Sean Entin and life after the 'choke'

Two months ago, on a beautiful late summer night, my smartphone buzzed with a text.

"Josh, this is Sean Entin; it's been a while. I have a story that you may like to hear."

He was correct, it had been a couple years at least, but Entin hadn't forgotten how to grab my attention.

We met more than a decade ago, when I was a reporter feeling my way around mixed martial arts, and he was a manager trying to do the same. Entin, now 40, worked most closely with Mark Kerr during the heavyweight's self-destruction. "The Smashing Machine," an HBO documentary in 2003 that focused on Kerr's fall as he participated in Pride's famed Grand Prix 2000 tournament, only provided a glimpse into the troubles Entin dealt with on a daily basis.

Eventually, Entin fell out of touch with Kerr; his attempts at staying in the management game fizzled, and a move to create a televised professional league for amateur-style wrestling went nowhere. But he continued to maintain relationships in the business, and liked being at the fights.

The week before Thanksgiving 2011, Entin visited San Jose, Calif., to watch his friend Dan Henderson fight Mauricio Rua.

Henderson hooked up the tickets, as he usually does, and Entin had the pleasure of watching a bout thought of by many people as the best MMA contest of the year. Entin -- "part of the crew," Henderson called him -- had it all. He was married with two adorable daughters. He was in the best shape of his life. He was a successful businessman. And he got to watch guys like Henderson fight gratis; just hang and enjoy the spoils.

There wasn't much he wanted that he didn't already have, except for relief from the pain in his neck and the sensations of numbness and tingling in his left hand. That, along with tightness in his chest and bouts with vertigo, started a couple weeks prior to Henderson earning a unanimous decision over Rua.

"I was in my jiu-jitsu class last October," Entin texted. "Nine months ago, and I got choked out. Three weeks later, I had a stroke.

"My carotid artery blew."

The stroke

On the morning of Nov. 25, 2011 -- Black Friday -- Entin sat around a table in Paso Robles, Calif., with his family and friends discussing plans for the day. Visiting Santa would be fun. Some wine tasting, maybe. Hey, a little shopping never hurt anyone.

Entin stood up off the couch, mumbling and slightly moaning, and made it to the bathroom. He was confused, though ... why was he on the floor? Did he hit his head and fall, or fall and hit his head? Either way, the right side of his skull was pounding and he felt sick.

"I thought maybe I had a bad hangover from the wine tasting from the day before," Entin said.

He turned pale and sweaty. Paramedics were called, and Entin's wife, Stephanie, from whom he has since separated, helped him dress. That's when they discovered he couldn't move his left arm -- or feel it, for that matter.

Ambulance and helicopter rides put Entin at Cottage Hospital in Santa Barbara, where Dr. Alois Zauner discovered a major injury to the carotid artery that resembled "gunshot and knife wounds."

Zauner, an Austrian transplant, said Entin's artery, which supplies oxygenated blood to the neck and head, was shredded.

That, and a blood clot had formed around the injury -- which is what caused the stroke. Fearing it could "burst any second," Zauner performed a 4 1/2-hour surgery to repair the artery, inserted a stent, and removed a two-inch blood clot.

"Thanksgiving weekend, you know most doctors are out of town," said Entin's father, Allen, a retired OB/GYN. "To take an emergency call like that was really something. He's very lucky."

Entin remained in intensive care for the next three weeks, more than a third of the time under a medically induced coma because his brain continued to swell. It was bad enough that Zauner recommended a craniectomy, which meant removing the right side of his skull to alleviate pressure, and inserting the skull into his abdomen to preserve it. That worked; a little more than a month after the stroke, Entin's head was back together again.


The famed rear-naked choke is actually a misnomer.

The grandaddy of all submissions, where one opponent controls another from behind and wraps his or her arms around a neck in such a way as to limit blood flow to the brain, is technically a strangulation. Only if a move attacks the trachea, or, more specifically, a person's ability to breathe, should it be called a choke.

True, if it's held long enough, a strangulation hold will affect breathing, but that probably means there's also been a death.

Strangulations are what some refer to as "blood chokes." They aim to decrease blood flow to the brain, thus lowering blood pressure, which, if done for a long enough period of time, say eight to 10 seconds, elicits a reflexive response and victims go to sleep. Held for 30 seconds, permanent brain damage starts to occur. Two minutes, and it's all over.

"It's hard to strangle someone to death," said John Danaher, a Renzo Gracie black belt instructor and Georges St-Pierre's Brazilian jiu-jitsu coach. "You have to be pretty damned determined. You have to want to do it.

"When you suffer a strangulation, it's never the case where all of the blood gets shut off to the brain. There's actually four arteries that lead from the heart to the brain. Two of them run underneath the spine, and two of the carotids come through the front. What happens when there's an attack on the carotid, either through strangulation or some kind of cut, the result is a lowering of blood pressure and the brain detects that less blood is getting through and it starts shutting off functions. The brain knows damn well that there are certain bodily functions that are more important to survival than others."

The brain values heart rate and breathing and regulating body temperature -- primal elements of life -- over little things like memory and emotional drive and conscious thinking.

The reptilian side of the brain wins every time.

Entin wasn't caught in a rear-naked choke a year ago. He described it as a "Josh Barnett-type side-choke," essentially, and excuse the misnomer, an arm-triangle choke.

Intending to get into the best shape of his life, Entin studied Brazilian jiu-jitsu in San Diego with Phil Moore, earning a blue belt two months before the stroke.

Moore began training jiu-jitsu in 1998 and five years later connected with Rodrigo Medeiros. Moore's a competitor who medalled in several important tournaments. On his web page it's explained that Moore's goal is to "pass on the jiu-jitsu that I have learned and to teach people how to be humble and also dangerous."

While grappling with another student at Moore's academy, Entin was caught in a strangulation. This one felt different than the others, he said, and his arms were trapped so he couldn't tap. Still, he was released before going to sleep.

"Usually you pass out from a choke, which I have before. You get light-headed. You get dizzy. But this one, it was much different," Entin said. "It was more painful, something I can't really explain."

Entin insists the move led to the stroke, that there's no other way the injury could have occurred. He eventually sued Moore, although Entin said nothing came of the lawsuits because Moore didn't have insurance and declared bankruptcy. Moore did not reply to requests for an interview.

"It's like a pinched straw," said former UFC champion Pat Miletich, who was among a handful of people in MMA that were aware of Entin's condition. "If you pinch it and keep sucking, the straw stays closed. When the blood pressure is trying to pull the blood through the artery and it's been crushed or squeezed by a choke, sometimes that artery will stay closed and that's when damage occurs."

"When you think about it, it does make things a little bit scary," Henderson said. "But there are things in everyday life where there's always fluke accidents that can happen. In his instance, it is pretty rare that that would happen. I don't see that happening to me. It's like lightning striking."

Rare is right. Miletich and Henderson don't know of anyone else that experienced an injury like Entin's. Neither do Danaher, trainer Greg Jackson, or Javier Vazquez, who fought for more than a decade, teaches jiu-jitsu, and married into the Gracie family. Jon Fitch, whose reputation for fighting off chokes is legendary, was stumped, too.

Anyone can be strangled, yet there's no doubt that Fitch is about as good as it gets at keeping his brain swimming in plasma.

"That guy would be dead to rights in all sorts of craziness and never get choked out," Jackson said of the UFC welterweight contender.

"Over time as their expertise and knowledge grows they can make these small subtle shifts that somehow relieve the pressure to a degree where the stranglehold isn't enough to make them tap," Danaher said. "They get this Houdini-like aspect where seemingly impossible things become possible."

Just thinking about guys like Fitch makes Entin recoil in horror. It's an understandable reaction considering his past year. It also speaks to the lack of experience and thoughtfulness everyday Joes bring to the mat.

"A lot of people panic tap," Fitch said. "It happens all the time. It gets tight or your neck gets wrenched on a little bit and they kind of tap out. You should have a good feel of what each choke feels like and being able to know how to react when you feel those chokes. I should know if he's on my throat and I can't breathe, but the tunnel isn't closing in on me so I'm not getting a blood tap. I should know I have more time to defend."

For laymen like Entin, who might have seen Fitch tempt fate and thought they could too, Fitch recommended knowing "all the positions, and slowly, purposefully letting you and your partner getting chokes and using more and more pressure to finish while you're trying to escape."

Step by step

Entin doesn't reflect much -- he long ago stopped obsessing over why this happened to him, but once in a while he wishes he would have let his wife take him to the emergency room the night he was hurt.

Maybe everything else could have been prevented. The paralysis, which persists in his left shoulder, touched half his body. He couldn't see. He couldn't read or write or walk. He couldn't do anything alone, and that was the hardest part. Dr. Zauner may have saved Entin's life, but what kind of life was he going to live? That's invariably the question with stroke patients.

Secondary care is where life-rebuilding strides occur, and Entin had the good fortune to pay for and benefit from quality health insurance. He estimated seeing more than 100 physical and occupational therapists in the last year, all of whom helped reconnect Entin's mind and body with everyday life.

"Everything I do is step by step," Entin said. "I can't just get up and start walking. I have to think each step ahead of me. I have to.

"I was like a 95-year-old man and at the same time I was like a baby."

Entin quickly progressed and today gets around on his own very well, though he moves with a stiff left leg and flaccid arm on the same side that brings a pit-pat sound from the floor of his parents' home in Tarzana, Calif., where he has lived since early in the summer.

Shawn Finnegan, a physical therapist for Entin since August, is concentrating on getting muscles to fire that haven't fired in a while. It's all part of a process to expedite neuroplasticity, or remapping, where a part of the brain will adapt and take on functions to pick up the slack.

"The part of his brain that controlled [Sean's arm] is not working, so there's another part that can come into play and you try to make that happen faster by doing these techniques," Finnegan said.

Early on, Entin realized the important role therapists play in discovering as close to a full recovery as possible. He recognized how fortunate he was not only to be alive, but to have the means and ability to receive the best care. Compared to the treatments he saw for other patients, including military veterans, he felt he needed to do something.

"Patients are often released from medical care after receiving only a few months of rehabilitation," Entin said. "Many have very little hope of regaining more functional mobility or improving their level of self-efficacy because they are not able to pay for the necessary rehabilitation treatments.

"I've created plenty of for-profit businesses. Move2improve is my first nonprofit."

Entin hopes to make therapeutic excercise and rehabilitation more accessible and affordable to those in need by providing scholarships to rehabilitation centers and utilizing minimal in-home equipment, like the kind developed by Finnegan, installed at Entin's parents, that attaches to a wall and utilize fitness bands of varying types.

Henderson is already using Finnegan's Hammer Head Training System in his gym in Temecula, Calif., and he agreed with Miletich to lend their names and likenesses in support of Entin's foundation.

"He's had it pretty tough this last year and I commend him on staying mentally tough and working through it and staying positive," Henderson said. "There were a lot of down days, but for the most part he's striving to get better, and he'll be close to normal like he used to be."

The UFC light heavyweight contender already offered his friend tickets to his next fight against Lyoto Machida in late February. Entin promised to make it, and is aiming to drive himself south to the Honda Center in Anaheim.

"I want people in the MMA and jiu-jitsu world to know it's OK to tap out," Entin said. "Don't have an ego."