JAVMA Gives A Platform to AVMA Vet Who Claims Declaw Method is Painless and Uses No Pain Meds

Story published in 2017.

UPDATE, Jan. 2023.  Dr Kerry Yoon retired and this clinic, Hawaii Kai Veterinary Clinic no longer performs declawing.

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Because the method described by Dr. Yoon preserves the flexor process of the third phalanx and the attachment of the flexor tendons to this process, it may, theoretically, provide some benefits over procedures that involve removal of the third phalanx in its entirety. However, outcomes of this procedure, particularly long-term outcomes, still need to be studied. —- Kurt J. Matushek, DVM, MS, DACVS
Editor-in-Chief | Journal of the American Veterinary Medical Association (JAVMA)

Comment was made in an email to me after I emailed JAVMA asking them about this Letter to the Editor. Full email posted at the end of this story.

Please take 20 seconds and sign my petition to the AVMA.  AVMA petition

History repeating itself.

It is now common knowledge within the veterinary community that declawing a cat involves the amputation of the last bone of each toe. Recent evidence has raised serious questions about the true effect on the cat, both physically and mentally.  Pain and undesirable behavior may result. This surgical procedure can contribute to a clinic’s revenue so it is understandable that an alternative, less harmful procedure may be desirable as Dr. Kerry Yoon claims to have invented.

However, what Dr. Yoon has described is a partial amputation of the P3 digit, which has been in practice since the 1950s. By his own admission through email correspondence and his own constructed figure, a portion of the P3 bone is cut or crushed with nail trimmers.

The only difference is the use of electrocautery to stop bleeding and destroy a portion of the dermal claw bed.

It is disappointing that the AVMA’s journal, JAVMA,  has given him a platform to continue supporting the idea that cat claws need to be removed at all.

The most concerning claim, that was removed from his original JAVMA letter to the editor, is that this surgery is painless and he doesn’t use any pain meds.

His “thousands” of patients have NOT received pain management after this partial amputation procedure.

In my opinion this is unconscionable.

Pain management for all surgical procedures is the standard of care in the developed world for all patients, human and animal.

IN THE 11TH HOUR OF THIS STORY, DR YOON SENT ME THIS. “After conversing with Dr Nicole, I’ve decided it wouldn’t hurt to add postoperative pain medication to my protocol . You can print this too.”

(Dr. Moran is a veterinarian that has been involved with cat research involving anatomy, pathology and management of declawed cats since 2013.  This work includes surgical salvage procedures, pain identification and management along with publishing a study in the Journal of Feline Medicine and Surgery on pain and adverse behaviors associated with declawed cats.)

I received this email from Dr Yoon on January 30, 2018

“Hey Lori- strangest thing- recently I’ve gotten dozens of inquiries about my method, all very supportive, saying that after reading MY article, they believe it’s painless  (NO limping at all post op) and take my word over an animal rights activists.
My appointments are booking up! You must have just put the article online recently. Thank you very much for advertising for me!
PS-the input is that people can see the bias and slanting of your side comments.”

 

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PLEASE SIGN MY PETITION TO THE AVMA TO INSPIRE THEM TO DECLARE DECLAWING BELOW THE STANDARD OF CARE! [button href=”https://www.change.org/p/avma-make-declawing-below-the-standard-of-care” newwindow=”yes”] PETITION TO THE AVMA[/button]

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“I would rather just totally retire and travel, but feel compelled to continue my unique  painless method as a public service to my community and living up to the Hippocratic medical oath I took in vet school,” Dr Kerry Yoon, member of the AVMA for 48 years, December 14, 2017.

Many of you sent me a heads up over the last few years about a vet in Hawaii who claims to have a completely painless cat declawing procedure. [button href=”https://www.painlesscatdeclawinghawaii.com/painless-cat-declawing-procedure” newwindow=”yes”] Dr Kerry Yoon’s “Painless Cat Declawing” website[/button]

UPDATE ON JANUARY 30, 2018. Dr Kerry Yoon’s Painless Declawing website has been taken down. You can still view it on google cache by clicking on this link and then clicking on “go to link” [button href=”https://webcache.googleusercontent.com/search?q=cache:WLHPz_DYvD4J:https://www.painlesscatclawremovalhawaii.com/%3Flightbox%3Di0goy+&cd=5&hl=en&ct=clnk&gl=us&client=safari” newwindow=”yes”] Dr Kerry Yoon Painless Cat Declawing Procedure[/button]

I decided to look into this and do a story. I asked Dr Kerry Yoon many questions about his procedure and he also gave me 3 contacts of some of his clients that he wanted me to reach out to about their cats that had this “painless” procedure. Only one of them returned my call and gave me information that is at the end of this story.

At first Dr Yoon asked me to call his procedure, “Permanent Deep Nail Trimming” instead of “ Non-AMPUTATIONAL Declawing” because he said he has encountered so much stigma associated with the word declawing for years and people have a difficult time understanding the difference. But then he said he would like me to call his painless method, “Nailbed Ablation.”

He uses a small “cat” size Rescoe guillotine clipper to peform this amputation.

Dr Yoon sent me this photo and said, “White line shows where I cut- basically a coriumectomy and NOT a P3 phalangectomy( amputation)!” 

Here is a diagram of a cat’s toe bone, (P3). Dr Kerry Yoon confirmed that the broken blue line is where he uses his Rescoe clipper to amputate part of the cat’s toe bone. The red line shows the root of the conrnified claw sheath where the nail originates.

 

So here is more about Dr Kerry Yoon’s “Claw Removal by Nailbed Ablation – a Painless Method” procedure in his own words. He wanted me to post this word document that he sent me, so I am.

The first part, without the addendum, is the letter to the editor that he sent to JAVMA and they published their own edited version it in the January 15, 2017 issue. The JAVMA edited version is in a photo below.

” Non – AMPUTATIONAL Declawing Method

            First of all, as a point of clarification, the traditional method that is still taught in many veterinary schools and practiced by all the veterinarians in the country should more correctly be called “DIGITAL AMPUTATIONS” instead of “declawing”.

            Cats are wonderful, playful and affectionate companions, who by nature like to explore, play, and unfortunately because they are tree climbers, like to scratch the furniture and in some cases, endanger the lives of owners that are diabetic, on blood thinners, or immunocomprimised. They also live longer being totally indoors as they will not get run over by cars, get into cat/dog fights, pick up internal/external parasites or fatal diseases.

            So, if an owner chooses to have their cat’s claws permanently removed, the only option has been a painful cruel method of amputation that many state legislatures and animal welfare groups are up in arms over. Over half of the veterinary schools have dropped ONYCHECTOMY, as the amputation method is called medically, from their curriculums.

            In veterinary school I took an oath to “prevent and relieve animal suffering” so in 1976 I invented a true painless declawing procedure that totally eliminates the postoperative pain associated with the traditional amputation method. No pain medication needs to be given and the patient goes home the same day with NO LIMPING, NO STITCHES, AND NO BANDAGES.

DESCRIPTION OF AMPUTATION METHOD:

            A cat’s toe is much like our finger with three joints – the knuckle, the midfinger, and the joint just above our nail. The five flexor tendons from the muscles of the forearm attach to the last fingerbone – this allows cats to walk on their “tippy toes” giving them the suspension system for their incredible springiness. The traditional amputation method actually severs the tendon attachment where cats lose their tippy-toe suspension and walk flat footed. When they jump down from heights, their feet take a beating and may develop arthritis over the years prematurely. The last fingerbone with the claw (nail) is cut off AT THE JOINT and the skin has to be stitched over the exposed joint bone. Do you think a cat will not want to chew the stitches out?

DESCRIPTION OF MY NAILBED ABLATION METHOD:

            I use a certain type of nail trimmer and an Electricator (electrocautery) unit. I then trim all of the claw and most of the quick tissue from the last bone, not touching that last joint of bone. The flexor tendons are NOT severed and left intact. I then use my Electricator to kill the tiny piece of quick tissue that is left in the last finger bone, deaden the nerve and seal the blood vessel at the same time. There will be tiny little scabs on the tips of their toes that will fall off in 2-3 weeks. No home medication needs to be given and regular kitty litter can be used.

            General anesthesia is used and anesthetic and surgical time is short (10-20 minutes) depending if 2 paw or 4 paws are done; and the 4 fangs can be filed down 1/3 of their length and blunted for those cats that playfully bite and little too hard!

            I have performed over 2000 nailbed ablations (not true declawings) over the past 40 or so years and approximately .5-1% of my patients may have had a single regrowth which will look like 1/3 the size of a BB and blunt. I will operate at no charge, but most of my clients forego it because no furniture damage can be done.

            Surgeries are done on Fridays and pickup is the same afternoon.

Kerry K. Yoon DVM
Tuskegee Institute School of Veterinary Medicine 1970
Angell Memorial Animal Hospital Internship 1970-1972
Started my own solo practice in 1974
Current Hawaii State Veterinary License #VE79
Current member of the American Veterinary Medical Association
Past president of the Honolulu Veterinary Society
Past president of the Hawaii Veterinary Medical Association
Owner of two sibling Siamese cats that I’ve 4 paw declawed

ADDENDUM

            Specifically, the sterilized nail trimmer that I use is called a Resco Guillotine action sharpened razor sharp and having a very narrow oval opening that is not made anymore. I find it cuts much cleaner and more accurately than surgical bone cutters or a Gigli saw. I am removing only the nailbed portion from the top (dorsal) non-weight bearing surface of P3 (the last fingertip phalanx bone) and not the bottom (ventral) weight bearing surface of the last bone. Technically, this method could be called a “partial bony amputation” if one has to classify it, but bottom line, the joint and majority of the weight bearing and ground contacting part of the last bone is untouched, otherwise pain and complications with ensue.

            I am using three fingers as a tourniquet on each toe to prevent any bleeding when I remove each nailbed. I then apply a fine tipped electrocautery instrument that ablates (destroys) the small remaining nailbed remnants deep within the last bone (otherwise nail regrowth will occur), seals the tiny artery from bleeding and dessicates and vaporizes the raw sensory nerve endings to permanently stop any pain impulses from reaching the brain (like permanent nerve block). A board certified neurologist did confirm this fact. The area that I electrocauterize is a thin red line approximately 1mmx4mm. It’s rare to see even slight bleeding, as over the years I’ve learned what power setting, duration, and location to apply my fine tip electrocautery instrument for optimum results.

            The traditional method of declawing is an amputation of the entire last bone at the joint (medically called a phalangectomy) that is known to be the one of the bloodiest, along with ear cropping, elective operations that veterinarians perform, and have the most post operative complications. Most vets cringe and shy away from doing this so many in my state of Hawaii would rather refer to me. There are a few that still do the total amputation method and claim there’s no pain but do send home pain medication.

            Bottom line, all the 2000 plus patients that I’ve done all their owner’s report to me on my post op follow up calls that they are amazed that they see no difference in walking, running, or behavior from before and after my procedure. This is without any pain medication. I’ve had clients tell me they’ve had another cat done by total amputation (phalangectomy) by another veterinarian, then got another cat and did my method, and all tell me that my method is unbelievably painless.

            Whose testimony is more accurate and believable in the painlessness of my method than the actual owners who see their cats 24 hours a day and know their every normal behavior, rather than several animal rights groups that I’ve run across (I can’t say who) that are so closed minded to accept the fact that it’s impossible that a painless, humane method exists? And that their veterinary advisors say it’s impossible to be painless by just drawing from book knowledge and not having any actual clinical trials with my with my revolutionary unheard- of method or visually seen how painlessly they walk just after my procedure. I would call that “jumping to conclusions”.

The decision is yours.”

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Here is his letter to the editor that was edited by JAVMA and published in JAVMA’s January 15, 2017 edition. The editors at JAVMA took out the fact that Dr Yoon doesn’t use pain meds for the thousands of cats and kittens that he has amputated part of their last toes bone and then burned out the dermal nail tissue. JAVMA also took out the part that he said he invented a true painless declawing procedure.

Dr Yoon sent me this note after I said that the fact that JAVMA took out the worlds painless and that he doesn’t use pain meds makes me believe that JAVMA doesn’t think it is painless. Dr Yoon, “And apparently you know more than the dozen or so vets on the advisory board at the JAVMA who screen articles to be printed as to the credibility of it being painless and did approve it. Maybe your “vet advisors” could learn something from them.”

When I asked Dr Yoon to clarify that he is saying that JAVMA believes his procedure is painless, he said, Sorry-typo should have been…”of the possibility of it being painless”

Dr Yoon emailed me this and wanted me to add it to my story, “print the fact that the JAVMA vet editorial screening panel told me their policy is that if they’ve not seen any clinical studies to verify, that they have to omit the word “painless”, but are still going to go ahead and print it because there IS the possibility that it could be(painless). This is the age old accepted “scientific method” that apparently your”vet advisors” are either unaware of or are just as biased and closed minded as yourself. This is what I meant that your advisors could learn something from the JAVMA vet advisors, who I’m sure are much more credible and open minded than your advisors.”

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JAVMA Letter to the editor published on January 15, 2018.

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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I reached out to some very accomplished veterinarians for their input about Dr Kerry Yoon’s painless procedure and here are their responses.

 

Thank you for reaching out to me for comment on the claims being made about a “painless” declaw procedure. It is inaccurate to think this procedure is painless.

Once a nerve is stimulated, you cannot “deaden” the entire nerve just by cauterizing it. Cautery (touching a very hot metal instrument to soft tissue) itself is painful. The damage is done, the nerve impulse indicating pain has already been sent to the brain. The only way to block that (before it happens) is with a local anesthetic. This method appears to be eerily similar to the partial P3 amputation with rescoe nail trimmers.

The only difference is that the vascular tissue within the nail is being cauterized. Like other partial amputation methods, the entirety of the root of the cornified claw sheath (where the nail originates) is not removed leaving the possibility of nail regrowth.

Even though this may not be visible from the outside, nail can regrow abnormally under the skin and cause discomfort or pain.  I doubt this practitioner will stop performing this procedure but I hope he will at least consider using adequate pain management for these cats.

Nicole Martell-Moran DVM https://icatcare.org/press-media/declawing-linked-aggression-and-other-abnormal-behaviours-cats

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Feline Toe Amputation- Rebuttal to Yoon letter in JAVMA 15 Jan 2018
Robin Downing, DVM
MS, Clinical Bioethics
Diplomate, Academy of Integrative Pain Management
Diplomate, American College of Veterinary Sports Medicine and Rehabilitation
Certified Veterinary Pain Practitioner
Certified Canine Rehabilitation Practitioner
Hospital Director, The Downing Center for Animal Pain Management, LLC

I applaud the American Association of Feline Practitioners and the fact that it has (finally) taken an appropriate stand against the ongoing 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.

I am particularly appalled and horrified that the AVMA has chosen to publish a short piece by Dr. Kerry Yoon from Hawaii (JAVMA 15 January 2018) in which he describes a particularly barbaric mutilation of cat feet. By his own description, “…with a nail trimmer…” he cuts through the bone of the third phalanx, creating an open fracture fragment. Continuing with his own description, he then burns the end of that fracture fragment using electrocautery. Dr. Yoon attempts to reassure with the statement that “…General anesthesia is used…”, but as we now know unequivocally, general anesthesia only provides unconsciousness and provides zero meaningful analgesia. There is no mention in Dr. Yoon’s document that these cats are provided any appropriate pain relief, and they are sent home without even the protection of bandages on their feet.

The periosteum of the bone is extremely rich with nociceptors, which is, in fact, why fractures are exquisitely painful. In addition, raw bone surfaces have no choice physiologically but to attempt to reach out to a corresponding fracture fragment in an attempt to heal. Dr. Yoon even describes that some cats do regrow disfiguring tissue that resembles “…claws (that) are small and blunt…” that are left in place “…because no furniture damage can be done…”

All of this can only be described as unconscionable. And the fact that it has been deceptively “sold” to unwitting, well-intentioned cat owners as acceptable is an unspeakable violation of both business ethics as well as clinical bioethics.

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.

Cats are sentient beings with moral agency who, it has been recently argued (Andrews 2011; Copp 2011; Downing 2016; Nussbaum 2011; Panskeep 2012), should be approached with the same consideration as nonverbal children. As beings with moral agency, it behooves us to consider them within the context of the foundational principles of clinical bioethics – – respect for autonomy, nonmaleficence, beneficence, and justice (Beauchamp & Childress, 2012).

To respect the autonomy of cats, we must consider their preferences. Given a choice between being subjected to multiple toe amputation or to this even more barbaric mutilation versus maintaining intact feet, one can easily make the case that cats would prefer intact toes and feet, avoiding the pain and disfigurement associated with this unnecessary surgery.

Nonmaleficence means “do no harm” or “avoid harm”. Considering feline toe amputation, the question then becomes, “Does amputating all of a cat’s front toes (P-3) cause harm?” Amputation is painful, potentially for the rest of the cat’s life, it forever alters the way a cat walks, it prevents natural (scratching) behavior, and it forever prevents the cat from being able to defend itself by escaping (climbing) or fighting. Clearly toe amputation without medical imperative 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 for convenience sake is ever in that cat’s best interest? It appears that the answer to this question is a self-evident ‘no”.

Finally, considering justice as a function of fairness, the relevant question is if amputating the third phalanx of each 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 or this partial amputation procedure creates, as a formally trained clinical bioethicist, I respectfully submit this does not reflect fairness.

Considering feline toe amputation and Dr. Yoon’s barbaric mutilation from a 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 the establishment of permanent pain states. This means ongoing, perpetual, self-sustaining chronic maladaptive pain that constitutes lifelong torture (AAHA/AAFP 2007; WSAVA 2014; Costigan 2009; Dahl 2011).

The few studies that have evaluated either the presence of leftover bone fragments following toe amputation, or the regrowth of sharp bone spurs following amputation, demonstrate that an embarrassingly large number of cats suffer from this extra boney tissue. These sharp shards perpetually poke at the underside of the skin at the end of each toe stump, making every single step like walking on needles or nails. We must remember that cats are extremely good at masking their pain experiences, meaning we humans are often unaware of their silent suffering.

We know from pain physiology that when we sever any nerve there is a very high risk of creating an ongoing, self-perpetuating pain state called “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 quite well the unremitting torture they endure each and every day – – tingling, burning, electric-like pulsed pain, pins and needles. We also know quite well that once chronic, maladaptive, neuropathic pain is in place, these people report ongoing challenges to relieving pain (Sandkuhler 2006; Woolf 2006; Woolf 2004).

We also 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, etc.
over-grooming of feet and/or legs

These cats must walk on their painful feet!

Finally, we must consider any form of feline toe amputation from the perspective of the forever altered biomechanics of the patient. These procedures change the architecture of the feet, thus changing the biomechanics of how the feet work. Because approximately 60% 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 (Kerwin 2010; Lascelles 2010). 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 creates over time micro-traumas to these joints which can contribute to the development and progression of OA. OA, then, provides these cats with additional ongoing chronic maladaptive pain. As both a board-certified specialist in rehabilitation and a pain expert, this completely preventable endless cycle of altered biomechanics and chronic maladaptive pain is a call to action.

The bottom line is that amputating or mutilating 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/chronic maladaptive pain perspective. It is time for these arcane and barbaric mutilation procedures to be removed from the veterinary surgical lexicon.

Respectfully submitted.

 References:

Andrews K. 2011. Beyond anthropomorphism: Attributing psychological properties to animals. In: Beauchamp TL, Frey RG (eds). The Oxford Handbook of Animal Ethics. New York. Oxford University Press.

Beauchamp TL, Childress JF. 2012. Principles of Biomedical Ethics, 7th ed. New York. Oxford University Press.

Copp D. 2011. Animals, fundamental moral standing, and speciesism. In: Beauchamp TL, Frey RG (eds). The Oxford Handbook of Animal Ethics. New York. Oxford University Press.

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

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

Downing R; They do not deserve to hurt: Closing the gap between what we know and what we do for companion animal acute pain; Master’s Thesis; Union Graduate College; 2016.

Kerwin SC. 2010. Osteoarthritis in cats. Topics in Companion Animal Medicine. 25; 4; 218-223.
DOI: http://dx.doi.org/10.1053/j.tcam.2010.09.004

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

Nussbaum M. 2011. The capabilities approach and animal entitlements. In: Beauchamp TL, Frey RG (eds). The Oxford Handbook of Animal Ethics. New York. Oxford University Press.

Panskeep J, et al (eds). 2012. Low P. Cambridge declaration of consciousness. Presented at the Frances Crick Memorial Conference on Consciousness in Human and non-Human Animals at Churchill College, University of Cambridge, Cambridge, UK, July 2012.

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

Woolf CJ, Salter MW. 2006. 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.

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

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I am shocked that JAVMA would print the letter from Dr. Kerry Yoon, “A different approach to declawing.” [JAVMA 15 January 2018] The heavy editing of his original long letter (which he has shared online) is misleading. Had those claims been published, I believe most veterinarians would regard this letter with the skepticism it warrants.

Dr. Yoon uses a Resco and purposely leaves part of P3. The only real “difference” between his Resco method and the one used since 1952[1] is that he electrocauterizes the germinal cells, which he claims prevents claw regrowth.

However, leaving a P3 fragment is likely to cause increased pain, lameness, and claw regrowth.

A 2014 study reported that claw regrowth was more common with use of a [guillotine] nail clipper than with use of a scalpel or laser; but claw regrowth occurred regardless of technique.[2] This is the so-called “pebble in the shoe” issue, which can be extremely painful. Claw regrowth has been documented in cats up to 15 years post-declaw.[3]

In a 2016 study, researchers determined that cats declawed by guillotine were more likely to house soil than cats declawed by laser or scalpel. Laser surgery reduced, but did not eliminate, house soiling behavior.[4]

A case-controlled study of 274 cats, published in 2017, found radiographic evidence of retained P3s in 63% of cats. Declawed cats had an increased risk of back pain and adverse behaviors regardless of method, but the presence of fragments was associated with an even higher risk.[

Dr. Yoon reports that post-operative complications are rare. But bilateral lameness may not be recognized by clients. “Absence of evidence is not evidence of absence.” Cats are known for their stoicism, and may be in great pain without showing noticeable signs.

It is unconscionable that JAVMA would so eagerly promote a procedure without any scientific study. Dr. Yoon boasts that hedoes not provide any pain medication at all, which violates AVMA’s own policies. His nonsensical claims that his method is “painless,” is not an amputation, and does not affect gait should have been dismissed out of hand.

AVMA acknowledges that declawing causes pain and suffering.[6]  JAVMA editors should be ashamed to publish a letter that will likely result in even more cats suffering, far beyond the 2,000 cats Dr. Yoon has already declawed with zero pain management.

Jean Hofve, DVM

Denver, CO 80250

 

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One of Dr Yoon’s clients, who has been using him as her veterinarian for over 40 years, said he did the procedure on 10-15 cats that she owned.

One example is she had the front claws removed by Dr Kerry Yoon on one of her kittens. Then when the cat was 6 years old, she said her cat jumped off one of her leather chairs and ruined it with his back claws so she had Dr Yoon remove the back claws too. She said she was under the impression that Dr Yoon doesn’t amputate, he just removes the claws and kills the nerve. She said, “We feel it is kinder to take out their claws instead of being mad at them for scratching the furniture.” She said she knows that her cats are not in pain and whatever Dr Yoon does is, “great for the cat.”

After I informed this client that Dr Yoon is amputating part of the last toe bone and that it is painful for the cat, she wrote me this back. “I am very distressed that you don’t believe in Dr. Yoon.  Yes, he does use the clipper but he goes close to the nail bed and then uses electrocautery.  If the nail had grown back, it would logically be noticeable by 5 years.   If you would like to pay for x-rays then I would quite willingly permit either of my cats to be x-rayed.   Dr. Yoon is going to have an article in the January issue of the magazine for veterinarians.  He also is in the process of writing to all the veterinarian schools to inform them of his methods.  He HAS invented something remarkable and you need to keep an open mind that he has done it.  I agree that there are cruel methods out there but Dr. Yoon’s is not one of them.”

——————————————————————————————————————————————————————–Also I sent Dr Kerry Yoon this photo of cat’s claws that were amputated by a Resco guillotine clipper and asked him if this is where he also amputates the claws. Dr Kerry Yoon said, “the pics of claws you sent me- look for the shortest one WITHOUT the flexor tubercle and zoom down on it- it’ll be exactly mine. You showed (his clients name) a pic of a hundred Resco cut claws that were identical to mine- why should I waste the time to take and send you an identical picture?”

Here are some of the points that Dr Kerry Yoon wanted to convey to me about his “revolutionary” painless declaw procedure in emails he sent to me in December 2107 and January 2018.

I asked Dr Yoon why did he declawed his cats on all 4 paws and what age did he perform the procedure . He said, “I had contracted cat scratch fever previously and didn’t want to go thru it again- got it from work or my own previously owned cat- don’t know who; I’ve got some very expensive leather furniture and a very nice wood dining table  that when my cats get startled and power off the tabletop or leather furniture they WILL leave puncture marks or deep scratches when they leap off. I believe that’s why (his clients name) had rear paws done 6 years later cause she had gotten some leather or another material furniture that showed puncture marks easily. Yes I have done several 10-14 year old cats with the same good results as younger ones, only difference is I have to prolong the duration of electrocautery application because older cats have slightly thicker and deeper coriums. My sibling Siamese were done at 4 mo old cause 4 lbs is my minimum weight to operate ”

Dr Yoon said, “Another tidbit that you may or may not want to print (your call) and may help explain why I had put out so much effort in developing my revolutionary painless method is the honorary post graduate internship at the Angell Memorial Animal Hospital in Boston. It was an MSPCA owned and operated vet teaching hospital that was highly respected cause many of the staff instructors wrote the veterinary textbooks we studied in vet school. Our hospital policy was to refuse ear cropping, tail docking, and any other painful non necessary elective procedures. Please ask your vet advisors on their opinion of Angell Memorial. Declawing (phalangectomy) was not taught or done yet . This “do no harm” vet oath and Hospital philosophy is what drove me to develop my revolutionary method, especially after SEEING the post op behavior of a phalangectomy done by one of my associates.”

Dr Yoon said, “IDEALLY in a PERFECT world, that the cruel painful method be replaced with a painless one- All I hope for is for vets to just strive to develop a more painless method than the existing cruel one. Whether they try mine or want to develop their own, doesn’t matter to me. That’s my wish. Thank you for hearing me out.”

He went on to say, “I have neither the time or resources to do such a formatted clinical trial- all I’m going by is the personal testimony of HUNDREDS of very satisfied clients who as I mentioned before, are to me, the bottom line in my conclusion that my method is painless.”

Dr Kerry Yoon, “The main point: I’d like you to help educate the public and legislatures to amend the terminology in their bills to ban “DECLAWING” to “DECLAWING BY DIGITAL AMPUTATION” as the word amputation will help people realize how painful it must be and that these are two different operations. Have you ever seen an amputation method patient the day or week after surgery? You really should so you’ll know what you’re talking about.”

Dr Kerry Yoon, “You might know, veterinarians perform “soundness” exams on horses where we learn in school how to spot a lameness by studying the way they walk, and the same for dogs with joint or paw injuries/pain. This is how I know my procedure is painless versus the amputation method. I may do a video next year of before and the day after for you non believers!”

 Dr Yoon, “You seem obsessed with my removing part of the “bone”- in my removing only the nailbed portion of the bone, it’s only the top non– weight bearing portion- it’s only function is to house the nailbed, thereby explaining the painlessness. Amputation method removes the bottom weight bearing part of the bone and part of the protective toe pad-duh!-that’s why it’s so painful and everyone’s up in arms over the amputation method that many vet schools had been teaching. Think of my method like a deep permanent nail trim and enabling companionship of countless owners who may be immunocompromised, preventing “cat scratch fever”,on blood thinners,the very elderly who live alone,not just sparing furniture and drapery! I perceive that you’re having difficulty erasing the brainwashing you’ve been getting about the cruelty(I agree) of the amputation method,  I’ve been a cat owner for over 50 years and know if a cat is playful and has a sense of “well being” or not. I’ve owned cats with claws and without(my method) and see NO difference!” Dr Kerry Yoon

Dr Yoon, “After completing my internship at the Angell Memorial Animal Hospital, I started my own solo practice in 1974 and became so busy 6days a week until I sold it in 2015- the new owner had to hire 3 more doctors to handle the caseload. I did NOT have the time or inclination to go around and teach my method to other vets, plus because you’re not a vet , you wouldn’t understand about the professional jealousy that exists among us where many of them elect to continue their cruel phalangectomy procedure so that they don’t lose the income. ” Dr Kerry Yoon

 Dr Kerry Yoon speaking about his letter to the editor being accepted by JAVMA, “Now I’m semi retired I have some time to try to start getting it out there that there may be a novel unheard of painless procedure as opposed to the cruel methods existing. I am encountering so much negativity and pessimism and doubt(as I’m feeling from you) that I’m becoming discouraged. You forget again that I told you my method was read and accepted by the editor in chief (veterinarians) and will appear in the next journal out.”

Dr Yoon, “I did sell and retire from my practice in 2015, but am semi retired because there is a demand for me to continue doing my painless method as almost all of the vets in my state are referring cases to me. As the cruel phalangectomy method and ear cropping are two of the most bloodiest elective surgeries with the most post op problems that vets do and they’re GLAD to refer to me. Every 5-10 years I mail a letter to all the vets in my state describing my method- and what better feedback I get than not a single colleague has approached me at dinner meetings or otherwise that their clients complained to them that their cats are showing signs of pain. I work as an independent contractor and do my Nailbed Ablations on Fridays only. I would rather just totally retire and travel, but feel compelled to continue my unique painless method as a public service to my community and living up to the Hippocratic medical oath I took in vet school.”

Dr Yoon, “I’ve performed approx 450-500 since 2008, cause I average one a week – (90% of them are other vets clients). In 2008 he said he had done around 1500 of these “painless” procedures.

Here is a story in the Hawaii Pet Magazine, Sept/Oct 2008 issue  [button href=”https://www.painlesscatdeclawinghawaii.com/research” newwindow=”yes”] Dr Kerry Yoon “True Declawing” story[/button]

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Email to JAVMA about this Letter to the Editor.

Dear Javma editors and JAVMA veterinarians,
I’m doing a story about Dr Kerry Yoon’s “Painless Declaw Procedure” and wanted to ask you a few questions for it since you edited and published his letter to the editor.

 

The question is, why would JAVMA give a platform to someone who is performing an unverified surgical technique that has no scientific claim to assure it is painless. Why did you take out the pertinent information from his letter to the editor that hides the fact that he is not using any pain meds and his claims are that it is a completely painless procedure?

 

Also, he wanted me to reach out to you and ask you this. His words, “print the fact that the JAVMA vet editorial screening panel told me their policy is that if they’ve not seen any clinical studies to verify, that they have to omit the word “painless”, but are still going to go ahead and print it because there IS the possibility that it could be(painless). This is the age old accepted “scientific method” that apparently your”vet advisors” are either unaware of or are just as biased and closed minded as yourself. This is what I meant that your advisors could learn something from the JAVMA vet advisors, who I’m sure are much more credible and open minded than your advisors. Go ahead and call them yourself and ask if you don’t believe me!”

 

Dr Yoon also wrote me this, “And apparently you know more than the dozen or so vets on the advisory board at the JAVMA who screen articles to be printed as to the credibility of it being painless and did approve it. Maybe your “vet advisors” could learn something from them.”

When I asked Dr Yoon to clarify that he is saying that JAVMA believes his procedure is painless, he said, “Sorry-typo should have been…”of the possibility of it being painless.”

I hope to hear back from you soon,

Thank you,

Lori Shepler

 

Dear Ms. Shepler,

 

Thank you for your interest in the Journal of the American Veterinary Medical Association and, in particular, the recent letter by Dr. Kerry Yoon describing an alternative to more traditional methods for onychectomy in cats. Please be aware that the JAVMA editors are in full agreement with and completely support the AVMA position (https://www.avma.org/KB/Policies/Pages/Pain-in-Animals.aspx) that pain is a clinically important condition in animals and that methods to prevent, minimize, and relieve pain should be used anytime animals are in pain or expected to experience pain. We do not have any opinion on the degree of pain associated with the alternative declaw procedure described by Dr. Yoon in his letter. However, we agree with the general principle that veterinarians should assume that procedures are painful—and should, therefore, provide appropriate pain relief—until proven otherwise.

 

Note that the JAVMA editors also agree with the AVMA position on declawing of domestic cats (https://www.avma.org/KB/Policies/Pages/Declawing-of-Domestic-Cats.aspx), particularly that declawing should be performed only after full consideration of the risks and benefits of the procedure and following exploration of alternatives. Because the method described by Dr. Yoon preserves the flexor process of the third phalanx and the attachment of the flexor tendons to this process, it may, theoretically, provide some benefits over procedures that involve removal of the third phalanx in its entirety. However, outcomes of this procedure, particularly long-term outcomes, still need to be studied.

 

If you have additional questions, please do not hesitate to contact me.

 

Sincerely,

 

 

Kurt J. Matushek, DVM, MS, DACVS
Editor-in-Chief | Journal of the American Veterinary Medical Association

o: 847.285.6768 | www.avma.org