Saint Patrick's Day
This year Saint Patrick’s Day was stormy - in fact the annual Irish parade was being postponed until Saturday. The employees at the clinic were catching up on some much needed spring cleaning and stocking. Rainy days often give you a chance to catch up on all the non-essential busy work you let slide when patients need your attention. Rainy weather outside usually means one of two things happen at the clinic: clients will bring their pets in for a bath or bring them in extremely sick. The trip for extremely sick pets I can understand, but why people would brave the weather for a bath eludes me. In fact, the number of baths appears to increase with the severity of the storm. On this rainy Saint Patrick’s Day no one other than the bather was appreciably busy, but as I would soon find out, that was about to change.
One of our best clients was an eccentric older gentleman by the name of Mr. Klein. He and his wife were a one - couple humane society of sorts. Often they would have upwards of 30 cats and about half as many dogs on their property on the outskirts of town. Many of these pets they found along the side of the road. More than one of his pets were actually thrown over his eight foot fence, abandoned by their previous owners. He had a pregnant cat and kept not only the mother but the kittens as well. A Right to Life advocate Mr. Klein believed life began at conception and therefore would not abort a pregnant cat’s litter but would have her spayed once the litter was weaned. Each group of cats would have their own indoor and outdoor facilities. The basement of his house was filled with indoor feline housing with various ramps and shelves with an outside access near the top of the ceiling where the basement peaked out at ground level. The cats could then take advantage of being able to sun themselves outside, exiting the house to an outside enclosed run just for themselves. In order to avoid arguments the cats would be grouped according to who would be congenial with who, and if one was rather grumpy they would find themselves housed alone.
Alternatively, most of the dogs were outside pets with fenced areas from a fourth of an acre to several acres in size. Dogs were similarly housed with agreeable siblings, either natural or created. Each enclosure would have adequate housing for all those within. A few chosen house dogs would have a similar setup to the cats with indoor and outdoor housing through doggy doors leading to and from the laundry room area and there would always be that lucky individual cat or dog that had free roam of the house. The house pets usually worked into the elite house position through attrition.
In the basement there was also a food prep area adjacent to the cat housing area in which there was an exam table of sorts. On the opposite wall was a series of shelves for various medications and a large variety of different foods. Most of the critters were senior citizens and required a variety of treatments. This constituted the hospital area of the house. Unfortunately Mr. Klein was also becoming a senior citizen with the paper thin- skin of an older individual. Although Mr. Klein was always mentally sharp, due to his advancing age, his body wasn’t keeping up and he was becoming more and more frail himself. No longer was he able to medicate difficult younger critters by himself or wrestle with the larger dogs. He dearly adored them all but had to hire help to keep up with them.
On this particular Saint Patrick’s Day, Mr. Klein came upon a wet and mangled cat under an overpass where he had been left to die. The full-grown cat was unable to move, allowing Mr. Klein and his wife to scoop up the unfortunate cat and rush him into the clinic. Upon first glance I could tell the cat was in shock. He was breathing, but faintly, and his body barely registered a temperature as he tried valiently to hang on to life. Almost instinctively we started an IV catheter, pumping him with corticosteroids in the process, wrapped him in a warm towel with adjacent hot water bottles, and prepared to assess the rest of the damage. The black and white long-haired cat quickly became more alert but there was no movement from his back end at all. Pinching the toes on the back legs we could not elicit a response of any kind.
With dreaded anticipation my team set up radiology for an assortment of radiographs. Lack of feeling is never a good clinical sign and this would not be an exception. Once stable, the adult male cat was placed on his side and then again on his back for a variety of radiographic exposures. We all anxiously awaited the results. The radiographic processor seemed to take an endless amount of time in processing those pictures. Meanwhile the slender male cat appeared ever stronger as the color was beginning to return to his pink nose and gums. All in attendance were deeply saddened when our worst fears were realized. The brave male cat had a broken back. The first two lumbar vertebrae were completely luxated. There would be no return of feeing to those rear legs and everyone knew then that inevitably euthanasia would be necessary.
Packing up the radiographs, I proceeded to exam room three where I could give Mr. Klein the news. With a heavy heart I pointed out the obvious to Mr. Klein: the poor prognosis for survival let alone recovery. Mr. Klein, ever the optimist, told us to do whatever we could to keep him comfortable. He would not consent to euthanasia and decided the slender black and white cat would be given a chance to recover even though the two once adjacent vertebrae were not even close to one another. Surely spinal hemorrhaging was going to claim the little fellow but we would try to see what we could do for the sweet guy. The cat was to remain at the clinic and we would see how things went. In the meantime the unfortunate cat was named “Patrick” in honor of the day.
As a consequence of our medical training most of us expected Patrick not to live through the next 24 hours. When severe spinal trauma is present acending/descending myelomalacia will often cause a lethal result. The spinal cord has little or no muscular tissue with which to promote vacostriction and clotting of damaged blood vessel walls. This constant oozing of blood will then lead to progressive destruction of the spinal cord tissue. Even if Patrick, by some miracle, made it through the night he would never walk again. Would he have bowel control or bladder control? The chances were slim to none and I was of the opinion that there would be none. Unfortunately I was not disappointed. Although you always hope for a miracle, they can be few and far between.
The next day a wide-eyed, alert, and hungry cat greeted us. Unfazed by his ordeal, Patrick ate readily and the catheter was removed. There was still no pain or movement from the back end and the cat appeared to be quite comfortable. The bedding in the kennel was not damp in the least. Fluids had been given the previous day to counteract the forces involved in the shock process; therefore we quickly determined where all those fluids had gone. Yes, the bladder was full. Patrick was quickly removed to a grate covering one of our bathing areas and the bladder was emptied with gentle pressure being applied to the bladder wall. No stool was felt in the colon but I suppose that the little guy had not eaten in days, so that was not surprising. Then that evening the process was repeated.
It was day two and Patrick looked even happier to see us. He even scooted forward on his front two legs in order to come closer. No pain was exhibited, and fortunately two small fecal balls were detected behind him. Unfortunately the padding on the bottom of the kennel was still not wet. I scooped Patrick up and headed for the tub. Since we had received two fecal balls that morning the tail was gently lifted and the rear end wiped. Patrick could not lift his tail so when he had a gone to the bathroom the underside of the tail had become soiled. Fortunately there was a baby wipe to the rescue and the area was quickly cleaned up. That evening the process would be repeated— this time with training for each technician. The hospital staff soon learned how to palpate bladders and how to express them over the tub. Patrick soon became a great training aid. My staff was unparalleled in their ability to detect and express bladders. This process would continue twice daily for the rest of Patrick’s life.
One receptionist, Norma, took a personal interest in Patrick and would bring him behind the front counter, always keeping him well-padded. He would often go scooting by himself along the floor bringing his padding with him. Patrick loved attention and often attracted clients as well as staff members to his situation. Never depressed and always ready for attention, Patrick was a natural clinic ambassador.
Although he could not feel his tail and was never able to move it, the clinic staff made sure that at least twice daily the area below the tail was checked for soilage.
Norma had the day off that crisp January morning. Patrick was more or less confined to quarters for the day. Our other receptionist, Robin, had Patrick out in the office area for only a short time that particular morning. Apparently business was about as crisp as the weather and Patrick was always getting in the way. Often when Patrick thought he was being slighted in the attention department he would scoot out into the waiting room. Not always were his waiting room visits a good idea. Robin was afraid he would meet up with the wrong dog while she wasn’t looking and therefore put him up until business slowed down.
It was this particular morning that Mr. Henson brought his three dogs in for baths. Mr. Henson had a hard time taking care of himself let alone an Old English sheepdog and two very active, often obnoxious, Siberian Huskies. The Old English sheepdog was a doll while the other two dogs, Siberian huskies, had a bad reputation around cats and other animals.
All three dogs had their baths and were drying with a cage-attached drier. The male husky and the Old English sheepdog were being dried out in the kennel room while the third hairdryer had been placed in the cat room. The lower-level kennels in the cat room were larger and able to accommodate families that wanted their cats to board together— sort of a family affair. Unfortunately with all the other cage driers being used the bather decided to make use of the lower kennel with dryer attachment in the cat room. Being pressed for time she thought Tanya would quickly be dried in the cat room location.
Tanya was 100% Siberian husky and had already chased some of her neighborhood cats around. In fact, one of the neighboring cats was brought in months earlier to be patched up. She did not like other dogs and cats even less.
Patrick, under much kennel confinement for the day, was scooting around and suddenly allowed the limp tail to drop in front of Tanya’s kennel. The tail swayed in an out of Tanya’s reach as Patrick moved around the upper kennel. Seeing a play toy within reach was more than Tanya could stand, and she eventually was able to strip off the lower part of the tail. Patrick, oblivious to the attack since he had no feeling in the tail, acted as though nothing had occurred. When the bather returned she was horrified as to what had happened and the appearance of the tail. Even more concerning was the lack of a tail in either kennel. There was a thin strip of connective tissue where a large fluffy appendage had once been located. Patrick, for his part, didn’t realize he had lost anything and was curious as to why, suddenly, he was the center of all this attention.
Immediately Patrick was wheeled into surgery and became our resident Manx cat. He took the new look in stride, and for us, the daily clean-up ritual now became easier. Patrick was now less likely to develop a dermatitis from urine or fecal scalding. As for Tanya, she was never again allowed around a cat!
Occasionally, Patrick would need to be treated for a urinary tract infection which quickly resolved on antibiotics. Manual bladder expression is never quite as good as the true bladder reflexes, and the bladder emptied by external pressure will not be emptied thoroughly, thereby resulting in bladder infections. Over the next couple of years the bladder became ever thicker and harder to empty from the constant pressure used in getting it to drain and from the recurrent bladder infections that would become ever more frequent.
Always eager for attention, Patrick was the constant gentleman and allowed us to treat as needed. The infections were not only becoming more frequent, but they were traveling further up the urinary tract as well. Instead of the typical bladder infections, we were often finding ourselves dealing with a secondary kidney infection as well. Digital pressure was no longer evacuating the bladder as we came to accept that our little buddy’s days were numbered. Finally we were not able to evacuate the bladder through palpation and pressure. The kidney function was elevating and it was time to say good-bye to our loyal companion.
One by one the employees came by to visit one last time with our Irish lucky charm. He lived his rather short life as a testimony to those with handicaps. His job was to charm us, seeking attention always and never complaining once about his situation. We, his family, were not going to let him suffer through end-stage kidney disease and kindly put an end to his suffering that beautiful fall day. All Patrick ever wanted was a family to love him and with several of his family in attendance, he was laid to rest with other members of the Klein four-legged extended family.
Sometimes as you walk into the cat room, you can still feel Patrick smiling down at you— especially while reaching inside one of those middle kennels. He showed us all how rich life could be in spite of all his handicaps. We figure he is still scooting around on a cloud somewhere.