Knee Swelling - Bakers Cyst and Cortisone Injections

Baker's Cyst, RA in Knees and Cortisone Injections 

When you have knee swelling, there is a period of time where the swelling can be removed and flushed out by the body and recirculated and eliminated. 

But there comes a time at some point where what's called a baker's cyst can occur in the back of the knee. And what this simply means is that some fluid has gotten trapped, and rather than being flushed out constantly, it's caught. And so when it gets caught, it builds up, because then you've got a bag. You've got a sac that fills behind the knee, where it closes on itself if you were to try and sit Japanese style (legs straight back under you).

Sometimes the swelling that it's gone to the top of your knee, in my layman's understanding of this, is that there's either a little bit more fluid that is accumulated and there's nowhere to go. The joint's not designed to have this content of fluid in it, and so it's just finding some place to hang out on the top of the patella, knee cap.

But, because it's a closed loop, with nowhere to go for the fluid, it's had to find a place somewhere else. Because if the body can't reabsorb it again because it's actually formed in a sac. So if that's the issue then you've got a baker's cyst, the fluid's trapped and when there's nowhere to go, like a full balloon, it can squash from this side to that and up and down.

One option is to go and have a cortisone shot into the knee and have it drained. 

For many people with RA, this is as common as going and having haircut. And I postponed doing that for over a year after all of my other joints felt so much better, but I had one joint that was really problematic. That was my left knee. 

My left knee was the situation I've just described, which is why I'm familiar with it because it was exactly what I went through. And it just wouldn't respond. No matter what I did with my diet, no matter how strict and how many times I went to Bikram, that knee just wouldn't lose the swelling.

The muscles around the knee were getting a little bit stronger, slowly improving with time, but it was still not responding anywhere near all the other joints.

I had this grand plan of being able to not require any medical intervention ever again after I made my dietary changes via the Paddison Program, but eventually, I conceded and I thought, "I've got to get some outside help."

And so I went and the rheumatologist looked at the knee and he said, "Actually, there's not enough fluid for me to drain." He said, "There's obviously fluid in there." But he said that there's not enough to drain and if we just did a cortisone shot instead of drain and cortisone, just do the shot, he said that a lot of the swelling gets eliminated by the cortisone shot anyway. He said, "So I think that a cortisone shot will actually enable you to get rid of the swelling and the pain and then you probably will need to have it done again in another couple of months." And I said, "Yeah, that's fine."

Anyway, because I had done so much work on my gut health and I was so basically well on the inside, that one single shot absolutely fixed that joint and I've never had another problem with it other than the structural damage that was caused from a lot of it, from postponing the shot. I should have had it a long time earlier.

I'm very pro medical intervention when I see that we have a shortcut in ways that we should embrace. 

So, my rule of thumb is
- If you have one joint that is far worse than all the others AND
- If you've already implemented the Paddison Program for several months AND
- If you've been exercising solidly each day and getting the pain reduction benefits from this

And yet you're still got the one single joint that's an outlier

THEN talk to your doc about a cortisone shot.

And with the knee, what's fueling me to say that is that when you have a baker's cyst, you can't get rid of the fluid even if you go to daily Bikram Yoga, which is my preferred method of exercise for everyone with RA. (Let me just put an exception to that. Sometimes they burst. And when they burst, the fluid runs down the back of your calf for about three days and you don't see anything. You just feel a burning sensation at the back of the calf muscle. It's not more unpleasant than having a joint with rheumatoid, but it's unpleasant. And why I don't think that you should wait for that to happen, because eventually it probably will, is because it happened to me but, through whatever mechanisms are at play, it filled back up again and I eventually only got full relief from the cortisone shot).

So if you want to get a cortisone shot, ring the rheumatologist, book the appointment and tell them I also want to allow time in my booking for a cortisone injection and a potential draining of the synovial fluid. If you could make a note so that there's time for it if the doctor does it himself. Ask "Does the rheumatologist do them in the regular checkup?" And what he may do, he may not do them himself, and he may actually give you a referral to a specialist that does do them. But I would start with the rheumatologist, at least because that's the system that I'm used to. But if there's a different process in place, then go through that. 

Now, what you'll find is that once you get that knee drained and you get the cortisone shot and the swelling, once you find what's happening underneath all that swelling, what you're gonna find is that that the muscles around the knee are pathetic and weak. All the muscles around it are gonna be wasted, there's gonna be a general weakness in the muscles around that knee. When you have the knee cleared of inflammation and swelling from the shot, you've got a window of opportunity until this swelling and inflammation returns where you need to engage your muscles aggressively.

So I want you to be ready and to be able to maybe do some step-ups at home, like just step up onto a small platform and step down again. Just like step up, step down, step up, step down, step up, like that, okay, onto a bottom of a stair or your own little step-up thing, because you want to build the muscle here above the knee. This is where it's gonna be weak, in the quadriceps, right. But all the other major muscles in that leg, and the connective tissue to the knee joint, are going to be weak. So build them up when you get the chance and you'll be a big step ahead.

Ask for my help if you need it. Good luck!


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