The Etape de Tour Saved My Life - Part 2

Quite the cycling injury - and the mother of all registered niggles.

The continuing story of how a perfectly innocent medical certificate signoff for an Etape de Tour bike race entry form revealed a collapsing aortic heart valve, resulting in 44 year old cyclist Nigel Dalton having open heart surgery in early 2008.

Part 1 was here if you missed it.


That little scar, is what is referred to among the cycling fraternity as a 'registered niggle' - a certified (among your mates, bugger the UCI) excuse to perform poorly while racing or training. It's no use complaining after a ride about the injury you were carrying or feeling poorly, you have to register the problem in advance.

The photo is the only shot I have of the 'ouchy bit' as my little friend Harrison Rowe would say. Then again, if you did read Part 1, I have jumped ahead for dramatic effect. We left me in the waiting room at the Victorian Cardiac Centre at the Epworth Hospital in Richmond, confident of setting a new record on the treadmill stress test and having a medical certificate signed off the very next day for last minute submission to the good people of Bikestyle Tours.

Being a busy place, the cardiac nurse got me shaved in small circles where the electrodes needed to go, stripped down and lying on the bed with all manner of electrodes attached for the ECG part of the test. There's 3 parts to this test - the scan (like a baby ultrasound, but of your chest); the ECG where they measure all the electrical charges that make your heart work in a regular fashion; and the treadmill test, where the heart's response to exercise (aka stress) can be viewed using ECG and ultrasound scanning.

With wires attached, she brought up the first pictures up on screen. Despite the strange circumstances, imagine I'm managing to maintain my 50-something rest pulse and composure for being half-naked in a cold room. Within 30 seconds the nurse picked up the phone and asked for someone to come in as soon as possible. Within 30 seconds of their arrival, they are in turn, calling for Doctor Seow.

Their collective (but hushed) "ohhhhhh, very clear..." as the screen is flicked to a mode that allows blood flows to stand out among the muscular grey blur of the ultrasound. Dr Swee Seow, who has clearly been in this situation before, turns to give me the news.

"Your GP, who is he? He's a pretty smart fellow - I've not known a GP to diagnose so accurately a problem. Why did you see him again - out of breath? Feeling faint all the time? Bad chest pains?"

"A bike race entry form ..." I managed to utter - the cool, composed, cyclist evaporating fast. Not a common symptom of heart problems apparently. I explained the Etape de Tour as best you can in such circumstances - France, hard to enter, months of training, big mountains...

"Sooooo ... you booked your ticket yet?"

It wouldn't be the last time that Swee's humour carried me through an awkward moment in the next few months. Swee explained how when a heart valve malfunctions by not closing properly, high pressure blood leaks back into the aorta, quite often causing that side of the heart to swell as it copes with the extra work loaded on the 'exit' chamber of the pumping mechanism. And that in my case, it was a valve in very bad shape, severe regurgitation, and severe swelling of the heart muscle.

Thus I needed surgery urgently. Major surgery, cut open the chest cavity, risky and complex surgery. Surgery you see on TV and look away from. Surgery that happens to other people.

Flabbergasted, I lay there thinking "that wasn't supposed to happen" (I work in IT, that is a common phrase at the time of disaster). "Come on then" says Swee, "we've got a stress test to finish". I looked at him like he was a murderous madman - treadmill? After that diagnosis? You have to be joking!

As it happens, a good set of data from the stress test is vital in the process of assessing the problem (in particular the health of the heart muscle overall), so with mind and heart racing I took the treadmill to Level 5 as I had long anticipated, feeling no ill effects from exercise as usual, and the scans were completed.

Swee's plan was to engage Peter Skillington to try a procedure he was world-renowned for called the Ross Procedure, where the patient's own valve on the 'low pressure' side of the heart is substituted for the highly stressed aortic valve. The pulmonary valve is then substituted with a human donor valve.

The alternative would likely be a mechanical valve, as being of middle years, I'd need it to run for perhaps 40 years (here's hoping!) and they were highly reliable. The downside of mechanical was the need to take Warfarin for life, a blood coagulation controller. With thin blood, there are things you think twice about doing. Like cycling.

Swee would contact Peter and my GP immediately, schedule an angiogram, while I was to work out health insurance details, what do to with my job, and get ready for a lifestyle change. Two months minimum off-work, probably three.

A bit dazed, I dressed and left the hospital. I txted work to say I wasn't coming in that afternoon, and rode home. I walked round to the local wine shop, bought the most expensive bottle of NZ Pinot Noir they had (knowing it quite likely would be one of the last I'd enjoy), two Reidel glasses, and opened it in preparation for Lesley arriving home.

After breaking the news at home - needless to say I lacked Swee's calm bedside manner - I called my parents (who were already booked to come over after Easter weekend for a visit), and rang Robbo to register the mother of all cycling niggles.

That night I also sent the following email off to Bikestyle:

Dear Natalie, Had a bit of a shocking day. A routine stress test for my Etapes entry form medical signoff turned into a drama - it turns out I have a heart murmur, the aortic valve is not working correctly and I need open heart surgery to replace the valve as soon as possible. My fitness has apparently been disguising the defect for a while. This is not the outcome I was expecting from today! I have a good friend, with a racing license who I have asked if he will take my entry for me. Though shocked, he's considering it and will let me know tomorrow. He lives in Milan, so is on a different time zone. We should be able to pull together the necessary paperwork quite quickly via email and fax to you. Strange day for me, please let me know if this is going to be an issue to enter Andrew instead of myself. Regards (I'm not quite up to 'cheers' this afternoon) Nigel

Dave quickly decided he would make the France trip in celebration of our stated mission in life to record many more epic tales of cycling days out, and with luck Slim was now going to ride the Etape in my place.

I would have a different Tourmalet to climb.