Doctoring in the Wild

Aside from an ancient meniscus, my left knee works pretty well most of the time. Rather, it did work well until early this spring when it sprouted a lump about the size of a marble on the outside margin of my kneecap.

Over time the lump got bigger and smaller, more and less painful, until eventually it started to bother me and I got it checked out. It was a ganglion cyst. Benign, thank goodness. No big deal. It’s just a fluid-filled outpouching of the joint capsule. Treatment options are:

1. ignore it and maybe it will go away on its own;

2. multiple needles to aspirate the fluid followed by a steroid injection (outcomes are mediocre, and the cyst tends to recur);

3. surgical excision (outcomes are slightly better).

The obvious choice was to just ignore it. This was fine until I increased bike miles and the cyst got bigger and more painful. A couple of hours after a ride, the whole area would swell and become painful. I had to ice it before bed in order to fall asleep. It would usually go back down to marble-size and hurt far less by the next day, but I was losing patience with it. It was starting to slow me down on the bike. So I had an orthopedic surgeon take a look.

The day of the evaluative appointment, the cyst was a marble. Not very painful. I explained how it swells when I ride and that ice and Advil do help, but it seems to be getting worse over time. The doctor emphasized the mixed outcomes of excision and mentioned the recovery time: six weeks. Off the bike.

Off.

The.

Bike.

I had read that historically doctors used to treat this by smashing the cyst with a heavy object like a Bible. This ruptures the cyst and it goes away. Only half-kidding, I asked about this option. The doctor’s father had treated ganglion cysts this way, but she did not recommend it. Very painful. Risk of infection. Risk of damaging the surrounding tissue. Risk of recurrence. Risk of breaking a bone. Risk of bruising. Risk of doing more damage than the cyst itself. And pain again. Very painful to smash it. You have to hit it with great force. Do not attempt.

Nor did she recommend surgery just yet. Surgical outcomes are not much better than bashing it. The cyst just hadn’t reached the tipping point of slowing me down enough for her to muck around with it. So back to ignoring it and hoping it would just go away on its own. Take a truckload of Advil for a few days at a time, but not long-term. Come back for surgery when it becomes more of an issue.

Ignoring it was nice in theory, and this worked for a few more weeks. After that I couldn’t just ignore it because the pain and swelling continued to increase. It was constantly irritated and painful. Ice and Advil still helped, but I was starting to seriously slow down. I was riding fewer miles at an easier pace. I was taking more recovery days. I had trouble falling asleep and staying asleep, which made it harder to ride well the next day. I stopped doing yoga altogether. I had nightmares of gradually losing my fitness one mile per hour at a time. Eventually I would become immobile, like the Tin Woodman. I felt depression creeping in around the edges. 

So I forced it. I forced myself to ride fast and far, checking my speed and miles periodically to keep myself honest. I took Advil before and after. I iced it at least once a day. I took Benadryl when I couldn’t fall asleep. And I started psyching myself up to self-injure. Swelling always peaked a few hours after a hard ride. This would be an ideal time, I thought, to smash it. When it’s at maximum internal pressure.

I think I actually do own a Bible, but it’s buried in a box in the attic. I picked a different large book and started hitting myself with it. Hard. It turns out that I’m not very good at intentional self-injury. I was hitting hard enough to bruise, but not hard enough to rupture.

After the bruising and blunt-force swelling receded, I decided to try again. This time I had a better plan. Instead of violently smashing the cyst along with everything else in the vicinity, I would gradually apply pressure to the cyst in a way that might preserve the surrounding structures.

The day before a planned recovery day, I rode as hard as I could manage. My frustration was a powerful motivator. After the ride, I did yoga for the first time in weeks. I squatted and knelt, and sat cross-legged, and did everything I could think of to make the cyst swell. I took a very hot bath. When I emerged, the cyst was large and painful. It nested in soft pillows of general swelling around my kneecap. I closed my eyes and explored the topography with my fingers,  isolating my target with my index finger and thumb.

Still naked, I crouched over the bathroom floor tile like Spiderman.

I carefully placed my lateral left kneecap area down, balancing with my right foot and hand. I held the cyst in position until I was set. Then I put my left hand out for stability and gradually shifted my body weight over the cyst.

After many seconds of increasing the pressure, I heard a loud pop and felt an odd sensation of suction. It did hurt a lot, but only for a couple of minutes. The area was very sore and a little bruised for the next few days, but since then it’s been fine. I took one extra recovery day rather than six weeks, and I’ve been riding harder and getting faster ever since. If it does have the audacity to recur, I’ll be ready for it next time.



Disclaimer: I have become an Old, yammering on and on about health issues. Check back in a couple of decades and I'll narrate the details of my first colonoscopy.

This is an anecdote and not intended as medical advice of any sort.