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Outpatient Surgery and TKIs


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#1 LivingWellWithCML

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Posted 25 June 2012 - 07:34 PM

Hi,

So, after several months of painful running, I finally got an MRI done on my left foot.  Met with sports medicine today and I have a lesion in my ankle cartilage that will require arthroscopic surgery to repair.  My options are simple: shift to walking and do nothing, or surgery.  This is a no-brainer for me, cause running is pretty much the only natural method that keeps my CML anxiety at a minimum.  Have any of you been through outpatient surgery while on a TKI?  I do not want to take a holiday at all ... Is that an option?  I am only 14.5 months into Gleevec 400mg, but I had a PCRU at 12 months and will at least wait until my 15 month PCR test result before surgery.  It will involve at least heavy sedation and numbing of the foot, but I think they usually put you to sleep for it.

I know it is a personal decision, but I would be interested in hearing from others who have been through outpatient surgery in the first 2 years of TKI treatment ... What your anesthesia options were, could you avoid a TKI holiday, etc.  And following surgery, I am looking at some Naproxen for a bit to help with post-surgical swelling.  Based on the recent NSAIDs study, that does not appear to be a threat (but Ibuprofen does appear to pose risk!).

Any input and experiences would be really helpful.  Thanks everyone.....


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#2 momruns

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Posted 25 June 2012 - 08:33 PM

Dan,

I work in an operating room.  Since my CML, I have seen two people come in for emerg. surgery.  They were both on G like me.  Anesthesia was not too concerned.  Both patients had good CBC's ( H & H was a little low but not too bad ).  Best of luck with your ankle.

Loreta



#3 Trey

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Posted 25 June 2012 - 09:44 PM

Only issue is if your platelets are very low and/or you bleed a lot.  Even then arthro is not very bloody.  You would not need to stop Gleevec, but some docs would insist.  I just don't tell the docs (minor surgery, dentist, etc) any more about the Gleevec.



#4 hannibellemo

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Posted 25 June 2012 - 09:58 PM

I had sinus surgery, full anesthesia, never stopped my Sprycel. Not much pain, but I did take ibuprofen (pre-study).

We don't generally react any differently than others do to surgery. Some may have to stop Gleevec if it bothers them to take it without food, otherwise it should be business as usual.

Good luck!

Pat


Pat

 

"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>


#5 LivingWellWithCML

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Posted 25 June 2012 - 10:28 PM

This is very helpful feedback.  Thank you!  Last CBC was normal ... HGB and RBC run just a bit below the normal range, but I feel perfectly fine except for the foot/ankle issue.  I feel very fortunate despite the injury.  Might be best to be asleep for this one, since it'll be my first surgery since my knee was scoped back in the early 90's (basketball injury, go figure).  Getting banged up a bit is the price one pays for remaining a week (and weekend) warrior, but I refuse to complain about it.  Good to know that I can consider surgery without getting freaked out about TKI treatment - whew.

Quick side note - the PA who saw me at the beginning of the visit today ... he asked "what is Gleevec anyway?".  When I told him, he proceeded to let me know that he was an ALL survivor!  Diagnosed in the early 90's, he spent 3 months in the hospital getting chemo, then 1 year of outpatient chemo (no radiation at all), and he's been in remission ever since and only gets his blood checked at his annual physical.  The guy looked fantastic ... you'd never have known the battle he fought.  I was in awe!

Thanks all -


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#6 Sneezy12

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Posted 26 June 2012 - 05:24 AM

I had Back and also Neck surgery at The Mayo Clinic under general anesthesia, and did not miss a dose of Gleevec. Frank



#7 0vercast

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Posted 26 June 2012 - 08:53 PM

Out of curiosity, why would some docs insist?



#8 Sneezy12

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Posted 27 June 2012 - 06:40 AM

Ignorance. Frank



#9 Pin

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Posted 27 June 2012 - 06:53 AM

Hey Dan, sorry to hear about your ankle injury - those insidious injuries we can run through are both a blessing and a curse! Glad you are getting it fixed though, hopefully that will result in pain-free running when it's all healed.

Sounds like you are close to your next PCR test - hope you get another PCRU!


Diagnosed 9 June 2011, Glivec 400mg June 2011-July 2017, Tasigna 600mg July 2017-present (switched due to intolerable side effects, and desire for future cessation attempt).

Commenced monthly testing when MR4.0 lost during 2012.

 

2017: <0.01, <0.01, 0.005 (200mg Glivec, Adelaide) <0.01, 0.001 (new test sensitivity)

2016: <0.01, <0.01, PCRU, 0.002 (Adelaide)

2015: <0.01, <0.01, <0.01, 0.013

2014: PCRU, <0.01, <0.01, <0.01, <0.01

2013: 0.01, 0.014, 0.016, 0.026, 0.041, <0.01, <0.01 

2012: <0.01, <0.01, 0.013, 0.032, 0.021

2011: 38.00, 12.00, 0.14





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