Dear Dr. Roach: I am a 77-year-old woman who has enjoyed good health. Several weeks ago, I fell off a stepstool while trimming a tree in the backyard, bruising the shin on my left leg. The bruising has all disappeared by now, but a large (quarter-size), hard lump remains on my leg. I massage it gently each day, hoping it will dissolve. Should I be concerned about this, or will it take care of itself in time?
P.L.
Bruising is caused by broken blood vessels internally. Although the body鈥檚 systems will clot the broken vessels, the blood can be visible in the area of the injury (or pulled by gravity to an area that鈥檚 lower than the injury) as a reddish/brown colour, gradually changing to green and yellow as the blood is metabolized and reabsorbed.
In the case of the shin, the tibia bone is very superficial, and pretty easily can be damaged. If the blood vessels in the periosteum, the lining of the bone, are damaged, one can develop a periosteal hematoma, or a 鈥渂one bruise.鈥�
These last for weeks and can be quite tender when they first appear. I suspect that it will disappear. If it doesn鈥檛, go see your聽 doctor. 聽
Rarely, there is a bone tumour, which usually is benign, but unfortunately isn鈥檛 always, that is brought to one鈥檚 attention by trauma at or near the area.
Dear Dr. Roach: Would you please comment on high-school football coaches encouraging their players to use bodybuilding supplements such as creatine and others? Coaches want kids to bulk up to play high-school football. What happens to that body mass in five or 10 years, when physical activity slows? I think these coaches should be reprimanded for the future harm they are doing to these high-school kids.
Anon. 聽
Your question is about building muscle mass in young athletes, with the concern that they may become obese in later years. This isn鈥檛 necessarily true. Building muscle, through tremendous activity and weightlifting, can be somewhat increased by creatine, a supplement that is a key component of muscle. All this muscle activity burns calories, and football players eat a great deal just to keep up with calorie needs. (A large number of high-school athletes use anabolic steroids to build muscle, which I recommend against in the strongest possible terms.)
If the physical activity decreases, then food intake needs to decrease also, or the athlete will begin to gain fat. It is not the case that muscle turns to fat, but muscle bulk will decrease without regular exercise. 聽
Excess calories have to go somewhere, and in men, that often means around the middle. It isn't the creatine or the muscle gain that鈥檚 responsible, it鈥檚 the balance between eating and exercise.
I still don鈥檛 recommend high-school football. Despite recent improvements in coaching and technique, injury rates for high-school football players are unacceptably high, in my opinion as a parent and a physician. However, I recognize that that decision is made by the athlete and parent.
听听听听
Dear Dr. Roach: I understand that bile assists in the digestion and absorption of fats and is responsible for the elimination of certain waste products from our body. Could you please tell me what happens to a female who has had laparoscopic gallbladder surgery? I鈥檓 having a difficult time losing weight.
M.F.
Bile, which contains bile salts such as cholic acid, are secreted by the liver and stored in the gallbladder. They are essential in the digestion of fat, where they act chemically to emulsify fat (emulsification allows fat to dissolve in water, similar to soap breaking up fat when cleaning).
Ninety-five per cent of bile acids are reabsorbed, normally, in the intestine, allowing them to be reused.
The gallbladder releases bile in response to a fatty meal (which is why people with gallstones develop pain after a fatty meal 鈥� the gallbladder constricts, causing pain if the duct is blocked by a stone).
Without bile, fat cannot be properly absorbed, leading to steatorrhea (鈥渟teato鈥� for 鈥渇at,鈥� and 鈥渞hea鈥� for 鈥渇low鈥�), a fatty diarrhea, and often weight loss.
After gallbladder surgery 鈥� open or laparoscopic 鈥� in most cases, the liver learns to release the bile appropriately in response to a meal within a few weeks of surgery. There are many reasons for inability to lose weight, but it shouldn鈥檛 be related to your gallbladder surgery.
Thyroid disease may be the most common cause.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
