Richmond Times-Dispatch

Dr. Keith Roach

- — North America Syndicate Inc. Send questions to Dr. Roach at ToYourGood­Health@

Dear Dr. Roach: I am78 and have some difficulty swallowing. I must take calcium andmagnesi­um tablets, and they are very large. I have actually choked on pills in the past. Any suggestion­s?  P.P.L.

Dear P.P.L. : A proven method of swallowing tablets is to place the tablet on your tongue and suck water from a flexible water bottle. Capsules can be swallowed more easily by tilting the chin slightly toward your chest. These techniques are illustrate­d at https://

Many, but not all, large pills can be crushed and mixed with thick liquid like applesauce or yogurt. Pill crushers can be bought at any pharmacy, or you can get amortar and pestle.

Dear Dr. Roach: Oftentimes, when I get a hard smack to a bony area, I develop a hard, tender lump on the bone. This lump will last and stay sore for weeks and sometimes months. Why does this happen? Is something wrong withmy bones? I still have a sore lump on the edge of my tibia from a long time ago.  B.H.M.

Dear B.H.M.: We often think of bones as constant and unchanging, but bones are metabolica­lly active, constantly reabsorbin­g themselves and laying down new bone to stay strong and healthy. Of course, they need a blood supply, and onemajor way the bone gets blood is from the periosteum, the lining of the bone.

This hasmany blood vessels and nerve fibers, so a blow to the bone can cause damage to the periosteum and break blood vessels. This is especially true for the tibia, or shin bone, which is very superficia­l and has a propensity to knock into things. This causes a “bone bruise,” or subperiost­eal hematoma. Theplentif­ul nerve fibers account for the very unpleasant pain that accompanie­s a really hard knock on the shin. It can take weeks or months for the blood to get reabsorbed and the bone to reshape itself back into normal.

Bones consist of a shell of cancellous bone, the smooth, hard substance we all know fromskelet­ons. But the deeper structures of bones contain trabeculae (Latin for “small beams”), which are orderly units of bone, around which is the bonemarrow, the cells that produce your blood cells.

A really hard blow can also cause a microfract­ure of the bone, breaking some of the trabeculae on the inside of bones. This doesn’t require the treatment of a complete fracture, but it can delay healing and cause persistent pain.

Bone bruises are common, and they don’t mean there is anything wrong with your bones.

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