Partial Digital Amputation (Onychectomy or Declawing) of the Domestic Felid – Position Statement 3/16/2017

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Position

The Canadian Veterinary Medical Association (CVMA) opposes elective and non-therapeutic Partial Digital Amputation (PDA), commonly known as declawing or onychectomy, of domestic cats.

PARTIAL DIGITAL AMPUTATION (ONYCHECTOMY OR DECLAWING) OF THE DOMESTIC FELID – POSITION STATEMENT

Summary

  • Scratching is a normal behaviour in cats.
  • The CVMA views non-therapeutic PDA as ethically unacceptable when performed without comprehensive client education including a thorough review of available alternatives, as the surgery has the potential to cause unnecessary and avoidable pain and alternatives to PDA are available.
  • Veterinarians should educate clients about strategies that provide alternatives to PDA.

Background

  1. Scratching is a normal feline behaviour. It is a means for cats to mark their territory both visually and with scent, and assists with nail conditioning and whole body stretching. Nails are used by cats to assist with balance, climbing, and self-defence.
  2. Partial digital amputation (PDA) is the surgical removal of the third phalanx of each digit. Non-therapeutic PDA is generally performed for the convenience of the owner to eliminate the ability of a cat to cause damage from scratching. The surgery typically involves the digits of the front paws, although surgery on the digits of all four paws is sometimes undertaken.
  3. Veterinarians strive to use their scientific knowledge to promote animal health and welfare and relieve animal suffering in keeping with the principles of veterinary medical ethics (1). With or without concrete scientific evidence, ethical consideration has to be given to the welfare of the animal. Veterinarians need to consider what advantages non-medically driven PDA’s offer to the feline. Viable alternatives to PDAs exist. Therefore from an ethical viewpoint, the CVMA views this surgery as unacceptable as it offers no advantage to the feline and the lack of scientific evidence leaves us unable to predict the likelihood of long-term behavioural and physical negative side effects.
  4. The CVMA recognizes that appropriate medical therapy may necessitate surgery, including PDA (2). Medically necessary PDA surgery may include, but is not restricted to, biopsy of a nail or phalanx or surgery  to treat: neoplasia of nail bed or phalanges, severe or irreversible trauma, immune-mediated disease affecting nail bed, paronychia (inflammation or infection), onychodystrophy (abnormal formation), onychogryphosis (hypertrophy and abnormal curvature), onychomadesis (sloughing), onychomalacia (softening), onychomycosis (fungal infection), or onychoschizia (splitting) (3).
  5. Surgical amputation of the third phalynx of the digit alters the expression of normal behaviours in cats, causes avoidable short-term acute pain, and has the potential to cause chronic pain and negative long-term orthopedic consequences (2,4-7).
  6. As with any surgery, PDA can result in complications due to adverse reactions to anesthetics, hemorrhage, infection, and lack of effective perioperative pain management.
  7. Since the third phalanx is removed by PDA, cats must thereafter bear their weight on the second phalanx. This fact has implicated PDA as a cause of lameness. It is recognized, however, that lameness is difficult to diagnose and detect (5). For this and other reasons the long term orthopedic effects of PDA are poorly understood.
  8. A recent long-term study assessed cats six months after PDA (6,7). No significant differences were found between cats that had undergone bilateral forelimb onychectomy with successful outcomes and cats that had not. Specifically no differences were noted in peak vertical force and vertical impulse, the most commonly evaluated parameters in kinetic gait analysis, when measured at least 6 months after surgery. Since the original study only considered cats with successful surgical outcomes, the results likely have limited application and generalizability.
  9. Both acute and chronic pain in felines can result in an increase in behaviours such as inappropriate elimination, excessive vocalization and increased aggression. The CVMA believes that current studies on long-term behavioural effects as a result of PDA are insufficient to draw firm conclusions about its role in causing chronic pain. The CVMA will therefore continue to review new studies as they are published (8,9).
  10. It has been suggested that PDA be performed on cats in order to decrease the health risk to immunocompromised humans. The U.S. Centers for Disease Control and Prevention does not list PDA as a means of preventing disease in either healthy or immunocompromised individuals (10).
  11. There are currently no peer-reviewed studies that identify a higher rate of relinquishment of cats with intact claws versus cats that have undergone PDA, including in countries in which PDAs have been banned. Partial digital amputation is not considered to be a justifiable alternative to relinquishment (11).
  12. Tendonectomy is not an acceptable alternative to PDA because it causes similar pain post-surgery (8) and could lead to increased complications if the nails are not properly maintained.
  13. Veterinarians should educate their clients about reasonable and effective alternatives to PDA including providing advice on the design and location of scratching posts and other suitable scratching materials and approaches aimed at preventing aggressive play behaviours.
  14. Other strategies that offer alternatives to PDA include:
  • feline pheromone sprays to redirect the cat to more desirable scratching materials;
  • double-sided tape to deter cats from scratching the edges of furniture;
  • regular nail trimming (recommended every two weeks);
  • artificial nail covers;
  • environmental enrichment and appropriate daily play to decrease feline aggression;
  • avoidance of hand/foot play which can lead the cat to see these human parts as prey;
  • the application of basic principles of reinforcement of desirable behaviour, including the use of catnip, treats, and verbal praise.
  1. Partial digital amputation procedures are currently banned in several countries and/or regions including the United Kingdom (e.g., Ireland, England), Europe, and Australia.
  2. In the current absence of a legislated ban on PDA surgery in Canadian jurisdictions, the CVMA, though opposed to elective and non-therapeutic PDA, supports the actions of provincial veterinary governing bodies that require that veterinarians, as a minimum, provide clients with information regarding PDA surgery, potential side-effects, and alternatives that is sufficient for owners to give informed consent (12).
  1. Veterinarians have the right to refuse to perform non-therapeutic PDA surgery. If alternatives fail to alleviate undesirable scratching behaviours, veterinarians have the right and responsibility to use professional judgement for a humane and ethical outcome.

References

  1. CVMA Veterinarians Oath. 2004. Available from: https://www.canadianveterinarians.net/about/veterinary-oath Last accessed September 30, 2016.
  2. Mills KE, von Keyserlingk MA, Niel L. A review of medically unnecessary surgeries in dogs and cats. J Am Vet Med Assoc 2016;248:162-171.
  3. Verde M. 2005. Canine and Feline Nail Diseases. Proceedings of the NAVC. Available from: http://www.ivis.org/proceedings/navc/2005/SAE/110.pdf?LA=1 Last accessed August 2, 2016.
  4. Robinson DA, Romans CW, Gordon-Evans WJ, et al. Evaluation of short-term limb function following unilateral carbon dioxide laser or scalpel onychectomy in cats. J Am Vet Med Assoc 2007;230:353–358.
  5. Stamper C. Osteoarthritis in Cats: A More Common Disease Than You Might Expect. Available from: http://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm382772.htm Last accessed March 30 2016.
  6. Romans CW, Conzemius MG, Horstman CL, Gordon WJ, Evans RB. Use of pressure platform gait analysis in cats with and without bilateral ocychectomy. Am J Vet Res 2004;65:1276-1278.
  1. Schnabl E, Bockstahler B. Systematic review of ground reaction force measurement in cats. Vet J 2015;206:83-90.
  2. Hellyer P, Rodan I, Brunt J, Downing R, Hagedorn JE, Robertson SA. AAHA/AAFP pain management guidelines for dogs and cats. J Fel Med and Surg 207;9:466-480.
  3. Cloutier S, Newberry RC, Cambridge AJ, Tobias KM. Behavioural signs of postoperative pain in cats following onychectomy or tenectomy surgery. Appl Anim Behav Sci 2005;92:325-335.
  4. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available from: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf Last accessed March 30 2016.
  5. ASPCA Position Statement on Declawing Cats. Available from: http://www.aspca.org/about-us/aspca-policy-and-position-statements/position-statement-declawing-cats. Last accessed March 30, 2016.
  6. Nova Scotia Veterinary Medical Association Information and Consent Form for clients who request cat declawing. Available from: http://celticcreatures.ca/wp-content/uploads/sites/281/2015/04/declaw.pdf.Last accessed March 30, 2016.

(Revised November 2016)

LINK TO POSITION STATEMENT

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No More Declawing In Nova Scotia-New Law For The Safety Of Felines

 

Nova Scotia becomes first province to ban declawing of domestic cats
HALIFAX — Nova Scotia has become the first province to ban medically unnecessary cat declawing, part of a worldwide movement against the practice.

The Nova Scotia Veterinary Medical Association decided Tuesday to amend its code of ethics to make the practice of elective and non-therapeutic declawing ethically unacceptable.

It will come into effect on March 15, 2018, following a three-month education period.

Dr. Frank Richardson, registrar of the association, said the decision follows years of discussion by veterinarians, surveys, public input, and a recent statement from the national association.

The Canadian Veterinary Medical Association strengthened its stand against declawing domestic cats in March, saying the practice causes unnecessary and avoidable pain.

Vets’ groups in many other provinces are having active discussions on the issue, Richardson said: “It’s on everybody’s radar.”

Richardson said while declawing was popular 20 years ago, fewer and fewer veterinarians have been willing to perform the procedure.

“The number is getting smaller and smaller each year. I think if we did nothing it would die off on its own,” he said.

Dr. Hugh Chisholm, a retired veterinarian who has been pushing for the change, said while some municipalities have enacted regulations against declawing, Nova Scotia becomes the first province or state in North America to declare the practice unethical.

“It’s a great day. I’m so proud of the Nova Scotia Veterinary Medical Association,” said Chisholm, Atlantic Canada director for the Paw Project.

“You are amputating 10 bones from 10 digits on the paws of a cat, and if that doesn’t constitute mutilation, I don’t know what does,” he said.

The practice has already been banned in the U.K., Europe, Australia and several California cities. New Jersey is considering a law that would ban the practice unless a vet decides the operation is medically necessary.

“Now that we have this success in Nova Scotia, I will be contacting the other provincial veterinary associations to encourage them to do the same thing. I think it’s just a matter of time,” Chisholm said.

For years some pet owners have had their cats declawed to prevent scratches to furniture, people and other pets. But the Canadian Veterinary Medical Association says scratching is normal behaviour that cats use to mark territory, help with balance, climb and defend themselves.

Chisholm said there will still be cases where declawing will be medically necessary.

“Those would be very rare cases, but yes if it is in the cat’s best interest to have a claw removed or a few claws removed because of trauma or infection, then yes it is the right thing to do. To do it because you’re worried your sofa is going to get picked or scratched is just wrong,” Chisholm said.

— By Kevin Bissett in Fredericton.

The Canadian Press

LINK TO ORIGINAL

People Magazine And World Famous Dr. Evan Antin Declaws A Human!

 

Dr. Evan Antin hails from Kansas City, Kansas where he grew up spending the majority of his childhood in search of native wildlife including snakes, turtles and insects. He went on to study evolutionary and ecological biology at the University of Colorado at Boulder and spent multiple semesters abroad in Australia and Tanzania to learn more about their respective ecosystems and fauna.

In addition to his love for cats and dogs, Dr. Antin’s passions lie in exotic animal medicine and interacting with exotic animals in their native habitats around the world. For more than a decade Dr. Antin has made an effort to seek opportunities to work with wildlife on a domestic and international level to include locations such as Central America, Australia, New Zealand, South America, Eastern and Southern Africa, South East Asia and a variety of North American ecosystems. The accumulation of Dr. Antin’s hands-on experience with exotic animals has prepared him exceptionally with their handling, husbandry, and enrichment. He is capable of caring for small, delicate animals; large, dangerous animals; and of course our beloved household dogs & cats with ease and confidence.

Dr. Antin has been happily employed as a full time associate at CVVH directly following his graduation from Colorado State’s veterinary school in 2013. Since then he’s developed clinical medical & surgical skills to help provide the right care for the dogs, cats, exotics and wildlife of the Conejo Valley.

Dr. Antin currently lives near Calabasas, California with his dog, Henry, his cat, Willy, his savannah monitor lizard, mangrove snake and an assortment of tropical freshwater fish. Other hobbies of his include traveling, scuba diving, snowboarding, hiking, and weightlifting.

LINK TO DR. ANTIN’S PRACTICE

Declawed Cat-Four Years Worth Of Coiled Claw Growth Inside Pawpad

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6 yr DLH brought in for possible abscess on front right paw. The owner just noticed lump on paw a couple days ago and was expecting it to be an abscess. After further inspection DVM noticed what looked like nail peeking through a tiny spot under the skin. After sedating and removing the hair, he cut open the “abscess”… This poor cat was declawed over 4 years ago before the current owner received him. When declawing, the previous DVM must have left enough behind on the dewclaw to allow it to grow back. This is at least 4+ years of nail curled around on itself underneath his skin!! Craziest thing I’ve ever seen!
** permission to post granted by owner****

LINK TO ORIGINAL

It’s Time For Veterinarians To Stop Mutilating Cats’ Feet By Robin Downing DVM, DAAPM, DACVSMR, CVPP, CCRP, CVA, MS

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LINK TO ORIGIONAL

Commentary: It’s time for veterinarians to stop multilating cats’ feet
Declawing is a barbaric procedure that violates bioethical principles and sets feline patients on a path to chronic maladaptive pain.
I applaud the American Association of Feline Practitioners and the fact that it has (finally) taken an appropriate stand against the mutilation of cats through toe amputation. I am saddened that any compassionate veterinarian would object. It is worth remembering that we are one of the only developed nations on the earth that still allows it.

Amputating the last phalanx (P3) of the toes of cats was once considered a “commodity” procedure, commonly performed by well-intentioned veterinarians. As time has passed and our understanding of feline pain, biomechanics and quality of life has evolved, we now recognize many downsides to this procedure and truly no upside.

For the purpose of this commentary, let’s consider three distinct perspectives on the issue of feline toe amputation:

The clinical bioethical perspective
The pain perspective
The biomechanics perspective.
Clinical bioethical perspective

Cats are sentient beings with moral agency who, it has been recently argued, should be approached with the same consideration as nonverbal children.1-5 It behooves us to consider them within the context of the foundational principles of clinical bioethics.

The four cornerstone principles of clinical bioethics have been described as respect for autonomy, nonmaleficence, beneficence and justice.6 Let’s look at each of these in turn as we examine the clinical bioethics of feline toe amputation.

Respect for autonomy means we must consider cats’ preferences. If cats could be given a choice between being subjected to multiple toe amputations and maintaining intact feet, one can easily make the case that cats would prefer intact toes and feet, avoiding the pain and disfigurement associated with multiple toe amputation.

Nonmaleficence means “do no harm” or “avoid harm.” The question then becomes, does amputating all of a cat’s front toes (P3s) cause harm? Amputation is painful, potentially for the rest of the cat’s life. It also forever alters the way a cat walks, prevents natural (scratching) behavior, and forever prevents the cat from being able to defend itself by fighting or climbing to escape a threat. Clearly toe amputation causes harm.

Beneficence means to act in a being’s best interest. Can we truly argue that amputating all of any cat’s third phalanges of the front toes is ever in that cat’s best interest? It appears that the answer to this question is a self-evident “no.”

Justice is the fourth cornerstone principle of clinical bioethics. Translating this for application in veterinary medicine focuses on fairness. The relevant question to ask is if amputating the third phalanx of each of a cat’s front toes could ever constitute fairness to the cat within the context of its life and lifestyle. Considering all of the compromise that toe amputation creates, as a formally trained clinical bioethicist, I respectfully submit this does not reflect fairness.

Pain perspective

Multiple studies have demonstrated that most cats receive woefully inadequate pain prevention and management for procedures like spays and neuters—procedures far less traumatic than multiple toe amputations. The pain literature clearly demonstrates that acute pain poorly managed at the time of the trauma often leads to permanent pain states. This means ongoing, self-sustaining, chronic maladaptive pain that constitutes lifelong torture.7,8

The few studies that have evaluated either the presence of leftover bone fragments or regrowth of sharp bone spurs after toe amputation demonstrate that an embarrassingly large number of cats suffer from this extra bony tissue.9 These sharp shards perpetually poke at the underside of the skin at the end of each toe stump, making every step like walking on needles or nails.

Finally, we know from pain physiology that when we sever a nerve, there is a high risk of creating self-perpetuating neuropathic pain. Humans most commonly develop neuropathic pain as a result of conditions such as amputation, direct nerve trauma, shingles and diabetes. People who develop neuropathic pain can describe how it feels, so we know the unremitting torture they endure each and every day—tingling, burning, electric-like pulsed pain, pins and needles. We also know that once chronic maladaptive neuropathic pain is in place, these people report ongoing challenges relieving pain.10-12

We know from pain and neurology research that companion animals are “wired” precisely as we are. When nerves are cut—as they are in feline toe amputation—the probability that the cat will develop neuropathic pain is exquisitely high. These cats can go on to develop many different aberrant behaviors. These may include:

reluctance to walk on certain surfaces
reluctance to jump onto or off furniture, window ledges and so on
overgrooming of feet or legs.
These cats must walk on their painful feet!

Biomechanical perspective

Finally, we must consider how feline toe amputation forever alters the biomechanics of the patient.

When a cat is subjected to toe amputation, in addition to having the last bony phalanx removed, all of the surrounding tendons and ligaments that attach to that bone are severed. This changes the architecture of the feet, thus changing the biomechanics of how the feet work. Because approximately 60 percent of the cat’s body weight is carried on the front feet, altered biomechanics changes the way the entire body moves. If we superimpose chronic maladaptive neuropathic pain in the feet onto altered front foot biomechanics, we amplify the downstream implications of the cat moving in an abnormal fashion. The altered biomechanics can significantly interfere with the cat’s ability to exhibit normal cat behaviors.

We also know that the vast majority of cats 10 years of age and older suffer from degenerative osteoarthritis (OA) in at least one joint.13,14 The majority of cats who develop OA in later life have it occur in their equivalent of the human lower back—where the spine and pelvis come together. When the biomechanics of movement are altered, so are the forces generated throughout the body’s joints—in particular the joints of the spine.

The repetition of ergonomically unsound movements over time creates microtraumas to these joints, which can contribute to the development and progression of OA. Then, OA contributes to ongoing chronic maladaptive pain in these cats. As both a board-certified specialist in rehabilitation and a pain expert, I find this completely preventable, endless cycle of altered biomechanics and chronic maladaptive pain to be a call to action.

Conclusion

The bottom line is that amputating the last phalanx of the toes of cats violates those cats on many levels—bioethically; from an acute pain perspective; from a neuropathic pain perspective; from a biomechanical, movement and lifestyle perspective; and from an OA and chronic maladaptive pain perspective. It is time for this arcane and barbaric mutilation procedure to be removed from the veterinary surgical lexicon.

References

1. Andrews K. Beyond anthropomorphism: Attributing psychological properties to animals. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

2. Copp D. Animals, fundamental moral standing, and speciesism. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

3. Downing R. They do not deserve to hurt: Closing the gap between what we know and what we do for companion animal acute pain. MS thesis, Union Graduate College, Schenectady, New York, 2016.

4. Nussbaum M. The capabilities approach and animal entitlements. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

5. Low P. Cambridge declaration of consciousness, ed. Panskepp J, Reiss D, Edelman D, et al. Francis Crick Memorial Conference on Consciousness in Human and non-Human Animals, Cambridge, UK, July 2012.

6. Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th ed. New York: Oxford University Press, 2012.

7. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: A maladaptive response of the nervous system to damage. Annu Rev Neurosci 2009;32:1-32.

8. Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol 2011;24:331-338.

9. Martell-Moran NK, Solano M, Townsend HGG. Pain and adverse behavior in declawed cats. J Fel Med Surg May 1, 2017; epub ahead of print.

10. Sandkuhler J. Spinal cord plasticity and pain. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack’s textbook of pain, 5th ed. (e-book). London: Elsevier, 2006.

11. Woolf CJ, Salter MW. Plasticity and pain: Role of the dorsal horn. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack’s textbook of pain, 5th ed. (e-book). London: Elsevier, 2006.

12. Woolf, CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004;140:441-451.

13. Kerwin SC. Osteoarthritis in cats. Top Companion Anim Med 2010;25(4):218-223.

14. Lascelles BDX. Feline degenerative joint disease. Vet Surg 2010;39:2-13.

Dr. Robin Downing, who holds a master’s degree in clinical bioethics, is a diplomate of the Academy of Integrative Pain Management, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, a certified veterinary pain practitioner, a certified canine rehabilitation practitioner, and hospital director at the Downing Center for Animal Pain Management in Windsor, Colorado.