[Barnard Ghim]

I was diagnosed in 2012 with PD and I find that exercise is the only consistent therapy that reduces my symptoms, but it causes fluctuations in my Ld/Cd dosage and my dyskinesia.  My condition is now considered advanced because my response to medication is unpredictable.  It is actually quite predictable.  If I eat, my medication fails and I go into an “off” period.  To help keep me in the sweet spot of having enough medication to reduce the symptoms and not so much to fend off dyskinesia and nausea , I am on the Duopa pump delivery system for Ld/Cd.  The pump is just a more efficient delivery system for Ld/Cd and precludes me worrying about taking my medication 6 times a day, but results in carrying around a bit of a brick 14 hours a day.  The tube goes to my stomach and has a smaller tube that continues to my intestines bypassing my stomach and delivering the Ld/Cd solution to my intestines.  The pump is solid, but it has very limited functions.  It has a morning dose, continuous dose and extra dose.  The morning dose kick starts you and is the highest dose and had a daily lockout provision to keep you from accidentally overdosing.  The continuous dose is exactly that and maintains a level dose.  It would really have helped to have a “sedentary dose” and an “active dose” because the Ld/Cd required watching TV and walking are very different.  The extra dose is for when you require a boost, but it also has a lockout timer and slower delivery of a higher dose than an immediate increase when you increase activity would make so much sense.  The extra boost helps get you out of an “off espisode” faster, but it may not be enough.  Because Ld has to make it to the brain, it may take time to be effective.  The pump delivery cuts the response time, but exercise makes it hard to hit the target area of symptom treatment vs. unwanted side effects.  The Duopa pump system has its benefits, but its drawbacks too.