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Old 08-18-2009, 05:14 AM   #1
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dolejaly HB User
30 mg morphine every hour too much?

My mom was on Hospice and as she suffered from Congestive heart failure and COPD she was in a lot of pain, towards the end the Dr. ordered her 30 mg of morphine every hour, liquid of course, wouldn't that of pushed to stop her heart and depress her breathing more so....almost like a assisted suicide in some factor or was that amount safe under the circumstances?

 
Old 08-18-2009, 09:00 AM   #2
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rekem HB User
Re: 30 mg morphine every hour too much?

The purpose of Hospice care is to provide physical and spiritual comfort during end-of-life stages. Morphine will decrease respiration and is very useful in that regard when such condition sigificantly spikes above the norm of 16-20 per minute or when pain is quite apparent.

Personally, before my wife died last week, I requested oral morphine as often as possible during the last 12 hours of her life. She passed without any noticeable discomfort.

In a study of Hospice patients in the mid-1990's, high morphine dosages did not affect patient survival. So if one is going to die anyway - how much pain do you wish to endure during the process.

 
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Old 08-23-2009, 02:53 PM   #3
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Re: 30 mg morphine every hour too much?

I'm sorry for your pain, I can relate. My father died July 7, septic shock and renal failure. The morphine was given after he entered the hospital, and slowly increased. I was at first against it, but knowing death was certain, we decided to administer for his comfort. It hurt not being able to speak with him the day he died as the morphine wiped him out, his eyes stayed fixed on me though. If there had been any hope for cure, I would have decreased the morphine, as I'm sure it played into the heart failure faster. The final hours all life support was taken away, just oxygen and my Dad seemed peaceful. I've been fighting legal issues over this, the nursing home created the septic shock, and its been so draining. Just starting to "come down" now and feel the pain, anger was the ruling theme this past month. It's so hard losing a parent and for me now, both parents are gone. Take care, and make the best of life while you're here!!
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Old 08-26-2009, 05:48 AM   #4
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Re: 30 mg morphine every hour too much?

Hi dolejaly,

I'm sorry about your loved one. My Mom is also in hospice for pancreatic cancer. I know it is a tricky situation as far as administering pain medication. Too many narcotics can affect breathing but if, as some members here have experienced, the person is in the process of dying then I think it helps to keep them comfortable. But it is a precarious process cause on the other hand I personally wouldn't want to give to much narcotics and cause crisis either when the family member isn't active in the process of dying. At our hospice the rule of thumb is to have the regular pain meds and then after three breakthrough pain med doses in one day to call the hospice for further direction. I spoke with our pharmacist also and he agreed there should be some rules about how many doses to administer. Some patients do build up a tolerance and need higher doses.

We did one night get bad advice from one of the hospice nurses and my Mom had overload narcotics and she was not at all ready to die - her breaths were down to 6 breaths a minute and my RN neighbor came over to assist. The hospice management did correct that nurse but I think it is important to stay informed and be watchful. I would have really felt terrible if I gave her too much morphine and the labored breathing was very uncomfortable for her. But on the other hand she wanted me to promise her that when she dies she won't suffer so it is a situation that can be full of questions.
I hope that helps.

Last edited by Karen4Mom; 08-26-2009 at 05:53 AM. Reason: add more information

 
Old 08-26-2009, 06:44 AM   #5
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Re: 30 mg morphine every hour too much?

It is very hard at this stage because sometimes I wonder if the right choice was made w/ my moms condition and then knowing the results of morphine and how it can alter a persons breathing and that being one of the issues my mom had was COPD, Emphysema that I felt that it was like a quick suicide assistance in some manner.

But, yet she was on 20mg every 2 hrs(orally, being they had taken the IV out the day prior) and they had changed her dose to 30mg every hour and only 4hrs after the medication being raised my mom passed away.

I realize she was passing away and I understand the Hospice, but it just seems it wasn't about comfortably anymore it was about quickening the process. The reason for that was the doctor was in that morning and talked of how strong she was and she just wasn't ready to go yet and only a few hours after the medication raise she passes away.

My mom was only on the morphine for 5 days total, that day they stopped giving her fluids, her other medication and no longer was offered food and was only offered morphine and ativan for comfortably it just seems like a high jump of medication when just before the change it was 20mg every 2 hrs it seemed like they would have just changed the time on the 20 mg to every hour. Maybe I don't understand the meaning of hospice totally either, where as they are to make her comfortable in her last few days to feel no pain, but it just seems like the increase to me was a quicker way to have her pass.....

I know it was for the best so my mom would feel no pain, and I am glad that she did not have to be in any pain beings she put in a couple of rough nights for 2 days, but none the less that part of the medication bothers me. Is part of hospice to also to quicken the process to?

I wear morphine patch and if I am in direct sunlight the medication dispenses quicker into my system and even I have a hard time w/ breathing and can't breath deep enough so I just feel like that kind of dose would almost make a person in her situation feel as if they were suffocating and under her condition she couldn't tell us anything being the medication was so strong and was not on any monitors at all to know of what was going on. The hospice care she was receiving was in the local hospital.

 
Old 08-26-2009, 08:19 AM   #6
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Re: 30 mg morphine every hour too much?

My mom died in the nursing home with COPD/lung cancer. My son and I had to sit and watch her agonized breathing for three hours because the nurses weren't able to reach the dr. to prescribe morphine. It was horrible and the memory of the look on her face and what she went through will remain with us always. If only I had known enough before-hand to insure her last hours would be eased with morphine. I am making sure my children don't have to watch me go thru this.

 
Old 08-26-2009, 11:58 AM   #7
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Re: 30 mg morphine every hour too much?

My father was in amazing shape and the doctor made the same comment about him. He was too strong. He was told he had days to 2 weeks in January and died in mid-March. The doctor went the other direction with him and pulled back on the meds. He suffered and I still live with it. He asked me to bring him a gun more than once. The doc took the idea that since Dad was so strong he would have been moving him along with the morphine. Well, duh. I was young, barely 30, and stupid. I wish I could do it over again. I am sorry for what you are going through and thinking/feeling but since my Dad was dying with cancer all through his body, it would be far less painful for me to now be wondering if he'd gone 2 or 3 weeks too soon than watching what he went through. I still don't know what the doctor was thinking. I hope that in time you can accept the way things went.

 
Old 08-27-2009, 05:33 AM   #8
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Re: 30 mg morphine every hour too much?

(((Dolejay)))

I'm sorry about the loss of your Mom and I am glad that she didn't suffer. As caregivers in hospice it seems like we have a tremendous responsibility on our shoulders. As you know by morphine yourself you can feel the discomfort if it is too much and the time my Mom felt overloaded she let me know because she was not actively dying but she was also in horrific pain at the time so the meds were needed. But personally I think you did the right thing to make her comfortable as she clearly was in a place to move on with her spirit. My Mom made me promise that she wouldn't suffer in the end and if she is dying I will make sure she is comfortable. My Dad died in a hospital and he was very comfortable with pain meds.

God bless you for allowing your Mom to die with dignity and with her family. I hope you will be comforted in your grief.

 
Old 08-27-2009, 07:13 AM   #9
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Re: 30 mg morphine every hour too much?

I am not for sure if it was the right thing or not, I still question it all beings my oldest brother and sister which did not have a relationship w/ my mom and actually my oldest sister had not spoken to my mom in several years was the ones making the decisions w/ her care and when I would ask questions they were never answered. Whether it be by my siblings or the medical people involved. All I would hear is this is the right choice...

I just have this terribly gut feeling that my mom would have had a chance and survived a lot longer w/ medications as I seem to be reading more and more about COPD and being that the doctor could not even tell me what the percentage my moms lungs were damaged and how much she could breath on her own, I do know that even after taking her off the machine for sleep apnea and the oxygen level only on 2, my mom was holding a 93% oxygen level, even w/ congestive heart failure her heart rate was steady as well, but the doctor and my oldest brother and sister kept saying well she is going to pass anyways and this way she has no suffering...I realize doctors will always give you the worse scenario but if there is medications out there to help people w/ COPD then why wasn't it mentioned when we met w/ the doctor. I think that is why I keep questioning the morphine and the dosage as to the quickening of her passing...All the puzzle pieces just don't fit together.....I am not angry that mother had passed so I know I am not feeling this way out of anger, but why does it keep bothering me?

Then there is a side to me that knows my mom is in a better place now and w/ people she loved that she missed. To know that her loneliness is over and that she didn't have to deal w/ any more medical problems, emotional unhappiness and she is not in any kind of discomfort....Maybe it is normal to bounce back and forth w/ these thoughts and emotions, I don't know....When my dad passed I never really gave it much thought beings I didn't really know him and did not have a relationship w/ him...but I just wish the gut feeling would go away w/ the high dosage of morphine that could have basically overdosed her....Is this normal to feel this way?

 
Old 08-28-2009, 02:10 AM   #10
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Re: 30 mg morphine every hour too much?

I think what matters is that these are your feelings and you would like to be at peace with them. And since you weren't allowed to be as involved as you wanted in the decision making I am see why you have questions. Was your mother in pain when she was prescribed the morphine? For example, my Mom had 20 mg morphine for breakthrough every hour a while back so the dose is figured out according to what the patient needs to bring the pain under control. Some people need hefty doses just to being the pain down cause they build up tolerance. Perhaps you could set up an appointment with the doctor and have some of your questions answered and that might help you understand.

Maybe also you are really missing your Mom and wish there was some way she could still be here. I am still a bit wondering myself how it will be when my Mom passes away and those final moments.

Karen4Mom

 
Old 12-29-2009, 09:24 AM   #11
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rekem HB User
Re: 30 mg morphine every hour too much?

Whether it is called passive euthanasia, comfort care or terminal sedation I would hope that I could pass without the pain of many people who are verbally unable to express their agony.

After watching my wife deteriorate after nine years of dementia with the last days absorbing morphine and ativan, I could only express my appreciation to the Hospice personnel who enable my spouse to pass without any noticeable pain. I have always thought it better to be in infinite tranquility than constant pain.

 
Old 05-03-2010, 09:45 AM   #12
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Re: 30 mg morphine every hour too much?

Quote:
Originally Posted by dolejaly View Post
My mom was on Hospice and as she suffered from Congestive heart failure and COPD she was in a lot of pain, towards the end the Dr. ordered her 30 mg of morphine every hour, liquid of course, wouldn't that of pushed to stop her heart and depress her breathing more so....almost like a assisted suicide in some factor or was that amount safe under the circumstances?

 
Old 05-03-2010, 10:00 AM   #13
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Re: 30 mg morphine every hour too much?

hi, never done this before but hope I can help put your mind at rest. my mum had similar conditions and given last rights several times before passing away - much faster than we thought and not able to get there on time. Seeing your loved one in pain is awful but the morphine does take the pain away. a very fine line when one is overmedicated but hospital my mum was in did not have advantage of hospice and specialists in this field. Everyone is dif. depending on weight and other medical complications. I have had morphine at much higher dose myself and it really helps - without it I couldnt have kept going! I dont have other conditions but no matter how quick (feel cheated of precious time at end) staff have to and do TRY to reduce pain Im glad they didnt keep dose down till we got there. If they can take even 1 minute of pain away its got to be worth it. Im sure your mum and other patients can hear you and know you are with them and love them. Be kind to yourself and concentrate on the relief she got.

 
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