Letters to the Editor

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Watering hole cover art

The outstanding painting—“Nebraska Watering Hole”—on the cover of the November 15, 2017, issue of the JAVMA by Dr. Dale Sworts typifies much of the ranch landscape of western Nebraska. It was an honor and privilege to have been associated with Dr. Sworts at the Colorado State University College of Veterinary Medicine and Biomedical Sciences when he was in my pharmacology class. It is with pride that I remember Dr. Sworts and the many other cream-of-the-crop veterinary medical students I had in my classes over 34 years and who have saved the livestock industry untold billions of dollars.

Nicholas H. Booth, dvm, phd

Jacksonville, Fla

More on breed-specific legislation

After reading the recent JAVMA News story “The dangerous dog debate,”1 I wanted to share my perspective as a board-certified pediatrician working in an urgent care center. Let me state up-front that given my professional and personal experience and my reading of the literature, I favor not just strong dangerous dog legislation in general, but breed-specific legislation in particular.

Anecdotal evidence from surgeons, emergency room doctors, and pediatricians who treat dog-bite victims' injuries,2 along with results of various scientific studies, suggest that pit bull–type dogs are the most common cause of serious dog bite injuries in children and that bite injuries caused by pit bull–type dogs are more severe than those caused by dogs of other breeds. For example, a study by Golinko et al3 of 1,616 consecutive dog bite injuries found that pit bull–type dogs were implicated in half of all injuries requiring surgery and that these dogs were 2.5 times as likely to bite in multiple anatomic locations as were dogs of other breeds. Similarly, a study by Bini et al4 of patients admitted to a Level 1 trauma center with dog bite injuries found that attacks by pit bull–type dogs were associated with higher median severity scores, higher median hospital charges, and a higher risk of death than attacks by dogs of other breeds.

Although it is true that visual identification of dog breeds is often unreliable, most dog bites in young children occur while interacting with familiar dogs,3 which would tend to make breed identification more reliable and reduce the chance of witness bias. Various veterinary and animal organizations, including the AVMA,5 argue that the predominance of bite injuries caused by pit bull–type dogs may be attributable, at least in part, to the high prevalence of these dogs in certain neighborhoods and to owner factors such as a lack of training or socialization of the dogs. However, the scientific evidence indicates that breed itself is also an important factor.

To me, these frequent and life-changing attacks have become an urgent public health and safety issue. Therefore, I have been writing to key medical organizations encouraging them to collect breed data on dog bites that cause serious injury or death and to create educational materials for families when choosing a pet. In its information for families, the American Academy of Family Physicians currently advises that families “take time to learn about the breed of dog you want” and states that “aggressive dog breeds aren't right for families with children.”6 In that regard, pit bull–type dogs have been categorized as aggressive dogs.7 Given the predominance of pit bull–type dogs in reports of dog bite attacks and the reported greater severity of injuries caused by them, I believe that pit bull–type dogs are too dangerous to have as pets and pose a risk to owners' friends, neighbors, and visitors and to the general public. It is true that any dog can bite, but there are many other breeds that make wonderful pets and are much safer.

Laura E. Marusinec, md

Milwaukee, Wis

  • 1. Nolen RS. The dangerous dog debate. J Am Vet Med Assoc 2017;251:10941099.

  • 2. Safety Before Pit Bulldogs. Medical professional experts on treating victims of dog bites. Available at: safetybeforebulldogs.blogspot.com/2014/04/medical-professional-experts-on-pit.html. Accessed Nov 14, 2017.

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  • 3. Golinko MS, Arslanian B, Williams JK. Characteristics of 1616 consecutive dog bite injuries at a single institution. Clin Pediatr (Phila) 2017;56:316325.

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  • 4. Bini JK, Cohn SM, Acosta SM, et al. Mortality, mauling, and maiming by vicious dogs. Ann Surg 2011;253:791797.

  • 5. AVMA. Dog bite prevention. Available at: www.avma.org/public/Pages/Dog-Bite-Prevention.aspx. Accessed Nov 13, 2017.

  • 6. Information from your family doctor: preventing dog bites. Am Fam Physician 2001;63:15731574.

  • 7. Presutti RJ. Prevention and treatment of dog bites. Am Fam Physician 2001;63:15671573.

More on the dangerous dog debate

Regarding the recent JAVMA News story on breed-specific legislation,1 I have, for the past several years, been alarmed to see pit bull–type dogs portrayed as safe family pets. There are currently 2 websites—www.dogsbite.org and www.daxtonsfriends.com—that document fatal dog attacks by year in the United States, including links to supporting newspaper accounts, photographs of the dogs, and other records, and I have been impressed by the ongoing dedication of the founders of these websites to raising awareness of this issue. One thing I was not aware of prior to visiting these websites is that 40% to 50% of fatal dog bite attacks have involved trusted family pets that reportedly had not previously shown any signs of aggression.

Dog bites are a public health issue, and emergency room physicians are taking issue with the position that pit bull–type dogs and Rottweilers do not pose excess risk to the public. Ken Phillips, an attorney who specializes in representing dog bite victims and who is widely recognized as a leading authority on dog bite laws, takes issue with this position as well, stating on his website2 that “[t]he best solution would be to ban pit bulls and their mixes, as well as similar breeds such as Presa Canario, Cane Corso and others. …Pit bulls are the primary canine killers of people, and … are also the primary killers of other people's pets and horses, to the tune of 40,000 per year.”

Approximately 40 countries around the world and all US Military housing sites have breed bans or restrictions in place. Most breed-specific laws include provisions that allow current owners of affected breeds to keep their pets, generally with some restrictions. I personally believe that having owners comply with these restrictions or move to an area without breed restrictions is an acceptable price to pay for the life of even one child or pet.

Finally, I do not believe the AVMA should oppose breed-specific legislation in areas where it is needed to protect the public. I would encourage the AVMA to hold a forum on this issue, inviting emergency room physicians, dog attack victims, attorneys specializing in dog bite attacks, and concerned academics, along with practicing veterinarians and humane society representatives. Veterinarians and their staff members who handle these breeds and advise owners on their suitability as pets need clear information to protect themselves, their clients, and the public from injury and liability.

Patricia Partridge, dvm

Williamsburg, Mich

Further thoughts on diversity

I read the recent letter to the editor by Dr. John Parker1 and accompanying editor's note2 with interest. In my opinion, the topic of diversity in general and within the veterinary profession in particular is beset by a number of erroneous assumptions. For example, with regard to the high percentage of veterinarians who are Caucasian, I wonder whether it is possible that veterinary medicine is not exclusionary but simply not attractive to individuals of different groups. Not all cultural groups value animals the same. Additionally, given recent discussions on the high educational debt of graduating veterinary students, relatively low starting salaries, high rate of suicide among veterinarians, and increasing competition among veterinary practices, perhaps veterinary medicine is simply not as glamorous a profession to outsiders as we think it should be.

I believe Dr. Matushek also misses the mark in assessing the diversity of the veterinary profession simply with race. Diversity is multidimensional. Inherent aspects of diversity consist of our genetic makeup and biology. Acquired aspects of diversity include our life experiences, upbringing, perspectives, viewpoints, and passions. Every individual is unique, and there are an infinite number of permutations for the human race shaped by our cultural backgrounds, inherent interests, and strong devotions.

Within the veterinary profession, we have a diverse number of disciplines, such as small animal, food animal, equine, laboratory animal, research, academia, and military practice. We cover our nation from the largest cities to the most rural and remote outposts, and we have a diverse set of perspectives on topics such as animal welfare, euthanasia, alternative medicine, and the value of a veterinary education. But we have a deep commitment to our patients and to their human owners. We are committed to the veterinary oath and a higher calling.

So why don't we celebrate the diversity we actually do express, rather than dwell on that which we may not explicitly display? With an increasing understanding of human ancestry and genetic testing, we as a profession certainly have a much greater inherent diversity than meets the eye.

Robert B. Cherenson, dvm

Turlock, Calif

  • 1. Parker JS. Diversity concerns (lett). J Am Vet Med Assoc 2017;251:1124.

  • 2. Matushek KJ. Editor's note: diversity concerns (lett). J Am Vet Med Assoc 2017;251:11241125.

Editor's note:

Dr. Cherenson is quite correct that diversity goes well beyond race to also include gender, ethnicity, culture, and numerous other factors. In response to this wide array of factors, companies are now emphasizing diversity of thought as the new frontier for diversity.1 In simple terms, diversity of thought recognizes that, as human beings, we differ in how we think and solve problems and that, by harnessing diversity of thought, groups can enhance problem-solving, avoid group-think, and develop new insights. Importantly, diversity of thought is less about biological factors such as genetic makeup (what Dr. Cherenson refers to as inherent aspects of diversity) and more about how our thinking is shaped by our background, life experiences, and personality (what Dr. Cherenson refers to as acquired aspects of diversity). Yet, the problem remains that regardless of how diverse the veterinary profession currently is in terms of background, life experiences, and personality, the fact that the profession predominantly represents a single racial background means that we are missing a crucial segment of the potential diversity of thought and experience that exists, a segment that could be vital in helping the profession address and overcome the challenges it faces.

Dr. Cherenson is also correct that there are numerous barriers to entering the veterinary profession. But, I believe we would do ourselves a disservice by concluding that those barriers simply mean that the profession is not as attractive to others as we think it should be. We owe it to ourselves to examine the barriers that individuals of other races, ethnicities, and cultures face, and we owe it to the profession to work to remove them. Once those barriers are gone, then perhaps efforts to increase diversity will no longer be needed. But, we're not there yet.

Kurt J. Matushek, dvm, ms

Editor-in-Chief

1. Diaz-Uda A, Medina C, Schill B. Diversity's new frontier: diversity of thought and the future of the workforce. Deloitte Insights. Available at: dupress.deloitte.com/dup-us-en/topics/talent.html?icid=left_talent. Accessed Dec 5, 2017.

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One health and preventing disease associated with animals

I read with interest the “Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2017,” which was prepared by the Animal Contact Compendium Committee of the National Association of State Public Health Veterinarians.1 The materials covered are pertinent, well done, and a valuable addition to the scientific literature. All of the co-authors, their associated organizations and institutions, and the consultants to the committee have impeccable scientific credentials and excellent reputations.

However, I was chagrined to discover a glaring omission: the lack of any mention of one health. Given the current national and international recognition that the one-health approach is essential to nearly all, if not all, aspects of global public health—particularly as it relates to humans, animals, and the environment—and comparative medicine, it seems to me that one-health considerations should have been included and highlighted.

Recently, I responded to questions from the Pan European Networks about the progress that has been made in developing and implementing one-health approaches, the challenges the one-health approach faces, and some of the biggest recent developments in the field of one health.2 The article highlights, I believe, the considerable interest in one health and its high level of global recognition over the past few years.

Bruce Kaplan, dvm

One Health Initiative Sarasota, Fla

The authors respond:

Thank you for your interest in the “Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2017.”1 This version was the culmination of much work by our committee and consultants, aided by input from many stakeholders. We are proud of its utility as a resource that can be used to help prevent the occurrence of zoonotic disease in public animal settings.

Although used in the document to describe investigating and reporting zoonotic disease outbreaks, you are correct in your observation that “one health” was not a frequently used term in the document. We would, however, hold this publication up as a very pertinent example of one health in action. Preventing zoonotic disease in people who come in contact with animals in public settings requires the expertise of individuals with an understanding of animal health, human health, and the environments in which people and animals interact. The document provides the background and gives practical recommendations for dealing with this very important one-health issue.

As public health veterinarians, we welcome and applaud efforts to promote one health on a global stage. It is good to remember, however, that many, many people put one health into practice every day, whether a veterinarian counseling a pet owner on zoonotic disease in the exam room, a public health veterinarian consulting with a physician on a potential rabies exposure, or national committees working on recommendations to minimize zoonotic disease.2 Whether labeled one health or not, these everyday efforts also merit recognition as true examples of one health in action.

National Association of State Public Health Veterinarians Animal Contact in Public Settings Compendium committee

Russell F. Daly, dvm, ms (Chair)

Jennifer House, dvm, mph

Abigail Mathewson, dvm, mph

Kerry Pride, dvm, mph

Danielle Stanek, dvm

Mary Grace Stobierski, dvm, mph

  • 1. Daly RF, House J, Stanek D, et al. Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2017. J Am Vet Med Assoc 2017;251:12681292.

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  • 2. National Association of State Public Health Veterinarians. NASPHV Compendia. 2017. Available at: www.nasphv.org/documentsCompendia.html. Accessed Dec 6, 2017.

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A different approach to declawing

As alluded to in the AVMA policy on declawing of domestic cats,1 the traditional declaw procedure practiced by many veterinarians across the United States might better be referred to as digital amputation, rather than declawing. Many state legislatures and animal welfare groups are opposed to this procedure, and many veterinary colleges no longer include traditional onychectomy in their curricula.

In 1976, I developed an alternative declaw procedure that I call nail bed ablation and believe to be a substantial improvement on the traditional procedure. In short, with a nail trimmer, I remove all of the claw and most of the underlying ungual process and corium, but do not enter the distal interphalangeal joint or sever the flexor tendons, thereby retaining most of the third phalanx and allowing the cat to maintain a normal stance. I then use an electrocautery unit to destroy any remaining corium, deaden the nerve, and seal any blood vessels. General anesthesia is used, and most cats are discharged the same day without any evidence of limping or need for bandages, sutures, or an Elizabethan collar.

I estimate that I have performed > 2,000 declaw procedures in this manner over the past 40 years without notable complications. A small percentage (0.5% to 1%) of cats have regrowth of a single claw, but these claws are typically small and blunt. I will remove these regrown claws at no charge, but most of my clients forego this because no furniture damage can be done.

Kerry Yoon, dvm

Honolulu, Hawaii

1. AVMA. Declawing of domestic cats. Available at: www.avma.org/KB/Policies/Pages/Declawing-of-Domestic-Cats.aspx. Accessed Nov 30, 2017.

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