3943. 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. "I can't get my cat into the carrier," Mr Hall said when I requested him to the Surgery. So I had to make a house-call on this fine weekday evening.

I drove to the Grand Hyatt, Singapore in less than 15 minutes and such prompt attendance impressed Mr Hall. I presumed his vet was not available. I saved time as I was allowed to park outside the hotel entrance as I told the valet I was going to treat Mr Hall's cat and handed him my car's key.

In the semi-darkened glowing lights of the lobby, I met my two assistants, Mr Aung and Mr Saw at the lobby. Mr Saw was off-duty but he did not mind attending to this emergency.  The hotel receptionist, dressed in smart black jackets and well groomed ushered us into a lift, pressed the lift button 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 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, antibiotics, 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. I envisaged that this case would be full of surprises and dangers but since I could not get the owner to bring the cat to the Surgery, I had to make a house-call reluctantly.

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 DANGERS
Being a hands-on man, Mr Aung never hesitate from feline dangers. He walked on his tip toes and squatted swiftly in front of the day curtains. In one speedy grab, his right hand lifted the cat's scruff. He placed the cat on the white blanket on the master bed. I was ready with my weapon (syringe) 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. Antisedan injection 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. Most important, the cat survived an anaesthetic.

Mr Hall asked me for my name card 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.

RE-ORGANISATION
After a battle, the soldiers will re-group and review. In my case, I said to Mr Aung and Mr Saw that Xylazine 20 + Ketamine 100 @ 0.1 ml + 0.4 ml respectively in one syringe IM would be more effective for this <3kg cat as a sedative compared to Domitor 0.1ml + Ketamine 0.1 ml IM. There are many ways to sedate a cat and since Domitor was chosen and it was one of the recommended sedatives, I had to respond to the challenges involved when the cat was full of beans after the Domitor injection and ambled off. Mr Hall must be thinking that the vet was a dud.

We all learn from hands-on experiences and real situations. All theories about anaesthetics are excellent but the realities of the situation can be so much different and in this case, quite painful for Mr Aung and Mr Saw as they were scratched and attacked by the suicide bomber cat. 

A cat in pain and fright is as dangerous as a lion if you had been present in Mr Hall's apartment when I was doing the house-call. I still can't believe that there was a suicide-bomber cat digging his claws into Mr Aung's hands and fighting off Mr Saw's intervention. If the case was handled at the Surgery, it would have been much more safer for the feline patient and the vet assistants!