It all Starts with Heart
In 2009, NorthBay Health was just starting to launch its full Heart & Vascular Center, introducing everything from minimally invasive catheterization lab procedures to much more complex open heart surgery.
Fast forward 14 years and NorthBay Health is continuing to raise the bar when it comes to cardiothoracic and vascular procedures performed in Solano County by physicians with training from some of the most premiere institutions in the world.
In this issue of Wellspring, you’ll meet the dynamic team of cardiologists and interventional cardiologists, interventional radiologists, a cardiothoracic surgeon, a vascular surgeon, an electrophysiologist and the teams that support the many life-saving procedures they perform every day.
To start us on our journey, we’d like to share what would happen to you, if you were experiencing a myocardial infarction, aka serious heart attack.
Meet “Coronary Carl,” a hypothetical patient.
Carl was 14 when he tried his first cigarette. Now at 55, he’s a pack–a–day guy. He’s put on some weight through the years but that doesn’t concern him. He figures he works hard at his construction job and stays active around the house, though lately he gets out of breath more quickly.
Still, he didn’t worry when he woke up feeling what he thought was some indigestion — a burning sensation below his sternum. “It must be those spicy chicken wings I ate last night,” he tells his wife.
After taking a shower, he heads downstairs. He feels pain in his neck and jaw, is exhausted and notices an overall feeling of dread settling in. As he sits down in a chair next to his wife, he manages to tell her he isn’t feeling right. And then he passes out.
His wife dials 911 and an ambulance arrives within minutes. Carl regains consciousness but the pain in his chest is excruciating as the emergency medical technicians take an EKG and then load him into the back of the ambulance.
The ambulance crew calls NorthBay Health Medical Center Emergency Department, a designated heart attack (or STEMI) receiving center, to let them know a possible STEMI (ST Elevation Myocardial Infarction — a heart attack with a completely blocked coronary artery) case is on its way.
Carl arrives at the hospital minutes later. The medical team is waiting. That phone call from the ambulance triggered a cascade of events at NorthBay, including an overhead page to the physician and the cardiac catheterization team. Everyone who will treat the patient is notified to get all their equipment into place and be ready.
The emergency team confirms the heart attack with another EKG and a blood test. A screening test measures high levels of troponin I proteins in his blood. These proteins are released when the heart muscle has been damaged, particularly during a heart attack. The more damage there is to the heart, the greater the amount of troponin there will be in the blood.
In most cases the location of the blockage in an artery can be identified by an interventional cardiologist who uses a catheter to clear the blockage and place a stent inside the artery so blood can flow without being blocked. The doctor explains to Carl that he’s having a heart attack — the blockage in his artery is cutting off the flow of blood to his heart muscle. Without intervention, his heart muscle will die. In Carl’s case, however, physicians determine that it’s not just a single blockage. Carl has multivessel coronary artery disease, which is a narrowing of more than one coronary artery.
“There are situations where, for whatever reason, a stent cannot be placed,” explained NorthBay Health cardiothoracic surgeon Shea Pribyl, D.O. When that happens, Dr. Pribyl is called in to perform Coronary Artery Bypass Grafting (CABG — pronounced like the word “cabbage”).
“We reconnect the flow of blood around a blockage,” said Dr. Pribyl. He often explains to patients that their heart attack is a little like rush hour traffic.
“I tell my patients that it’s like you are driving on I-80 and come to a traffic jam, so you take an exit and drive on the side streets before getting back on the highway later on down the road,” said Dr. Pribyl.
During the surgery, a vein is taken from Carl’s leg and attached to one end of the graft above the blockage and the other end below. Blood bypasses the blockage by going through the new graft to reach the heart muscle.
Following his surgery, Carl wakes up under the care of a specialized team of nurses. He will spend the next 24 hours in the intensive care unit. His nurses will help him to get out of bed the very next day, when he will also be moved to a medical-surgical unit in the hospital. In all, he’ll spend five to seven days in the hospital before going home.
In cases like Carl’s there will be a considerable amount of oversight.
“We are sending them home but there are restrictions,” explained Rebecca Parker, Acute Care Nurse Practitioner, a key player on the NorthBay Heart & Vascular team. “There is no driving and no lifting while they heal.”
Rebecca has spent a career making sure patients such as Carl and his family have what they need while in the hospital and are most vulnerable. “I’m their advocate,” she says simply. “I want them to have the tools they need to achieve their health goals.”
Carl’s care doesn’t end when he heads home. While in the hospital, he is connected with a dietician who begins the process of helping him improve his nutritional choices and understand the importance of a healthy diet. Four to six weeks after surgery, he will see his surgeon again and if all is well, he’ll be cleared to begin cardiac rehabilitation.
Located in NorthBay Health’s VacaValley Wellness Center, the Cardiac Rehabilitation program is key to getting patients back on their feet and helping them launch a new, active lifestyle.
Dr. Pribyl uses another automobile analogy to help patients like Carl understand the importance of the rehab process: “You’ve got that rebuilt engine, now it’s time to get it back out on the road and let it purr.”
Karen Loewe, Clinical Manager of Cardiac Rehabilitation, explains that Carl and patients like him will spend three days a week for the next 12 weeks rehabilitating with her team and re-learning what it is to be fit.
In the first meeting, patients sit with a registered nurse to learn about the program. The nurse will get their history and help them understand what the goals are and what to expect for future visits. When the patient starts the exercise portion of the program, they will walk on a treadmill while their heart rate and breathing is monitored. A functional assessment is performed in which every 30 seconds the speed and incline will be increased until they can do no more. The maximum speed is set at 4.2 and the incline at 8 but the test can end before those limits are reached.
“It’s a way for us to know what they are able to do and how to write their individual exercise prescription,” explained Karen.
Patients may feel some fear about the exercise efforts. That’s normal. “It can be frightening for the patient because they aren’t sure what they can and can’t do,” said Karen. “But it is also comforting for them to know that the program is all monitored by registered nurses who are also trained in exercise.”
As the weeks pass, patients also do free weights, ride recumbent bikes and Airdyne exercise bikes to get their arms and legs strengthened. Many will find they can do far more than they could even before their heart attack.
“They are always so surprised by how much more they are doing at the end,” Karen said. “It’s the unique thing about the program. It’s so gradual that by the end of the 12 weeks, patients do not even realize they have increased from 18 minutes of exercise to 40 at much higher levels. It’s very gratifying and rewarding.”
Lucky for Carl, his rehabilitation and new diet and exercise plan are working. The Cardiac Rehabilitation team celebrates his accomplishments on his final day with a ring of a cow bell, applause, cheers, a T-shirt and congratulations.
Meet Cardiothoracic Anesthesiologist Adam Tibble, M.D.
There’s nothing like delivering care to wounded warriors in the back of a flying, vibrating C-130 to push a doctor out of his hospital comfort zone.
But according to NorthBay Health cardiac anesthesiologist Adam Tibble, M.D., his four years in the Air Force as a physician with Critical Care Air Transport resulted in some of his most meaningful, rewarding work.
He served during the Iraq/Afghanistan conflicts and was deployed twice over four years, once to Afghanistan and once to the Middle East. He found himself teamed up with an ICU nurse and a respiratory therapist — both with exemplary skills, he says proudly — handling the care of as many as two dozen high-acuity patients, as well as numerous other low acuity or insurgent patients.
The lessons he learned overseas, he said, are easy to apply to patients back at home — both at David Grant Medical Center and at NorthBay Health, which he joined in 2011.
NorthBay Health specializes in cardiac anesthesiology and is part of NorthBay Heart & Vascular.
Meet Cardiothoracic Anesthesiologist Cameron Swift, M.D.
A common denominator among many of NorthBay Health’s H&V team members is U.S. Air Force military experience, and with that naturally comes a propensity for hard work and collaboration under stressful situations.
Cameron Swift, M.D., obtained his medical degree from the Uniformed Services University in Bethesda, Maryland, and did his residency in anesthesiology in San Antonio. He gained early experience as a member of the Air Force’s Critical Care Air Transport team, helping transfer ICU-level patients from Afghanistan or Iraq to Germany and on to the United States.
He began working part time at NorthBay Health in 2011, while still active duty in the Air Force at David Grant Medical Center. He came on board full time after retirement as a Lt. Colonel in 2020.
He considers his NorthBay team to be more like family than co-workers. “My CT anesthesiology colleague Dr. Tibble is a close friend. Dr. Pribyl (also an Air Force vet) is an amazing surgeon — so kind and patient in the OR. I also appreciate having the opportunity to work with NorthBay’s stellar cardiologists, whether it’s supporting our TAVR program or our electrophysiology cases. Their procedures are really state-of-the-art, and we all get to provide an incredible service to our patients together.”
As a medical student, Dr. Swift realized that anesthesiology was a good fit for his personality as he is a self-described introvert. He was also drawn to the specialty because “there are a number of invasive procedures (central lines, arterial lines, regional blocks, spinals, epidurals, etc.) that require proficiency and technical knowledge. I took further training in cardiothoracic anesthesiology and transesophageal echocardiolography because the cases are more challenging. The specialty is multi-faceted and requires much more than just being an airway expert. Knowledge of all our medication’s interactions, maintaining constant vigilance during monitoring, and dealing with an unexpected crisis with a cool head are just examples of this.”
Meet Cardiothoracic Surgeon Shea Pribyl, D.O.
Caring for Heart & Vascular patients is a team sport for NorthBay Health cardiothoracic surgeon Shea Pribyl, D.O.
“Each heart patient I treat is going to interact with 60 to 70 people through the process — from nursing staff to occupational therapists, internists, hospital, X-ray, dietitians, rehab, etc. We are all part of big team,” he said. “Each has an important role that we play in order to have a good patient outcome. And I’m blessed to be at NorthBay where all of the links in that chain are very strong.”
Dr. Pribyl came to Solano County through the Air Force. He started in the U.S. Merchant Marine Academy in 1996 and served four years after college in the U.S. Naval Reserve. Then he “crossed over to the Blue” and joined the Air Force in medical school, eventually coming to David Grant Medical Center at Travis Air Force Base and then NorthBay.
His initial plan was to be a trauma surgeon but during a cardiothoracic surgery rotation early in his training, he became inspired to change course.
“Anatomy and function come together with cardiothoracic surgery. It’s a specialty where you can watch physiology in action,” he said. “It’s a marriage of hands and mind — all in the context of being able to impact people’s lives in a concrete way.”
To learn more about Dr. Pribyl, visit www.northbay.org/Pribyl