Saturday, May 29, 2010

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).


  1. I'm sorry that the medical system couldn't find a way to make the obviously more efficient thing happen, but it does sound like you are making good progress.
    Looking forward to seeing back out there soon!

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