Diagnosed with a Baker's Cyst (Knee swelling) Can I finish my thru-hike?

[Mike2012]

I am currently thru hiking and up to mile 964 but got off to rest, hide from the heat and visit with family and friends. I was going to get back on the trail on Monday but decided to see a doctor for my swollen and stiff knee. They tell me I have a Baker's Cyst which is a sac of synovial fluid behind the knee and to see an orthopedic surgeon. I called one and the office manager suggested I get some health insurance as I would most likely need arthroscopic surgery which can run many thousands of dollars.

Any orthopedic surgeons here that can give me some advice? I'd like to finish the trail but I don't want to end up making things worse. As it is I will probably have to flip flop to get it done if I can't average 13-15 miles a day pretty soon. I was doing 15-20+ mile days before I got off the trail.

[SCRUB HIKER]

Any orthopedic surgeons here that can give me some advice?

Good Lord, no. They might be out there, but their answers will probably be drowned out by all the noise from people who have no idea what they are talking about. I preface my statements by saying that I too don't know what I'm talking about from a medical standpoint and I have only anecdotal evidence for what I'm saying, which is: thru-hiking with injuries goes both ways and it's very hard to tell what can be endured and what will ruin you. I've at various times heard of people successfully thru-hiking, against their doctor's advice, with:

Tibia stress fracture
Tarsal stress fracture
Bone bruising
Broken ankle
Broken fibula
Not to mention Lyme disease, plantar fasciitis, and a thousand other undiagnosed knee and foot pains

On the other hand, you can hike through pain or even an adverse diagnosis and do yourself a lot of damage. One of my best friends from college tried to thru-hike and developed knee pain around Erwin. She tried to make it to Damascus, but by Kincora could no longer continue. 6 months later, she still couldn't get a complete diagnosis from doctors and couldn't walk a half-mile, with no pack, without roughly the same amount of pain. Someone else I met was diagnosed with tibial stress fracture in Pennsylvania and decided to keep hiking. While he was walking downhill in New York, he felt a pop in his shin and shooting pain--his stress fracture, which is something other people hike on with no problem, had resulted in a full tibia fracture.

My point is that two people can be diagnosed with the same injury, decide to keep hiking, and one might be successful and the other might only get worse. Few doctors are willing to give you the green light to hike because they have to cover themselves, and they only have 31.2 seconds on average (or whatever the number is) to speak with you anyway. Few WhiteBlazers are going to have the medical expertise to give you a truly helpful answer based on the limited information in your post. Basically, you have to decide for yourself, and if you do decide to keep hiking, it would be helpful to have reliable bail-out options the whole rest of the way.

[rocketsocks]

Had this very condition about 20 years ago, all the doctor did was drain fluid with a big ass needle (didn't hurt much) and pat me on the too too, and said no futher treatment required,if it happens again, come back and I'll drain it again.

If the sac were to break, then yes that could cause complications,.Maybe things have changed in the medical field since my visit, they always do, I go by what your doctor is telling you.Good luck with your hike Mike, Cheers

[Biggie Master]

No, I'm not a doctor and this is not medical advice... but, the office manager you spoke with is not an orthopedic surgeon either, and I would steer clear of any "pseudo-medical professional" who immediately tells you that you probably need surgery. The determination of need for surgery should come from the surgeon -- and only after a hands on exam and most likely other diagnostic tests. But you also have to remember that those folks get paid for surgeries, not to say "ice it 3 times a day and keep it elevated as much as possible". If the possibilty of a blood clot has been ruled out and it is truly a Bakers cyst, then it will likely get better just by getting some rest and also by lightening your pack weight. The family physician you saw initially should have given advice similar to that as well as ruling out the blood clot... It's always safer to see the specialist "just in case", but if it's serious swelling or pain and it's my knee, I would probably take at least 3-4 days off to RICE it (rest, ice, compress, elevate) and see what happens. If it responds well to that, - then return to the trail for a "test" with a lighter pack and less miles per day... Again, this is what I would do -- this is not medical advice, and I am not a doctor...

[Biggie Master]

Oh... forgot to say -- good luck with the knee and your hike!

[verasch]

I was going to get back on the trail on Monday but decided to see a doctor for my swollen and stiff knee. They tell me I have a Baker's Cyst which is a sac of synovial fluid...

Wait. What did the doctor say when you asked him or her this same question? You did ask them right?

Also, just because someone is an office manager and not a doctor doesn't mean they don't know how much a standard procedure costs. Doctors will mark it off on the chart, but somebody else will put down the price. Mostly because of the way the insurance companies pay for these things. Typically, they only pay for the first few services listed; so offices typically put down the most expensive items first.

My recommendation (which isn't what you want to hear), is why risk it? The trail will be there tomorrow, so what's the bother? If you lack insurance, try to find a teaching hospital and see if you can work out a deal to get it fixed.

[Mike2012]

thanks for the feedback! Upon reflection I think I've had this condition off and on for the almost 1,000 miles I have already done but I wrote it off to favoring my right knee when I was recovering from a sprained ankle for the first 2 months. Doing a marathon hike recently may have aggravated it to show up again. After a week of rest (and carbo loading ;) ) the swelling is subsiding and I am going to get back on the trail. I remember pulling into Damascus 500 miles ago with a swollen knee and here I am. Getting back on this weekend and going nobo again! I'll have to average about 13 miles a day but that's cake!

If I am coming too close to the Katahdin cutoff I will bounce ahead and finish somewhere in Maine or New Hampshire. I used to live up there so the weather isn't a problem - just arbitrary state park closures.

[rocketsocks]

Cool,glad you'll be able to get back on. I've got some other inflammatory issue going on,and have had for years, though they have gotten worse. After you mention this the other day I started poking around a bit, and found that this condition,(bakers cyst), can be a caused by some inflammation type ailments as well (Arthritis),just something else for you to put in the back of your head should other things start to happen later on in life, good luck with the reat of your hike.Cheers