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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?

P.L.

Dear P.L.: Bruising is caused by broken blood vessels internally. Although the body’s 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’s lower than the injury) as a reddish/brown color, gradually changing to green and yellow as the blood is metabolized and reabsorbed.

In the case of the shin, the tibia bone is superficial, and easily damaged. If the blood vessels in the periosteum, the lining of the bone, are hurt, one can develop a periosteal hematoma, or a “bone bruise.” These last for weeks and can be tender when they first appear. I suspect it will disappear. If it doesn’t, go see your doctor.

Rarely, there is a bone tumor, which usually is benign, but unfortunately isn’t always, that is brought to one’s attention by trauma at or near the area.

Dear Dr. Roach: Would you 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.

Dear Anon.: Your question is about building muscle mass in young athletes, with the concern that they may become obese in later years. This isn’t 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.)

If physical activity drops, then food intake needs to drop also, or the athlete will gain fat. It is not the case that muscle turns to fat, but muscle bulk will decrease without regular exercise.

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’s responsible, it’s the balance between eating and exercise.

I still don’t recommend high-school football. Despite recent improvements in coaching and technique, injury rates for high-school football players are unacceptably high.

Dear Dr. Roach: Twelve years ago, my wife was diagnosed with colorectal cancer, which resulted in a permanent colostomy. She is now cancer-free, but one thing worries us. She has had regular colonoscopies, implemented through the stoma. Since the rectum (which is where the cancer was) has been bypassed, is a colonoscopy not reaching the area that needs to be checked more closely, since that is where the cancer originally was? Or does some other test check the rectum?

T.C.M.

Dear T.C.M.: You are correct, the remnant of the rectum left after surgery is not evaluated by a colonoscopy through the stoma (the opening of a colostomy), and must be checked by physical exam. Often, this is done during the colonoscopy, while your wife would be sedated, to do a thorough exam without discomfort.

Email questions to ToYourGoodHealth @med.cornell.edu.

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