlessly!
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Solfeo, best wishes.
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surgery was at 11 a.m. I was home by 6 p.m. . you will be happy to hear zero complications so far. surgeon met me in recovery with big smile on face said she will be using the procedures again in the future. That was after scaring me half to death for the last week over all the possible complications . she wasn't trying to be cruel but just wanted to warn me what I was possibly getting myself into . would be lying if I said it didn't scare me a little but I just remembered everything that I have read and learned and stuck to my guns . I'm using Google Voice typing so please excuse my typos and one long paragraph . so what I got was pectoral block only no other kind of block and propofol as the general anaesth no opiates were used although I did give permission to use something if they needed it. They did not need any. Woke up with very little pain no pain at all on the good breast side and on the right side where the cancer was the only pain I have is mild and it's where they did the SNB .. its now 12 hours later I still don't have much pain I had to two extra strength OTC tylenols and that got rid of all the pain I was feeling near armpit . Thie pectoral block was supposed to give between 12 and 24 hours of pain relief so I guess its still working . The pectoral block is several one time injections strategically applied you are not hooked up to anything that's why you can go home so soon it keeps working. Two more things they took 2 sentinel node both were clear yippee. Also I do have a toradol prescription for pain relief for the next 4 days but I decided not to take yet since since I don't need it and to give my wound a little more time to clot and heal I'll start using it tomorrow if I need pain relief. That is all for now I will edit this for clarity when I feel like using both hands for typing for the future . I also left a lot out because of the limitations so please ask any questions and I am will be happy to answer
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Solfeo: that's great news! Wishing you a speedy recovery.
I had out-patient surgery to remove a cyst on my back yesterday. As I was being discharged, the nurse handed me a script for Norco. I mentioned my neurologist's advice to use Toradol instead. The nurse wasn't familiar with Toradol and I didn't think this was the time or place to get into all the research on the recurrence issue, so we settled on tramadol. I like it much better than Norco. It's not a migraine trigger and doesn't cause that sluggish feeling.
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Thanks chicagoreader, its gonna be,a challenge to always find a surgeon who will use toradol. The sooner it becomes standard for women who have had BC the better. Forgot to mention I also got the totadol injection pre incision. Will add it to my my earlier post when i can sit at desk and type. Stilll not much pain this morning. I did get tramadol script too in case the toradol wasnt enough but havent neded it yet looks le i might not need it. Block may not have worn off yet but still on plain extra strength tylenol
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Solfeo, Dr. Retsky passed this on. Thought you might get a kick out of it
www.youtube.com/watch?v=IkKEFF_c0yo
>>>>>>>>>>>>>>>>>
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Great news!
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Solfeo, I am so happy for you! That's excellent news that your sentinel nodes were clear!! I'm so glad you got everything you asked for, and that your pain levels have been low. Sounds like the pectoral block worked great for you (and is still working for you). Thanks for sharing all this with us. I hope the rest of your recovery goes just as well as the surgery went!
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Solfeo, another person here who is very happy to hear the news! Let's hope that more and more surgeons will keep an open mind and do what is best for their patients without worrying about lawsuits( I do understand the need to protect themselves)
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Thanks again ladies, couldn't have done it without your help!
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Solfeo, we will give you time to rest and recoup. (What? do I sound like Nurse Ratched?) Please, add any more observations.
Stephy, Rainny, and Solfeo. You have gone through this effectively as a group. I think the next logical thing to do is to look at NSAID as maintenance. Also, completing the form, but the form isn't done yet.
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Congratulations Solfeo!!!
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Upate on me: Clearly any concerns that I would bleed to death from ketorolac were unfounded. I appear to be a master clotter. It has been a challenge keeping the drains unclogged, in fact. Everything is healing up nicely and I really never had much pain from the surgery itself. Feels like moderate muscle soreness like when you do push-ups after not doing any for awhile. The only thing that hurts is the damn binder, from cutting into my armpit area (the reason I haven't posted more since the surgery). I wouldn't need any pain relievers otherwise. And of course the drains are a pain in the behind, but there's no medicine for that. I have four and three of them will hopefully be removed tomorrow. One wants to hang around a little longer. Hang around - get it? heh heh. (yes, I'm going a little stir crazy but I haven't been able to wash my hair yet so I'm not going anywhere)
I took the ketorolac/Toradol for three days after the surgery to keep the anti-inflammatory effect going, alternating with extra strength Tylenol, then I switched the ketorolac for ibuprofen yesterday, which was the 5th day. I could have taken the ketorolac another day but I didn't really need it and we were getting into possible side effects territory. I still have 14 left, which I will hoard for reconstruction in case the plastic surgeon doesn't want to give me any. I didn't need it but I accidentally took one tramadol at some point I don't remember, discovered when I counted the Toradol and had one more than I should have.
The only side effect I have had from the Toradol is that it does make my stomach grumble if I don't eat enough food with it. That is one reason I didn't take more - it was too much of a hassle at times to eat something.
Follow up with surgeon tomorrow afternoon.
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Great update!
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Solfeo, ditto to 123
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👐👐👐👐 Solfeo
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Solfeo, hope you get those three drains out tomorrow! That's great that you had no bleeding issues and the pain has been so tolerable. And nice that you have a nice stash, just "in case". Glad to know your healing is going so well!
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Solfeo, DITTO Falls
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Hi all, I hope you don't mind me joining in. I've been a lurker on these boards ever since my aunt was diagnosed with BC 2 years ago and this thread has prompted me to create an account. Everthing I've read on this topic addresses opoid use only in the context of cancer surgery but I'm wondering what the implications are for past and future use of opoids for cancer survivors. My aunt has been taking vicodin on occasion for back pain and this is very concerning to me. She doesn't take it often - maybe every few months her back will flare up and she'll take a couple pills at night to help her sleep, but based on what I can glean from the online articles I've read, even that might be enough to cause any cancer that may be forming to spread. I haven't mentioned this to her yet because I don't want to worry her especially if there is no cause for concern. I tend to worry much more than she does though and maybe I am reading too much into these studies? Can anyone provide additional insight into this?
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Hi Darcy123!
I can relate to your concern for your aunt. My aunt had BC, too. On the one hand you want to protect her, but on the other you don't want to worry her. I've gotten a mixed view of opioids from what I've read so far, but I'm one who follows the precautionary principle, that if there is a question of harm, it is better to avoid it until there is more evidence either way.
Your aunt isn't using vicodin very often, though. I think I'd be more worried if it was an everyday thing. I haven't seen anything specifically linking hydrocodone to cancer recurrence. Most of the concern about opioids seems to be coming out of the use of morphine around the time of surgery or in advanced cancer. But then, that raises concerns about other drugs in that class.
On the other hand, there are plenty of alternatives to vicodin. Maybe you could suggest to your aunt that she talk to her doctor about them. For example, there is ultracet, which is a combination of tramadol and acetaminaphen. Tramadol is a synthetic opioid that seems to lack some of the negative effects of natural opioids. And I've been reading about the use of antiepileptics like gabapentin and pregabalin for back pain. So maybe she could switch to something else, just to be on the safe side.
Hard call! It's difficult to know what is worth making an issue of. Wish I could be of more help....
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