Question: What are you supposed to do when the pump alerts for high pressure [HI P]?
Answer: [HI P] stands for high pressure. The alarm is given when a resistance has built up that prevents the pump from administering the medicine via the tube. Check that there is no blockage in the passage and that the tube is not overly bent. If the obstacle still cannot be located the reason may be that the tube has a kink inside the gastrointestinal tract. In such a case the tube may either straighten itself out after a short while or be straightened out when rinsed with water. If the problem persists you should go to a nurse or doctor who is familiar with the tube connections and who may straighten out the kink by gently pulling at the inner tube. Sometimes you many need to have a fluoroscopic examination of the tube and the position may have to be adjusted thereafter.
Question: What can you do if it is impossible to rinse the tube?
Answer: If you cannot rinse the tube check that there is no blocking obstacle or a kink in it. After doing this wait and see if the tube straightens out by itself and the problem goes away. Otherwise, see a nurse or a doctor who is familiar with the tubing system.
Question: What should you do if suddenly there is a drop or irregularities in the therapeutic effect of the medication?
Answer: If you experience a sudden drop or irregularities in therapeutic effect it is probably because the tube end is pulled into the stomach. Contact a nurse or doctor who is trained on the tubing system and who can perform fluoroscopic examination and position the tube.
Question: Why is the movement effect different in the morning and afternoon?
Answer: If the morning period gives predominantly off-symptoms then the morning dose is probably too low, whereas many involuntary movements means that the morning dose is probably too high. The morning dose should give an effect within 30 minutes, otherwise it is too low or else the tube has moved back into the stomach. If the effect is good in the morning but deteriorates in the afternoon then it is recommended to adjust the continual pump speed.
Question: What medication can you have if the pump stops working?
Answer: You should always have a bottle of L-dopa tablets on you in case the pump stops working. The correct dose would then be the one you had before Duodopa® therapy started. It is also possible to work out the tablet dose (Madopar® or Sinemet®) that you need based on the Duodopa® dose. Multiply the set pump speed (mL/hour) by 20 mg/mL (Duodopa concentration). For example, if the pump is set to a speed of 5 mL/hour it will then be 5 mL/hour x 20 mg/mL, which gives a 100 mg dose per hour. In such a case you can try taking a 200 mg tablet every two hours (= 100 mg L-dopa per hour).
