It took an interventional radiologist from the Hospital of the University of Pennsylvania and a veterinary surgeon in Conshohocken to perform a first-of-its-kind procedure on a lovable 2-year-old pit bull to correct a rare condition that is also found in humans.
In August, Victoria Bary noticed something off about Jefferson, a rescue from Providence Animal Center in Delaware County, Pa..
"His stomach looked weird," said Bary, now of Williamstown, N.J.
Worried that Jefferson have bloated or twisted intestines, Bary and her fiance Michael Mroczek took him their veterinarian where fluid was found in Jefferson's chest cavity. After tests, they were told that Jefferson had chylothorax, a rare chronic condition that is caused when fluid from the lymphatic system leaks into the pleural cavity, the space between the chest wall and the lungs.
The lymphatic system is network of vessels and lymph nodes that run throughout the body and are part of our immune system. It absorbs and transports chyle, a milky liquid made up of fat and lymph fluid from the digestive system. That liquid was collecting in Jefferson's chest.
When the fluid builds up, the pressure can cause breathing problem _ something Jefferson was beginning to experience. The couple consulted with Ron Ben-Amotz, a veterinary surgeon with Veterinary Specialty and Emergency Center (in South Philadelphia. Jefferson would need expensive and invasive surgery to correct the problem, Bary was told.
The couple was trying to figure out how to pay for their upcoming wedding and honeymoon, and the $10,000 lifesaving surgery when Ben-Amotz called back with an interesting proposal. Maxim Itkin, an interventional radiologist at the Hospital of the University of Pennsylvania, who performs a similar, less invasive procedure on his human patients, would help Jefferson.
The condition can be congenital, caused by an injury or occur spontaneously, Itkin said.
With Itkin's help, the recovery would be much faster and cut the cost in half, Ben Amotz said.
"I was in a bit of a shock honestly," she said. "How often does someone get a world-renowned doctor from Penn to help your dog?"
As it turns out, Ben-Amotz and Itkin are good friends.
Ben-Amotz knew Itkin had corrected Jefferson's condition in adults and babies. Itkin's patients travel to Philadelphia from around the world for the procedure, in which he inserts a catheter through the abdomen into the main lymphatic duct to the area of the leak, and closes it with a medical-grade glue.
But with canine patients, the veterinarian performs a 6-hour costly operation, in which he must open the chest cavity of the dog to fix the leak.
Ben-Amotz called Itkin to "see if (Jefferson) was a good candidate" for the minimally invasive procedure. The two talked about the dog's condition while watching their kids play football in the backyard and then again over Thanksgiving dinner a few weeks later, he said.
Ben-Amotz said he had already removed fluid from Jefferson four times _ once nearly half a gallon.
Itkin was in. It is not his first veterinary case. He has also performed a tumor ablation procedure on a rabbit, he said.
Collaboration between physicians and veterinarians has been going on for at least a century in the Philadelphia area.
Dentists have fixed broken teeth in large zoo animals, oncologists weigh in on animal cancer, and veterinarians have helped poison control centers track down anti-venom to treat snake bites. In 2017, a Thomas Jefferson University Hospital obstetrician helped deliver a baby gorilla at the Philadelphia Zoo.
On Nov. 28, the two doctors met at VSEC Conshohocken to perform the procedure.
If it worked, it would be a game changer for veterinarians who before used invasive surgery to correct the problem, said Ben-Amotz.
The small operating room was packed not only with equipment but more than a dozen interns, residents, technicians, staff and other veterinarians who came to watch.
"I've never seen an OR this crowded before," Ben-Amotz said.
The plan was to thread a guided wire and catheter through Jefferson's groin into the main lymphatic duct up to the area of the leak. A small platinum coil would then be maneuvered into position to inject medical-grade glue, similar to the product that is used to close small wounds.
Itkin maneuvered an ultrasound probe across Jefferson's groin to guide him as he threaded the wire into the lymph node.
On a nearby monitor, the doctors tracked the progress of the wire using fluoroscopy, a type of imaging which allows the doctors to see an X-ray in real time. At times, the only sound in the room was the steady beep from the heart monitors attached to Jefferson.
"We punctured the sternum and we're in the thoracic duct," Ben-Amotz said.
There was some last-minute improvising. The end of a bulb syringe was cut in half to use as a small sterile mixing bowl for the glue.
When the glue was in, Itkin pulled out the wires. The procedure over in less than an hour.
Jefferson did very well overnight and was ready to go home by the next morning, Ben-Amotz said.
"He almost escaped from the cage. He was ready to go," he said. "It was like we didn't do anything."
As a precaution, a special pleural port was placed under the dog's skin to make it easier to use if fluid does collect. It can be accessed with a needle and without anesthesia. In a few weeks, if there are no complications, it will be removed, Ben-Amotz said.
Jefferson will have to take it easy until his next appointment in about 10 days.
"I think he will recover very quickly from this," Ben-Amotz said.
