Question from Ann:
I am a big supporter of early age spay/neuter and our group does 2lbs/2months. However, there is another group in town that won't do early age, because they have seen 5 kittens die after surgery and feel the risks are too high. I have tried to explain that this could happen in adult surgeries too. It could be an unknown condition or some other reason besides the early age surgery, but they are adamant that they will not do below 5 months because of this. I have offered countless studies but they say that their vet agrees below 5 months is too young and can cause problems. When you are arguing against this type of emotion and personal experience they had, what can you do to help convince them to try it again and give it more of a chance?
Response from Brenda Griffin:
Wow, now there's a question! I am hoping Dr. Levy will have some answers for you here...
I have to say, that first off, you can't convince everyone. No such thing as 100%, and that's okay. Just go about convincing everyone else... and in the end, the others will likely follow. Try some of the video resources I described in my answer to the last question; those would be great to give them to watch.
Second, it will be very hard for them to "go against" the advice of their own vet. Difficult situation. Maybe the vet will attend a CE on pediatric spay/neuter sometime.
Keep up your good work... and let's see what other advice Dr. Levy can offer.
I have to say, that first off, you can't convince everyone. No such thing as 100%, and that's okay. Just go about convincing everyone else... and in the end, the others will likely follow. Try some of the video resources I described in my answer to the last question; those would be great to give them to watch.
Second, it will be very hard for them to "go against" the advice of their own vet. Difficult situation. Maybe the vet will attend a CE on pediatric spay/neuter sometime.
Keep up your good work... and let's see what other advice Dr. Levy can offer.
Response from Julie Levy:
Death after surgery should be a rare event, regardless of the age at which it was done. It's hard to say much without knowing more. Did the kittens die at the same time or were all the deaths unrelated? A cluster would suggest something unusual, such as an outbreak of panleukopenia, a medication error, or a high-risk litter. Intermittent deaths might suggest a more systematic problem such as inappropriate anesthetic protocols or monitoring.
To put surgical death rates in perspective, the rate of death in our feral cat sterilization program is 0.35% (3.5 deaths per thousand surgeries). We sterilize cats as young as 12 weeks in that program. In our foster program, we've sterilized more than 2000 kittens as young as 7 weeks, and I can count the deaths on one hand.
There is no question that kittens and puppies can be safely sterilized at very young ages. There are differences in how we handle them compared to adults, such as short fasting times, attention to preserving body temperature, and rapid recovery times. I am a big believer that most animals that are healthy enough for adoption should be healthy enough to be sterilized. "Neuter-Before-Adoption" takes the guesswork out of sterilization contracts and guarantees that we won't unwittingly contribute to the problem we are trying to solve.
With this in mind, it is also important that everyone work within his/her comfort zone. Veterinarians who have had a bad experience might prefer to restrict the animals on which they perform surgery. In doing this, they are looking after the welfare of the animals, which should always be the primary concern.
Change does not happen in a day. Some groups have embraced early neutering with gusto and others have been more cautious. Since everyone is working toward the common goal of ending overpopulation in their own way, it's more important to focus on what we all agree on than on the few differences we have.
To put surgical death rates in perspective, the rate of death in our feral cat sterilization program is 0.35% (3.5 deaths per thousand surgeries). We sterilize cats as young as 12 weeks in that program. In our foster program, we've sterilized more than 2000 kittens as young as 7 weeks, and I can count the deaths on one hand.
There is no question that kittens and puppies can be safely sterilized at very young ages. There are differences in how we handle them compared to adults, such as short fasting times, attention to preserving body temperature, and rapid recovery times. I am a big believer that most animals that are healthy enough for adoption should be healthy enough to be sterilized. "Neuter-Before-Adoption" takes the guesswork out of sterilization contracts and guarantees that we won't unwittingly contribute to the problem we are trying to solve.
With this in mind, it is also important that everyone work within his/her comfort zone. Veterinarians who have had a bad experience might prefer to restrict the animals on which they perform surgery. In doing this, they are looking after the welfare of the animals, which should always be the primary concern.
Change does not happen in a day. Some groups have embraced early neutering with gusto and others have been more cautious. Since everyone is working toward the common goal of ending overpopulation in their own way, it's more important to focus on what we all agree on than on the few differences we have.
Wet labs for vets on pediatrics and feral cats
Question from Sandy:
How useful do you think wet labs are in helping convince vets to try pediatric spay/neuter and also on feral cats? If you think it is useful, how do you go about setting one up?
Response from Brenda Griffin:
Hi, great question!!!!!
I think wet labs are very helpful for teaching pediatric spay/neuter. Having the opportunity to see one and do one in that setting can really jump start the learning curve and be a real confidence builder. I find that vets are often "scared" to perform surgery on very young/small patients. Once they see it is easy and okay, they are ready to go.
I teach a pediatric Spay/neuter wet lab at the Annual Veterinary Conference hosted each year by Auburn University College of Vet Med. I have had vet's tell me how surprised they were by how easy it was. One very skeptical and nervous vet emailed me a few months after the lab to tell me she had since spay/neutered almost 800 puppies and kittens since participating in the lab. I almost fell out of my chair. There's a testimonial!
After attending the NMHP Symposium in California, one attendee who heard me singing the praises of wet labs set up several in her area hosted by the Animal Match Rescue Team (AMRT). Their web site is www.amrt.net. They may be able to give you ideas on how to organize a lab based on their experience.
I think wet labs are very helpful for teaching pediatric spay/neuter. Having the opportunity to see one and do one in that setting can really jump start the learning curve and be a real confidence builder. I find that vets are often "scared" to perform surgery on very young/small patients. Once they see it is easy and okay, they are ready to go.
I teach a pediatric Spay/neuter wet lab at the Annual Veterinary Conference hosted each year by Auburn University College of Vet Med. I have had vet's tell me how surprised they were by how easy it was. One very skeptical and nervous vet emailed me a few months after the lab to tell me she had since spay/neutered almost 800 puppies and kittens since participating in the lab. I almost fell out of my chair. There's a testimonial!
After attending the NMHP Symposium in California, one attendee who heard me singing the praises of wet labs set up several in her area hosted by the Animal Match Rescue Team (AMRT). Their web site is www.amrt.net. They may be able to give you ideas on how to organize a lab based on their experience.
Go for it!!!
Response from Julie Levy:
Nothing beats first-hand experience. Trying out a scary new procedure under the watchful eye of a trusted experienced colleague is a real confidence builder.
This can be done in several ways. Formal wet-labs are nice because they are organized specifically for teaching. Educational materials, lectures, demonstrations, and practice can be organized to provide a thorough review and step-by-step practice.
The limitations of formal wet-labs are the cost and effort that needs to go into them, as well as the limited times and places they can be offered. One should also be cautious about running afoul of regulations that are designed to protect animals used for teaching. You may know that your animals are well cared for, but that does not absolve you of the need to comply with state and federal regulations (which are constantly changing). The last thing you want is to be cited for an animal welfare violation because your paperwork was not in order.
If a formal wet-lab can't be organized, an alternative is to invite your veterinarians to observe and perform surgeries somewhere they are already being done. This has the advantage of providing a "real world" context, and they can observe how the supporting environment is organized. Spay/neuter clinics and shelters are great places to see quality pediatric surgery being performed and to witness the quick recoveries these patients have compared to adults. Large-scale feral cat neutering clinics operate all over the country and provide examples for how the cats can be safely handled, methods for efficiently sterilizing large numbers of cats, and how to incorporate volunteers into the process.
The benefits of visiting other facilities is that vets can get their feet wet without putting their practice and private patients at risk. In my experience, once they've done it a few times, the fears evaporate and they tend to loosen up on their own turf as well. Anyone who has spayed a puppy will curse the necessity of performing surgery on a 100-pound obese in-heat female dog in the future.
This can be done in several ways. Formal wet-labs are nice because they are organized specifically for teaching. Educational materials, lectures, demonstrations, and practice can be organized to provide a thorough review and step-by-step practice.
The limitations of formal wet-labs are the cost and effort that needs to go into them, as well as the limited times and places they can be offered. One should also be cautious about running afoul of regulations that are designed to protect animals used for teaching. You may know that your animals are well cared for, but that does not absolve you of the need to comply with state and federal regulations (which are constantly changing). The last thing you want is to be cited for an animal welfare violation because your paperwork was not in order.
If a formal wet-lab can't be organized, an alternative is to invite your veterinarians to observe and perform surgeries somewhere they are already being done. This has the advantage of providing a "real world" context, and they can observe how the supporting environment is organized. Spay/neuter clinics and shelters are great places to see quality pediatric surgery being performed and to witness the quick recoveries these patients have compared to adults. Large-scale feral cat neutering clinics operate all over the country and provide examples for how the cats can be safely handled, methods for efficiently sterilizing large numbers of cats, and how to incorporate volunteers into the process.
The benefits of visiting other facilities is that vets can get their feet wet without putting their practice and private patients at risk. In my experience, once they've done it a few times, the fears evaporate and they tend to loosen up on their own turf as well. Anyone who has spayed a puppy will curse the necessity of performing surgery on a 100-pound obese in-heat female dog in the future.
Long-term studies on pediatric surgeries
Question from Crystal:
If I had a dollar for every person who said, "Gee, I didn't know my five-or-six-month-old cat could go into heat and have kittens!" I'd be rich enough to start my own spay/neuter clinic! For this and many other reasons, I'm inclined to believe that early-age spay/neuter is the way to go for shelters and rescues.
My question is... have any studies been done on the long-term effects of early-age spay/neuter? The kittens I have seen who have been spayed or neutered at a young age all seem to bounce back beautifully and are romping and playing the next day. But are there long-term negative effects once they grow up?
Thank you for your time. I believe that spay/neuter is the only way we are ever going to make a difference in pet overpopulation.
My question is... have any studies been done on the long-term effects of early-age spay/neuter? The kittens I have seen who have been spayed or neutered at a young age all seem to bounce back beautifully and are romping and playing the next day. But are there long-term negative effects once they grow up?
Thank you for your time. I believe that spay/neuter is the only way we are ever going to make a difference in pet overpopulation.
Response from Brenda Griffin:
Although virtually all animal shelters require adopted pets to be sterilized, the compliance rate of owners according to the American Humane Association is only approximately 50-60% on a national basis, despite implementation of spay/neuter contracts, coupons, other incentives and time-consuming follow-up. For these reasons, the American Veterinary Medical Association advises that all pets be neutered before adoption, including puppies and kittens as young as 8 weeks of age.
The ideal age to spay/neuter dogs and cats is unknown. Currently, the most common age or the "traditional age" for recommending spaying/neutering is 6 months. This recommendation, however, is not based on research indicating that this is the ideal age to perform these procedures, but was probably chosen because anesthetic and surgical techniques were less advanced at the time and surgical success was more likely in a larger patient.
Approximately 30 years ago, humane organizations began sterilizing young puppies and kittens. Understandably, many veterinarians expressed concerns and questions regarding the short- and long-term safety of sterilizing pediatric patients. In response to these concerns, numerous controlled prospective studies and retrospective cohort studies have been performed to verify the safety of early age spay/neuter. Based on these studies, we can now conclude that sterilizing young puppies and kittens is a medically sound practice, and is not associated with any serious medical or behavioral risks. In addition, early age spay/neuter offers many advantages including well-established, safe anesthetic and surgical techniques, shorter surgical and recovery times, and avoidance of the stresses and costs associated with spaying while in heat, pregnant or with pyometra.
There are also numerous long-term health benefits including virtual elimination of the risk of mammary and testicular tumors. Finally, in addition to benefiting the individual patient, early age spay/neuter helps veterinarians to fight the single largest killer of dogs and cats: overpopulation and euthanasia of unwanted, homeless pets.
Reasons to Perform Early Age S/N:
- No substantial medical reasons to wait
- Guaranteed compliance
- No "whoops litters" (pregnancies at <6 mos)
Controlled studies have been done looking at everything from body composition to growth rates, immune function, urinary tract disorders, behavior, and long term effects. So many studies have been done; it would take me several pages to describe them all to you. No significant differences have been found in cats spayed or neutered at an early age versus a traditional age. Most recently, a retrospective study done at Cornell by Spain and Scarlett showed that no serious long-term medical or behavioral risks are associated with early age sterilization.
In cats, there is no increase whatsoever in the risk of urinary tract disease, and development (including size and function) of the urethra is normal in neutered cats compared to intact controls, regardless of age at neuter. For cats, this has always seemed to be the biggest concern among practitioners - the thought that if spayed/neutered too young, the urinary tract would not develop correctly. It is clear from numerous studies that it develops just fine! The one thing I would say is that for female puppies, there is a higher risk of incontinence later in life if spayed before 12 weeks of age (Spain and Scarlett showed that). Bear in mind, that incontinence in female dogs is easily and inexpensively treated, and in the study was not associated with relinquishment, which was notable to me. Finally, bear in mind all health benefits those young pups got from being spayed that young, no mammary cancer, no uterine infection... all good things. This increased risk of incontinence does NOT occur in cats.
See below for a handout I like to use to explain all the medical benefits of S/N
SPAYING/NEUTERING
Why it's medically best for your pet
FOR YOUR FEMALE DOG OR CAT:
Spayed females are often healthier than those who are not spayed. Intact females commonly develop problems such as:
Breast cancer
Ovarian or Uterine Cancer
Uterine Infections
Vaginal Prolapse
These problems can be life threatening.
- Breast cancer occurs more frequently in dogs and cats than in humans.
- Mammary tumors are the most common tumors in female dogs and nearly 50% are malignant. A dog spayed before she has had her first heat cycle has virtually NO RISK of developing breast cancer. Her risk dramatically increases if she is spayed after experiencing heat cycles.
- In cats, mammary tumors are the 3rd most common type of cancer and nearly 90% are malignant. They have usually spread to other parts of the body by the time they are diagnosed. A cat spayed before she is 2 years of age is 7 TIMES LESS likely to develop mammary tumors.
FOR YOUR MALE DOG OF CAT:
Intact males are at risk to develop serious problems such as:
Testicular Cancer
Prostate Disease
Hernias
Perianal Tumors
The ideal age to spay/neuter dogs and cats is unknown. Currently, the most common age or the "traditional age" for recommending spaying/neutering is 6 months. This recommendation, however, is not based on research indicating that this is the ideal age to perform these procedures, but was probably chosen because anesthetic and surgical techniques were less advanced at the time and surgical success was more likely in a larger patient.
Approximately 30 years ago, humane organizations began sterilizing young puppies and kittens. Understandably, many veterinarians expressed concerns and questions regarding the short- and long-term safety of sterilizing pediatric patients. In response to these concerns, numerous controlled prospective studies and retrospective cohort studies have been performed to verify the safety of early age spay/neuter. Based on these studies, we can now conclude that sterilizing young puppies and kittens is a medically sound practice, and is not associated with any serious medical or behavioral risks. In addition, early age spay/neuter offers many advantages including well-established, safe anesthetic and surgical techniques, shorter surgical and recovery times, and avoidance of the stresses and costs associated with spaying while in heat, pregnant or with pyometra.
There are also numerous long-term health benefits including virtual elimination of the risk of mammary and testicular tumors. Finally, in addition to benefiting the individual patient, early age spay/neuter helps veterinarians to fight the single largest killer of dogs and cats: overpopulation and euthanasia of unwanted, homeless pets.
Reasons to Perform Early Age S/N:
- No substantial medical reasons to wait
- Guaranteed compliance
- No "whoops litters" (pregnancies at <6 mos)
Controlled studies have been done looking at everything from body composition to growth rates, immune function, urinary tract disorders, behavior, and long term effects. So many studies have been done; it would take me several pages to describe them all to you. No significant differences have been found in cats spayed or neutered at an early age versus a traditional age. Most recently, a retrospective study done at Cornell by Spain and Scarlett showed that no serious long-term medical or behavioral risks are associated with early age sterilization.
In cats, there is no increase whatsoever in the risk of urinary tract disease, and development (including size and function) of the urethra is normal in neutered cats compared to intact controls, regardless of age at neuter. For cats, this has always seemed to be the biggest concern among practitioners - the thought that if spayed/neutered too young, the urinary tract would not develop correctly. It is clear from numerous studies that it develops just fine! The one thing I would say is that for female puppies, there is a higher risk of incontinence later in life if spayed before 12 weeks of age (Spain and Scarlett showed that). Bear in mind, that incontinence in female dogs is easily and inexpensively treated, and in the study was not associated with relinquishment, which was notable to me. Finally, bear in mind all health benefits those young pups got from being spayed that young, no mammary cancer, no uterine infection... all good things. This increased risk of incontinence does NOT occur in cats.
See below for a handout I like to use to explain all the medical benefits of S/N
SPAYING/NEUTERING
Why it's medically best for your pet
FOR YOUR FEMALE DOG OR CAT:
Spayed females are often healthier than those who are not spayed. Intact females commonly develop problems such as:
Breast cancer
Ovarian or Uterine Cancer
Uterine Infections
Vaginal Prolapse
These problems can be life threatening.
- Breast cancer occurs more frequently in dogs and cats than in humans.
- Mammary tumors are the most common tumors in female dogs and nearly 50% are malignant. A dog spayed before she has had her first heat cycle has virtually NO RISK of developing breast cancer. Her risk dramatically increases if she is spayed after experiencing heat cycles.
- In cats, mammary tumors are the 3rd most common type of cancer and nearly 90% are malignant. They have usually spread to other parts of the body by the time they are diagnosed. A cat spayed before she is 2 years of age is 7 TIMES LESS likely to develop mammary tumors.
FOR YOUR MALE DOG OF CAT:
Intact males are at risk to develop serious problems such as:
Testicular Cancer
Prostate Disease
Hernias
Perianal Tumors
Young kittens being stressed after surgery at the shelter
Question from Lea:
Our organization does some work with a large municipal shelter that does on-site spay/neuter before adoption. We are very thankful of that.
We have been concerned lately about their protocols with a new staff veterinarian. They previously did not do surgery unless the juveniles were at least 2 pounds and at least close to 8 weeks. There is a small yet effective foster program for the ones that are pulled but are too young, and most are willing to keep them as long as needed.
However, we are seeing ones done that are 5 and 6 weeks and as small as 1.5 pounds or even just under that. I know there are vets that have been doing pediatric s/n for years, and are doing very young and small like that, but this vet is not only new to pediatric s/n, but new, period.
The little ones get adopted so quickly, and this shelter, being very large, municipal, short-staffed, and very low on volunteers, doesn't have time to do counseling or follow-up. But many of those that are around for a couple of days or so, look like they aren't recovering well. That usually gets attributed to the upper respiratory that perpetually goes around in shelters, and that may be so. But we are worried that at that age, their immune systems just can't handle it and wonder if this is serious enough to be addressed. We don't want to offend the vet or the rest of the staff, but we are concerned.
We have been concerned lately about their protocols with a new staff veterinarian. They previously did not do surgery unless the juveniles were at least 2 pounds and at least close to 8 weeks. There is a small yet effective foster program for the ones that are pulled but are too young, and most are willing to keep them as long as needed.
However, we are seeing ones done that are 5 and 6 weeks and as small as 1.5 pounds or even just under that. I know there are vets that have been doing pediatric s/n for years, and are doing very young and small like that, but this vet is not only new to pediatric s/n, but new, period.
The little ones get adopted so quickly, and this shelter, being very large, municipal, short-staffed, and very low on volunteers, doesn't have time to do counseling or follow-up. But many of those that are around for a couple of days or so, look like they aren't recovering well. That usually gets attributed to the upper respiratory that perpetually goes around in shelters, and that may be so. But we are worried that at that age, their immune systems just can't handle it and wonder if this is serious enough to be addressed. We don't want to offend the vet or the rest of the staff, but we are concerned.
Response from Julie Levy:
I've sterilized very small kittens without problems, although I don't see the benefit of doing them much younger than the age of adoption. On a technical level, the anesthesia and surgery are no problem. Is this shelter adopting out 5 week-old-kittens?
The bigger issue is whether it is a problem to add an additional stressor at the time when kittens are undergoing weaning stress and may be in the gap between good maternal immunity and their own acquired immunity. This can be a difficult time for juveniles, and surgery can be another drain. Delaying the surgery to 7 or 8 weeks may help reduce that drain, but it does not remove it entirely.
In general, I believe that time in the shelter should be minimized due to the risk of infectious diseases such as upper respiratory infection. The shelter may be trying to do this by neutering the juveniles young and adopting them out quickly. An alternative is to put them in foster homes until they are older, then bring them back for sterilization and adoption. During kitten season, it may not be possible to provide enough foster space for all of the underage kittens, and it can be complicated to manage such a system.
I wonder how many people reading this are wishing they had these problems: vets wanting to sterilize cats and dogs very young and the shelter adopting out animals very quickly! So many groups can't find vets to sterilize before 6 months and so many shelters are nothing more than a holding facility for condemned animals. I think I'd count your blessings. How about arranging a big "thank you" party for the shelter for being so progressive? After you've made a public display about how much you support the shelter, you might arrange a private meeting about how you'd like to help improve any problem areas.
The bigger issue is whether it is a problem to add an additional stressor at the time when kittens are undergoing weaning stress and may be in the gap between good maternal immunity and their own acquired immunity. This can be a difficult time for juveniles, and surgery can be another drain. Delaying the surgery to 7 or 8 weeks may help reduce that drain, but it does not remove it entirely.
In general, I believe that time in the shelter should be minimized due to the risk of infectious diseases such as upper respiratory infection. The shelter may be trying to do this by neutering the juveniles young and adopting them out quickly. An alternative is to put them in foster homes until they are older, then bring them back for sterilization and adoption. During kitten season, it may not be possible to provide enough foster space for all of the underage kittens, and it can be complicated to manage such a system.
I wonder how many people reading this are wishing they had these problems: vets wanting to sterilize cats and dogs very young and the shelter adopting out animals very quickly! So many groups can't find vets to sterilize before 6 months and so many shelters are nothing more than a holding facility for condemned animals. I think I'd count your blessings. How about arranging a big "thank you" party for the shelter for being so progressive? After you've made a public display about how much you support the shelter, you might arrange a private meeting about how you'd like to help improve any problem areas.
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