Erwin I take my hat off for you...

You're a STAR!!

Nic 62/20

On 27 November 2014 at 03:55, Erwin Matthews <[log in to unmask]> wrote:

> My PWP, now 23 years since diagnosis, was trialed on a 20mg in 2ml dose of
> Apomine (apomorphine hydrochloride) plus saline in a 10ml capacity syringe
> beginning in September 2013. The solution was delivered  continuously for
> 12 hours by a CRONO APO-go II pump through a Unomedical  Neria infusion
> needle. Over several months it was thought my PWP would benefit by infusing
> Apomine 24/7 and the Apomine was gradually increased to 120mg in 12ml plus
> 8 ml of saline to fill a 20 ml syringe. In addition to the 120mg of
> Apomine, my PWP currently takes per day 1x Sinemet 250/25, 5x Sinemet
> 100/25, 5x Sinemet CR 200/50, 5x Deralin 40 and 2x Motilium 10 (anti-nausea
> for Apomine).
>
> Because we live some distance from experienced support, we have a spare
> pump in case of failure so  each pump is used on alternate days.
>
> A clear plastic dressing covers the infusion site and sticky tape supports
> the supply tubing from the pump which is carried in a small bag held around
> the neck. An alternative is a belt around the waist. The pump must be
> either removed or placed in a waterproof container while showering.
>
> The infusions have all been made in the lower abdomen, moving the
> insertion points daily to avoid previous locations where small firm nodules
> occur beneath the skin. Nodule formation seems to be minimised by
> application of a small hand held vibrator and Calmoseptine ointment.
> Periodically, I apply a small hand held ultrasonic massager to the whole
> area.
>
> There are two types of "needle"; we use the more expensive 8mm long type
> that is simply pressed against the skin and held there by a ring of
> adhesive, the other is the 19mm long winged infusion or "butterfly" type
> which requires the needle to be inserted at a 45 degree angle (we have some
> of these for emergency use only, not intending to use them routinely).
>
> Apomine has to be supplied through our local hospital's pharmacy. We order
> on-line the accessory kits containing a month's supply of infusion needles,
> syringes and saline. Plastic dressings for the infusion sites, sticky tape,
> alcohol swabs, antiseptic creams, hand sanitiser gel are bought at our
> local pharmacy. Sharps boxes for disposal of infusions points, syringe
> needles and empty glass ampoules are free at our local Community Nursing
> Centre.
>
> My PWP is the only Apomine user in our local area. Local nursing staff are
> always interested, never having seen Apomine in use before. My PWP has
> never attached an infusion point or prepared a syringe for herself partly
> due to hand stability and eyesight problems. She lacks confidence with
> inexperienced nursing staff following a couple of incidents. Common sense
> suggests self administration may be useful in times of emergency.
>
> Some months ago neurologists had my PWP reduce her conventional Sinemet
> dosage by half. Within a week she became so immobile she was unable to
> stand, needing much more assistance than usual to rise from chairs and the
> toilet. After I  experienced shoulder and back problems from assisting her
> she returned to her previous quantities of Sinemet.
>
> It is believed that spinal problems have been the cause of her left leg
> intermittently failing to support her since before she began Apomine and
> her mobility problems have now increased to the extent that she has to be
> wheel chair bound whenever we are away from home. At home she uses a walker
> and then never walks more than 20 paces. After showering and dressing (we
> have help in to assist her) she frequently needs a chair to sit on when
> pushing her walker from the bedroom to where she has breakfast. She has not
> fallen for quite some time; needing emergency seating occurs daily.
>
> How effective is Apomine? On her current 24/7 dose of Apomine, she begins
> her conventional medications at 6am, then is eager for Sinemet at 10am
> because of shaking in her body and legs , from 1pm she is "off" and tired
> and her 2pm Sinemet may not kick in till 4pm, then she is "hanging out" for
> Sinemet at 6pm and from 8.30pm she feels "useless" until her 10pm Sinemet
> in bed.
>
> Around 10pm I change over the Apo pumps which takes about half an hour
> filling a new syringe, attaching and removing infusion points. My PWP has
> incontinence problems; sleeping on most nights is disturbed, even using
> incontinence pants and pads, so she may take a Sinemet 250/25 around 2am.
> Recently I encouraged her to take half a sleeping pill at bedtime but she
> found that caused too much drowsiness the next morning.
>
> Perhaps this wordy description may give you some idea of one PWP's
> experience with Apomine.
>
>
> On 18/11/2014 11:05, A Phillips wrote:
>
>> Anyone on this list using the apomorphine pump ?  It's ben suggested I
>> try it as off-periods are driving me crazy and I'm terrified of DBS.
>>
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>>
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