Infections, Atx, & Pancreatitis

[Guest guest]

I have been out for several weeks due to further an exacerbation of my

disease. Here's is part of my story:

I developed a Baker's Cyst several years ago, however, until recently I did

not know what it was.

Pathophysiology: A Baker cyst is a synovial cyst located posterior to the

medial femoral condyle between the tendons of the medial head of the

gastrocnemius and semimembranosus muscles. This usually communicates with the

joint via

a slitlike opening at the posteromedial aspect of the knee capsule just

superior to the joint line. A Baker cyst is lined by a true synovium, as it is

an

extension of the knee joint. Popliteal cysts range from 1-40 cm3.

The cause is not clear, though associated articular disorders included

osteoarthritis, rheumatoid arthritis (RA), psoriatic arthritis, nonspecific

synovitis, meniscal tears, and chondromalacia patellae. (As I sit here writing

this

I am fully aware that my right leg is constantly popping out of place and I

likely have a torn meniscus, as I did in my left leg several years ago.)

The most common complication of Baker cyst is the rupture or dissection of

fluid into the calf, which results in a pseudothrombophlebitis syndrome

mimicking symptoms of DVT. The incidence of Baker cyst rupture is 3.4-10%.

It is debatable among the experts if the cyst should be drained or allowed

to possible be reabsorbed into the synovial joint. Unfortunately, I didn't even

realize what it was so I never told anyone, as it is essentially painless.

Painless, that is, unless it ruptures. Ouch! That is what happened. I do not

recall any trauma, however, I do have my fair number of falls, especially if I

am caught off guard by pain, and lose my balance when walking. I have been

having serious problems with edema of the lower extremities which have been

uncomfortable and have made walking quite difficult to do at all. This edema

has been symmetrical and has not had any associated redness, etc.

One day, my right leg suddenly became quite edematous, tight, with a large

amount of redness to the calf and shin. Unfortunately, I did not notice it

immediately, I wrote it off as a 'another bum deal,' thinking, " This too shall

pass. " It did not and soon I was nonambulatory, could not bear any weight, the

swelling began to rise into my thigh, the redness and erythemia was marked,

and the skin was warm to touch. This is where so many do not understand how I

could have waited even a day, but when you are sick, taking more pain meds,

one day easily runs into the next when you have been bedbound for a while. I

made an appointment with my Internal Medicine PCP and was able to see him

within two days of my call. I thought that was pretty good. I did not realize

this was such an emergency.

I arrived to his office on crutches. I was examined and sent to the ER with

a diagnosis of " Rule out DVT (Deep Vein Thrombosis). " A dopplar study quickly

identified the primary culprit as a " Ruptured Baker's Cyst. " It seems

everyone was interested in this, but really did not know much about it. It was

as

much of an emergency as a DVT, except for the secondary cellulitis and

infection which had developed. No diabetic wants an infected leg!

I was placed on Keflex 500 mg Q 6hrs, which is twice the recommended dose.

Normal dosing of Keflex is 250 Q 6hrs or 500 Q 12hrs, except in the concern of

a diabetic leg infection. What makes this a concern and explains why the leg

was so terribly painful, swollen, etc., was that synovial fluid had been

essentially squeezed into the lymphatic system and tissue bed. The synovial

fluid, which should be contained within the synovial joint, is very caustic to

the

tissue in my leg. It is somewhat like having an IV infiltrate and cause

extravacation to the tissue around the site. I was sent home on bedrest with

the

Keflex, and a follow up with my PCP.

I saw my PCP within a few days and reported that, though the swelling had

decreased, the leg was still significantly larger than the left, warm to touch,

and red. Oh, and painful. Additionally, I had experienced an exacerbation of

my pancreatitis, most likely caused by the infection and the Kelfex. Even

though the Keflex does not list pancreatitis as a complication, it does list

nausea, vomiting, dizziness, lethargy, and abdominal pain, all of which I had.

My question was: Do I really need this much Keflex? I was able to walk

without crutches, but was not sure if I should bear full weight or partial

weight,

etc.

" Well, gee, hum, you have such an excellent interdisciplinary care plan team

I think that is the best approach we should take. Let's call in sports

medicine to manage this problem. Okay? " , says my Internal Medicine PCP. My

situation is considered problematic and will likely require surgery. The goal of

surgery is to remove the whole cyst and repair the hole in the joint lining

where the cyst pushed through. It will also repair any underlying anatomical

problems such as a torn meniscus.

At this time, I have a pending orthopedic appointment and my pancreatitis is

raging!

I regret that I have not been present as much as I would like to be and I

wanted to try and explain one of the situations that has kept me from being as

active of a participant, as I would like to be.

Karyn E. , RN

Executive Director, PAI

Indianapolis, Indiana