Managing fractious cats (Proceedings)
Fractious cats are an inevitable part of small animal practice. A client's decision to return to your hospital for future veterinary services may hinge on how the doctor and staff deal with these patients. In fact, your level of achievement in the "art of practice" is seen vividly in your ability to deal with these difficult patients.
There are several general principles that need to be recognized: 1) A cat's behavior may change quickly. 2) Cats are territorial, even in a hospital cage. 3) When in a strange environment, most cats become intimidated instead of aggressive. 4) Cat's have defensive and offensive strategies, which you should recognize.
The first decision that must be made is whether or not the hissing or growling cat is bluffing or really serious. Although this is usually learned by trial and several errors, there are some things that should be observed. Two of the most reliable are the placement of the ears and the shape of the tongue. If the cat's ears are flat on its head and its tongue is rounded, it is usually not bluffing.The way a cat is approached in the examination room can determine how the cat will react throughout the visit. You should begin by letting the cat smell your hand. Almost every cat will want to do this. Stroke the cat and talk to it in a high-pitched voice. Picking up the cat before it is secure with its surroundings is not a good approach. However, if you do pick up the cat do so with authority.
Removal of the cat from a carrier can be a difficult task. If it is done improperly, the borderline cat may become aggressive or vicious. My favorite method is the "dump truck" or "gravity" method. Papers or towels are removed from the carrier. Its door is opened wide, and the rear of the cage is SLOWLY tilted upward. As the carrier becomes nearly vertical, the cat will slide out the door. When two front or two rear feet are on the exam table, the carrier can be lifted upward and the cat will have no choice but to walk out.
Cats in hospital cages should be approached much like those in exam rooms. They should be allowed to smell your hand and stroked before attempting to pick them up. Talking to the cat helps to calm it.
Identifying truly fractious cats can be easy or somewhat difficult. Pay attention to comments made by the owner; they may be warnings in disguised.
One of the keys to proper handling is having the proper equipment. Several companies make a variety of restraint devices. Some devices are designed for dogs and are inappropriate for cats since cats react differently than dogs. Be very careful about putting anything around a cat's neck.
Cats can be restrained in various box-type devices. Care should be exercised in choosing devices. Be sure that the cat cannot get a foot or its head caught as the panicked cat can cause severe damage to itself and those nearby.
The difficult, but not truly fractious, cat can be handled with finesse alone or with simple devices such as heavy bath towels and cat bags. Other devices for minor restraint include a feline muzzle and the catch net.
For seriously fractious cats, my preferred restraint box is the Wild Child by Veterinary Concepts. This device is a squeeze-type box that permits injections to be administered though the lid. It can be used to retrieve a cat from a carrier or a cage. It can also double as an anesthetic chamber. For very fractious cats, I send the Wild Child home with the owner. When possible, the cat is treated in the hospital without ever leaving the box.
Anesthesia can be very complicated in fractious cats. Their fight-or-flight capacity can cause them to die if restraint is excessive. Anesthetic chambers are my first choice for these cats, but some cats cannot be placed in anesthetic chambers. For these, oral ketamine plus diazepam can be very effective. The calculated dose is drawn into a 1 cc syringe. An open-end tom cat catheter is placed on the syringe. It can usually be inserted into the cat's mouth through the cage door or the wire in the trap. The ketamine: diazepam combo is squirted into the cat's mouth. It takes about 5 minutes for the drug to take effect. The degree of sedation is generally enough a face mask with an anesthetic gas to be applied. Note that ketamine can cause corneal ulcers so do not squirt it in a way that it can get in the cat's eyes.
It is dosed as follows:
Another special situation is the dyspneic cat. Cats with pleural effusion, diaphragmatic hernia, or pneumothorax can die quickly if stressed. Be especially careful with these cats.
Dr. Norsworthy's favorite feline restraint devices (other than a heavy bath towel)