Mongolia Update #6

Sunday, April 25
So today we went to church with one of the missionary families here, the Heiseys. They are from Pennsylvania. Before moving to Mongolia, Leon worked as an engineer for Hershey while Heather was a small animal veterinarian. They have 3 children Sarah (11 years old), Jonathan (9 years old), and Lydia (7 years old). Sarah and Lydia were adopted as babies from China and Jonathan is their natural child. Karen also goes to this church. The church could not afford to pay for the heating and so the church service was the coldest one I have ever been to (we were blowing smoke)! You should have seen me. I was bundled up like an Eskimo, and let me just tell you, it is an act of fate to turn pages in your Bible with thick gloves on. However, I was not going take them off and risk getting frost-bitten!
After church we decided that it was way too cold to walk back to the Heiseys and so we all 9 piled into a taxi. Yes, that means 3 in front and 6 in back. One of the funniest things on the ride home was Jonathan and Sarah were discussing where they were in regards to Bible reading (they were in the life of David) when Lydia pipes up from the front seat and says, “Oh yeah, I am all the way to where Jesus wose from the gwave!” (She says her r’s like w’s.)
Once back at their house we ate a light lunch and then we played games. They received a Wii for Christmas and Lydia had a fun time creating a Mi for each one of us. She analyzed our face shape, hair color, eyebrow shape and she even added a mole on the right side of my face! We played some different board games and some that Lydia made up on her own. I don’t know if you have figured it out, but Lydia is quite the character! It was so nice to spend time with a family and have a little American food!

Fun Fact of the Day: Lake Khuvsugul in Mongolia is the second largest fresh water lake in the world.
Mongolian Word of the Day: teme—means “camel”

Monday, April 26
So today was a super busy day at the clinic. I worked on a blocked cat that had been in the previous Friday. He had stayed over night and then was sent home over the weekend with a urinary catheter. Well, he ended up pulling it out and came back in this morning and his abdomen was so taught. I passed a urinary catheter again and drained 150 mls off of his bladder! (For you non-vet people, that is a lot for a kitty cat!) The computer that we use to develop the radiographs is down and so we cannot take one in order to see if he has stones (yes, I do know that struvite stones will not show up on x-ray). So until we can get that up we will keep the u-cath in, put him on IV fluids, antibiotics and an anti-inflammatory.
Probably the most bizarre case of the day is a German Shepherd male dog named Roxy. He came in supposedly for 10 days of anorexia and diarrhea. Karen decided that an e-tube would be advantageous in this case and they worked very hard trying to get that placed. After we gave him the only injectable pain medication we had (morphine) and guess what happened next??? He vomited up a large amount of undigested kibble, potato and onion! So evidently he had been eating. Then he had a blow out of watery diarrhea complete with parasites. While he was under for the e-tube placement, we were palpating his abdomen and found what felt like a sausage in the mid-abdomen. We were very worried about an intussusception (where part of the intestine folds in on itself) and because we did not have any sort of imaging available and his color was so poor, we decided that it was better to open him up for an emergency exploratory surgery after dinner. We ate a quick dinner and then came back to the clinic for what we thought was likely to be a small intestine resection (removal) and anastamosis (reconnecting the ends of intestine).
Meg and I were the surgeons and Kellie and Karen were the anesthesiologists. Meg and I opened him up and the strangest thing happened. There was absolutely no small intestine present in the abdomen. The liver was completely displaced to the left side. The right kidney was pendulous within the abdominal cavity (normally it is tight up against the body wall). This was our supposed “intussusception”. When trying to figure out what was going on, we realized there was a hole in the diaphragm and all of the small intestine plus the pancreas were located in the thorax (chest)! We were dealing with a congenital abdominal hernia which was NOT on our differential list!!!!! If we could have taken a radiograph before surgery, it likely would have been! Meg and I removed the intestine from the chest while Kellie breathed for Roxy (when you have a hole into to the thorax it causes the lungs to collapse). There was a 4” hole running from right next to the AORTA to about midway down the right ribs. We needed an extra set of hands in order to keep the organs out of the way and the incision site open so we stole Karen away and she scrubbed in. Kellie was now the only one not sterile. She was quite the trooper dealing with all of our “breathe for him”, “don’t breathe for him”, “the intestines are too dry and need some saline”, “we need more gauze”, etc. At one point I knocked a bowl filled with blood off the table and it splattered all over the wall making it look like some crime scene. We finally got the hernia closed and then we placed the organs back in the abdomen and sewed him up. By the time we got everything cleaned up and Roxy recovering it was nearly 2 a.m. When we were leaving the clinic to walk back to our apartments, there was a blanket of snow on the ground—the perfect strange ending to a very strange day.

Fun Fact of the Day: Mongolians do not particularly like the Chinese.
Mongolian Word of the Day: mere (pronounced merd)—means “horse”