HUP Pulmonologist
Goes Down the Blowhole
 

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Andrew Haas GM’05 doesn’t usually get nervous before he slides a balloon down a patient’s throat and inflates it inside her bronchial passage. It’s all part of an airway-expanding procedure that he’s done many times as a pulmonologist at the Hospital of the University of Pennsylvania.

But recently a patient named Sarah had Haas feeling anxious. Her trachea had narrowed and she’d been having trouble breathing. Sarah is 29 years old and a big girl—well over six feet, and about 365 pounds. She has two daughters of her own, and provides therapy for children with developmental, emotional, and physical difficulties. In spite of her altruistic bent, Sarah’s close friends describe her as a “princess” who “knows what she wants, when she wants it, and how to get it.” Inside her Key Largo, Florida, home, she’s used to being pampered.

None of that made Haas nervous, though. He was nervous because Sarah is a dolphin.

Before Sarah, Haas had never performed the balloon catheterization procedure on a dolphin. No one had. Yet there he was, at the Island Dolphin Care facility on May 11, stuffed into a room with 20 other people and one large ocean-going mammal.

At this point in recounting the story, Haas backs up. He has some explaining to do—specifically, how a doctor from Philadelphia, who’d only worked with humans, wound up performing surgery on a dolphin in Florida.

“When my boss first got the call, I said, ‘Do you think someone’s pulling a prank on you?’” the assistant professor of medicine says with a chuckle. “But these types of problems in the airways are not commonly seen in animals. As a result, there’s really nobody in the animal medical world who has experience dealing with them. The next best thing is to jump to people who have experience dealing with them in humans.”

Jeffrey Solomon M’94 WG’02 was brought in first. His company, Infiniti Medical, makes specialized medical products for animals and was charged with creating the devices for Sarah’s surgery. A former Penn radiologist, Solomon says he contacted the HUP doctors because “I know those guys are phenomenal—and I knew they wouldn’t think I was crazy when I told them what I needed. There’s a spirit of collaboration at Penn that’s shared among all the schools, and a desire to solve problems. People at Penn are truly interested in doing things that have never been done before.”

With Haas, Solomon and several animal specialists on board, the planning for Sarah’s surgery began in March.

“When we’re doing these procedures at Penn, we’re in a fully stocked hospital,” Haas says. “All the equipment we could possibly need is right at hand. At [Island Dolphin Care], we were going into a room where they have nothing. We had to conceptualize everything we’d need, and go through this procedure over and over in our minds and plan for any complications that might arise. The list of equipment just kept getting longer and longer.”

Two months later, Haas was in Florida with Solomon and Penn pulmonology fellow Kassem Harris, plus two veterinarians, an anesthesiologist, and a radiologist who all specialize in marine mammals. They fed Sarah sedative-spiked Jell-O and brought her out of the water on a giant sling. She lay on a padded platform, surrounded by eight dolphin trainers who made sure that her slippery skin and tiny eyes stayed damp—a necessity for dolphins.

Then the surgery began. It was a lot like the balloon procedure Haas does on humans, only with a very different entry point. Whereas human lungs can be accessed through the mouth or nose, in dolphins, “the blowhole is what opens up to their respiratory tract,” Haas says. “But once you get into the airway and forget that you’re putting all this through a blowhole, it’s just like doing a procedure on a human.”

Before Haas used custom-built balloons to expand Sarah’s airway, the dolphin’s breathing was severely impaired. “Picture trying to run a race while breathing through a straw,” Solomon says. “That’s what it probably felt like for her.”

After the surgery, Sarah’s breathing improved to 80 percent of normal—and Haas earned a new fan.

“When you come into the facility, there’s a lagoon where the dolphins swim,” he says. “They’re smart, curious animals, and the day we got there, they all popped their heads out of the water, looked at us, and then swam away after a few seconds. After we did the procedure, we walked over to the lagoon and Sarah came over, popped her head up and looked at us. Then we walked around the outside of the lagoon and she followed me with her head out of the water, looking at me the entire way around.

“Later, when we were sitting with the trainers, she kept swimming over to me and putting her head right next to my leg,” he adds. “She clearly had some recognition and connection to me, but it’s like my wife said: ‘You don’t really know if she’s happy because you helped her—or if she’s pissed off because you went into her airway and it hurt.’”

Whatever the case, Sarah is now back to her day job as a therapy dolphin and “doing really well,” according to Deena Hogland, Sarah’s owner and the founder of Island Dolphin Care. Children with a variety of difficulties can once again “light up” from spending time with Sarah and, “she seems to have a lot more energy and her attitude is really good,” Hogland adds.

There is a chance she may eventually need another procedure. In humans, balloon catheterization doesn’t always permanently fix the problem, so the same may be true for dolphins. Or perhaps Sarah’s daughter, who shows signs of the same breathing issue, will be next on the operating table. Either way, Haas says he wouldn’t hesitate to offer his aid.

“I told them, if and when she should ever start to have a problem, I’m in,” he says. “It was an incredible experience.”

—Molly Petrilla C’06

 

©2013 The Pennsylvania Gazette
Last modified 07/01/13