MY PARKINSON S PASSPORT

Transcription

1 MY PARKINSON S PASSPORT ESSTIAL MEDICAL PAGE 1 MY PERSONAL DETAILS First name: Family name: Date of birth: Address: Town/city: Country: Postal/zip code: PAGE 3 I have Parkinson s disease and it affects my ability to speak, coordinate and initiate movements How can you help me? Please: Give me time when I am walking, talking and eating Speak normally and be patient when I find it difficult to make myself understood Be aware that Parkinson s affects facial muscles, and smiling can be difficult. I may not be able to respond as you would like me to Do not push or pull me if I am finding it difficult to move Ensure that I am sitting down before giving me a drink Do not walk away from me if I am experiencing difficulties. Most of all, please be patient and give me time. Thank you EMERGCY CONTACTS Person to notify -1: Relationship to me: Person to notify -2: Relationship to me: My Doctor: Practice address: PAGE 2 PAGE 4 PAGE 3

2 MEDICATION I SHOULD NOT BE GIV Metoclopramide MY MEDICATION It is very important that I receive the correct dose of my medications at the correct times. These are: Cyclizine Anti-psychotics (e.g. haloperidol) Prochlorperazine Atypical anti-psychotics (e.g. risperidone, olanzapine) but may be safer than typical agents PLEASE NOTE: If I require an anti-emetic (anti-sickness), use domperidone If I require an anti-psychotic, use quetiapine Pethidine and other opioids (pain killers) should not be used at the same time as selegiline and rasagiline NOTE TO USER: If you have any of the following therapies, you may also wish to print off the individual additional Passport pages (at the end of this document) relating to each therapy: - Apomorphine - Deep brain stimulation (DBS) - Duodopa MY MEDICATION (CONTINUED) It is very important that I receive the correct dose of my medications at the correct times. These are: PAGE 5 PAGE 6 OTHER MEDICATION I TAKE REGULARLY OTHER (EG BLOOD GROUP, ALLERGIES ETC) Doctor s signature or stamp: Date: / / Doctor s name and institution [CAPITAL LETTERS]: PAGE 7 PAGE 8

3 APOMORPHINE Apomorphine is a medication for people with Parkinson s (the active ingredient is apomorphine hydrochloride). ADDITIONAL Apomorphine My apomorphine dose is as follows: Injectable pen dosage: [ Infusion dosage: [ PAGE 1 (APORMORPHINE) ] mg ] mg/hour Apomorphine is administered subcutaneously (under the skin) using an injectable pen OR via a catheter using a small, portable infusion pump system. This medication is essential for me. I therefore need to carry with me (in my hand luggage): injectable pens OR an apomorphine pump system to include: - pre-filled syringes or ampoules (small sealed bottles containing a single dose of a clear solution i.e. apomorphine) - catheters (thin tubes connecting to my pump) - cannulas (short, thin tubes inserted into my body for the delivery of apomorphine) PAGE 2 (APORMORPHINE) PAGE 3 (APORMORPHINE) PAGE 4 (APORMORPHINE)

4 ADDITIONAL Deep brain stimulation (DBS) Security and other device precautions The DBS system is a pacemaker-like device. It may interact with other devices that generate electromagnetic energy or have strong magnetism. These may include electrical equipment such as welding machinery, microwave transmitters and power amplifiers, or household appliances that contain magnets such as refrigerators, stereo speakers and power tools. Airport/security screening: devices such as theft detectors for example those used at entrances and exits of shops, libraries and other public buildings, as well as airport/security screening may cause uncomfortable increases in my stimulation and may turn my stimulator off by accident. I should therefore bypass such devices if possible, or pass as far from the device as possible. I request that security officers carry out a manual search if one is required. A hand-held security wand may be used but this must NOT be placed over my neurostimulator. I should not have: PAGE 1 (DBS) Diathermy treatment (use of high-frequency electric current to produce heat) Magnetic Resonance Imaging (MRI) unless specifically approved by my system provider DEEP BRAIN STIMULATION I have had deep brain stimulation (DBS) My DBS system consists of a pacemaker-type device located in my upper chest or abdomen with cables that travel up my neck and pass beneath my scalp. I have visible scars on my head indicating where electrodes were implanted during DBS surgery. I received a neurostimulator on: / / Device serial number: Name of hospital and country: Any therapy directed at the site of my implantation, including ultrasound, electrolysis, radiotherapy, electrosurgery and electro-magnetisation Radiography that compresses the implantation area(s) (other radiographies are permitted) Ultrasound for dental cleaning Cardiac defibrillation. CAUTION PAGE 2 (DBS) Any medical treatment in which an electrical current is passed through my body from an external source must be used with caution. If I require a local anaesthesia, adrenalin should be administered with caution. dd/mm/yyyy PAGE 3 (DBS) PAGE 4 (DBS)

5 ADDITIONAL Duodopa My Duodopa should not be stopped and/or the dose should not be reduced unless so directed by an experienced doctor. Suddenly stopping or lowering my dose quickly may cause a serious problem. My pump can be used safely on airplanes and will not interfere with the aircraft s instruments, including during take-off and landing. If I require general anaesthesia, treatment with levodopa/ carbidopa may be continued for as long as I am permitted to take fluids and medicines by mouth. Cassettes should be refrigerated or kept cool (2ºC to 8ºC) at all times and protected from sunlight. Cassettes can be used for up to 16 hours once at room temperature. PAGE 1 (DUODOPA) DUODOPA INTESTINAL GEL AND INFUSION PUMP Duodopa is a levodopa/carbidopa medication that comes in the form of a gel. The gel is contained in a cassette that is attached to the pump during use. The medication is administered through tubes inserted directly into the gut (small intestine) using an electronic pump. The pump should only be handled by someone who is familiar with the device. I may experience difficulties handling my Duodopa pump and tube connections, which could lead to complications. It may be necessary for a carer to assist me. My medication is administered as a continuous intestinal infusion by a pump I received my levodopa/carbidopa pump on: / / dd/mm/yyyy Pump serial number: PAGE 2 (DUODOPA) PAGE 3 (DUODOPA) PAGE 4 (DUODOPA)