Brief Answer:
Trospium may have less SIDE EFFECT PROFILE compared to OXYBUTNYNIN

Detailed Answer:
Good evening and MANY thanks for sharing your questions with me. Let's see what we can help you get a better handle on this time around.

Trospium CL and oxybutynin are referred to as ANTICHOLINERGIC medications and are found to be generally SIMILAR in efficacy according to studies, however, trospium is pharmacologically "improved" over oxybutynin because it has less aggressive and overall less side effects involving less body systems. Its main claim to fame over oxybutynin is that it does not cross readily into the brain so does not typically result in fatigue, confusion, or disorientation nearly as frequently as oxybutynin.

In patients who are over the age of 60 I tend to prefer agents such as TROSPIUM ahead of Oxybutynin in order to avoid CENTRAL NERVOUS SYSTEM side effects such as drowsiness, fatigue, and slowed cognitive processes.

In terms of bladder training the general principles are the following:

(mainly urge incontinence)
1. Use of a voiding diary is highly recommended in order to track progress.
2. You shoud be voiding on a REGULAR and CONSISTENT schedule which is represented by the SHORTEST amount of time you can find between voids in your DIARY. Make sense?
3. When an episode of URGENCY strikes you then, use distracting thoughts and/or maneuvers as well as hip thrusts and Kegel movements. Tighten the hips and pelvic floor while you count to 8 while contracting. Relax the muscles and count slowly to 10 then, start the process again.
4. Increase the time between voids on a weekly basis by no more than 25% over the previous week. If that is not working then, go back to the previous level for another week and try again.

Although I believe the cause of your urge incontinence and spastic bladder is likely due mainly to the PARKINSON'S DISEASE it may also be the case that your camptocordia is causing compression of the spinal cord and interfering with normal electrical signal flow from the spinal cord to the bladder.

Just so you're aware...I've had much better success in my patients with Parkinson's Disease who use BOTOX injections for their spastic bladders rather than the anticholinergic medications. Effects are more predictable, less prone to suffering significant side effects and there are really no drug to drug interactions that have to be dealt with compared to using pills. Also, there is no hassle with having to take daily medications. BOTOX is good for up to 12 weeks at a time....sometimes we will inject patients at around the 8 week mark but the results are VERY VERY GOOD indeed.

I'm not sure why more doctors are not using BOTOX for their spastic bladder patients....perhaps the drug companies manufacturing the pills are sending more lunches over to the primary docs than the BOTOX people are! HA! There is also another consideration with the BOTOX injections and that it is patients could develop rather acute inabilities to empty the bladder and may even require SELF CATHETERIZATION in order to empty their bladders.

I am unaware of any high grade medical studies performed that support the use of any type of marijuana, cannabidiol, or hemp oil that really works and KEEPS working. I understand and agree that you are living with a veritably impossible situation with the PD and the camptocordia and willing and ready to try anything....but I've never seen that work for anybody that I've treated and there have been several patients who have tried it with very high expectations only to find that it led to no improvement and in one case the patient told me that he started developing cramping and even more problems with is PARKINSON'S after being on the marijuana for a short period of time.

Another up and coming method of controlling bladder symptoms without the headaches of having to deal with medications is the INVASIVE approach of DEEP BRAIN STIMULATION which can have the DOUBLE POSITIVE effect of addressing both the bladder symptoms AS WELL AS improving the PARKINSON'S DISEASE symptoms. Also, have you been CHECKED for possible BLADDER INFECTION? This can be an overlooked cause of bladder dysfunction. Good bladder training is probably your best bet at overcoming the problems with the least amount of headache and complication.

People who are persistent with your bladder training in the end have been shown to be only suffering from 50% of their previous symptoms. One other pearl or nugget of information is that in some people SINEMET or carbidopa/levodopa can actually WORSEN spasticity symptoms but that over a period of about 2 months people will improve...SIGNIFICANTLY.

HEMP vs. MARIJUANA vs. CANNABIS

1. Cannabis is a LARGE family of plant to which HEMP and MARIJUANA belong
2. MARIJUANA is the residual dried leaves of CANNABIS SATIVA.
3. It has a psychoactive ingredient referred to as THC which is what gives MARIJUANA its psychoactive function and can affect brain function.
4. Marijuana is a SCHEDULE 1 drug (Illegal/Illicit judged to possess NO SIGNIFICANT medical uses) and is used either RECREATIONALLY or for MEDICINAL purposes.
5. HEMP is derived from the Cannabis SATIVA plant and is grown for industrial purposes
6. HEMP does not have psychoactive effects and is cultivated and produced for INDUSTRIAL PURPOSES. HEMP also comes from the MASCULINE CANNABIS plant while CANNABIS comes from the FEMALE Cannabis plant.

In summary:

1. Hemp and Marijuana are both DERIVED and produced from the CANNABIS SATIVA plant.
2. Hemp comes from the MALE CANNABIS SATIVA plant (very low THC or psychoactive potential). Used in commercial and industrial products such as clothing, paper products, textiles, and fabrics.
3. Marijuana derives from the FEMALE CANNABIS plant (HIGH THC and psychoactive potential) and is used strictly for RECREATIONAL or MEDICINAL PURPOSES.
4. Cannabis comes from FEMALE CANNABIS SATIVA plants and is HIGHLY psychoactive.

If I've provided useful or helpful information to your questions could you do me the utmost of favors in CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information if you'd care to drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this discussion has aided in your understanding of a few concepts related to your problem of incontinence as well as what may be possible to do with respect to your PARKINSON'S and CAMPTOCORMIA.

This query required 120 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Trospium may have less SIDE EFFECT PROFILE compared to OXYBUTNYNIN

Detailed Answer:
Good evening and MANY thanks for sharing your questions with me. Let's see what we can help you get a better handle on this time around.

Trospium CL and oxybutynin are referred to as ANTICHOLINERGIC medications and are found to be generally SIMILAR in efficacy according to studies, however, trospium is pharmacologically "improved" over oxybutynin because it has less aggressive and overall less side effects involving less body systems. Its main claim to fame over oxybutynin is that it does not cross readily into the brain so does not typically result in fatigue, confusion, or disorientation nearly as frequently as oxybutynin.

In patients who are over the age of 60 I tend to prefer agents such as TROSPIUM ahead of Oxybutynin in order to avoid CENTRAL NERVOUS SYSTEM side effects such as drowsiness, fatigue, and slowed cognitive processes.

In terms of bladder training the general principles are the following:

(mainly urge incontinence)
1. Use of a voiding diary is highly recommended in order to track progress.
2. You shoud be voiding on a REGULAR and CONSISTENT schedule which is represented by the SHORTEST amount of time you can find between voids in your DIARY. Make sense?
3. When an episode of URGENCY strikes you then, use distracting thoughts and/or maneuvers as well as hip thrusts and Kegel movements. Tighten the hips and pelvic floor while you count to 8 while contracting. Relax the muscles and count slowly to 10 then, start the process again.
4. Increase the time between voids on a weekly basis by no more than 25% over the previous week. If that is not working then, go back to the previous level for another week and try again.

Although I believe the cause of your urge incontinence and spastic bladder is likely due mainly to the PARKINSON'S DISEASE it may also be the case that your camptocordia is causing compression of the spinal cord and interfering with normal electrical signal flow from the spinal cord to the bladder.

Just so you're aware...I've had much better success in my patients with Parkinson's Disease who use BOTOX injections for their spastic bladders rather than the anticholinergic medications. Effects are more predictable, less prone to suffering significant side effects and there are really no drug to drug interactions that have to be dealt with compared to using pills. Also, there is no hassle with having to take daily medications. BOTOX is good for up to 12 weeks at a time....sometimes we will inject patients at around the 8 week mark but the results are VERY VERY GOOD indeed.

I'm not sure why more doctors are not using BOTOX for their spastic bladder patients....perhaps the drug companies manufacturing the pills are sending more lunches over to the primary docs than the BOTOX people are! HA! There is also another consideration with the BOTOX injections and that it is patients could develop rather acute inabilities to empty the bladder and may even require SELF CATHETERIZATION in order to empty their bladders.

I am unaware of any high grade medical studies performed that support the use of any type of marijuana, cannabidiol, or hemp oil that really works and KEEPS working. I understand and agree that you are living with a veritably impossible situation with the PD and the camptocordia and willing and ready to try anything....but I've never seen that work for anybody that I've treated and there have been several patients who have tried it with very high expectations only to find that it led to no improvement and in one case the patient told me that he started developing cramping and even more problems with is PARKINSON'S after being on the marijuana for a short period of time.

Another up and coming method of controlling bladder symptoms without the headaches of having to deal with medications is the INVASIVE approach of DEEP BRAIN STIMULATION which can have the DOUBLE POSITIVE effect of addressing both the bladder symptoms AS WELL AS improving the PARKINSON'S DISEASE symptoms. Also, have you been CHECKED for possible BLADDER INFECTION? This can be an overlooked cause of bladder dysfunction. Good bladder training is probably your best bet at overcoming the problems with the least amount of headache and complication.

People who are persistent with your bladder training in the end have been shown to be only suffering from 50% of their previous symptoms. One other pearl or nugget of information is that in some people SINEMET or carbidopa/levodopa can actually WORSEN spasticity symptoms but that over a period of about 2 months people will improve...SIGNIFICANTLY.

HEMP vs. MARIJUANA vs. CANNABIS

1. Cannabis is a LARGE family of plant to which HEMP and MARIJUANA belong
2. MARIJUANA is the residual dried leaves of CANNABIS SATIVA.
3. It has a psychoactive ingredient referred to as THC which is what gives MARIJUANA its psychoactive function and can affect brain function.
4. Marijuana is a SCHEDULE 1 drug (Illegal/Illicit judged to possess NO SIGNIFICANT medical uses) and is used either RECREATIONALLY or for MEDICINAL purposes.
5. HEMP is derived from the Cannabis SATIVA plant and is grown for industrial purposes
6. HEMP does not have psychoactive effects and is cultivated and produced for INDUSTRIAL PURPOSES. HEMP also comes from the MASCULINE CANNABIS plant while CANNABIS comes from the FEMALE Cannabis plant.

In summary:

1. Hemp and Marijuana are both DERIVED and produced from the CANNABIS SATIVA plant.
2. Hemp comes from the MALE CANNABIS SATIVA plant (very low THC or psychoactive potential). Used in commercial and industrial products such as clothing, paper products, textiles, and fabrics.
3. Marijuana derives from the FEMALE CANNABIS plant (HIGH THC and psychoactive potential) and is used strictly for RECREATIONAL or MEDICINAL PURPOSES.
4. Cannabis comes from FEMALE CANNABIS SATIVA plants and is HIGHLY psychoactive.

If I've provided useful or helpful information to your questions could you do me the utmost of favors in CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information if you'd care to drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this discussion has aided in your understanding of a few concepts related to your problem of incontinence as well as what may be possible to do with respect to your PARKINSON'S and CAMPTOCORMIA.

This query required 120 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Swelling in ankles as described very unusual side effect

Detailed Answer:
Thank you for the additional questions.

Although virtually all dopaminergic medications have the potential for causing swelling or edema in patients, localized ankle swelling of what seems to be a milder type (based on your description of “feels worse than it looks” would be very unusual. it would be more likely to be a side effect if the onset of this swelling could be synchronized or clearly coincided with a time frame of when the medication in question was initiated or at least within 4-8 weeks of starting. If the swelling in the ankles clearly happened well after the start of the medications then, side effect is less likely.

in that case you would be advised to speak to your primary to check into some other possibilities for the swelling if it is presenting a problem that is reducing your quality of life or getting worse.

Some metabolic parameters that I would check right off the bat would be general electrolytes, thyroid hormones, serum protein, albumin, and perhaps a random cortisol.

Once again, if you were willing and able to be seen in the office so that I can actually witness and examine your feet and legs I would be able to opine a bit more confidently since long distance “guesstimates” are so much less accurate than seeing the Real McCoy! :)

Also, if you find my responses helpful then, your positive feedback as well as a 5 Star rating is extremely appreciated.

Cheers!

---

Brief Answer:
Swelling in ankles as described very unusual side effect

Detailed Answer:
Thank you for the additional questions.

Although virtually all dopaminergic medications have the potential for causing swelling or edema in patients, localized ankle swelling of what seems to be a milder type (based on your description of “feels worse than it looks” would be very unusual. it would be more likely to be a side effect if the onset of this swelling could be synchronized or clearly coincided with a time frame of when the medication in question was initiated or at least within 4-8 weeks of starting. If the swelling in the ankles clearly happened well after the start of the medications then, side effect is less likely.

in that case you would be advised to speak to your primary to check into some other possibilities for the swelling if it is presenting a problem that is reducing your quality of life or getting worse.

Some metabolic parameters that I would check right off the bat would be general electrolytes, thyroid hormones, serum protein, albumin, and perhaps a random cortisol.

Once again, if you were willing and able to be seen in the office so that I can actually witness and examine your feet and legs I would be able to opine a bit more confidently since long distance “guesstimates” are so much less accurate than seeing the Real McCoy! :)

Also, if you find my responses helpful then, your positive feedback as well as a 5 Star rating is extremely appreciated.

Cheers!

---