There was a big commotion at the stuffy fifty-year-old Kim Keat
wet market as the government people came to
enforce the laws of public health and order.
Illegal hawkers had to flee for their lives as
they wrapped up their wares and dashed for safety.
The officers, in beige shirt and dark brown pants
would give chase and being younger, would have the
advantage of stamina and energy. They overcame the
sixty-year-old peddler who could only limp and
brought him back to the van to be given a
summons.
Mrs Tan was a licensed stall holder, working half
a day selling pork, pig's brains, tongue and
lungs. All these would be delivered at dawn by
trucks from the Jurong Abattoir. The pigs were
slaughtered starting from the evening and the meat
and offals would be delivered just before dawn,
except on Mondays. There was no slaughter on
Sunday evenings. Fresh pork was what the average
Singaporean house wife liked. Besides they cost
less than those beautifully plastic-wrapped at the
air conditioned supermarkets. As much as thirty
percent less, but younger women with higher income
shun the blood and fishy smells of the wet
market.
Mrs Tan was alert. The government officers from
the Primary Production Department could be
conducting raids on stray dogs and cats too. She
was a 50-year-old matronly woman, wearing a maroon
small-flowered blouse with short sleeves and
slacks made of polyester, a fashion popular with
her generation of "Ah So". "Ah So" is
a Singapore Cantonese term meaning "Auntie"
referring to Chinese women over forty, many of
whom worked as office cleaners or stayed at home
looking after the children and making sure they
studied hard to improve their position in life.
Today, she spotted the dog and cat catchers who
probably happened to be at work. The Environment
officers distracted her. She quickly rounded up
the mother cat with three kittens and hid them
inside a cabinet. They were safe for the time
being. But something was wrong with the mother cat
and she went to the veterinarian when the
government officials had left.
"This cat vomited a few minutes after eating
canned food this morning," said Mrs Tan said. "As
if there was something stuck in its throat.
She is mothering three kittens. I suspect she had
swallowed a fish bone."
Fish vertebral bones trapped inside a cat's throat
were a common veterinary complaint amongst stray
cats in Singapore and stray cat lovers diagnosed
the problem usually correctly.
These cats ate leftover food including fish bones
as they waited patiently near the dining tables of
the hawker centre near the wet market stalls.
The mother cat was not a fierce cat but was
nervous and tried to escape from the strange
surroundings and pungent antiseptic smells of a
veterinary surgery. I gripped its upper jaw with
my thumb and forefinger forcing her mouth to open.
I could see no bones in the two seconds the cat
was caught unaware. Her left paw dug into my hand
to stop further exploration from the stranger. I
felt the pain of the long three-inch claw scratch
and stopped manipulation. The mother cat was still
strong.
The treatment of stray cats was no different from
other cats but there was the need to reduce
veterinary cost to the lowest by not insisting on
X-rays.
I had no choice but to give a tranquiliser
injection as it was difficult to open its mouth
wide for examination. This tranquiliser caused the
cat to vomit out the canned food but there was no
bones or their fragments. No fish bone
was seen lodged in the back of the mouth. I
used a pair of forceps to press down the tongue.
There was no fish bone seen inside the back of its
throat.
Sometimes, the bone would be trapped across the
back of the throat causing difficulty in
swallowing and I could see them. In this case, the
bone must be deeper down, past the tonsils. This
cat was eating. I saw blood clots at the
back edges of the tongue. There was slight
bleeding. This was due to the fish bone or bones
piercing the tongue as the mother cat attempted to
swallow it?
"Good news," I said to Mrs Tan. "There is no fish
bone stuck in the throat, but an X-ray would be
need to show the presence of any bone." The
cat could vomit out its feed indicating no
obstruction of the gullet. It was alert and had no
fever. A false alarm. Case closed.
Mrs Tan reiterated: "It had this choking sound
when it vomited its food this morning. As if it
had great difficulty in vomiting."
This was going to be a difficult case or a
challenging one if you subscribed to positive
mental attitude management concept. The classical
textbook description of gullet or esophageal
obstruction was difficulty in swallowing food.
The cat had no problem swallowing its food as
evident by a large amount of canned food vomited
out, a side effect of the xylazine tranquiliser.
Could the bone be inside the gullet in this case?
Sort of lodged sideways so that food could still
be swallowed but would be vomited out a few
minutes later as most of the food, blocked by the
bone could not reach the stomach? A projectile
type of vomiting a few minutes after eating would
be a sign of gullet obstruction.
Extending the cat's head upwards, four cm down the
throat, a small swelling could be seen on closer
inspection. It was below the 'Adam's apple'.
The cat objected to the hard bony lump being
palpated by me. It was painful even under
tranquiliser's pain killer effect. Yes, a
bone was lodged very near to the epiglottis, the
flap covering the airway opening when food is
swallowed. That would explain why the cat
could swallow some food as the opening of the
gullet was not obstructed.
This was an instant diagnosis. What Mrs Tan needed
was an instant economical solution.
"It would need an X-ray and surgery to remove the
bone," I said. It would be too dangerous to
pull out the bone as the bone would slice through
the walls of the gullet and cause considerable
damage. It might even pierce the big blood vessels
if I take it out with the forceps."
 "This is a stray cat." Mrs Tan reminded
me. What was not
said was that there should be minimal costs to the
stray cat Samaritan who brought in the cat for
treatment. Preferably, the vet should
provide a charitable service as a stray cat was
nobody's responsibility.
If the bone was hard to remove by forceps, the cat
needed surgery and Mrs Tan had to pay. The total
cost of surgery, X-rays and hospitalization was
estimated at around $500 which was half a month's
pay for many clerks. This was not a lot of
money for Mrs Tan whose business had been affected
by the economic downturn. People seemed to
spend less and were more cautious with money.
Most stray cats don't get veterinary treatment as
there is no free clinic for small animals in
Singapore.
"I am worried about its kittens not being given
milk if the cat undergoes surgery and would be
unfit to nurse the kittens. Somebody at the hawker
centre had dumped her earlier litter of kittens
into the garbage dump." Mrs Tan said sadly.
"My husband forbids me from bringing any cat
home." So she could not hand feed the
kittens every two hourly.
"Are you going to leave it at the hawker centre
after surgery and it may get another fish bone
jammed inside its throat later on?" I
asked.
This was a pragmatic question with no answer.
Even if Mrs Tan would pay for the surgery, who
would look after the kittens since the mother cat
would be unable to nurse the kittens for a few
days? Milk production would stop too if the
kittens don't suckle. The kittens would
starve to death since nobody had the time to
bottle feed them.
Ideally, this cat should be X-rayed to determine
the position of the fish bone inside the gullet.
It was not too far down the gullet and could be
extracted with a pair of forceps with risk
of tissue damage and bleeding leading to
infections and death of the mother cat. Yet, there
were the three kittens which Mrs Tan could not
bring home to bottle feed. Groomer Ken could
provide nursing services but the costs would be
high.
This was the last chance for the mother cat to
live. If Mrs Tan walked out of the consultation
room because I could not recommend her an
economical solution, the mother cat would die from
infection and loss of appetite.
Bacteria would colonise the pricked throat area in
the next few days. She suffered intense pain as
she could not swallow food because the bone was
jammed at the opening of the esophagus. Without
eating, she would not be able to produce milk for
the three kittens. The kittens would die. There
were four lives at stake.
What was the cheapest treatment besides X-rays and
surgery?
I put the cat under general anesthesia using a gas
mask so that she would not feel the pain if I
explored the deeper part of her throat. If the
fish bone could be seen, it was easy to extract it
out with a pair of forceps.
I pulled the reddish tongue out as much as
possible. There was no fish bone seen. The
cat still felt the pain when I put the forceps
down the gullet.
The protective cough and swallowing reflexes were
overactive. The fish bone obstructed the
anaesthetic gas from entering the lungs. The bone
must be large and it must have lodged above the
air way. An X-ray would be the easy way to see the
bone if costs were not the problem. In real
life, veterinary costs are a major concern of
stray cat Samaritans.
The gas anaesthetic would not work in such
situations. I decided to give the cat the
injectable anaesthetic. Nurse Ann pressed the
right elbow of the cat with her thumb and fingers.
The cephalic vein swelled in a short thin line on
the side of the fore arm.
I inject into it the short acting thiopentone
barbiturate. The cat was now at peace, unconscious
and pain free as it went into surgical
anaesthesia.
I inserted the
curved end forceps into the pharynx, the area
above the windpipe and gullet. I felt
something rough. Something big obstructing further
entry. I opened the jaws of the forceps and
clamped blindly on something.
The forceps locked on one tip of the fish bone. I
could see the tip being blocked by the throat or
pharyngeal tissue on the right side as I
manipulated it out. Slowly, I pulled out the
bone. There was no blood seen in the bone. This
was good news as it meant that the gullet tissues
were not lacerated when I pulled it out. I
gave the cat an antibiotic injection.
"The mother cat should be all right." I said. Mrs
Tan was very happy as she smiled. She seldom
talked much.
"Why don't you bring her home for the next few
days?" I advised.
"My husband will divorce me if I bring the cat and
kittens home," Mrs Tan explained gravely. "He does
not like the cats to dirty the HDB (Housing &
Development Board) flat."
Since she worked half a day, what would now happen
to the cat? Would she be too doped to feed
her kittens? Would the anaesthetic
drugs affect the kittens as they suck the milk and
kill them as their livers were immature enough to
metabolize the barbiturate given to the mother and
would now be excreted into the milk?
There were so many stray cats in this world to
worry about. Since the mother cat would be
unsupervised, I suggested that it be kept in the
surgery for 3 days. At least Nurse Ann would
care for them. Mrs Tan bought the
canned food for the cat and milk powder and bottle
in case the kittens could not suckle.
"I could not sleep the whole night when the cat
had its fish bone removed," Mrs Tan said. "It was
a stray cat but it was well loved by us at the
hawker stalls. The other ladies were enquiring
about her health. I would put her in a cage."
Two days later, Mrs Tan drove the Nissan pick up
and brought her beloved cats to be cared for by
everyone. "How about sterilising her so that
no more kittens would be produced?" I asked.
"It is just too expensive an operation," Mrs Tan
replied. "My pork business had been wiped out
since the outbreak of Nipah virus in pigs in
Malaysia. The people just avoid eating pork as
they are worried about being infected by the
virus and become comatose. I hear that the
government wants us to install meat chillers and
that would cost a lot of money. If I can't afford
it, I will be out of business."
Stray cats are the unwanted animals of society.
"There are vouchers to get stray cats neutered
free if you go to the Society for the Prevention
of Cruelty to Animals to get them. You can bring
the cat to be sterilised in veterinary clinics
participating in the SPCA scheme." I advised.
"In addition, spayed stray cats would have a small
tip of their ears cut so that the cat catcher from
the government would know they have been neutered
and will would not take them away to be put to
sleep," I elaborated.
Mrs Tan arched her penciled lined eye brows and
wrinkled her forehead. She looked me in the
eyes and did not comment. I knew she disbelieved
my government propaganda of spayed cats being
given a lease of life in a stray cat management
and control scheme not much publicised.
"Would it not be better for your business if
people don't spay the stray cat? After all,
rentals, like bus fares keep increasing over the
years and your net profits decrease accordingly.
Bigger operations like hospitals and supermarkets
overwhelm the small operators with the economies
of scale, convenience and therefore lower
priced products and services.
You will need more cases if you don't advocate the
spaying of stray cats. The cats give birth to
kittens. Some get adopted and some of the new
owners here may patronise you." Mrs Tan said.
Quite logical and correct. A down to earth
business woman who did not need to get a Master of
Business Administration to expound the laws of
supply and demand a graduate who had more years of
education which was narrow-based to animals.
She was correct. Less kittens born equal to less
cat owners and ultimately much fewer cases for the
vets to diagnose treat. What would a cat
veterinarian do if there were no cats to treat? Go
treat the lions?
I could see that Mrs Tan did not believe when I
said that spayed cats with a snipped off left ear
tip would not be rounded up and taken away by the
government cat catchers to be euthanased. The
nemesis of stray cats come in armour-like trucks
and the stray cat catching officers are eyed with great wary and
suspicion.
A neighbourhood watch group of Aunties would warn
each other when the cat catcher has arrived so
that the stray cats get kept safely hidden in the
hawker cabinets.
It is always a cat and mouse game between the
stray cat protectors and the government cat
catchers all over the world. The government
cat catcher in Singapore wins many battles over
the years but as long as he or she cannot win the
hearts of all Aunties and their daughters making
them stop caring for the strays, the war against
stray cats will never be won.
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TOA
PAYOH VETS
