Letters: Onychectomy complications

I felt compelled to respond to "Mind Over Miller: An exorbitant onychectomy" in the August 2013 issue. I hope Dr. Miller's family elected surgery only after a thorough discussion and implementation of the numerous environmental, behavioral, and medical approaches available. I was dismayed to read that Dr. Miller had declawed "thousands" of cats during his career. An onychectomy is a procedure of last resort. It is only appropriate when all other techniques have failed and the only remaining options are surgery, euthanasia, or relinquishment.

In regard to his concern over the quoted fee at the first facility, questions that should be asked when evaluating a higher fee include:

• Is appropriate preoperative, perioperative, and postoperative analgesia recommended (including local blocks)?

• Will the patient be intubated, catheterized, and monitored?

• Will a dedicated anesthetist be present?

• Is a surgical technique going to be used?

I hope the answer to all of these questions was "yes." Providing this high level of care does result in an increased cost, along with increases in surgical success and patient care, comfort, and safety.

I also wish to comment on the so-called Resco technique. Complications following an onychectomy are relatively high compared with other surgical procedures. This is particularly true when nail clippers are used.1 Other problems, including chronic pain, nail regrowth, and behavior changes, can also be seen regardless of the technique.

Finally, I found Dr. Miller's dismissive and sarcastic remarks toward current medical procedures, thought, and costs to be inappropriate. Much work has been done in recent years to advance the level of care for our patients, educate the public why this care is needed, and describe how we provide it as professionals.

Thomas Hansen, DVM

Walnut Creek, Calif.

REFERENCE

1. Fossum TW. Small animal surgery. 4th ed. St. Louis, Mo: Elsevier, 2013.

Dr. Miller's response: I've received more flak about this column than I ever have during the 45 years I have been writing it. All of the critics missed the humor. Maybe I'd better stick to cartooning.

Onychectomy is wrought with emotion. I deplore unnecessary, unjustified mutilating surgery. Throughout my career, I refused to do certain procedures such as ear cropping and "setting" horses' tails because I did not consider them justifiable.

But I'll bet my critical colleagues have spayed and neutered countless pets. Isn't a panhysterectomy a radical procedure? Is it justified? Yes! Because the end result is beneficial, I have defanged lions, dehorned cattle, and neutered many species.

Done properly, as I discuss in "Mind Over Miller: The declawing controversy: Stepping into the ring" from December 1998 (see link to article at dvm360.com/DeclawDebate), forepaw onychectomy is easy and rapid. Every one of my own cats, all in a rural environment, did fine after being declawed. Most importantly, children, other animals, and other people in the house are protected from being scratched after this procedure. Did you know that veterinarians are the No. 1 population testing positive for bartonellosis? Cat scratch fever is the most common form of Bartonella species infection in the United States.

When I asked my former partner, Dr. Jim Peddie, if he could recall a poor result in the countless onychectomies we did, he said, "Yes! Whenever we tried a new technique that had been published."

Robert M. Miller, DVM

Thousand Oaks, Calif.

What do you think about declaws? Join in on the discussion at dvm360.com/decawdebate.