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My Aunt, in her nineties, is in end-stage chf and wants to die at home. Palliative Care is pushing the morphine and Ativan cocktail although my aunt says her pain is mild. I'm calling her doctor tomorrow to discuss pain relief and I know I'll hear the same song-and-dance about morphine. Does anyone know of a natural alternative to morphine for end-stage discomfort? I'm looking in my area for a homeopath or alternative medicine MD also.

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What are you trying to achieve? Is your goal to keep her comfortable? Why is the homeopathic route better? Is she alert enough to make her own decisions? Is Hospice involved? At this stage of her illness, I'm not sure I would be in the process of changing doctors. Maybe someone who has gone through this can offer more insight. I haven't dealt with it before.
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Morphine will help with her breathing, not just pain. If there were homeopathic alternatives, I'm sure they would be selling like hotcakes. Articles I have seen written by homeopaths state they can lessen the need for the morphine, but not eliminate it entirely.
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What has she been using for pain up until now? If she feels that all she needs is something like OTC tylenol or advil then use that, creams for sore joints such as myoflex or voltaren are also good. As divisive as the anti hospice thread can be it has brought to light some disturbing trends in hospice care. Hospice staff sometimes seem to want to administer these drugs just because that is the way it is usually done, without bothering to access if there is truly a need or desire for them. But don't reject them completely, keep them on hand if the need arises when she reaches her final days and hours.
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Thank you cwillie, I do have the meds on hand and would use them if she were suffering badly. It's just that I'm looking for something less toxic to deal with her mild pain. Those were good ideas. And I know some of my posts about Hospice haven't been popular but I too feel that their end-stage protocol bears some investigation. They are, at the very least, understating the potentially deadly effects of Morphine - intentionally or not.
I'm going to give the Advil a try - thanks again.
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Sunnygirl, at this point yeah we're not trying to save her, just to alleviate her pain without risking a fatal dose of morphine, which she is afraid of. I thought of bringing in a natural doctor in addition to her regular MD. I'm rocking this thing alone and it's not a great feeling so I'm just trying to do the right thing by her.
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Pamstegma, that's good information. Thank you.
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I guess what's complicating the whole thing too is that she's making noises of distress but says she's not in pain. The nurse said this morning that some vocalizations are normal and not necessarily a sign of pain. She's enrolled in palliative care but I think I'm going to bring in a nurse to help me with this. It's pretty scary.
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If the Advil seems to give some relief, maybe you can think about asking for Tylenol III. It has 300 mg Tylenol and 30 mg codeine. It is good for pain of inflammation, e.g. arthritis, and is fairly mild. It isn't so good for circulatory pain -- the type that comes with vascular disease.

I am sorry that you are going through this. I am glad hospice is there with you. I agree with you about putting off the morphine unless the pain becomes bad. Morphine tends to make people nod out, so they lose time with their family. There may be a time when this will be a good thing to ease pain. You will know when that time is.

I don't see any problem with some Ativan if it helps your mother feel more calm. Maybe some tablets would be good if that is a problem. It can also help your mother sleep on those difficult nights, so can be very handy.
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Thank you, JessieBelle. She's actually used the Tylenol with codeine before and it worked well. I had forgotten. I'll ask her doctor to reauthorize her scrip tomorrow.
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A "natural" alternative to the poppy-based drug morphine? What makes morphine "unnatural"? Wouldn't you be trying to find a plant-based herbal concoction to relieve pain? But isn't that what morphine is? I guess I'm not understanding your objection to that drug.

In any case, since she is under your care it is your decision whether to use the morphine or not. Hospice does not force that on you. I did not use the morphine I was given for my husband. He was not in pain or in distress. Each case is different.

Morphine was not used for my mother while she was on hospice, based on previous bad reactions to it.

It sounds like you very much want to keep this dear lady out of pain, and in her home environment. That is very commendable. I hope that you can achieve that using only drugs you approve of. And if you can't achieve it that way, I hope you will be flexible enough to take hospice advice. But remember that you are the person in charge. You make the decisions.
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As a hospice worker and one who has cared for four family members through end of life, please know that morphine can make a huge difference for the better when used wisely. Most hospices use concentrated liquid morphine, which can be given in tiny doses if that's all it takes. You mentioned that codeine has helped her in the past. Codeine is actually converted to morphine in the body; that's why it relieves pain. A small dose of morphine has exactly the same effect, and really is the same active drug. Ask that your hospice use medications at the lowest possible dose to relieve her symptoms. As someone mentioned earlier, morphine is very effective for shortness of breath, which is a very common and very uncomfortable symptom seen in heart failure patients at end of life.
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I was the person who would never consider toxic narcotic medications. Then I got a kidney stone and I had to take me morphine to not commit suicide. The morphine allowed me to communicate and be a participant in decision making in my care. Until I surrendered and accepted the medication I was begging them to help me die. This poor soul needs to pass in peace. Morphine takes away the pain improves breathing and relaxes the body offering her clarify and the ability to engage with loved ones in their passing. I am not a fan of medication. I have experienced people in hospice refuse narcotics over and over again in my job. I have also experienced those who have taken the medication. Those who take the medications pass in peace. My experience with morphine is that it really improved end of life. Especially when passing away is inevitable. The will only offer the dose that will give her peace. Hospice is not about being out of it, they are about quality of life until you pass. Prayers for her and you. This is a challenge time.
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If she is saying her pain is "mild", then the morphine is working. What makes you think someone dying is going to be helped with homeopathic remedies? Nothing you do is going to stop CHF. Just love her for the time she has left, and start preparing for the end. Someone in their 90s deserves a rest. Let her go.
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"This poor lady needs to die in peace." And " You can't stop chf." Where in my posts did I imply that any of that was applicable? Some of you should really watch the way you say things here. This isn't an interrogation. Most of us who have given up two years of our lives to care for a loved one instead of shuttling them off to a nursing home love them enough to not allow them to suffer. Nowhere did I state that she is in pain or that I would allow her to suffer. I simply asked about natural alternatives to morphine. People come here for comfort and advice, not a barrage of accusations and abuse. As much help as I've received here - and I sincerely thank all who responded thoughtfully and kindly - this will be my last post.
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Correction: THIS will be my last post. So that everyone understands where we are coming from, my aunt is lucid and actively involved in her own care. She objects to the use of morphine because like me, she is aware that a toxic dose is all too easy to administer. She has asked for alternatives and knows that if she changes her mind and requests the morphine it will be given to her. And FYI - morphine is no longer poppy- based, it is synthesized - and the kind that Hospice hands out is the strongest made. The drug fact sheet that accompanies it states clearly that it may cause death. I would rather not accidentally kill my aunt because she had a gas pain and had to fart. In no way does my refusal to be trigger-happy with the morphine bottle imply that I would allow her to suffer. I think my remarks about our particular Hospice have created some bad sentiment but I've never been one to dance around the truth. It is all too easy to administer a drug with a heavy hand; it's not as easy to live with the possible consequences of doing so. Making the decision to use a powerful and potentially deadly drug like morphine requires thought and consideration - and that is not something that our particular Hospice encouraged in the least. As I write this, my aunt is sleeping peacefully in her own bed, not drugged up and not in pain. That's as it should be. Thank you again for those good responses I did receive in this thread. Over and out.
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Ask the doctor to give her a self-administered pump to use the morphine as she wishes. We will be sorry to see you go, but that is your decision.
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When my mom went on hospice, morphine and Ativan were the first medications to arrive. They stayed in the refrigerator for months, before we actually needed them. Mom used Oxycodone for pain, and then added Ativan for the anxiety resulting from her shortness of breath. My dad and I were in some disagreement about when to use the morphine- the decision seems so final. About two weeks before Mom died, she asked for morphine. She started at twice a day, and then began to ask for more. During the last week, she would just whisper "morphine", and open her mouth and wait for its delivery. Yes, she was pretty much in Lala land those last two weeks- I would tease her, and call her my "baby bird". She would pat my hand and drift off.....
Anyway, we didn't try "natural" painkillers, other than basic comfort measures.
I think the idea of consulting a Naturopath is a good start, and I also think it will become obvious when it's time for the Morphine. I know that in my own anxiety I was always trying to look ahead to the next "phase", but it wasn't really productive- as the dying process was it's own moment by moment affair.
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My mother's doctor said absolutely no Ibuprofen. Not only is it hard on the stomach it is bad for the heart. My mother ended up with the morphine and yes, she did die, but she died peacefully and she would have died with or without the morphine.

Now, my own doctor says, don't ever take Ibuprofen again, because of your heart. It make irregular heartbeats worse.
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I think the answers on this thread have been very good, thoughtful and informative. We often encounter those on this forum who are totally anti hospice anti morphine/ativan and seem all too willing to dismiss the good along with the bad, so I don't think there is anything wrong in those posters who cautioned against this. As others have stated so well, life and death are never black and white, but an infinite variety of greys.
Elizabeth, I wish you and your Auntie peace.
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I'd say try the morphine in low doses without the Ativan, greatly reducing risks for respiratory depression and unwanted sedation. Most people taking oral morphine can be lucid. It is not otherwise really terribly "toxic" - watch for constipation, that would be the most common side effect.
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It seems that some people have a very difficult time accepting terminal illnesses. Even in those who are very old. I recall that years ago, I thought that hanging on to every minute of life was the ultimate goal. Then...life happened and I saw how enduring pain and agony are not your friends. I changed my perspective. I realized that it's crucial to put your feelings on the topic in writing and hope that the person you trust will properly interpret your actions if the time comes.

We never know what something is like until we experience it. That's why I like to get those personal and candid perspectives from those who have been there with their loved ones.
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Elizabeth49: I know of NO OTC medication that will ease this level of pain. Stick with the narcotic.
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I agree, if she can still communicate then allow the med. Even if she got addicted she is leaving you.
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I don't think anybody here is a fan of meds, especially opoids. Leave that red poppy alone, let it be in the field. Tylenol w/ codeine is 10 times better
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Uhmmm.... just what do you think codeine is, Cak???
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Excuse me, but Tylenol #3 is a narcotic.
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I couldn't resist. Where on God's green earth did I imply that I didn't know she was dying, or that I'm denying her meds?? Do some of you even read thoroughly before you post, or do you just sight, load, and attack? Do we have trolls in our midst here? Methinks we do!
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Um. I haven't read all of the responses in detail. I was just going to say that as long as your aunt is lucid I should check with her whether she wants her next morphine dose or doesn't feel she needs it.
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Thank you, Churchmouse. The facts: My Aunt, who is experiencing mild, everyday type of pain, is lucid and aware that she has morphine available to her if needed. She is adamantly against its use unless absolutely needed and I am in full compliance and agreement with her. My original question - Does anyone know of any natural alternative to morphine? - was lost in a sea of accusation and the politics of Hospice and morphine. Not surprising, since I've gotten the same response in the real world and reacted with the same frustration at having been completely misunderstood. Again, I'll thank the thoughtful and kind posters who responded to my question, too many to respond to individually. It's time for me to move on to another topic in another thread this one has run its course.
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Elizabeth, I'm so glad that you're still with us!
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