No More Homeless Pets Forum
February 29, 2003
Pediatric Spay/Neuter

Dave Sweeney
Is early age spay/neuter really okay? Dr. Dave Sweeney, veterinarian and chief of staff at No More Homeless Pets in Utah’s Big Fix mobile van, talks about early age spay/neuter, neuter before adoption, and provides answers for all your spay/neuter related questions.

Introduction from Dr. Dave Sweeney:
I would like to thank the Best Friends staff for allowing me to participate in this controversial topic. In my first posting, I will give a little detail about the history and issues of prepubertal (before puberty) spay/neuter. In my second posting I will explain my approach to prepubertal spay/neuter.

The issue of prepubertal (puberty occurs around 4 months in cats and 6 months in dogs) altering of pets has been controversial for quite some time, largely because there has never been any scientific data stating the ideal time to spay/neuter dogs and cats. Veterinarians have traditionally spayed/neutered pets between 5-8 months for over 50 years, mainly because it seemed like the best time to do it. Fortunately there are currently studies coming out that will give the debate more scientific foundation to determine when exactly is the best time to have a pet fixed.

Veterinarians opposed to prepubertal spay/neuter have argued for years that early spay/neuter could lead to stunted growth, obesity, perivulvar dermatitis, vaginitis, behavioral changes, urinary incontinence, urethral obstructions in cats, hormonal problems, heart problems, decreased immunity and increased surgical and anesthetic risks during the spay/neuter procedure. Some of these concerns were more easily studied than others, and in the 1990's some excellent research was done on the effect of prepubertal neutering on urethral size and flow in male cats, growth and obesity. Most studies found prepubertal spay/neuter to have no significant consequence.

Larger retrospective studies that look at many of the other concerns are beginning to be published will be very helpful. One such retrospective cohort study was presented at a conference in January 2003. The soon to be published study was conducted by Dr. V. Spain (and others) of Cornell University. He and his team separated dogs and cats that were adopted from a shelter over a nine year period into two groups, those that were spayed/neutered before, and those that were spayed/neutered after 5 and one half months. The study compared the incidence of more than 50 common medical and behavioral conditions in the dogs and cats in those two groups. While this is just one study, the lack of previous similar studies makes this report worth scrutiny. Briefly, the author found a number of benefits to early spay/neuter in cats and dogs: Early neutered male cats had fewer abscess, less gingivitis, less asthma, less aggressions towards veterinarians, less sexual behaviors and were typically more shy and less hyperactive than male cats neutered after 5 and one half months. Early spayed female cats had less asthma and less gingivitis. Early neutered male dogs had a lower incidence of escaping, separation anxiety and inappropriate urination when frightened, but there was a higher incidence of hip dysplasia, noise phobias and sexual behaviors in these dogs.

Female dogs that were spayed before 5 and one half months did however have a higher incidence of urinary incontinence. The study found "Neutering before 6 months of age was not associated with any serious or substantially elevated risks of medical or behavioral conditions and may provide some important long-term benefits, especially for male cats." I do not know when the study will be published, however PetSmart Charities funded the study in part and might be a good source to contact if anyone is interested in getting a copy. I look forward to more studies like this one finally ending the debate on when is the ideal time to spay/neuter dogs and cats.

Many veterinarians claim that prepubertal spay/neuter is not safe for dogs and cats. They argue that anesthesia and surgery on these pets carries a higher risk. This is true, if prepubertal kittens and puppies are treated like small adult patients, which they are not. Prepubertal puppies and kittens respond much differently to anesthetic agents and anesthesia than do older animals. Among other things, puppies and kittens are much more sensitive to hypothermia, hypoglycemia and many anesthetic agents. If these differences are recognized and addressed, however, these animals can be altered just as safely as older pets. There are a number of good sources in the veterinary literature that describe how to perform safe anesthesia and surgery on pediatric patients.

Opponents of early spay/neuter claim that it is not widely accepted. However, the American Veterinary Medical Association, which has over 50,000 veterinarian members, states the following in their members' handbook: "The AVMA supports the concept of early (prepubertal, 8-16 weeks of age) gonadectomy in dogs and cats in an effort to reduce the number of unwanted animals of these species. Just as for other veterinary procedures, veterinarians should use their best medical judgment in deciding at what age gonadectomy should be performed on individual animals." That position was approved by the AVMA House of Delegates in 1999. Other distinguished bodies such as the American Animal Hospital Association have also endorsed early age spay neuter. Many Veterinary Colleges such as Florida, Texas A&M and the University of California Davis endorse prepubertal spay/neuter. Many of these same Veterinary Colleges routinely perform prepubertal spay/neuter in their own institutions.

In summary, prepubertal spay/neuter, when approached carefully, is just as safe as postpubertal spay/neuter. While there is still insufficient data to conclusively determine when the best time to fix a pet is, new research finds few consequences, and in some cases definite benefits to early spay/neuter.

Introduction, Part Two:

In my first posting, I briefly covered the general issues of prepubertal spay neuter. In this posting I will give my personal opinion on when is the best time to alter pets.

As a veterinarian, I believe every dog and cat should be fixed by 20 weeks of age, at the latest. The surgery on these pets is much easier, much quicker and much less traumatic than when they are older. Young animals have a much easier recovery from anesthesia and are much less painful postoperatively compared to older animals. Many of my young surgery patients (dog spays too) act completely normal the day after surgery. Owners frequently say, "It's as if nothing happened." You rarely hear this from owners of older patients, despite aggressive pain management. As animals get older, the surgical risks increase substantially. I frequently work in an emergency clinic, yet am rarely confronted with surgeries more challenging than an obese dog spay.

I believe that privately owned pets should be spayed/neutered 7-10 days after their last puppy/kitten vaccine, which is generally given around 16-18 weeks. Veterinary clinics, which have some of the same disease transmission issues as shelters, are one of the worst places for unvaccinated animals to spend any amount of time. Cat distemper and dog parvo, which infect thousands of animals in the US yearly, are commonly found in veterinary clinics, where the sick animals go for treatment. I feel we should attempt to limit the time unvaccinated animals spend in veterinary clinics until they are protected with their full vaccine series. Veterinary clinics are much less threatening once animals have been fully vaccinated because the vaccines, when administered appropriately, offer excellent protection against these diseases. In addition, I feel that owners are no less likely to have their own pets fixed at 18-20 weeks, than they would at 8-12 weeks.

Many shelters realize the longer a pet stays in a shelter the greater the chance it will become ill. The sooner we get these pets out of the shelters, the greater the chance they will stay healthy. However, many shelters require pets to be spayed/neutered before they are released from the shelter to the new owner. Many shelters correctly realize that allowing unfixed animals to go into adopted homes, with the owners promising to have the pet fixed, frequently results in owner noncompliance and ultimately the birth of more puppies and kittens. By spaying and neutering shelter puppies and kittens as early as 6-8 weeks, we can limit the time they spend in the shelter, in addition to guaranteeing the adopted animals will not worsen the pet overpopulation problem. I am not nearly as concerned about unvaccinated shelter animals visiting a veterinary clinic, as the risk of disease transmission in a veterinary clinic is not any greater than in the shelter.

Although the AVMA prepubertal spay/neuter position lists 8 weeks as the minimum age, many spay/neuter veterinarians believe that spays and neuters can safely be done as early as six weeks of age. I agree with them and will perform surgery on these pets in special circumstances, such as fixing a litter of puppies or kittens, or enabling a pet to be released from a shelter into a home.

Regardless of the age of the animal, or the vaccination status, veterinarians and staff must be meticulous about hygiene when handling patients. This is especially critical when handling unvaccinated pediatric animals. Each one of our staff is required to wear gloves at all times when handling animals and must disinfect hands between each and every animal. When housing shelter and non-shelter animals together in a surgical holding unit it must be realized that shelter pets are more likely to be contagious to other pets. Every attempt possible should be made to limit the exposure of non-shelter surgery patients to shelter surgery patients.

Questions

Is there training for vets on pediatric spay/neuter?
What if you only work with one vet and he won't do pediatric?
How do shelters convince vets to do pediatric spay/neuter?
Is there a universal anesthesia protocol for pediatric?
Do dogs fixed early have greater hip dysplasia and incontinence?
Refuting concerns on pediatric s/n health problems
Approaching vets about lowering their costs for low-income programs
What factors should groups consider in deciding to support early age s/n?
Resource list for early age s/n materials
Anesthesia protocols for pediatric
When area vets are opposed to shelters hiring vets
Thanking the vets
Is there training for vets on pediatric spay/neuter?
Question from a Member:
Part of the problem in our community is that the vets do not physically feel comfortable doing early age spay/neuter because the animals are so small and they have no experience doing surgeries at this age. How can the vets ever feel comfortable doing this if there is no training? Is there a place they can go for training or a training that can come to them?
Response from Dr. Sweeney:
There a number of things a veterinarian can do to learn more about early spay/neuter.

I think the simplest and best recommendation would be to read two excellent reference articles, "Prepubertal Gonadectomy in Dogs and Cats", in Compendium Vol. 21, No. 2-3, February-March 1999, and "Early Neutering of the Dog and Cat", in Kirk's Current Veterinary Therapy XII, WB Saunders & Co., Phila., pp 1037-1040. These resources are widely read and respected by veterinarians all over the world. After reading these articles, I believe most experienced veterinarians would feel more comfortable performing early spay/neuter.

Another idea would be to visit another veterinarian who performs early spay/neuter. Most spay/neuter clinics perform early spay/neuter and would likely be open to visitors.

If finding a clinic to visit is difficult, there is at least one veterinarian I know who will train other veterinarians in his spay/neuter clinic for a fee.

Many clinics have veterinary students work with them at the end of their training. Many of these students are trained in early spay/neuter. They would be excellent resources for veterinarians to consult during the students' time in their clinic.

There is a video available through the Univ. of California, Davis School of Veterinary Medicine that shows the surgical techniques used for early spay neuter. Call UC Davis at 530-752-1324 or visit their web site at www.calf.vetmed.ucdavis.edu.

Periodically, there are lectures on early spay/neuter at some of the veterinary conferences offered during the year.

Lastly, any veterinarian who wanted some information on early spay/neuter could contact me by sending an email to aimee@bestfriends.org.
What if you only work with one vet and he won't do pediatric?
Question from a Member:
We work strictly with one veterinarian in town and owe a large sum on our bill. This vet does not do early age spay/neuter so we cannot do 100% neuter before adoption.

We have considered going to another vet who does do early age spay/neuter but are afraid that our vet will become upset and force us to pay our entire bill at once, which we cannot do, or tell us he will not work with us anymore. We feel that we are stuck in this situation. Any suggestions?
Response from Dr. Sweeney:
I don't know if anything will work. Many veterinarians are convinced that early spay/neuter is wrong and will never be convinced otherwise. I would proceed carefully regardless what you decide to do. Based on the credit line this vet gives you, you have a good relationship that you don't want to ruin. Here is what you might try:

Explain to your vet why you would like to have your animals spayed/neutered early. Discuss the failure of post adoption spay/neuter and its effect on pet overpopulation. Finally, explain to your vet that your program has to begin pre-adoption spay/neuter and ask him/her to help you with this change.

This may or may not work. Veterinarians, like most people, are not receptive to others telling them how to perform their jobs, especially when they disagree with the views expressed.

If your vet still refuses to perform early spay/neuter, you might want to ask if he/she would be offended if you had another vet perform those surgeries. I would assure your current vet that, except for early spay/neuter surgeries, you would continue to only use his/her services.

I would go into full retreat and accept the policies of your current veterinarian if he/she becomes angry at your requests. I don't think you can lose this vet's services, especially since you may not be able to afford another vet, who likely would not extend a credit line to you. I would, however, focus on getting the vet's bill paid off so that you would have more leverage to compel him/her to begin early age spay/neuter, or alternatively, be able to afford the services of a different, more accommodating veterinarian.
How do shelters convince vets to do pediatric spay/neuter?
Question from a Member:
How do we as rescuers and shelters convince veterinarians to do pediatric spay/neuter when they are opposed and won't listen to those of us not in the profession?
Response from Dr. Sweeney:
Good question. Most veterinarians oppose early spay/neuter for medical reasons. Professionals, even more than others, resent being told how to do their jobs. Convincing these veterinarians is not only difficult, but often impossible.

I do feel, however, that some veterinarians can be won over with some subtle tactics. Although the case for early spay/neuter is strong, a large percentage of veterinarians are completely unfamiliar with the basic facts surrounding the issue. For example, many veterinarians do not know that the American Veterinary Medical Association supports the concept of prepubertal spay/neuter, or that early spay/neuter has gained acceptance in many veterinary schools. The question to me is not so much how do we convince them, but how do we compel them to examine the facts of the issue. I feel that, upon examining the facts, many veterinarians would begin early spay/neuter.

I think the first step in convincing some vets to begin early spay/neuter is to make the case for why we need prepubertal spay/neuter. This approach might be more successful because some vets might not feel threatened by an animal advocate discussing an animal welfare issue. If the vet seemed somewhat receptive to the issue, but dismissed the concept of prepubertal spay/neuter for medical reasons, a humble request could be made to at least read a couple of veterinary articles (I will list two below) about early spay/neuter. Using this approach, I think that some open-minded vets might be won over to begin early spay neuter.

As noted in my postings, animals spayed/neutered at an early age are generally not fully vaccinated and therefore more susceptible to disease. You might want to discuss this with your vet and explain that you accept the increased disease risk of the young animal in the veterinary clinic. Additionally, although, when done appropriately, there are no increased surgical or anesthetic risks associated with early spay/neuter, you might make the vet more receptive by offering reassurances that he/she will not be held liable for any surgical or anesthetic deaths or complications.

Two excellent resources:

Prepubertal Gonadectomy in Dogs and Cats, in Compendium Vol. 21, No. 2-3, February-March 1999

Early Neutering of the Dog and Cat, in Kirk's Current Veterinary Therapy XII, WB Saunders & Co., Phila., pp 1037-1040
Is there a universal anesthesia protocol for pediatric?
Question from Sharyn in MA:
We are a small, all-volunteer group of 5 foster homes that started in 2000. We have been doing the early spay/neuter (almost 400) since our startup. We have been finding much difficulty in trying to recruit more of our local vets to help us out during our busy kittens season. Our biggest problem seems to lie not in their willingness to try, but that there is no written protocol for them to follow. We have found a great article that we have been using from Dr. Susan Little, DVM, Diplomate ABVP (feline Practice) - Ottawa, Ontario, Canada. She talks about the different anesthesia to use on the little ones and some of the before and after care. We were wondering if there is an actually written protocol we could give vets when approaching them for assistance?
Response from Dr. Sweeney:
There are many different anesthetic agents and dozens of different anesthesia protocols used by veterinarians for adult patients. This is also the case for pediatric patients. While there certainly are guidelines veterinarians should follow when anesthetizing adult and pediatric patients, there is not any one protocol that is universally better than any other. Most veterinarians have their preferred adult anesthetic agents, with which they become very familiar and consequently more skilled using. It would make sense for veterinarians to use their preferred anesthetic agents when they formulate their pediatric anesthesia protocols, provided, of course, those agents can be used safely and effectively on pediatric patients. Therefore, I would recommend that veterinarians wanting to perform pediatric anesthesia review the published guidelines and then formulate an anesthetic protocol they feel comfortable with.

I have found Paddelford's Manual of Small Animal Anesthesia, second edition, published in 1999 by WB Saunders & Co., Philadelphia to be an excellent resource for pediatric anesthesia. However, I am certain any recent small animal anesthesia text would be helpful. Both of the resources I mentioned in my previous responses do actually list a number of pediatric anesthetic protocols in addition to some of the guidelines of pediatric anesthesia: "Prepubertal Gonadectomy in Dogs and Cats", in Compendium Vol. 21, No. 2-3, February-March 1999, and "Early Neutering of the Dog and Cat", in Kirk's Current Veterinary Therapy XII, WB Saunders & Co., Phila., pp 1037-1040.

I have not seen Dr. Little's article, but would be interested in reading it.
Do dogs fixed early have greater hip dysplasia and incontinence?
Question from Mindi:
Your have said that early neutered male dogs exhibit higher incidence of hip dysplasia and female dogs of urinary incontinence.

I consider these two traits very severe. The cost of hip surgery is high. Incontinence is very hard to live with. Both are reasons that otherwise good pet owners would have a pet put down. Don't you feel that these are significant negative conditions? How could gingivitis and asthma be related to altering?
Response from Dr. Sweeney:
I am glad you brought up these points.

One of the reasons this issue remains so controversial is the lack of more studies like Dr. Spain's. Although Dr. Spain's study is very good, I believe it would be premature to interpret his findings as reproducible facts. Other smaller studies have not found higher incidences of incontinence or hip dysplasia. More studies will follow in the future that will give us more insight.

Because the Spain study has not been published, I have not been able to look at the data closely. It would be helpful to know the actual increase is in the frequency of dysplasia and incontinence. The author's notes about the study stated that "Neutering before 6 months of age was not associated with any serious or substantially elevated risks of medical or behavioral conditions and may provide some important long-term benefits, especially for male cats." The author's conclusion would lead me to believe the increased incidence of dysplasia and incontinence is not very large.

For the sake of argument, let's say there is an increased incidence of dysplasia and incontinence in early spayed/neutered dogs. I don't agree that these would be significant reasons for owners to euthanize these pets. Lack of estrogen is a common reason for incontinence in spayed dogs. Some studies report estrogen responsive incontinence to be around 4% in conventionally spayed dogs. Many of these dogs can be successfully managed with estrogen, or other medication, and would not likely be euthanized by their owners. Hip dysplasia leads to hip arthritis and can vary in severity from mild to severe. Certainly some animals do require expensive surgery, yet many can be successfully managed with weight control, exercise, chondroitin sulfate and glycosaminoglycans.

I have no idea why the Spain study found less gingivitis or asthma in cats. Again, this was just one study and the findings may be erroneous. Asthma is really poorly understood and so it would be difficult to pinpoint what could contribute to the lower rates. If there truly were a lower incidence of asthma in early spayed/neutered animals, my guess is that it would be a result of getting those pets out of the shelter environment and into homes earlier. The same might apply for gingivitis. Pets are more likely to accept teeth brushing when it is started early in life. Perhaps the earlier adopted pets were more receptive to regular dental hygiene?

To make a decision on how to proceed we need to compare the benefits and risks of early spay/neuter. I believe the benefits are quite clear. Many people believe that pre-adoption spay/neuter has the potential to spare millions of animals the pain of shelter abandonment and euthanasia. With all the research that has been done on early spay/neuter to date, there has been very little evidence of any increased short-term or long-term risk to the pets. In my eyes, the tremendous benefit of preadoption spay/neuter significantly outweighs the small risks that may accompany early spay/neuter.

I feel that shelters and rescue groups that adopt out intact animals are spinning their wheels. In my opinion, the only responsible alternative to early spay/neuter is to delay adoption until 5-6 months of age, when the animal may be conventionally spayed/neutered before going home with the new owner.

Who knows where the debate may go in the future. If there were indeed some undesirable effects of early spay/neuter, the administration of 2-4 months of hormone replacement therapy for our early spayed/neutered animals might be the next controversy. Regardless what happens, I think this issue will remain controversial for some time.
Refuting concerns on pediatric s/n health problems
Question from several Members:
I am one who believes in the early spay/neuter concept. Our local shelter does early spay/neuters on all over 8 weeks old, and I have never had any immediate problems. The pets are then placed by rescues so I have no long-term follow up on behavior, etc., but they have all done fine during the surgery and during the recovery period.

One comment that has been made by others when discussing the topic is that when females are spayed early, they may have more aggressive tendencies as they age due to hormonal imbalance. Could you also give suggestions on how we can address other concerns, such as their growth will be stunted, they may have more health problems later on, early-age procedures haven't been around long enough or done enough to really see the long-term effects. I would really be interested to hear an expert opinion on this one.
Response from Dr. Sweeney:
I am guessing you sent this question along before you read my second introductory posting, which should answer most of your question(s).

Aggression: The Spain study that I referenced found that male cats tended to be less aggressive. He did note, however, that there was a higher incidence of male dog aggression in the before 5 and one half month neutered dogs than in the after 5 and one half month neutered dogs. He concluded, however, that this was likely because older shelter dogs showing aggression were unlikely to be neutered and adopted out, and therefore not part of the study.

Growth: All studies that I have read show that bone length is the same or slightly increased in early spayed/neuter animals. So, early spayed/neutered are the same size, or slightly larger than later spayed and neutered animals.

I hope this helps.
Approaching vets about lowering their costs for low-income programs
Question from Hanna:
In our area, it is very difficult to get the local vets to donate even one spay/neuter per month. During our first ever spay/neuter campaign, we again approached the vet association and begged for assistance to reach out to help low income families. Our usual two jumped right on the wagon to help. Two others offered help but complained bitterly about all the money they were losing by helping.

How does any community build a working relationship with all the vets (or majority) to understand what we are trying to accomplish? It seems the prevailing attitude is that we are trying to take business away from them.
None of the families that we are targeting can afford $150 to $250 to alter their pets.

Note: Dr. Sweeney is working a 12-hour day doing surgeries on the Big Fix, so Faith Maloney, director of animal care at Best Friends, is helping out by sharing some of her experiences.
Response from Faith Maloney:
Veterinarians are business people. It cost them a lot to get their education, some may be raising families or have a huge clinic overhead. We have to approach them knowing this. We have to let them know that we understand what they are dealing with in order to make a living. Many vets have told me that they feel that people in animal rescue do not seem to understand this, and expect free services just because "it's the right thing to do".

Several years ago a group in Philadelphia called The Spayed Club saw the problem and decided to start an organization to raise funds to help low income people get spay/neuter services. They talked to local vets and got them to agree to a reduction in their prices. The Spayed Club donated a third, the vet donated a third and then the client paid the balance.

Before long this group signed most the local vets into the program. They wanted "to do the right thing" but had felt pressured to donate their services for nothing. When they saw they were going to get something for their work, they agreed to substantial reductions. Not everyone can do a Spayed Club, it was a huge undertaking, but I think there is a gem in there to work with. I don't know what you have already done, so forgive me if you have thought of all of these ideas before.

1) Is it possible for you to raise funds from the community for this program? I know this is a lot of work, but I am familiar with one Humane Society that raises funds from their local businesses like car dealerships, and other merchants to sponsor s/n for low income families. Or others who have used benefits, luncheons, dinners, bingo nights, etc.

2) Here in Utah, as in many other states, we have an animal friendly license plate that channels funds into spay/neuter for low income families.

3) Enlisting local media to promote a s/n sponsorship program in the local community.

4) Also, make sure you are thanking the vets who are helping -- write a nice thank you letter, give them a nice looking certificate to post in their offices, write a letter to the editor of the local paper to talk about what they have done. . . more vets will want to get on the band wagon and they will not burn out the ones who are helping. You might even try thanking the ones who were complaining! You never know, it might work wonders!

Your description of the "usual two" vets who jumped into help is something I think we can all relate to. Vets who are willing to help out in a crisis without compensation are not that common. But it sounds like you need more than just two to get the job done. I hope this has given you some points for discussion.
What factors should groups consider in deciding to support early age s/n?
Question from a Member:
We are an all-volunteer rescue group. Our group is torn over whether or not to make early age spay/neuter a requirement for our adoptable animals. There seems to be a lot of controversy just among vets, and we are getting conflicting information from different vets on what age, what weight, and what potential side effects there are. What factors should we as lay persons take into consideration when making our policy decision for our group?
Response from Dr. Sweeney:
I am confronted regularly by pet owners telling me that, according to their veterinarians, I should not be spaying/neutering anything less than 6 months of age. Other veterinarians have told me that I am wrong for performing early spay/neuter. I would guess that a majority of veterinarians in the US believe it is wrong to perform early spay/neuter. Yet the American Veterinary Medical Association, the American Animal Hospital Association and several veterinary colleges, including my alma mater, the University of Minnesota, endorse the concept of early spay/neuter. It is not surprising you are confused.

Veterinarians, like most people, tend to resist change. The concept of early spay/neuter is new and therefore unappealing to many conservative veterinarians. Because spaying and neutering pets is a low profit, mundane task, many vets have little desire to objectively examine the issue of early spay/neuter. Although difficult to prove, I believe that many of the veterinarians opposed to early spay/neuter have not carefully reviewed the early spay/neuter research.

My best advice to you would be to get on the web and do some research of your own. In one of my earlier responses during this forum, I have listed a very helpful web site and several good papers on early spay/neuter. I would encourage you to read those reports and form your own conclusions. (I think that most non veterinarians would not have difficulty understanding the essential parts of the articles.) I believe that seeing is believing and I think you will need to convince yourself what the best plan for your group is.

If, after reviewing the literature, you decide to begin early spay/neuter, your next task will be to find a veterinarian in your area who will perform the surgeries for you.

Resource list for early age s/n materials

Some readers have asked for advice on how to access some of the articles I have mentioned. After searching the web, I have found a great site with the Stubbs Current Veterinary Therapy XII article, along with lots of other information and links on early spay/neuter. The web master did a great job. The site is: http://www.danesonline.com/earlyspayneuter.htm. Be sure to check out all of the links at the bottom.

The two compendium articles may be purchased for $8 each from Veterinary Learning Systems on their web site. Enter the Author's name, Howe, and the articles will be listed for you.

An additional online article by Howe and Olson, titled "Prepuberal Gonadectomy-Early Age Neutering in Dogs and Cats", may be found on the Ivis web site. Unfortunately, IVIS limits access to their site to veterinarians only.

I hope this helps.
Anesthesia protocols for pediatric
Question from a Member:
Can you describe the anesthesia protocol you use in your Big Fix program? I am trying to expand the number of vets that support our low-cost spay/neuter certificate program, but some have told me that the cost of their anesthesia is more than the price I try to negotiate with them (about $35 for a spay). We do have 8 vets that have found a way to make this work financially for them - most use a ketamine mix (I believe) as opposed to isofluorine, but I don't pretend to know enough about the process to know what all the costs are and would appreciate your input. Also, is the anesthesia protocol for early age spay/neuter different than for adult surgeries?
Response from Dr. Sweeney:
I have five different anesthesia protocols that I use on the Big Fix: adult dog, adult cat, pediatric puppy, pediatric kitten and feral cat. The adult dogs receive acepromazine and torbugesic as premedications; ketamine, Valium and micro dose medetomidine for anesthesia induction; then isofluorane gas by endotracheal tube to maintain anesthesia. The puppies receive the same as adult dogs, except significantly lower doses of acepromazine and medetomidine along with an increased dose of torbugesic. Adult cats receive acepromazine and torbugesic as premedications, ketamine and valium for anesthesia induction, then isofluorane gas by endotracheal tube to maintain anesthesia for females and male cryptorchids. The kittens receive the same as adult cats, except significantly lower doses of acepromazine. The feral cats receive buprenorphine, medetomidine and ketamine. The female ferals are intubated and given isofluorane gas to maintain anesthesia. Both male and female ferals are reversed postoperatively with atipamezole.

The injectible drugs listed above (with syringe costs added in) cost $1.60 for a 40 lb adult dog, $1.00 for a 10 lb puppy, $1.00 for a 10 lb adult cat, $0.55 for a 5 lb kitten and $1.50 for a 10 lb feral cat. The isofluorane gas and the oxygen cost approximately $0.25 per patient.

I have designed my anesthesia protocol to be safe, effective, humane and fairly inexpensive. The veterinarians who quote you the higher prices likely use safer, more expensive anesthetic protocols. One such example is propoflo, which I frequently use in the Animal ER. Besides costing $10-$20 (for the vet to purchase), it may only be given safely by IV catheter, for which most veterinarians charge $20-$40. Etomidate is another very safe anesthetic agent, which is even more expensive than propoflo. There is also a newer, more expensive gas called sevofluorane, which some veterinarians are using instead of isofluorane. Some veterinarians require IV fluids intraoperatively, which significantly increases the price.

The Big Fix, by design, is a high volume, low cost spay/neuter clinic. The only way to keep the costs affordable for owners is to keep the anesthesia as inexpensive as possible, without compromising animal care. I feel we have accomplished this goal, as we have had only one anesthetic death in the last 13,000 patients. (The industry average is approximately 1 per 1000.)

You mention ketamine mix vs. isofluorane anesthesia. Ketamine is an injectible drug, which causes loss of consciousness. It is usually given either intravenously, or intramuscularly. When given alone, ketamine can cause rigidity, convulsions and seizures, so it is generally given with another drug to counteract those effects. Ketamine may be used (usually intramuscularly) for induction and maintenance of anesthesia, or it may be used (usually intravenously) for induction only, after which the patient is then switched to an anesthetic gas, most commonly isofluorane. I would guess the veterinarians using the ketamine mix (or some say ketamix) are administering the ketamine (mixed with other anesthetic agents such as acepromazine, xylazine or medetomidine) intramuscularly to induce and maintain anesthesia, as opposed to maintaining the animals on isofluorane gas. The main difference between the two approaches is the cost of the anesthesia machine (around $2500) and the increased labor costs to intubate and monitor the patient while on the anesthetic gas.

The anesthesia protocol for early age spay/neuter is different than adult protocols for a number of reasons. Pediatric patients' liver function is not quite fully developed. The drugs are distributed differently than in adults. Pediatric patients are more prone to hypotension. Therefore, when anesthetizing pediatric patients, extreme caution should be used when giving acepromazine, xylazine, medetomidine and pentobarbital. To avoid hypoglycemia, pediatric patients should be fasted no longer than 6 hours preoperatively. Because of their small body size, pediatric patients must be kept on a warm water blanket during surgery to prevent hypothermia.

My anesthesia preferences: There are many different protocols that are safely and effectively employed by veterinarians. Probably more critical than what protocol is used, is how well trained and vigilant the anesthetic staff is. Having said that, I feel that gas anesthesia is safer for puppies and kittens than intramuscular anesthesia. I feel that our low anesthetic death rate on the Big Fix is in large part because we intubate all of our patients (except the cat neuters because it is such a quick surgery) and place them on gas. Delivery of anesthetic gas can be adjusted according to patient need, with a rapid patient response to changes in flow rates. Thus, the anesthetist has much greater control over the patient. The injectible only protocols do not offer the same level of control to the anesthetist. Lastly, patients placed on gas anesthesia tend to wake up faster than patients given intramuscular anesthesia.

I would be happy to email copies of my anesthetic protocols (in excel) to anyone interested in reviewing them. Email Aimee at aimee@bestfriends.org if you are interested.
When area vets are opposed to shelters hiring vets
Question from Mary:
We are in a rather wealthy community. We have more veterinarians than a typical city. One would think that competition would benefit the pet owner, however, the vet community is very tight-knit. When our municipal shelter hired a vet as director, many local vets were irate. We now have our second vet director, and again they are upset. They seem to view us as competition to their services. When we began our vaccinations at the shelter, they were irate! We want only to be able to service our pets (heartworm checks, fecal checks, etc) and spay/neuter prior to adoption. How do you propose we instill in the vet community that we are not competition and want only the best for our pets?
Faith Maloney's response:
We faced this problem in Salt Lake City when we rolled out the Big Fix mobile spay/neuter unit. Gregory and Julie Castle, who are in charge of the No More Homeless Pets in Utah program, attended meetings of the UVMA (Utah Veterinary Medical Association) with Dr. Dave Sweeney to listen to their concerns. I hear that some of those meetings were pretty heated!

What came out of those meeting was the creation of a committee consisting of three vets who supported our programs and three vets appointed by the UVMA to oversee the concerns of state vets. Dr. Sweeney heads up the vets on our side. Also, Dr. Sweeney, when he is not spaying and neutering like crazy, visits vets throughout the state and talks to them about our programs.

Some adjustments were made. For example, the UVMA asked that we not park our s/n mobile van in high income areas, like large malls, and that we have regular meetings to discuss concerns and issues.

Over time, this has helped a lot to allay their concerns. We have also instituted programs in Utah that have involved the vet community, but I will need to have someone from that area speak to that, as I don't have all the details and no one is answering their cell phones right now!!

Many years ago here in Kanab we also faced opposition, but only from one veterinarian. He made veiled threats about suing us for "unfair business practices" because we offered a subsidized spay/neuter surgery to the public. I called our County attorney and asked if we were doing anything wrong. He replied, "Welcome to America, land of free enterprise. No, you are not, go ahead." End of story. We have offered a subsidized surgery ($25 per animal, spay or neuter) for close to seventeen years now.

We do not offer full service to the public, only the spay/neuter surgery and vaccinations. No other vet has control over what you do with your own shelter animals if you have a state licensed vet performing the services. We have two Utah licensed veterinarians who share the duties between working with the sanctuary animals and the public spay/neuter program.

For the sake of harmony, you might try and create a liaison between you and the vets as they did in Salt Lake City, or you can take the words of our Kane County attorney to heart and just get on with it.

And may I say congratulations on having a vet heading up your facility. That does make life so much easier, I'm sure.
Thanking the vets
Question from Linda:
What kinds of recognition do vets tend to value most highly? Are there some awards or other kinds of special notice that groups can name their veterinarian partners to receive?

Note: Dr. Sweeney is working a 12-hour day doing surgeries on the Big Fix, so Bonney Brown, director of No More Homeless Pets for Best Friends, is helping out by sharing some of her experiences. Before working for Best Friends, Bonney oversaw a spay/neuter program in Massachusetts that worked with 17 vet clinics providing discount services.
Response from Bonney Brown:
When you're not sure what to do, remember that vets are people and they respond to the same type of thank-you's the rest of us do. You'll notice that many of these tips make the vet look good to the public, AND they also help to promote your organization's work. (It pays to be nice!)

- Always pay your vet bills on time.
- Encourage your staff and volunteers to be unfailingly polite and pleasant in their interactions with the vets and the clinic staff, and to always say thank you at every visit. (Let them know that if there is a problem, you want them to come to you, and you'll address it.)
- Write a nice thank you letter.
- Give them a nice looking, framed certificate to display in their waiting room.
- Write a letter to the editor of the local paper to tell the community about the contributions of the veterinarian.
- Call the local papers and TV stations to do a story about what the vet is doing to help animals. This works especially well in cruelty cases, or accidents when the vet is giving off-price services to the organization. It can also present an opportunity to seek donations for the animal in need. One note of caution: you do need to ask the vet first to see if they want the coverage.
- Thank the vet clinic in your newsletter to members.
- Invite the vet to speak at one of your public meetings.
- Stop by with a nice tray of cookies and a thank you card for the entire clinic staff.
- Invite them to participate in special events or programs your organization is hosting where their clinic will get public exposure.

If you make it worth their while and show your appreciation, more vets will want to get on the band wagon and you will not burn out the ones who are helping.

Final tip: Try thanking the reluctant vets in your community, even for very small gestures. It might work wonders!