by JULIAN EARL
As soon as the other driver saw my appearance, his jaw dropped, his knees went weak, and he exclaimed, ‘Oh No! Oh No! What have I done? Are you all right? Are you all right?’
Resisting the temptation to milk the situation, I briefly explained why I looked like a mass murderer, and he was fine – although he did offer to pay for my door mirror there and then.
The student that I had accompanying me on this particular day, Liz M, still remembers the shock that we all received from this near-disastrous collision. I do hope that she learnt about de-horning cows as well. We were lucky to experience a near miss. Some of my patients haven’t been so lucky.
Occasionally, animals experience things you never would expect them to survive. One cat I treated was remarkable. Whilst dogs can learn to sit and wait at the side of a road for cars to pass by before they cross, cats tend to have the idea that if they shut their eyes, sprint and hope for the best, they will be successful at crossing roads. This, of course, is nonsense and means many, many cats are hit by vehicles with a fatal outcome. A poor little tabby cat came to the surgery having lost an altercation with a car. She was clearly in serious trouble, having difficulty with breathing, visible skin wounds, an injured back leg, and had physically collapsed. Examination revealed an open wound just in front of a back leg, a dislocated hip, but also abdominal contents, fat and intestine protruding out of an abdominal wound that was approximately eight centimetres across. After emergency supportive treatment, and a period of stabilisation, we anaesthetised her to deal with her abdominal wound. Appropriate cleaning and exploratory surgery of the wound revealed a mass of necrotic (dead or dying) muscle and fat protruding through the hole in the body wall. I removed this tissue and continued investigating. There was remarkably little blood but, alarmingly, I found one kidney floating free in the abdomen. Considering the kidney has a very major blood vessel – the renal artery – for its supply, the absence of blood, clotted or otherwise, was astonishing. In addition, the cat’s spleen, also normally having a very rich blood supply, had been torn in two. The loose organs, the kidney and fragments of spleen were easily removed and the hole in her body wall repaired. However, this cat should not have been alive, never mind able to survive a general anaesthetic. But survive she did, and a few weeks later required orthopaedic surgery to treat her dislocated hip, the least life-threatening of her injuries. It would have been a major mistake to have euthanased her after the serious accident. Luckily we gave her a chance, which she repaid by recovering well and living for years afterward. Clearly some surprises are pleasant.
Regarding the absence of significant internal bleeding despite the massive trauma, as found in this cat, my logical explanation is that in the wild, trauma generally causes tearing of tissues rather than neat cuts like a razor cut, and blood clotting has evolved well to cope with tearing and trauma. Out in the wild, there are no sharp scalpels, razors nor glass to cause cuts, so evolution has dictated that bleeding from tearing wounds, i.e. non-slicing wounds, stops rapidly, but smooth wound edges are effectively unnatural, resulting in clotting being less efficient for those types of cuts. Even bites by predators involve some crushing and tearing, so clotting works well following such trauma. A road accident generally involves tearing and crushing injuries, inducing rapid clotting as nature intended.
Dogs can be lucky as well. I once took an X-ray of a Labrador that had got his head in the way of a shotgun blast and had about a hundred pellets scattered around his skull. The good luck is that he survived the shooting, but I have often wondered how close this gun was to have caused all of the pellets to be close together, and how the dog survived the shooting in the first instance.
A second case that was unexplained and even more saddening was the poor cat presenting late on a Saturday night with multiple head wounds. In fact, on X-rays this poor cat had seven screws embedded in her head. The screws were embedded so deeply, that I had to unscrew them from parts of the skull in order to extract them. Any surgeons reading this need to be told that they were not stainless steel orthopaedic screws but appeared to be small woodworking screws. I can only imagine that they were perhaps fired out of a powerful catapult and had been embedded for some time. This cat was also okay after their removal, and incredibly, her eyes were safe and untouched.
One cat I saw had done what we now know quite a few have done and fallen from an upper floor of a multi-storey block of flats – the seventh floor in this case. Although the cat wasn’t injured at all, not even limping, the owners had brought the cat in for attention, thinking that there must be some sort of injury. But no, the cat was fine, not a mark or a bruise at all.
Sometimes one sees neglected cases that require some explanation. For example, I attended to an eighteen-month-old Border Collie on a farm that had been chained up as a puppy and kept there. Of course, the puppy grew but the chain didn’t and, at the time of presentation to me, the chain had cut in so deeply and for so long that the skin was now growing back over the top of the chain. The only option was to surgically remove the chain. The chain was successfully removed; the wound repaired, and for the rest of his days, the dog went round with the huge scar to boast about to his friends because it made him look as though he had received a head transplant. The farmer was suitably embarrassed by his inadvertent neglect but ultimately the dog was fine.
Burns are an occasional cause of trauma in animals. Often it is puppies or kittens that have tripped somebody who happens to be carrying hot liquids, or sometimes puppies or kittens have fallen into a bath of hot water and been unable to climb out. Fire is the obvious cause, but there can also be friction burns – these are really deep abrasive wounds. I was called out late on a Saturday night to a barn fire on a moor, to look at possibly the luckiest calves ever. The calves were trapped in the only corner of a straw- and hay-filled barn that had not caught fire. The rest of the barn was a charred mess, smoke-filled of course, but the fire brigade had arrived there in very good time, put the fire out and saved the lives of the dozen or more calves. All the calves had suffered were singed and blistered muzzles and ears, plus severe coughs as a result of smoke inhalation.
Regarding friction, there is an upsetting cause of trauma of which I have seen two examples and believe other vets have seen similar ones. The most memorable was a tiny Yorkshire Terrier that had been taken out into the countryside and, whilst the family had their picnic, they decided to stop the dog from running away by tying the lead to the bumper of their car. The owners admitted to having then driven for one and a half miles before they realised that no one had unfastened the lead to put the dog back in the car. It still makes me cringe to think what the dog went through, but he never complained during his treatment. I suspect that it was because whatever we needed to do for treatment was nowhere near as bad as being dragged behind the car, which must have been both excruciatingly painful and terrifying.
Chapter 10
Dosing cats the proper way
Cats can’t read instructions
I have long been convinced that there must be thousands of tablets prescribed for dogs, and more particularly for cats, that sit forever unused on household shelves because no one has demonstrated the correct way to give a tablet to a cat. One can obtain plastic devices to introduce a tablet to the back of a cat’s mouth, and some tablets are intended to be palatable. Unfortunately, all too often, cats either don’t appear to be able to read the labels stating palatability or – even if they can read – they simply don’t agree.
Some cats do take tablets crushed or mashed into food but some medications should be given without food, in which case there is only one correct way to give a cat a tablet. Some individual cats are feral and semi- or completely wild, and can behave like a feline psychopath if they are manhandled. In these cases, even the technique described below is not safe, and dosing feral cats has to be done via the injectable route or by trying the food route instead. Contrary to popular belief I am not a complete idiot and nor am I brave enough to try to dose such
feral cats manually. Even some trusting and friendly cats do become wise and need a second person holding them around the shoulders to stop them fending you off with their front paws. In addition, I always ensure I’m wearing long sleeves in case the cat’s paws become free. For the individual cat that needs to be given a tablet by hand because the cat cannot or will not eat for whatever reason, the best and most reliable way is as follows.
First, always make a point of stroking the cat’s head and chin before and after the procedure, hopefully creating a nice friendly trusting association with the treatment. This also allows you to assess the cat’s temperament when initially handled around the head, forewarned being forearmed of course. Then, stand to the side of the standing or sitting cat on the side of your dominant hand. With your non-dominant hand, the left for me, take a firm but comfy grip over the top of the cat’s head, with your third and fourth fingers extending loosely down the back of the head between the ears, and have first fingertip and thumb tip of this non-dominant hand at the commissures of the lips (where the top and bottom lip meet at the sides of the mouth). Crucially, you gently roll the head backwards, with your third and fourth fingers at the back of the head acting as the pivotal point until the cat’s nose points vertically straight up at the sky. Note that you do not try lifting the head or chin straight upwards (because the cat will struggle as it thinks you’re trying to pull its head off), but gently roll the chin and nose upwards and backwards through ninety degrees or so. When the nose is vertically upwards, the mouth will start to open up to perhaps five millimetres, just exposing the incisor teeth. That gap allows you to use a finger, say the second or third finger of your other hand, to pull the jaw open and down gently. Using this small gap between the upper/lower front teeth (the incisors), there should then be little resistance as you gently pull the lower jaw down to open the mouth wide. You should have the tablet in the fingertips of your other (dominant) hand, between the first or second finger and the thumb. When the nose is pointing upwards, most cats will sit comfortably in this position with their nose up, mouth open for several minutes if necessary, as long as you are gentle. The correct grip is crucial to success. When open fully you can see, at the back of the mouth, the U-shaped notch formed by the back of the tongue, and that is where you aim to drop the tablet. After dropping the tablet in there, release the jaw and head; the cat will shut its mouth, automatically and immediately lick its lips, which indicates swallowing, and then you can reopen the mouth to check that licking the lips has meant that the reflex swallowing has occurred. Finally, if you are a vet, stand back and receive the plaudits from the disbelieving owners. If however, you do miss the bullseye of the notch at the back of the tongue and the tablet drops to the side of the tongue, or too far forwards in the mouth, then the tablet will indeed be spat out. The next attempt is harder because the tablet will be sticky and sticks to your fingertips when you try to drop it in the second time. I promise you that this is the correct way to dose a cat without needing food. It becomes a knack that is easy once the method has been learnt.
The only time it failed, just once, unfortunately was at a practice open day when I was demonstrating the method to the visitors using a nurse’s cat and the subject spat the tablet at the feet of the watching crowd. However, I was able to immediately repeat the procedure successfully, which was a relief. I have used this method successfully for forty-five years now on all sorts of cats, of all different shapes and sizes.
Cats do sometimes become wise to your routine, and become fed up, but some cats are very tolerant. For example, take my own eighteen-year-old cat with chronic kidney disease. For perhaps four or five years, I dosed him daily with tablets to improve his kidney function, and sometimes with other tablets to stimulate his appetite, and with antibiotics now and again. Although I have to concede that he was a wonderfully docile and affectionate cat and well above average in terms of temperament, he never struggled or ran away, not once, and continued to tolerate this method daily for all those years without ever complaining. One other memorable thing about this cat was his name: Horse. Ironically, he was named after a vicious cartoon cat from New Zealand. I could ruin my veterinary credibility by including a picture of this gorgeous silver tabby with the caption ‘Horse’ at which point smart alecks might think, no it’s not, what kind of vet are you? Horse was a very special cat and responded well to his tablets and diet for his failing kidneys but eventually died, as they all do, aged eighteen, following surgery for a throat cancer. At least he passed away at home in his favourite place: in my arms.
Chapter 11
Goodbyes
Losing one of the family
As every pet owner knows, losing a pet is an awful experience. It can feel as if one has physically lost a limb or a part of one’s self. These are common emotional descriptions from pet owners, and this was exactly how I felt after Horse the cat had died. Many owners state, ‘That’s it, I’m not having another one’, but then proceed to replace their absent friend with another pet, often after a very short period. Every vet I have spoken to about this acknowledges that one does not become hardened to the process of euthanasia, but rather the reverse, finding it more difficult and stressful as time goes by. The most difficult can be watching children losing their pet rabbit or losing a family dog or cat that is older than they are. Nothing that we can say takes the pain away, so one has to try to explain to the sobbing children how terrible the pain is or was for their pet, and that kindness is what is now important. It sometimes helps for them to write down their happy memories that they can re-read many years later.
Elderly owners can be devastated too when they lose a dog or cat that they have cared for during the previous twenty years or more, and this is now their last goodbye. I think the saddest case for me was a man probably somewhere in his mid-thirties, who had an arthritic old Labrador, that had been his late mother’s dog and he had given the Labrador a new home when his mother had died. However, time passed as it does, and the man requested a home visit because he thought the poor old dog had had enough and was ready to go and join the man’s mother again. I drove out, with the nurse, to carry out the procedure. I am a bit of a softie with Labradors at the best of times, but this one was particularly painful for us all.
It was very clear that this young man was finding it extremely difficult, and there was no macho pretence of a stiff upper lip. He was open about how he felt at losing his last contact with his mother. He was absolutely in pieces, in floods of tears, and words failed both me and the nurse. One has to choose one’s words carefully and it is important not to be verbose, but let the occasion pass in calm and relative silence.
One memorable case involved a lady who had been abroad for two or three weeks and had left her elderly cat to be looked after at home by her good friend Dee. The cat had no known specific health problems, but had become rather thin in the previous twelve months. This cat, Lottie, now seventeen years old, had travelled with the owner from Europe almost ten years previously. Wherever they lived, Lottie would always be seated at the window, eyes staring outside as she waited for her owner to arrive home, apparently able to recognise the sound or appearance of the owner’s car. Not so on this occasion. When the owner arrived home from holiday Lottie was nowhere to be seen. Only Dee was there, running across the driveway to greet her friend back home. She had tears in her eyes, and a red face, then she hurriedly explained that she’d just come round to feed Lottie, and Lottie had not come when called. Dee wandered the garden to call for Lottie again and had found her under a nearby bush about ten minutes earlier, Lottie being collapsed and gasping. The owner ran with Dee to find Lottie and, a couple of minutes later, after a brief moment of recognition and gentle mewing, Lottie passed on. The owner never forgave herself for not being at home just that little bit sooner to be with Lottie for all of her final moments, because it is not only dogs that bond strongly with owners; cats do so as well. Lottie’s owner felt she should have been there whilst Lottie was still mobile and ale
rt during her last few days.
That was very sad indeed. Very soon, this same lady had replaced Lottie with a cute little tortoiseshell female kitten, named Missy, who also bonded very closely to the owner. She would regularly curl around the back of the lady’s neck, for the comfort of both, I believe, and when not doing that was doing the usual kitten things of climbing the curtains, climbing the wallpaper by straddling corners, and generally enjoying her kitten life. Missy would behave more like a dog on occasion, trotting along at the heels of the owner as she walked through the nearby countryside at her home and then dutifully following her back home as well. Missy lived to a ripe and active old age of nineteen, never failing to follow the owner in the house or out in the garden, clearly wanting to be physically close at all times.
