Specialist brings passion for hearts back to childhood home
November 29, 2013
The bubbles that filled the left side of the heart pictured on the screen in front of Dr. Kyle Ulveling were exactly what he was looking for.
The cardiologist was conducting a transesophageal echocardiogram, or TEE, during which a physician inserts a probe into a patient's esophagus to perform an ultrasound on the heart. Ulveling brought the procedure with him to St. Anthony Regional Hospital and Nursing Home four months ago.
Ulveling was at his element in teal scrubs and purple disposable gloves as he examined the patient's heart, at one moment teaching a new term and at the next admiring the "pretty" heart on the screen and the "beautiful" sound it made.
The patient had stroke symptoms that, in unusual cases, could be caused by a small hole in the heart that allows a blood clot to travel up to the brain. While using the ultrasound probe to observe the heart, Ulveling pumped saline bubbles to the right side of the heart, which would normally pop in the lungs unless a hole in the heart - called an atrial septal defect - allows them to travel to the left side of the heart, causing it to fill with bubbles and light up on the screen showing the heart's image. If the hole exists, it changes how the cardiologist would treat the stroke symptoms.
Two cardiac sonographers, Jamie Pelleymounter and Michelle Anderson, assisted Ulveling during the procedure. Comfortable with the two after several months of working with them, Ulveling joked with Pelleymounter about if she'd shown him the quickest way from his clinic to the area of the hospital where he would perform the TEE and agreed with her that the sight of newborn babies in the obstetric ward right outside the elevator was a nice stop on their route.
At one point during the procedure, Ulveling asked Anderson to zoom in on the image of the heart on the screen.
"Oh!" he said with a laugh as the image rapidly became larger. "That was a little too much. It kind of scared me. I kind of wanted to duck."
The three looked at various parts of the heart before performing the bubble study, which showed bubbles on both sides of the heart, indicating the atrial septal defect - a positive bubble study.
"Well, that was kind of fun," Ulveling said.
Walking back to the clinic, the sonographers reflected on the past few months working with the cardiologist, noting his enthusiasm during a procedure is common.
"He loves his heart," Pelleymounter said.
Becoming a cardiologist
Ulveling, 34, was born and raised in Breda and attended Kuemper Catholic High School.
He was involved in sports throughout school, playing Little League and coming to Carroll to play football. He also took to music, learning to play piano, guitar and cello - the latter because he couldn't figure out how to make a sound on a trumpet.
In high school, he played basketball and met a cheerleader, Onica, on a bus ride to an away game. Although boys and girls weren't allowed to share bus seats, they turned around to speak to each other during the ride.
"I had my one good game the entire year that night," Ulveling said with a laugh. "I was meant to be a doctor, not a basketball player."
The two dated and later married, and now have two sons - 8-year-old John, who goes by Jack, and 6-year-old James, who are in second grade and kindergarten at Kuemper Catholic Schools. Onica is a pharmacist at Children's Hospital and Medical Center in Omaha, Neb. Onica's parents, Steve and Jane Kock, work in banking and in the driver's license division of the Iowa Department of Transportation, respectively.
"It's like a nonstop football game at home," Ulveling joked about his sons. "They're like magnets - you can separate them by floors, and they'll seek each other out and then start wrestling down the stairs."
When Ulveling was his sons' age, he heard about medicine regularly. His mother, Sandy, was an emergency-room and operating-room nurse at St. Anthony for decades, and Ulveling grew up hearing about the hospital and shadowing Dr. Francis McCabe, a general surgeon at St. Anthony, when he was old enough.
"It was the first career I ever wanted," he said. "When I got into college, I knew that as long as they let me, I was going to do medicine as a career."
Ulveling completed a bachelor's degree in biology and a medical degree from Creighton University before completing a residency and cardiac fellowship there. He also completed a year of cardiovascular research at the University of Nebraska Medical Center.
It was that year of research, on top of a cardiothoracic surgery rotation, that made Ulveling decide to work with the heart.
"I spent two months getting there at 5 in the morning and going home at 7 at night but doing extremely cool things every single day," he said. "So I would say probably that time in the OR, doing cardiothoracic surgery, was when I knew - I knew I didn't want to be a cardiothoracic surgeon, but I knew I wanted to do cardiology."
Unlike surgery, which - ideally - has the patient leaving the hospital and never seeing the surgeon again, Ulveling said, his field allows him to develop relationships with patients.
"Cardiology actually gave me the privilege of being able to do both - going into the hospital, having a very sick patient in the intensive care unit, doing a procedure on them, but then also getting to follow up with them when they get better and getting to help prevent another event and seeing them decades later," he said.
He recalled one of the first patients he had while working at a clinic in Ottawa, Iowa - a farmer who bought new jeans and a T-shirt with a funny saying on it because he was embarrassed to wear his farm clothes to visit the doctor.
"I thought, that doesn't happen at big urban centers, where the patients care enough about their relationships with their doctors to want to look presentable in the clinic," Ulveling said. "And that was when I said, 'You know what? I definitely could go back to Carroll, and I could work in a smaller community again, where you have that rapport with patients."
Returning to Carroll
Ulveling, whose dad, Jim, is retired director of the Carroll County Recycling Center, is the first full-time cardiologist to be based in Carroll for many years. In the past, Iowa Heart Center physicians would come to Carroll from other areas to provide medical services.
"Carroll is unique for this area because it's got a ridiculously strong hospital system and support from the community," he said. "The primary docs in town ... actually like taking care of their own patients and practicing medicine, where some of the smaller-town hospitals in the region, the patients go there to the ER and then get transferred out to a larger center. I didn't want to go to a place that did that. I wanted to be able to take care of the patients the next day also and not just see them in the ER and say, 'Yeah, you need to go somewhere else.'"
Ulveling typically has a morning and afternoon clinic, spends time making rounds at the hospital and sees new consults at the hospital on a triage basis.
"If it's a very sick patient, I apologize to my patients in the clinic, and I go over there right away," he said. "If it's a routine patient, where they're going to stay in the hospital overnight and I just need to see them before I leave, I either see them over the noon hour, or I see them as soon as the clinic is done."
He estimated two-thirds of the patients he currently sees are outpatients, and one-third are inpatients.
Four Tuesdays a month, Ulveling also goes to Audubon and Manning to see patients in the hospitals there and provide outpatient clinic care.
In addition to TEEs, Ulveling performs other procedures at the hospital, including electrocardiograms, stress tests and cardioversions, which use electricity to reset a heart that has an abnormal rhythm.
The area is lucky to have Ulveling, said Ed Smith, St. Anthony's president and CEO.
"He came to us with outstanding credentials," Smith said. "He has a wonderful bedside manner, and the fact that he and his wife are both from the Carroll area makes it a perfect fit."
Ulveling said he's seen many instances of young professionals who grew up around Carroll returning to work and raise their families.
"Lawyers can practice anywhere. Dentists can practice anywhere. Physicians can practice anywhere. People can run a business wherever there's a demand," he said. "But people are choosing, willfully saying, 'I want to come back to Carroll to live and raise my kids,' which is a huge testament to the community."