Spay/neuter in shelters: Does raising the bar mean raising the cost?

Every day, thousands of pets get low-cost or even free spay or neuter surgeries in shelters, spay/neuter clinics, and mobile spay/neuter vans. Some of them are operated on by private veterinarians who have voucher and other arrangements with local shelters, rescue groups, and animal control agencies.



What all those surgeries have in common is that they're being done for far, far less than they cost to perform. A surgery that requires pre-operative care, careful anesthesia, pain prevention, and the attention of a surgeon and highly skilled staff to monitor heart rate, respiration, and anesthesia levels might be reimbursed for as little as $35. Some vets even do a certain number of such procedures for no money at all.



This creates a conflict between doing the best possible job -- or even an adequate job -- from a medical standpoint, and performing high-volume, low-cost surgeries with the very laudable goal of reducing the number of pets entering, and probably dying in, local shelters.



Into this morass of conflicting interests stepped the Association of Shelter Veterinarians, who, in the July 1 issue of the Journal of the American Veterinary Medical Association, published a clarion call to standardize care in low-cost and free spay/neuter clinics and shelters at levels many private veterinarians don't even meet. The report stated the "proliferation and diversity" of low cost, high volume spay-neuter programs has "created a need for guidelines for appropriate veterinary medical care in these settings." It went on:

In developing these guidelines, the Association of Shelter Veterinarians hoped to establish spay-neuter practice as a recognized practice area within veterinary medicine; instill confidence in the general public regarding the use of spay-neuter programs; promote acceptance of this practice area by the veterinary profession and the public, thereby encouraging increased veterinary participation; provide guidance for veterinarians in this practice area; encourage existing programs to recognize and adhere to these guidelines as a means of ensuring acceptable levels of care; foster confidence among private practitioners regarding local spay-neuter programs and facilitate patient referral; provide a reference for use by state boards of veterinary medicine, other governing agencies, and veterinary professional associations; and provide a set of benchmarks by which funding agencies and donors can determine whether the spay-neuter programs they support provide acceptable levels of care.

They outlined basic standards for "preoperative care, anesthetic management, surgical care, and postoperative care" for pets undergoing spay and neuter surgery in these facilities -- standards that, as Dr. Patty Khuly writes over on Dolittler, raise the bar considerably not just for shelter vets, but for many vets in private practice, too.



The conflict in private practice comes because few people are willing or able to pay several hundred dollars for a sterilization surgery, and veterinarians can't just give their work away. Where do they compromise to reduce costs? From Dr. Khuly:

(I)t’s clear to me that not every vet can afford to spay and neuter pets at the price pet owners are willing to pay ($100 to $400, on average) AND meet these guidelines’ requirements.



Nope. Not while we’re paying more for our leases and our staff…not while we’re keeping detailed, computerized records on every patient, practicing individualized medicine and paying top dollar for our drugs and supplies.

The team that put together the report -- some of the top shelter medicine specialists and vets who have worked in the trenches of the low cost spay/neuter movement -- insists these standards are reachable for most shelters and low cost facilities. If they're right, it's just a matter of getting the right information and having the will to implement it.



But I've read the guidelines, and while I agree that they represent a very good standard of care, I find it hard to believe they're as achievable in shelters and high volume, low cost programs as they suggest they are. The anesthesia protocols, the individualized care and monitoring, the use of pain medication -- all of these things are consistent with what I've had done for my own dogs in surgical specialty practices by board certified surgeons, at a cost of as much as $900 for a spay on a giant breed dog.



Dr. Khuly writes:

Can we really afford to spay and neuter as many pets if every procedure requires a cap and a gown and a mask and a new set of sterile instruments? The short answer is, “No, of course not.”



It’s a conundrum, for sure. If meeting these guidelines poses expense issues for the average vet with paying clients what does that mean for the rest of our pet population?

Veterinarians should not be in the business of performing substandard medical procedures, regardless of what their clients can or cannot afford to pay. But the pets of people without the means to pay hundreds of dollars for a surgery still need to be spayed and neutered. This benefits society, it benefits animals, and it benefits their owners. And voluntary low cost, free, or even incentivized spay/neuter is the absolute foundation of any drive to achieve no-kill in a community.



The question is this: can we afford to pay to do it right, and still do it at levels high enough to make a difference, and meet the needs of people and animals in our communities?



The authors of this study say we can. What do you think?

Comments

[slt]

I only skimmed the paper (you know, I'm "working") but I didn't see where they outlined how the increased costs could be met. It's good to set standards but Vets will need a plan for how to meet them if they are to be implemented. I certainly don't want to do anything to DECREASE the number of shelter neuters unless it's proven that the current standards are causing harm to pets.

[Christie Keith]

Well, this was a medical journal article -- I wouldn't expect them to include that here. But the authors are not all ivory tower academics. Some of them are from the trenches.



*digs through day trying to find time to interview someone about this*



*fails*

[Lis]

What disturbs me is that Dr. Khuly says that these standards aren't being met in private care, and can't be, because clients won't pay--and several of her commenters say that it's not worth even bothering to tell private clients, because they won't understand the explanation and will just conclude that the vet is trying to gouge them.



The level of contempt and condescension is amazing and scary.

[slt]

Comment by Christie Keith — July 11, 2008 @ 8:24 am



Well if I write in a pet nutrition journal that the minimum standard of pet care - particularly for low-income owners - is feeding steak, I don't know that I'm exempt from splainin how the heck that's supposed to be financially achievable just because it's a nutrition journal. Sure I *could be* exempt on that basis but it wouldn't make much sense to me. You shouldn't just say "We know you're already having financial difficulties so here's some more expensive standards to meet kthxbye".

[Gina Spadafori]

Lis ... I've been following that discussion. You're right: Amazing degree of condescension from veterinarians (not Dr. K)and techs in the comments.



Among the things I worry about -- now including a hit on the earth by a space rock, killing millions, gee thanks! Atlantic magazine -- is what on earth I'm going to do when my veterinarian retires.

[straybaby]

Comment by slt — July 11, 2008 @ 7:32 am



In regards to increased costs to shelters, there is funding out there if there is a no-kill effort going on. For shelters that are not currently altering before placement, from what I have seen, they have low adoption fees. An increase in fees is a possibility. In my experience, most people are fine with paying a bit more and brining home a pet that is all checked out, s/n and UTD on vacs. NYC is serviced by the ASPCA low cost vans and vouchers. The city shelter started having "Big Fix" days and that has expanded to permanent days at 2 locations. Pre no-kill, I think we just had they vans and vouchers. Most shelters and rescues were adopting out only s/n, not sure about the city though. Once the city organized to become no-kill, Maddies funds became available. In the beginning the ASPCA vans would go to the city shelters to help with the s/n load (not sure how much they do now). Shelters and rescues are required to adopt out altered pets. The shelter by me has the ASPCA services along with an on-site vet who has a private practice but also handles the shelter animals. The vet will sometimes handle all the neuters while the ASPCA does the spays (kitten season!). Feral cat rescuers and other rescues in my area also have access to the van services. There is also a group of vets that work at lower costs with shelters and rescues. Spay/aborts and more complicated procedures are usually handled with them. The low cost services here are good as far as the actual procedure. My 2 oldest pets were done under the voucher plan 16yrs ago ($60 per spay) the rest have been done on the van ($25 per pet)through whichever shelter they came from. The van services are quite popular here and the service has increased in the last 5yrs. The shelters and rescues were pretty much only adopting out altered pets before it became required and the funding was available. A lot of it is working tog ether and organization. Some smaller communities and rural animal controls could have cost problems due to the lack of funding they already face, but I'm sure there are models out there that they may be able to adapt.

[straybaby]

apologies for the one LONG paragraph! {goes to get more coffee}

[Tara]

As I said on dolittler, I'm just not seeing the major issue here. The paper gives guidelines that are really very broad. Going by the paper, for example, animals could all be monitored manually (a combination of jaw tone, palpebral reflex, and etc would be appropriate), surgeons don't have to wear gowns, pets don't all need to be intubated, and feral cats don't need to be fasted before they're anesthetized. Also, there is no requirement for pre-anesthetic blood work and no requirement for an IV catheter.



At a specialty hospital like the one you describe,. I would expect a catheter to be inserted, blood work to be done, monitoring equipment to be used, and a separate gown to be worn while the surgeon operates on my pet. This paper doesn't require any of these. I'm not sure why everyone seems to think that implementing the bare minimum recommended by this paper will involve all these things.

[Christie Keith]

Tara, I think you're missing the point.



The paper doesn't "require" anything. It's a paper in a medical journal. It lays out an idea, a concept, of what best practices are, even if it phrases some as more "optional" than others, even if it has zero enforcement power.



That is what is the threat to veterinarians, in private or shelter practice alike. That an idea is being put out there that certain things -- again, phrased as "optional" or not -- are "good medicine," and the way they're doing it now is less than that.



So while I understand the point you're making, I don't think it changes a thing.

[Serijna]

Maybe I am naive but I will not insult my vet by asking if sterile instruments are used or other "common sense" questions. Would you really expect a different answer other than affirmative.

I fully trust my animal clinic I do take my many pets to. I carefully selected them not based on price but based on recommendations from other pet owners. I never felt my bill was padded. I respect and trust their professional decisions/actions based on their extensive training. Although I must admit that some drugs are getting horrible expensive.

In the final analysis when I take a sick pet over there and receive the pet back on the mend, I really donot care how they got from A to B(maybe they did a VooDoo dance around it LOL), just that my pet is getting better.

Frankly I always marvel that the bills are really very very reasonable if you compare it to bills for humans for similar treatment/surgery.

You have to carefully shop for a vet though, since like in any profession, there are good ones, bad ones, dishonest ones, stupid ones etc. Similar to finding a good/honest car mechanic.

If a vet is cutting corners because he/she is afraid the client might suspect padding of bills, he/she is more in need of building a relationship of respect/trust with subject client.Most pet owners I know would not want corners cut if the risk is increased significantly. The pet owner should be involved in such decisions.

[slt]

Certainly I can imagine *some* pet owners thinking that neutering pets is akin to neutering livestock. However, there are definitely other owners who treat their pets as family members - sharing their homes and food with their pets - not at all regarding them as livestock. Whatever the case, *all* owners should be making informed decisions as regards neuter surgery protocols. The idea that a Vet might not advise the owner of protocols/options because of a certain set of assumptions is wrong thinking IMO.

In my case, I trust my Vet very much. I don't know her surgical protocols but now that I'm thinking about it, I'd like to. Because unless I found out something shocking, I am inclined to think that whatever her protocols are - they're "good enough for me". But wouldn't it be nice to simply say, "O I go to an AAHA accredited hospital so I know the surgical protocols they use - there's a link to them on the web"?

[Christie Keith]

Doing operations on animals without extreme attention to asepsis is insanity in this day and age of drug-resistant bacterial infections. It's putting not only your clients' pets at risk, but you and your staff and every animal in the hospital.



That there is debate on this issue blows my mind.

[C.L.H.]

My dog suffered a very nasty post-op infection at the incision site when we had her fixed. I now wonder what, if anything, was done to maintain antiseptic (or even clean) conditions during her surgery. A few years later I had big problems when I had her teeth cleaned. She had the runs for two weeks. I've since changed vets. I had the feeling that the vet's office just wasn't "clean." I don't want cheap, I want it done right.

(I've been on a farm at pig castration time. Don't know if it's fine for pigs, but I sure wouldn't want my dog treated that way.)

[Gina Spadafori]

H. ... I have seen cattle castrations, when visiting my friend's ranch. Bull calves into the chute and then one by one into the "squisher." Splash of betadine, clamp off with what looks like channel locks, slash, slash, bellow, bawl ... steer out the other end ... next.



Vet asked if we wanted the testicles ... "You know, to eat. Lot of people cook 'em!"



Uh, no thanks.

[Gina Spadafori]

Don't know why ... but they were all snared by the spam filter. I liberated your first one. :)

[The OTHER Pat]

Comment by Dr Patty Khuly — July 12, 2008 @ 8:30 am



"Unfortunately, standards for regular vets (and now I’m not referring to shelter situations) do differ by community. They differ based on price-points (you do tend to get more when you pay more), based on what paying clients in that area demand, and on what veterinarians in that region deem acceptable."



I'm going to again bring up the example of agricultural practices, and how far they fall from what goes on in the clean office of a veterinarian. Here's a page describing procedures commonly performed on piglets within the first couple days of their birth. Pay particular attention to the description of castration (down the page a ways) and realize that at the conclusion of this procedure, the baby piglet is simply tossed back down into the yard with his siblings and the next one is grabbed up to do it again:



http://edis.ifas.ufl.edu/AN025



Given this, you can see how people in an agricultural community - for example - might have a really hard time understanding how "the same procedure" should cost so much more when the vet performs it on their young dog. Consequently, downward price point pressure on veterinarians doing Small Animal work in agriculturally-dominated areas is very real. Do they cut corners? Well - I can tell you that while I was in school for vet tech and did a rotation with a rural vet, that one of my duties - for example - was to "clean" and re-sharpen hypodermic needles for re-use. It was one of the economies practiced by rural vets to meet the pressures of the low fees their clients demanded.



To a greater or lesser extent, I can see how people in different areas exert their own kind of "downward pressure" on what they're willing to pay vets, when comparing it to their own experiences of what to expect in health care - whether human or animal.



And yet the fact remains that I have been present for veterinary surgeries where the people involved wore gloves but otherwise were in their normal street clothes, no monitoring took place unless the vet looked up and asked one of the techs to take a look at the heartrate, other people wandered in and out of the room doing other things - sometimes standing and watching for a while with a Coke in their hand - the closed incision was swabbed with iodine but otherwise no other antibiotics, or pre- or post-op bloodwork was done, and so forth. And the vast majority of these animals did not develop post-surgical infections or complications, but healed up just fine and went on with their lives.



We were told (at that time) that animals had a far better resistance to infection and a better ability to heal, and that this was why it wasn't necessary to take all the safeguards with animal surgery that were taken with human surgery. And I have to say that - at the time - what I saw and what I experienced seemed to support that.



And those are the memories I flash back to as I read through this discussion. And I'm not sure what I think now . . . . . . . .

[H. Houlahan]

test -- where are the comments going?

[Lis]

That may be hard to believe for those of you willing to pay reasonable prices for excellent care but, let’s face it, a great many pet owners (dare I say most?) are so price sensitive on spays and neuters as to feel cheated when their pet’s procedure costs more than it does at the shelter. (Much as I explain the difference, some clients will not *get it* and I’m happy to see them go.)



In the past, I've had great sympathy for vets on that particular point (people expecting a speuter at their regular vet's office to cost what it does at the shelter.) I've explained that at the shelter, it's below cost, and the animals aren't necessarily getting everything the private patient does: No pre-op blood work, less post-op monitoring, maybe not post-op pain meds, likely little or no emergency equipment on-site--cutting out the things not absolutely essential to a basic spay.



But now we're being told that even sterile instruments are "not essential"--and that we may not be getting these things at our regular private vet's office, either.



And that the vets "know" that we we won't pay for them anyway, so there's no need to even mention that the instruments used in our own pet's surgery may have been used on a couple of animals before, and not sterilized in between.



This makes me a lot less sympathetic, and a lot more likely to tell people, "Don't just have faith in your vet; grill him or her in detail about what he or she considers "necessary" or "optional" when taking your pet's life in his or her hands.

[Dr Patty Khuly]

A much more relaxed tone on this thread...whew!--and more to the point.



For me, the issue is *standards*. As Serjina writes,



"Veterinarians should not be in the business of performing substandard medical procedures, regardless of what their clients can or cannot afford to pay."



Unfortunately, standards for regular vets (and now I'm not referring to shelter situations) do differ by community. They differ based on price-points (you do tend to get more when you pay more), based on what paying clients in that area demand, and on what veterinarians in that region deem acceptable.



So what's considered substandard for one facility in one area may well be above the standard of care for another facility in another region.



It's all very confusing in the real world--even when you think you understand the ins and outs of why standards tend to differ and how vets arrive at these decisions. This is why a paper like this needs to take up precious space in the US's top veterinary journal.



Ultimately, vets need to wake up to the need to conform to certain standards. Understanding why vets don't already do this is crucial, then, to solving the problem.



So back to the main point: Can we afford to meet the standard of care for paying clients? Of course. That is, if pet owners are willing to pay for what a spay or neuter costs. Some vets in some areas find that their clients won't pay for this. That's why they cut corners, not because they're money-grubbing evildoers.



That may be hard to believe for those of you willing to pay reasonable prices for excellent care but, let's face it, a great many pet owners (dare I say most?) are so price sensitive on spays and neuters as to feel cheated when their pet's procedure costs more than it does at the shelter. (Much as I explain the difference, some clients will not *get it* and I'm happy to see them go.)



And now to the ultimate question Christie asks: How many can we spay and neuter if we raise the bar for shelter pets? Does raising the bar mean less for the pet overpopulation problem? I think it's obvious that it does. But that doesn't mean it's not worth trying.

[slt]

"If providing monitoring, sterile instruments, and careful patient selection are standards a private vet doesn’t follow or live up to, then I’d sure hate to take my pet to them."



Comment by Tara — July 12, 2008 @ 4:50 am



You might hate to take your pet to them but may be taking your pet to them right now. I may be. We all may be.

[H. Houlahan]

Has anyone ever bothered to track outcomes? Just gross outcomes -- death, infection, major surgical complications?



If there's no difference in mortality/morbidity between that $1200 surgical specialist spay, the $300 local GP spay, and the $50 assembly-line model, then we are looking at much sound and fury.



If there's a massive difference (in the conventionally expected direction), then the assembly-line may beggar justification after all.



Most of us would hypothesize that there would be some difference, and that variations in outcomes would relate to exactly which compromises occur in each environment. But has anyone, you know, checked?



The two most common surgical procedures undergone by domestic animals. (And for livestock, one of these procedures is typically done out in a pasture, often with a rubber band and time, no vet, so put thatsurgical protocol in your smoking pipe.) It shouldn't be difficult to set up a large-scale study comparing gross outcomes.



Has evidence-based medicine even made a scratch in the veterinary world?

[Tara]

Christie, I understand what you're saying, too. I think I phrased my point badly - I understand the paper doesn't enforce requirements or really hold any sway, besides in how it affects standard practice in a given area. But again, this paper doesn't say best practice must involve anything that's way out of the ordinary. If providing monitoring, sterile instruments, and careful patient selection are standards a private vet doesn't follow or live up to, then I'd sure hate to take my pet to them.



I've worked at one of the spay/neuter clinics that *does* follow all of these practices. Remember that for subsidized clinics, donations are the key. Public support is the key. Not making your surgery so dirt cheap that it only costs *you* the $50 you charge the client.

[Lis]

Serijna, your vet may not cut corners, regardless of whether it's a low-cost speuter or not. But go read the Dolittler thread; some vets are worried that they might have to meet these standards on their regular clients, the ones who believe they are paying full price for good medical care for their vets.



And they're even more outraged at the idea that the "stupid" client might want to know whether or not they're doing these things.



They don't regard sterile instruments as basic, but an optional extra.



I don't think my vets are doing this. But now, I can't be 100% sure, and I'll have to ask if/when a pet needs surgery again.

[Lis]

I just don't understand how sterile instruments can be "optional." Especially with private clients in a private setting.

[H. Houlahan]

A paper such as this one is just one way that a generally accepted "standard of care" is established in any professional service. It contributes to the consensus, as it were. Ultimately, that standard of care is something that entities are held to -- in court (seems unlikely in this case) and in the court of public opinion.



If the paper is pushing the standard of care for shelter medicine into *more expensive* territory -- essentially establishing that only best practices can be applied to the shelter population -- then it has the potential to cause harm.



If it's going to cost hundreds of dollars to spay every kitten in the pound, then in many places, none of them are going to get spayed. Whether that means intact adoption or "euthanasia" -- Houston, we have a problem.



Or put it "out on the streets." One of my conditions for having barn cats at our new place was that they will be neutered. No scrambling for homes for kittens every spring. No contributing to the problem.



There's a low-cost clinic that will castrate/spay cats for under $30/$50, and also provides vaccinations very cheap. Because that exists, I accepted two "free" barn kittens, who are already at work out in the barn (terrorizing moths, as far as I can tell, also taunting dogs). The stable manager who gave them to me thanked me profusely as I took them to my car, a strange feeling when one is getting something nice for free. For $16 I purchased their first vaccines and wormer at the feed store, and did that myself. They'll go to the clinic when they're old enough, and I'll walk out having paid maybe $110 for the surgeries and rabies shots and sundry.



If it was going to cost me three or four or five hundred dollars to have two neutered and properly vaccinated barn cats -- I wouldn't have gotten any at all. Mouse traps are cheap. Two fewer cats with a home. (Oh -- and the shelters will either never adopt out for barn cats, or will only place hostile ferals. So it was the "free kitten" signs for me. And I got two very nice kittens indeed, by looking around a bit and being picky.)



Will these kittens get the same standard of care that my operational SAR dog got this week when she was spayed by my regular vet? Nope. Would I take my operational SAR dog to the clinic, where a dog her size is spayed for a paltry $100? Nope. Is that fair? Probably not, but I'm the one paying the bills.



Who is going to be the one paying the bill for a standard of care in shelter medicine that private owners of beloved pets aren't willing to foot for their own animals?

[Lis]

Who is going to be the one paying the bill for a standard of care in shelter medicine that private owners of beloved pets aren’t willing to foot for their own animals?



And this is a big part of my unhappiness with the thread over on Dolittler.



No one tell us what choices we're supposedly making.



I ask my vets about a lot of things, but I've never asked about sterile instruments because it never occurred to me that that might be an "optional extra."



Many people, who love their pets just as much as I do, haven't spent years working in the pharmaceutical and biotech industries, with medical journals crossing their desks every day. They have even less idea of what questions they need to ask.



The comment thread on Dolittler makes it plain that many vets are cutting these corners without ever asking these clients, because they "know" that the client will not pay for anything but a barebones procedure, because they "know" the client regards the pet as disposable and easily replacable.



And yet, if that were true, why would the client be a client, taking their pet to the vet in the first place?

[Christie Keith]

Before my "Redemption" awakening, I might have agreed with dire prognostications that meeting these standards in a shelter medicine practice is too expensive, but I've gotten in the habit of questioning the conventional wisdom, and I suspect that's not the case. I know there are facilities that meet these standards, and if they can do it, other clinics can, too.



First you have to know what to do, then you need to have the will to do it, then you have put a program together to make it happen. Just like anything else. But without knowledge and will, it'll never happen.



This article is the first step, in assembling the knowledge of what needs to be done.

[Gina Spadafori]

It is a veterinarian's responsibility to stay informed and current as to what constitutes "best practice" within the profession.



It is furthermore her or his obligation as a doctor to make sure you understand how and why the procedure you have chosen for the animal in your care differs from these "best practices," and how that might -- or might not -- affect the outcome.



With that knowledge, you can then make a decision based on informed consent, taking into account your situation, the relationship you have with the animal and the risk/benefit analysis for the animal and, in some cases, the community. (For a feral cat, even "bare bones" spay-neuter has a high level of benefit for both. probably more than offsetting the increased risk.)



By the way, I have long found it interesting that when veterinarians follow best practice, they are sometimes ripped by clients for "padding the bill," etc. When in human medicine best practice is not followed, malpractice suits will be close behind, rest assured.

[slt]

As I've digested this more and given it further thought, I'm reminded of how I felt at the beginning of the pet food recalls - learning that most pet food companies don't each make their own food but contract out to different facilities. And those facilities alter recipes, share cheap ingredients among brands, etc. Total deer in the headlights moment.



Now I'm realizing that there is no basic standard of care for low cost spay-neuter clinics or really even for private clinics as regards spay-neuter. I might pay $40 or I might pay $400. I might get a sterile surgical pack used exclusively on my pet or I might not. And I'll never know unless I roll out a scroll of checklist questions in the exam room to take up my Vet's time (and probably patience) in advance of the surgery.



What about AAHA accreditation? Does that dictate any surgical standard of care? Cos that's like a plaque in the lobby clients can see and think "OK, we're good". Or maybe not. I don't know.



I guess I'd like to know what I'm paying for. I don't need every bell and whistle available, but I'd like to know what, if any, bells and whistles my pet is getting.

[Serijna]

Veterinarians should not be in the business of performing substandard medical procedures, regardless of what their clients can or cannot afford to pay.

Oh my , that statement really made my neck hair stand up. Kind of implies that the more you pay, the better care you get. It all depends on the individual veterinarian, independant of the fee. Over the past five years, I have had about forty cats spayed or neutered. Most of them ferals/strays and some of my house cats thru various sources. Some regular vet clinic, others low/no cost thru rescue groups. Always got the cats back without any problems regardless of the source for spaying/neutering. Actually I changed vets because I noticed that the low cost spayed cats had a smaller incision than my regular vet. So I switched to the animal clinic that also did the low cost for the rescue group.

I donot like the implied suggestion that those wonderful vets who volunteer their valuable time to low cost spaying/neutering deliver substandard unsafe operations. Maybe it does happen, however, not based on my experience.

[Roberto]

I am a working class person who lives in the northeast. I have found the older farm vets are the ones who help us. The "youngster vets" are predominantly focused on the weekenders/city people. They and their business managers offer the discounts to the wealthy. They get a 400 dollar package; we get charged item by item. Please don't bash us. In my area we are the ones who care for the strays and ferals. Yanno, we're really not stupid and the farm vets aren't bad guys.

[Christie Keith]

Most of us would hypothesize that there would be some difference, and that variations in outcomes would relate to exactly which compromises occur in each environment. But has anyone, you know, checked?



There are indeed studies comparing outcomes from different procedures discussed in this article -- anesthetic protocols (masking down vs induction with injectable drugs, for instance), the use of different forms of analgesia, or none at all, using or not using prophylactic abx when performing different kinds of surgeries. These things are well-studied.



What is troubling me here is the co-mingling of these different categories of standards in the discussion we're all having. Each individual procedure and each surgery has a different risk vs benefit profile. You can't lump them together like this.



For instance, neuters and spays are completely different surgeries. A neuter is, sorry guys, really not that big of a deal, and that's why you can do them in a field and not end up with a lot of infection, etc. I still argue that's inhumane and the animals suffer stress, pain, immune suppression, etc, but the complication risk, from infection etc, is not that great.



But a spay is abdominal surgery and it's a very big deal indeed. Try doing a few spays in a cow pasture and then tell me there's no risk or danger from infection and post-surgical complications.



Lastly, any surgeon who thinks asepsis doesn't matter is out of his or her mind. Any client who thinks it doesn't matter is stark raving insane or uninformed. It isn't just, or even primarily, about the recovery rate or morbidity or mortality of your pet; it's about the risk to other animals and the hospital staff and customers from letting your equipment and surfaces become colonized with bacteria.



There is no scientific analysis in which that's an acceptable risk. Only emergency procedures, field surgeries, meatball surgery in wartime, etc are a justification for doing surgery without full attention to asepsis. If anyone wants to argue that with me, I'm right here. Bring it. Because you're wrong.

[Gina Spadafori]

>I fully trust my animal clinic I do take my many pets to.



I have been with my veterinarian for 25 years, and I absolutely adore him. But that doesn't mean I check my brain at the door when I walk in to the hospital. I have a responsibility to my animals to ask questions and work with my veterinarian to make good decisions on their behalf.



>You have to carefully shop for a vet though, since like in any profession, there are good ones, bad ones, dishonest ones, stupid ones etc. Similar to finding a good/honest car mechanic.



First, how do you know you have a good veterinarian if you don't inform yourself, ask questions and discuss your pet's care?



Second, it's NOT like choosing an auto mechanic. My car dies, I get another. My pet dies, I'm out a family member.

[slt]

Comment by Roberto — July 12, 2008 @ 10:46 am



I didn't interpret anyone bashing you. I drive a long way to get to my large animal Vet (for my dogs) because I like her so much. I could go to (and have tried) many Vets much closer to home but I have such trust in my "farm Vet" that I drive over there instead. But if *any* Vet wants to use livestock neuter protocols on my pet, I want to be informed in advance and discuss it thoroughly. I don't think anyone's stupid, but pet owners who think they're buying the "Cadillac" surgery might actually be getting the "old Buick" surgery without giving informed consent. And that sux.

[Serijna]

My TNR rescue group told me neuter takes about 5 minutes of the vet's time. Spaying 25 minutes or longer, especially if already pregnant female. This time does not include ofcourse prepping which is done by volunteers.

I did have complications with a low cost neutered stray a few years back. Severe bleeding the next morning. Panic time. No animal hospital would take him, not even my regular animal clinic(soon to be ex clinic) at that time since they did not do the neuter. I had no clue who did the neuter since my rescue group picked up the cat in trap at my house and I could not get a hold of them. A VCA animal clinic some distance away finally did take him. He was a bleeder, and they pulled him thru. He also became a (wonderful)house cat over time since I was afraid to put him outside again. I guess blood work would have prevented this almost fatal complication.

BTW, my TNR rescue group paid the VCA bill eventhough I did not ask for it.

[Roberto]

Never said anyone was bashing me. I was just bringing up the point that newbie vets are not always the vet of choice. Many of us have long term relationships with vets who have helped us through thick and thin. They are not always up-to-date on everything. But perhaps they care more than the techno-vets.

[Lis]

Roberto, who said anything about "newbie vets" or "techno vets" ?



All anyone said was that using livestock neuter protocol for pets, especially without informing the client, is not appropriate. Do you disagree with that?

[Roberto]

No argument. Just trying to remind people that just as modern human medicine is run bean counters, so is vet medicine. The newbie, modern vets tend to have business managers and efficiency experts telling them who runs the world. My vet is 82 years old. And he would never do surgery without gloves. And he doesn't care that I'm poor. That's all. Just trying to tell folks that because a vet is old, doesn't mean he's stupid. If you have a problem with that-oh, well.



Later days, dude

[Serijna]

This article is on important guidelines, most of them easily attainable, most of them already in use by the average veterinarian. Standards, either above or below is in the eye of the beholder and a moving target as Dr Khuly so graciously explains .It mainly depends on lowering the risk factor vs the associated cost increase analysis and how much John Q Public is willing or able to pay for that decreased risk factor. Also, how could you enforce a "standards" system. Practicing as a veterinarian is more like an honor/integrity system anyway. Besides, it would not make business sense to kill off your animal clients.

In my area(PA) the average cost for an initial office visit(which includes an examination) to a veterinarian is about $35.00 to $45.00. Truly the bargain of the century when compared to other professional services at a doctorate level. And still in reach for even the poorest among us. Many of these less affluent pet owners do not even ( or rather cannot afford) go to doctors for their own ailments. The bar( and ofcourse the cost) was raised significantly for human medicine over the years( mainly due to threat of malpractice suits, not greedy MD's) but sadly resulted in medical care out of reach for many Americans.

We donot want that to happen to pets.

Ironically since many people donot have health insurance, pet owners quite often provide better health care for their pets IMO then for their own medical care.

I , for one , am very pleased with my local veterinarians and the still affordable service they provide.

And Gina, I do ask my veterinarian many questions pertinent to their specific ailment when I take one of my cats to the animal clinic

but I will not ask general "common sense" questions which are truly an insult to my vet's their intelligence/integrity.

Last not least, wonder if there are any comparison statistics on price increases over the last twenty years on animal visits/surgeries/treatments vs human visits/surgeries/treatments.

Bet they are lot lower without any measurable decrease in the quality of care.

[The OTHER Pat]

Roberto, not sure what point you're trying to make. But the story I relayed about the environment I saw (spay) surgeries performed in and the rural vet who had me cleaning and re-cleaning hypodermic needles for re-use took place in the 1977-1979 timeframe - about 30 years ago. Don't think there were many "techno vets" around then, and both vets I'm referring to had been in practice for many years already at that time.

[Dorene]

It just blows my mind that sterile instruments are considered an "option" for surgery, especially for a spay.



What surprises me about the discussion from the vets and vet teches is



1) the close-mindedness on the need for education for clients. Maybe some vets don't have time for one-on-ones with every client, but if it's such a widespread problem, then it's time for the professional societies or those who spend time in the media to take THAT time to educate the public about what "best practices" for spay and neuter are.



Close to this -- a friend of mine finally decided to neuter her 4 year old Carin Terrier -- the price the vet quoted was more than what my vet charged to SPAY my 6-month old Border Collie. When questioned (this was an excellent client who paid her bill without question for her "baby" and also patroned several other doggie services at the office) all the vet would say is that "he's old." It made no sense to either of us at the time (why would a neuter of a terrier cost more than a Border Collie spay?), but based on the discussion here and on DoLitter, my guess is that my friend's vet was rolling out the bloodwork and monitoring since he was worried about the dog. IF HE HAD JUST MENTIONED THE ADDITONAL SERVICES, my friend would have been just fine with that -- and would have paid without question and felt that her vet was truely looking out for her dog and she was paying for a service. Since he did not explain it, she had him perform the neuter because she was too nervous to have a new vet perform it, but it has soured their relationship and she's convinced he ripped her off.



2) Is anyone looking at business flow in the vet profession from spay/neuter? Since this is one of the first services the owner of a new pet requires, is it worthwhile to consider spay/neuter (especially neuter because it just doesn't take that much time and effort) a "loss leader" or "marketing expense" to establish a relationship with new clients?



After all, most spay/neuterings are done on young animals -- one would think that if the relationship was good after this surgery, a client would be impressed enough to continue patronizing that vet -- and a good start to a relationship that has a very good chance of continuing for 15 years should mean a resonable profit for the vet.



Dorene

[Hilary]

I took my rescue to a private clinic - knowing how much more I had to pay. I had to pay a 'refundable' fee to the shelter that they would have reimbursed if I brought her back for the procedure.



I interviewed 7 vets and went to 4 clinics before I decided on a surgeon I was comfortable with. The total spay, with the rescue 'deposit' cost $750 to spay my 2.7 lb. dog. It was spread between credit card payments and I'll be working to pay it back for a long time...However, it was worth every penny. The bloodwork, follow up care and everything...was worth it.



I looked into low cost clinics and was appalled by what I saw. The lack of sterile equipment, the filth of the clinics and the lack of enthusiasm and care on the part of the vets was appalling.



I thought it was hard to get into vet school? How come so many vets are substandard and could care less about animals?



Our 'animal activists' need to raise funds for spaying and neutering done the proper way. Instead of the cost of passing mandatory spay/neuter legislation, why not redirect funding into improving the quality and care of spay/neuter procedures and facility.



If we are serious about decreasing the number of homeless animals and decreasing the number of euthanasia, doctors, legislators, drug manufacturers...everyone will need to work together to help make spaying and neutering safe and affordable.



Unlikely...very, very unlikely...I guess we will just continue to exist in a world where we commit a veritable holocaust each year against millions of defenseless animals who could have been wonderful pets.

[Dr Patty Khuly]

Christie: You raise a great point: Wartime surgery. Some veterinarians liken spay and neuters of strays to battlefield medicine. We see just how much suffering is out there so we take a calculated risk in alleviating it through often less-than-sterile techniques.



I, too, have taken this approach, neutering (yes, even spaying) slews of trapped cats on my kitchen table. Because what's the alternative? My neighbor will kill them by shooting them in the head with an air rifle. Sometimes, I think you'll agree, exceptions to asepsis seem the lesser of several evils.

[Christie Keith]

Patty, I agree -- in practice. But I feel all squirrelly about the argument (not being made by you) that asepsis doesn't matter because most animals are fine after surgeries not done to the highest standards of asepsis (and anesthetic protocols, analgesia, etc).



I mean, there are "standard of care" guidelines in human medicine for field amputations, battlefield triage and first care, emergency C-sections -- all kinds of situations where asepsis takes a backseat to lifesaving.



The problem is not those kinds of battlefield decisions, it's the institutionalization of bad medicine when it's not really necessary to save lives.



I certainly don't question your judgment about an individual case; I question the systemic acceptance of low standards of medicine on an institutional scale, using "need" as a justification.



And of course, my nagging sense that many of the compromises aren't really necessary, if people just had the will to change things.

[Dr Patty Khuly]

Ah, the *will* to change things. Sometimes it comes down to the *push 'n shove*. I hope this set of standards gets vets talking AND feeling squeezed to improve their practices. For my part I'll be writing about this issue for September's Veterinary Practice News: "High" Standards, "Good" Medicine, and YOUR Practice (working title, needs some jazz, right?).

[Joy]

I agree surgeries offered to low income pet owners should be offered with the exact same care being given to the client paying full price ...or else they should not be offered at all. If it’s a $200 operation at that clinic, the veterinarian needs to donate a $200 surgery, not do a $50 job.



In human medicine, when we read about these great hospitals and physicians offering everything from cleft palate surgeries to heart transplants for disadvantaged children, are those surgeries being performed any differently than the ones offered to children whose families can pay? I'm not sure but I certainly hope not.



Either way, is it really fair to automatically consider rescues, shelters and their adopters “low-income” and in need of greatly reduced prices? High-volume (or high demand/need) doesn't necessarily mean the organization can't afford the services and choosing a rescue/shelter does not necessarily mean the adoptive family is poor. Right?



I think that rescues and shelters should budget for whatever the going rate is for spay/neuters in their area and transfer that expense to their adopters. If the rescue or shelter can negotiate volume discounts, great!: that is good business sense and creates funds for an increased numbers of surgeries. Likewise, if some otherwise qualified adopters cannot pay, the organization can fund raise and budget for some discounted adoptions as needed.



Otherwise, I think “low income” spays/neuters should be reserved for truly low-income pet owners whose pets might not otherwise ever be altered. And when those are offered, they should be subsidized with donations, not by lowering the standard of care.

[Gina Spadafori]

I disagree. I do not believe spay-neuter surgeries should be "needs-tested." There's a definite benefit to society to having more pets spayed and neutered, especially feral cats. Who owns or who brings in these animals is a side-issue to me.



I do NOT think veterinarians should be forced to donate services, staff time and supplies to cover the need to society to have more pets altered.



Instead, I would prefer to see fund-raising focus on spay-neuter efforts, providing low-cost, free and even pay-to-spay programs (especially for feral cats) that get people off the dime with regards to getting more animals altered. If getting a feral spayed puts $10 in your pocket, that's to the benefit of all.



I don't have a problem with someone who makes a good salary getting a low-cost or free spay-neuter, as long as 1) the cost isn't unfairly coming out the veterinarian's pocket; and 2) it gets an animal who needs to be spayed or neutered done.



The point is to get more animals spayed and neutered, not to put up barriers to that getting done.

[Serijna]

I donot want to see any changes that could result in a decrease to the current spay/neuter practices for mainly cats but also dogs. Unless ofcourse the current practices result (so far unproven IMO)in many preventable (due to questionable standards) deaths.

I donot support "the pay for spay" though. Some sicko individuals might see an opportunity for making some bucks.

I also think it is totally unrealistic to expect veterinarians to donate their services or even more stupid to finance such procedures out of their own pocket just because they happen to be a veterinarian. Do you expect that from your pediatrician, lawyer, plumber, electrician, landlord, IRS etc. ? Do you ,yourself, provide free services or even pick up the additional expenses in your own profession.

I admit, I am a fanatic when it comes spaying/neutering for all feral, stray and house (those allowed to roam outside) cats. Will even make a pact with devil to get positive results.

I challenge Pet Connection to show some pictures(before and after) of euthanasia to the many cats and dogs in our "humane" kill shelters as a wake up call. Also pls keep in mind that many "no kill" shelters do take their unadoptable ones to "kill" shelters thereby maintaining the "no kill" accolade.

I pity the shelter workers, quite often volunteers, who have to endure euthanasia to perfectly healthy, and quite young or even babies as a result of unspayed/unneutered mamas.

Another experience I had with some local animal clinics I encountered for my ferals(as a normal paying client) is that they wanted at least two appointments. First one for initial shots/examinations/tests and a later one for actual spaying/neutering. Probably very prudent/STANDARD(love that word) for a tame house cat but totally unrealistic for a feral.

And Gina, I am sure that some people use the low cost spay and neuter eventhough they can easily afford vet. clinic's still very reasonable spay and neuter services. However, by hook or by crook, just grateful their animals were spayed/neutered regardless of the method. But no spay for pay. My goodness, many rescue groups will pick up/trap the animal and deliver it to the front door afterwards, all for free. How much more could they do.

[Joy]

Gina, I just feel that if there are only x-amount of spay/neuter dollars available within a community they should be spent in a sort of needs-based or cost/benefit basis. Starting with animals most likely to reproduce and least likely to be altered without intervention. Ya know?

[Lis]

Also pls keep in mind that many “no kill” shelters do take their unadoptable ones to “kill” shelters thereby maintaining the “no kill” accolade.



Cite, please. Evidence. With some specifics. No "we can't name the guilty" evasions.