One Year Later

It is incredible to me, but yesterday was the one-year anniversary of my ankle surgery. And one year ago today I was sitting here, all casted up, wondering how the coming year would play out. This blog was sort of born from the occasion of my injury, and I am struck by the evolution of both as the months have passed. The paths of the two have spread apart, thank goodness! As I look back on the very early first posts back from the spring of 2008, I see that I wrote a lot about the recovery process (and the pre-recovery period when I couldn't even do anything yet). As I progressed, I let you in on less and less of what was happening, mostly because I had less time to sit at the computer and describe what I was doing but also because it seemed less interesting. And soon, thankfully, my cohorts joined in and you got to hear several voices tell the story of being a dancer at OBT.

For the record, and to put a satisfying cap on what was the origin of this blog: the surgically repaired ankle from last year is doing very well. I managed to make my way through the first performances of the season in Swan Lake, though it was not easy and I was really not at all fully recovered. There were lots of secondary problems that cropped up as a result of favoring a weak and painful ankle, as well as from the basic fact of returning to dance after so long. The nastiest problems were my toe woes-- my toenails could not adapt fast enough to pointe shoes and loosened in their beds, making wish they would just fall off. Or that I could chop them off! My podiatrist convinced me not to, and did his best to shave down the ingrown parts and the corns, but could do nothing about the loose nail beds. The problems were compounded by the fact that I was in the process of trying new pointe shoe makers, one of which was too square and wide and didn't support my foot enough. Unfortunately, I didn't realize this until the week we opened and then had to deal with trying to perform in shoes that I was sliding around in.

The three week layoff after Swan Lake was a respite for me. Nutcracker rehearsals began, my toes had recovered enough, and I found a couple of new pointe shoe makers that fit much better. I remember having a lot of ankle trouble throughout the rehearsal weeks and while we were in Anchorage, but reached a turning point when we returned to Portland. It was like a switch had been flipped and all of a sudden I was on the other side of the healing process. Not completely through it, but standing on the far side looking back over the field behind me. And since then... knocking on wood fervently.... my ankle problems have been minimal. I don't even feel I need to ice it every day, though I do pay special attention to working out the muscles of my lower calf and instep. A little tendonitis-y stuff is most of what I deal with now.

And the blog... it's grown and evolved and become a wonderful forum for so many voices. It's exciting to think of things to write about here that you'll be interested in hearing. The blogger team has hatched several ideas for blog-projects, a few of which have come to fruition and a few of which are still on the drawing board, so stay tuned and keep checking in with us.

I don't want to belabor this topic, but I can't stop thinking about the passage of a year and marvelling at what a body can do. I'm remembering the various milestones along the way, the stages and phases I passed through. My daily routines were so habitual because I had no option for varying them. For weeks it seemed that the days were filled with small tasks that just took a lot of time, like taking a bath, making the bed, making breakfast, cooking up exercises that I could do without standing on two feet. There were the tiny triumphs of walking again, going up and down stairs, standing on one leg. I remember so vividly the first time I walked outside, by myself, without crutches and in two regular shoes. It was a gorgeous spring afternoon and I felt like everything in life was about to be reborn! I sorted through boxes of photo cds from years of OBT's past, figured out what was on each one, labelled it, and filed them into categorized notebooks for the OBT archives. I wrote here and tried to imagine something interesting that didn't have to do with my injury.

Thanks to all you readers for sticking with us and responding with your wonderful comments. It's wonderful to hear your thoughts and questions, so please keep them coming. And here's to the upcoming years of the OBT blog!

Tomorrow

Amazingly, it's here. I am offically "back", as we say (dancers are "out" when they're injured and "back" when they're, well, back) and tomorrow is the first day I will be rehearsing, almost six months after ankle surgery. Now that I'm sitting here at this vantage point, six months doesn't seem like a very long time. In fact, I almost can't believe the journey of these recent months even happened--- really? My big daily expedition was crutching down the block to the coffee shop, and even that was exhausting? Going up and down the stairs to get the mail was a daunting task? I relied on doing the James Brown shuffle to get a cup of tea from the stove to the table on one leg without hopping? And then, finally, released from that crazy cast, my leg quivered like a leaf when I merely stood on it? During those times I don't think I truly thought about the future. I dealt with each day, each hour in fact, as they happened. It was just too difficult to imagine the future without fear.

I may be dancing again, but I am far from normal (or from where I started). My ankle is not the same as it was, and may not be for a long time yet. But I'll start out into this new phase of things and just keep taking it one step at a time. I can't wait to get back in there and do my thing.

The Home Stretch, Sort of...

I'm back from my week of "getting away from it all", which wasn't on a beach on Paradise Island but was spent tromping the sidewalks of New York, visiting my family, and taking in the whole different scene and energy that is the city. I had a wonderful time.

But now it's back to business. Progress on getting me and my ankle ready to work again has been moving forward in fits and starts. After my little setback I'm feeling ultra-cautious a bit nervous about pushing it too much, too fast, but at the same time am acutely aware that the clock is ticking and I need to keep moving forward at a good pace. The main stumbling block seems to be jumping on my right leg. For one thing, despite all the gazillions of exercises intended to stave off just this problem, my entire right leg is just less powerful than my left. And the impact of landing on that ankle seems to be one thing it is reluctant to accept. I've been practicing in the pool a lot lately, which feels great and (I imagine) helps recondition my nervous system to understand the mechanics and coordination of accelerating and landing, as well as jumping in the studio with gradually more and more amplitude. Jumps on two feet are mostly fine, but traveling steps and pushing off one foot (namely the right one) are dicey.

My daily routine is still similar to what it's been all summer long, minus teaching class now that the summer course has ended. I'm in the studio every day, either taking a class or doing one by myself. What am I mainly focusing on? Everything. Super-correct placement and alignment, articulation, speed (both quick and slow), strength and control. I do extra releves at barre, working on springing up to pointe quickly, which I hope will translate into a quick spring action in allegro. An extra-long adagio is also super for getting back muscular stamina, though I wouldn't say it's fun. And strangely, I have to kind of recalibrate my balance to get used to spotting in turns again! If you haven't done consecutive turns for a while, like chaines, the first few times feel bizarre and wildly out of control.

After class I'll head either to the PT clinic for some manual therapy, pilates workout, a little bike riding, and balance and stabilization exercises, or to the pool for some laps and shallow-end playtime. My playtime is a little different from the kiddies romping around with their styrofoam noodles and the dudes playing water volleyball, but whatever... it's a big pool and we stay out of each other's way. I'm doing several sets of sautes on each leg,which must make me look ridiculous bouncing up and down like I'm a pogo stick, but so what.

Somewhere during the day I fit in all the other "accessory items" that are on the list of things to do, like stretching out after all that work (got to keep the calves loose-- they're readjusting to all this impact, too), icing my foot, massaging it with Traumeel. I've also got to get my feet used to being in pointe shoes for extended periods of time again, so (don't laugh, I'm not the only one who does this) I have taken to wearing pointe shoes around the house. No joke, it is a great way to build your feet back up! My feet are still baby's-bottom soft.... that has got to change or else my ankle problems will be overshadowed by toe pain of a serious degree.

And, finally, I can see those athletes in China cashing in on their hard work, which is definitely fun to see and inspiring as well. There was a time, back when I was about 10, that I wished ballet was an Olympic sport so I could go compete and win a medal. Thank heavens it's not, because now I know that I hate competing and would crumble under the pressure, but I still get a little push of energy watching other people do it!

My Turn in the Studio

Although I've been in the studio quite a bit over the past few weeks teaching classes, today I put on my other hat and took class for the first time, almost exactly four months after ankle surgery. I'd tested the waters already by doing an experimental barre a few times by myself (at first in my kitchen, holding onto the countertop, and then in an empty studio after class had finished) and felt ready to be in the company of others and follow someone else's direction. How's it feeling? So far, so good. I even put pointe shoes on and went up and down a few times. I'm sure this will change, but for now the most painful thing is my toenails.

I've got two months to get fully back up to speed in time to start rehearsals in September. That's not really very much time. Eight weeks will go by quickly, and I'm still at the very beginning of this next phase of recovery. I'm not sure if it's the last phase or not, but it IS amazing to think back on all the milestones that I've taken note of so far. The one that sticks in my mind the most is the first time I walked outside without a cast, boot, or crutch-- in two normal shoes. That was back in late April sometime, I think. The sensation of freedom was overwhelming--- I felt so unencumbered and free!

So here we go, back at the old familiar barre, doing the old familiar exercises. Except they don't feel quite as familiar as they did once before!

Progress Report

Even though I'm back in regular shoes and on my own two feet, I'm still in the middle of the rehab process for my ankle injury. The rest of the company is hard at work in the studio every day, rehearsing for the last three ballets of the season, and I'm hard at work at the physical therapy clinic, looking for every gained inch of mobility and ounce of strength. I go there about four times a week for actual hands-on therapy, which includes soft tissue work, joint mobilization, and what they call "scar mobilization"--- that's the loveliest treatment of all. It means doing cross-fiber friction massage directly on the scar to break up the adhesions underneath it. Everyone says it's very important, but it feels so gross that I'm wondering how much I care about having a mobile scar.

The other aspects of my sessions at PT are less unpleasant. The therapist works on getting some more degrees of flexion in my still-stiff ankle joint by basically teasing it further and further, coaxing it along as I resist and then let it stretch further. I'm having a lot of trouble with all the tendons surrounding the area where the repair was made, so we do a lot of flushing and scraping of my Achilles and posterior tibialis tendons to get them less irritated by the sudden uptick in load that they're being put under. When such weak muscles are suddenly asked to take some strain, they often seize up in response, so I do get a bit of calf rubbing to work out the protest knots. Then I'm turned loose into the gym to do my exercises, which can take quite a while since there's really no end to what I can work on. The major focus for the ankle itself involves getting back basic strength and stability. So I do a series of exercises on the balance board and Airex pad, which are unstable surfaces, to re-train my legs and feet to stabilize themselves. There are basic calf raises, but also a lot of work on controlled strength as opposed to just straight repetition. The latest one has me balancing on one leg on the balance board while tossing a ball back and forth to someone. That is hard enough on a "normal" leg. I pretty much started to quiver in fatigue after about a half a minute.

Here are the tools of my current regimen. There's the balance board (also called a rocker board), the blue foam Airex pad, the half-foam (I use that for calf raises and more balancing work), my friend the Magic Circle (adductor strengthening), and the family of Therabands for my foot exercises.

The pig is named Oliver and he's the cheering section.

In addition to ankle-focused therapy, I have a little routine of whole-body maintenance exercises that I do every day to make sure the rest of me will be in good dancing shape when my ankle is ready to go back to the studio. I do several different kinds of core strength exercises, hamstring curls, pushups, and a few times a week I get onto the Pilates reformer for more of the same. One of my favorite/least favorites is the "clam shell", which is hard to describe but is the best turnout strengthener around. There's also a half hour of cardio on a stationary bike and a bunch of different stretches. That stuff is invaluable, and honestly I'll probably be stronger in some ways than before this injury happened.

After all the physical work is done for the day, I do a really good ice-down, massage some Traumeel into my ankle and foot. At some point each day I also do a contrast bath, when I stick my leg first into a bucket of ice water, then into hot water, and back and forth for 15 minutes. That's the best way to flush blood into the area and also helps loosen up the joint even more. While my foot's in the hot water I do toe curls for the intrinsic muscles on the bottom of my foot.
And last thing before bed every night is another ice-down, preferably with my foot elevated over my head, since there's still a fair amount of swelling that happens by the end of the day, especially if I've been up and about a lot.

This whole routine is keeping me busy. I have to say that a lot of it comes from knowledge I've picked up over the years (and from the various injuries and therapies), so although there are always a lot of unknowns I do feel a fair amount of confidence in how I'll come out of this episode of my career. And there are always interesting things to be learned about one's body and mind when going through something like this.

Two Month Anniversary

Another couple of milestone events in the unfolding Story of My Ankle:

• Wednesday marked 9 weeks since the injury occured. We don't often think about what happens in our lives during a period of nine weeks, when everything's normal and we're going about our usual business, but this experience has made me look much, much more closely at the day-to-day passage of time. Not to get all philosophical, but it's worth it to consider that there's no way to slow time down better than to observe it every day.
• Wednesday was also the first day in nine weeks that I wore two normal shoes outside! I'd been going around the house boot-less for a week or so, but stepping outdoors in two regular shoes felt as free as my first foray out without crutches did. My friends know that since I discovered clogs two years ago I have hardly worn any other type of shoe-- I quite literally have worn my clogs virtually every single day--- so it was kind of funny to me that there was a coating of dust all over my poor ignored right clog.
• And finally, today marks 8 weeks since I had surgery. I want to say I've come full circle back to where I started, but am not even close to that. But at least I'm walking and starting to get my calf back.

Looking Back

Here is a question that came into the home office about my ankle injury:

With the injury/surgery that you had, will you be limited on the type of dancing you can do long term or will you be able to do the turns, jumps, balances after rehab?

The short answer is no, I shouldn't be limited in what I can do after the rehab from this surgery is over. It's also true, though, that no one can ever completely guarantee beyond a shadow of a doubt the outcome of an injury. There's an added element of the unknown in my case right now because my surgeon had not only never seen an injury exactly like this one, but he did some research and still couldn't find any reports of a similar case. So.... I have the very dubious honor of a case study on my ankle repair. This is not exactly how I wanted to leave my mark in history.

The prognosis is very good, despite the unknowns. The structure that was damaged (a band of fascia had torn away from the bone it is supposed to be anchored to) is not one that is relied upon to create movement in my foot, and is less load-bearing than a tendon or ligament would be. And since it is now secured in place with pins, it's probably stronger than before. Or it will be, as time passes and the hardware anchors down into the bone. I still can't help but worry and fret, of course, since the state my foot is in right now is so, so far removed from its normal level of strength and flexibility. Simply standing on my right leg is hard. I can't even imagine standing on pointe, or jumping off that leg. So I don't try to imagine it just yet, I just think about starting small and building one layer of strength at a time. Right now I just want to do a tendu.

Someone reminded me today, however, to be sure to look backwards periodically to see how far I've come, instead of always looking forward at the long, dry road ahead. And speaking of dry roads, today it turned out that the muscle tone I had thought was a mirage was in fact real. Ah.

Progress Report

For those who've been wondering how the healing progress on my ankle is coming along, I'll tell you that yesterday I went for a walk (!!), outside in the real world, on my own two feet, for the first time in almost two months! I still need to wear the walking boot since my foot isn't ready or able to support all of me by itself, but I'm back to being a biped. True, my "walk" was only two blocks long, but it was still a beautiful feeling to be outside without crutches. I felt so free, even though I still had to drag one foot behind me like a ball and chain.

Just since last Monday when I got the cast off there has been visible improvement in my range of motion and a decrease in the swelling. A little bit of definition has come back, so it doesn't look like an elephant foot anymore. Pointing my foot is hilarious, though-- luckily I'm able to see how truly comical it looks compared to my other foot. But even that has improved quite a bit in just a few days. I've been doing the contrast bath soaks to flush blood in and out of the area and encourage the joints to loosen up again, along with a lot of gentle manipulation to kind of tease it into gradually moving further and further towards where I want it to be. I can do some theraband exercises now, sort of, to start getting a tiny bit of strength back. My calf is utterly pathetic. It feels like pudding. I thought I saw a tiny bit of muscle definition yesterday, but it was just a mirage. There's nothing there.

But at least I can stand on it now! I've never felt such weakness in my leg, or anywhere, but supposedly it'll get better. I do believe that, but it's hard to imagine at this point. I've been practicing just standing on it (holding onto something, of course), to try to find the muscles again and see if they can still fire up, and it makes me feel like a little newborn colt, all spindly and wobbly. I've got a ton of exercises to do with the aim of re-activating all those slumbering muscles. I'm sure it'll work, but it can't be fast enough for my taste.

My tentative goal is that by the time the company is performing the last rep of this season in June I'll be able to join them in class, even if only for the tiniest bit of barre. I hope that by putting that down in writing, in public (!), I'll be even more driven (if that's possible) to make it happen.

Hello, Leg

I got my cast off yesterday. I was prepared for the worst, and in some ways it was as bad as I expected but in others not so much. The tool they use to remove a hard cast is an electric saw with a circular blade that slides through the fiberglass with an ear-splitting whine. It seems to come alarmingly close to the leg inside the cast, but the guy operating the thing assured me that it never does actually cut anyone. That wasn't enough to keep me from wincing through the whole process, especially since he couldn't get the saw to go all the way through the fiberglass and had to keep going over it again and again. Then he took these plier-things to wedge into the seam he'd created with the saw and pry open my little leg-cocoon. By that point, I almost wished I could just leave the thing on and forget about it. I'd gotten pretty good at getting around with it anyway.

But it came off, and I got my first look at my leg in five weeks, except for the brief glimpse in between the splint and the cast. Hi, Leg! It looked pretty bad. Pretty gross. Emaciated and flaky and hairy, and stiff as a board, of course. I was able to clean it up a little bit before they put me in the walking boot, but as soon as I got home I filled the bathtub with hot soapy water, added a little bath oil for extra moisture, and gave my poor little foot and leg the most satisfying, nurturing soak and scrub it's ever had. The dry, dead skin came off in sheets and flakes. I've never loved putting lotion on my skin so much! Just being able to get my hands on my foot, to work some gentle motion and circulation into it, to move it a tiny bit, makes me feel like I am now really starting to heal.

There's a long ways to go. Here is a comparison of my right and left legs, so you can see just how much muscle I've got to regain. (My left calf has gotten huger from all the extra use over the past few weeks, however).





The incision looks good and is healing perfectly. (I won't post the photo of it because this site should be a no-gross-photo zone). Maybe later when it's more presentable. The stiffness in my ankle joint is incredible. There's a bit of swelling (but not much), which will go away as I get it moving a little. The strangest thing, though, is the sensation of standing on my right leg and having real pressure through my foot. It hasn't really had any weight put on it in so long that just feeling the bottom of my foot against the floor is bizarre. Yes, I'm supposed to be wearing the boot most of the time... I'll go put it back on.

Six Weeks Later

Only five more days until I say goodbye to my lovely black legwear. I thought I had better document it on film just in case I ever want to remember what it was like. (Special thanks to Brian Simcoe for the nifty red sock):



I tend to get sentimental about things that pass in and out of my life, regardless of whether they were good or bad, happy or sad, of mixed emotion or impact. As much of a drag as the past six weeks have been, I know that sometime later on in the coming months I will look back on this time and sigh to remember how simple things were back in March and April, back when I couldn't see or really feel what was happening with my ankle. (I can sort of tell what's going on with it now, but there will be a lot more to feel when I'm moving it and using it). I guess what I mean is that this time is like milling around, waiting to start an endeavor that's not clearly mapped out, but will be defined as I go through it. I can see into the future in that I know with certainty that it's going to be full of unexpected pitfalls and breakthroughs, the obvious ups and downs, and all sorts of unknown sidetrips along the way to the end goal. But at the same time, I can't even compare it to a race or journey, because there's no set end point or finish line. "Complete recovery" will sneak up on me someday, but it'll never truly be complete.

I've been through something similar already. Three years ago I had surgery on my other ankle to repair a torn tendon. That was also a recovery full of unknowns and discoveries, just like this one will be, but this time there will be an entirely new book of lessons to learn. Talk about the school of life... What if a nuclear physicist had a brain injury, brain surgery, and recovered but had to re-train their mind, starting with basic math? I'm certainly not aiming to discover clues to the genesis of the universe, thank goodness, but I kind of feel that what I'm going to ask of my body is the equivalent of going from basic addition to incredibly complex physics.

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I realize that what I described above sounds a little woe-is-me. There's a certain amount of that, yes, but mostly I want to use myself as an example to explain what it means for any one of us to be injured. There is never a foolproof remedy or absolutely predictable outcome, no matter how common the injury, because each body is so different from every other. And each of our psyches will handle the experience differently, too, of course. But the common thread of being a dancer with a body part that got outrun by the pack is this sudden vulnerability, the crash down to reality (and into the "real world") from the hyper-reality of the ballet world. So, knowing that my situation is unique yet completely commonplace, and I'm going to try to bring you all a little ways into this place along with me, and us.

Grrr....

Irritating news: April 9 had been my red-letter day--- get the cast off and change to a walking boot-- and it was just postponed for almost a week later. Right now this feels like a big deal, but I know that in the very near future I won't even remember that it happened because I'll be caught up in the next challenge, the next phase of rehab, the next step forward.

I haven't had much to say about my rehabilitation process yet because there hasn't BEEN any rehabilitation to speak of, really. With this cast on, there's nothing to do for my ankle itself other than keep it elevated as much as possible for good circulation. When I had the cast put on two weeks ago, I was shocked to see how swollen the ankle was. Inside the post-surgical splint it had started to feel quite roomy, so I thought it would be almost normal size when they took it off, but it was actually very puffed up. No one else seemed surprised, so I decided not to worry about it. Even now there are drastic changes in how tight or loose the cast feels at various times of the day, which I guess is my signal that at least there's blood flowing down there.

Since my leg's been inside this hard black fiberglass thing I've been trying to make sure that (and this is almost a lost cause) my leg stays somewhat strong. It is amazing, just amazing, how quickly an appendage loses muscularity when it's not used, and especially when it's not even being stood on. I knew this was going to be the case, so I cooked up various exercises that I could do (without standing on my right leg) to keep those muscles activated. There's really quite a lot you can do! (Don't be alarmed, anyone, I'm very careful). Anyway, I'm sure it's helping somewhat but I still know that when I get the cast off in another ten days and see that leg for the first time I'm going to gasp at how shriveled, flimsy, and hairy it is. But it will come back, it will, it will, it will...

I do have photos of the actual surgery in process-- but perhaps they're too graphic to post here? I think so. I can't even bring myself to look at them yet. Something about seeing your very own flesh... yeah.

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I have to add something. I just read an article in today's Oregonian about a man who was hit by a car and suffered such extensive injuries that his entire leg had to be amputated. I know that everything is relative, but I read that article and had to take a moment to feel extremely guilty for ever having complained about being in a cast for a mere five weeks.

"The Dancer" at PAM

Yesterday I went to see "The Dancer" exhibit at the Portland Art Museum. (Here's a lesson on the evils of procrastination--- if you put off going to see an exhibit at a museum, when you finally do have the time to see it, you may not be able to walk). I had to put my already somewhat deflated pride on the floor and run over it with a wheelchair. I was able to smile about it, a little, when I saw this sign and begged the security guard to let me take a picture with it:



Too ironic for words...

I have been gaining a whole new appreciation and sympathy for handicapped people over the past few weeks, and this outing was another chapter in that lesson. Art exhibits are arranged for adults who are standing upright, looking at the art on the wall. Children and wheelchair-bound people have to look at it from below. I realized that I've also always taken for granted the simple ability to turn around easily and at will. In a wheelchair, you can't see what's going on behind you unless you crane your neck or are skilled enough to maneuver your chair around quickly. I felt like I had blinders on, was bulky and awkward and in the way (I can't believe I didn't run over someone's foot), and very quickly was stiff and achy from sitting in this uncomfortable chair. It was hard to appreciate what I was there to look at.

Just another page in this chapter of my life, I suppose. I can't say that I'm going to come out of this unchanged, that's for sure.