After three weeks of travel and two weeks of rest, I still wasn’t feeling better. I was able to cajole my rheumatologist’s nurse into squeezing me in for a last-minute Friday morning appointment. By this point, my knees were swelling exponentially as the day  progressed, receding only slightly come morning.  The pain, however, was constant. Walking was becoming exceedingly difficult—slow and awkward. People were starting to ask if I was alright.   bakers-cyst-injection-avoid-surgery

I was worried, but not about the pain. I had dense lumps behind both of my knees. The one behind my right knee made the pain radiate into my calf muscle. This pain was very different, more like a sharp burn than the dull annoyance of RA swelling. It scared me.

I thought it was a blood clot. My father had a pulmonary embolism seven years ago, and no one knows why. I’ve been tested for whatever hereditary factor might make me prone to the same thing, and have always come up negative. Then last year, I tested positive for antiphospholipid antibodies the first time the test was run. When I asked my-then rheumatologist what that meant, she lapsed into a very detailed response, delivered in a monotone.

“You’ll have to go on blood thinners. Yes.”

“And the risk of blood clots is high during pregnancy. And also in general.”

“So you might miscarry in your third trimester.”

“Those are some of the things to think about.”

I was speechless. Only then did she decide to mention that the test is only definitively positive if it’s positive two times. The next test was negative. So was my impression of this particular doctor.

“You’ll know when you have a blood clot,” my mother told me.

“I had three blood clots and I didn’t even know it,” my coworker said.

They weren’t blood clots. They were Baker’s cysts. The name makes them sound gross, like dough left sitting out on the counter. They’re benign, but the pain isn’t. The key is to avoid them bursting, which is extremely painful, but again, not really dangerous. You can have the cysts drained, but this requires the use of an ultrasound and some kind of extra special training, which my rheumatologist does not have.

“Dr. C has received some additional hours of training and she’ll do the draining if these don’t go down,” my rheumatologist explained.

It sounded to me like Dr. C might have received this extra training online.

“I don’t want to drain them myself because there’s a lot of important stuff back there. Even an artery,” my doctor said.

Great.

“We’re going to inject you with steroids to see if it makes the swelling go down,” was the doctor’s plan.”

Fine.

I arrived an hour early to my 9 a.m. appointment, hoping to be out in time to make it to my 10:20 a.m. class. The class I teach. And I really, really wanted to teach the class—twice a week I teach Civil Rights Litigation, a class that lets me talk about the Constitution, about police, about prisoners, about life and how to make a difference as a lawyer. This is why I get up in the morning.

I sat upright on the edge of the examining table, bare legs hanging over the edge, my husband within arm’s reach.

“Will you hold my hand,” I asked him.

“Yes, I’ll hold your hand,” he replied, but in a baby-like voice, imitating how I’d asked the question.

“Nevermind!” I snapped.

He laughed at me, kindly. I am ridiculous.

Before you get your knee injected, it has to be cleaned. The iodine looked like ill-applied self-tanner. The doctor spread it around in a circular motion. He was quiet as he prepared my prone skin for the impending violation.

It is harder to inject a knee when it’s swollen. The needle used for steroid injections is smaller than the needle used to drain fluid, but you feel it. First, you feel the needle breaking the skin, and soon after, you feel the sting of the numbing medication. Next, you feel the burn of the steroid.

Swelling also affects how long it takes for the steroid to go in. The left knee procedure, which should have taken a few seconds, took the doctor about thirty. He had to manipulate the knee’s exterior as he moved the synovial fluid out of the way, and during this process, the needle didn’t hit its mark, but instead grazed some tender cavern hidden within my joint.  I cried out.

“Aaaaah . . .” was the noise I made. Staccato and dramatic, but not very loud. The same noise I might make if I stepped into a too-hot bath. I’ve been through worse.

The right knee was more swollen. The Baker’s cyst on the back of my right knee was bigger.

Same kind of pain the second time around, only it lasted longer. It took the doctor about a minute to get all of the steroid injected into my right knee. This felt like forever.

I never watch the procedure. I keep my eyes open, and I stay calm and relatively poised, but I look away. So my patient husband, who knows that I’m impatient, and that I like fractions, kept me posted.

“About one third of the way done now,” he said.

“Halfway through,” he updated me.

“Just a few more drops now, almost there,” he told me when it was nearly through.

This is why I love my husband. He knows what to say and he knows what to do, and he doesn’t make a big fuss about it. He manages to remain supportive while still morbidly interested in the science of it all.

Injections completed, we left the clinic, and I was already feeling better. I walked to our car. My husband carried my purse, but I walked without holding on to him. I decided I didn’t need to go home but would have him take me directly to school. I gave what I think was, overall, a strong lecture. I spent most of the class sitting down, but also stood for about ten minutes, working the images on the projector, trying to spice up what I was talking about with images and real-life examples, appealing consciously to a variety of learning styles. I needed to do this. I needed to feel like a professor, not an invalid.

The numbing medication carried me through the day. Over the next week, my knees shrunk, and the steroid, which seemed to have spread throughout every joint, gave me a skip in my step.

But not for long. I’m back where I started. It’s a few days after Thanksgiving and I can already feel another Baker’s cyst on the back of my right leg. I can’t straighten the leg out, once again. I’ll be back in the rheumatologist’s office soon. It’s a lot easier for me to get last-minute appointments these days. I’m officially on the “squeeze her in” list. I’ve been upgraded.

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