Tuesday, February 16, 2016

How Do You Feel About Medically Unnecessary Surgeries?

When I was a child, people used to tell me that as one ages, time passes more quickly. As I write this now, it is clear that those sage folks were correct. How has it been almost 20 years since I started vet school?

A lot has changed about vet school since I attended in the ’90s. My class was almost 20 percent male. Today, such a ratio is hard to find. A class with so many males would be considered almost outlandishly diverse.

The course material has changed quite a bit as well. In the ’90s, modern veterinary medicine was still waging the end of the battle against a rearguard of old-school types who believed that animal pain was not significant, or was in some instances beneficial. The old-school types decisively lost the battle a few years later.

Dr. Eric Barchas. (Photo by Liz Acosta)

Dr. Eric Barchas. (Photo by Liz Acosta)

And then there was the matter of medically unnecessary surgeries, those that serve no benefit to the patient.

My classmates and I were required to learn the techniques for, but were not required to perform, declawing of cats, debarking of dogs, and dewclaw removal in dogs. The techniques for ear cropping and tail docking were optional, and I joined many of my classmates at happy hour, rather than the lecture, so that I would be able to profess ignorance when asked to dock tails or crop ears.

Vets who have graduated since my time can profess even more ignorance than I; many veterinary schools no longer teach any of the above surgeries. For more than a decade, I have predicted that medically unnecessary surgeries such as declawing, tail docking, and ear cropping would cease to be performed as fewer vets became willing or even able to perform them. That prophesy, which was obvious to anyone capable of basic observation, now is coming true.

The Jan. 15, 2016 issue of the Journal of the American Veterinary Medical Association contained an article titled, “A review of medically unnecessary surgeries in dogs and cats.” It discussed all of the surgeries mentioned above, and also debunked many of the arguments that are deployed by supporters of some of the procedures.

For instance, supporters of tail docking cite a reduced likelihood of tail injury among working dogs with shortened tails. Of course, this argument is not relevant to Dobermans and German Short Haired Pointers who serve as household pets and do not participate in hunting or police work.

And even among working dogs, the argument does not hold water. Two studies were cited in the paper. One estimated that 500 dogs would need to undergo tail docking to prevent one tail injury. The other came to a slightly rosier (for would-be tail dockers) conclusion — only 232 dogs would need to have their tails docked to prevent one significant injury.

Those 232 to 500 dogs, on the other hand, would be at risk of complications from the procedure. For instance, might tail docking be painful? It turns out that opinions on the matter vary wildly, but not among veterinarians. A study found that 82 percent of dog breeders thought that the pain caused to puppies was “none” or “mild.” Their vets, however, felt differently: 76 percent reported the pain to be “significant” or “severe.” Given that puppies universally vocalize in distress when their tails are docked, it is safe in my opinion to rate the pain they suffer as mild at the very least. With that in mind, the best-case scenario of 232 dogs suffering mild pain in order to prevent one tail injury simply does not add up as worthwhile.

To sum up: Tail docking is a fail. Here are the conclusions of the authors of the JAVMA piece:

Collectively, the available evidence suggests that tail docking is unnecessary as a routine procedure to prevent injury, particularly in nonworking companion dogs; that it causes short-term pain and has the potential to cause long-term neuropathic pain in some animals; and that it impairs social communication, which could lead to increased negative interactions with other dogs.

Supporters of ear cropping often cite similar arguments to those who support tail docking. For instance, there is little doubt that dogs raised for fighting will be less likely to suffer ear injuries if their ears are cropped. I therefore recommend that people who have fighting dogs immediately relinquish their dogs and go to prison.

How about pet dogs? Give me a break. Ear cropping is a cosmetic procedure, but in fact it actually makes the dogs less attractive. If you support it, you must never have seen a Doberman or Dane puppy with painful, infected ear margins from an unnecessary surgery. The next time you see a Doberman with intact ears, I recommend that you stroke them. They will be sublimely soft and wonderful. Don’t forget that the ears, like the tail, are important for canine social communication. Ear cropping: fail.

When I was in general practice, many people would ask that their puppy’s dewclaws be removed at the time that the dog was spayed or neutered. The rationale: dewclaws, especially unarticulated (loose and floppy) dewclaws, might get caught on something and be injured. Sound familiar?

The rebuttal: Dewclaws bleed like crazy when they’re removed, and if you don’t think it hurts, then you should have your thumbs amputated. In 16 years of veterinary practice, I have not once, not ever, treated a dog with a dewclaw injury more serious than a torn nail. Fail.

Boxer with cropped ears by Shutterstock.

Boxer with cropped ears by Shutterstock.

The JAVMA article moves on to cover debarking. In my opinion, debarking is to dogs what declawing is to cats — it’s an easy way out for owners who don’t want to deal with nuisance behaviors. And just like declawing, it doesn’t work. Declawed cats learn fast to strike with their teeth rather than their feet. Debarked dogs can still vocalize. The hoarse bark of a devocalized dog is one of the most unpleasant sounds I have experienced. Fortunately, I haven’t heard such a sound in at least 10 or 12 years. Where I live, nobody devocalizes dogs any more. That’s a good thing in more ways than one, because botched debarking surgeries can lead to a fatal complication in which a web of tissue grows across the voice box, leading to suffocation. Do I even need to say it? Fail.

The future (or lack thereof) for these surgical procedures is even clearer now than it was 10 years ago, when I first predicted their demise. A rearguard of old-school types still performs the procedures. If you you want your dog debarked, you’d better hire a vet to do it quickly, before he dies of old age.

Many of these procedures are restricted or illegal in many places. In fact, Quebec banned tail docking and ear cropping as of 2017. Even the American Veterinary Medical Association, never known for being progressive, long ago came out in opposition to tail docking and ear cropping. It also published the review paper in its journal. Medically unnecessary surgeries in pets are not long for this world.

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