“ASK THE DOCTOR” WITH DR. REBECCA GILBERT
Q: I always seem to be nauseous. Are there treatments for this?
A: Nausea can be a side effect of carbidopa/levodopa, the most common and effective medication for PD. If this is the case, then try taking the medication with food. Some people find that dietary protein such as beef, chicken, or fish interferes with absorption of levodopa. So, it is best to take the levodopa with a food that doesn’t contain protein, such as crackers, vegetables, pasta, etc. Since ginger can be effective against nausea, you can also try taking the medication with ginger ale or ginger tea. If these strategies are not enough to quell the nausea, your doctor may try a prescription medication to help. It is important to choose the right one since some medications for nausea can make the symptoms of PD worse and should not be taken by people with PD.
Nausea can also be a symptom of gastroparesis, or delayed gastric emptying, a non-motor symptom of PD in which the transit time through the stomach is slowed. If nausea is persistent and does not seem to be a side effect of carbidopa/levodopa (does not occur after ingesting a dose of medication), ask your neurologist for a referral to a gastroenterologist who can evaluate you for gastroparesis. Lifestyle modifications such as eating small frequent meals, avoiding fatty foods, and walking/moving after eating can go a long way to help with this condition.
Q: My mom is experiencing very troubling delusions that someone is coming to hurt her. She is constantly calling me because she is worried that she is not safe. I assure her that she is. What can help the situation?
A: Very often, PD medications are the cause of psychosis – which can be broken down into delusions (thoughts that are not consistent with reality) or hallucinations (sensory phenomenon – visual, auditory, or tactile – that are not based in reality). When the delusions or hallucinations are related to medication, then the first thing to do is to lower the dose of medication. However, sometimes the dose of medication can’t be lowered enough to stop the delusions or hallucinations – either because that decreases mobility too much or because the hallucinations or delusions are not related to medications and are a non-motor symptom of the disease itself.
When this is the case, the person with PD may need to start a medication to treat hallucinations or delusions. There are specific medications that are used in people with PD with psychosis, since some medications used in the general population to treat psychosis can worsen the motor symptoms of PD and need to be avoided in people with PD. Be sure to talk to your mother’s doctor about her delusions and the possible solutions that can help her.
Q: My husband’s voice is very low, and this makes it difficult for him to communicate. What can be done?
A: A low voice volume is unfortunately very common in PD. There are speech therapy techniques directed at raising voice volume. These include Lee Silverman Voice Technique and the Speak Out program from Parkinson’s Voice Project. You can find a clinician trained in these techniques on each of their websites. In addition, there is a device called Speech Vive, which some people find helpful as well. This device produces extraneous sound only when you speak, which induces you to speak louder. When you are silent, the device is silent, so that you can hear what is going on around you. In addition, participating in singing programs like APDA’s Sing Loud for PD can help exercise your voice. You may also find APDA’s Make Your Voice Heard: Healthy Communication & Parkinson’s Disease to be helpful. It is important to try to improve this symptom as people with PD can get frustrated and ultimately withdraw from social interactions if they feel like people can never hear them.
Dr. Rebecca Gilbert is the Chief Mission Officer at APDA. She oversees APDA’s research portfolio in conjunction with APDA’s Scientific Advisory Board. She also provides medical and clinical expertise to support APDA programming as well as print and web content.