Danish triathlete Torbjorn Sindballe has retired at age 32 due to a dangerous heart valve abnormality, leaving a great career and some unfinished business. Thunder Bear mixed great victories – an ITU long course World Championship and a silver medal, two Oceanside California Ironman 70.3 wins, an Ironman Hawaii bike course record in 2005 and a third place finish at Kona in 2007. And he also endured a string of career-discouraging injuries that included back troubles and shin splints in 2001, Jumper’s Knee syndrome in 2005, and the discovery of a heart valve issue in 2005 that eventually forced his retirement. But above all, Sindballe will be remembered for his innovative attitude and curiosity which sought and found out of the box solutions to his search for health and speed in the service of his triathlon dreams.

In the short history of triathlon, there have been several prominent figures hit by heart-related problems: Less well known is Aussie Bruce Thomas, 7th at Ironman Hawaii 1993 whose career was ended by a heart malfunction in the late 1990s. Then there is Greg Welch (1999) and Emma Carney (2000-2004) whose careers were ended by ventricular tachycardia. Steve Larsen (2009) died suddenly of what appears to be a viral or allergy-related effect which caused him to stop breathing during a run workout. And in what seems to be the closest parallel to Torbjorn Sindballe’s problems, Ultraman and ultra runner/Navy SEAL David Goggins discovered this year he had atrial septum defect - ASD – which effectively created a hole in the heart which limited blood flow by roughly 10-20 percent.

Slowtwitch: What does this tell us about the elite athletes who incur these heart injuries? And about their natural willingness to absorb pain and discomfort in the service of training for their beloved sport?

Torbjorn Sindballe: Results wise it is not a bad club to join :-) First of all the heart issues are not necessarily a consequence of the vigorous training, but often has underlying malfunctions that are detectable in a screening. So everyone should get their heart checked thoroughly once they start serious training.

Secondly. As an athlete you have to create a state of mind or a zone for long periods of time where you block out everything else but the training. Often you encounter different pains and soreness’s along the way which you have to ignore as you will otherwise be stopped constantly and not find the rhythm necessary to pull off tough sessions and days. Separating good pains and sensations from bad ones are probably the most difficult task you have as an athlete, as they require a complete change of mind to a more sensible, internal focus to the body which is contradictory to the structured, goal-oriented way of thinking we normally need to refine over the years. In a race, this focus is intensified even more and people finish and do well in races with all different kinds of issues. The standard is getting a deep cut in your feet at the swim exit and not knowing about it until you look at your blood colored shoes after the finish line. In worst cases (which are very rare) you die because something serious hits you and you don’t know what it is but keep on going.

ST: Have you been aware of others in your sport that have had heart issues? And did that affect your ultimate decision to surrender to the diagnosis and retire?

Torbjorn: I have read about most of the stories above in the past months. None of them are directly related but you definitely think about how much stress we actually put our bodies and hearts through. As there is very little scientific data on top athletes and heart issues it is mostly a judgment call unless the condition is life threatening off course. What is a bit surreal is that my very good friend Steffen Liebetrau has had some serious heart issues as well in this time. After Challenge Kraichgau some weeks ago, he was hospitalized with a thrombosis in his heart and was lucky to be alive. His case affected me a lot because of our friendship, but also because our sensations in training over the past year or so have been very similar with burnout feelings and troubles doing the most intense workouts which might relate to the heart issues.

ST: You were apparently aware of it in 2005. How did you adapt to race so well (Ironman Hawaii bike record in 2005, third overall in 2007)?

Torbjorn: In 2005 I experienced sudden chest pains just before leaving to Kona and we feared for an infection in the heart. After a scan I was cleared for the infection, but the doctor found the valve problem and reviewed it shortly at that time. It was OK and within acceptable limits, so as the pain disappeared pretty quickly with some back therapy I went on to race. I have had yearly checkup’s since then ensuring things where good and have thus not been worried until I experienced some more serious symptoms this spring and we did the full examination getting exact data on the size of the malfunction etc. which were then up in the grey/red zone.

ST: To what degree were you competing as a calculated risk? In other words, what did doctors tell you about it then? And what did you discover after Wildflower that changed the diagnosis prognosis?

Torbjorn: See above. Based on the advice I had I felt safe to race from ‘05 until now. Many people live with a bicuspid valve all their life without knowing and in most cases there are no complications. In some cases the leak starts to grow or aorta dilates over acceptable limits and then you are at a more serious risk in the short and long term perspective. The risk for something happening acutely is small but still markedly increased. In the long term you risk moving a possible valve replacement forward which involves open heart surgery and blood thinners for life. As a family father I could not accept either of these as my condition seems to have gone from a mild to a moderate state. Combined with the feeling I had in my body and what my gut told me I made the decision.

ST: When did you first notice any symptoms?

Torbjorn: During Wildflower I had an abnormal drop in HR during the bike ride ending in a hyperventilation attack in T2 with tingling in the arms and face. A similar but not so serious thing happened during Hawaii Ironman in ‘08 and in milder ways earlier in ‘05 as well. When I came home, I rested and when I started more serious training a week later I started getting the same tingles alongside pain in the left side of the chest. After 4-5 days I ended up scared in the hospital fearing for something acute, but was cleared. The pain and tingling decreased when I decreased training to short easy sessions. We cannot tell if these symptoms are directly related to the heart matter, but it cannot be excluded either. Usually symptoms occur at a later state and are worse, but when you push your body to and often over the limit it gets its own way of telling you when enough enough is.

ST: In retrospect, do you think you might have been feeling the effects of abnormal heart valve this past year in Kona? Were your feelings after fading at Kona similar in type but less in scale than at Wildflower?

Torbjorn: See above. Yes it is possible that this has something to do with the valve, but it is hard to tell as again there are no studies or research on it.

ST: You have battled so many afflictions (Jumper’s Knee et alia) to compete at such a high level. Was your first instinct to find another solution?

Torbjorn: Once I got the full picture of the valve function I knew I was not going on to race several years. The long term risks I feel would be too big. I seriously considered racing Kona for a final time this year, but only if I could regain the trust in my body and do a 100% preparation that would make it possible to race for the win as this is the only thing I miss in my career. The doctors could not give me a green light right now and they would have needed to do more testing during stress and also monitor me every 3-4 weeks during the buildup before they might be able to say it was safe to race. Combined with the pain and tingling that seems to come as soon as I start training for real, I could not meet my goal of a 100% preparation and decided to stop now rather than go through 4 months of uncertainty, low quality preparation and maybe get stopped on the way.

ST: Realistically, what percentage of your heart capacity was missing because of your heart condition? Do you ever fantasize what you might have accomplished had your heart been whole?

Torbjorn: It is more the efficiency than the capacity that is affected. So my heart is working harder than in normal people, but is luckily still meeting the demands I put it through. At rest, I need to pump 20% more blood to get the required oxygen to the cells. At work, this falls to 5-7% more blood and therefore the heart muscles are taxed more during exercise. To a certain extent they have adapted by getting stronger and my heart is huge also compared to other top athletes. To me it makes sense that some of the breakdowns I have had might be caused by this as the body shoots me down if the heart is threatened, but I cannot tell for sure.

ST: What did your beloved wife and children say to you when you found out about your latest diagnosis?

Torbjorn: They all got really scared at first, especially when I went to the hospital. There have been a lot of worries at times when waiting for results of the tests, but after the final meeting with the docs it was pretty clear to all of us that this was the right thing to do. My wife is more emotional than me and was probably ready to pull the plug much earlier in the process, but she waited and gave me time to make the decision myself. She knew that I needed to grasp and fully commit to it, before we could leave this part of our lives in a good way. My son got a little sad when we told him as he sensed it was a big change and meant a lot.

ST: What did your family man (heart tell you when you heard this latest diagnosis? What did your competitive/warrior heart say when you heard?

Torbjorn: My family heart was worried about my long term health as well as my ability to provide and support my family. Major health issues are one of the most mentally and emotionally demanding things for anyone and I would hate to put that stress on the family I can avoid it. I need to be there as a father and husband for many years and I want to be able to have good job and go play with my kids without concerns.

The warrior/Viking heart was tempted by a final, all out, 100% race in Kona and where thinking up plans on the meanest training to be done so I could kick everyone’s ass for good. I knew that I needed complete trust in my body to pull of such a preparation and go through all the suffering. As I could simply not see myself do long and hard session anymore it was clear that even though I wanted what was going down in October, I was no longer able or mentally ready for everything that would come between now and then.

ST: What has been the reaction in your country?

Torbjorn: I was all over the sports news yesterday so must have done something right. As in other countries our biggest problem in the general media is that we only get coverage when we do something really outstanding. We have too few races to build a momentum for the media to follow and this makes it hard for us to get more regular coverage. When that is said I have achieved a lot and have a good name especially inside the sport community in Denmark.

ST: You have had a lot of ups and down in your sporting life. Which were the steepest?

Torbjorn: Before this? Whoa! Actually there were several points where I faced a lot of injuries. I definitely hit a lot of valleys on my journeys. I think there’s been couple points in 2001 had injury lasted a year and half, when my back issues started, and it took me eight months to find someone to solve it. After that, I had shin splints and I was out of racing for a year and half. After that, I came back and had a bad season. So for 2.5 years I would cry a lot and did not achieve the level I wanted.

After that tough time, my wife Mette convinced me to continue. She could see clearly, if I stopped then, in six more months I’d be back again. So then I had probably the best whole season of my career, one of only seasons I went through uninjured. In 2002, I won Oceanside, took a silver medal at the ITU long course World Championship, and won the Danish championship against a tough field including Rasmus Henning and Peter Sandvang, who were both really tough that year. I also won the Danish sprint and duathlon titles and I won another race in Ibiza where I beat Patrick Vernay late in the season.

Then another low point was last Fall. Of course to go down again in Kona again for the second or third time was obviously not happy. But I got a good finish to the season with a second at Ironman Florida to Tom Evans who had a great, great race.

After that I was just completely burned out and went through a lot of changes to fix things that I had not dealt with for eight years. The biggest issue was with my back and I wanted to change all the little things that had gone bad and rebuild a lot of things from the ground up. So it was a very troublesome. I worked hard with Michael Brueger, our national coach, and Ricky Jorgensen, a 40-time national champ in swimming who also has been a triathlete himself, with Mark Evans with my running and also with Wieke Hoogzaad.

ST: The biggest thing you missed out?

Torbjorn: One of the things I really missed. I wanted to see the things we worked on and changed succeed how they would have developed. Definitely there was a time 10 weeks before Wildflower when I had one of best bike rides in a long time. It was encouraging because I also had top swim sessions at this time and I was very encouraged with all the work we had done. I feel bad we won’t get to see results. But all this work definitely left me with a clearer picture how I think things should be done and I hope to use it in the future.
ST: Might you have second thoughts?

Torbjorn: I really feel well balanced with this decision. I don’t feel I want to go out and hammer my bike. In my mind I do. But when I listen to my body I am not going anywhere. Then I have to say that I can look back on what is almost a full career few people get to experience that I feel privileged to do all those things and meet all the wonderful people. All that is a great thing I can take with me in life.