"Talking out of his head"

[Emily B.]

Question: 6 years in and we might be near the end. O2 levels have fluctuated in the last 2 weeks, but are now in the 90's. Giving Morphine and Ativan every 4 hours. He has started "talking out of his head" - meaning asking about things that aren't real or if I did something. His go to question is "What's going on?"
The hospice nurse suggested that this was the disease process and not the mediation talking. Just wondering if that is right and if anyone else has experienced it.

 

[nona]

Morphine could definitely cause those symptoms.

 

[nona]

A hospice nurse should know that.

 

[lgelb]

I'm very sorry to hear, Emily. CO2 retention could as well. It does not have to be one factor only, but I agree with Nona that the meds could play in.

Have his BiPAP settings been adjusted to attempt to improve his oxygenation? They often need work as ALS progresses.

Best,
Laurie

 

[Emily B.]

I'm very sorry to hear, Emily. CO2 retention could as well. It does not have to be one factor only, but I agree with Nona that the meds could play in.

Have his BiPAP settings been adjusted to attempt to improve his oxygenation? They often need work as ALS progresses.

Best,
Laurie

They have been adjusted but not since March when he went on hospice. What numbers am I looking for?

 

[vltsra]

Just before my PALS started using the BiPAP he was babbling and incoherent to the level that the neurologist thought he might have FTD. I believe it was CO2 buildup. Now he is clearheaded.

 

[Emily B.]

They have been adjusted but not since March when he went on hospice. What numbers am I looking for?

We just changed the Tidal Volume to 550.

 

[lgelb]

I will send you my email in case you need to make any other changes.

 

[affected]

While the morphine can do that - it is probably a combination of everything, and elevating CO2 levels will contribute a lot.

 

[Nuts]

As you can see, this can be caused by a number of things. Morphine can do it, but when our PALS need the morphine, there is no choice. It could be C02, and Laurie is a fabulous resource. My husband went through this at the end; we tried various different medications (he had a tracheostomy and was vented). Ultimately, he had one moment of clarity where he told me to let him go if he mind was gone. That was our last coherent conversation. I'm so sorry you are experiencing this--hopefully some adjustments will give him more quality time.