My Mother's doctor has her on Morphine and I'm afraid it's too high of a dose?

My FIL was in the hospital with one of MANY stays with his chronic lymphocytic leukemia. He got bad one night, the family was called and we were told he wouldn't make the night. Well, he rallied, ate some soup, chatted with us all and we thought "OK, he's going to shake this again--amazing" and went home. 6;30 am the next day we got the call he was comatose, Ran back to the hospital and his doc was there, dad was totally unresponsive. Doc told us he would not possibly come back from this, his lung were filling with fluid faster than they could drain them, his red blood count was negligible and there was no way he was making it out of this. The doc asked if he could give him some morphine to ease his breathing (it was so horrible to hear that painful rasping for each breath) His kids agreed. The nurses had gotten dad all cleaned up, and the dr went to the IV line and put the biggest syringe of morphine in dad's IV. He did it with his back turned, so my hubby and his sis didn't see, but I did. He left us and said he'd hang around the hospital until the end. My hubs said "But that could take all day"--15 minutes later, at the most, I quietly said to my hubby "honey, your dad is gone". Dad went peacefully and calmly, not fighting for each breath.
I THANKED that gracious dr and he said "I just gave him comfort", Did he OD dad on morphine? I couldn't swear to it, but it is highly unusual for drs to administer actual pain relievers.

This kind of thing happens all the time. I was aware of the drs intent and I kept my mouth shut. Dad had suffered enough. His dr was an oncologist and he eventually loses all his patients. I think trust in your dr is paramount.

To "Llama lover47", the survey was sent from the hospice's headquarters out of state, not directly from the hospice we used. As for my phone #, the survey had a place to put it if I chose, besides, why wouldn't I want my phone # to be given to the headquarters? My hope was that the headquarters would forward my complaints to this local hospice, and somebody would contact me about coming in for a discussion.

Lassie: You're right on point. Heroin is coming across the borders in major quantities. We need the elected President to make this his #1 priority!

I regret to say that the CDC has now recommended doctors cut way back on prescribing painkillers. The CDC has recommended doctors prescribe OTC ibuprofen, exercise, etc. before prescribing painkillers. The CDC thinks doctors hand out painkillers, are getting the entire nation addicted, and then when cut off for being 'drug seekers', the people are forced to go out and buy cheaper heroin....This is all very well, they have a point, and the unfortunate junkies won't care because, heroin. I fear when our loved ones (and ourselves someday), are in terrible pain, we can expect to be told to take aspirin, practice deep breathing, and go to our mental 'happy place'. Isn't that a lovely prospect?

All good comments about how morphine can relieve her pain. Yet, I hear your concern and wonder if part of it is because she is not as aware as you might like her to be? Maybe I'm projecting my own experience ? When Mom was in hospital and in dying process she was in pain from multiple health problems. DR. gave her intravenous morphine (with my father's consent),and by the time I got there (I lived 1500 miles away), Mom was basically in a coma from the medication. She lived another 8 days, even after Dad, Dr. and I had made the difficult decision to withdraw food and water - My 90 yr old Dad left this decision to me and I asked the Dr. and he recommended it. Anyway, I never got to say goodbye to my Mom or hear from her as she was really out of it in morphine. This may not be your situation at all. But just make sure you consult with Dr. and family and get all the information you can about her situation. So that you can make a clear decision and not regret it like I regret my situation (i.e. Why I never asked the DR. why he had my Mom on such a high dose of morphine).

sdnbishop...im sure it was extremely hard for you to watch you husband die...BUT...it's even harder for someone to keep living for longer lengths of time in that condition. i don't think anyone wants to live longer than necessary when the end comes. it's mercy from above that takes them sooner than later! said with lots of love...my mother is on her death bed now...and it's killing me too...i adore her...she was the best mother ever. hope god takes her soooooon! extreme dementia is taking her life.

I'm with you Lassie!

I'm sorry, sdnbishop,that you think there was some malfeasance. It's POSSIBLE. But I don't know that you could prove anything, no matter what some worker with an agenda would whisper to you.....If your loved one passed away in peace, NOT in agony, I'm sorry, I would be grateful for that (I live in terror in another 10-15 years when my time is up, I will be told 'take 2 aspirin, do some mindful deep breathing, we can't give you sh*t to relieve your pain because so many raving junkies highjacked the drugz so they could walk around sh*tfaced 24-7, and so we can't give out painkillers any more. Forbidden..Verboten. Because, junkies.)

What I keep hearing from pain doctors is that opioids used for pain relief do not lead to addiction the way they do if used "for recreation." I certainly don't get high from taking 4mg of Hydromorphone q. 6 hrs. to manage my chronic pain. I get better relief from this drug (aka Dilaudid) than I ever did from Percocet, which contains acetominophen, which is dangerous for the liver.

Sdnbishop: What survey and why did you include your phone #?

Muffincat, you gave an excellent, very complex and complete answer! Thank you!
To the OP, yes, I would definitely take your questions to the Dr, but I expect that you will get much the same answers. My Mother died very comfortably with a lot of morphine on board, but she was in a significant amount of pain from Cancer, and her body was shutting down. When my own MIL, was in Hospital with Pneumonia, complications from Severe COPD, the Drs and staff, gave her Morphine to ease her breathing, and she did pass away. COPD, is a very difficult disease to watch a loved one to die from, and its very difficult to watch them struggle to breathe. You should not at all be worried about addiction, but relieved to see her breathing easier, even if they are loopy and or asleep a lot of the time. It takes them so much effort to breathe, that they are often exhausted anyways. Please do everything you can do to keep her comfortable, despite your being uncomfortable with the drug. Ask Her how she feels, and if she is breathing more easier on it, and then go to the Dr with your concerns. Good luck and God bless you and your Mom!

I did meet with the Social Worker from hospice who is the one who spoke with me first about my husband's being transferred. She basically said I need to take it up with the person on duty that night. A survey came in the mail, so I took full advantage of it to express my feelings. I included my phone #, but haven't heard a thing back from them. The entire hospice experience was a nightmare! A hospice nurse confidentially told me the reason the hospital wanted to get my husband "out of there" and transferred to hospice so quickly was that it reflects negatively on the hospital's ratings. No one questions why "X" number of patients die in hospice, but the number of patients dying in the hospital lowers the hospital's ratings. The drug my husband was given is a derivative of morphine. It's Roxanol, a pinkish liquid. I requested a copy of all reports, notes, etc. that hospice had on my husband, but info was sketchy. He had pleural effusion which the oncologist said was from the chemo. His fluid was drained every other day. Breathing was becoming more and more difficult, and I'm not that inhumane to want him to suffer. But I can not rid myself of this worry. I just have this "gut" feeling that things weren't on the up and up. We were totally ignored, and no one explained what was happening. My husband had lost a great deal of weight and was about 155-160 lbs. and 5' 6" and was 68 yrs. old. Thank you for your kindness in replying.

Any morphine can send an elder into bad hallucinations.

Sdnbishop. I am sorry that the death of your husband has left you with doubts. I will not stand up for the hospice. but can only say from the experiences I have observed and played a part in, that would be unusual
I do know that a person can be chatting really weill with the reles that have just got in from overseas, and much hilarity and 'life' happening in the room.. then family decide to go for a meal, the person has a rest, and wham bam, go in to see that all is OK, to find them in their final breaths, and semi comatose. In one case the family had reunited that afternoon, so since everything seemed great they went out to a restaurant for dinner. I called the daughter about 7pm to say Hey dad isnt so great but could come out of it he might just be very exhausted.. then call them at 8.10 to say sorry but he has passed away. So they all trooped back up to the hospital. I can say that he wasnt given anything I was the only RN on and I had the keys to the medicine cabinet.
For those with breathing problems like increased phlegm. tightness then its 2-5mg depending on size of patient.
Did you meet with the team after to voice your concerns, and maybe get an explanation as to why that nurse gave it , and exactly how much.

Doctors do expect you to tell them that you think the dose is too high and she is getting loopy or cannot walk well enough. The dose tolerance varies for individuals, and there is no set dose for a weight or age. Its always a matter of trying to strike a balance between benefit and side effects.

You needed to call her doctor. I would think, like other meds, it depends on the person and what they can tolerate.

Sdnbishou, sorry to hear abiut your husband

Sorry i did not know the situation....wishing u the best

I seem to have a different opinion than the others. My husband was in the end stage of prostate cancer and was in the hospital. One day when I returned to his room, he remarked, "They want to put me on morphine!" ( as if there's no way they are going to do that to me.) A few days later his condition started going more downhill, yet I still never recall his saying he was in pain. That night they wanted to send him to hospice, although I wasn't ready for that. My husband could speak some and could sit up somewhat and was somewhat coherent. That night at hospice the nurse gave him morphine "to help with his breathing". Not too long after the morphine, my husband's demeanor changed completely. He became almost comatose, stared at the ceiling, didn't talk or move, just laid there on the hospice bed like a mummy. He passed away early the next morning. My suspicion was hospice wanted to help him along with his dying process. I definitely feel that was their intention in giving him morphine. Comments?

Mariamaria--
This is end-stage COPD we're talking about. Addiction isn't a worry. Keeping the patient comfortable is all they're doing. BTW, My SIL hallucinates on 200 mgs of IBUPROFEN, so everyone's ability to stand drugs is very, very different.

We hear "morphine" and freak out--it's a terrific drug at doing to do what it's meant. All my daddy "ate" the last week of his life was two cherry popsicles and constant morphine drops. Thank goodness he was out of pain, is all I can say.

I would voice my concern, but than my preference would be to take non addictive pain killers since they dont mess with mental capacity...since i dont know if non addictive pain killers would evan help her.. .i would tell the doctor....please only use when necessary at mimimoum quantity possible...one after an opration, my mom was afraid the boogie man would get her...it was kind of funny but i told the nurse...if possible no more strong pain killers if possible...i understand your concern...

Both my father and brother died from complications of COPD and its so hard to see a loved one having trouble with breathing. My brother was in hospice and my father died in the hospital before entering hospice. When ever you have concerns you should be able to address the hospice and DR that you feel uneasy about your mom being over medication with the morphine. Of course the increase of such a drug will cause these side effects and why are they increasing and your concerns about how unsteady and somewhat incoherent your loved one is. I am not aware of your whole situation but I do wish you all the luck.

First how much morphine and by what route as others have asked. pill, injection subcut, or continuous subcut.
Second. how much does she weigh and has she been on morphine for some time. third... you are worried, but why.. is it because its morphine ??? or what its doing to her
I used to do palliative and long term care for a few years.
Morphine is great stuff, and forget the movies where its used to knock folk off, it has many uses
1. it relaxes the breathing muscles including the bronchii, which means instead of needing a steam engine to get the air out, it will fall out with just a tricycle of effort, by opening them.. it relaxes the skeletal muscles used for breathing, hence it will allow her to drop her shoulders, let her straighten up, and get some sleep
2. it will sedate her but usually after a week most patients get used to it and start waking up for longer spells
3 if she has cardiac problems to go along with her COPD then it also relaxes the main branch supply vessels and eases the work of the poor pump.
so yes that is why morphine in a dose that is tolerated is given.
the bad things are constipation as mentioned.. giving too much and going from relaxing to reducing respiratory action.
then the usual nausea, vomiting and confusion.... they are controlled by reduction in amount etc
I was often horrified how relatives would scream what on morphine when we started it.. they thought I was about to knock off their relative there and then.. and so much time was wasted in explaining that it has it uses. as well as its abuses.!!!
so work out what your worry is all about, and go from there
Now 95% of the COPD cases Ive cared for in their final months would all say, relieve my breathing. they have no QOL they have no interests as its a case of them focusing on their breathing both in and out........ not a life at all. So put aside your fears/worries....... and look at your mother, is she better for it.
Were you concerned when she smoked with the 35 chemicals that were all killers??
Morphine wont cure her, but it will make her days better
I , BTW am highly allergic to the stuff, so not selling it as such only the idea that it can help

I would think the doctor would know what he's doing, not that you shouldn't question him, for sure! He could explain why he recommends it, if you do ask. I know it's a terribly difficult thing. My father died of lung cancer and sort of went into a coma near the end. His breathing sounded labored and bad, and we asked the doctor if this was normal. He said it was, and he took quite a bit of time to explain the dying process to us... (I only hope when it is my turn to go, they anesthesize ME very well indeed, I will probably be alone - I certainly don't want to be alert and die in labored pain!)...Bless you and your mom, I wish you both well.

I would just give it more time. The benefits most likely out weigh the other things. She will get use to it once she takes awhile, and it is built up in her system. If your still uncomfortable with it in another week then asking for it to be reduced sounds like a good idea. Prayers for your mom;-)

It is hard watching your Mom go through the final stages of life with this dis ease. I have been there, and has the same thoughts. I gave her less morphine and tried to keep her as aware as possible, but as she got less and less oxygen to her brain, and things shut down, it gets harder and the pain gets extreme...morphine keeps them comfortable and peaceful.

Wow! I am hesitant to chime in, but do make your concern known to as many doctors as are involved. Over a period of two years I have seen my husband with severe COPD go from sleeping 22 hours a day, shallow breathing, with an unresponsive episode, to being alert, walking with a walker, and even using a tablet to look up info. on the internet. Along the way he broke hip, survived surgery against the odds, and recovered from three weeks in the hospital with pneumonia. His up side has lasted eleven months now. And it all started when a young doc in the emergency room said lets get him off the morphine and see what happens. A miracle? Maybe. I tend to think that the fall from being on the morphine was a painful blessing in disguise. But, I do not know the details of your situation. I do encourage everyone to keep asking. Someone might listen.

there could never be enough morphine if you are pain and dying

Morphine WILL make her tired and "loopy"..it will also make her breathing less painful. End stage COPD is horrible. The fight for every breath....poor thing.

I agree, drs are being so stingy with pain meds that they are finding that people are just living with unbearable, yet treatable pain now. Trust the dr. Ask more questions, we aren't getting enough info from you to really make any helpful comments.

Oh, important--try Senna. Pooping gets difficult with opiates.