Priorities of owners using reduced-cost spay-neuter clinics

I applaud Benka and McCobb¹ for their study on users of a reduced-cost spay-neuter program for cats in Massachusetts.¹ Some of the findings related to so-called spay delay, however, give me pause.

According to the report, when users of this reduced-cost spay-neuter program were asked to indicate why their cats had not previously been spayed or neutered, 526 of 1,188 (44.3%) respondents selected “too expensive.” Although it may have been true that from the owners' perspective, the procedure was too expensive, the study did not assess the owner priorities that led to this assessment. In particular, I suspect that, were they asked, owners in every income category who placed a low priority on their pets would cite cost as the primary or secondary reason for spay delay. If so, then the real reason is not cost, but the low value these owners place on their pets.

There was at least some suggestion that this may have been the case for some owners in the study by Benka and McCobb. First, although “too expensive” was the most common single reason cats had not been neutered previously, a higher total percentage (50.8%) instead selected reasons related to ignorance (“too young,” 25.2%; and “indoors only,” 6.7%) or indifference (“new cat,” 17.8%; and “too busy,” 1.1%). Second, a study² cited by the authors (which is apparently no longer available online) found a substantial disparity between the amount owners were reportedly willing to pay to sterilize a dog ($144) and the amount they were willing to pay to sterilize a cat ($109), suggesting that owners may place a lower value on cats. Third, the study found that most owners did not actively seek out the cat they brought to the program, suggesting that they had neither planned nor budgeted for its care and that the cat may have had a low value to the owner.

Focusing on the expense of the procedure versus the priorities of the owners may have the unintended consequences of shifting the responsibility for unwanted litters from the owners of these animals to the veterinarians who must charge full price for their services and lending credibility to the notion that the fees veterinarians charge for spay and neuter procedures is a major contributor to pet overpopulation.

Also unaddressed was the negative impact that reduced-cost spay-neuter programs can have on nearby veterinary clinics. Since a local spay-neuter clinic was established in my region, my practice has seen as much as a 50% reduction in the number of routine spays and neuters we perform annually.

It is undeniably true that for some people, cost is the true reason they delay having their pets neutered. But, other motivations should also be considered before concluding that cost really is the most important barrier.

Bruce R. Coston, dvm

Seven Bends Veterinary Hospital Woodstock, Va

The authors respond:

We appreciate Dr. Coston's feedback on our study of cats sterilized through a subsidized spay-neuter program in Massachusetts, and owners who selected this program.

Coston questions the role of owner priorities in decision-making about spay-neuter and posits that, had they been asked, “owners in every income category who placed a low priority on their pets would cite cost as the primary or secondary reason for spay delay. If so, then the real reason is not cost, but the low value these owners place on their pets.” There are two key points to consider regarding this speculation.

First, our study found significant correlations between income and spay-neuter decision-making and between income and prior veterinary visits. In this need-based program targeting economically disadvantaged cat owners, relative financial resources were found to matter. Thus, these particular data are unlikely to be masking the relative value that the owners place on their cats. Notably, the variability in income and behavior should not be considered a reason to reduce the income cutoff used to determine which owners would be eligible for subsidized veterinary care. Across household income categories, cost was an important factor leading to a delay in spay-neuter surgery, and a large proportion of cats had never before been seen by a veterinarian.

In interviews, 44 of 99 owners responded that had the subsidized program been unavailable, they likely would have used a private veterinarian. However, nearly half of these 44 owners would have delayed surgery so that they could save money to pay for the procedure. This strongly supports the assertion that cost is an important factor in determining when—and possibly if—an owner will sterilize his or her cat. Even if the animal eventually is sterilized, the chance of unintended breeding, particularly for cats, as a result of “spay delay” is high.

Second, our study did not conclude that cost was the sole reason why clients of the subsidized spay-neuter program had not previously been to a veterinarian or why they had not previously had their cat spayed or neutered. In fact, we state quite the opposite, concluding that “our data revealed several factors that likely influenced spay-neuter decisions without being directly tied to the owner's financial well-being.” One of these factors was value, and as stated, “the fact that many owners were not looking for a cat could potentially impact the relative value placed on the animal.” It is plausible that someone who was not seeking a cat and who had not budgeted for one would exhibit a lower willingness to pay for veterinary care. Coston rightly does not use this possibility to argue against subsidized spay-neuter programs, in that the data suggested that most owners would not have gone to a private veterinarian, at least not as a substitute for the subsidized clinic (ie, in a timely manner).

Valerie Benka, ms, mpp

Alliance for Contraception in Cats & Dogs Portland, Ore

Emily McCobb, dvm, ms

Center for Animals and Public Policy Department of Clinical Sciences Cummings School of Veterinary Medicine Tufts University North Grafton, Mass

Caring for elephants after the circus

The recent JAVMA News story “After the Circus”¹ quoted the International Elephant Foundation, with reference to efforts to sustain North American populations of Asian elephants, as stating that “Due to the few elephants that are contributing to the current birth rate, the North American population faces a crisis.” However, elephants are not a natural part of the North American landscape. Therefore, how can they be facing a crisis here? Although the elephant population in the United States may be dwindling, as veterinarians we should realize that that's okay.

The name of the Ringling Bros. and Barnum & Bailey Center for Elephant Conservation may suggest that elephants living there roam free throughout the center's 200-acre grounds or that the center is working to return elephants to their native lands. In fact, these elephants are highly managed and routinely touched, manipulated, tethered, tested, and hand-walked. In addition, they are confined to stalls and paddocks, which may lead to stereotypical behaviors, such as rocking and stall weaving, as well as foot problems, arthritis, and other concerns.² This artificial approach is counter to sanctuary features—uninterrupted social groups, natural behaviors, and freedom to explore—that would benefit these animals.

Elephants have sensibilities similar to those of people and develop lifelong relationships.³ Young elephants do not wean naturally until they are between five and 10 years of age. Cows remain in herd groups with their mothers; bulls detach but return periodically. In separating elephants to loan them to zoos, the Ringling Bros. elephant breeding program will cause emotional pain.

As veterinarians, we know and understand the physical, physiologic, ecological, and behavioral needs of animals, both domesticated and wild. It is our responsibility to educate the public and to be thought leaders on issues regarding animals, from elephants to dogs and everything in between.

I am encouraged by the positive steps the AVMA has made in recent years to promote veterinarians as guardians of this obligation. By introducing animal welfare as a boarded specialty through the creation of the American College of Animal Welfare and by continuing its advocacy efforts in Washington, DC, the AVMA is making unprecedented strides in improving the lives of animals.

But veterinarians working on the front lines must also take up this charge, which extends well past the literal task of day-to-day care for clients' pets. Ringling Bros. and Barnum & Bailey played a large role in popularizing the circus in America. They have a responsibility to give back. And the veterinary community should guide them in doing so.

Joan Capuzzi, vmd

Newtown Square, Pa

Report on onychectomy technique and house soiling in cats open to misinterpretation

The AVMA Animal Welfare Committee Management Subcommittee actively supports research into animal welfare-related issues, including the declawing of cats. However, we worry that findings of the recently published “Telephone survey to investigate relationships between onychectomy or onychectomy technique and house soiling in cats”¹ may be misinterpreted if readers do not carefully read the report. In particular, the authors concluded that onychectomy was associated with an increase in house-soiling behavior of cats. However, the prevalence of house soiling was not significantly different between cats that had undergone onychectomy (87/304 [28.6%]) and cats that had intact claws (33/151 [21.9%]). Also, in the multivariate analysis, onychectomy status (claws removed vs intact) by itself did not have a significant risk ratio in relation to house soiling. Therefore, we would advise readers to carefully read the methods and results sections of this report before accepting the conclusions drawn by the authors in the abstract and discussion.

AVMA Animal Welfare Committee Management Subcommittee:

Elizabeth Mackey, dvm

Athens, Ga

Michelle Sprague, dvm

Audubon, Iowa

Jack Advent

Powell, Ohio

Leanne Alworth, dvm, ms

Athens, Ga

Hilton Klein, vmd, ms

Philadelphia, Pa

Comments on two JAVMA News stories

I would like to comment on two recent JAVMA News stories. The first, “Horse tripping can fly under the radar,”¹ expresses concern about horse tripping during Mexican-style rodeos. Horse tripping is, of course, detrimental to horses both physically and emotionally, inducing pain and fear. But, I have to wonder why we as veterinarians are not speaking out against similar events involving cattle that are a common component of traditional rodeos in the United States. This strikes me as similar to the discord in welfare statutes that require anesthesia and pain relief for horses undergoing castration and similar painful procedures, but not for cattle, pigs, sheep, goats, or birds.

The second story² involved recognition of US Senator Harry Reid for his “contributions to the veterinary profession, including cosponsoring legislation that restored the rank of brigadier general to the chief of the US Army Veterinary Corps.” While I applaud his work on this issue, his recent action to block a vote on the Prevent Animal Cruelty and Torture (PACT) Act, which would have outlawed the distribution of videos showing animals being maimed or tortured, suggests that this may not be the best time for veterinarians to be congratulating him.

Betsy R. Coville, ms, dvm

Lutz, Fla

Importance of dental care for guinea pigs

The recent commentary on diagnosis and treatment of dental disease in guinea pigs¹ did a great job starting an important discussion.

As stated by the authors, guinea pigs are not small rabbits. In fact, rabbits and guinea pigs are prone to different dental problems. The authors also do a great service by mentioning iatrogenic damage during trimming of the incisor teeth, and it is safe to say that no patient in small mammal practice should have its teeth trimmed with nail trimmers. Furthermore, incisor crown elongation requires a diagnosis and not just trimming. That diagnosis frequently involves the cheek (ie, premolar and molar) teeth.

With regard to diseases of the cheek teeth, abnormal wear is often a sign of painful dental disease, and malocclusion of the cheek teeth also needs a diagnosis. In guinea pigs, a complete bridge of multiple teeth over the tongue is common. Although this bridge must be eliminated to allow for proper tongue movement and chewing, the bridge is a sign of serious underlying dental disease that must be diagnosed to solve the problem. Frequently, these patients are cachectic and may be too ill to allow for complete diagnostic testing without aggressive supportive treatment.

Diagnosing dental disease in guinea pigs generally involves radiography of the skull, with most guinea pigs requiring sedation to obtain views of acceptable quality. Laterolateral, ventrodorsal, dorsoventral, and left and right oblique views are the most helpful; however, interpreting skull radiographs can be quite difficult. Bohmer and Crossley² provide an objective method for interpreting skull radiographs, although one must also look for abnormally wide interdental spaces and lucencies in the bone and teeth. Bohmer³ also discusses specialized extraoral views to examine certain maxillary and mandibular teeth. Sometimes, intraoral dental radiography is recommended to refine the diagnosis.

Performing a complete oral examination is also vital in diagnosing dental disease in guinea pigs but typically requires deep sedation or, more commonly, general anesthesia. Use of an endoscope is ideal.

Without a diagnosis for our patients' oral disease, we are at best palliating the occlusal problem and miss the chance to attend to the proximate cause of the disease. Failure to correct the underlying problem is compounded by the delay in presentation of guinea pigs to a veterinarian. It is not uncommon to have patients brought in with end-stage oral disease that might have been treatable had the owners come in sooner.

There is one important point not mentioned by the authors. Veterinarians with advanced training or years of experience may have a better idea as to how to successfully deal with dental disease in guinea pigs. Referral to an experienced exotic animal veterinarian should always be a consideration.

Jeffrey L. Rhody, dvm

Lakeside Veterinary Center LLC

Laurel, Md