TORADOL (ketorolac) linked to Recurrence Prevention

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  • __asher__
    __asher__ Member Posts: 147
    edited June 2016

    I'm new here. I'm not lurking, just catching up on all this important reading and trying to prepare for my own surgery on the 5th. Thank you all for providing such vital information as well as your experiences. So valuable.

    Rainy, thank you for the draft of your letter to your docs. It's very helpful!


  • WenchLori
    WenchLori Member Posts: 1,558
    edited June 2016

    I'm hoping the hospital has the name of my anastesiologist when I call tomorrow. If not I'll call my BS and request a note he added that I want Toradol be give before surgery starts on 7/6. I may even call my PS and request the same thing. At least it will be on my surgery records and not be over looked.

    Thank you Sassy for all you do for all of us here on BCO! Love you to pieces

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited June 2016

    Asher, Sorry you are here, but happy you found us. We are actually the lurkers here now. We took the subject as far as we could take it. Please read all the connecting threads The Blocks and opiods are important for before surgery. NSAIDS asa continuing thing for after surgery.

    Beta blockers is a new topic. It is in the same "realm" as all these discussions. Not absolutely proven, but the research is from compelling to useless HAHAhahahah. Sorry, only a person whose read way to many studies in her lifetime, would think that funny.

    If you have questions post, we all lurk :)

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited June 2016

    Hi Wenchi, thanks, but so many others do too. It's one of the beautiful things about BCO. Remember it's pre-incision Toradol. The connecting thread has all the research info for the docs. Hugs


  • rainnyc
    rainnyc Member Posts: 1,289
    edited July 2016

    Asher, I haven't logged on in a while and just saw your note about my letter. I hope it got good results if you used something like that. More important, I hope your surgery went well!

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017
  • carmstr835
    carmstr835 Member Posts: 388
    edited August 2017

    I am scheduled for port surgery on Wednesday the 9th of August. I just left the consult and I am happy to report I copied all the info and the Dr letter I found here as well as each of the professional info and clinical trial and gave it to my surgeon. It was a very hard sell, but he agreed to do the ketorolac preincision. I can't believe this iam so happy. Thank you everyone for sharing this info and giving us the tools to be active participants in our cancer journey.

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    carmstra, Hi glad you found this. this link is the final composite of several threads. Toradol, blocks, and opioids. it's shorter than this and the other threads. It was specifically put together for the docs. You may want to send the link to your doc.

    It starts with Dr. V's video.

    https://community.breastcancer.org/forum/73/topics/843381?page=1#idx_18

    Good Luck, sassy

  • carmstr835
    carmstr835 Member Posts: 388
    edited August 2017

    Thanks Sassy. Just had the ketorolac waiting to go in for the port placement probably 30 minutes. The are going to use propophol. They are afraid they won't be able to numb it completely with just local. But nothing else no versed or narcotics it is a difficultl port they will use the jugular vein on the left side. I hope I wake up with a port placed :

  • carmstr835
    carmstr835 Member Posts: 388
    edited August 2017

    All went well. Zero pain. I am very happy the port was placed exactly where I wanted it, I got ketorolac preincision and no amnesiac medication or narcotics. They left the 2 needles in so I can have my infusion tomorrow without any pain from the stick on my new double bard power port. Thank you everyone who helped with this information and to Dr. Forget. I believe this has just saved my life. :)

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    carmstr, YAY plesee,keep us up todate. Please, review the linked thread. Let me know if it would have been easier to use.Which letter did you use with your doc. There are several. I think Rainnyc wrote one too. There is a letter from Falleaves, and me. Memory issues . I should add Rainnc's letter too.

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    Carmstr--on the link look at Techtonicshifts post at the end. She actually had circulating tumor cells measured before and after surgery. CTC's.. No one here has had that done before. So.her situation is very unique. I may send her post on to Retsky and Forget. I'll send your Thanks to Forget if I do ;)

    Your situation sounds a bit different. I read that you had the torodal in pre- op versus preincision?

    I think it's important that you send the links to your docs for review. Link the composite thread first.

    Are you on any anti-hypertensive medications?

  • carmstr835
    carmstr835 Member Posts: 388
    edited August 2017

    I printed this post from Sas-

    Apr 12, 2016 09:53AM - edited Apr 12, 2016 11:02AM by sas-schatzi

    https://community.breastcancer.org/forum/73/topics...

    Then I printed each article in full. I also copied TectonicShi's post about her port experience and raised cancer markers in her blood.

    It was about 34 pages, in a bounded booklet, in protective inserts,(that way I used both sides of the inserts easier to turn pages and read), a table of contents with tabs acrossed the top for each article and tabs down the side with chapters.

    Title page:

    Pre-incision Ketorolac and Surgery

    Introduction- letter to the Dr.

    Cancer recurrance studies

    Personal story

    Risk of Bleeding

    The meeting was about 45 minutes, it didn't start out well, he was very much against this, but did listen. I told him this book was his to keep, if it doesn't help me, maybe it will help someone else after he read it more in detail. I would rather bleed to death, than die of breast cancer, he knew I was very sure this was what I wanted. I doubt I would have gone through with this without the ketorolac. I did have my own on hand incase I decided to take it without the surgeon's knowledge. I did not know if 3- 10 mg tablets would be as effective as IV 30 mg. Hense my insistance on no sedation. But that became a moot point when he agreed, and I sure was happy. I doubt I would have just taken it, I probably would have just canceled the surgery and did without a port and risk serious lymphodema from the piclines and blood draws, I seem to have more issues than most with these things. I am happy to have my port.

    He first said, that he could not in good conscience go into surgery without a plan B and with the subclavian port there was no option if I started to bleed. I asked about a different vein. He could use the right jugglar vein. He could use pressure if needed. I got him thinking. Then I informed him he could not place my port on the right. It needed to be radiated. He said left juggler is not a straight path, would require 3 turns and each turn could cause a kink and could force a failure of the port. I just said to him, but you can do it, can't you? It was a challenge then, and he was up to it. I was so happy. My port is just fine and works great, so far. The surgery took about 1 hour 15 min. The ketorolac was administered IV at about 1 +/_ 15 minutes hours before the surgery began. I believe the anti-inflamatory properties were well instilled by then. I had very little pain after and never did need any pain meds even after the lidocaine wore off.


    Sas, I am not on any medications except pre and post chemo steroids. No BP meds. I did have the ketorolac pre op, but probably no more than an hour or so before the incision.


    You guys are awesome for keeping up with all this!

    Cindy

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    Cindy, that was a lot of paper and ink. :) Good Luck!

  • beach2beach
    beach2beach Member Posts: 996
    edited August 2017

    Hi,

    I had a bilateral mastectomy on 8/7. I just came across this thread. In recovery they came at me with this big liquid bottle. I asked the nurse what it was, she told me it was ketorolac, a heavy duty anti-inflammatory. I even came home with a few pills of it but never used, maybe I should have. My PS is an oncologist reconstructive PS and does not like to use any other drugs. I remember him telling me prior to surgery that he would give me a block so that I'd be good for a few days. Honestly I can say, I really had no pain from when I woke up until now. Just some tightness from the implants, and some zings from where the sentinel nodes were taken out.

    Wonder why they all don't use it especially since the concern these days are with addiction to Opioids.

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    Hi beach2 The final story i.e clinical studies aren't done. The studies to date on Toradal are retrospective studies. Patrice Forget has a prospective study going now.

    The three Torodol, blocks, no opioids are the best combo. In sharing the info with your docs use the info from the link i will place at the bottom. I'm also going to place a copy of Techtonicshift's post from that page for rview here.

    https://community.breastcancer.org/forum/73/topics...


  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    repost


    Jun 29, 2017 11:25PM - edited Jul 1, 2017 07:51PM 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.

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    What is interesting about TectonicShift's post is they had measured her circulating tumor cells - CTC's. Generally, CTC's are measured after a tumor has been diagnosed. That is not common practice before the initial surgery. I wonder in the future it will be used from initial surgery and for all subsequent surgeries. I certainly would add valuable insight as TechtonicShift post demonstrates.

  • beach2beach
    beach2beach Member Posts: 996
    edited August 2017

    Sas, very interesting. Really. It's great to see many women researching and finding studies etc. It's so hard, we have to advocate for ourselves or at the very least, gather any information we can and place it out there to our Dr's. With a dx of cancer, anything we can arm ourselves with to help during, before or after and in the long run is a plus in my book. I'm still learning. Been looking at diet changes, melatonin, turmeric, D3...etc.. going all over to read and see what's new and old etc.

    I had looked up comparisons of Ketorolac to any other type of anti-inflammatory. Was wondering if there was something in same class we could take that perhaps would help further to reduce reccurrance. I know some look-see's have been done with Aspirin use.

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    Beach look in the topic box for the link to NSAIDS by 123 Just Me. The problem with NSAIDS is they can cause cardiovascular problems i.e. heart attack and stroke. The should always have the permission of your doc for use, preferably, cardiologist.

  • beach2beach
    beach2beach Member Posts: 996
    edited August 2017
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    The following is a partial response from Dr. Michael Retsky in regard to a forwarding of TectonicShift's post(with her permission)

    "That is good information. Please thank the person who sent it. I edited a book with Romano Demicheli on the breast cancer project. It was published a few weeks ago by Springer/Nature. Here is title and link - https://www.amazon.com/s/ref=nb_sb_ss_i_1_6?url=search-alias%3Dstripbooks&field-keywords=retsky+demicheli&sprefix=retsky%2Cstripbooks%2C135&crid=27YLYLVMUNFXX

    If that link doesn't work, I am sure you can find it online at Amazon.

    Much is pretty technical but some is readable and useful for interested persons"

  • carmstr835
    carmstr835 Member Posts: 388
    edited August 2017

    I found the book and would love to read it, but I don't have $130. I found the free previews very readable, just too expensive for my financial situation.

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    Carmstr, I now get what Michael was saying. Don't worry about the publication. It will go down in price. It's meant for the big wigs in the field that have library budgets.

    What I liked is that he said Tecnocshifts information is interesting. Interesting to a science person means they don't have an answer. Which with a science person sends them on a search ------to search or develop a study

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited August 2017

    From Michael Retsky:

    There are several chapters in the Springer Nature book that will be very useful to members of

    the breast cancer group. Reconstruction is discussed in one chapter by Jayant Vaidya a UK

    surgeon who is PI of the intraoperative radiation project. He also presents new and very important information

    on reconstruction. CIrculating tumor cells before and after biopsy and surgery are measured and reported by

    Mazen Juratli et al. I will see if these chapters and others can be open access to patients in the breast cancer group.


  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited November 2017
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited November 2017
  • 123JustMe
    123JustMe Member Posts: 385
    edited May 2018

    In reply to:

    • More research on Toradolfrom 123JustMe May 21, 2018 11:23AMKetorolac Lowers Breast Cancer Risk in Patients With Elevated BMI
      Journal of the National Cancer Institute.
      Save Recommend Share Get Topic Alerts TAKE-HOME MESSAGE
      • This retrospective series was designed to evaluate the impact of intraoperative nonsteroidal anti-inflammatory drug use on breast cancer recurrence. Patients receiving intraoperative ketorolac (but not diclofenac) appeared to have a reduced risk for distant recurrence (HR, 0.59; P = .03).
      • The reduction in distant recurrences was particularly pronounced in patients with an elevated BMI given ketorolac.– Neil Majithia, MD
  • solfeo
    solfeo Member Posts: 838
    edited June 2018

    Good to hear! I was morbidly obese at surgery (not anymore), and requested and received the intraoperative Toradol, thanks to this thread. Also took the pills for a few days after surgery. I need to send this to my surgeon, who tried to talk me out of it!

  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited May 2018

    Solfeo Hello, :) again. Glad you are doing well. Me too. I know you posted way back when about the doc not wanting to do Toradol. But if you could cut and paste that discussion here, it may convince someone to seek talking to their doc. Searching through many pages can be tough for folks.

    I received a PM from Retsky a few weeks ago, I really should have done something with it, but something was going on. Oh Vey, I'm worried about my memory. Seriously, glad you are good. Pm'd with !23 today because of above post. I said to her that the work that we all did in 2015 was at the Masters level of problem solving. We had such a team. But I was saddened by so few viewings. This thread had 8,000 viewings therabouts. But the composite thread to direct folks to all three threads only had < than 600. Changed forums, Didn't improve viewings. Perhaps you could make a suggestion as to where it might get better viewings.

    The number of women, that if they had a singular < 10$ injection, may have been the difference with recurrence is unknown. Bummer

    Solfeo, another friend is going to start a Paleo diet thread soon she's working on the format now . Her name is Egads. You may remember I studied the Microbiome at the same time as when we were working on Toradol. The Microbiome study lead me to Paleo as a really healthy diet. BUT, I stopped b/c I like my wine and the diet said I couldn't have my wine. Hahaha Hard cider was the thing. NO NO NO. I dropped it then. Learned today Red wine is good, forget the hard cider.

    Now have Egads who I have asked to be our Coach. It should be much fun. She's excited to be Coach. Kinda, Mostly, She's a hoot.

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