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Need input about Morphine

Discussion in 'Random Discussion' started by pyritechips, Oct 3, 2003.

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  1. pyritechips

    pyritechips Gone but Never Forgotten Thread Starter

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    Jim
    As some of you may know, my Dad is in an advanced stage of terminal lung cancer: small cell extensive. Of course a major problem is the constant pain. He has 2 different scripts of morphine to deal with it.

    One script is for 5 mg and the other is 15 mg. His dosages are:

    Morning: 2 x 15 mg.

    Evening: 2 x 15 mg.

    In between he can have 1 x 5 mg. up to 3 consecutive hours.

    Question 1: How "heavy" are these doses, as I have no experience with them. They make him feel dopey, and he says "slow".

    Question 2: How much and how often can morphine be taken before it becomes addictive? How will I know he is really in pain; ie. he needs the drug more than he need relief?

    Any info on cancer and the effects of morphine is appreciated. And please don't post links; I have plently of literature already but what I want is personal experiences.

    Thanking you in advance,
    ~Jim
     
  2. CyBerAliEn

    CyBerAliEn

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    Well I will attempt to say what I can best recall from my memory when my grandfather was dealing with cancer...


    I don't remember how much he was on (or how "much" the dose your father is taking), but it did make have an effect on my grandfather. Generally, in a case like cancer, they will give you as much morphine is as needed to relieve the pain, no matter the amount. Really, any amount of morphine is addictive. But considering when they decide to use morphine for cancer in most cases, they do it because it is the only thing they can do, so they do what they can to relieve the pain as much as possible. I also really hate to say, but it isn't going to matter if he becomes addicted or not if he is having to take morphine to ease the pain, since usually when it comes down to the point it is because the only thing they can do is relieve the pain.

    Hopefully the above will help you and/or make sense. I'm also sorry to hear about the current situation.

    My advice: if HE WANTS morphine, give it to him.

    He should have as much relief from the pain as possible considering the situation (I'm sure you know what I am getting at, but I really don't want to say it). And as noted, it won't matter if he becomes addicted or not due to the situation.

    Good luck to you and your father Jim! :)
     
  3. hotskates

    hotskates

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    My grandma is on morphine too, lots and lots of it, she is 90 and fades in and out "socially", but we know she is in "no pain" which is some comfort. She has dimensha, and a heart condition and arthritis.......... so, at this point morphine is the drug of comfort. To us and her. One thing that comforts me is that she is in "no pain". When we ask her how she's feeling, she always says, "great". We know its from the morphine.

    I don't know if this will help you Jim, but I hope so.
     
  4. mobo

    mobo

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  5. CyBerAliEn

    CyBerAliEn

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    I just looked over your doses again, and I do believe the doses my grandfather were on were a bit higher or so.

    And my grandmother, who was also a nurse (not at the time, use to be when she was young; and is now a pharmacist), said that he was extremely OVER medicated; but it was needed to relieve the pain.

    As I recall.... he took a pill in the morning (big dosage), and another big dosage at night before going to bed. During the day, if he was hurting or in pain, I believe he would take a 5mg pill, or as many as needed, until he wasn't hurting.
     
  6. angelize56

    angelize56 Always remembered in our hearts

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    Jim: The patients I took care of were on Fentanyl patches. Has your Dad's Dr considered them over the morphine?

    Question 1: How "heavy" are these doses, as I have no experience with them. They make him feel dopey, and he says "slow".
    A-In my experience those are not too heavy of a dose. When my patients were on morphine, we needed to assess their pain level frequently and contact the Dr to increase the dose as necessary because the patients become tolerant to the dose eventually and it didn't control their pain well.

    Question 2: How much and how often can morphine be taken before it becomes addictive? How will I know he is really in pain; ie. he needs the drug more than he need relief?
    A-I've not seen any of my former patients become addicted. The majority were eventually placed on Fentanyl patches. I honestly think you will be able to judge when he is in pain when he can no longer tell you so Jim. A problem I noticed with the narcotic usage was the patients got really "snowed under" and could not communicate with their families. I believe towards the end this is a blessing. But you need to work out with your Dad and Dr a dose that keeps your Dad comfortable and able to communicate with you and your family until or unless the pain becomes unbearable. It's imperative to ease all the pain one can with cancer. Towards the end the patch is a great alternative if your Dad becomes unable to take meds by mouth.

    If I were in your situation Jim. I'd make sure I talked to my Dad and Dr about controlling the pain in a way that he is not so drugged up he can't communicate, and at the same time discuss the meds needed if Dad were to get severe or uncontrolled pain. Don't worry too much on the addiction factor....the Dr will know the proper doses to maintain your Dad's comfort. I'm so sorry your Dad and you have to go through this Jim. This is the part I dislike about being a nurse...I know what to expect.

    Take care and hope this helped a little. Marlene *HUGS*
     
  7. pyritechips

    pyritechips Gone but Never Forgotten Thread Starter

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    Thanks for all the input Mobo, Cyber and Marlene.

    So far he is still quite alert mentally. I have been grilling him about his sailing experiences, which I will eventually write up into a small essay. He is definitely "slow" but I haven't witnessed any incoherent behaviouor.

    I suppose addiction is not the main issue here but it is in a way. I will give my Dad as much morphine as it takes to give him comfort. I don't believe that I will ever give him enough to endanger him. I can imagine the worse-case scenario: I give him too much and it causes a premature death, then the authorities decided to persue the matter. If that ever happened the sense of grief and guilt would drive me over the edge. But that is all hyothetical; long before he needs potentially lethal doses he will be in better hands than mine.

    I wish him only peace.
     
  8. angelize56

    angelize56 Always remembered in our hearts

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    We all wish him peace Jim.

    Are you considering hospice care at all so your Dad can stay home? They have that in Canada too right?
     
  9. pyritechips

    pyritechips Gone but Never Forgotten Thread Starter

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    Hello Marlene:

    Yes he is home and being monitored by what here is called HomeCare. A RN comes around and makes sure the patient and family understands all the medications (he has several). She also checks his mental alertness, blood pressure and oxygen level.

    I had to call the RN the other day because he had taken his morning doses but suddenly experienced pain that scared me in its intensity. SO i called after giving him an extra 15 mg. The nurse came the next day and called the doctor and had his doses upped.

    Next week he begins round 2 of his chemo. I fear that if it hits him as hard as his first round he will end up bed-ridden or in hospital. At best his prognosis is only a few months to live so I don't expect him to see the new year.
     
  10. angelize56

    angelize56 Always remembered in our hearts

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    :( So sad Jim. Would you feel better off at the end if he were in the hospital? In a way I would...but I know what will be involved in his care. It's hard on a family. Has he said if he wanted to be at home for the end...or doesn't he discuss that yet? I feel so bad for him and you and your Mom. :( Chemo can be so devastating! I'm not sure I'd accept it if I needed it Jim. May I never have to make that choice. :( God bless you all in whatever decisions you make. You take care of yourself too Jim! Marlene
     
  11. CyBerAliEn

    CyBerAliEn

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    My grandfather had hospice care once we learned that the chemo wasn't helping. They never actually did any "care"... but they sort of helped arrange everything for the inevitable in terms of my grandfather sort of being as mentally and emotionally prepared.

    He was kept at home the whole time. He passed away at home.

    As I noted in chat in the past Jim, the chemo was the worst the first time my grandfather went through it. When he went through chemo, he was usually feeling pretty good just going in, would go in, and come out feeling really weak (this is simply because of what the chemo does to your body, it is completely natural to be really tired and weak after chemo). The first week or so following chemo, he was generally pretty weak and all. The following week it would really improve, and the following week after that he would feel pretty normal, and then the following week he'd go back in for another round of chemo (a full five days strapped up to a constant chemo drip or whatever in the hospital).

    I'm sure you'll notice a slight increase in how he feels after the second round of chemo and each chemo round to follow should not effect him as badly. However, if the cancer is in progressed state, you might not really notice a difference, or he may get worse; even more so if he is extremely weak right now. Generally they want to do chemo when you are as strong as possible (while doing the chemo as soon as possible), because taking the chemo just sort of rips away your strength. If your weak going in, your not going to be well off coming out of the chemo (although it should not be serious in terms of life or death), but you will feel extremely more weak and tired and the effects of the "weakness" will last longer.

    Likely due to the cancer your father has, he is probably being treated along the same or similar lines as to how my grandfather was treated; so hopefully my (or my grandfather's) experience might be of help, and possibly, comfort, to you.

    Also understand the first time through chemo, your not use to the effects it has on a person. As he goes through additional rounds of chemo, you'll eventually, sort of sadly to say, get use to the situation.


    Andrew
     
  12. eggplant43

    eggplant43 A True Heart and Soul - Gone But Never Forgotten

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    I've been where you are, and I respect you for what you are doing. It won't be easy, but I think it will be worth it for both of you. You've both been given the gift of being together in his last days, lots of people don't get to do this.

    I lost one of my best friends several weeks ago to cancer, and will share some of what I learned.

    Last year I was visiting, and Iris said "Bruce, I'm hurting, do you think I should call the Dr?" I'd known her for twenty fives years, and never once heard her complain. So I told her yes. She looked in the phone book, but could not find the Dr. She was in the wrong town, so I got her to the right page and she called the Dr. He told us to go to the ER. I told the nurse that Iris who was a very bright person with a Masters Degree wasn't thinking well.

    The next day I was visiting her in the hospital, she was on an IV drip, and could have no more than 15mg every 7 minutes, so I don't think your dads dosage is anywhere near high. We were told this was enough to kill any of us. A nurse came by who knew a lot about pain management, and explained the situation to us. First she explained that when a person is dealing with extreme pain, that their systems begin to shut down in order to deal with the pain. That's why Iris couldn't think straight. Secondly she said there was a real art to pain management, and that when the medication was dispensed by a knowledgeable pain management Dr. you could eliminate pain with a very small dosage.

    After she was discharged, she was fitted with a drug dispenser that applied the drug to a specific site. There was a supply within the unit, that needed to be renewed periodically. The first time it was renewed she had only used 3mg of the 15, and had been pain free. So perhaps a consult is in order if that is possible.

    Hope some of this might help. Secondly, I'd ask any of the nurses that are involved with him what they can tell you based upon their previous experience. there's a whole reservoir of knowledge there. Hope some of this may be of help.

    One last piece of advice. Take care of yourself, because you can't take care of your dad, if you're not taking care of yourself. Seen it too many times.
     
  13. john1

    john1

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    Hi Pyritechips,

    Sorry to hear about your dad.
    My dad died from cancer some years ago now.

    John.
     
  14. Servant of Eru

    Servant of Eru

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    Really sorry to hear about that Jim (it is Ok if I call you that?).

    On a side note. You wouldn't believe how hard it is to get the bastiges at the insurance companies to actually pay for the in home care! My mom's had to have it for over three months now, and we've been forking over the dough for it; even though the sum of it per week almost equals what my dad makes. To the detriment of my dad's and my family's finances. To make things worse, the money that I worked for over two years to make they took because it belonged to the "family." Even though my dad tried to save it by hiding it in an insurance policy that we should have had a return from that was abou the same amount, it looks like somehow the return was lost; and along with it, my best hope at getting a first payment on college, buying a car, or a new 'puter (to replace the "laptop" that overheats if I have the keyboard in it!:rolleyes:)! I have a serious loathing for those damn fookers over at Medical! :mad:

    Anyway, I'm sorry to hear that about your dad Jim. Depending on how long he's had it, it's really better this way. My grandpa (I'm his namesake BTW) was in the hospital for almost six months before he finally "kicked the bucket" for lack of a better term... :(
     
  15. Rhettman5.1

    Rhettman5.1

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    My own father died from throat cancer at 73 years of age, he also was alert and aware of what was happening.

    As his condition worsened, he went to radiation therapy and fought the good fight...as he later learned, his prognosis was for 3 months, about 1/2 of the time it would take for the radiation to BEGIN working, he immediately quit the radiation and the family had hospice come to the house to help my stepmother care for him.

    To-wards the end, he had a trake tube in his throat so we could use suction to remove the flem from his throat, I was chosen to do this task as he seemed to think I did the best job, so I was available 24/7 to perform the task, I am fortunate he lived only 1 block from me.

    As the end neared, the hospice nurse advised we call and get the DR to administer morphine, he was laboring heavily, and the fight to stay alive was taking all of his strength and conscience thought.

    Once the morphine was administered, he lived only one more day, it allowed him to relax enough to let go.

    I don't have a positive response for you, I only know the morphine allowed him to relax and pass on without pain...I hope this in some way helps you...Rhett... :( I know how it is PC...buck up and be strong for him...
     
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