It was meant to be a routine physical.
By Denise Woodin
It was meant to be a routine physical.
In January 2015, John Grieco was a trim 48-year-old who followed a healthy diet, didn’t smoke, and trained rigorously with his wife Melissa for triathlons, including the elite Ironman distance. A Rye YMCA member since 2004, he considered himself to be “ultra-healthy.” So it was only in passing that he mentioned to his doctor a general soreness in the core of his body and a prominent heartbeat.
Three weeks later, John was wheeled into surgery at New York Presbyterian/Weill Cornell Medical Center. During a six-hour procedure, a leading vascular surgeon implanted seven stents in five arteries to relieve pressure from four dangerously large, and one forming, aortic aneurysms. Although the procedure — Endovascular Aortic Repair, or EVAR— had been used for nearly 25 years, John became the first person in the United States to receive an EVAR extension for the smaller affected arteries. This part of the surgery was so experimental it did not yet have FDA approval.
John and Melissa moved to Rye from New York City in 2004 and quickly found a community of athletes who shared their passion for physical activity. “I’m at the Y all the time,” John noted. “Staying healthy and active is a priority for people in this area, so having the Y here is a real asset.”
Around that time, John also caught the “triathlon bug,” as he later wrote in an article for the Ironman webpage. He joined the Rye Tri Club, eventually becoming its president, and began to train more seriously. After completing his first Ironman in 2011, he was hooked on the grueling competition, which consists of a 2.4-mile swim, a 112-mile bicycle ride, and a marathon 26.2-mile run, raced in that order and without a break. Melissa shares his passion and the couple train, travel, and compete together. On New Year’s Eve 2014, they toasted 2015 by setting an ambitious goal: completing four Ironman competitions that year.
“Everything was about the best way to deal with these medical issues. It’s easy to talk about now, but there were definitely some sleepless nights.”
So, their resolve was badly shaken when, two weeks later, John was diagnosed with abdominal aortic aneurysms. Although his mother had died at age 82 of an aortic dissection, a break in the artery wall, John never suspected that he carried a genetic condition that led to the aneurysms. “About 15,000 people die annually of aortic aneurysms, and those are just the ones who are diagnosed,” he noted during a recent conversation. “The risk factors are older age, high blood pressure, arteriosclerosis, heavy drinking, smoking — I had none of these.”
As frightening as the diagnosis was, the treatment options were equally discouraging. The first involved a large incision in the abdomen and synthetic replacement of the affected arteries, an invasive operation that would result in reduced blood flow to his lower body. The second option was the EVAR procedure. However, this surgery was only approved for the main arteries, and John had aneurysms in the smaller iliac arteries. In some patients, the smaller arteries are simply blocked off. But if this were done in John’s case, he would still suffer the effects of reduced blood flow: cramping, pain, and the high probability of never running again, according to the head of vascular surgery at Mt. Sinai.
The rest of his life — the Ironman training, his job at The Bank of Tokyo Mitsubishi — took a back seat as John met with the best cardio-vascular surgeons in the region, seeking answers that would allow him to enjoy his life on his terms. He recalled, “Everything was about the best way to deal with these medical issues. It’s easy to talk about now, but there were definitely some sleepless nights.”
And there was not much time to decide. The aneurysm had stretched the vessel, normally the radius of a garden hose, to twice that size. The iliac arteries, which branched off the main artery, were 250% over their normal size. Just when John’s prospects looked most bleak, a doctor at Mt. Sinai remembered that a former colleague, Dr. Sharif Ellozy, practicing at New York Presbyterian/Weill Cornell, was working with W.L. Gore on an active study using bifurcated iliac stents as an extension of the standard EVAR method. These stents offered John his best hope for continuing his life as an athlete.
Four weeks after the surgery, the doctors told John he could start training again. In June, John and Melissa completed the Ironman in Coeur D’Alene, Idaho, on the hottest race day on record —105 degrees. They then proceeded to complete Ironman Lake Placid and Ironman Mont Tremblant, racing, at times nearly side by side, to accomplish their New Year’s goal.
On November 15, John finished his fourth Ironman, in Tempe, Arizona, with Melissa cheering him on. John’s post-surgical follow-up exams show that he has healed well.
In a satisfying postscript, John was invited to visit W.L. Gore’s medical research and development facility in Flagstaff, only a half-hour drive from the race in Tempe. He later reported “I gave a presentation to the staff of 200+…thanking them all for their contribution to producing the medical device which has enabled me to continue doing all the things I love to do.”
Reflecting on his experience, John observed, “I was fortunate to live in an area where there are great medical resources, and to find a doctor who referred me to Cornell, where they had the perfect combination of medical expertise, surgical facilities, and access to cutting-edge procedures. Having it all come together has allowed me to continue enjoying a full life and confidently engage in sports that I’m super passionate about.”
Always seeking a challenge, John has set a new goal for 2016. This year he plans to complete five races: The Assault on Mt. Mitchell, Ironman Lake Placid, Ironman Timberman 70.3, Ironman Chattanooga, and the Philadelphia Marathon, where he hopes to qualify for the 2017 Boston Marathon.
The author is Director of Community Impact and Social Responsibility at the Rye YMCA.
