The Rebuttal of the AVMA's Declawing Position Statement. - City the Kitty

Published May 5, 2022

Thank you to Dr Jean Hofve for this important rebuttal to the AVMA’s declawing position.

Here’s the link to the AVMA’s current declawing position. AVMA’s Declawing Position


Declawing is the surgical amputation of all or part of a cat’s third phalanges (toe bones) and the attached claws.^1,2 Most often the procedure involves the front paws only¹, but sometimes the claws are removed from all four paws.^2,3 The surgery may be performed using sterilized nail trimmers, scalpel blades, or surgical lasers.^{1,2,4,5,6,7,8,9,10,11}	No argument with the basic recital of facts. However, it provides an interesting illustration of the tendency of the AVMA, in this paper, to count the slightest mention of a real or postulated effect as “scientific evidence.” How many “studies” does it take to prove that there are 3 methods of declawing?
If only part of the phalanx is removed the claw may occasionally regrow.^12,13 While it has been suggested that retaining a portion of the phalanx allows the paw to retain more of its normal function and appearance,^12,14 recent evidence suggests retained P3 fragments may impact the occurrence of adverse outcomes.¹³ Declawing may be performed at the same time as spaying or neutering.^{2,15,17,18,19,20,21}	Later in this report, the AVMA states that “Claw regrowth is a consequence of incomplete removal of the ungual crest and can result in abscess formation and pain.” Why mention an option that later research proved to be totally unacceptable (6 studies cited)?
Declawing may be performed at the same time as spaying or neutering. 2,15,16,17,18,19,20,21	However, doing so violates the AVMA own policy statement on the Declawing of Cats (dated 4/09), which stated that declawing shouldn’t even be considered until all other alternatives have been tried. Any sincere effort at using all non-surgical solutions would take more than the period between acquisition of a kitten and spaying/neutering, which typically takes place at 4-6 months of age. However, shelters routinely spay/neuter at 8 weeks of age, and many will also declaw at the same time upon adopter request. Data from the Southern California Veterinary Medical Association (2009) showed that 76% of kittens are declawed before 8 months of age. The AVMA revised its policy statement (7/19) to remove this language. Now it states, “it is incumbent upon the veterinarian to counsel the owner about the natural scratching behavior of cats, the alternatives to surgery, as well as the details of the procedure itself and subsequent potential complications.” It should be noted that the AVMA is essentially a lobbying group, and its policies are not enforced, nor are they enforceable.
REASONS FOR DECLAWING
*Human Benefits*—Many owners choose to have their cats declawed to protect their furniture or other household possessions. ^{4,5,15,20,22,23,24,25,26,27,28,29,30} Scratching is a normal behavior of cats, but destructive scratching represents approximately 15 to 42% of feline behavior complaints.^{8,22,31,32,33,34,35,36}	A 2009 member survey from the Southern California Veterinary Medical Association, suggests that 95% of cats are declawed to protect furniture. How has veterinary profession so abysmally failed in its duty to educate the public to the extent that people who acquire a cat don’t know that it needs an appropriate scratching surface? Nearly half (48%) of cat guardians don’t provide a scratching post (APPMA 2009). If no suitable surface is provided, the cat will choose a surface to scratch that fulfills this strong instinct. However, leaving the decision up to the cat may cause damage that results in the cat being declawed—all preventable with 30 seconds’ education, a simple handout, or a free cardboard scratcher at the first kitten or new cat visit.
The act of scratching serves many purposes; it conditions the claws by removing aged cuticle, serves as a visual and scent territorial marker, provides defense from attack, and stretches the muscles of the limbs, thorax, and back.^{8,31,32,36,37}	But it is apparently acceptable to permanently remove the ability of the cat to fulfill all these needs.
After declawing cats continue to show the same frequency of scratching behavior.³²	This shows how strong the scratching instinct is, and how necessary scratching is to the well-being of the cat. According to Bennett (1998), “declawed cats will continue to “scratch” the furniture, indicating that their motivation to engage in this normal marking behavior has not been suppressed by the consequences of onychectomy.”
Overall, owners who chose to declaw reported that the procedure met or exceeded their expectations.²⁰ A survey found three (of 273) owners reported that their cats exhibited negative behavioral changes (house-soiling, resentment of having paws handled, and refusal to cover feces); but only the owner of the house-soiling cat was dissatisfied with the declawing procedure.²⁰ Ten respondents reported the cats may have bitten harder or more frequently, but biting was considered less problematic that the previous scratching behavior.	As the AVMA itself states at the end of this same report, “Although owner perceptions of the procedure are important, surveys are subject to self-selection and respondent bias.” This particular survey is cited 17 times by the AVMA in this report. It was not published in a veterinary journal, but in a quarterly publication that calls itself “a multidisciplinary journal of the interactions of people and animals.” The study itself cites a number of non-scientific references including books by a holistic veterinarian, a groomer, an untrained behavior consultant (who calls herself “the founding mother of cat psychoanalysis”) and Cat Fancy magazine, thus calling its scientific objectivity and validity into question.
Another survey, of 60 cat owners, indicated that the only behavior problem observed significantly more often in declawed cats than clawed cats was jumping on counters or tables; this was also the most commonly reported misbehavior exhibited by clawed and declawed cats.³³	This small 1989 internet use-group survey is cited six times as “scientific evidence” by this AVMA report. Not only is this survey highly biased due to self-selection of those choosing to answer, but in 1989 very few people (or businesses, agencies, or organizations) were even aware of the internet, much less technically savvy enough to join a use-group.
*Cat Benefits*
In some cases declawing may be an alternative to relinquishment, outdoor housing or euthanasia.^15,32	The first “study” cited is the account of a grad student’s experiences during 9 months in a private veterinary clinic, following people around and asking questions. While the article is illuminating in its own way, the opinion of the receptionist hardly qualifies as scientific evidence. Yet the AVMA cites this collection of personal opinions as scientific fact. The second citation isn’t a study at all, but a 1-1/2 page opinion paper by 3 Canadian vets published in 1988. A 32-year-old editorial opinion is not, by any stretch of the imagination, scientific research. The AVMA and its “peer reviewers” should be ashamed of even mentioning this article, yet they do so 15 times in this backgrounder.
For example, in a 1991 survey of Ontario veterinarians,²⁰ respondents indicated that approximately 50% of their clients would no longer own their cat if it had not been declawed.	(Incorrect citation, should be #27) In a 1991 survey, 102 Ontario veterinarians took a wild guess as to how many of their clients would get rid of their cat if it couldn’t be declawed; the number they came up with was 56%. This was not founded on any factual basis whatsoever. The entire report comprises less than 1-1/2 pages. It’s interesting how often it is used as evidence. Its title (“Declawing controversial but still saves pets”) has become a mantra for the justification of declawing. The survey AVMA cites here (#20) is a a follow-up to #27. It found that, when those veterinarians’ own clients were surveyed, only 4% said they would actually have gotten rid of the cat—a significant discrepancy. Perhaps not coincindentally, this number is similar to the rate of adoption returns reported by shelters. Sometimes a cat is just not a good match with a particular home. It is folly to insist, as veterinarians do, that every cat should remain in a home—even when the home is not appropriate.
Unacceptable behaviors such as daily scratching increase the risk of relinquishment of an animal to a shelter, and declawing decreased the risk of relinquishment. As approximately 72% of cats relinquished to animal shelters are euthanatized,³⁹ owners may feel they are faced with the choice of declawing their pet cat or potentially condemning it to death.^3,4,28,32	“Declaw or death” is not the right question. The choice is actually “Declaw… or use one or more of the 18 humane alternatives to declawing.” AVMA is using a well-known logical fallacy. The “false dilemma” is a logical fallacy that presents only two options when there are actually many options. Essentially, a false dilemma is “black and white” thinking, when the issue is many shades of gray. Moreover, the AVMA leaves out important information and cherry-picks the data it does cite. While it cites the 2001 Patronek review (#28), AVMA somehow forgot to mention the 1996 Patronek study—published in its own journal–on risk factors for relinquishment. That study found that, while declawing as a single variable appeared to reduce the risk of relinquishment, when the statistically more valid and powerful multivariate analysis was applied, declawed cats were almost twice as likely to be relinquished (OR 1.89, CI 1.00 to 3.58). As previously noted, reference #3 dates back to 1961, and the others are unsubstantiated opinions of the authors.
Because outdoor cats are exposed to predators, street traffic, inclement weather, and diseases (e.g., feline leukemia, feline infectious peritonitis), owners may not consider keeping a scratching cat outside to be a viable alternative.^3,6	Since the dawn of declawing in the 1950s (the second of AVMA’s citations is from 1961), it’s been recommended to keep declawed cats indoors. However, this advice is apparently widely ignored. Studies show the just as many declawed as clawed cats (31–41%) go outside. (Clancy 2003, Landsberg 1991).
Thus declawing may sometimes be necessary to ensure that a pet cat keeps its home.^{6,20,26,27,32,33}	This is the favorite argument of the pro-declaw side. However, there is zero evidence for this assertion. While AVMA provides several citations as “evidence,” in all cases (except the 1989 survey with serious methodological problems), these are all outdated opinions masquerading as fact. Moreover, a 2021 study done by the British Columbia SPCA found that “a declaw ban does not lead to increased feline shelter intake or euthanasia.” The SPCA team analyzed three years of data both before and after the ban. They found: There was no significant difference in surrender for destructive scratching, and overall, this is a rare reason for people to give up cats (only 50 cats over 6 years) There was a decrease in the number of cats entering the shelter and a decrease in cat euthanasia Cats spent less time in the shelter waiting to be adopted after the ban vs before. “As far as we know, claims by opponents of declaw bans that bans could lead to greater relinquishment of cats to animal shelters are not substantiated by any data, anywhere,” says Dr. Gordon. “Now we know with certainty that in B.C., this did not happen.”
WELFARE CONCERNS: ACUTE PAIN	The word “acute” was added in the 2019 revision, and chronic pain given a new section
Declawing is a painful procedure, although there is debate about the degree of pain experienced under ideal or typical conditions.^{1,8,11,15,17,18 29,40,41,42} Objective assessment of pain in cats is difficult, due to their stoic nature and relatively subtle behavioral indicators of pain.^{4,16,18,25,41,42,43,44,45} Fossum’s Small Animal Surgery textbook (2019) estimates the pain score at severe which should be mitigated with multi-modal pain management.¹	The AAFP, after reviewing the same evidence, concluded that “Physically, regardless of the method used, onychectomy causes a higher level of pain than spays and neuters. Patients may experience both adaptive and maladaptive pain; in addition to inflammatory pain, there is the potential to develop long-term neuropathic or central pain if the pain is inadequately managed during the perioperative and healing periods.” AAFP watered down this language in its 2017 statement while expanding the statement itself. Nevertheless, it regards pain management as mandatory, not optional. One sign of pain—significant lameness—has been noted for: · more than 3 days (Landsberg 1991), · 1 week (Martinez 1993) · 8 days (Holmber 2006) · 12 days (Romans 2005) · 180 days (Jankowski 1998) · 96 months (Tobias 1994) Currently, aggressive, multimodal pain management is recommended (Gaynor 2005, Gordon-Evans 2005, Short 2006). One pain management specialist (Dr. Jamie Gaynor, DVM, MS, DACVAA, DAIPM) describes a “chronic pain syndrome of onychectomy” in which pain persists for months or years.
Clinical signs of pain following declawing include a “guarding” posture, reluctance to bear weight on the declawed limb(s), and reluctance to move.^2,43	Gaynor further suggests that, over the long term, decreased activity, decreased appetite, and increased aggression are signs of chronic pain due to declawing.
Nine of 163 (5.5%) declawed cats were non-weight-bearing on the affected limbs for one day after the operation, and another cat was non-weight-bearing for three days. The risk of non-weight-bearing lameness was increased by the use of adhesives to close the surgical wounds, especially if nail trimmers were used to amputate the third phalanx.²	This is truly cherry-picked data. AVMA chose to cite a single study in which only 1 cat was NWB lame for 3 days. Specifying “non-weight-bearing” lameness allows AVMA to ignore the many reports of serious lameness after declaw surgery, including the study cited, which found lameness persisting for 1-42 days. As previously noted, significant lameness has been documented for: · 3 days (Landsberg 1991, Yeon 2001) · 1 week (Martinez 1993) · 8 days (Holmber 2006) · 12 days (Romans 2005 · 180 days (Jankowski 1998) · 96 months (Tobias 1994) Currently, aggressive, multimodal pain management is recommended (Gaynor 2005, Gordon-Evans 2005, Short 2006). However, there is an acknowledged gap between “ideal” and “typical” conditions (Gordon-Evans 2005, Wagner 2000). Variation in surgical skills is noted as a particular problem (Gordon-Evans 2005), an observation supported by studies where surgery was done by inexperienced veterinary students, which have a high rate of complications (Jankowski 1998, Martinez 1993, Tobias 1994, Yeon 2001).
Some physiological parameters, such as heart rate, respiratory rate, and rectal temperature, have been determined to be poor indicators of postoperative pain in cats⁴¹ and other parameters have yielded mixed results.	It has indeed been difficult to find a reliable physiological measurement that adequately correlates with pain in cats. ** New position statement refers to #38 here?
Systolic blood pressure increases were reliable indicators of increased cortisol concentrations and pain following declawing of laboratory cats,⁴⁵ but failed to correlate with cortisol increases for client-owned cats following ovariohysterectomy.⁴⁶ Painful stimuli are known to elicit an adrenal response,^43,45 and declawing induced significant increases in epinephrine and/or norepinephrine concentrations in adult cats.^43,47	In other words, there have been no practical, reliable ways to gauge pain in cats. However, as AVMA’s backgrounder was revised, a new tool was being validated for assessing pain in cats, the Feline Grimace Scale. [Evangelista et al. Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Scientific Reports. 2019;9(1):19128.] It was mentioned as a JAVMA news item in the October 1, 2019 edition, and more fully discussed in JAVMA News, April 1, 2020 edition. AVMA has not seen fit to update its backgrounder to reflect this new tool.
Postoperative administration of morphine or xylazine significantly attenuated the catecholamine response, while postoperative administration of salicylate had no effect.⁴³ In contrast, Cambridge et al (2000)⁴¹ did not observe increased catecholamine concentrations following declawing or tenectomy (resection of tendon to leave claws permanently extended and impede normal scratching). Although increases in plasma cortisol concentrations were good indicators of pain following ovariohysterectomy,^45,46 they were not significantly elevated by declawing^18,41,48 or tenectomy.⁴¹	It is inadvisable to give aspirin, an anticoagulant, for a surgery whose most common complication is hemorrhage. (#1, #6, #2, #28) Another worthless measurement. Repetitive.
Chronic Pain	New section since 2009
Sixty-one of 163 (37%) cats exhibited signs of pain for a median duration of two days (range 1-42 days).² Lameness was also observed for a median of two days in 43 of 163 (26%) cats (range 1-54 days).² The risk of lameness increased with longer surgical time and the use of a scalpel blade for disarticulation of the third phalanx.² Thus, postoperative analgesia should be provided on the day of surgery and for a minimum of one full day after surgery.¹⁶ Measurements obtained from use of a pressure-sensitive mat to assess weight-bearing after declawing suggested that mild lameness was still present 40 hours after surgery despite administration of analgesics.¹⁹ Declawing with a surgical laser or using sharp dissection with a scalpel blade produced observable lameness for eight days after surgery.⁴⁹ Limb function in 27 declawed cats was still significantly reduced 12 days after surgery in one study, leading the investigators to recommend analgesia for the duration of this period.⁴² A review of onychectomy studies reported that persistent lameness was observed in less than one percent of declawed cats (five of 582, or 0.86%).²⁸	Lameness is usually noticed when there is a change of gait, often with less weight being put on one leg than the other. If less than 1% of cats have visible, persistent lameness, that still amounts to about 200,000 cats. AVMA apparently considers that acceptable. Another point to ponder is whether bilateral lameness cam be detected by owners. Will they report it to their veterinarian? Will owners simply change veterinarians? (VIN 2005) That could result in significant underreporting. One recent study suggests, “While owners may not bring their cats in for the problem early, it becomes apparent from the history that the pain, which the cat is manifesting as some problem, began sometime soon after the declaw procedure.” Decreased activity, decreased appetite, or increased aggression are noted as some of those problems; it is also suggested that these problems may develop over weeks, months, or even years (Gaynor 2005). There is scant published research on very long-term physical complications, but scurs and nail regrowth have been reported by private practitioners at 2, 3.5, 8, 11, 12, and 15 years post-declaw (VIN, 2005-2009).

However this rate varies according to the population being observed, for example one study comparing onychectomy methods classified 12 of 88 (13.6%) of cats as mildly lame at the long-term recheck.⁵⁰ Another study showed that declawed cats were at an increased risk of back pain (OR 2.9) and barbering (OR 3.06) when compared to an age and location matched non-surgical control group.¹³ Retained P3 fragments may impact the occurrence chronic pain as declawed cats with radiographic evidence of retained P3 fragments were at an increased risk of back pain (OR 2.66) when compared to declawed cats with complete removal of P3.¹³ The short-term and possibly long-term pain that can result from onychectomy could be related to neuropathic pain, residual inflammation, infection, or remaining bone fragments.⁵¹	The authors of this study point out that it is difficult to assess lameness because there is no limp when both front paws hurt. Study #13 by Martell-Moran, et al. (2017) of 274 cats used control groups, with declawed and non-declawed, age-matched, owned and shelter cats. AVMA had to add this section because this study directly disproved its previous assertion: “There is no scientific evidence that declawing leads to behavioral abnormalities when the behavior of declawed cats is compared with that of cats in control groups.” True, but doesn’t address all possible causes, including phantom pain.
WELFARE CONCERNS: SURGICAL COMPLICATIONS
The reported incidence of postoperative complications ranges from rare to 50%.^{1,2,8,20,24,52}	Absolutely false. Reported medical post-op complication rates include: · 24% (Jankowski 1998) · 53% (Martinez 1993) · 1.4% (Pollari 1996) · 82.5% for blade and 51.5% for shear technique (Tobias 1994) · 80% (Yeon 2001) AVMA cites Tobias (#2) but gets the numbers completely wrong. The study found that “50% of cats had one or more medical complications immediately after surgery while still in the hospital; 19.8% developed complications after release.”
An examination of medical records at a veterinary teaching hospital revealed that two of 76 (3%) cats developed postoperative complications.²¹ In another study, one or more surgical complications were observed during the immediate postoperative period in approximately 50% of 163 cats, and the overall complication rate was higher when scalpel blade disarticulation was performed than when guillotine nail trimmers were used (complications during the immediate postoperative period were more often associated with the use of a scalpel blade for disarticulation of the third phalanx, whereas later-onset complications were more frequently associated with the use of guillotine nail shears).² Complications that arose after discharge from the hospital were observed in 24 of 163 (20%) cats.² A survey of private practice records reported a higher postoperative complication rate associated with spaying/neutering when performed in conjunction with declawing.²¹	Very misleading. This study compared computerized records, from which the complication rate of 2.6% was taken, to original paper records, and found that the actual complication rate was “4 to 7 times higher” (12.2% for cats) than computerized records showed (Pollari 1996). Misleading. What this study actually says: “Complications were noted more frequently in cats that underwent blade onychectomy (82.5%) than in cats that underwent shears onychectomy (51.5%). Early complications included pain, hemorrhage, swelling, non-weight bearing, and lameness. Sixty-one cats showed post-operative pain for 1 to 42 days after surgery.” The number of post-release complications is cited correctly. True; yet combining surgeries is frequently done, which, as previously noted, violates the AVMA’s guidelines (Bennett 1998, Landsberg 1991, Pollari 1996, Jankowski 1998, Franks 2000).
*Hemorrhage*—Hemorrhage is the most commonly reported complication of declawing,^1,2,28 and older cats may bleed more profusely than kittens.⁶	True.
Intermittent hemorrhage was observed in 51 of 163 cats (31%) for one to 13 days following surgery and was more often observed in older cats.²	True, but appalling that almost 1/3 of cats experienced this complication for up to 2 weeks. It’s unlikely that bleeding all over rugs and furniture was a desirable outcome in affected households.
*Claw regrowth*—Claw regrowth is a consequence of incomplete removal of the ungual crest and can result in abscess formation and pain.^1,2,12,28,31	True.
Approximately 3% of declawed cats exhibit claw regrowth,^13,31 but a 10% incidence was reported with a technique that left the flexor surface of the third phalanx in situ.¹²	This is greatly underestimated, since claw regrowth can take months to years. There has not been adequate research on long-term consequences (Gaynor 2005, VIN 2005-2009).
*Wound dehiscence*—Reopening of the surgical incision resulting in lameness was observed in 17% of cats that underwent declawing at a veterinary teaching hospital.¹² Although the differences were not statistically significant, dehiscence occurred more frequently following scalpel dissection and disarticulation, and was attributed to increased surgical time, greater soft tissue dissection, and tissue handling techniques.¹²	This study (Martinez 1993) reported dehiscence in 22% of cats declawed by disarticulation (scalpel) and 12% of cats declawed by bony amputation (shears), for an average of 17%. A 30% difference between the two techniques was not considered statistically significant.
*Paralysis*—Neuropraxia or radial nerve paralysis from improper tourniquet application has been reported with signs usually resolving in 6-8 weeks.^1,2,28,29 Manual compression of the brachial artery by a technician may be an alternative to tourniquet use.¹	Only Fowler (#12) reported actual neuropraxia; the others simply list it (as many other authors do as well) as a potential complication. The applicability of this study is questionable, since Fowler was looking at exotic cats only, not domestic cats. Veterinarians on VIN report this as a complication of tourniquets that usually (but does not always) resolve with time.
*Distal limb ischemia*—Distal limb ischemia secondary to improper bandage application has been reported as a potentially serious complication.^1,2,28,31,53 Bandages are usually removed 12-24 hours after surgery.¹	This is a very serious complication and unfortunately not uncommon, as multiple case reports on the Veterinary Information Network (www.vin.com) confirm.
*Disease*—Pain activates the stress response, which can reduce immune function and potentially increase the animal’s susceptibility to disease.⁴⁸ Opponents of declawing claim that the procedure can worsen or induce chronic illnesses such as skin disorders, asthma, and cystitis.^26,28,31 Neither clinical evidence nor anecdotal reports support this assertion to date.	All of these conditions are associated with stress, which the AVMA just cited as a consequence of pain-induced activation of the stress response (Quarcoo 2009, Arck 2006, Westropp 2006).
*Other reported complications* include wound infection, draining tract formation, sequestration of the third phalanx, and exposure necrosis of the second phalanx.^1,2	The AVMA failed to note other documented complications, including: · incomplete healing · protrusion of 2nd phalanx · scurs (growth of deformed claw segments · chronic draining tracts · self-mutilation · dermatitis · lethargy · palmigrade stance (walking on wrists) · chronic intermittent lameness · chronic pain syndrome · aggression (Cooper 2005, Gaynor 2005).
Bilateral flexor tendon contracture following declawing of two cats was reported by Cooper et al;²⁴ the affected cats were unable to extend the digits of the front limbs, and fibrosis and adhesions between the deep digital flexor tendon and the soft tissues surrounding the second phalanx were observed in one cat. Deep digital flexor tenectomies were necessary to return normal forelimb function in both cats.	This is a heartbreaking paper to read, especially since one of the cats died shortly afterwards. AVMA failed to mention another report published in 2015. [Cabon Q et al. Digital flexor tendon contracture treated by tenectomy: different clinical presentations in three cats. Journal of Feline Medicine and Surgery. 2015 Jul-Dec;1(2):205.]
WELFARE CONCERNS: BEHAVIOR
*Impairment of normal behavior*—Because scratching is a normal feline behavior, opponents state that declawing causes emotional stress when the animal cannot scratch.¹⁵	As previously noted, this opinion paper is not a credible source. However, others have addressed the issue of emotional stress, which remains largely ignored by the veterinary community (Fox 2006, Fraser 1989, Hellyer 2002, Houpt 1991, McMillan 2002).
However, between 59 and 78% of declawed cats will continue to exhibit scratching behavior with a normal appearance.²²	As previously noted, Bennett (1998) states that, “declawed cats will continue to ‘scratch’ the furniture, indicating that their motivation to engage in this normal marking behavior has not been suppressed by the consequences of onychectomy.” This behavior is equally likely to represent an effort to stretch toes that are subclinically contracted with scar tissue.
Critics also claim that declawing adversely affects balance, climbing, and feline social interactions.^20,26,31	True; yet in the 2 decades since these issues were raised, not a single study has been conducted to evaluate their validity. Perhaps it is less important to know the answers, than to avoid what those answers might reveal.
Incidence of problem behavior—Because scratching is considered a means of stretching and using the muscles of the forelimbs, shoulders, and torso, it has been suggested that declawing eliminates the normal isometric resistance associated with the claws pulling against a stationary surface and so may produce weakening of these muscles.^20,26,28 Neither clinical evidence nor anecdotal reports to support this assertion have been reported to date.	However, one study does report an unexpectedly high incidence of arthritis of the elbow in cats. Unfortunately, the authors did not ask about the declaw status of these animals. The elbow joint is considered the most affected by the altered gait of declawed cats. (Hardie 2002). but felt the question should be asked in future studies (personal communication).
*Incidence of problem behavior*—Opponents of the procedure state that declawing increases undesirable behaviors, including inappropriate elimination, aggression and biting.^{13,15,26,28,31,32}	These are interesting references, since 4/5 of the cited articles being written not by “opponents,” but by declawing advocates. In a court of law, this assertion would be called “hearsay.” The other (#15) is the graduate student’s account of what people employed in a clinic said, which is not only opinion but also “hearsay.”
Empirical studies show that behavioral changes may occur, but are conflicting as to whether there is a net increase in problem behaviors. One study of 122 cats revealed no significant difference in serious behavior problems between declawed and clawed cats.³³	Most studies on declawing have been very short-term (hours to days). While not many studies followed cats long enough, or were thorough enough, to fully evaluate post-surgical behavior, at least nine studies reported one or more behavioral complications at some point after surgery. In the most credible long-term studies, the data show that up to 1/3 of declawed cats develop behavior problems after declawing. The study cited here by AVMA is, once again, the invalid 1989 internet use-group survey of 60 owners.
Another, of 877 cat owners, suggested that declawed cats were not more likely to bite than clawed cats.⁵⁴	This written owner survey was done in 1987. The sample population consisted of owners sitting in the waiting room of several vet hospitals. The AVMA itself correctly points out that, “Although owner perceptions of the procedure are important, surveys are subject to self-selection and respondent bias.” Since recent studies have suggested that cats get significantly less veterinary care than dogs (AVMA’s 2007 U.S. Pet Ownership & Demographics Sourcebook), this study population is seriously biased.
One smaller study found that 3 of 25 (12%) cats exhibited increased biting behavior following declawing and one began to defecate outside the litter box; however, declawed cats had better scores for overall good behavior than did clawed cats.²³	Misleading. Biting was seen in 12% of cats, but a total of 16% of cats developed behavior problems after declawing, no matter how “good” they were. This particular study also found that a majority (54%) of cats referred for behavior problems were declawed, even though they represented only 22% of the population. The AVMA did not mention this result.
In a study comparing declawing to tenectomy, one of 18 (5%) declawed cats exhibited inappropriate elimination for two days after discharge. A survey of 57 owners of declawed or tenectomized cats reported that three of 18 (16%) tenectomized and 13 of 39 (33%) declawed cats developed at least one behavioral change following surgery, but the difference was not statistically significant.³⁶	Misleading, and statistically incorrect. The correct model for this study is the “within-subject” experimental design. That is, you compare the behavior of the individual cat before declawing to the same cat’s behavior after declawing (Bennett 1998). The difference between declawed and tenectomized cats may not have been statistically significant, but the difference in behavior between declawed cats’ individual behavior before and after declawing was 33%. If 1 in 3 is not a statistically significant number, one has to wonder about the method used for the analysis.
Six of 39 (15%) cats house-soiled following declawing;³⁶ because the overall incidence of house-soiling in cats (clawed and declawed) was reported to be 16%,³³ there did not appear to be an increased risk of house-soiling following declawing. In a study of shelter cats, no significant correlation was found between declawing and biting.³⁸	Using a poorly designed 1989 internet survey as the “control group” for a completely unrelated population in 2001 is not only bad science but a completely invalid, worthless analysis.
Finally, a study addressing risk factors for relinquishment of cats to animal shelters²⁸ did not observe a statistically significant difference in aggression or inappropriate elimination between declawed and clawed cats. In contrast, a recent retrospective cohort study reported an increased risk for inappropriate elimination (OR 7.2), aggression (OR 3.0) and biting (OR 4.5) in declawed cats when compared to an age and location matched non-surgical control group.¹³ However, it was unknown whether the undesirable behaviors began before or after onychectomy.¹³	Technically, AVMA’s reference #28 was a review article and did not itself address risk factors for relinquishment, although it was the same author, and the relinquishment study is reviewed therein. [The relinquishment study is Patronek 1996.) The cited review states that declawed cats had a higher incidence of both housesoiling and aggression than normal cats. (Housesoiling, 25% of declawed cats vs. 15% of sexually intact cats; and aggression 12% of both declawed and sexually intact cats. Although the differences were not statistically significant, it’s a bit of a red herring to compare declawed to sexually intact cats, since sexually intact cats are more likely to both bite and to housesoil than neutered cats (Patronek 1996), regardless of gender. Such a skewed comparison is, however, a good way to avoid reporting that declawed cats are more likely to bite and housesoil. as reported in later studies. The 1996 study found that inappropriate elimination was reported in 52% in declawed cats vs. 29% in clawed cats; and it also found a very significantly increased risk of relinquishment for declawed cats–almost 2 to 1 compared to clawed cats (OR 1.89, CI 1.00-3.68).
DECLAWING REFINEMENTS
*Indoor housing of declawed cats*—A 2003 survey of 181 cat owners identified that approximately 31% of declawed cats were allowed outdoor access.⁵⁵ A 1991 survey of 276 owners of declawed cats reported that 41% of the declawed cats were allowed outdoors, and no problems were reported by the respondents.²⁰ Owners in this study,²⁰ and anecdotally,^3,14,22 report that declawed cats allowed outdoors climb well, hunt well, and are able to defend themselves successfully. However, in general, declawing of outdoor cats is still not recommended.^1,33	Agree with the recommendation that declawed cats should not be allowed outdoors. However, the AVMA acknowledges that between 31 and 41% of owners will ignore this advice. Worse still, in one survey (Landsberg 1991), 84% of veterinarians said that declawed cats still go outdoors. What liability do we assume for performing a procedure that has a high risk of ultimately killing the cat? The AVMA said above: “…outdoor cats are exposed to predators, street traffic, inclement weather, and diseases (e.g., feline leukemia, feline infectious peritonitis)….” AVMA cites anecdotal reports that declawed cats are not at a disadvantage outdoors, but Hart (1972) suggests that cats cannot defend themselves as well, nor climb as quickly, thus putting outdoor declawed cats at increased risk of injury and death. If we are going to start accepting anecdotal reports as scientific data, it is easy to find many anecdotal reports about declawed cats being injured or killed because they couldn’t climb well or defend themselves.
*Early age declawing*—It has been suggested that declawing is best performed on young cats because it is more emotionally traumatic for adults to be declawed.¹⁵ Although age-related psychological repercussions of declawing have not been empirically reported, younger animals may experience fewer complications and recovery more rapidly.^1,32 In a survey of 276 owners of declawed cats, respondents reported that cats declawed at one year of age or less exhibited fewer postoperative problems and faster recoveries than those declawed when they were older than one of age.²⁰	Except that AVMA’s own ethical policies prohibit declawing as a preventative measure that should be considered only after all other alternatives have been “exhausted”—a process that takes time. Since scratching behavior also develops over time and is often not present in young kittens, this creates a virtual Catch-22 situation.
*Surgical tool selection*—Declawing using a surgical laser resulted in improved subjective pain assessment for eight days after surgery compared to scalpel blade dissection, but both treated groups were walking normally within nine days after surgery.^56,57	Cherry-picked data. Other studies have not found an appreciable difference in pain between different methods of declawing. “Both techniques appeared to result in discomfort of a similar duration (#51). But studies underline the difficulty in assessing pain in cats and the pitfalls of subjective pain assessment. *“Cats, due to their stoic nature, are notorious for not expressing pain and suffering.” (Benson 1991); “Detection of pain in cats is a particular challenge, because signs of pain in cats are often subtle” (Cambridge 2000). “Until recently, cats’ perioperative and traumatic pain was seriously underestimated and under treated. It is difficult to detect and assess pain in cats because they do not demonstrate overtly painful behaviors.” (Taylor et al. Pain management in cats–past, present, and future. J Fel Med Surg*. 2004;6:313-320). The “recommendation” for use of analgesics with laser declaw is put a little stronger by the author: “postoperative pain management is essential” (Young 2002).

AVMA REFERENCES

Bellah JR. Surgical management of specific skin disorders. In: Slatter D. Textbook of Small Animal Surgery. 2nd ed. Philadelphia: WB Saunders Co, 1993; 341-354.
Tobias KS. Feline onychectomy at a teaching institution: a retrospective study of 163 cases. Vet Surg 1994; 23: 274-280.
Price DA. Feline onychectomy. J Am Vet Med Assoc 1961; 139: 577-578.
Curcio K, Bidwell LA, Bohart GV, et al. Evaluation of signs of postoperative pain and complications after forelimb onychectomy in cats receiving buprenorphine alone or with bupivacaine administered as a four-point regional nerve block. J Am Vet Med Assoc 2006; 228: 65-68.
Mison MB, Bohart GH, Walshaw R, et al. Use of carbon dioxide laser for onychectomy in cats. J Am Vet Med Assoc 2002; 221: 651-653.
Goodyear MD. A technique for onychectomy in the cat. Vet Med Small An Clin 1977; 72: 569-572.
Nagle AC. A technique for feline onychectomy. Vet Med Small An Clin 1976; 71: 1685-1687.
Swiderski J. Onychectomy and its alternatives in the feline patient. Clin Tech Small An Pract 2002; 17: 158-161.
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Young WP. Feline onychectomy and elective procedures. Vet Clin North Am Small An Pract 2002; 32: 601-619.
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Fowler ME, McDonald SE. Untoward effects of onychectomy in wild felids and ursids. J Am Vet Med Assoc 1982; 181: 1242-1245.
Miller RM. The declawing controversy: stepping into the ring. Vet Med 1998; 93: 1043-1045.
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Atwood-Harvey D. Death or Declaw: dealing with moral ambiguity in a veterinary hospital. Soc Anim 2003; 13: 315-342.
Carroll GL, Howe LB, Slater MR, et al. Evaluation of analgesia provided by postoperative administration of butorphanol to cats undergoing onychectomy. J Am Vet Med Assoc 1998; 213: 246-250.
Carroll GL, Howe LB, Peterson KD. Analgesic efficacy of preoperative administration of meloxicam or butorphanol in onychectomized cats. J Am Vet Med Assoc 2005; 226: 913-919.
Dobbins S, Brown NO, Shofer FS. Comparison of the effects of buprenorphine, oxymorphone hydrochloride, and ketoprofen for postoperative analgesia after onychectomy or onychectomy and sterilization in cats. J Am An Hosp Assoc 2002; 38: 507-514.
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Landsberg GM. Cat owners’ attitudes toward declawing. Anthrozoos 1991; 4: 192-197.
Pollari FL, Bonnett BN, Bamsey SC, et al. Postoperative complications of elective surgeries in dogs and cats determined by examining electronic and paper medical records. J Am Vet Med Assoc 1996; 208: 1882-1886.
Beaver BV. Feline communicative behavior. In: Beaver BV. Feline Behavior: A Guide for Veterinarians. 2nd ed. Philadelphia: WB Saunders Co, 2003; 118-126.
Bennett M, Houpt KA, Erb HN. Effects of declawing on feline behavior. Companion An Pract 1988; 2: 7-12.
Cooper MA, Laverty PH, Soiderer EE. Bilateral flexor tendon contracture following onychectomy in 2 cats. Can Vet J 2005; 46: 244-246.
Jankowski AJ, Brown DC, Duval J, et al. Comparison of effects of elective tenectomy or onychectomy in cats. J Am Vet Med Assoc 1998; 213: 370-373.
Landsberg GM. Declawing revisited: controversy over consequences. Vet Forum 1994; 13: 94-95.
Landsberg GM. Declawing is controversial, but still saves pets. Vet Forum 1991; 10: 94-95.
Patronek GJ. Assessment of claims of short- and long-term complications associated with onychectomy in cats. J Am Vet Med Assoc 2001; 219: 932-937.
Winkler KP, Greenfield CL, Benson GJ. The effect of wound irrigation with bupivacaine on postoperative analgesia of the feline onychectomy patient. J Amer An Hosp Assoc 1997; 33: 346-352.
Landsberg GM. Feline scratching and destruction and the effects of declawing. Vet Clin North Am Small An Pract 1991; 2: 265-279.
McKeown D, Luescher A, Machum M. The problem of destructive scratching by cats. Can Vet J 1988; 29: 1017-1018.
Morgan M, Houpt KA. Feline behavior problems: the influence of declawing. Anthrozoos 1989; 3: 50-53.
Rife JN. Deep digital flexor tendonectomy—an alternative to amputation onychectomy for declawing cats. J Am An Hosp Assoc 1988; 24: 73-76.
Landsberg GM. Feline behavior and welfare. J Am Vet Med Assoc 1996; 208: 502-505
Yeon SC, Flanders JA, Scarlett JM, et al. Attitudes of owners regarding tendenectomy and onychectomy in cats. J Am Vet Med Assoc 2001; 218: 43-47.
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Smith JD, Allen SW, Quandt JE. Changes in cortisol concentration in response to stress and postoperative pain in client-owned cats and correlation with objective clinical variables. Am J Vet Res 1999; 60: 432-436.
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ADDITIONAL REFERENCES NOT CITED BY AVMA

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AVSAB Position Statement: The Use of Punishment for Behavior Modification in Animals. 2007. American Veterinary Society of Animal Behavior. www.avsab.org, accessed 1/14/2010.

Azrin NH, Rubin HB, Hutchinson RR. 1968. Biting attack by rats in response to aversive shock. J Exp Anal Behav 11: 633-639.

Beaver BV. Feline Behavior: A Guide for Veterinarians. 2002. Philadelphia, PA: W.B. Saunders Company, p. 45.

Dhabhar FS. Enhancing versus suppressive effects of stress on immune function: implications for immunoprotection and immunopathology. Neuroimmunomodulation. 2009;16(5):300-17.

Dodman NH, Commentary on declawing, 2004 (private communication).

Gaynor J. Chronic pain syndrome feline onychectomy. NAVC Clinicians’ Brief. 2005 April.

Hellyer PW. Ethical considerations in the treatment of pain. Vet Forum. 2002 June:38-41.

Hellyer PW, Gaynor JS. How I treat: acute postsurgical pain in dogs and cats. Compend Contin Educ Pract Vet. 1998;20:140–153.

Hornstein, et al. (J Am Vet Med Assoc. 2005 Sept 1;227(5):707.

Levy J, Lapham B, Hardie E, et al. Evaluation of laser onychectomy in the cat . Proceedings. 19th Annu Meet Soc Laser Med. 1999;73.

Lonne-Rahm SB, Rickberg H, El-Nour H, Mårin P, Azmitia EC, Nordlind K. Neuroimmune mechanisms in patients with atopic dermatitis during chronic stress. J Eur Acad Dermatol Venereol. 2008 Jan;22(1):11-8.

Mitschenko AV, Lwow AN, Kupfer J, Niemeier V, Gieler U. [Atopic dermatitis and stress? How do emotions come into skin?] Hautarzt. 2008 Apr;59(4):314-8.

Quarcoo D, Pavlovic S, Joachim RA. Stress and airway reactivity in a murine model of allergic airway inflammation. Neuroimmunomodulation. 2009;16(5):318-24.

Patronek GJ, Beck AM, Glickman T. Dynamics of dog and cat populations in a community. J Am Vet Med Assoc. 1995;210(5): 637-642.

Patronek GJ, Dodman NH. Attitudes, procedures, and delivery of behavior services by veterinarians in small animal practice. J Am Vet Med Assoc. 1999 Dec 1;215(11):1606-11.

Patronek GJ, Glickman LT, Beck AM. Risk factors for relinquishment of cats to an animal shelter. J Am Vet Med Assoc. 1996 Aug 1;209(3):582-588.

Slingsby LS, Waterman-Pearson AE. Comparison of pethidine, buprenorphine and ketoprofen for postoperative analgesia after ovariohysterectomy in the cat. Vet Rec. 1998;143:185-189.

Stanway GW, Taylor PM, Brodbelt DC. A preliminary investigation comparing pre-operative morphine and buprenorphine for postoperative analgesia and sedation in cats. Vet Anaesth Analg. 2002;29:29-35; 31.

Taylor PM, Robertson SA. Pain management in cats–past, present and future. J Fel Med & Surg. 2004;6:313-320.)

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In 2013, American Veterinary Medical Association (AVMA) committee members unanimously “condemned” the same declawing procedure being performed on wild or exotic cats of any size, due to adverse health effects.

Declawing domestic cats causes the same adverse health effects yet the AVMA won’t completely condemn declawing because the majority of their member vets perform declawing. There is money to be made in declawing domestic cats.

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