Sunday, August 30, 2009

The Etape de Tour Saved My Life - part 5

50 Rides to do Before You Die - suggested recovery reading for open heart surgery patients.

The final chapter in the 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 4 was here if you missed it.

The last days at Epworth Cardiology Unit had involved some excruciating rehab sessions. The physical stuff involved rolling and coughing, 2 things you really don't want to do with dozens of stitches in your chest. All that caused was physical pain however. The counselling was far worse, having to sit through textbook learning sessions, including the aforementioned 'resuming sexual activity' and discussions about giving up cigarettes, fatty foods, and other vices.

Seeing my keenness to leave, and frustration that my INR levels were not coming up quickly enough, I received some great advice - 'dress like you are already home'. Not only did it take me out of my 'pyjama'd patient' frame of mind, it clearly altered the perception of the professionals for the better. I loved the look on nurses' faces when they came in to check on me and found a shaven, well-dressed visitor instead - "so where is he?" they'd chime. "That would be me" I'd reply, smiling at the deception.

Finally running again (for a couple of minutes), with Adam Martin at Trewrehab in late July 2008

All of this left me determined to take a different approach to my rehabilitation. 'Healthy grocery shopping' is not a subject that needs much study when you live in a gluten-free, no dairy household anyway.

My descent from a high level of fitness (brought about by long miles on the bike) to pathetic zombie shuffling around Middle Park shops (quickly followed by exhaustion) was shocking and complete. Every ounce of my body's energy was being absorbed into the healing process, the organs trying to settle back into position and wounds heal. It was all I could do to keep up with the weekly blood test cycle as my Warfarin dose was perfected to a healthy INR range.

My magazine pile for the recovery. Robbo delighted in sending me Procycling's
50 Rides To Do Before You Die with a bookmark on page 46 - the Tourmalet in the Pyrenees where
I should have been climbing in the Etape de Tour on 6 July 2008.

Initial estimates of how long it would be before I recovered to a level of fitness I had enjoyed before were all suspiciously short. Three months, maybe four. It just didn't seem right from where I stood - I was still stuffed walking up the stairs at home.

I finally twigged as to what was going on - as the Adam's Heart Valve Surgery blog notes, the onset of depression following cardiac surgery is epidemic, and is counted one of the most significant side-effects. Nobody was going to tell me 'be patient, it'll take a year' for fear of sending me into depression and examining the meaning of life. So let me offer other sporty open heart surgery patients some advice - be patient, it will probably take a year.

I found that I was having out of body experiences, watching me unable to open the marmalade jar (left and right sides of your body being joined together at the sternum has all sorts of strange benefits you might not have considered!), and shuffling at tragic pace to the tram, then 100m down to the Albert Park Medical Centre for a checkup in the weeks after surgery.

I felt 90 years old.

The only major pain I was suffering was in the 2 places where the operation invaded my muscles - the twin drain tubes for the chest cavity which were routed through the diaphragm and out the abdominals; and my neck where the matrix-like spider device had been connected. Despite the occasionally frightening 'click', the chest bone was no real source of discomfort. My utter sympathies go out to those recovering from cesareans or radical surgery like mastectomies - that would be the definition of pain.

My first assessment at Trewrehab was 2 May. Getting past the usual BS "but you must be feeling so much better these days" was not an issue - Adam had met me before the operation and could see the demolition job the surgery had done on me. We scheduled my first session for 6 May, with a clear goal of getting back on the bike in July, for at least a short ride around Albert Park.

With a 'program' and surrounded by fit athletes I never had time to feel sorry for myself. The beta blockers were leaving me in a daze, but they were gone by the end of July. Some people stay on those forever! The arrhythmia that had seen me condemned to these damned pills was a fairly frightening experience, my heart rate racing out of control to 180 bpm whilst lying quietly in a hospital bed trying to be zen and stay calm.

We visited my surgeon Peter Skillington on 29 May - he had a strong message for me - for god's sake slow down! He was not thrilled I was aiming to resume cycling, having recently attended to a cycling buddy who had come off second best with a parked car descending a hill in the suburbs. I examine every one of these tales with an eye to the avoidability, what could have the cyclist done differently to miss the crash altogether.

My cycling buddies won't thank me for this, but I suspect that many accidents are avoidable if you assume homicidal intent on all car and truck drivers' behalf, and that a surprise lurks behind every intersection or parked or stationary car. It's a tactic I've been using for 30 years on my motorcycle.

I assembled a "Warfarin-special' first aid kit with the help of the local pharmacist (someone you'll get to know well) to ride with that includes cold compress (to reduce bruising); antiseptic powder, antiseptic wound cleaning pads; tape; stretch bandages; and wound covers. It fits in an airline toilet bag in my middle pocket at the back of most cycling jerseys.

I wear a Medic Alert bracelet and a fancy ICE necklace with a built in USB device that holds records of my medical condition. My colleague Mark, who is also a CFA volunteer in the rural fringes of Melbourne, assures me if he attends any bike crash I'm in that it'll make a nice souvenir as they're not due laptops in their vehicles until about 2019. Ah well...

As my INR settled into an acceptable range, I made the big decision to avoid alcohol entirely. Simplify, simplify, simplify. That NZ Pinot Noir Lesley and I had drunk on the day of discovering my faulty aortic valve was a fitting departure point for a lifetime's enjoyment of fine wine and beer.

The surgery and the recovery period that followed brought some surprising benefits - once I got fit enough to walk, I was able to spend a lot of daylight time with our 7 year old boy that high pressure corporate Dads just don't get these days. I was very sad to go back to work and lose the thrill of dropping Noah off and picking him up, sharing a pie at Annabels in Albert Park before guitar lessons, and a joke about the day's schoolwork.

Now, in September 2009, I ride most weekends, have turned rehab at the gym into a weekly personal training session with Adam (which I am thoroughly addicted to), am back to full speed at work and enjoying it more than ever.

I made a list of things that looks a lot like that great cliche 'the bucket list', the first of which I have already ticked off - playing in the Lonely Planet Band at the Espy in June this year. Little things bring memories flooding back - the anniversary of my operation which is now my second birthday; and Paris-Roubaix will always be special to me now.

Which, to circle back to the start of this 5 part epic, sounds like a bloody good reason to go to Europe and knock off a couple of those 50 rides before we die.

Note: if you'd like to read about how Robbo and Slim's trip to the 2008 Etape de Tour went, it's all documented on the Robertson Communications blog here. There are times I think Slim drew the short straw! Here's Dave climbing Hautacam with 10km to go.


Andy said...

Lovely set of articles.
I was in tears at times.
I am not sure what more I can say.

Thank you

Barnes London.

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