Are you ready for your close-up?
Hospital cath lab scheduled to open in 2005
The heart is a secretive organ. Shielded behind walls of bone and muscle, it resists prying eyes and probing fingers. As a result, doctors have long had to rely on the faintest of clues to gauge its health. But the soft throb of a heartbeat, the subtle whoosh of blood through vessels, is hardly the best way to pinpoint ailments in this complex organ.
For this reason, cardiologists consider a picture of the heart worth far more than a thousand pulses. Now the ability to create detailed images of sickly hearts and their surrounding vessels is coming to Community Hospital.
Scheduled to open in 2005, the new cardiac catheterization laboratory brings state-of-the-art heart imaging technology to the Monterey Peninsula for the first time. The laboratory will offer doctors the power to observe the cardiovascular system at work without the trauma of invasive surgery. As part of Community Hospital’s expanding cardiology program, the laboratory will provide Peninsula residents with a convenient and safe way to diagnose life-threatening heart ailments, followed by expert consultations and speedy access to treatment. The biggest reason people die from cardiac disease is because they don’t receive care quickly enough.
The need for a local catheterization lab is great, says Michael Barber, R.N., Community Hospital’s director of Cardiovascular Services. “The Baby Boomers are now largely over 50, and that’s when people usually start to come down with their first hints of heart disease. And one of the primary things they will be coming to hospitals for is cardiac care.”
Cardiovascular disease is the leading cause of death in America. “The next five or six causes combined, including cancers, accidents, and AIDS, still don’t kill as many people per year as cardiovascular disease,” Barber says.
Many things can go wrong with a heart. “The heart is a muscle, and it needs oxygenated blood to pump well,” Barber says. “Sometimes it can’t get a good supply because its coronary arteries are blocked. Sometimes the valves inside the heart don’t close or open well, so blood can’t flow to the rest of the body. Sometimes the electrical impulses that cause the heart to beat don’t transmit well.” Cardiac catheterization is often the best way to identify and then treat these problems quickly.
The technique combines the imaging abilities of X-rays with the miniaturization of modern medical instruments. By themselves, X-rays reveal little about the heart. They pass right through its soft tissues, leaving just a shadowy outline on film. But it’s possible to change that by adding contrast dye to local blood vessels. Afterward, the heart and its network of blood vessels pop out like the stripes on a zebra.
Cardiac catheterization is the technique doctors use to deliver contrast dyes to the heart. At the start of the procedure, a cardiologist inserts a slender, flexible tube, or catheter, into a large artery in the patient’s leg or arm. The doctor then threads the catheter through a maze of arteries toward the heart. An X-ray machine that produces real-time images helps the doctor track the catheter’s progress every inch of the way. When the catheter reaches its final destination, which can include the coronary arteries as well as the interior of the heart, the cardiologist injects liquid dye and takes pictures of the area with the computerassisted X-ray machine.
The resulting images, known as angiograms, can reveal whether arteries are blocked and, if so, how severely. Instruments within the catheter can also measure the pressure within the chambers of the heart. This information can also show how well the valves are functioning and whether they must be surgically repaired.
“Thirty years ago, you had these labs only at the Stanfords and Johns Hopkins of the world, and most patients had to travel great distances to have this procedure done,” Barber says. “Now it’s much safer and has evolved into something very accepted as the standard of care in community hospitals everywhere.”
Though cardiac catheterization labs are used in many hospitals, the technology remains extremely expensive. The X-ray machine and the sophisticated physiologic monitors used in the lab cost approximately $1.4 million.
Community Hospital also has a third component — the cardiovascular information system, or CVIS. Instead of printing angiograms on bulky X-ray film, the lab will be able to store all images taken during the procedure in digital format. “CVIS will allow doctors to review catheterization images in their own offices, allowing them to be as productive as possible,” Barber says. “And instead of having to box up X-rays to obtain the opinion of an expert elsewhere, both doctors will be able to look at the same pictures while conversing on the phone immediately following a procedure.”
Initially, our first interim cardiac catheterization laboratory will be used only to perform diagnostic procedures. As Community Hospital’s cardiology facilities expand to include cardiac surgery, the lab will become the site of therapeutic procedures as well. Angioplasties can help expand narrowed blood vessels by delivering and inflating a small balloon in clogged areas. Tiny tubes called stents can be inserted to keep artery walls from closing up altogether. And pacemakers can be inserted inside the heart without the need for open-chest surgery.
For residents of the Monterey Peninsula, that’s heartwarming news no matter how you look at it.
Meet the doctors
Designing and implementing a successful new heart program at Community Hospital requires a top-notch group of healthcare workers. One of the first steps along this path has been to bring together an experienced, incredibly qualified group of doctors.
“The key thing is to build a good team, and that’s what we’re going to do,” says Dr. Vince Gaudiani, a senior cardiac surgeon at Sequoia Hospital in Redwood City who will be head of Community Hospital’s new heart surgery program when it opens in 2006. “Every part of the team can help or harm the patient.”
Dr. Vincent Gaudiani
Gaudiani has performed approximately 7,000 cardiac operations over the past 20 years. He operates on about 200 heart-valve patients each year. In addition, he operates on many of the most difficult cardiac cases and has recorded some of the highest success rates in California. Gaudiani, 57, received his undergraduate degree from Harvard University and his medical training at Case Western Reserve University, the National Institutes for Health, and Stanford University.
Dr. Stephen Brabeck
Born with congenital heart disease, Dr. Stephen Brabeck, 54, was one of the first children put on a heart/lung machine. He’s since devoted his life’s work to saving the lives of people with heart disease.
“I love science and I love working with people,” says Brabeck, a native of St. Paul, Minnesota, who graduated from medical school at the University of Minnesota in 1976. “Choosing this profession was a no-brainer.” As a noninvasive clinical cardiologist in Monterey since 1996, Brabeck says the new heart program will create a one-stop heart shop that will be more convenient and also save lives. “This is going to raise the level of cardiac care for the people of the Monterey Peninsula.”
Dr. Rich Gerber
Gerber has been a cardiologist at Community Hospital for the past 10 years. He also treats patients at Salinas Valley Memorial Hospital where he’s an experienced heart cath lab doctor. “I was a psychology major in college, and I thought I’d become a psychiatrist when I went to medical school,” Gerber, 44, says.“ Instead, I felt that the greatest opportunity to make an impact in the care of patients was by going into cardiology.” A native of New York, Gerber graduated from Chicago Medical School in 1986 and conducted his fellowship at the University of California at Los Angeles Medical Center.
Dr. Richard Kanak
Kanak is medical director of the Intensive Care Unit at Community Hospital. He is part of a team of pulmonary and critical-care specialists at the hospital who will assist in caring for many of the heart patients following their procedures in the new cath lab and surgical center.
A Chicago native, Kanak, 45, graduated from medical school at Loyola University in Chicago in 1984. He served in the U.S. Navy from 1989 to 1993, traveling to Saudi Arabia and the Persian Gulf. He has 15 years’ experience as a lung specialist.
Dr. Soteria Karahalios
Karahalios is the medical director of Noninvasive (does not require sutures or cuts to the body) Cardiovascular Services at Community Hospital. She has been part of the team selecting the cardiovascular information system that will archive and manage all cardiovascular diagnostic and imaging studies. This system will allow doctors to review those studies and correlate them from anywhere in the hospital or off site via the Web.
A cardiologist with clinical and invasive cardiac experience, Karahalios graduated from the University of California San Francisco Medical School in 1976. She started her career working with heart patients in the early 1980s in private practice as an invasive cardiologist in Los Angeles, treating patients and working in several cath labs, including St. John’s Hospital in Santa Monica. A native of Greece, Dr. Karahalios, 53, grew up on the Monterey Peninsula.
Dr. Pir Shah
Shah has been named medical director of Community Hospital’s Catherization Laboratory. His medical career spans the globe from the Khyber Pass in Pakistan to Monterey. He received his medical education at Khyber Medical College and Stanford University. About twice a year, Shah returns to Pakistan to do charity work in the hospital near his hometown. He’s worked in the Monterey area since 1993. Shah, 49, an invasive clinical cardiologist, currently lives just a mile from Community Hospital but logs about 30,000 to 35,000 miles a year driving to other hospitals to find the technology needed to treat his patients. With the new heart program, Shah expects to drastically cut back on his mileage. “Now the buck stops here,” he says.
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Michael Barber, R.N., will never forget the first time he performed CPR. He was 19 years old and a brand-new paramedic when his ambulance responded to the call.
“It was Thanksgiving evening, there were 20 people all around the dinner table, and here was the father, the patriarch, dying of a heart attack,” Barber says. “That left an impression on me. I remember the faces in the room, the anguish. The man was only in his 50s.”
Even as Barber worked to save the man’s life, he knew the chances of survival were poor. Even when administered by an expert, CPR saves less than 7 percent of patients. “I wished that there was more we could do,” Barber says.
That was back in 1972. A lot has changed for Barber and the field of cardiac care since then.
Driven by the chance to save lives, Barber became a hospital orderly and then a registered nurse, eventually becoming a supervisor on a cardiac care ward.
“The American Heart Association in Fresno used to hold educational seminars for nurses. I always got a lot out of them, so I became a volunteer,” Barber says. “I worked on more and more of their fundraisers,
joined their board, and eventually was asked to chair it.”
Meanwhile, the dollars he helped raise for the association have translated into tangible improvements in heart disease prevention and treatment. “Safer cardiac catheters, defibrillators, angioplasty balloons, and stents — none of that would have happened without the American Heart Association,” he says.
In recognition of his years of work spreading the word about heart disease prevention, Barber received the Heart of Gold Award this year from the Fresno chapter of the American Heart Association.
After three decades of healthcare work in Fresno, this year Barber became director of Cardiovascular Services at Community Hospital.
“I’ve always loved the coast, and my wife and I and our two boys used to drive here whenever possible,” he says. “I’d often said that someday I’d like to work here, and when I heard of the position at Community Hospital, a wonderful institution, it was a dream come true.”
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