Ask the Experts: Traveling with Incontinence; Knee Replacement; Avoiding Gluten

Q. I’ve just retired and am soon going to be fulfilling a long-held ambition to “roadtrip” across America in my car. I’ve invited my elderly mother to accompany me, but since she suffers from incontinence do you have any advice for how I can ensure she is accident-free as we travel?

A. Your first step should be planning a route that includes plenty of rest stops where there are likely to be restrooms your mother can use. Mark these on a map, and also keep in mind that if you use a GPS or in-car navigation system, these also can locate and direct you to gas stations and local attractions and businesses that will have restrooms. Another handy option if you use a smartphone is the “Sit or Squat” app, which not only locates nearby restrooms but also provides a cleanliness rating. You can download this and similar apps via the app store on your phone.

Plot in a rest stop every three hours or so. As well as giving your mother a bathroom break, stretching your legs will help protect you both from blood clots, which can be a risk if you’re seated for long periods of time. As added insurance, I suggest that your mother pack incontinence underwear or pads she can wear just in case you get delayed en route. It also may be useful to stow a “changing bag” in the car—pack it with spare clothing and sanitary wipes, as well as plastic bags for storing any wet clothing while you continue driving. I also recommend protecting the car seat with a waterproof pad.

With careful preparation, there is no reason why your vacation can’t be a relaxing and enjoyable experience for you both. Have a wonderful time!

–Rosanne M. Leipzig, MD, PhD
Geriatric Medicine

Q. Can you explain the difference between a total knee replacement and unicompartmental knee replacement?

A. The knee joint comprises three compartments at the end of the thighbone: the medial (which is the inside of your knee, closest to the other knee), the lateral (the outside of the knee), and the patellofemoral (the front, between the kneecap and thighbone). In total knee replacement, all three compartments are resurfaced with metal and plastic components, as is the top of the shinbone. Your doctor is likely to recommend a total knee replacement if arthritis is affecting all three compartments of your knee. However, if arthritis is only affecting one compartment of the knee, a unicompartmental (also called partial) knee replacement may be recommended. In this procedure, only the medial or lateral compartment of the knee is replaced (along with the top of the shinbone).

A unicompartmental knee replacement has some advantages. For example, while a total knee replacement requires several days of hospitalization, unicompartmental replacement can be carried out on an outpatient basis. The recovery period is shorter, with less physical therapy required, and the surgery also leaves the ligaments of the knee intact, which helps with future knee stability and range of motion.

–Michael J. Bronson, MD 
Orthopaedic Surgery 

Q. I’ve been trying to lose weight, and a friend told me that if I cut gluten out of my diet I will shed more pounds. Is this true?

A. Some people do find that they lose weight by avoiding gluten (which is an umbrella term for the proteins present in wheat, rye and barley). However, any weight loss is typically due to the fact they’re actually cutting their calorie intake by avoiding foods that contain gluten—for example, bread, pasta, and cereal. Alternately, they may have gluten sensitivity, and removing gluten from their diet reduces inflammation and fluid retention. But certainly not everyone who follows a gluten-free diet will find that it helps them lose weight—moreover, by removing sources of gluten from your diet, you’d be missing out on whole grains that may help protect against disease. Instead, I would recommend that you focus on portion control, eating a balanced diet, and burning more calories through regular exercise.

–Fran Grossman, RD, MS, CDE, CDN

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