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$C team doctor - Bruce Wang - 01-06-2015

https://sports.vice.com/article/usc-football-team-doctor-admits-to-ignoring-fda-and-ncaa-painkiller-regulations/?utm_source=vicesportstwitter

I joke around about $C being evil.  This one is no joking matter. If true, this is horrifying.

Re: $C team doctor - dabigv13 - 01-06-2015

This article is pretty sketchy with the science, as most popular press is when reporting medicine. It's also Vice, which while I read a lot of, is not exactly the New England Journal of Medicine.

Toradol, or ketorolac, is a non-narcotic painkiller, of the NSAID class. It's pretty much super strong advil, and it's main indication is for acute pain. My experience with it is limited- sometimes for postoperative pain management, however since it can lead to a higher risk of postoperative bleeding and that's generally not well tolerated in head and neck surgery procedures, I don't commonly use it.

The side effect profile of ketorolac is similar to other NSAID medications. Just as with advil, long courses can predispose to kidney injury or gastrointestinal bleeding. I just did a quick pubmed search, and the only article that specifically looked identified ketorolac as potentially cardioprotective. This was a relatively poor article. From what I can tell, the potential risks of myocardial infarction with ketorolac is based on experience with other NSAID medications, and this is an area of emerging knowledge. Only recently have we appreciated that nonspecific NSAIDs such as advil can elevate cardiac risk. We've known for a bit longer that COX-2 selective NSAIDs such as a celecoxib increase cardiac risk. It seems that some NSAIDs, such as naproxen (aleve) may not have this risk profile. With what we know now, most MDs would not recommend people with elevated cardiac risk factors take prolonged courses of NSAIDs.

Does ketorolac predispose to myocardial infarction? The evidence is not there to say definitively either way. In a young and otherwise healthy person it seems unlikely.

To the broader issue of toradol usage in sports, it sounds like most NFL and college football teams use it off-label. Many medications are used off-label in medical practice. However as with any medical intervention, informed consent to treatment is critical. Most players receiving these shots probably were never told of potential risks versus benefits, which is wrong, though I suspect many players probably don't care about the risks. I think players should be discouraged from frequent toradol injections, but if they want them and receive them frequently should probably be monitored for kidney injury. Players with elevated cardiac risk (these would be rare) should be counseled against frequent toradol injections.

Sounds like this guy acted improperly. But I think some context is useful in understanding the topic.

Re: $C team doctor - Bruce Wang - 01-06-2015

This stuff freaks me out a little bit more than normal.  I got rear ended at a stop light during grad school.  Was in a fair amount of pain and the doctor suggested that I take Alleve (naproxen sodium).  The doctor warned me that it could make me drowsy so  I told the professors before hand to not get offended (irritated) if they caught me drifting.  We had a substitute professor one class and I forgot to mention this to him.  Sometime during the case discussion I was out cold and the next thing I knew, the professor called on me for an answer.  Apparently the answer was written on the board.  Then I started crapping out blood and decided the cure was worse than the disease.

Re: $C team doctor - jacketree - 01-06-2015

(01-06-2015, 03:02 PM)Publius link Wrote:Sometime during the case discussion I was out cold and the next thing I knew, the professor called on me for an answer.  Apparently the answer was written on the board.  Then I started crapping out blood.....

If you were able to do that in response to being called out in class, then color me impressed.  When that happened to me back in the day, and it often did, I just kept on sleeping (real or fake) until the prof asked someone else.

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