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New Bolton Center Kennett Square, PA
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Ryan Hospital Philadelphia, PA

Specialized Surgery Gets Goliath Back to the Farm

By: Katherine Unger Baillie Date: Jan 8, 2019
Goliath, at left, with Hershey on the Jefferson farm.

Steve and Leah Jefferson were looking for a way to protect their 38 chickens from roving coyotes on their 10-acre farm in Martinsburg, West Virginia. Goliath was their answer. The Great Pyrenees joined the family in the spring of 2017, when he was just eight weeks old. The Jeffersons quickly realized the “flock dog” would be spending as much time indoors as out.

“I fell in love with him,” Leah said of Goliath, who carefully kept tabs on the chickens during the day, then retired to a comfortable bed in his owners’ room each night.

From the beginning, however, Jefferson noticed that Goliath wasn’t putting on as much weight as he should. She tried different foods but the problem persisted. One day while out in the fields, he had a seizure and collapsed.

“We’d had so much rain I thought maybe he ate a mushroom,” Jefferson said. He revived, but later that evening acted aggressively toward one of the family’s other dogs, and seemed to be walking around in a daze. After repeated trips to veterinary emergency rooms over the next two days, she finally took Goliath to The Life Centre, a veterinary practice in Leesburg. There, Dr. Robert Justin diagnosed the dog with an intrahepatic portosystemic shunt, an abnormal blood vessel in the liver.

Normally, a single vein carries the body’s blood to the liver, which acts as a detoxifying filter. But Goliath was born with an extra vessel that allowed some of his blood to skirt around this filter. His dazed look, stunted growth, and odd behavior arose due to a combination of decreased blood flow to the liver and unfiltered blood reaching the brain and other organs.

Justin knew of a specialized procedure that could correct the shunt, called percutaneous transvenous coil embolization. Only a few veterinarians around the country perform it. One of them is Dr. Andreanne Cleroux, an interventional radiologist at Penn Vet’s Ryan Hospital.

“The goal of the procedure is to progressively block the blood flow through that abnormal vessel and restore more normal blood flow through the liver,” said Cleroux. “What’s nice about the procedure is that everything is done through a five-millimeter incision along the neck to allow access to the jugular vein, which is how we access the vascular system during the surgery, so recovery is typically really fast.”

During the procedure, which was adapted from human medicine, Cleroux and colleagues worked through the vena cava, the largest vein in the body, to access Goliath’s shunt using a wire and catheters. With a goal of progressively blocking the blood flow through the abnormal vessel, they placed a stent in the vena cava where it met the vessel, then added 18 coils, one at a time, to physically impede blood flow. Tiny fibers on the coils also act to encourage blood clotting, again with an aim of diminishing the amount of blood that bypasses the liver.

This image shows the mesh stent at bottom and the 18 coils in the abnormal vessel.

“Goliath did great during the procedure,” Cleroux said. “His recovery was quick and uneventful. And from what we hear from his owner, it’s like he’s a different dog now.”

By every measure, Goliath seems to have responded well since the November surgery. He’s put on weight and renewed his friendships with the family’s other dogs.

“Within two days you could tell the difference,” Jefferson said. “It was amazing. We were supposed to be keeping him quiet to recover but he would do this thing where he would just leap into the air with all fours, it’s hysterical.”

He’s also cheerfully returned to his flock guarding duties.

“The other night, about three weeks after the operation,” said Jefferson, “I heard coyotes right by the house and he started barking, so I opened the door and let him out. Steve and I were standing there in our pajamas in the frosty grass and Goliath took off all the way across the field, chased them away and came back inside, so happy with himself.”

Goliath, at left, with Hope and Hershey.

About Penn Vet

Ranked among the top ten veterinary schools worldwide, the University of Pennsylvania School of Veterinary Medicine (Penn Vet) is a global leader in veterinary education, research, and clinical care. Founded in 1884, Penn Vet is the first veterinary school developed in association with a medical school. The school is a proud member of the One Health initiative, linking human, animal, and environmental health.

Penn Vet serves a diverse population of animals at its two campuses, which include extensive diagnostic and research laboratories. Ryan Hospital in Philadelphia provides care for dogs, cats, and other domestic/companion animals, handling more than 34,600 patient visits a year. New Bolton Center, Penn Vet’s large-animal hospital on nearly 700 acres in rural Kennett Square, PA, cares for horses and livestock/farm animals. The hospital handles more than 6,200 patient visits a year, while our Field Services have gone out on more than 5,500 farm service calls, treating some 18,700 patients at local farms. In addition, New Bolton Center’s campus includes a swine center, working dairy, and poultry unit that provide valuable research for the agriculture industry.