Tuesday, November 17, 2015

How to Lead a Band - Part I

OK... I'm not Bob Wills, Woody Herman, Benny Goodman, or Johann Strauss the Elder, nor even the Younger. I'm just a seat of the pants geetar picker who start his first band at age 12, and has been at it now for 55 years. If you're reading this after 2015, then add an appropriate number of years on to that figure... I assume that if you can read, you can probably add.

I've played probably close to 10,000 gigs plus or minus, both as leader and sideman, so this blog comes from the perspective of both. I've played for as many as 25,000 people, and as few as zero... that's right -- ZERO. (I'm not sure I like ZERO, but I'd far preferred the ONE GOOD LISTENER to 25,000 inebriated idiots, just for the record.)

First, here's a few things that leaders should be aware of, followed by some things that sidemen should be aware of. If you're in a "band" and it's very democratic and no one is really the leader... enjoy your childhood. This is not the real world.

For leaders dealing with sidemen (learned by experiences as a sidemen)

1. Respect your band. Sidemen are your peers... not your servants. Treat them with ultimate respect, listen to what they play, and enjoy!

2. Sidemen are human and like most creative people, have somewhat fragile egos. Don't confuse "professional" and "hey, I'm giving them money", with "needs no praise or encouragement." Express your appreciation first time and every time.

3. NEVER NEVER NEVER, no matter how badly deserved, criticize a player's performance in front of his peers and the audience. If you have a problem with a performance, address it privately. (This does not apply for certain substance induced behavior which needs to be addressed immediately... you know what I mean and you know the difference.)

4. Hire great players who are good human beings, then let them play -- no need to micromanage. Roots music is NOT Beethoven. It's fun to hear what great players -- specialists in their instruments -- contribute to your music. This doesn't mean you can't guide or shape... just trust that you're going to hear some great licks that you never would have thought of.

5. Know your repertoire. Everyone forgets a lyric now and again -- this isn't what I mean. I mean know the songs. For covers: who wrote it, what other versions have been recorded, the meaning of the lyrics, where it was recorded, who were the players. This doesn't mean you have to cough this up to the crowd before (or after) each song. But it's part of making it real... if you don't know this stuff, you're just regurgitating. For originals: when you wrote it, why you wrote it, when you recorded it, who recorded with you. You get the picture? If you're not inside the music, your band will be off in the pasture.

6. Talk to the audience, not the band. Yes... you need to be sure the band knows what song is up. Even a regular band often needs the key. Most of us in Austin play with at least a half dozen other bands, many times the same songs but in a different key, with a different groove, intro and all.

7. Be sure your sidemen pay attention. Lead the band -- be sure they know who has an upcoming solo... cue breaks when needed. Also, cue endings -- but, keep in mind, a good musician will guide the band musically with their outro lick, if it's not a rehearsed ending. Trying to cut off the band visually before an outro lick reaches its logical conclusions will almost certainly cause a train wreck.

8. Make the band look good. Often, an audience need guidance -- cue them in on the virtuosity that's happening on stage. When your band looks good, you look good.

9. It's all about the song. Yes -- I know there are charismatic stars who could sing the preamble to the constitution and make it sparkle. But, without fail, I'd rather hear a good band working well together. And, if you have good, appropriate repertoire, well ordered and well played, it'll work. If everyone plays "the song", it'll be great.

For sidemen (learned by experience as a band leader)

1. Watch the leader. It doesn't matter what kind of music you're playing -- symphony orchestra to garage band -- or, for that matter, garage orchestra. This is how you play together and all music sounds best when the musicians play together. I can't think of anything that irritates me more than having to holler to get the attention of a player who's lost in a daze.

2. Commit. Be there in your entirety. If you're dragging your gear out to a gig because you think it'll make you more attractive in the eyes of the opposite sex, your in the wrong business -- it might for a night or two, but the attraction is on the surface and wears off quickly. Nope... BE THERE. Stay connected to your bandmates emotionally. Make it happen! That's what makes it fun!

3. The gig is not practice. Know the songs, learn the lyrics, know your parts, know how to play those parts, know the melody, know the groove... or be quick to pick up.

4. Dress for the gig. Don't wear the clothes you wore to change your oil that afternoon. Show some respect for your audience... dress appropriately, but dress for the gig, not for couch. Miles Davis said he wanted his audiences to think he was special, so he dressed the part.

5. Don't whine. Keep your eyes off your watch. Don't complain about the leader's song selection -- just play it to the best of your ability. A player who complains just signs his own pink slip.

6. Maintain your gear. You were hired for the gig to make good sounds. Broken cables, noisy tubes, rattling speakers, and intermittent pickups do not make good sounds. It might be a good idea to step off stage and take a peek at how your gear looks to the audience -- if it makes you feel like you're looking into the shower in Bubba's trailer, maybe you should dig out the handy wipes.

7. Don't show up drunk or whatever! I once played a gig as a sideman alongside a player who was so screwed up that he sat down and went to sleep in the middle of a song! After the gig, he looked at me and said, "Are you playing tonight?"  Believe me, this guy would never play another gig in my band. Everyone has their threshold... know yours and don't step over.

8. Be musically flexible. Rock and roll, jazz, country, bluegrass, and virtually all roots music is largely improvised... be ready to go with the flow. Even in non-improvised music, some nights the tempo may be slower or faster... the group louder or softer. Don't be so committed to your particular concept that you can't change to make the ensemble sound its best. Maybe your amp doesn't sound like you want it to sound... hey, just play the sound that it IS making.

9. Listen. Possibly the largest difference between poor or mediocre players and top notch players is the higher level player's ability to listen to the other players and to the whole group, not just their own part. Players who have not yet mastered their instrument will be so intent upon keeping it together that they don't hear the other players... they'll be too loud/soft for the band, or they'll determinedly pound on a wrong chord. They rush, drag, play inappropriate or out of genre parts, noodle over other players fills. So... just listen and be a contributing part of the whole.

10. Make the leader look good. I've done thousands of sideman gigs and I know some front people are egotistical, blathering idiots. (I've had my own moronic periods.) Still.. while you're on the gig, if you make the leader look bad, it winds up making you look bad, and pretty much like an idiot for taking the gig in the first place. Do your best... take it up with the leader when you're off the gig and/or don't take that gig again! A corollary -- don't step on the leader's patter. It may be stupid and you may have heard it every night for the last 10 years. The audience has NOT heard it as often as you have. Think about Steve Martin saying, "Excuse ME!" for the millionth time, to thunderous applause. You may be wittier... if so, get your own gigs. For tonight, just go with it.


Tuesday, March 3, 2015

Part V - Some Life Lessons

Some Life Lessons

Action vs. Consequences

It's alarming that an innocuous action such as putting your foot down on, what turned out to be, a non-existent step, can be one of those before and after points in life. Although I expect to recover as fully as possible, nothing will ever be the same for me again.

Not only did I disrupt my own life, but also the life of my wife, my co-workers, and everyone that I am associated with socially an professionally. The ratio of consequence to action is extremely high -- very small action with huge consequences.

Life Goes On

I'm almost like a ghost, dwelling in the world I previously inhabited. 

I found replacements for gigs... and the gigs went on a scheduled. Different, to be sure, but the Earth continued to rotate.

My racquetball playing friends are still running and sweating. I'm sure they don't really miss my presence in any material way.

Everyone can be replaced -- and this is actually a relief in many ways. At this age, it's sometimes nice to know that life will go on.

Betrayed by my Body

That knee always worked on steps before. And, I never developed blood clots in my lungs. I have felt my age for several years now -- minor aches and pains, night vision not so great, trouble remembering names. If you don't think this will happen to you, think again.

Still, I had the vague feeling of invincibility that most of us feel throughout our lives. Just because everyone else has things like cancer, strokes, heart attacks, Alzheimers, etc., it doesn't mean that I will! But I can't feel that way any more -- particularly after the blood clot episode.

I can bravely say that I'm not afraid of death -- I already feels detached from modern culture, I hate the political climate in our country and the world, and I feel satisfied with what I've done with my life, and how I've resolved my existential questions.

I do, however, have a dread of becoming a burden on those close to me; and this experience has given me a taste of what this would be like.

Loss of Independence

I can't walk unaided... I can't drive... I can't come and go at will. Thank gawd for Amazon -- I've had items as insignificant as a light bulb shipped to me, as brick and mortar merchants are inaccessible to me.

It's like being a seventeen year old, driving for a year, who has been grounded. The pain of the injury, surgery, and post op, is minor compared to the loss of independence. I know its getting better and I know I'll regain my independence, but it's painfully slow in coming. Each day is long, right now... I know as I look back on it, it will seem like a short episode.

Constantly Moving Goal

Recuperating from this injury is hard for a goal oriented person. Imagine playing a football like game where the goal line was constantly moving. I can make estimates about my progress and what to expect -- but these estimates are elastic. Where you thought you might be in four weeks, turns out to be where you ARE at eight weeks. It's hard to plan ahead -- I've just decided to make only short range plans for the next six months. And by short range, I mean what I'm going to do RIGHT NOW -- not tomorrow, not next week, and certainly not next month.

Sunday, February 15, 2015

PART IV: Recovery and Hurdles Along the Way

This section will be in "diary" form and I've included this entry largely for my own perspective, though I hope it will be of interest to others who have had quadriceps tendon repair. It's just my own experience -- if there's anything I've learned it's that each individual progresses at his own pace.

January 16, 2015 "Operation Day"

Early day -- 6:00am at the venue where my surgery would be performed: Texas Orthopedics in northwest Austin. I don't really remember much about this day other than they knocked me out and when I came to, I had a big bandage on my right leg. I had opted for a "nerve block", so I could feel absolutely no pain at the incision. Somehow, Dana managed to get me piled back in the car, and we picked up the prescribed pain meds on the way home -- Hydrocodone for pain, and Diazepam for potential muscle spasms. I was pretty much out for the day.

January 17, 2015 "The Day After"

I slept... the nerve block was still in effect so I didn't really need pain meds. However, I couldn't get up easily, though this is just something you learn as you go along. I actually had to have a PT person come out to show me such tricks as getting up out of a chair, going down and up a single stair (our house has TWO of these small steps.)

January 18, 2015 "Fun (or NOT) with Diazepam"

The nerve block began expiring. Post op instructions said to try to stay "ahead of the pain". So... I tried. However, I soon learned that Hydrocodone and I do NOT agree on many things. I don't have the nausea that many people complain of, but did have the following: rash, itching, drowsiness, depression, and BIG time issues with NUMBER 2. Ouch...

When my leg began twitching, I added the diazepam to the mix. Turns out, I also experience many of the side effects of this drug, too -- particularly "impaired motor functions", "impaired coordination", "impaired balance", and, apparently a touch of the "anterograde amnesia", since I really can't remember much from the days I took diazepam.

Unfortunately, this kept me off my feet (on the walker) for a couple of days... who needs a setback at this point in recovery.

January 26, 2015 "Learning to Scoot"

I had my first follow-up appointment with the Orthopedic Surgeon. They removed the staples and said the incision was healing well. My mobility at this point is still "light toe touch" on the walker.

Let me tell you... getting 20 feet on a walker with "light toe touch" is an athletic feat. My triceps will be good and strong after this, even if everything else is completely gone to pot.

The plan was to begin early PT around February 9. I was eager to continue down the road to rehab.

February 2, 2015 "Pain in the Ankle"

I began having severe pain in my right calf. By Thursday, the pain was so intense that I had trouble making the 20 foot trip to the bathroom.

February 5 - Feb 10, 2015 "Six Days on the Road"

The calf pain was worse... I called Texas Orthopedics. My surgeon's physician's assistant told me to go to ARA (Austin Radiological Association) for a ultrasound on my leg... N O W. So... we piled into the car.

I figured that they'd do a test... tell me everything was fine... go home and bite my lip. But... this is NOT what happened!

Instead, they told me that I had developed major blood clots in my femoral vein and multiple pulmonary clots. Serious stuff. They told me to go immediately to ER. We did, and I went from ER to ICU where stayed for the next three days.

I was first told that the pulmonary clots were the most dangerous and that they were planning to do a "procedure" to stick some sort of tube down my neck into my lungs, then pump a drug (something like this link) to break up the blood clots.

However, after the radiologist reviewed the CT Scan, the physician in charge decided the pulmonary clots were too small to be dangerous and that they should perform the "tPA" procedure on my leg... let the body take care of the pulmonary clots.

They did something to desensitize my leg, and gave me some mild sedative. First in was a "portal" about the size of a coffee stirrer into a vein in the back of my leg. Through this, they threaded three IVs (or a XII -- ha ha) into the vein. One tube carried the tBA (the clot busting substance"; a second was an Ultra Sonic carrier -- high frequency vibrations; and, the third was a saline cooling solution to keep the Ultra Sonic motion from overheating my body. All this was guided in real time via an X-Ray display. When the tubes were all inserted, I could still see two of the captured images on the displays -- one of my hip joint, and the area in the femoral vein where the largest part of the clot resided. The other image was just below the knee, the portal insertion joint.

The attending physician, Dr. Poley, told Dana that I'd slept through the whole thing. I'm glad that I fooled them... I was awake for the whole thing!

From Radiology, I was moved back to ICU. Seton has some good staff... attending nurses (Travis, Josh), clinical assistants, and attending physicians (Dr. Kalyanaswamy... pronounced exactly as it's spelled) were really good, friendly, responsive to questions, and informative. This is good -- I was to keep my leg immobile for at least 24 hours.

Sometime during the night after this procedure, the insertion point began oozing blood -- not just a little bit. I mean it was pooling on the floor. The nurse on duty, Josh, was, I'm sure, alarmed. However, he immediately called the company that provides the equipment for this procedure, and managed to reach Dr. Poley. It turns out, although it's not what they intend, it's not unusual. Keep in mind, the insertion portal was like a coffee stirrer or small soda straw. So... .they just cleaned, changed pads under the leg, until morning when the redressed the leg.

Late in the morning or early afternoon, the opted to inspect the progress. I was taken back to the same (or similar) radiology lab, where they examined the blood clot. Once again, I was sedated, but awake, and I heard a round of "look at that!" from all the staff. Turns out, this was the GOOD response... the clot was largely dissolved and full circulation was restored to my leg. They pulled the entire apparatus out. Before closing the portal, the sent a "stint" up the vein (similar to how they do the heart thing), to help clean the vein. Back to ICU... until Sunday when they moved me up to the orthopedics wing for recovery. Much better... much MUCH better.

I still had a couple of days to spend in IMC (intermediate care) while they fed me Heparin, a powerful anti-coagulant, and monitored my blood by withdrawing copious quantities from a dozen or so pin pricks in my left arm.

I'm glad they were doing all this, but what I can tolerate five, six, seven... maybe even eight times... becomes REALLY irritating the fifteenth or twentieth times! Yikes... what do they do with all that blood?

Finally, on Tuesday morning, Dr. K (what they call Dr. Kalyanaswamy) came by... I asked when I might be released. She said, "This morning... in about an hour." I have to admit, it brought tears of joy to my eyes... I immediately called Dana. She was caught off-guard, but was equally as happy as I.

My advice... Seton is a really good hospital, and the people are very nice and seemingly quite competent. However -- DON'T GET STUFF THAT MAKES YOU WIND UP IN THE HOSPITAL. "Out of the" is a much better relationship to the hospital than "in the".

I'll be taking a blood thinner for probably 3 to 6 months, and this is not without issues. But this is a relatively new drug call Xarelto and doesn't involve dietary restrictions or constant dose monitoring and dose alteration like the alternative, Coumadin. Unfortunately, being new to the market and sold only under the brand name, Xarelto is also expensive.

A really proactive and energetic social services person at Seton, Emily, found me a card that would cover the first 15 days of Xarelto, for which Walgreens was asking $565. THANK YOU EMILY!!!

Walgreens, by the way, was less than helpful about anything. As a result, we had the prescription transferred to Costco where, as in every other aspect of Costco's operation, the pharmacy staff was very helpful. Also, for the same prescription that Walgreens would charge me $565, Costco would have charged about $300. So... next time you start to go to Walgreens, think twice. Go to Costco -- if you don't have a membership, GET ONE!

So... out of the hospital... .home... back to learning to walk again!

February 12 "Checkup"

I had my first post-hospital appointment with my primary care physician. I had written down all my questions -- the most important of which was, "Can I re-start rehab on my leg?" The answer was affirmative... if I could have jumped up and click my heels, I would have. Oh happy day.

Possibly the most interesting aspect of my trip to Austin Diagnostic Clinic was getting from the car (Dana let me off at the circle drive entrance while she parked) to the doctor's office on the 2nd floor.

I told Dana that I'd meet her inside. My means of locomotion is a walker, an alternative to crutches which I just don't trust -- I mean, why not a pogo stick?

However, moving with a walker when you're restricted to "light toe touch" on one leg is physically demanding. You take a step on the good leg, then lift yourself fully off the ground with your triceps, lightly touch the toe, and quickly again support yourself on the good foot. Although I know much of my body has suffered from this whole event -- obviously, I have not been able to play racquetball -- my triceps will be powerful. Going the 200 or so feet from the entrance to the office was exhausting. Thankfully, Dana found a wheel chair and I got a free ride for about half the distance. There's got to be a better way, you would think.

February 16 "Learning to Bend"

For my visit to my orthopedic surgeon, I was rewarded by the loosening of my leg brace to 30 degrees flexation, and no lock on extension. And, the big thing... I can place full weight on the "bad" leg. Instead of hitching along on the walker, I can move normally -- the walker just serves as protection. I've been running laps inside the house -- currently trying to get 200 - 250 steps a day.

Also, I began Physical Therapy (PT) on February 20. I selected Austin Physical Therapy Specialists... I read good Yelp reviews, and the office is very close to my house -- within walking distance... er, if I could actually walk.

March 1 and March 2 "Return to the Stage"

I played my gigs on March 1 (Jim's Country Jam) and March 2 (The White Horse). I refuse to use a walker to get into a gig. I had human crutches. Since I can walk reasonably well, albeit slowly, I just needed reliable support, similar to what's provided by the walker. My wife and I practiced at home for several days before the gigs.

Of course, the tricky part is stairs. At the March 1 gig, there is a flat path into the venue, but three relatively steep steps onto the stage. Going UP is easy -- good leg on the step, raise and plant the bad leg. Going DOWN is harder... bad leg leads and there's a tendency to flex and support with the weak quadriceps. This was a preview a feeling I'll probably fight for months, if not years, to come -- this is how my leg was injured in the first place... going down stairs.

The other challenge to playing gigs is that I have very little stamina. Even sitting on a chair, playing and singing uses considerable energy. As of March 3, after these two gigs, short as they were, I'm pretty exhausted. I'm playing only 9 shows in March 2015 as compared to 29 shows in March 2014. I'm not sure when I might feel like working more.... I'll just take it day by day.

March 3 "Walk In PT"

Today was my fifth PT session. A session consists of:

1. Electro-stimulus. They attach four electrodes to above and below, on each side of my knee. A current passes between the electrodes that automatically contracts the muscles surrounding the knee. It feels much like allowing a pack of crazed, microscopic gerbils to run wild under your skin. It doesn't really hurt -- but it's a little disquieting. And it really does feel good when it stops.

2. Deep message of the quadriceps. Since the muscle is partially atrophied, this can be painful -- but I'm sure this is vitally essential at this point to prevent adhesion and to promote circulation.

3. Ankle Pumps. This is a seemingly trivial, but very important exercise. You just elevate your feet, dangle your heels over the edge of the support, and wiggle your foot. It helps to reduce swelling and to prevent blod clots -- I sure don't need any more of those! I'm doing a set of 30 at least twice a day.

4. Quad Sets. This exercise consist of flexing the quadriceps muscle, just short of the pain threshold. Again, I'm doing these daily, twice daily, 30 reps holding for 5 seconds each.

5. Squeezing ball between my knees. I don't know the name of this exercise, however, it's the one exercise that makes me feel a little lactic acid buildup -- a good burn.

6. Heel raise. Lay back, knee on the riser, high side at the knee -- lift my heel as high as possible, short of pain. It's pretty obvious what this is intended to accomplish, given that this is the primary function of the quadriceps muscles -- extension of the leg.

7. Laser treatment. This helps with the scarring from the incision. It gets a little warm, but it doesn't hurt and it seems to work. The incision is now completely healed. The scar will be there for life -- but it's just another of life's tattoos.



 



Sunday, February 1, 2015

Up to my Knees, Head First

I've written a series of posts related to my recent knee injury. I wrote that for several reasons:

1. They'll explain what happened and why I'm absent from my gigs;
2. They'll be a helpful resource to others with similar injuries;
3. They'll be characteristically witty and entertaining to read, and not become known as "Stringer's Pity Papers";
4. I don't really have much else to do while I've been lying around waiting for this knee to heal;
5. And last, a chronicle for myself and family... the first three won't change much... the last two, I'll try to keep up to date.

PART I - What Happened

PART II - What is a Disrupted Quadriceps Tendon

PART III - Getting Treatment

PART IV - Recovery and Hurdles Along the Way

PART V - Some Life Lessons


I would appreciate comments and reposts.

Thanks

--Jim


PART III: Getting Treatment

How I Did It vs. How it Should Be Done

I injured my knee on the evening of December 26, 2014. I had surgery to repair the injury on January 16, 2015... exactly 3 weeks.

All the authoritative sources say you should 1) be taken to the emergency room; and 2) surgery should be performed as soon as is possible. The tendons and muscles begin atrophy almost immediately and the repair becomes more and more difficult, and less and less effective!

So... what happened?

First... I'm an idiot musician -- the show must go on. I felt that I need to play the show at Belly Up, regardless of the fact that my role was a bit part. In my nearly 55 years of playing gigs, I can count on one hand that shows that I've cancelled because of health issues. I played my Hall of Fame show in 2007 with a 104 degree fever and walking pneumonia!!! In a snow storm!!! In sub zero weather!!! Geez... you get the picture?

Second... as I mentioned, I have a history of pulled muscles. I sort of figured that's what it was... I'd do the RICE treatment, limp around for a couple of weeks, and that would be that.

Third... we were 1800 miles from home looking at a 3 hour plane trip. We delayed our trip for a day (which cost nearly $600 for ticket alteration, extra car rental, extra hotel, etc.) to allow a trip to the Urgent Care Center... by that time, because of the excruciating pain and my inability to extend my foot, I knew this was not a pulled muscle. So... we went to a recommended Urgent Care Clinic in Mission Viejo... more about this a bit later.

Fourth... it was Christmas holiday and orthopedic surgeons apparently are orthodox observers of this holiday. Though I tried to get an appointment with my primary care physician (PCP), as of Dec. 28, the first appointment available was not until January 2 -- that doctor was on holiday. My PCP referred me to an Orthopedic Surgeon... the first appointment I could get was January 6. At that appointment, they set me up for an MRI on January 8... and I could not get the results until January 12. At that time they said I needed surgery ASAP... well DUH!!! 

Ok... as many of you know, I quickly called about 100 people to find replacement geetar players, get the OK from bookers, etc. Everyone was, of course, very nice and I'm eternally grateful to my friends and colleagues who accommodated my sudden schedule change.

But... surgery finally occurred three weeks from the accident.

How it should be done -- GO TO THE EMERGENCY ROOM! This is a serious leg injury, one that if left untreated, can leave you permanently hobbled. I may not be young, but I tell you what -- I''m not ready for the now or EVER!!!

Now... I have to comment on the Oso Urgent Care Clinic, and in particular, Dr. Joy who examined my leg. I described my problem thus (reiterating much of what I've written on other pages.)
  1. I injured my knee when I missed a step;
  2. I heard a loud "pop" when my leg buckled;
  3. The incident was accompanied by intense pain in the patella;
  4. My knee was extremely swollen and discolored;
  5. I could not extend my foot.
If you do a search on Google for "Quadriceps Tendon Rupture", you'll get millions of hits. Each one with list, almost literally, the symptoms I've described. However, here's what Dr. Joy, in his medical wisdom, told me: "It's bursitis."

Once my head stopped spinning around on my neck, I inquired, incredulously, "Correct me if I'm wrong, Doctor... bursitis is a chronic inflammation of the bursa in the knee.. it would not suddenly be brought on by a slip on some stairs, would it? I was FINE before this incident... these symptoms began simultaneously with my slip on the stairs."

Dr. Joy was unshaken in his medical wisdom, even though his "diagnosis" was the equivalent of suggesting to a patient who had come in with a knife protruding from his chest, that he had acne. A little tetracycline would clear it right up.

As treatment, Dr. Joy wanted me to take a powerful steroid (methinks someone close to this situation might be taking a few too many of these, himself), and, thankfully, some Vicodin, to at least allow me to make the trip back to Austin.

Of course, what Dr. Joy SHOULD have said is, "Oh geez... you've ruptured your quadriceps tendon.... we need to get you to an emergency room, quick", or at least, "Oh geez... this looks serious and I don't really know what it is... let's get you to an emergency room."

Now... I realize I've named names, and left myself somewhat at risk. However, I have his written diagnosis and I have my wife as a witness. This is possibly the most irresponsible medical behavior I've ever personally experienced. Gawd forbid, my issue was not a stroke, or a heart attack... he might have diagnosed it as fatigue, or indigestion, depression, or who knows what. I have NEVER in my life levied blame against a doctor... what they do is difficult, and involves a certain amount of guess work. However, in this case, we have filed a formal complaint to the California Board of Medicine. Someone could die, next time -- my hope is taking the time to file the complaint my help prevent a needless death. No lawsuit, no damages... I just don't want this clearly incompetent "doctor" ruining someones life.

THERE... done with the vitriol. If you have a medical issue which requires "urgent care", I'm sure there are alternatives to the Oso Urgent Care Clinic.

One again, how it SHOULD be done -- GO TO THE EMERGENCY ROOM.

Next up... PART IV: Recovery




Saturday, January 31, 2015

PART II: What is a Disrupted Quadriceps Tendon

Way back in the old days, I was a sprinter, something you certainly would not guess from the present day body that I drag around. I was fast... fastest in the state the year of my graduation. I was offered various full ride track scholarships, but opted to attend the University Of Kansas which had offered me only a small stipend, having spent all the scholarship money on lightning quick, out of state runners. But, it's where my friends were going -- particularly the guys in my high school band.

The point of this aside relative to the topic of this blog is that I injured by right quad so many times that I had to drop out of track entirely. I'm no newbie to Quadriceps Injuries in general. However, I entered college in 1966 when we wrote with pens and paper, added and subtracted by "thinking" (or more accurately, by counting on fingers and toes) We avoided long division entirely, when possible. There was NO internet -- all research was done by thumbing through the library's card index, then scouring the cavernous building's shelves until you discovered that the sought after book was checked out. With any luck, you might get the information you needed in a few weeks.

So, I knew what my quads were -- and in particular, that they were the most important muscle to speed. A good sprinter's legs work like pistons. You plant one foot, then raise the alternate foot in a straight a motion as possible to near the buttocks. Then you swing the knee/foot/calf/upper legs as a unit forward and quickly extend the foot and plant it on the track, which the process repeats with the other foot. This process of tucking, swinging and planting is the key to every good sprinter's motions. Here's a YouTube video that shows at about 0:48 seconds in slow motion the process I'm describing.



That quadriceps fueled kick is, in a large part what shaves those 1/100's of a second off a sprinter's time that today divides the winner from the "also-rans". I was fortunate to be tutored in the science of sprinting by a pioneer in the field, Cliff Abel, who later became head track and field coach at Cal State Northridge -- they fondly refer to him as "legendary men's track & field head coach". At the time, immature ingrate that I was, had no appreciation of his coaching talent. I'm glad he's been appropriately recognized by those more discerning that I was at that age.

But back to ruptured quadriceps tendons.

I never ruptured a tendon during my running career. My injuries at the time were confined to "pulled muscles", or tears in the muscle fiber -- serious enough, but not, on their own, totally debilitating. This was all in a time before the now well known pulled muscle treatment acronym -- RICE: rest, ice, compression, elevation. In fact, I don't recall any treatment at all beyond rest and limping for a few weeks.

Also, I was complicit in that I didn't like excessive warm up, despite Coach Abel's admonitions. To make matters worse, our early season track meets were in the Spring, when temperatures in the region were often in the 40s, 50s or 60s, at best. (By the end of the season, you could iron pants n the sidewalk, but in March you wouldn't take off those pants to iron them!) Also, my muscles are a little too short for my bones, I guess... the muscles always seemed to be stretched a little tightly.

I'm certain that although I didn't suffer actual ruptured tendons, the fact that I DID have repeated torn quads also suggests that there was a trap being laid.

Quadriceps Tendon damage is often referred to a "runner's knee", "jumper's knee", etc. Those who are most prone to this injury are runners, volleyball players, basketball players... anything that subjects a bended knee to repeated abuse. When these athletes mature (that is get older... some never mature), their knees are most prone to tendon damage.

I've now learned a lot about the knee, and associated ligaments, tendons, cartilage and its general engineering. Had I studied this earlier, I might have done a few things that might have prevented this.

Heading up the list -- LOSE WEIGHT. When you use the quadriceps muscles to, say, climb stairs, you place the entire weight of your upper body (about 80% of your total body weight) on the quadriceps tendons. Here's a diagram of the apparatus:


So, in order lift your self one stair step, you contract your Quadriceps Muscle, which pulls on the Quadriceps Tendon, which is draped over the Patella (Knee Cap), and pulls up on the Patellar Tendon, which is, in turn, connected to the Tibia (or Shin Bone)... sort of like the action of a backhoe loader where the hydraulic cylinders are replaced by tough little pieces of tissue called Tendons.

Probably as the result of a combination of my age, my "runners knee", fatigue, and poor warm up -- racquetball is famously hard on knees, too. This is article explains the nature of the injury much better than I can -- plus there's some good, grizzly, CSI type photos of an open incision with tendons and all: Quadriceps Tendon Rupture

Another good read is Michael LaBossiere's "Quadriceps Tendon Rupture" blog... full of information, entertaining and well written.

Next up...

PART III: Getting Treatment -- How I Did It vs. How it Should Be Done

Sunday, January 25, 2015

PART I: Disrupting the Quadriceps Tendon -- DON'T DO IT - E V E R

How it Happened


I suppose that if you're going to "disrupt" (i.e., rip like a cheap piece of packing tape) your quadriceps tendon, as I did, you might as well pick a really beautiful setting to do it... as I did.

Aunt Dana with Ruby and Rylee
My wife, Dana, and I took a little Christmas trip to SoCal for the holiday... a multitude of in-laws: sisters, brothers, parents, aunts, uncles, nieces, nephews, dogs, family friends... gazillions of people to visit... parties and feasts. The wads of colorful wrapping paper, which having delivered their mysterious payloads, now litter the living room in clumps, like used shell casings on a battlefield... AND,, most importantly, EXTREMELY cute. lovable kids everywhere.

Uncle Jim with Finley


Our friend, Rosie Flores (best living country/rockabilly singer on the planet, and a rockin' geetarist, to boot) was going to be playing a gig at Belly Up in Solana Beach during our stay. Dana and I made arrangements to get the entire "of-age" gang down there for the show -- roughly 16 of us. Knowing I'd be in the vicinity, Rosie asked me if I'd bring a guitar and join her for the set. Given how I feel about Rosie personally and professionally, I said YES!!!

So fast forward past all the Christmas frivolities -- every family with grandparents, parents, kids, nieces, nephews, friends, hangers-on, etc, knows the drill. Sound levels to rival a battle of the bands between "Blue Cheer", "Nine Inch Nails" and, (why this is in a battle of the bands, I don't know, but humor me) a DC-10 revved up for take off. It was Dec. 26, Belly Up Concert Day.

The quick 4 p.m. sound check left us with a couple of hours to kill prior to downbeat. One of Rosie's friends had graciously offered her rustic, sea side house as a place to nap, get dressed, and generally relax.

NOTE: All events which which follow are due COMPLETELY  to my carelessness, stupidity, crappy depth perception... you name it. Sometimes it would be nice to have someone to blame... in this case NADA... le coupable, c'est moi.

Leading from the house to the car parked in the drive was a simple, three step flight of stairs. I had gone UP them, earlier -- no problem. But somehow -- it was dusk, the step were gray, my night vision is not so good -- going down, I wasn't sure if I saw THREE steps or TWO. Whatever my selection, it was WRONG. My foot came down at a strange angle, my right knee buckled and I collapsed... accompanied by excruciating pain and a loud "T-W-I-N-G" from somewhere just above my knee -- sounded very much like a "D" string breaking. Although I wish that it hadn't happened at all, here's three things that I'm glad for:
  • This step was not step 1 of a 20 step marble, spiral staircase, leading to a landing of jagged rocks, or into a trash compactor;
  • The staircase was in Sunny California, not, say, miserably cold Buffalo, NY... and was in the US where my Medicare is honored; 
  • I was surrounded by a bunch of really nice people who helped me get up and get going, rather than a gaggle of YouTubers, just looking for something that might go viral.

So... you know the old adage -- THE SHOW MUST GO ON!

Rosie grabbed the keys to the bizarre FIAT rental... hard to grasp even after driving for a week. We sped to the venue, pulled around in back of the Belly Up and someone helped me get into the green room.

Dana, who had come down with family, managed to get past the crowd, and Nena Anderson (who among her many musical endeavors, plays "June Carter" of "Cashed Out", the Johnny Cash tribute anchor band) helped me get to ice on my wounded knee. I discovered that by locking my right leg, I could mount the stage stairs at Belly Up and Rosie delivered a rockin' set.

Part II of this blog will be informational -- just what is a disrupted quadriceps tendon? Part III will cover my "day after" trip to the Oso Urgent Care Clinic (possibly the WORST medical facility in existence, if you consider the fundamental criteria as the ability to diagnosis and appropriately treat medical issues. Later installments will cover rehab. Some of this writing, I hope is entertaining; other parts are to offer support and information to other unfortunates who have suffered a quadriceps tendon injury.

I encourage comments, particularly if you've had a similar experience,

PART II: What is a Disrupted Quadriceps Tendon?