Post by Colleen-NC on Apr 15, 2008 8:24:40 GMT -5
I just read on another forum that some of them have morphine that they put into there nebulizer. I am curious as to why this is done. It is a very frightful experience when you feel like you cannot get any air but I was unaware there was a lot of pain. Is the morphine used mainly for panic you feel while you are fighting for your breath. What other things happen during the very end stages of this disease. This is something I don't believe has been covered on any of the threads.
I was told by my Pulmonologist I was at the end stage. I asked him exactly what that meant. He said my emphysema was very bad and if I sat around an didn't do anything I would die shortly. But he said if I decide to get up and carry on a normal life as much as I can I would live longer. He also said that exercising was going to be an important factor for me not only for my breathing but to strengthen my bones. I have osteoarthritis pretty bad as I'm sure most of us on the forum do.
Hopefully someone can give me a little inkling of what is to come.
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MarthaK
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Re: Morphine in Nebulizer
« Reply #1 on Mar 15, 2008, 10:25pm »
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I'm not exactly sure but I think you are probably referring to LarryGA who is in hospice and sharing his story. You must understand that Larry's lung function is about 8% or so and he has a very serious heart condition. In my opinion, his situation is somewhat unusual.
It is quite common to administer morphine to patients who are in the dying process. My mother was administered morphine in the final few days of her life. The morphine suppresses the feeling of breathlessness. It is not a drug for general use...for one thing, it's a controlled substance and addictive. Of course, if you're dying, who cares whether you get addicted.
Totally forget that hideous phrase "end stage". It is meaningless and only frightens people. It was generally used in the sense that there is not a whole lot more in my magic bag of tricks to prescribe for you. It does not mean you are in imminent peril of dying.
I can't tell you how to die with this disease...everyone is different. However, a respiratory therapist I know and trust tells me most die quite peacefully. I suspect most of us go out while in the midst of pneumonia or some such malady and have lots of meds to help us out.
For goodness sake, don't worry about it!!!! You could be hit by a truck tomorrow--OK, I know that's trite. But, the point is that we don't know and can't predict how we'll die. Your doctor is right about getting up and doing. It's better for you mentally, physically and spiritually.
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maryaz
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Re: Morphine in Nebulizer
« Reply #2 on Mar 15, 2008, 11:40pm »
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Linda, Your doctor put it better than a lot of them do. More often they say 'end stage' type statement, but neglect to tell them to keep moving. Martha is absolutely right with what she told you.
I was dx'd end stage, if you want to call it that, back in August 2002. Actually, I asked my doctor within a month of dx, just how long would I live. She actually used the getting hit by a truck. She said if I didn't get hit by a truck I should live at least 15 years. I am into year six right now. My FEV then was 24%. I don't know what it is right now. Nothing could change much to improve it.
I can lose weight if I could keep up the workouts and that would help. Working out more regularly would help. I think I am doing better with the Symbicort. Actually, I know am doing better. My numbers may be the same. My honest guess would be that my numbers would be 24% or lil less. I have no idea. I get enough out of life. I would like to have had it different but I am glad I am here.
Larry is doing a very nice thing, I think, by sharing his realistic journey. It will be of benefit to many and not all in a negative way. I think probably more die not in the pain. We were discussing this at the dinner table today. I brought it up. I shared what Larry posted and I reminded everyone of where I was almost 6 years ago. Had I died, I was in no pain. I was on a ventilator but not uncomfortable as they had me on so much morphine. I was not having problems breathing.
Martha, Could it be that Larry gets the feeling he does because he is trying to breath on his own and might otherwise use a ventilator. I know several people that just sort of slept away.
Linda, I know it can be scary. You need to be comfortable with your beliefs and go on and live for today and not worry about tomorrow. It is okay to ask but don't fret. Learn what you need to and go on.
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toby
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Re: Morphine in Nebulizer
« Reply #3 on Mar 16, 2008, 9:09am »
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I'm sorry. I guess I worded that all wrong. When my doctor told me I was "end-stage" I have to admit I was scared. I didn't have a computer yet and really had no idea what it meant. He told me to go home and live my life normally. Once I got my computer I researched that phrase and there was someone that posted somewhere her opinion on end-stage. She was a NP and a care-giver to someone with emphysema. After I read that very long post I didn't think about it hardly at all. What she said made a lot of sense to me.
Putting morphine in the nebulizer was something I had never read anywhere until recently. (Yes, it was Larry's experience with hospice that I read that.) Experiences I have had with morphine were not the best to say the least. Also, I have spoke to people that have watched a loved one die with our disease and their description of how it was going to be also scared me. One thing I am not doing is sitting around waiting to die, I refuse to do that. My doctor told me to keep active and that has been what I'm doing. Sometimes you read something that concerns us or confuses us and that is what I love about the forum. We are able to ask questions and receive answers. Curiousity is normal, obsessing isn't. I was curious not obsessing.
Thank you both.
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Pennypa
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Re: Morphine in Nebulizer
« Reply #4 on Mar 16, 2008, 11:55am »
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Linda, the actual 'dying' part WAS probably much harder on those who were watching a loved one die than on the loved one themselves. As far as the morphine goes, I LOVED it! Of course, I got sick as it was wearing off but while I had it (kidney stones), I had no pain...and that was most good, LOL.
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frilly
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Re: Morphine in Nebulizer
« Reply #5 on Mar 16, 2008, 6:23pm »
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Linda,
Those of us that have taken care of, and watched loved one's die of this disease probably have the worse thoughts of what end stage COPD will deal us, but as already mentioned - it's probably our thoughts as to what they went through in the end, not what they felt they went through it.
Thinking about dying is scary....but inevitably we will all die from something. I don't play any mental games with living - I don't play any games with dying. I certainly realize that I could have avoided some of the "bad habits" that have contributed to my lung function, but many of my medical situations were not what I could have controlled.
I know nothing about inhaled morphine, I do know that morphine has been my choice in my PCA machine during many medical situations.
Hugs
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toby
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Re: Morphine in Nebulizer
« Reply #6 on Mar 16, 2008, 7:48pm »
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One thing I am going to say is I'm not sitting here waiting for the end, when it comes it comes. I might not take morphine, but any other narcotic you bet your life I will! (LOL)
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toby
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Re: Morphine in Nebulizer
« Reply #7 on Mar 17, 2008, 2:37pm »
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I googled this yesterday and couldn't find anything to explain why the nebulizer was used for morphine but today I worded it differently and came up with this:
The exact mechanism by which opioids palliate dyspneais unclear. The drugs' cardiovascular effects are thought to be most likely responsible for relieving dyspnea.[3] Therapeutic doses of opioids produce peripheral vasodilation, reduce peripheral vascular resistance, and inhibit baro receptor responses; they also decrease brainstem responsiveness to carbon dioxide (the primary mechanism of opioid induced respiratory depression) and lessen the reflex vasoconstriction caused by increased blood PCO2levels so that the perception of dyspnea is reduced. Furthermore, opioids reduce the anxiety associated with dyspnea. There is also speculation that they may act directly on opioid receptors present in the airways.[4]
The nebulization of opioids delivers medication directly into the airways and hence into the pulmonary circulation. Hepatic first-pass metabolism is avoided, and this route has been advocated as causing fewer adverse reactions, such as drowsiness, nausea, vomiting, and constipation.
There was a lot more to the article but this answered my question the best.
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charles
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Re: Morphine in Nebulizer
« Reply #8 on Mar 19, 2008, 9:18pm »
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I have been on hospice and they use morphine for sob--but until now I had not heard of it being used in a nebulizer.
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I was told by my Pulmonologist I was at the end stage. I asked him exactly what that meant. He said my emphysema was very bad and if I sat around an didn't do anything I would die shortly. But he said if I decide to get up and carry on a normal life as much as I can I would live longer. He also said that exercising was going to be an important factor for me not only for my breathing but to strengthen my bones. I have osteoarthritis pretty bad as I'm sure most of us on the forum do.
Hopefully someone can give me a little inkling of what is to come.
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MarthaK
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Re: Morphine in Nebulizer
« Reply #1 on Mar 15, 2008, 10:25pm »
--------------------------------------------------------------------------------
I'm not exactly sure but I think you are probably referring to LarryGA who is in hospice and sharing his story. You must understand that Larry's lung function is about 8% or so and he has a very serious heart condition. In my opinion, his situation is somewhat unusual.
It is quite common to administer morphine to patients who are in the dying process. My mother was administered morphine in the final few days of her life. The morphine suppresses the feeling of breathlessness. It is not a drug for general use...for one thing, it's a controlled substance and addictive. Of course, if you're dying, who cares whether you get addicted.
Totally forget that hideous phrase "end stage". It is meaningless and only frightens people. It was generally used in the sense that there is not a whole lot more in my magic bag of tricks to prescribe for you. It does not mean you are in imminent peril of dying.
I can't tell you how to die with this disease...everyone is different. However, a respiratory therapist I know and trust tells me most die quite peacefully. I suspect most of us go out while in the midst of pneumonia or some such malady and have lots of meds to help us out.
For goodness sake, don't worry about it!!!! You could be hit by a truck tomorrow--OK, I know that's trite. But, the point is that we don't know and can't predict how we'll die. Your doctor is right about getting up and doing. It's better for you mentally, physically and spiritually.
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maryaz
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Re: Morphine in Nebulizer
« Reply #2 on Mar 15, 2008, 11:40pm »
--------------------------------------------------------------------------------
Linda, Your doctor put it better than a lot of them do. More often they say 'end stage' type statement, but neglect to tell them to keep moving. Martha is absolutely right with what she told you.
I was dx'd end stage, if you want to call it that, back in August 2002. Actually, I asked my doctor within a month of dx, just how long would I live. She actually used the getting hit by a truck. She said if I didn't get hit by a truck I should live at least 15 years. I am into year six right now. My FEV then was 24%. I don't know what it is right now. Nothing could change much to improve it.
I can lose weight if I could keep up the workouts and that would help. Working out more regularly would help. I think I am doing better with the Symbicort. Actually, I know am doing better. My numbers may be the same. My honest guess would be that my numbers would be 24% or lil less. I have no idea. I get enough out of life. I would like to have had it different but I am glad I am here.
Larry is doing a very nice thing, I think, by sharing his realistic journey. It will be of benefit to many and not all in a negative way. I think probably more die not in the pain. We were discussing this at the dinner table today. I brought it up. I shared what Larry posted and I reminded everyone of where I was almost 6 years ago. Had I died, I was in no pain. I was on a ventilator but not uncomfortable as they had me on so much morphine. I was not having problems breathing.
Martha, Could it be that Larry gets the feeling he does because he is trying to breath on his own and might otherwise use a ventilator. I know several people that just sort of slept away.
Linda, I know it can be scary. You need to be comfortable with your beliefs and go on and live for today and not worry about tomorrow. It is okay to ask but don't fret. Learn what you need to and go on.
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toby
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Re: Morphine in Nebulizer
« Reply #3 on Mar 16, 2008, 9:09am »
--------------------------------------------------------------------------------
I'm sorry. I guess I worded that all wrong. When my doctor told me I was "end-stage" I have to admit I was scared. I didn't have a computer yet and really had no idea what it meant. He told me to go home and live my life normally. Once I got my computer I researched that phrase and there was someone that posted somewhere her opinion on end-stage. She was a NP and a care-giver to someone with emphysema. After I read that very long post I didn't think about it hardly at all. What she said made a lot of sense to me.
Putting morphine in the nebulizer was something I had never read anywhere until recently. (Yes, it was Larry's experience with hospice that I read that.) Experiences I have had with morphine were not the best to say the least. Also, I have spoke to people that have watched a loved one die with our disease and their description of how it was going to be also scared me. One thing I am not doing is sitting around waiting to die, I refuse to do that. My doctor told me to keep active and that has been what I'm doing. Sometimes you read something that concerns us or confuses us and that is what I love about the forum. We are able to ask questions and receive answers. Curiousity is normal, obsessing isn't. I was curious not obsessing.
Thank you both.
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Pennypa
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Re: Morphine in Nebulizer
« Reply #4 on Mar 16, 2008, 11:55am »
--------------------------------------------------------------------------------
Linda, the actual 'dying' part WAS probably much harder on those who were watching a loved one die than on the loved one themselves. As far as the morphine goes, I LOVED it! Of course, I got sick as it was wearing off but while I had it (kidney stones), I had no pain...and that was most good, LOL.
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frilly
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Re: Morphine in Nebulizer
« Reply #5 on Mar 16, 2008, 6:23pm »
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Linda,
Those of us that have taken care of, and watched loved one's die of this disease probably have the worse thoughts of what end stage COPD will deal us, but as already mentioned - it's probably our thoughts as to what they went through in the end, not what they felt they went through it.
Thinking about dying is scary....but inevitably we will all die from something. I don't play any mental games with living - I don't play any games with dying. I certainly realize that I could have avoided some of the "bad habits" that have contributed to my lung function, but many of my medical situations were not what I could have controlled.
I know nothing about inhaled morphine, I do know that morphine has been my choice in my PCA machine during many medical situations.
Hugs
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toby
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Re: Morphine in Nebulizer
« Reply #6 on Mar 16, 2008, 7:48pm »
--------------------------------------------------------------------------------
One thing I am going to say is I'm not sitting here waiting for the end, when it comes it comes. I might not take morphine, but any other narcotic you bet your life I will! (LOL)
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toby
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Re: Morphine in Nebulizer
« Reply #7 on Mar 17, 2008, 2:37pm »
--------------------------------------------------------------------------------
I googled this yesterday and couldn't find anything to explain why the nebulizer was used for morphine but today I worded it differently and came up with this:
The exact mechanism by which opioids palliate dyspneais unclear. The drugs' cardiovascular effects are thought to be most likely responsible for relieving dyspnea.[3] Therapeutic doses of opioids produce peripheral vasodilation, reduce peripheral vascular resistance, and inhibit baro receptor responses; they also decrease brainstem responsiveness to carbon dioxide (the primary mechanism of opioid induced respiratory depression) and lessen the reflex vasoconstriction caused by increased blood PCO2levels so that the perception of dyspnea is reduced. Furthermore, opioids reduce the anxiety associated with dyspnea. There is also speculation that they may act directly on opioid receptors present in the airways.[4]
The nebulization of opioids delivers medication directly into the airways and hence into the pulmonary circulation. Hepatic first-pass metabolism is avoided, and this route has been advocated as causing fewer adverse reactions, such as drowsiness, nausea, vomiting, and constipation.
There was a lot more to the article but this answered my question the best.
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charles
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Re: Morphine in Nebulizer
« Reply #8 on Mar 19, 2008, 9:18pm »
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I have been on hospice and they use morphine for sob--but until now I had not heard of it being used in a nebulizer.
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