I stumbled upon a recent article by Dr. Robert M. Miller. I strongly encourage you to read it. You also may want to hop over to Dr. Miller’s Facebook and Twitter feeds to let him know how you feel about the article.
Dr. Miller is well known in veterinary medicine. He is among a tranche of, shall we say, experienced vets who write sometimes humorous articles for monthly veterinary publications. The item in question is called “An Exorbitant Onchyectomy.” Onchyectomy means declaw. And had the article been dated April 1 rather than Aug. 1, 2013, I might be willing to cut Dr. Miller some slack for writing it.
Again, I encourage you to read the article and form your own opinions. What follows will be a summary of the article, with some of my thoughts interjected. I will then conclude with a diatribe.
The article begins with a bit of a disclaimer: Dr. Miller states that he had vowed never again to enter the declaw debate, but recent circumstances were forcing him to. I hate to start off by splitting hairs before the surface of the article is even scratched, but this statement is simply inaccurate. By my calculations Dr. Miller is or will soon be an octogenarian. He (as the article will show) retired from veterinary practice long ago. Nobody is forcing Dr. Miller to write, and nobody is forcing him to write about declawing cats.
Dr. Miller next relays a story in which he visited some family members. Their 8-month-old cat was noted to be scratching the people and dog in the family. Dr. Miller suggested declawing the cat. Now, perhaps he abridged his story a bit, but it caught my eye that he didn’t recommend trimming the cat’s nails, nor did he discuss behavior modification, nor use of Soft Paws (old-school types have always scoffed heartily at the notion of Soft Paws). Nope, he went straight for the declaw.
The family members called their vet, who quoted $1,000 for the surgery. Dr. Miller was aghast; at the time he retired he only charged “fifty bucks” for the surgery. I wonder if at the time Dr. Miller retired, gasoline cost 30 cents per gallon, bread was a nickel a loaf, and fifty bucks could pay two months’ rent.
Dr. Miller pondered why the surgery could be so expensive. Was the vet trying to discourage declawing? (It is possible — declawing isn’t something most actively practicing vets relish. In fact, an ever-growing number refuse to do it.) Was the vet trying to gouge the family? Was his gout acting up? Was he suffering from a migraine?
Conspicuously absent from the article was one potential cause for the estimated cost. To perform a declaw properly — and under most circumstances it is not appropriate to say that a declaw procedure can ever be proper, but it is safe to say that some techniques are better than others — one must use anesthetic, analgesic, and surgical techniques that increase cost. Properly performed surgeries cost more than back alley hack-and-chops. Perhaps Dr. Miller was exercising artistic license, and that is why he did not mention it. Or did Dr. Miller not mention this because he does not understand this?
Dr. Miller next took it upon himself to meddle in the situation. He contacted a colleague who had been an intern (a formalized way of saying trainee vet) in Dr. Miller’s practice in 1969. The colleague had not yet retired, and Dr. Miller arranged for the declaw to be performed at “a realistic fee.”
Dr. Miller next launched into a tirade of his own. Back in his day, when he learned surgery in 1955, the accepted technique was the “Resco nail trimmer technique." He has used it on thousands of cats, including every cat he’s ever owned, and found it better than any newfangled technique that has been introduced since. His complication rate with the Resco nail trimmer technique was nil. In fact, those newfangled techniques (such as laser surgery, scalpel blade dissection, and cautery) seem to him to be nothing more than attempts to jack up the price of declaws. So what is needed is for someone to invent really expensive nail trimmers with fancy names so that vets can charge high prices, still perform declaws using the “best” technique, and feel good about themselves.
End of article, thank goodness — if he had gone on much longer I would have felt compelled to try to strangle the magazine that I was holding in my hands.
Let’s review some of what was taught in medicine and veterinary medicine in 1955.
ÔÇó The Resco nail trimmer technique was the best way to declaw a cat.
ÔÇó Animals and children did not truly feel pain; however, any postoperative pain they felt was a good thing because it kept them from being overactive during postoperative recovery.
ÔÇó Smoking cigarettes offered numerous health benefits.
ÔÇó Methamphetamine could be used to boost performance and stamina.
You get the idea: accepted medical practices and thinking change over time. In medicine there is something called “the standard of care.” This standard is generally defined as the level of care that is offered by the average practitioner in the area. If one’s level of care falls below it, one risks running afoul of regulatory agencies, and if one’s level of care falls dramatically below it, one is committing malpractice. If one does not make an effort to stay caught up on currently accepted medical knowledge, one’s level of care will eventually fall below the standard of care.
The standard of care is a moving target. It keeps changing, and I daresay it keeps improving. At one time in history, blood letting to balance black and yellow bile for the treatment of melancholy was well within the standard of care. At another time, circa 1955 in fact, “cowboy boot anesthesia” met the standard of care for feline castration. Cats were neutered by shoving them face-first into a cowboy boot so that their feet were restrained and their testicles exposed. The procedure was quick and simple, and the cats never reported any pain because cats can’t talk. Fortunately the standard of care has changed, and cowboy boot anesthesia is now considered a barbaric act of animal cruelty that would result in a veterinarian being stripped of his license and perhaps, in some locations, jailed.
Nail trimmer declaws, in which a guillotine-style nail trimmer is used to snip off the most distal (last) digit of each toe, evidently were the standard of care in 1955. However, that standard in my opinion has changed, and I believe that the practice falls below the current standard of care. Guillotine declaws are not yet generally considered barbaric acts of animal cruelty that would result in a veterinarian being stripped of his license, but I suspect that they will be in my lifetime.
My beefs with Dr. Miller’s article are numerous, and I’m not a fan of laundry lists, but the article demands an attempt at an organized response. So what follows are my most significant complaints.
First and foremost, Dr. Miller jumped straight to declawing without even considering trimming the cat’s nails, working on behavior modification (which has especially high potential in young cats), discussions of tactics to recognize and redirect the cat’s aggression, or use of Soft Paws. The easiest way (for the people, but certainly not the cat) out of the situation as the first and only recommendation.
Also, he’s a meddler. As a practicing veterinarian, I am always open to well-thought-out and well-researched suggestions on management of cases. But I have, on occasion, had some vet call me up demand that I perform a procedure for his friends using outdated techniques that in the worst cases amounted to outright malpractice. I always refused — I need to live with myself. But these situations have inevitably been awkward and have created ill-will among all parties. There is a reason that there are countless synonyms for people who engage in this behavior, and they all carry negative connotations. Whether you call him a meddler, a buttinski, an armchair quarterback, a busybody, or a back seat driver, what I’m saying is that Dr. Miller should mind his own business. If he wants the procedure performed in a particular way, he should perform it himself.
Dr. Miller’s article devalues good veterinary practice and advocates bad medicine. Perhaps his colleague who performed the declaw used best practices. Perhaps he performed appropriate preanesthetic testing. Maybe he administered interavenous fluids before, during and after the procedure. It is conceivable that he used a balanced anesthetic technique and administered aggressive analgesic agents. Perhaps he used regional anesthesia, and applied a fentanyl patch for long-lasting, powerful postoperative pain control. Maybe he carefully dissected the last digit from each toe, taking care not to damage the digital pads (the overwhelming majority of veterinary pain management experts disagree with Dr. Miller’s belief that these things aren’t important to do). And perhaps after surgery he carefully monitored the cat and administered supplemental pain killers as necessary. In that case, the colleague performed the surgery at a financial loss — and it still was ethically dubious at best.
Or perhaps Dr. Miller’s colleague performed the procedure using the technique that I have seen among vets who practice outdated medicine. In that case he gassed the cat down, slapped a tourniquet on each leg, dipped a set of dirty old nail trimmers in an antiseptic solution, guillotined off the last digit of each toe, glued the skin fragments together, woke the cat up, and went to lunch while the cat writhed in agony in its kennel during anesthetic recovery. In that case he could have charged a couple of hundred bucks and still made a bit of a profit. Only the colleague and the cat know what happened, but the cat can’t complain about how much pain he suffered (and might still be suffering) so apparently from Dr. Miller’s perspective it’s safe to assume that the procedure went just fine.
Declawing cats is controversial for a reason. Many cats exhibit evidence of significant pain after declawing. And others experience lifelong complications including forelimb lameness, house soiling (thought to be a litter box aversion because of pain associated with digging), intractable biting, recurrent toe abscesses, and abnormal and difficult-to-treat nail regrowth. These complications are possible with all forms of declawing, but in my experience they are far more likely with the guillotine nail trimmer technique. (I have never performed the guillotine method — in fact, I have performed almost no declaws in my life, and none in the last decade. However, I had a former colleague who was fond of the nail trimmer technique and his complication rate was astronomical.)
I am happy to report that declawing cats is becoming markedly less controversial. There are ever fewer people in this world, including vets, who believe that declawing is acceptable. Young vets generally don’t perform the procedure. Heck, I’m in my 40s and I have no plans ever to declaw a cat again. Most vets around my age feel the same way, and younger vets generally feel even more strongly. As the saying goes, progress in medicine occurs one retirement at a time. Soon there will be no controversy, and there will be no declawing.
In the meanwhile, we are left with the likes of Dr. Miller publicly advocating declawing and cheap medicine. Let us hope he is sincere when he says that he truly intends to stay out of the declawing controversy in the future. Perhaps if a few of you post your thoughts on his Facebook and Twitter feeds we can help make that intention a reality.
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