Engholdt Party

Well, my day off was fun...I traveled down to the grand town on Pardeeville WI for a little Engholdt get together. Many of the Engholdt's showed up...it was really gret to see everyone that I have not seen in such a long time...and being there made me think about a lot of things...no matter how terrible life may seem, it is nice to know that family is always there on your side! Here is who was all there: Don, Jen, and the kids; Karen; Uncle Bud; Grandpa Dick and Betty; Brian and his girlfriend Jen; Jeff and his 3kids...and then Kev and I. Kev grilled burgers, brats, chicken...and then of course there was a ton of other snacky foods and salads as well. It was a great meal, and like I said really nice to see everyone. For me it was nice to get out of Milwaukee and to surround myself with others who really care and are happy to see me. The house looks really great..Kevin has his big 55gallon fish tank set up which looks really nice, and he built a pond in the back yard that looks really nice. He has a little kitty friend as well, Callie (a beautiful little calico cat) is what he calls her, she is feral to us all but friendly with him...I tell him Apache and Webbie would be jealous if she knew...but I won't tell them right now that they have been replaced...that is the worst thing in the world you can tell someone and I would never want to inflict that type of pain!! Work...My Friday shift was amazingly quiet...yes I am definitely looking forward to things slowing down over the winter time!!! I had a dog..vomiting, tachycardic, dehydrated, painful abdomen, febrile, whopping heart murmur that was brand new (hmmm...anemia? you might think but surprisingly no)...ran full bloodwork, thoracic radiographs, placed nasogastric tube, scheduled abdominal ultrasound and echocardiogram. Right away gave pain meds and anzemet (dolasetron..anti-emetic), measured blood pressure (90mmHg with HR-160bpm)...uh oh - bolused 300mls of fluids (P-lyte) and rechecked...BP 40mmHg and HR 180bpm...oh no - bolused hetastarch..brought BP up to 60 - uh oh...gave another hetastarch bolus and 300ml p-lyte bolus and started on CRI of Hetastarch. BP stayed pretty stable then at 120mmHg and heartrate at 130bpm. Ok, got that crisis taken care of. Thoracic rads showed right heart enlargement and mild interstitial pattern...not too bad, however part of abdomen I could see on those rads seemed a little hazy and loss of detail. Uh-oh. Bloodwork results - CBC shows definite inflammation with a very high mature white cell count and increasing bands. Chemistry panel shows severe elevations in liver enzymes and mild renal elevations (these prob pre-renal due to dehydration). Then comes our acid base: hypochloremic metabolic alkalosis with compensatory respiratory acidosis.....oh crap...this is classic classic classic bloodwork for pyloric outflow obstruction (obstruction in stomach not allowing emptying into intestines). Abdominal ultrasound shows mass in pylorus of stomach (that explains the obstruction), mass in the liver (explains elevated liver enzymes), and free abdominal fluid that was tapped and was bloody with a PCV/TS of 24/4.5 ---uh oh!! Dog is 14 years old, very arthritic, extremely sick and laterally recumbent...I know owner will not want surgery but that is all there is...a call to owner confirms what I thought...humane euthanasia it is. Would have been a cool surgery but she would probably have needed to have duodenum reattached to stomach and in papers dogs with this procedure performed do very poorly anyhow...so a good choice to euthanize I feel. My next case? A torn dew claw...sedated...ripped it off with hemostats, wrapped foot, and checkd a CBC because dog was febrile--but was normal so gave SQ fluids to help with the fever. My next case...a Rottweiler with a hard swelling in the tarsal region (uh-oh...if you are thinking osteosarcoma so am I)...however in meantime dog is laterally recumbent, cannot walk, has a heart rate of 210bpm which is severely tachycardic...severely dehydrated with white mucous membranes. I talk to owners and say that first thing we would need to do is some resuscitation because dog is in shock...this alone is $400-600...owners need to call their mom first, I ask if I can at least administer pain meds...they agree to that. Oh I forgot to mention, this dog is not vaccinated and despite being on the verge of death...tries to swallow my arm in the process of my physical exam...muzzle it is. Talk more with owners and osteosarcoma (a common cancer of bone seen in this breed) was already diagnosed at rDVM 2 weeks ago...they did not want biopsy or amputation at that time...decided to go with Rimadyl, even though dog could not walk... and let me tell you...this is a painful cancer...Rimadyl ain't gonna control the pain...but whatever...dog is in my care now so lets see what we can do. Mom finally arrives and I talk with owners about the cancer both osteosarcoma as well as hemangiosarcoma (as mucous membranes are white). I say we first need to stabilize the dog and pull him out of shock before we can start with any diagnostics. I say I am afraid that the cancer has taken over and that we may spend a lot of time and money on trying to stabilize and they may still walk out of the clinic without a dog. They are realistic, I talk with them about his declining quality of life...after about an hour they are finally all in tears and have decided to humanely euthanize....a good choice in this dog...he was suffereing and it would likely be very hard for us to make him comfortable if they are not willing to amputate, which they were not. So I euthanized him with all of them crying...very sad...I had to keep thinking of how sick the dog was though and that this was the best choice for him. I saw a recheck of one of my other patients from last week -- a splenectomy patient with pancreatitis...removed her j-tube (tube in intestine) today and rechecked liver values...she is doing great at home...the man is very nice...love when they come in...she is a great patient and I am really happy she is doing well. And the best thing was that after her 2 week hospital stay she was just as happy to see me and to follow me back into the treatment area...what a great patient!!! And that was my night...I was done by 11:30p but stayed until 1a to help the other clinician...however that is still the earliest time I have been out. I have to say, I was in a really sad and depressed mood going to work that day...didn't want to do anything but curl up in bed and lay there....so the slow night and getting out early really helped alot. Am I in better spirits now? I don't know. I hate the internship...dread going to work...hate that it causes me to lose touch with those I really care about... But, I am strong and I do know that life goes on. When one door closes it is usually because another is going to open up. I refuse to cry over spilled milk. It is only a year...then I can move on with my life... Please don't any more of you walk out on me though...i need your support, I need your comfort, I need to hear your voice when I am sad and need an ear to listen to...I promise to keep in touch...I promise not to lose that "Ang-ness"...and honestly I do see that little light at the end of the tunnel so please walk towards it with me...this will all be over soon and I can live normal lives with all of you...I NEED YOU FOR SUPPORT!!!! This is a very rough time for me right now....help me to smile... PS--dont forget to scroll down for some pics