Go Hard or Go Home: Determination Despite Cardiovascular Disease
Northwestern Memorial Hospital February 01, 2011
CHICAGO, IL – John Marschall, widely known as “Coach Jay”, is not a pro athlete, but he’s also not your average amateur. At 49, he’s competed in over 275 multi-sport races, primarily triathlons. Many times, he’s either placed in the top one percent of all competitors or finished first in his age group. Among sports enthusiasts, he’s what’s known as an “elite” athlete. However, according to his cardiologist and cardiac surgeon at Northwestern Memorial Hospital, Marschall’s progress—by most standards—is nothing short of a miracle.
“I go hard or I go home; that’s all I know how to do,” says Marschall, a triathlon coach for more than 20 years, after transitioning his love for endurance sports into a lifelong career. “There have been times when because of my heart disease, I’ve thought about quitting. But for anyone who’s seen the movie ‘Vision Quest’, competing is my ‘Vision Quest’. I want to show people who have illness, that not only can they come back, they can come back at full strength.”
Marschall’s quest for a comeback is to qualify for and compete in the 2011 Hawaii Ironman—a competition he’s done seven times before over the course of his competitive career. This feat wouldn’t be so miraculous were it not for a congenital defect known as bicuspid aortic valve, where the aortic valve has two leaflets instead of the usual three, that, by the time he reached his 40’s, lead to a downward spiral of Marschall’s heart function. Despite two open-heart surgeries and endocarditis—an inflammation of his inner heart wall that nearly killed him—he’s on course to compete in Kona, Hawaii this October.
“What Jay has done and continues to do is truly remarkable, even by clinical standards,” says Patrick M. McCarthy, MD, Marschall’s cardiac surgeon and Northwestern’s chief, Division of Cardiac Surgery, director of its Bluhm Cardiovascular Institute and the Heller-Sacks Professor of Surgery at Northwestern University Feinberg School of Medicine.
As McCarthy explains, bicuspid aortic valve is a treatable condition—and Marschall says he always trains and competes under the care and supervision of a cardiologist. For a number of years, medicines were all that was required to manage his disease. But very typical of bicuspid aortic valve, his valve progressively weakened, was leaking and had begun to narrow (an condition known as stenosis). In 2007, Marschall experienced dizzily waking up on his bathroom floor, when his last memory had been of brushing his teeth. He had fainted, another common trait of bicuspid aortic valve, as the development of stenosis can restrict blood flow to the brain.
Marschall had been advised that any progression of his disease might someday require surgical intervention—even aortic valve replacement. Fainting was “a blow, but all I wanted to do was make it right so I could continue competing.”
Thoughtful research, advice from friends—and advice from friends of friends—led Marschall to McCarthy and cardiologist Robert O. Bonow, MD, Northwestern Medicine's vice chair, Department of Medicine, director for its Center for Cardiovascular Innovation and the Goldberg Distinguished Professor at Northwestern University Feinberg School of Medicine. So, in 2008, Marschall, a resident of Billings, Montana, flew to Northwestern Medicine, in his native hometown of Chicago, and underwent his first open-heart surgery to replace his aortic valve.
With the collective guidance and counsel of the Bluhm Cardiovascular Institute’s support clinicians—and more importantly, their encouragement—within a week after surgery, Marschall was cleared to resume exercising and eventually his regimen resumed its usual intensity. At just 12 weeks following surgery, Marschall placed first overall in the Vikingman Half Ironman competition in Burley, Idaho where he completed a 1.2 mile swim, 56 mile bike ride and 13.1 mile run (a half marathon) in personal record time. “It’s pretty amazing when I look back on that. Not only had I come back, I came back full bore,” he recalls.
In the months that followed, Marschall continued competing at top speeds. However, by 2009, he would develop severe case of endocarditis, an inflammation the endocardium, which is the heart’s inner lining. Endocarditis usually affects the heart valves, which it did in Marschall’s case. He was sent back to Northwestern Medicine via a life flight, and would remain in the hospital for more than a week.
He was eventually released for discharge, but this time he’d lost a good amount of muscle tone and had little stamina to resume extreme exercise. Marschall recalls coming back from that episode as being “harder than coming back from surgery.” He could barely eek out an eight-mile per hour pace on the bikes, when the average person rides at 15 mph with minimal effort. He recalls, “battling back was brutal.”
And battle back is just what Marschall did. In May 2010, within the first 10 months following his endocarditis diagnosis, he won his age group at the Rev-3 Olympic Triathlon in Knoxville, Tennessee. However, when he finished, something just didn’t feel right. Heart palpitations prompted his Billings cardiologist to order an echocardiogram. He recalls receiving the results and thinking, “my heart was a ticking time bomb.”
The echocardiogram revealed an aortic aneurysm—a circumstance that is most often fatal to those who are unfortunate enough to experience rupture. It’s the fate that befell well-known individuals including, actor John Ritter and most recently, politician and White House diplomat Richard Holbrooke, who died from an aortic rupture just this past December. When rupture occurs, bleeding is so swift and so severe that 80 percent of victims don’t survive the trip to the emergency room.
Marschall was lucky in that his aneurysm hadn’t burst, but his cardiologist in Billings feared it could at any moment. No stranger to life flights, Marschall was airlifted back to Northwestern Medicine—this time to treat the aneurysm that bulged in his aorta and to replace his aortic valve for the second time. “My cardiologist in Billings didn’t say this to me at the time—but much later he admitted that he didn’t expect me to return to home.” Marschall said.
This most recent surgery occurred in June 2010. Today, Marschall’s competing for a chance to qualify for the Ironman in Kona, Hawaii in October. He admits that he and his family have considered having him end his regimen for extreme competitions. A father of two young daughters, “I couldn’t bear the thought of them being without a father,” he says.
However, those thoughts proved fleeting. Marschall says he and his wife have come to accept that “Coach Jay” isn’t some persona or fictitious character—it’s what defines Jay Marschall at this stage in his life. He’s back swimming five miles per week, biking another 200 miles and averaging 30 miles of running. In order to qualify for the Ironman in Kona this fall, Marschall aims to finish in the top one percent of his age group in a half Ironman competition in St. Croix this May.
“I’d rather have him being himself, which means he’s happy and competing,” says his wife Sarah Keller, also a triathlete, who has retired from triathlons, but since taken up ultra-marathons—50+ mile runs—since the birth of their two daughters.
“With this last set back I was mad that this happened to me,” said Marschall. “But that anger is now channeled as determination. If you tell me I can’t do something—that’s when I’m going to do it. This is a one-time shot for me. I want to do it this year, and then I’m done; I don’t have to do it anymore after that. This task seems impossible, but I want to show people that many roads are tough, but anything is possible through commitment and dedication.”
Learn more about Northwestern Medicine Cardiovascular Care.