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Handbook for Mortals : Managing Other Symptoms

Shortness of breath

"I feel very short of breath, as if I just can't breathe."

Depending on why you are short of breath, various procedures may ease your breathing. Fluid that collects around the lung can be drained through a needle. You may get relief from changing position, being propped up on pillows, using oxygen, or shrinking a tumor with radiation or steroids.

If you have mild, persistent shortness of breath that can't be treated directly, you may breathe easier with a regular, low dose of opioids. Opioids include morphine, oxycodone, dilaudid, and similar medications. Although these medications are frequently prescribed for pain relief, they also ease the feeling of being short of breath. Taking opioids at bedtime can help you sleep comfortably and prevent you from waking up fighting to breathe. Some patients get the same sort of relief from drugs commonly used for anxiety.

Some doctors really resist using opioids for shortness of breath. If your doctor is concerned, you might discuss what you learn in this chapter and encourage a look at texts on symptom management. You might also try just a low dose of medication for a few days (or a few bedtimes). You may be able to try a medication in a situation where someone can monitor any tendency to breathe less well effectively. This might be in a hospital or when someone (family member or nurse) can check on you after four and eight hours. This kind of a trial run might be reassuring enough to you and your doctor.

Shortness of breath is a common symptom for people who are dying. Many people have mild, persistent shortness of breath as they get very sick. Some, however, have illnesses that make it likely that they will die with much more severe or sudden shortness of breath that does not respond to treatment to remove its cause. People with chronic heart or lung disease often require more aggressive treatment to relieve the distress. Some ilnesses, such as emphysema, are more likely than others to make you feel as if you just can't catch your breath. You may be afraid that you will feel as if you are suffocating, but you should not feel this way. You do not have to fear a feeling of suffocation, no matter how you die. This is an emergency situation that you must be prepared for if you are likely to have significant shortness of breath.

Hospice physicians agree that patients suffering in this way should be given enough opioid, usually morphine, to relieve shortness of breath, even if the patient becomes drowsy or unconscious. If you are likely to experience severe shortness of breath at the end of your life, make sure that your doctors and nurses will treat your shortness of breath aggressively, even if it may lead to unconsciousness. You may need to keep the medication in your home and have a way to have it administered relatively quickly. If your doctors and nurses are not comfortable with such a plan, you should consider looking for another care team.

A Case Study

Frank James, a 67 year old retired bricklayer with severe emphysema, called his doctor's office to see when Dr. Miller would stop by. Ever since Frank got so short of breath that a doctor's office visit was exhausting, Dr. Miller had been stopping by every month or so to do his check ups at home. They had a firm understanding that Mr. James would never again be put on a ventilator. Mr. James' sister, Clara, lived with him and agreed to page Dr. Miller if there was a sudden change or a bad episode. Thus, Mr. James was startled to hear the receptionist say:

"Mr. James, Dr. Miller has had a health problem of his own. He's arranged for a new doctor, Dr. Winchester, to take over his practice until things get straightened out."

As his anxiety mounted, Mr. James felt his breathing getting hard and motioned to Clara to take the phone. She arranged for Dr. Winchester to come by a few days later. At that time, after an examination and talking generally, this conversation took place:

Dr. Winchester: "I see from Dr. Miller's notes that you have firmly decided no to go back to the hospital for shortness of breath."

Mr. James: "That's right. My time is close. This life is okay, but it's not great. When the angels come by next time, I'm going along."

Dr. Winchester: "What will you do?"

Mr. James: "I was supposed to page Doc Miller. What am I to do without him?"

Dr. Winchester: "When you get really short of breath again, do you want to have a drug to make you sleepy? Some people would worry that you run a risk of dying more quickly. But if you can't breathe you might rather be asleep than struggling. And if you are that short of breath, you will probably fall asleep from the increased medicine before you take enough to really hasten your death."

Mr. James: "Yeah. That's what Doc Miller said, too. He promised I could have the medicine."

Dr. Winchester: "Let's see what I can do. I don't live nearby like Dr. Miller. I can't be as sure that you can reach me quickly, and I have two other doctors covering for me after hours."

After a few minutes of conversation, it turned out that Clara had been a registered nurse and was comfortable with responsibility for keeping and giving the medication. Furthermore, a good hospice in the area was available to back her up. By the time Dr. Winchester left, Mr. James and his sister were reassured that they had a good plan, a caring doctor, and the opportunity to live fully in the time remaining. Clara called her son and her prayer group to tell them the good news.

Other symptoms:

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