Surgical and Behavioral Relationships With Welfare

Abstract

Veterinarians perform surgery for a number of reasons, from treating a problem to preventing future problems. There is an inextricable link between the physical and psychological aspects of an animal's health, and surgery is often a conduit to bridge that gap. Some surgical procedures can affect an animal's behavior, such as castration, and some pose an ethical dilemma, such as ear cropping and declawing. Ameliorating pain, decreasing stressful experiences for the animal, and identifying and treating concurrent problem behaviors are hallmarks of improving animal welfare. The purpose of this article is to outline some of these interrelationships and ethical dilemmas, providing evidence-based verification as applicable.

Full text

REVIEW
published: 14 August 2020
doi: 10.3389/fvets.2020.00519
Frontiers in Veterinary Science | www.frontiersin.org 1August 2020 | Volume 7 | Article 519
Edited by:
Michelle Anne Kutzler,
Oregon State University, United States
Reviewed by:
Gabrielle Christine Musk,
University of Western
Australia, Australia
Maria Fahie,
Western University of Health
Sciences, United States
*Correspondence:
Melissa Bain
mjbain@ucdavis.edu
Specialty section:
This article was submitted to
Veterinary Surgery and
Anesthesiology,
a section of the journal
Frontiers in Veterinary Science
Received: 15 March 2020
Accepted: 06 July 2020
Published: 14 August 2020
Citation:
Bain M (2020) Surgical and Behavioral
Relationships With Welfare.
Front. Vet. Sci. 7:519.
doi: 10.3389/fvets.2020.00519
Surgical and Behavioral
Relationships With Welfare
Melissa Bain*
Clinical Animal Behavior Service, Davis School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
Veterinarians perform surgery for a number of reasons, from treating a problem to
preventing future problems. There is an inextricable link between the physical and
psychological aspects of an animal’s health, and surgery is often a conduit to bridge that
gap. Some surgical procedures can affect an animal’s behavior, such as castration, and
some pose an ethical dilemma, such as ear cropping and declawing. Ameliorating pain,
decreasing stressful experiences for the animal, and identifying and treating concurrent
problem behaviors are hallmarks of improving animal welfare. The purpose of this
article is to outline some of these interrelationships and ethical dilemmas, providing
evidence-based verification as applicable.
Keywords: animal, behavior, surgery, human-animal bond, medical, ethics, welfare
INTRODUCTION
Problem behaviors are often cited as reasons for relinquishment and euthanasia of companion
animals (1,2). While not often thought to correlate with behavior, behavioral effects of surgery
are commonly seen, but sometimes not fully understood. Surgery is a principal aspect of veterinary
medicine, whether performed to treat a medical condition, to lower the incidence of disease, or for
population control, and it is important to understand the impact that surgery has on the welfare
and behavior of an animal. The effects on the behavior and, subsequently on the human-animal
bond and welfare, should be taken into consideration when consulting with clients, either directly
via the outcomes from the surgery, or via changes to the animal’s behavior.
HISTORY
John Hunter (1728–1793) is credited as the founding surgeon in human medicine. Discoveries at
this time helped advance this area of medical care, with a primary focus on treating battlefield
trauma, progressing to the treatment of other medical problems unrelated to trauma. In the
veterinary medicine, however, advancements were not quite so quick. Until the 1920s, veterinary
surgery was mostly limited to neutering and wound repair. As an example, aseptic technique was
not utilized in large animal surgery until after World War II.
To demonstrate the rising importance of surgery in veterinary medicine, the American College
of Veterinary Surgeons (ACVS) was founded in 1965 (3). The ACVS is a specialty board recognized
by the American Veterinary Medical Association (AVMA) Boards of Veterinary Specialties and sets
the standards for advanced professionalism in veterinary surgery. Although there is a higher level
of training for specialists, all veterinarians are legally allowed to perform surgery. It’s uncertain
what percentage of all surgeries are performed by specialists compared to those performed by
veterinarians in general practice or in conjunction with shelter, rescue, or other organizations.
Given the greater number of veterinarians in general practice, and that veterinarians performing
up to 45–50 surgeries per day in shelters, it is likely that non-specialists perform more total
surgeries (4).

Bain Animal Behavior and Surgery
Understanding the inter-relationship between medical and
behavioral problems in animals has been a point of discussion
for a number of years. Some of the earliest documentation of this
relationship is in the area of feline inappropriate urination (5–
7). One of the earliest review articles of medical differentials for
problem behaviors was published in 2003 (8).
SURGERY PERFORMED FOR
UNDERLYING PROBLEM BEHAVIORS
Some surgeries are performed as emergency procedures related
to an underlying problem behavior. Examples include surgery to
treat a cat presenting for being hit by a car (transitioned to an
outside cat due to inappropriate elimination in the house), a dog
requiring multiple extractions of broken teeth from escaping its
crate (due to separation anxiety), or a dog requiring a gastrotomy
to remove rocks (due to pica). Others are performed to prevent
or “treat” problem behaviors.
Emotions often run high for clients when going to a veterinary
clinic for an emergency, as frequently they must make a
hurried decision about the healthcare of their pet. Effective
communication doesn’t need to take more time, but perhaps
takes a more concerted effort to overcome potential limitations
of not having a long-lasting relationship with a client (9). It
takes time for veterinarians and their staff to become culturally
competent to most effectively gather information, as well as
be comfortable asking open-ended questions to more efficiently
gather information. Informed consent plays a role in all aspects
of veterinary surgery, whether emergency or elective (10). It
is necessary, however, to be able to obtain consent in a more
truncated fashion in an emergency, where shared decision
making may not be at the forefront of the process. Training
in successful communication has received more attention in
veterinary schools as of late, and is listed as highly sought after
by veterinary employers (11).
These skills provide veterinarians with tools to investigate
how problem behaviors may play a role in the presenting
complaint, a skill in which veterinarians currently lack experience
(12,13). While it is important to provide urgent care, once
the animal is stabilized, veterinarians should investigate the
underlying reasons for the presentation. Although an individual
veterinarian, such as a veterinary surgeon or one who is
working in emergency and critical medicine, may not directly
address the underlying behavioral reason for surgery, they should
acknowledge the existence and offer resources for referral or
treatment. These resources can include referral back to the pet’s
primary veterinarian or to a veterinary behaviorist.
PERI-OPERATIVE PAIN MANAGEMENT
Surgery, by design, involves incisions and tissue manipulation.
These interventions cause discomfort at best, and intractable pain
at worst. Veterinarians are increasingly aware of the need to
identify and treat pain, but are often presented with challenges,
sometimes brought about by their underlying attitudes (14–
16). There are even some misconceptions on how different dog
breeds perceive pain (17). Aside from the concerns surrounding
ameliorating pain, one must also consider the role that pain plays
in problem behaviors (18).
Identifying pain in animals is a growing competency. Whereas
previously it was thought that some pain post-op helps keep
the animal quiet, thankfully these beliefs are changing. There
are different checklists and criteria by which veterinarians can
measure pain in animals (19). Even with these measurements,
there is sometimes a lack of agreement between veterinarians
when evaluating levels of pain (20,21).
Control of pain, whether related to an underlying
physiological condition or due to post-operative complications,
can be attained via a number of methods, and include
nonsteroidal medications, opioids, and local anesthetics, along
with other means such as physical therapy. Pain management
is the subject of an increasing number of research studies and
subsequent books and book chapters (22–24).
PERI-OPERATIVE BEHAVIORAL
MANAGEMENT
Behavioral management pre- and post-operative is also an
integral part of decreasing stress surrounding these procedures.
Many studies have demonstrated that animals exhibit stress-
related behaviors and undergo physiological changes related
to visiting a veterinary clinic (25–28). A study of dogs
undergoing elective spay and neuter surgeries, with appropriate
pain control, resulted in decreased interactive and exploratory
behaviors, increased cortisol levels, short-term lymphopenia and
eosinopenia, and long-term neutrophilia and monocytosis (29).
It is uncertain whether these results were related to incomplete
pain control or other stressors.
It is imperative that all staff in veterinary practices use
appropriate means to alleviate anxiety, aside from pain
control. These can include low-stress handling methods, playing
music, and suitable housing. This is an increasing area of
research, and many resources are available by which staff
can learn and practice these techniques (30–37). Effective
pharmacological interventions include trazodone, gabapentin,
and transmucosal dexmedetomidine, as well as the use of
pheromones (26,38–42).
Kenneling animals in a veterinary clinic can be another
source of stress. Kennels should be configured with the animal’s
physical and psychological comfort in mind whenever possible.
One should remove collars and harnesses prior to placing in
the kennel, as they can be choking hazards. If a cat is in a carrier,
the open carrier can be placed inside the kennel until the cat exits
the carrier, leaving the kennel in there as a hiding place for the cat.
All signs on the cage and notes in the medical record should
be heeded, and the animal’s behavior upon approach to the
kennel should be assessed. Depending on the level of waste, etc.,
kennels should only be spot-cleaned during a patient’s stay, and
its “furniture” placed back in the same locations as the animal
moved them. Of course, the kennel should be sanitized between
patients or if the level of mess is at a critical level. The same towel
and litterbox should be placed back into the cage if they are not
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Bain Animal Behavior and Surgery
dirty, to maintain a familiar scent. Animals should be provided
with a place in which to hide or hide behind, such as a box for a
cat or a towel covering the kennel door for all species, aside from
those that require 24 h per day observations.
Environment outside of the cage should also be managed.
Animals are sensitive to noise levels and can hear sounds outside
of our level of hearing. Keep noise levels to a minimum (<60
dB—quiet conversational level), and keep dogs away from cats.
Also, be sensitive when opening and closing cage doors as the
metal clanging is jarring. Music can be played to help block out
other sounds, but should be played at a quiet level. Studies show
a potential for classical music to have a calming effect on animals
(33,43–45). Cats prefer a much warmer environment than what
we prefer, between 35 and 38◦C. Offer cats large towels so that
they can burrow underneath, if desired, to help them maintain
their preferred ambient temperature.
Staff should educate clients on how best to perform specific
medical procedures required at home, both to prevent problems
from occurring, as well as to help owners perform procedures
when necessary. As examples, if owners are taught how to clean
out their dog’s ears, or how to give medications safely and
effectively, they will be more likely to give their pet appropriate
medical care. Depending on the medical or surgical procedure
performed, different handling techniques should be highlighted,
such as wound care, bandage changing, physical therapy, and
bladder expression. Overarching all of this is proper pain control
and medical management; if something is painful, no amount of
behavior modification or low-stress handling will help the animal
tolerate procedures.
Crate training prior to surgery can dramatically improve a
dog’s ability to cope with post-surgical confinement. Most dog
owners have heard of crate training, but may not know how to
effectively implement it. It takes time, effort, and patience, but
when used properly, it can be a positive experience for both
the owner and their dog. A dog cannot be expected to tolerate
being in a crate post-operatively if it had never been trained
prior, and if placed into a crate without behavior modification
ca exacerbate its anxiety (46). Resources are widely available,
including in veterinary behavior textbooks (47–49).
While it is ideal owners follow the recommendation for 100%
confinement post-operatively, this likely will not occur, and they
should be given explicit advice on how to interact with their
pet. Such instructions can include the proper use of a sling to
help a dog walk, safe ways to carry a pet, and what collar and
leash to use. They should be given assorted ideas on how to
safely provide for low-activity mental exercises, including food
puzzle and toys and training exercises, such as the Protocol for
Relaxation1(50).
BEHAVIORAL TREATMENT OF
UNDERLYING PROBLEM BEHAVIORS
It is critical to address the underlying problem behaviors
associated with the condition for which an animal requires
1Available online at: https://championofmyheart.com/relaxation-protocol-mp3-
files/
medical care. Many textbooks provide veterinarians with detailed
information on diagnosing and treating a myriad of problems
(47,48,51).
As is the case in all areas of veterinary medicine, it is important
to have a correct diagnosis in order to properly treat behavior
problems (52). In one study of urine marking cats, almost a
third of veterinarians did not meet the criteria of correctly
diagnosing urine marking. Of those that did not mention the
classic symptom of vertical urine marking, only 10% said that
they had success in treatment (53).
Treating problem behaviors can be summarized in a “Five Step
Treatment Plan.” These steps include management, relationship
building, behavior modification (including desensitization and
counterconditioning), tools, and pharmaceutical and other
therapeutic treatments. While listed separately, they often
overlap one another when one develops a treatment plan (54).
Management includes avoiding the trigger that causes the
animal to either be placed into an undesirable emotional state,
such as anxiety or fear, or display the unwanted behavior. Each
time that the animal is in this situation it is then fearful or
anxious. It also allows the animal to “practice” the behavior.
An example of management is covering the front windows to
prevent a dog from seeing passersby, thus, decreasing its barking
behavior. Avoidance is also a safety recommendation, as a dog
cannot be placed into a situation where it feels that it “needs” to
bite someone.
Relationship building is a broad category covering educating
the owner on an animal’s emotional state (and the behavioral
signs that signal such states), proper training techniques, and
utilizing cues to teach an alternative behavior in a predictable
and humane way. Some parts of this step can include: “Say
Please” in which an animal is asked to perform a cue before a
desired reward; and teaching cues that one can use to redirect
in the future, such as “look” or “target.” A significant portion of
this step may be spent refocusing the owner from using harsh
punishment-based training techniques that can instill fear and
anxiety in animals which increases the likelihood of a problem
behavior surfacing.
Behavior modification is primarily focused on systematic
desensitization and counterconditioning (DS/CC) toward the
trigger that causes the animal to feel distressed and display
unwanted behaviors (55). This is a process in which a conditioned
emotional response (CER) such as fear is extinguished by
exposing the animal in a graduated manner to the fear-eliciting
stimuli, and replaced with an alternative, competing response by
pairing it with an eliciting stimulus that will trigger an opposing
emotional or physiologic response. When creating a program for
systematic DS/CC, a stimulus hierarchy is created which ranges
from a level that elicits no discernable response to a level that
elicits an extreme response. The animal is exposed to the first
step in this hierarchy, where it shows a very mild response, such
as noticing that the trigger is present, until the mild response
is no longer being displayed. Once this occurs, the animal is
exposed to the next step on the stimulus hierarchy. All the while
the animal is presented with something that will change the
emotional response to one that is favorable toward the trigger,
such as a high-value treat.
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For example, a show cat may need to be bathed and dried
prior to a show. If the cat is afraid of the sound of the blow
dryer, the sound of the dryer can be paired with a favored food,
which elicits pleasure. It is even more beneficial if the cat never
gets this favorite food unless it is going through desensitization
and counterconditioning. Counterconditioning occurs only if the
new eliciting stimulus triggers a response powerful enough to
supersede the original CER. If the cat is extremely afraid of the
sound of the dryer, it is very likely that it will not eat in the
presence of the blow dryer. By minimizing the intensity of the
original conditioned stimulus, the new eliciting stimulus is likely
to be salient enough to overcome it.
Tools are such products that are used to help implement
management, relationship building, and behavior modification.
Such tools include: muzzles, baby gates, and hiding places
for cats (for management); clickers, treats, and toys (for
relationship building); and leashes, harnesses, and treats (for
behavior modification).
Pharmaceuticals and other therapeutic treatments are
often needed to treat underlying anxiety that is hindering
the effectiveness of behavior modification. Medications by
themselves are not the answer, similar to how antibiotics are
themselves not the answer for treatment of a cat bite abscess.
Foundations of pharmaceutical interventions include quick-
to-onset anti-anxiety medications, such as benzodiazepines,
trazodone, gabapentin, and clonidine, and longer-to-onset
medications, such as selective serotonin reuptake inhibitors
(SSRIs) and tricyclic antidepressants (TCAs). Other therapeutics
include pheromones, nutraceuticals, and special diets (56,57).
There are specific behavioral treatments for the disorders for
which surgical treatments have been suggested. Management,
behavior modification, and perhaps the use of psychoactive
compounds are the hallmarks of treatment for aggression, urine
marking, barking, and scratching behaviors or, more specifically,
the underlying reasons for these problems (58–60).
ELECTIVE SURGICAL PROCEDURES AND
ANIMAL BEHAVIOR
Castration and
Ovariectomy/Ovariohysterectomy
Americans have been enculturated over the past number of
years that one must neuter companion animals to prevent
unwanted litters. The current estimate is that a high percentage
of dogs in the United States are neutered and, even though there
are recent shifts toward later neutering, it is often performed
prepubertally, prior to 6 months of age (61). A survey of
veterinarians in New York state demonstrated that 70% of
veterinarians routinely recommend neutering for all dogs and
cats, while roughly 35% believed that client-owned animals
should not be neutered until at least 6 months of age (62). There
are different attitudes toward neutering in other countries. As
an example, roughly 15% of veterinarians in the U.K. believe
that pre-pubertal neutering is not desirable, compared to roughly
8% of veterinarians in Australia and New Zealand (63). Reasons
veterinarians give for neutering, especially at a young age, include
the prevention of mammary and prostate cancers in females
and males, respectively, that it prevents or helps decrease the
chance of problem behaviors in dogs, and that it decreases pet
overpopulation. The AVMA has a policy supporting pediatric
spay and neuter of dogs and cats to reduce the number of
unwanted animals, stating “veterinarians should use their best
professional judgment based on the current scientific literature
in deciding at what age spay/neuter should be performed on
individual animals”(64). This in contrast to the British Small
Animal Veterinary Association, which while recommending it
for population control, states “Before neutering for reasons of
undesirable behavior it is important to consult a veterinary surgeon
or animal behaviorist to ascertain the role of sexual hormones in
the development and maintenance of the behavior (65).
There is conflicting research on the potential positive,
as well as harmful, outcomes from neutering. Veterinarians
frequently cite the prevention of mammary gland cancer as
a reason to spay dogs. However, a recent meta-analysis of
published studies found that the link between ovariectomy
in females and mammary cancer is weak at best (66). The
link between castration and prostate cancer in dogs is even
weaker, with some research showing an increased risk of this
cancer in castrated dogs (67,68). Aside from these medical
conditions, more research is emerging on the potential negative
effects of these surgeries. Increases in other types of cancer
(osteosarcoma, hemangiosarcoma, lymphosarcoma, and mast
cell tumors), orthopedic disease, immune-related disorders, and
urinary incontinence are reported (69–77).
Sexually dimorphic behaviors are defined as those
predominantly seen in one sex or another, and many are
associated with reproduction or mate attraction. These behaviors
are more strongly affected by castration. Castration usually
abolishes overt sexual behavior in males, except for the more
experienced the male, the longer mating behaviors persist (78).
The effect of castration on cat behavior can be quite dramatic.
Fighting, roaming, and spraying are markedly reduced or
eliminated in 80–90% of cats, usually with a rapid decline (79).
There is no evidence of a relationship between age at time of
castration and persistence of these behaviors, and neutered cats
can still display these behaviors. Of castrated male cats, 10% are
reported to be problem urine markers, while 5% of spayed female
cats are reported to be problem urine markers (80).
Castration’s positive effects on dog behavior are not to
the extent seen in cats. Most improvement is seen in urine
marking, mounting, and roaming behaviors, all of which
are predominantly sexually dimorphic behaviors. There are
additional behavioral reasons for these behaviors. As with cats,
urine marking can be a symptom of an underlying anxiety-related
disorder. Unrelated to sexual behaviors, mounting behaviors can
continue as way of social communication or in a display of hyper-
arousal in castrated dogs. Roaming behavior, which is related
to mate-seeking behavior, can also be due to escape behavior, a
symptom of separation anxiety in dogs. As with cats, there is no
evidence of relationship between age at time of castration and
persistence of these behaviors (81).
There is conflicting evidence on the effect of neutering on
aggression in dogs. One paper demonstrated there was a decrease
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in aggression toward people and dogs after castration (81).
However, another study found castrated dogs were no less likely
to demonstrate aggression (82). Results from a paper evaluating
the effects of gonadectomy in Viszlas were that the younger
the age at gonadectomy for males and females, the earlier the
mean age of diagnosis of a behavioral disorder (83). Results from
another paper concluded that there was an increase in the odds of
aggression toward unfamiliar people for all gonadectomized dogs
compared with intact dogs. They determined this effect primarily
seen in dogs gonadectomized at 7–12 months of age (82).
Ovariectomy usually abolishes sexual behavior in females.
Alternatively, there is evidence that ovariectomy is correlated
with an increase in aggression. One study demonstrated that, if
a dog already displayed aggression as a juvenile, if spayed at <1
year of age, there was an increased chance of aggressive behaviors
(84). The results of another study showed increased reactivity
in spayed German Shepherd Dogs compared to those that were
intact (85).
One must differentiate an ethical choice to neuter for pet
population control, from a welfare choice for positively, or
negatively, affecting an individual animal’s welfare, which are
both separate from the choice to neuter for the owner’s benefit.
While benefits of castration for cats are more conclusive,
aside from population control, there is no definitive single
recommendation for whether or not to neuter dogs, or at
what age, and owners should make an educated decision after
discussion with their veterinarian.
Tail Docking (Amputation)
This procedure, amputating the distal portion of the tail, is
“traditional” for certain breeds, such as hunting breeds and
terriers. Reasons cited to have the tail docked include the
potential to prevent injuries and to be able to more easily
pull a terrier out of the ground when hunting (86). In some
circumstances, the breeder will dock the tails, while other times
a veterinarian will do it, and it is usually performed within a
few days of birth. In Australia, the procedure is regulated and
“. . . should only be carried out in respect of those breeds with a
known history or propensity to injury and/or damage in their
tails in the course of their normal activities for therapeutic and/or
prophylactic purposes. . . ” (87). Some states have also regulated
this procedure (88). National veterinary medical associations
also have position statements about cosmetic surgeries, including
the statement from t he AVMA which “. . . opposes ear cropping
and tail docking of dogs when done solely for cosmetic purposes.
The AVMA encourages the elimination of ear cropping and tail
docking from breed standards” (89,90). And one large veterinary
corporation has banned the procedure for cosmetic reasons (91).
A survey conducted in Australia found that 75% of
veterinarians believed that tail docking causes significant to
severe pain, with none believing that dogs do not experience
pain during this procedure. In contrast, roughly 80% of breeders
believed that puppies experienced either mild or no pain (92).
While there should be no argument that this procedure is painful,
as part of the tail is amputated, it is uncertain for how long
the pain lasts. One paper suggests that the pain experienced is
relatively short-lived in dogs undergoing tail docking, and that, at
the time of publication, only 10% of veterinarians used analgesics
(93). While there are limited studies in dogs, there is evidence
of behavioral and physiological responses to pain in production
animals undergoing tail docking procedures (94). There are
also behavioral effects from this procedure. Dogs showed more
cautionary behaviors toward a short-tailed dog. The hypothesis
is that it may be more difficult for the dog with the docked tail to
signal appropriately to other dogs (95).
There is some evidence that dogs with intact tails are more
likely to sustain injury to the tail compared to dogs whose tails
were docked (96,97). However, another study demonstrated that
only three out of 2,000 visits to an emergency clinic in Australia
were due to tail injuries; all three of these were due to post-
docking complications (98). Currently, there is no evidence that
pain due to tail injuries of dogs with complete tails is worse
or more difficult to manage than the potential for chronic pain
from tail docking. Therefore, one should weigh the pain from an
unlikely injury against certain pain from tail docking.
There are flawed arguments in favor of tail docking in dogs.
The most flawed one is in favor of tradition. Arguments in favor
of tradition reflect an inherent sense of superiority of humans,
and a disregard for the status of dogs in our society, especially as
we have transformed from an agrarian to more urban society. If
tail docking is done to prevent unlikely injuries incurred while
hunting, we should ask the question: what is the likelihood for
a particular dog to actually hunt? Given these weak arguments,
there is little evidence to support the continued practice of
tail docking.
Ear Cropping (Cosmetic Otoplasty)
Ear cropping is a procedure in which the external pinna is
reshaped to obtain an erect ear, usually performed when a dog
is roughly 2–3 months of age. It is considered breed standard
for some breeds, such as Doberman Pinschers and Great Danes.
While breed clubs within the American Kennel Club (AKC)
determine whether or not breed standard include cosmetic
alterations via ear cropping or tail docking in order to show
a dog in an AKC trial, owners of dogs with natural ears and
tails report discrimination against them, as they are infrequently
selected as winners (99,100). Some states regulate ear cropping
so that a licensed veterinarian must perform the procedure;
Washington prohibits the procedure except when it is considered
a customary husbandry practice (88). As with tail docking, some
national veterinary medical associations have position statements
against ear cropping in dogs, especially if done solely for cosmetic
reasons (89,90). As with tail docking, one large veterinary
corporation has banned ear cropping for cosmetic reasons (91).
One erroneous argument made for ear cropping is to prevent
illnesses and injuries in spaniels, terriers, other hunting dogs, and
dogs with pendulous ears; however, there is no evidence to back
up these claims (101). The etiology of otitis is related to many
factors, including allergies, and breeds historically shown with
cropped ears are no more likely to be diagnosed otitis (102–104).
There should be no argument that this surgical procedure causes
pain. As with tail docking, people will provide the argument
in favor of “tradition” to support the continued practice of ear
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cropping. Given these weak arguments, there is little evidence to
support ear cropping.
Devocalization (Ventriculocordectomy)
Ventriculocordectomy is the partial or complete surgical removal
of the vocal folds to reduce the volume of a dog’s bark. Dogs
still “bark,” and if not prevented from vocalizing post-op, are
able to regain the ability to produce some sound. This surgical
intervention does not address underlying reasons for barking,
such as anxiety, social facilitation, aggression, and stereotypies,
as well as being a more breed-typical behavior (105–107).
Treating only the symptoms of any problem can actually increase
behavioral and physiological stress, as evidenced in research
performed on the use of anti-bark collars (108). The results
of this study demonstrated that, while both electronic and
citronella spray bark collars decreased barking, dogs wearing
either collar had an increase in plasma cortisol. Another study
demonstrated behavioral and physiological (salivary cortisol and
heart rate) responses to an electronic shock collar (109). As
with other elective procedures, veterinary organizations have
published position statements and white papers on this subject.
The AVMA policy states that “Canine devocalization should
only be performed by qualified, licensed veterinarians as a final
alternative to euthanasia after behavioral modification to correct
excessive vocalization has failed and after discussion of potential
complications from the procedure with the owner” and has a
literature review supportive of this (110,111). Some states
passed various laws limiting or banning this procedure, including
Massachusetts, Rhode Island, and Ohio (88). As with tail docking
and ear cropping, one large veterinary corporation has banned
devocalization (91).
Owner factors come into consideration when veterinarians are
presented with a dog for devocalization. Until a bill was passed in
2012, landlords in California were allowed to require that a dog be
devocalized as a condition of leasing (112). There may be pressure
from neighbors to have their dog stop barking, sometimes
resulting in tickets and fines from municipalities. Owners are
faced at minimum with continued judgement and coercion, and
at the gravest, pressure to relinquish or euthanize their pet. While
treatment options exist for the underlying reasons for barking,
some owners may find it difficult to adhere to the treatment
recommendations. As such, the decision to devocalize or not
turns into not only a welfare issue, but also an ethical dilemma,
with devocalization balanced against potential relinquishment
or euthanasia.
Dental Procedures
Procedures range from vital pulpotomies, which is an endodontic
procedure of capping only the canines or all of the teeth, to
extracting only canine teeth, to extracting all of the teeth (113).
Each of these procedures has the potential for a negative outcome,
from failure of a crown resulting in a fractured tooth, to failure of
a vital pulpotomy, resulting in an infected tooth root (114).
When these procedures are performed to “treat” aggression
and prevent injury, it gives a false sense of security, as these dogs
still can bite and cause crushing injuries. It does not eliminate
the underlying motivation for aggression. If the animal is placed
into a situation in which it feels that it must bite, its welfare is
negatively impacted.
National veterinary organizations and specialty organizations
have provided policy statements on such procedures. The AVMA
is “opposed to removal or reduction of healthy teeth in nonhuman
primates and carnivores, except when required for medical
treatment or approved scientific research” (115). The American
Veterinary Dental College supports the removal of crowns of
teeth in selected cases where other corrective measures have
failed, but also states that the removal of teeth will not prevent
injury (116). As there is, at best, little safety benefit, weighed
against the pain and other negative outcomes, to having these
procedures done, they should not be performed.
Declawing (Onychectomy)
Onychectomy is the surgical removal of the P3 phalynx, done to
prevent the ability of a cat to damage the environment or injure
people or other pets. Anecdotally it is estimated that up to 24%
of cats in the United States are declawed (117). In a study on
scratching behavior in cats, 52% of cat owners reported their cat
to inappropriately scratch in the house; 65% of these cats reported
their cat to inappropriately scratch at least daily. Respondents
excluded from this study included those who owned declawed
cats; of those owners, 45% chose to have their cat declawed to
prevent damage, and 27% to prevent injury to people or other
pets (118).
Feline rescue organizations and shelters historically have
promoted the idea that declawed cats have a higher likelihood of
being aggressive or eliminating inappropriately. Research into the
circumstances surrounding declawed cats in shelters did not bear
the same results (119). There were significantly fewer declawed
cats in the shelter studied than would be expected based on the
population at large. Where only 9% of the sheltered cats were
declawed, it is estimated that 24% of the feline population at large
at the time of the study were declawed. Additionally, there were
fewer cats in the shelter reported to bite compared to population
at large. Declawed cats also were no more likely to be euthanized
at the shelter compared to cats that were not declawed; however,
declawed cats stayed at the shelter longer. Owners surveyed
after the procedure stated that they were generally satisfied
or very satisfied with the procedure, and evidence of negative
outcomes on behavior is limited (119–123). These numbers could
be influenced by bias on the owners’ part, as they elected to have
their cats declawed.
It should come as no surprise that evidence shows declawing
causes pain in cats, in part due to a number of surgical sequelae
including retained bone fragments, osteomyelitis, excessive tissue
handling during surgery, and complications from bandaging
(124). While pain is an expected outcome of any surgery and
should be ameliorated appropriately, there is evidence that there
is short- and long-term pain due to onychectomy (124–129).
Behaviors indicative of pain, such as forepaw shaking and laying
on their side, were seen in cats that were declawed compared
to those having a sham procedure performed (125). Although
veterinarians provide pain control post-operatively, it does not
seem to have a substantial immediate positive effect on a cat’s gait;
however, in one study (130), their gait was considered normal
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Bain Animal Behavior and Surgery
by 6 months (130–132). In another study, more cats were non-
or limited-weight-bearing at discharge in control cats than in
cats that received butorphanol post-operatively. By the second
day, there were no differences between owner-assigned lameness
scores (133).
Surgical methods and adherence to appropriate technique
affect the outcome for declawing, as with all surgeries. A recent
study demonstrated that 63% of cats had radiographic evidence
of P3 remnants, and this was most highly correlated with back
pain, periuria, and aggression (128). These results were seen far
out from the surgery date. Other studies demonstrated that there
were fewer negative welfare outcomes in cats in which a CO2
surgical laser was used (127,134). Another study demonstrated
that cats that underwent an onychectomy compared to a
tendonectomy showed evidence of more pain and short-term
behavioral changes (135).
Veterinarians have an evolving view on declawing. Two
separate studies of veterinarians in Canada and the United States
came to similar conclusions. Results included ∼75% of
veterinarians performed this procedure, most of them after
counseling the owners about alternatives. Of these veterinarians,
60% of them performed the procedure less than monthly and
between 10 and 15% performed it at least weekly (136,137).
There are alternatives to declawing to prevent injury to
people or other animals, or damage to the household. Physical
alternatives include nail trims and nail covers (138). The
benchmark of treatment includes behavior modification and
environmental management, such as providing appropriate
outlets for scratching and other species-typical behaviors and
needs, preventing access to objects that one doesn’t want
scratched, and addressing the underlying reason for aggressive
behavior (60,118,139–144).
As with procedures mentioned previously, some national
veterinary organizations and other animal-related organizations
have published policy statements on declawing (145,146). The
Canadian Veterinary Medical Association “opposes elective and
non-therapeutic Partial Digital Amputation (PDA), commonly
known as declawing or onychectomy, of domestic cats” (146). The
AVMA published a detailed literature review that summarizes the
pros and cons of this procedure, as well as outline alternatives
(147). The Cat Fanciers’ Association and The Canadian Cat
Association do not allow declawed cats to be shown in sanctioned
shows (148,149). And most recently, three large veterinary
corporations have banned elective declawing surgeries (150).
Some municipalities, and even some countries, have banned
this procedure (88,151–153). Until a bill was passed in 2012,
landlords in California were allowed to insist that a cat be
declawed as a requirement for leasing (112).
Despite declawing performed not infrequently, and despite
the research on this procedure producing equivocal results if
performed correctly with appropriate pain control, there is no
direct benefit to a cat to be declawed, other than potentially
remaining in the household and not being relinquished or
euthanized for problem scratching behavior.
SUMMARY
Veterinary medicine is more than the sum of its parts. It is not
medical OR behavioral, it is treating an animal as a whole; these
boundaries blur as we understand more their interrelationship.
With this knowledge, it remains imperative for veterinarians to
understand the potential behavioral consequences of surgery,
and understand the underlying motivations for problem
behaviors in pets. It is also incumbent amongst veterinary
professionals to be champions for the welfare of the animal,
and be able to communicate those points to owners and
the public.
AUTHOR CONTRIBUTIONS
The author confirms being the sole contributor of this work and
has approved it for publication.
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Conflict of Interest: The author declares that the research was conducted in the
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