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Subject: Recognising ON and OFF A number of people have commented recently on going Off while shopping or walking round the Supermarket. One point which occurs to me, as anyone who has sat in a car waiting for someone to come out of a supermarket will testify, is that people spend twice as much time as they think they do in supermarkets, and are therefore at greater risk of going Off. ( And I can see the outraged replies already for this -I'm only joking, honestly). More seriously, you need to realise that when we do go Off (and in later years it can happen very quickly, we are paying the penalty for forgetting to take a tablet 30 to 60 minutes previously. By the time you actually go Off, the damage is done, and you must resign yourself to at least half an hour of being Off. It is a sad fact in my case, and probably others as well, that the 5 to 10 minutes before I go Off are probably the most relaxed, symptom-free minutes that I have had for a long time. However, the penalty of half an hour Off is too much. There is only one available treatment which can produce an almost immediate effect on symptoms when in the Off condition, and that is Apomorphine, which is injected into the muscle (Not a vein), and which has nothing to do with Morphine. My neurologist has suggested that I could carry some around as an emrgency back-up, and I'm thinking about it (I dislike injections). The effects of Apomorphine only last for about 30 mins, so it is not really suitable for all-day use. In the UK (I don't know about the USA, some people with advanced PD are using a built- in pump to deliver a continuous supply of carefully metered apomorphine, and this seems to be effective when even levodopa cannot cope. It would be best described as a useful backup, especially for the younger PWP who is experiencing difficulties with medication. Regards, Brian Collins