* Morphine and COPD Don't Mix

Written 04/18/2006

Dear Dr. [ ],

FYI pertaining to my Mom:

I believe I’ve identified the very likely cause of my Mom collapsing and ending up in the emergency room for the second time in a week and a half. Here is a record of the chain of events that led up to it.

• Mom came home on Sunday March 19, from an alternative cancer treatment center feeling better than she had in many months, with more energy, and breathing better
• On her way home she had trouble with the altitude in Black Forest but stabilized once she got home to Pueblo.
• Over the week her energy and breathing slowly declined to where on Friday March 24 she checked into the ER and found that her oxygen level was extremely low - in the 50s. Once she was warmed up and on hospital oxygen her level stabilized in the 90s. An X-ray was clear other than expected cancer and COPD – no pneumonia. An EKG came back normal. Once stabilized, she was sent home.
• The oxygen company was called to check out her equipment. The concentrator was checked and calibrated and her oxygen tube was switched to a liquid oxygen tank as a precaution. The tube and canella were not checked or replaced.
• By Saturday April 1 Mom was again feeling a lack of energy and shortness of breath but decided to keep a previously planned shopping trip with a friend. While shopping she was using her portable oxygen unit and started feeling better.
• Sunday morning April 2 Mom was again having a very difficult time breathing and no energy. I had her call the oxygen company and the hospice nurse. The oxygen company said that her tubing was clogged and replaced it along with the canella. The hospice nurse started administering Morphine to help with anxiety and breathing. When I arrived I questioned the Morphine because my Mom was not in pain or had she ever been in pain due to the cancer. I noticed that Mom was breathing through her mouth and repeatedly reminded her to breathe through her nose. After the oxygen company brought a mask at the request of the nurse, Mom’s oxygen level finally stabilized in the 90s. By this time she was pretty well out of it from the Morphine and slept most of the afternoon.
• On Monday April 3 the hospice nurse came by to check on Mom. She administered more Morphine and then left my Mom by herself. My aunt brought dinner for my Mom later and she ate most of it. About 9:30 pm my aunt tried calling Mom and it was busy. Since it is unusual for my Mom to be on the phone at that time of night, my aunt got concerned and went over to her house. She found my Mom collapsed on the floor and only barely conscious. She was taken to the ER where the ER Doctor ordered an X-ray to evaluate her condition but the hospice nurse canceled the order stating that it would not be paid for by Medicare. She was moved to a private room where more Morphine was administered on a regular basis. Albuteral lung treatments were administered, but no tests were ordered to evaluate her true condition.
• Throughout her treatment both at home and at the hospital I continued to question the use of Morphine. On April 5 Mom said that she did not want any more Morphine because of the way it made her feel. At the same time, hospice was discontinued and Dr. Shapiro was called in to take over her care. A Dextrose drip, antibiotics, and a steroid for her breathing were ordered and administered. A blood work and CT scan were also ordered. Mom took a sudden turn for the better.
• Mom was discharged from the hospital on April 8 and has continued to improve on a daily basis.
• On the evening of April 16 we dodged yet another bullet by noticing the oxygen tank was dangerously near empty. The oxygen company was called and the tank was filled.
• Not having any answers as to why Mom collapsed, I began researching all of the medications that Mom was / is taking and found some very disturbing information about Morphine and COPD.

I believe that Mom’s body was already compromised by the two weeks of oxygen level fluctuations and slow oxygen depravation that was then compounded by the Morphine. The night that Mom collapsed it was apparent that she had thrown up due to regurgitated remains of her dinner in the trash can. I feel that the Morphine made her sick and also caused her to pass out and possibly stop breathing for a short time. Continued administration of Morphine in the hospital hindered her recovery progress.

Attached is the information on Morphine that I have based my assumptions on. I know that all this is speculative and behinds us now, but for the future I have advised my Mom to refuse any further administration of Morphine or any of its derivatives.

I ask that you please keep this in mind with other COPD patients so that they do not have to go through the same agonizing experience or worse. I also ask that you make the hospice doctors and nurses aware of this so that they do not just follow standard practice with COPD patients and administer Morphine at the drop of a hat.

Thanks you for your time.