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  • Morphine & Fentanyl For Emphysemia?

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    Old 03-09-2007, 10:24 AM   #1
    MuleKistWoman
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    Morphine & Fentanyl For Emphysemia?

    My mom is 78 yrs old and has had "bad" emphysemia for years and has been on oxygen constantly. She also has a "slow growing" growth on her lung that we SUSPECT is cancer,. She does not want to have a biopsy and her Dr agrees, reasoning that she is not a canidate for surgery. She also suffers from fibromyalgia. Althou she is not in any real, excrutiating pain, she does have respitory problems. Nonetheless, the Dr put her on liquid morphine and then, several moths later, on a fentanyl patch. Last week ma called 911 to go to the emergency room, mostly for depression (dad is dying at home on hospice care and its hitting her hard) When the admissions Dr at the hospital learned what medications she was on, she was shocked. It was her belief that morphine and the fentanyl patch should only be administered for pain or if someone were in their "end days". She stated her opinion that ma was being over-medicated, in any case, with liquid morphine AND the Fentanyl patch. I have also read that morphine should not be administered to anyone with breathing problems, period. The admissions Dr. took her off of the liquid morphine and reduced the strength of the patch from 50 to 25.
    Any input on prescribing morphine and fentanyl for someone with bad emphysemia,. please post! Thanks.

     
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    Old 03-09-2007, 06:23 PM   #2
    mworry
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    Re: Morphine & Fentanyl For Emphysemia?

    How end stage is her COPD? How are her ADL's and how does she get along?
    How advanced (the size,what type and where is the "spot" located) is her nodule? A biopsy is not always considered a surgery as it can even be done at bedside using a fiberoptic bronchoscope depending on it's location. Why does she not want to have this done? Some lung cancers are highly aggressive and can advance rather quickly. Had she discussed end of life desires with her doctor prior? I know that it is a common practice for doctors to give morphine and other pain medicines to patients who have terminal respiratory illnesses while in the hospital. The morphine works on the respiratory centers in the brain so that it tricks the body into thinking it is recieving enough oxygen. Breathing is less labored and more comfortable for the patient.
    Have you and your mother talked to the doctor whom prescribed these meds? I think that if you are concerned, you deserve to know why she put her on them. Just make sure you go with your mom, otherwise due to HIPPA you probably won't get any answers.
    COPD is irreversible and only progresses over time. The fact that she could possibly have "cancer" is also something you need to invest looking into further. I hate this for you and your family and I hope you find the answers and the comfort you are needing during this time in your life. Hugs to you.

     
    Old 03-09-2007, 09:15 PM   #3
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    Re: Morphine & Fentanyl For Emphysemia?

    Bless you Mworry for taking the time to give us your input. It really helps to get it from someone outside the family and who is going through it or has been through it themselves or with a loved one. I do not believe my mom is "end stage" ,....she gets around Ok if she takes her time and sometimes needs a walker. She only gets "winded" when pushing herself too hard trying to do stuff and rushing. I dont know what an "ADL" is, but I shall find out. She knows about the non-surgical biopsy procedure but chooses not to bother, as Dr. told her she is not a canidate for surgery (if needed) because of her age (78) and her compromised lungs. Nor do they think she would survive the chemo, if needed. So they do give morphine to respitory patients, under certain circumstances, huh? Sounds like for "end of life" patients. Maybe this IS something that we do need to discuss with her Dr. (in her presence, of course) Is he not telling us something? She is also on the fentanyl patch (25) and takes adavan and/or zoloft every day. I think the drugs and the depression are taking their toll on her. She hasent been herself for awhile and stays in her room most the time, and, away from my fathers bedside. Right now I am not sure if she is even speaking to me. What I been saying and my concerns over the direction of my fathers care is upsetting for her to hear. She says he is "going out" just fine as is. She dosent want me to "upset the apple cart" by saying, questioning or second-guessing anything. Remember, its her daughter (the gereatic nurse) that is in charge of their healthcare, and lives with them now. Any questions concerning the quality or direction of care is taken as an afront or challange to the status quo/plan they have set. But is that what we want for him? To die of dehydration? More importantly, is that what he wants for himself, to die of dehydration, not a heart attack as we all thought he would some day? I am for trying to re-hydrate him. Who knew he would last this long? Maybe it isnt his time to go. Hes in his 7 or 8th month of hospice. Its a terrible mess, and we (the family, 8 sisters & brother, and mom) are all so gosh darn sensitive we cant even discuss things without a BIG DRAMATIC outbreak of some sort each time. Someone always gets bent out of wack and storms out. Guess these things happen in familys going through things like this. Mom just hopes nothing so drastic happens as to have us not-speaking to each other for the rest of our lives when they are gone. Seems like our parents are the only thing holding us kids all together (all 8 of us) I am told we will have to work at staying close after they are gone. We shall see, I guess, soon enough.

     
    Old 03-09-2007, 10:54 PM   #4
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    Re: Morphine & Fentanyl For Emphysemia?

    I just kind of stumbled upon this thread. But was interested in what you had to say about the hospice care your father is getting. My mother passed away 11 years ago. She had had a cerebral hemmorage and was in a nursing home because of severe brain damage. She was paralyzed on one side and couldn't communicate very well. She was this way for 6 years. One day she decided to stop eating and drinking. I tried everything under the sun to get her to eat, even promising her all the ice cream and cookies she wanted. The nursing home suggested that we call hospice, because they thought that her body was shutting down. Hospice came in and gave us the option of hydrating her but also explained that in her condition, hydrating would only prolong her inevitable death. My mother didn't have a living will, so it was up to my sister and I to make that decidion. I think we knew her well enough to know that she was trying to tell us she was ready to go. So we chose not to hydrate or tube feed her. She last almost 14 days, but went very peaceful. There was no pain, no fluid on her lungs, no bloating = all which is typical of forced hydration or feeding. She just simply went to sleep. The nurse said her actual cause of death would heart failure due to lack of potassium because of the dehydration. I cannot thank hospice enough for explaining all of this to us and allowing my mother to die in such a peaceful way. I have no regrets at all. I hope this helps you make the hard decisions that you have to make. I pray you and your family peace and comfort during this time.
    Cindy

     
    Old 03-10-2007, 09:14 AM   #5
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    Re: Morphine & Fentanyl For Emphysemia?

    Dear Howitt44, thank you so much for your input. It does help me to understand the process. I am sorry for what you had to go through with your mom. It is nice to know, though, that she went peacefully. There are two differences I see here distinguishing your moms case with my fathers. First off, no one is telling him of the consequences of dehydration, or about his option to re-hydrate. Secondly, he dosent have a dibilitating, life threatning wasting disease like cancer, alheimers, etc, just a bad heart. Who knows how long he could live with the bad heart before it would quit on its own, as long as we kept him comfortable and hydrated? In my mind, he is not nor never was terminally ill. Are people with "weak" hearts or a history of "mini" heart attacks considered as terminally ill? I really dont know, but off hand, I would say not.

     
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