"You are very heavy-handed," the vet was told.

July 26, 2007

You may have heard of a snapping turtle or a snapping alligator. But a snapping domestic cat?

Strong jaws "click-clack, click-clack, click-claw" whenever my hand gets near her mouth. She was wrapped up in a towel and the maid was holding her well. In any case, the cat had been sick for some time and was not eating. She had lost all her excess weight. No more energy to struggle and lift her front paws to swipe at her nemesis associated with pain.

She could meow and protest inside the wrapped towel. The maid wrapped the towel loosely but Nellie did not have the vigour to extend her front legs and prevent her mouth from being touched. Her pupils dilated. She looked as wild as a tiger.

"Coughing and bad breath" were the complaint of sister 2 who was the one who cared for this cat.

I knew what was she suffering from as this was not the first time. It would just be so easy to give her the usual injection and not risk of biting and clawing.

"You are always heavy-handed," sister 1 suddenly said to me as I tried to open the cat's mouth to examine it. Nellie's eyes followed my hand movement. Her jaws opened and closed, clacking her teeth together.

I was surprised about sister 1's comments. She had never commented about my animal restraint in the past 2 or 3 years I had treated Nellie. It was distressful to her, I think back retrospectively. It would not be good for the cat if her mouth was not examined before treatment as I would not know how effective the treatment would or how long it would last. Each animal reacts differently to steroid injections to suppress inflammation.

The dose must be sufficient but not too much. Too little and the owner would not be satisfied with the results. Too much and the cat might die.

I said to sister 1, "I had scheduled teeth scaling and examination on June 19,2007 and even phoned up sister 2. Decayed teeth would be one cause of stress, mouth ulcers, gingivitis and bad breadth. But the cat did not turn up."

Sister 1 said, "You warned that the cat might die during anaesthesia. So Sister 2 did not want to do it."

Around June 19, 2007, the ulcers had come back but had not caused severe pain. I examined the mouth with sister 2 holding the cat. Sister 2 knows how to handle Nellie firmly. The steroid effect had worn off. So, anaethesia would be less risky. I had to give this warning of risk because Nellie was around 10 years old. A senior citizen of Singapore. A history of recurrent mouth ulcers. I suspected "rodent ulcer". In this reportedly immune disease, there is no cure. The cause is unknown. Mouth ulcers develop after the steroid effects wore off.

But keeping the teeth clean is important. I saw a decaying grey molar tooth in Nellie and had timed the anaesthesia to give her the least risk of death.

I could not guarantee no risk. Sister 2 had told me an incredible story of Nellie's mother. She took Nellie's sick mother to a vet (Vet 1) one day. The nurse of Vet 1 advised her not to consult the vet but to go to Vet 2 as the cat would die under Vet 1. So, Sister 2 went to Vet 2. Vet 2 said that the cat would be all right. A few hours later, Nellie's mother was dead at Vet 2.

Now, why did the nurse of Vet 1 advised her against consulting her employer? It was a puzzle but we discovered that Vet 2 had employed her. As to why Nellie's mother died at Vet 2's place, it was not possible or ethical for me to comment as I did not know what happened.

As far as Sister 2 was concerned, the vet must be not good.

So I understand why she did not go for the teeth extraction and scaling appointment for Nellie.

"We picked up a tooth on the floor in Nellie's room," Sister 1 said to me during my house call. "It must be Nellie's." I did not think another cat would go to Nellie's room and dropped a tooth. I had seen the decayed molar and presumed this must have had dropped off.

Sister 1 wanted to open the mouth for me while I shone the big bright torch inside the mouth. Nellie snapped at her, eyes bright tracking her hand. What if Sister 1 get bitten and needed to go to the hospital? Cat bites are known to be infectious.

Was there another way? Should I just give the injection and go? The status quo cannot remain. A decision must be made. Sister 2 was busy at work.

"Get a spoon," I asked the maid. I opened the mouth with the spoon wedged between the front of the upper and lower jaws. Nellie snapped at the spoon. Sister 1 shone the torch. Bits of glimpses between the snapping jaw and a distressed Sister 1.

I saw a bright bloody red ulcer of 1.5x1.5 cm in the corner of the roof of the mouth on the right hand side. Gum ulcers under the teeth. The rodent ulcers were very active. Nellie's mouth was very painful. An injection behind her back under the skin was given.


PICTURE OF NELLIE'S MOUTH TAKEN PREVIOUSLY, ON APRIL 28, 2007

Peace returned. This was nearly 9 p.m on Wed Jul 25, 2007. Sister 2 was still at work. On day 2, I phoned Sister 2. Nellie was feeling so much better.

There is a need for dental check up. Would Sister 2 have time or be willing to take the risk? We live day by day.


FOLLOW UP ON SAT JULY 28, 2007
On day 2, Sister 2 said Nellie was eating but was too busy to talk.
Today is day 3, a Saturday. Managed to tel Sister 2.
She was very happy that Nellie was now eating. No bad breadth.

"Now, the cat needed not run away to hide when she sees us carrying a syringe. We had been syringing a high energy liquid (an expensive product for people unable to eat) for the past few days as she was not eating.

"We will take her for her dental examination when she is ready, as you advised," she said.

I said, "Sister 1 told me that Nellie's tooth had been found on the floor."

"I work late, so I was not aware of that," Sister 2 was in especially high spirits.

I advised her to get a tray, put Nellie on the tray and weigh her with the usual people bathroom scales.

"I can carry Nellie and subtract my weight from our total weight," Sister 2 said.

"The weight of Nellie might not be accurate," I replied. "As she is small and even a 1 kg change might not be too obvious compared to the total weight."

Sister 2 understood. She would weigh her weekly.

"Once the weight dropped back to normal, that means the steroid effect is gone and Nellie is less at risk of anaethetic death during dental scaling. It will occur in 4-6 weeks' time, but you have to keep written records of her weight and daily appetite.

"I am doing it," Sister 2 said. I don't know if she has the time to persevere. It is best to monitor Nellie carefully if we are going to put her under general anaesthetic for dental check up and treatment.

I was glad that Nellie's mouth pain had gone and was able to eat on her own. That also removed a lot of stress on her caregivers, esp. Sister 2 who works very hard and long hours.