Dying to Breathe

Regarding medical care, we are in technological wonderland in some areas and in others we are still behind. Regarding the management of dyspnea, (dyspnea is shortness of breath), we haven’t done so well in end-stage diseases which are not yet terminal. Research is showing that morphine and like drugs (opioids) are effective in its management so that people, no matter what their disease process, can live and have a quality life as well. In this discussion we are referring to the person who is not classified as terminal.

Palliative care is not just for the dying. It is about comfort whether or not you are in the category of the terminally ill (a life expectancy of 6 months or less). I want palliative care when I am getting a root canal and I am not terminally ill.

There are studies that show it works–Low Dosage Morphine Relieves Refractory Dyspnea and some that say it doesn’t Nebulized Opioids Use in COPD and some say yes and no in the same study, Nebulized Morphine for Relief of Dyspnea Due to Chronic Lung Disease.

So, sometimes it works and sometimes it doesn’t; and when people study opioids in the management of dyspnea, there are conflicting reports. When people do studies often it is difficult to replicate them due to inconsistencies in sample sizes and other issues.

If you are affected by dyspnea to the point of being unable to live as you would like, please do not let conflicting studies or conflicting opinions make your decision for you. Perhaps an appropriate second opinion on the matter would be a palliative care physician so more that just the present popular views are explored. There are always pioneers in every medical specialty; they lead the way. Palliative care physicians are leaders in the movement of end-of-life comfort. End-of-life illnesses can last years.

I wonder about the controversy. Have those who are against it been reading the latest palliative care research regarding its use? Do they know that it may take a few visits and/or frequent adjusting of the medication until it is just right? Are there frequent follow ups to ensure effectiveness? Are they aware that sometimes it takes just a couple of drops of liquid morphine to handle dyspnea? Are they concerned that if you do a trial of morphine and it works that you are going to love it so much you will begin making plans to rob the corner store so you can keep up your supply?

The diagnosis and prognosis of the condition of ‘terminal’ happens from one day to the next. For classification purposes Tuesday you are not terminal and Wednesday you are. Your condition hasn’t changed from Tuesday to Wednesday but technically now it is OK to do trials of morphine ‘for comfort’. Did you want comfort on Tuesday?

The only reliable measure of the relief of dyspnea is the person’s own report. Only the person who is affected can determine if the risks are worth the possible benefits. Every time we undergo surgery there is a form you sign stating that you may die or may suffer permanent damage you may live with the rest of your life. Whoever signs these forms and goes through surgery thinks the risk is worth it. The possibility of risks is less distressing than the present condition.

Am I trying to convince you to use morphine? No, I’m just giving some information so you can make your own informed decision…so that you can decide based on the latest research what you are willing to try for living with ease and without fear of breathlessness. Comfort is not just for the dying though some people are so distressed they wish they would.

There are options.