05/06/2002 11:00PM

Rider survives brush with death


SAN MATEO, Calif. - With each step he takes in his rehabilitation workouts, with each sentence he speaks, with each smile that crosses his face, Jose Arriaga's recovery continues.

Arriaga, 25, nearly died after being thrown from his mount in a race at Bay Meadows in San Mateo, Calif., on April 4. His life was saved by a fortuitous set of circumstances and four hours of brain surgery.

But Arriaga's superb physical condition and will to live also helped save him, doctors say.

Tossed and clipped

Arriaga was aboard Mother Fear, in the fifth race, an $8,000 claimer, on April 4, the second day of the Bay Meadows meeting. He was well off the rail in good stalking position on the far turn when Mother Fear suddenly propped and ducked out, tossing Arriaga to the track. He was apparently struck in the head as Sassy Linda tried to jump over him. Films are inconclusive, but Sassy Linda's rider, Miguel Perez, said he thought his mount clipped Arriaga.

"I don't remember too much [about the accident]," Arriaga said.

The track ambulance reached him immediately, and track physician Dr. David Seftel was brought to his side.

"When I arrived, the first thing he said was to give him a hand up," Seftel said. "But I had to tell him to lie still because he had a head injury."

Seftel noticed a cut on Arriaga's head below his protective helmet and recognized that Arriaga might have a concussion. (Arriaga suffered a concussion at the Bay Meadows meeting last fall.)

Seftel and the EMT's stabilized Arriaga's neck, and they took the additional precaution of adding extra bracing around his head to prevent any movement in case there was bleeding in the brain.

Seftel accompanied Arriaga in the ambulance to the track exit. As Seftel got out of the ambulance, Arriaga began complaining that the head restraint was too tight. "He was probably feeling the bleeding inside his brain," Seftel said.

Arriaga then started to vomit, another potential indicator of concussion or bleeding in the brain.

Before the ambulance left Bay Meadows for Stanford Hospital, about 15 miles south on the Stanford University campus, Seftel cleared Arriaga's breathing passages so that he would not suffocate on his own vomit.

Seftel alerted Stanford Hospital as the ambulance left Bay Meadows to prepare the emergency room and also to have a neurosurgeon on call.

'Full code' at Stanford

During the 20-minute ride to the hospital, Arriaga's breathing became more and more shallow. When Arriaga arrived at Stanford, he was not breathing. A "full code" was in effect, meaning that all available procedures were used to resuscitate him.

A breathing tube was inserted and soon artificial breathing was needed to keep oxygen going to his brain. Stanford neurosurgeon Dr. Griff Harsh and his team prepared for emergency surgery.

Seftel, who was in contact with the emergency room at Stanford, said he was chilled by the report he was given. He said he was told that Arriaga was brain dead, although Harsh said Arriaga "didn't meet the full criteria of brain dead, but his brain function was severely compromised."

Aggressive advocacy

Seftel urged emergency room personnel not to give up on Arriaga. "Aggressive patient advocacy is important," Seftel said. "Many times, they won't do a full-court press, but with young people like Jose, we owe it to them."

Harsh and his team faced a difficult surgery. The blood in Arriaga's brain had pushed the brain to the left, causing swelling down onto the spinal column.

The downward movement of the brain tissue, called coning, sometimes leaves the patient "virtually irretrievable" in Seftel's words, because the base of the brain that controls heartbeat and breathing is injured.

Harsh cut Arriaga's skull along the midpoint around to the side near his ear. The skull portion was removed so that he could reach the injured area of the brain to drain the blood that was causing the pressure.

The superior temporal vein was tied off to prevent further bleeding, and then the blood inside the brain had to be suctioned off carefully. Because of damage, apparently caused from a kick by Sassy Linda, a small portion of the temporal lobe was be removed. The temporal lobe does not affect essential living, but does affect things such as memory, balance, and mood.

Harsh warned Arriaga's family and agent Roger Olguin that the jockey might remain in a coma for some time, but Arriaga awoke the next morning, recognized his family and talked with them.

"It's a very rare individual who recovers from such an injury," Harsh said. "Certainly, being in top physical condition and being young and getting such a quick response to his injury helped."

The X factor

There is more than that to the recovery said Seftel. "The missing factor is his fierce, incredible persistence, tenacity, and will to live," Seftel said. "I work in emergency rooms, and you can tell quickly who is going to make it."

Although he had come out of a coma, Arriaga faced many potential problems in his initial recovery period, including the threat of seizures and raised pressure inside his skull.

Arriaga's weight dropped from 114 pounds to 98 as he was not allowed to eat following the surgery. When food was finally allowed, Dr. Seftel was present for Arriaga's first meal and said, "He was ravenous. I've never seen a jockey eat like that."

His weight got up to 106 pounds at Stanford and is back to his normal 114 now, Arriaga said.

On April 15, Arriaga was moved from ICU at Stanford to a rehab unit at Alta Bates Hospital in Berkeley, closer to Arriaga's home in Richmond.

He underwent a vigorous daily rehabilitation routine with programmed exercises to improve his strength, particularly on his right side, and coordination. He also has received some speech therapy.

"I need a lot of work on my right leg," Arriaga said. "I work all day, more on my right than my left. They have me work with weights. They have me drawing and writing." He also rides an exercise bicycle to maintain his fitness.

Eleven days after being transferred to Alta Bates, Arriaga showed so much improvement that he was transferred from that hospital to an adapted living facility in Vacaville where he continues his rehab. He is expected to stay there for one month.

Each day, a little better

"I think everyone's surprised because I'm better and better every day," he said. Arriaga is one of northern California's top riders, having finished second to perennial riding leader Russell Baze in the recently concluded Golden Gate Fields jockey race. He is also one of the most popular riders in the colony with the ability to tease his peers without the barbs getting too sharp. Arriaga has often been the first to check on the condition of his fellow riders when they are injured.

Yet he says he was surprised and extremely touched by the concern of his fellow riders for him. Ron Warren Jr., for example, gave his winnings to Arriaga after picking up a mount Arriaga was scheduled to ride.

"A lot of them have been coming here," Arriaga said while at Alta Bates. "Roberto Gonzalez has come by a lot and Miguel Perez."

Arriaga's head was shaved for his surgery, and his hair is beginning to grow back. He had highlighted his hair blond and says he plans to do that again when his hair grows back.

He eagerly follows news of the racetrack and said he was happy for Jason Lumpkins, who equaled a Bay Meadows record with six victories in a single day on April 21. Arriaga said he wished he had been at the track April 27 when jockey Rick Privitera won his first race in seven years.

As miraculous as the comeback has been, Arriaga still has a long way to go. No one knows yet if he will ever be able to ride again. He told Seftel when he was at Stanford that he hoped to resume riding in a month. He knows he won't be back that soon now.

"Right now, I don't think of riding," he said. "I need to take care of myself and make sure I feel good.

"When everything is done, I want to start riding again."