“Ask the Doctor” with Dr. Rebecca Gilbert
Q. How safe is knee replacement surgery for people with Parkinson’s?
A. Many people with PD can undergo successful orthopedic surgeries. However, there are additional challenges that can affect someone with PD who is having surgery, and the best way to ensure an uneventful surgery and hospital stay is to anticipate these potential issues and strategize on how to avoid them. It is therefore recommended to have your neurologist speak to your surgeon and anesthesiologist prior to the surgery.
Your neurologist can emphasize the importance of maintaining your PD medication schedule as much as possible, as well as the importance of avoiding particular medications during the hospitalization that can adversely affect people with PD. Other issues such as management of blood pressure fluctuations, post-surgical delirium, urinary dysfunction, swallow dysfunction, and constipation can be discussed as well. These issues are reviewed in more detail at apdaparkinson.org/Surgery.
Q. When I walk, sometimes I feel like I’m not able to move my feet because they are stuck to floor. How can I get them unstuck?
A. This sounds like you are experiencing freezing of gait, an abnormal gait pattern in PD where the person takes tiny steps in place and is not able to generate a big step forward. The best approach to getting out of a freeze is a technique called cueing, or using an external stimulus to restart your normal gait pattern. The cue could be visual (e.g. a line on the floor that the person steps over), auditory (e.g. a rhythmic beat that the person marches to), or tactile (e.g. shifting weight from side to side). A physical therapist can teach you these strategies, so it would be worthwhile to ask your neurologist for a referral to physical therapy.
You can read more about freezing of gait here
Q. My neurologist wants me to have a DaTscan. Should I be concerned about the risks of this test, especially as it relates to my thyroid?
A. DaTscan is an imaging test that uses a nuclear tracer to visualize the dopamine circuitry in the brain. This tracer can also be absorbed by the thyroid, which could cause damage to the thyroid. However, to protect the thyroid, a thyroid-blocking medication is given prior to injection of the tracer. When performed this way, the DaTscan test does not pose any significant danger to the thyroid.to visualize the dopamine circuitry in the brain. This tracer can also be absorbed by the thyroid, which could cause damage to the thyroid. However, to protect the thyroid, a thyroid-blocking medication is given prior to injection of the tracer. When performed this way, the DaTscan test does not pose any significant danger to the thyroid.