A needle and thread inside a cat's mouth

Going to an apartment to treat a ferocious cat with a needle and thread inside his mouth can send shivers down a vet's spine. It is like going to a lion's den. But Mr Hall said he could not put his cat inside a crate to bring him to the Surgery. So I had to make a house-call on a fine weekday evening. I drove to the Grand Hyatt in less than 15 minutes and such prompt attendance impressed Mr Hall. I parked outside the hotel after being given permission to do so as I told the valet I was treating Mr Hall's cat.

In the semi-darkened glowing lights of the lobby, I met my two assistants, Mr Aung and Mr Saw at the lobby. The receptionist in smart black jackets and well groomed ushered us into a lift and took us up to Mr Hall's apartment.

I knew what to do as I am an old vet and would finish the job in 20 minutes. But it would be best for my two assistants to get hands-on experience as they wanted to open their own practice in Myanmar next year. They are veterinarians if they practise in Myanmar but they are veterinary technicians or assistants when they work in Singapore.

PREPARATION FOR THE BATTLE
"What will you bring to this case?" I had phoned Mr Aung earlier. "Domitor and swabs to stop bleeding," he said. I packed my bag with Domitor, Antisedan, Xylazine, Ketamine, antibitoics, swabs, a pair of forceps, needles 21G and one-ml syringes. I forgot to pack 23G needles for use in the femoral vein injection as the cat has fine veins which bled in front of the Mrs Hall when Antisedan was injected IV using the bigger 21G needle. Experience is usually gathered after a case handled.

AT THE SCENE
Mr Aung is a hands-on man and he went for the cat. This cat was crouched tightly inside the master bathroom between the water closet and the wall. Mr Aung grabbed the scruff and got him out and placed him on the cat's white towel on the bed in the master bedroom. I had not briefed my assistants and was therefore surprised.

"It is best to prepare the sedative before catching the cat," I said to Mr Aung. "Look at the cat to estimate his weight and prepare the correct dose."

The cat was displeased and pawed Mr Aung vigorously. Mr Aung released him. The cat bounced off the bed and went under the master bed, exactly in the middle of the sanctuary. There was a moment of indecision as Mr and Mrs Hall and I did not know what to do.

"Maybe Mrs Hall should under the bed to get the cat out," I said like a General who bark orders from the safety of an army headquarters fall from the battle scene. Nobody moved.

"Let's lift up the bed," Mr Hall suggested intelligently. Mr Hall and my two assistants lifted up one end. I helped. It was surprisingly a very light bed but there were four of us. Mrs Hall looked on.

Being exposed, the cat sprang to hide behind the day curtains. The room has two sets of curtains. The day curtains are the translucent type. Mr Aung walked quickly towards the curtains to make friends with the cat. What he does normally is to talk to the cat and slowly let the cat (or dog) get used to the smell of his hand. The cat was ready to scratch him as he had scratched Mr Hall's hand a few times when Mr Hall tried to open the mouth to take out the needle.

ARMING THE TROOPS FOR BATTLE
"Prepare the sedative first," I said to Mr Aung. That would be what I would do before touching the cat. I estimated the cat to weigh 3 kg. Though he was adopted as a local cat, he certainly was bigger and fatter than the stray cats we see around the neighbourhood. Mr Aung got 0.1 ml Domitor and 0.1 ml Ketamine in one syringe and gave it to me. He realised that this cat would never accept an IV injection. IV injections at the Surgery could be done because the cat would be in foreign territory and would not be so ferocious usually. Here, the cat was on home ground.

FRONTLINE
Being a hands-on man, Mr Aung walked swiftly to the curtains and in one speedy grab, the cat's scruff was lifted up. He placed the cat on the white blanket on the master bed. I was ready and in less than one second, I had injected the cat's backside muscle with 0.2 ml IM of the combined sedative. Mr Aung let go of the cat.

UNDER-DOSED
It is always safe to under-dose a frightened cat. I knew the dose was insufficient. For the next 5 minutes, the cat ambled out of the master bedroom, dashed across the living cum dining room with the open concept kitchen and disappeared into Bedroom 2 at the other end of this apartment. Another 5 minutes passed. The cat was as fresh as a daisy.

REINFORCEMENTS
In a losing battle, the commander must call for reinforcements. "Give the cat Domitor IV," Mr Aung proposed catching the cat as he was one never afraid of getting cat scratches. "All three of us are veterans with cat scars on our hands" I had said to assure Mr Hall who must be wondering what was going on. The sedative seemed to be dud. A dud missile that fell and did not explode.

CAUTION
Soldiers could shock and awe in battle with more bombings to kill the enemies. But this is a cat that must be alive at the end of the house-call. "Better not to give another sedative," I advised Mr Aung. "The cat may react and die. Just wrap the cat inside a towel with his head sticking out. That would be safer. The cat would be sedated slightly by now. 15 minutes had passed." I asked Mr Saw to take the white towel and he went to the bedroom to get the cat for me. I could do everything myself but my assistants would never learn.

SUICIDE BOMBER ATTACK
Mr Aung went inside Bedroom 2 to risk his hands and got the cat by the scruff of the neck. Mr Hall and Mr Saw and possibly Mrs Hall were inside Bedroom 2. As the room was small, I stood outside the door to supervise. Like those consultants who talk but no action.

While Mr Aung was holding the cat for Mr Saw to wrap the towel around, the second cat, white with grey patches suddenly leapt up to claw either Mr Aung or the cat. I just could not believe this suicide bomber attack from the friendly troop. This attacking cat hissed and swung his paws widely. He leapt up and gravity pulled him down. From my point of view, he was attacking Mr Aung.

In cat attacks, it is wise not to interfere. Water hosing would be ideal but not inside the apartment. Mr Hall managed to get the attacker out of the room. He slinked outside the room and would not go away. He was just so furious. Was it the attention the other cat was getting? Mr Hall said to me: "This cat is very protective and was protecting me." Well, next time, no other cats should be present.
The next day, I noted that Mr Saw's left hand had two cat scratches too when we were taking blood from a dog. So, Mr Saw had suffered.

ACTION
After wrapping the cat in the towel, the cat seemed quiet. I said to Mr Saw: "Put the cat on this kitchen counter." I gave Mr Aung the forceps from my bag. He opened the cat's mouth. "There's the needle stuck in the hard palate!" he showed the culprit. I took some pictures with a zoom lens inappropriately. The zoom would not work at first until I stepped back further. Mr Aung took the needle out. A black thread with slimy saliva was attached to the end of the needle. I should have put the needle onto the tissue paper as Mr Hall seemed not too pleased when I placed it directly onto the kitchen counter. Mrs Hall took away the needle. I opened the cat's mouth to give a final check. "No injuries or ulcers," I said to Mr Hall.

ANTIDOTE
"Should give Antisedan," Mr Aung advised me. "Antisedan is an antidote," I said to Mr Hall. "The cat will wake up immediately. If Antisedan is not given, he would wake up fully over a few hours. Which do you prefer?"

"It is better that the cat be sedated for a while," Mr Hall said.

"There is a small risk that the cat may not wake up. A very small risk. An antisedan injection is an antidote that ensures that the cat's heart and lung systems are back to normal promptly."

The cat inside the towel hissed and hissed. Mr Hall agreed to the Antisedan injection. This was given via the cat's femoral vein at 0.1 ml IV. "Take the cat out of the towel and put him on the floor," I said to Mr Saw rather urgently. Mr Saw could not understand what I mean. In any case, he had no time to think. The cat looked up, assessed his situation well. The cat crawled out of the loosened towel, stood on the counter and in one spring, he leapt onto the floor and disappeared into the sanctuary of the master bedroom.

HAPPY ENDING
Everybody was happy that this cat was back to normal. Mr Hall asked me for my namecard as he was surprised that I was prompt in answering his house call. Mrs Hall would be more careful with her sewing needles and threads from now on.

CONCLUSION
Never give the frightened cat a second dose of sedatives as the cat may just die. This case took three times as long but the cat was alive and that was what every owner wants. It is best to treat such cases at the Surgery. Normally I don't even want to do it at the house as there are so many complications and surprises. Besides, it takes a longer time.

REVIEW
In this case, Xylazine 20 + Ketamine 100 at 0.1 ml + 0.4 ml respectively in one syringe IM would be more effective for this.