Cyst Gone, but not via Surgery / Cortisone Shot Received for Bursitis Behind Left Knee

Yesterday, I went in to get a ganglion cyst removed from behind my left knee.  My appointment was with a radiologist so the doctor could use an ultrasound machine (the same machine used when seeing a baby in a woman's stomach, except in this case they look for cysts).  They use the machine to locate exactly where the cyst is so that the needle incision can be precise to drain it.  I love this precision.  Prior to yesterday, I had no idea that radiologists actually performed procedures (I always assumed that they just read xray, MRIs, CT scans, etc.)

The ganglion cyst showed up on an MRI on May 6th.  At that time, it measured about 3cm x 2.2cm x 0.8cm (i.e. a pretty good size cyst).  I had no idea that I had a cyst prior to the MRI.  I also had some bursitis behind the left knee, so going into my appointment, I wondered if the bursitis or the cyst was the reason for my pain.  I thought it was a little strange that I could not feel the cyst with my hand. 

When the radiologist looked for the cyst, he couldn't find it.  I anticipated this, so I had my MRI report and copies of my MRI films for the doctor to look at.  I showed them where my pain was, and sure enough, they found the source of my pain.  In this case, it wasn't the cyst at all.  Rather, the bursitis behind my left knee had gotten worse (even though I'm not running these days).  Given that I have had this bursitis for over 2 months and it hasn't gotten better, they said that I needed a cortisone shot to help it heal.  I got the shot and immediately felt better  - the lidocane numbed the area even though the steroid cortisone shot is slow releasing and therefore the drug won't kick in for a few days (and the doctor said that the drug could help the area for up to a year).  Today, the area felt a little sore as the doctor predicted, but as the day went on, the pain behind my left knee was noticeably better.  The doctor told me not to run for a week, but that I could bike or swim starting Monday.  Riding a bike doesn't hurt at all, so I'll be doing that on a stationary spinning bike at the gym all next week.  I may try swimming also.

I also asked the radiologist to ultrasound my right knee and IT band, given that it hasn't gotten better from the May 6 MRI (despite hardly running at all for the last 3 weeks and taking anti-inflammatories (Mobic)).  I figured that if I was getting the cortisone shot to the left knee and couldn't run for a week, that it would make sense to get the shot to the right knee also so I could have both knees start to heal at the same time and limit the time I can't run to 1 week.  My doctor hadn't written a prescription to ultrasound my right knee, so I got some resistance.  I explained my thinking and the doctor did the ultrasound and found a pocket of swelling and a thickened IT band and said that a cortisone shot was needed there too.  So they called my doctor's office to ask for the prescription, but unfortunately he wasn't in (2pm on the Friday of Memorial Day weekend).  They said that it wasn't a medical emergency and that I didn't have a prescription so they wouldn't do the shot.  When I asked if there was a doctor covering for my doctor that could approve it, they said no, only for emergencies.  Of course, "it is an emergency to me" I explained, as (1) I don't want to have to retake the same tests I just took to determine that I need the shot, (2) deal with getting an another appointment at this hospital (Hospital for Special Surgery ("HSS") which was extremely difficult to do the first time and very tough for me to get there again because I'm very busy at work), (3) have to take 2 weeks off instead of 1 because I won't get the second shot, at the earliest, until next week).  I got no sympathy whatsoever.  It made total sense to get both shots at the same time.  It's not like I was making up the injury.  The radiologist clearly saw the injury on the ultrasound exam.  The radiologist had no ability to write his own prescription for the shot (which is surprising to me because one would think that the ultrasound test he conducted is far better evidence that a shot is needed than calling my knee doctor who is just going to ask the radiologist what he thinks anyway or read his report, which the radiologist told me was to get the cortisone shot).     Where I come from,  people want to help people.  A doctor would have called another doctor and somebody would have figured out how to write me a prescription to get it done so I wouldn't have to go back again to get it done.  Yesterday, me being the squeaky wheel made me feel like I was the bad guy.  A bad guy simply for wanting to get the best possible care so that I can recover faster, at a top rated hospital that prides itself on taking care of athletes.  It feels like the best possible care comes in a distant second place to the schedule and inflexibility of doctors and hospitals. 

At the end, I asked the doctor to look for the cyst.  He did and couldn't find it.  The doctors said that it is likely that it went away on its own because, as the Doctors put it, "I was behaving myself" (translation - when I reduced the overuse of excessive marathon running, it went away).

MRI Results

Unfortunately, for the 2 months before the Wisconsin Marathon (May 1), my knees started to hurt.  I managed through it, but I don't think that I had a run without pain during these 2 months.  Rest and ice baths helped, so looking back I was extremely fortunate to have actually completed the marathon.  As one of my friends said "you got lucky".  I also know now that I was lucky not to hurt myself more.  Live and learn.

So, I saw a doctor the Monday after the marathon and got XRays and MRIs of both knees and legs.

Here were the results:

Right Leg -
1.  Xray - No stress fracture in my right leg (I thought 50/50 I had one, although it did show thickening of the bone which indicates that I may have had one in the past).  Good news.  The xrays of both of my knees were completely normal.

2.  MRI - Right Knee

• (1) severe IT band syndrome in my right knee (I have had this before and can fix it via physical therapy, ice, rest, elevation, and anti inflammatories).  Despite the fact that I roll out my IT bands everyday, I still had this injury, and my physical therapist said that it will likely take 6-8 weeks for me to fully recover.
• (2) arthritis in the knee (I have had this in the past)
• (3) a small Baker's cyst behind the right knee (unexpected but it is small and doesn't really bother me, so nothing to do with it).
• Right knee bottom line - everything is fixable, no major problems.

3.  MRI - Left Knee

• (1) Bursitis behind my knee around my medial gastroc (I thought I had a gastroc strain, so this was good news).
• (2) A very large ganglion cyst behind my left knee (over 3 cm by 3 cm large). These occur normally in people (and I have a history of cysts in my body due to my Crohn's disease), but this cysts (non cancerous) is pushing under some tendons and around the bone and is really bothering me
• I am having this cyst drained tomorrow (5/27).  I'm told that I will feel better almost immediately.

After the marathon, I took 5 days off in a row and then ran 5 miles (8:18 pace), then 10 miles the next day (8:58 pace). During my 10 mile run, I felt good for the first 7 miles, but for the last 3 miles my right knee and leg were really hurting, so when I got done, I decided to shut it down for my family vacation to California (Newport Beach). I have only run twice in the last 3 weeks.  Not exercising in any form is extremely difficult for me, but I know it is the right thing to do to let my body heal and to get healthy. My body already feels much stronger and my knees feel better.  I also am taking Mobic (anti-inflammatory) to help reduce the swelling and bursitis in my knees and I have started Physical therapy with Allison Lind.  She is awesome, I highly recommend her.  She just qualified for the Kona ironman on 10/9/10.  I also would like to get more acupuncture with Anastasia Hall, but I haven't had time.  I'm a big believer in the benefits of acupuncture.  I don't think that I could have run the Wisconsin Marathon without her help.

Since I haven't been able to run much, I have been riding a spinning bike at the gym.  Luckily, I can do this without pain.  I'm really enjoying doing something other than running and hope to keep up cycling when my knees are 100%.  I'm actively looking to buy a road bike now, so any and all advice is greatly appreciated!

My next marathon is on 10/10/10 in Chicago, so this is a great time to take some time off to let my body recover.

Wisconsin Marathon 2010 - a 4:17, a tough day, a humbling experience

Today, I ran my 2nd marathon. 

Location = Kenosha, Wisconsin
Date = May 1, 2010
Weather = low 60s at the start, sunny, extremely humid (100%), 20 mph winds. Temperature near 70 during race. 
My time = 4:17, half marathon split 1:55

Comments:
Tough race today. Despite not meeting my goal time, I'm still proud of my performance, as I was feeling really bad starting around mile 9 and I really did not want to run 26 miles at that point.  It was extremely hard for me to simply finish this marathon (versus my first marathon when I ran a 3:58 in NYC and didn't walk at all). Today, I probably walked 5 miles of the course. When I saw my friend RFL at mile 12 as he was finishing his half marathon, I yelled to him "I'm going to be right around 4 hours". He said "that's ok, that's great". This motivated me to keep going. When I saw my friend BGR at mile 19, I said to him "I think I'm going to be at around 4:40". At one point, I actually thought that I might not break 5 hours, that's how bad I felt.

I'm proud because I kept going. I'm proud because I decided that having fun and staying healthy was more important than pushing myself to misery trying to break 4 hours. I run to feel good, stay fit, keep my Crohn's disease in remission, and so that I can run tomorrow. I had a great time once I decided to walk. I knew 4 hours was gone at that point. I really enjoyed talking to other runners (I think I spoke to every single runner around me except those wearing headphones that couldn't hear me, which is funny, because I normally don't talk to anybody when I run because I listen to music.  My xm radio died at mile 12 so I ran the second half without music). Talking to other runners totally changed my perspective forever. It made me truly appreciate how tough it really is to run a marathon and that everybody has good and bad days.  It was extremely humbling for me. I felt, for the first time as a runner, that I was living the experience with others. Most of all, I'm proud that I ran my 2nd marathon!!


The race ran through the neighborhood that I grew up in (and my mom met me on the out and back, out and back course 4 times, which was great!). My friends BGR (first full marathon, from New York) and RFL (half marathon, from Highland Park) also came to Kenosha to run the race, which is great. I also met my friend MT (half marathon) and SJ (first full marathon) at the race. My friend CBS came to play the his steel drum for runners, which was very cool (and it was great to see him too).  I also saw many old friends before, during, or after the race, which was very cool.

My time was 37 minutes below my goal of 3:40. All of my friends that ran the marathon were 23-40 minutes below their goal time. Tough day for all. My average heart rate was 171 for mile one (during the race, I saw that my heart rate was in the low 170s around mile 8, although I didn't realize that my average heart rate was 173 for my first 2 miles until I checked after the race). Way too high and very abnormal for me. At mile 8, I knew this meant trouble. I had a wicked cold early in the week, but I thought I was recovered by the race. Perhaps the cold contributed to the high heart rate? Even when I was walking after mile 13, it was in the 140s, also very abnormal for me. I've had training runs where I have run long runs at an 8:35 pace where my heart rate averages in the high 140s (although the temperature was in the 40s or 50s and the humidity was low).  The high heart rate shows why I felt like running was so much harder today.


I started out strong and stayed to my gameplan of running an 8:20-8:40 pace for the first 10 miles or so, but I just didn't have it today after that. I was hot, tired, and my average heart rate was way above normal for this pace. The humidity, heat, wind, and loss of my iPod at mile 12 killed me (the battery died, one of my worst nightmares).

Today was quite a humbling experience. I'll use it as a learning experience for my next race, where I will force myself to go even slower at the start (around 9:00 per mile).  Even if I would have started out slower, I'm not sure that I would have had any energy at the end.  I'll never know.

I started to feel bad around mile 9. I was bloated from drinking water/Gatorade together.  Plus, there weren't enough water stations, which was a killer with the temp in the 70s and 100% humidity plus the sun and wind. I really wish that the water and gatorade stations would have been staggered one mile apart (instead of being together every 2 miles), so that I could drink water at one mile then gatorade at the next (I saw the race director after the race and recommended this to him for next year's race).  This would have been beneficial because (1) runners would have had a liquid every mile, somthing that was badly needed because of the heat and humidity, and (2) it would have helped me drink less liquid at one time, as I would not have felt the pressing need to drink both every 2 miles (which caused me to get bloated and feel sick).  I actually thought that I might pass out at a few points (and one woman did with a 107 temperature right as she finished the half marathon - she's in Intensive care). I considered dropping out of the race. I have never considered dropping out of a race before. Generally, it is not a good sign for a marathon runner if he/she is tired of running before getting to double digit miles. When I saw my friend RFL near his half marathon finish (mile 12), I thought to myself "man, I wish I was done". Then, I saw my mom at mile 12, which perked me up. Before the race, I was worried about my xm radio battery dying but I couldn't find a replacement battery the day before. Therefore our gameplan was for me to run with my iphone for the 2nd half of the race if I needed it. So, my mom gave me a couple of GUs at this point but I told her that my xm radio was ok. Oops. About 40 steps later my radio died. I thought about running back to her, but didn't. 2 minutes later, I saw a family sitting on their lawn to cheer runners along. I said to them "do you guys live here?". "Yes", they responded. I said "would you mind if I leave my radio with you and I'll pick it up after the race?". They said yes, and I threw my radio on their nice lawn as I continued to run.

The night before the marathon, there were severe thunderstorms and the temperature was around 80.  When the race started at 7am, it was already 61 degrees, with 100% humidity and 20 mph winds.  The forecast projected the temperature to reach the 70s during the race with sunshine.  Unfortunately, the wind was not coming from Lake Michigan either, so it was not a cool breeze.

Over the course of my marathon training, I have learned that each person is different.  Some people like running in cold weather (me) and others like it a little warmer.  No marathon runner likes temperatures in the 60s or 70s with 100% humidity and wind.  I have only run one other race with this type of weather (a half marathon last fall in New York, and I had my worst race ever, walking a fair amount during the race, logging a 2:04).  Until today, that was the only race that I walked in. 

My goal for this marathon was to finish in the 3:40s.  I was properly trained for the race, having run three separate 20 mile training runs in the 8:23 - 8:35 per mile range (a 3:43 marathon would be an 8:30 per mile pace).  My natural comfortable running pace is usually between 8:20 - 8:35 per mile, and lately I was running many of my short runs below 8 minutes per mile.

Other

- After the race, I sat in Lake Michigan for 20 minutes to "ice" my legs. The water temperature was around 38 degrees. It definitely helped my recovery.
- After the race, we went to the Kenosha YMCA to sit in the jacuzzi and to shower. The jacuzzi really helped us feel better.
- It was great to see my friend CBS playing his steel drum for runners during the race. Very, very cool.
- It was great to see my friend SH (a triathelete) watching the race with his 2 dogs (he said that the dogs like the "socialization"). This made me laugh.
- After the race, it was great going to dinner with my friends JL, TM, SJ, MT, and RFL. We had a great time.
- My splits from my Garmin 405 GPS watch for the entire race


At the 4 mile point....

My friends BGR (full), MT (half), SJ (full) and RFL (half) after the race (with Lake Michigan in the background)