If you work with cats in the United States or Canada, you will face a few conundrums related to phalangectomy procedures (onychectomy/declawing).[1] The topic is considered controversial by many people, including some of your clients and their vets. This means that you not only have to recognize evidence that a cat is having physical trouble related to the amputations, you also need to broach the topic without inciting animosity between the humans. Helping these cats will require the owner, vet, and behavior consultant to work together as a team.  You are the person to make that happen!

But I’m not a vet!

As behavior consultants, we walk a careful line of not overstepping our boundaries by crossing over into practicing medicine, while simultaneously needing to know the many behavioral signs that an animal needs medical intervention. This can be particularly challenging if the animal in question has been deemed clear of medical conditions that might be contributing to the behaviors that brought you into the case. Your mission, should you choose to accept it, is to shine a light on the problem while creating an environment in which all parties feel safe and united in the goal of helping the animal.

You may have found yourself in this position before and been frustrated that a client’s vet missed an obvious medical diagnosis. When this happens to me, I recite these words from the always-insightful Dr. Susan Friedman: “They are us.”

“They are us” reminds us to have compassion for someone we initially want to cast as the villain, while we envision ourselves as the hero riding in to save the day. If you do save the day, you won’t do it alone! If you feel yourself criticizing a veterinarian for missing what seems obvious, recognize how much information you have at hand during an in-home consultation, generally lasting at least an hour, in the animal’s everyday habitat. Compare this to the limited exposure a vet typically has with the same cat during an office visit. Even if we give a generous allotment of time, say 30 minutes, the behaviors they are most likely to observe are “cat crouching in carrier” and if they are lucky, a sprinkling of “cat slinking around edges of room searching for exit.” Now consider that many vets still have little education about cat behavior, and probably no knowledge about the problems related to partial-toe amputations (see resources for programs designed to combat these exact issues). The cherry on top of our hypothetical scenario is a vet who did the declawing and/or a client who requested the procedure, neither of whom is likely to consider it as a potential component of their cat’s problem.  It should be evident that, in comparison to you, the vet is often at a disadvantage.

Medical and physical first

The Least Intrusive, Minimally Aversive (LIMA) approach to behavior modification and training hierarchy requires wellness (nutritional and physical) as the starting point to any behavior change procedure. This indicates that physical well-being should always be a consideration, no matter the reason for your consultation. Some consultants require their clients to see a vet prior to a behavior consultation. I do not do this unless I feel that the cat is in urgent need of medical intervention (e.g., “My cat urinates 20 times a day in small puddles all over the house” = Run to vet immediately!) because I want to keep the client motivation rolling by scheduling and possibly implementing some immediate stop-gap management skills.

Additionally, I’ve found that I end up sending quite a few clients back to the vet for additional evaluations. I prefer to save clients the first visit if possible, and send them to the vet much more prepared with a summary containing an outline of our basic behavior modification plan; relevant information from the history questionnaire, my interaction with the client, my observations of the cat, and even relevant photos and video. If necessary, I also schedule a short (about 10 minutes) phone chat with the vet.  This is important when there is any potential medical problem, but it is even more vitally necessary if there is a possible problem related to declawing. You are going to need as much evidence as possible to convince some vets and owners that the problem is real. Always get a signed release so that you and the vet can share client information.

If the cat has already had a medical evaluation, and the vet has determined the cat is medically fine, do not assume that this is an accurate conclusion. Review the examination notes for yourself, because things can be lost in translation between what the vet says, what the client hears, and what finally reaches your ears. The client may not have even mentioned to the vet that the cat is urinating out of the box, and so the vet just did a basic annual physical exam with vaccinations. Additionally, medical techniques vary between vets for many reasons. Maybe the clients—like most of us—have limited income and, knowing this, the vet didn’t mention doing more expensive diagnostics. Sometimes there is medical negligence or malpractice, but usually it is just that your knowledgeable eyes can be a benefit to the situation.

But I’ve never had a client hire me because their cat is having trouble due to declawing!

Actually, you probably have, the case just wasn’t presented to you in those words. Physical health and behavior are intimately connected. Sit back and reflect on your own behavior when you are in pain or not feeling well and you will probably notice that you are not your best self at those times. Being in pain constantly, or trying to avoid being in pain, is extremely fatiguing, which might contribute to a lower tolerance threshold for things that would otherwise be barely bothersome. A cat might refuse to use a litterbox, stop tolerating that darn dog’s rough interactions, or resist being picked up. This is not only relevant to pain related to declawing. Millions of cats are in pain from a variety of problems, such as joint disorders, dental disease, and bowel problems that their humans have no clue about. At the same time, cats see vets at a far lower rate than they should for optimal health. This is a bit of a bleak picture, but you can help make a big difference in these households by keeping your eyes open for the signs of physical maladies while you work on addressing behavior modification. Let’s take a look at some ways to get your observation on!

Observation basics and documentation

Most people will notice if there is a problem within a limited timeframe subsequent to the procedure. For example, if a cat is noticeably limping after the operation and six months later the limping has not subsided. It should also be obvious if a cat has tissue sloughing off due to bandaging constriction damage, or paws that are swollen or bleeding. It is much harder for people to connect the dots on an issue that is not apparent immediately postprocedure, or that is displayed initially (e.g., limping), subsides and then reappears months or even years later. You will be coming in with fresh eyes able to notice physical and behavioral states that crept up slowly under your clients’ radar.

I begin consultations by observing the cat’s behavior in the home while I speak with the clients. I look at things from both whole-picture and puzzle-piece viewpoints.  Below are some of the things I am considering during my observations and interview with the client.

Holistically:

  • How does the cat move, or not move, through the environment (e.g., avoids hard surfaces, hesitates to jump up, limping, sits with paw up, sits with front paws over the edge to take pressure off pads)?
  • How are social interactions between multiple animals?
  • How does the client interact with the focal cat in relation to their behavior toward other animals in the household?
  • How does the focal cat respond in general towards the client (e.g., solicits attention but shows discomfort with handling; specifically what kind of handling)?
  • Overall body language (e.g., signs of agitation, discomfort, pain).

Puzzle Pieces:

  • Does the cat use a litterbox and if so, how (e.g., sometimes, always, never, covers/doesn’t cover urine/feces)?
  • What do their paws look like (e.g., presence of paw pad calluses, pad lesions, pad atrophy, decreased space between pads, gaps in toes)?
  • Will the cat play?

I get videos of any movement-related observations and photos of visually apparent paw problems for the client file, educational purposes, and to submit to the vet.[2]

Gait and movement red flags

Some clients will have noticed pronounced limping or changes in their cat’s activity level and preferences. Other clients won’t have a clue that something is physically off about their cat, either because the indicators are extremely subtle, or because the clients don’t know what to look for. Many clients don’t even know they should be looking at all. Your visual observations are invaluable, and you can also often gather supporting evidence in your conversations and review of the cat’s history. These might come up as surprise puzzle pieces such as a client’s comment that “Adso used to be so playful but now that she is an adult, she mostly just sleeps.” The client may consider this an unavoidable artifact of their cat’s progressing age, but upon further investigation you notice the cat has difficulty walking. When you delve into that aspect, the client may reveal they hadn’t noticed the difficulty or that they did, but assumed it was just normal for their cat.

Here is a helpful video from Dr. Duncan Lascelles and the Comparative Pain Research Laboratory at North Carolina State University College of Veterinary Medicine. While the video lists arthritis as the primary diagnostic target, the details are relevant to any painful mobility issue. Note that when the camera is moved along with the cat, it is difficult or even impossible to observe any subtle issues. Remember to keep the camera as still as possible when you film and isolate the movement to the cat only.

Here are a few examples of declawed cats experiencing difficulty that is clearly evident on viewing a test of movement towards and away from the camera. Both of these cats were evaluated by vets and declared medically healthy. It is highly likely the vets never considered a locomotion evaluation to be a necessary part of a routine physical exam. Therefore, they probably never saw these cats anywhere other than in the carrier and on the exam table. These cats had observable indications of partial-toe amputation–related damage that would have been evident on visual exam if the vets had been educated about the topic and known what to look for. Perfect examples of how behavior consultants can really help vets get a fuller picture of their patients’ health!

Video 1: Daphne

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Video 2: Puffy

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Video 3: Pompie

Here is an example of a cat demonstrating more subtle signs of difficulty walking that the owners thought was simply the way she naturally walked.  I’ve worked with this client’s vet many times and she is knowledgeable about problems related to declawing.  This is an interesting case because the vet recognized the problems with the cat’s paws during her annual physical exam, but the clients did not believe her.  They did not inform me of this but I unwittingly confirmed the diagnosis during my customary consultation observations. Notice the stiffness, hesitancy to place paws, and limp.

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Munera Photo 2 Fiona lesions and calluses on pads, pad movementPaw pads

Some of the most obvious, yet also most ignored, signs that a cat is in need of further veterinary evaluation are misshapen pads and calluses on the pads. Dr. Kirsten Doub[3] is currently researching the correlation between paw pad calluses and pain scores on gentle digital palpation of the paw pad, as well as the correlation between paw pad calluses and radiographic evidence of pathology and explains:

“There have been associations made between these paw pad calluses and bed sores that people who are recumbent in the hospital receive from pressure points on bones not designed to withstand forces associated with bearing weight. With the declawing you remove P3, and P2 is a pointy bone that cannot withstand weight-bearing forces over time. The result is that P2 tries to “punch through” the paw pad, creating calluses.”Even on cursory examination, these abnormalities are obvious, however many vets do not know that they indicate trouble is brewing under the surface. They can be signs of osteomyelitis, abscess, or other issues that occur both with amputations following correct technique and declaws performed through surgically inappropriate methods. 

 

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Munera Photo 1 Daphne calluses on deformed pads, gap in toesDr. Doub also emphasizes that if cats exhibit misshapen pads or calluses on the pads, “exam of the paw pads should always be accompanied by X-rays, lateral and orthogonal cranial caudal views, of the paws.”

These paw pad issues unfortunately fit into the old analogical standby about icebergs. When you see them, you are only looking at the tip of the iceberg, not the massive problem under the ocean. The bigger problems require a vet who is knowledgeable about the diagnosis and treatment of the myriad problems related to partial-toe amputations. If your client’s vet is not familiar with these issues but is willing to learn, you can be a valuable resource by providing basic information about your concerns along with contact information for one of the vets who are currently offering assistance in this area.[4]

Other paw problems

A few years ago, a client’s cat had a laceration on her paw that wouldn’t heal and kept getting worse. The vet tried many techniques to repair the wound and help the cat heal, but every time the cat jumped down from a surface, the wound split open again. The vet then did an exploratory surgery and found quite a nasty surprise: 10 claws regrowing under the skin! One of the nails was actually slicing the cat’s paw open from the inside.

In fact, this type claw regrowth is a well-known problem with improperly done partial-toe amputations, particularly those done with Resco-type nail trimmers.  Some cases will be extremely obvious, with pronounced swelling in the toes or visible claws actually tearing through the skin. We can hope that most clients will notice such overt symptoms, but they rarely notice the less visible cases that manifest primarily though the type of movement and gait issues we discussed previously in this article. Currently, the X-ray protocol as described by Dr. Doub is the only known way to rule out nail regrowth.

Munera Photo 3 Nail regrowth fragments in jar

A jar of nail fragments that were pulled out of a cat’s paw during surgery.

Now what?

You have unwrapped a mess that no one is going to want to hear and your next steps can save a cat’s life, get you fired, or any number of fun variations of the two. Your ability to understand and interact with humans is absolutely key to a positive or negative result. You have to get the client to believe that there is a problem, potentially one that—in their mind—is completely unrelated to the reason they hired you, and then act to remedy the issue. There are likely to be some psychological defenses standing in the way, either within the household, at the veterinary level, or both. The best possible—but least likely—situation is one in which everyone in the client household disapproves of declawing, rescued or adopted the cat already declawed, and their vet does not perform declaws because they are opposed to them. Note that I have never come across that pleasant scenario, but it exemplifies the prime areas of cooperation or opposition: the client, other members in the household, and the vet. The main challenge is getting past the human psychological safeguards designed to preserve our worldviews and protect us from being the “bad guy,” without causing defense mechanisms to deploy. Always keep in mind that you must modify your technique based on the client situation in front of you. There is no easy recipe to follow because each client has their own combination of expectations, abilities, learning history, resources, and challenges to work with.

The client

If the client chose to have the cat declawed, there can be an enormous amount of distress involved in finding out that they relegated a loved one to a life of pain and dysfunction.  It is paramount to approach the topic in a manner that makes them feel safe, and that your focus is on moving forward rather than judging them. This is not always an easy task, because you know that they are at least partly to blame for the problem. Be particularly conscious of your body language, facial expressions and word choice as you introduce the topic. If your words are chosen well but your facial features make it clear that you think this client made a bad choice, the client sees that. Your responses need to be considered in the context of the entire situation.

One of my clients had six cats declawed at the insistence of her daughter, to prophylactically safeguard expensive new sofas she had purchased for her mother, despite no prior undesirable scratching behavior. A few years later, all of the cats were suffering crippling problems from nail regrowth and abscesses due to improper amputation techniques. Can you put yourself in that scenario? You’ve done something you did not want to do, in order to appease the demands of a family member, and it turned out to have devastating consequences to six of your other beloved family members. The very last thing you need is a cat behavior professional judging you.

In this case, the client had moved to a different state and no longer had contact with that vet, and it was clear to the client that the vet was negligent. We discussed reporting to veterinary oversight agencies and pursuing legal avenues, but the client was not emotionally ready for those steps. We then focused on ways to make the environment less difficult for the cats while she was seeking treatment. I also gave her some resources for possible funding to assist in the costs of treatment, as each case can easily cost $1,000, depending on the severity of the problem and the type of treatment required. Unfortunately, there are very few options and most people are forced to cover the expense themselves.

Some clients will absolutely not believe you, will believe you but won’t care, or will have problems making the leap because of someone else in the household.  These situations all require delicate handling, just as they do if you are trying to implement a behavior modification plan without having full buy-in. You absolutely must be able to find out what the client in front of you will respond positively to. Are there marital problems and one spouse is opposing the idea in order to provoke the other spouse? Does this client even want to keep the cat? Does the client have a physical challenge, such as injury or chronic pain that they have shared with you which you can gently use to get them into the cat’s perspective? Do they need a plan that is presented to them in baby steps or with a holistic overview? Are their behavioral goals achievable without addressing the medical problems of their cat? For example, if they don’t want to get rid of the cat, but they are dedicated to having the cat return to the litterbox, you may have to repeatedly link that goal specifically with the process of addressing the medical issue.

There will be times that you can’t, for whatever reason, get the clients to address the dilemma of their cat’s paws. The IAABC Code of Ethics states

1.4 Animal behavior consultants continue working with a client only as long as it is reasonably clear that the client is benefiting.

Can you move forward with clients who refuse to address a problem that is preventing a successful case resolution? You will have to determine the next step you take. Do you excuse yourself from the case, which means the cat will definitely not receive help? Do you continue to proceed with behavior interventions, and either avoid the topic of the declaw problem or try to build a better relationship with the client in the hopes that they will be ready to hear you in the future? What coping mechanisms do you have in place to help you move past clients who you cannot help?

Do you have an obligation to report this as a case of neglect, and if so, who do you report it to? These are difficult questions. The IAABC Code of Ethics states:

1.2 Animal behavior consultants comply with applicable laws regarding the reporting of animal bites and possible neglect/abuse.

This leaves some necessary ambiguity because there are a lot of variations according to federal, state, and local laws. You should consider a cat in need of treatment for declawing gone wrong and whose owners refuse to seek medical attention as a case of neglect, just as you would if the cat had an untreated broken leg. The veterinarian does have a mandate to report incidents of abuse and neglect, so that should be your first stop. If you do decide to report the client, keep in mind that you need to provide organized documentation regarding the condition of the cat and contact information for vets who work with declaw salvage situations, because this information will help the investigators better understand the situation. I highly recommend you discuss this possibility with your legal advisor so that you will be adequately covered.

The veterinarian

What happens when the client is on board but the vet isn’t? This is a particularly delicate situation, in part because most consultants are not also veterinary professionals and should therefore stay within the boundaries of the behavior field. There are wonderful vets out there but there are also many vets who have little or no knowledge of cat behavior, and even more who do not realize the damages inherent in multiple partial-toe amputations.[5] How do you interest these vets in cooperating with someone who, in their eyes, may not have any business interfering with their clientele?

The hardest cases are ones in which the client’s current vet performed the partial-toe amputations. Most vets really care about their patients and want to help them. It would be very upsetting to learn that a procedure you performed, thinking you were saving their life by keeping them in their home, led to a patient being crippled or having pain the rest of their life.[6] If you admit to yourself that even one of your patients is having this problem, then it is likely that other patients have also suffered and you had no idea. As behavior consultants, we are always learning more and improving our skills, yet we still remember clients who we could have helped more if only we knew then what we know now. I imagine that veterinary professionals might feel the same way, and that is not an easy feeling to have. One of the worst things you can do is make that vet feel like you are trying to turn his client against him, or saying he is incompetent.

As I noted, I usually have a short phone conversation with the client’s vet if there is any suspected medical involvement in the behavior issue. Almost every vet has been excited that I am there to rally the team! I can help the vet solve problems by providing missing information, boosting client compliance and suggesting resources where the vet can learn more about the relevant issues.

If you have a vet who refuses to talk with you or behaves against the best interests of the client, your relationship with that client will play a large role in determining how to proceed.  If the client-vet relationship is strong, you are the outsider and you need to be very careful not to say anything negative about the vet’s ability. You may have to slip in some references here and there without facing the issue directly. I might add “Because your cat is declawed, we…” or words to that effect throughout the consultation and any demonstrations. For example, “Because Kitty is declawed, could we move this ottoman here so he doesn’t get hurt by jumping from his shelf onto the hard tile floor?” The client then has the opportunity to consider that declawing their cat caused unintended problems.

Sometimes you can easily give the vet a pass by saying that she seems like a really caring vet, but this is not a topic that is taught in vet school and she hasn’t chosen to specialize in it. This is comparable to the human experience, where people have a general care practitioner and also see specialists in various health fields.

I have had some clients take charge of the situation in unexpected ways. One client, whose vet refused to speak to me, called me during her cat’s appointment and then handed the phone to the vet. I won him over in the end, but it wasn’t an easy task and it wouldn’t have been possible without the dedication of that client. So don’t be afraid to ask the client for their ideas on getting through to their vet.

If your client isn’t enamored with their vet or is open minded, you might suggest they get a second opinion. I still don’t recommend that you disparage their vet, but rather you focus on the positives to be had by getting the cat checked out by another set of eyes. Again, you can equate this to the human medical world in which it is very common to seek a second opinion in serious medical issues. You can guide them to vets who you know have the necessary knowledge or willingness to learn, and will take the problem seriously.

What comes next?

Wherever you stand on the topic of declawing—necessary evil, totally fine, or never appropriate—you have a duty to support a LIMA-based approach in which wellness is the first level of evaluation. It is inconceivable that multiple amputations of weight-bearing digits can cause no immediate or long-term damage to the amputee. There is ample research in the fields of human and non-human medicine disciplines to supply irrefutable evidence of that impossibility. There are also studies in progress that could invalidate the common justification that declawing actually saves cats’ lives. The status quo is being challenged by pressure on many fronts, and you need to be educated about the most current state of the controversy because you will work with these cats.

In a future article, we will examine ways you can help clients modify the environment to be friendlier to their declawed cats. In the meantime, if you follow LIMA, you already have a toolbox full of items designed to filter through the garbage (e.g., punishment, or a dominance-based training philosophy) and allow the truth to shine. Use those skills to help millions of cats and their humans have better lives!

Resources:

Assessing Pain:

Animal Pain: a pain scale for cats

American Association of Feline Practitioners: pain management guidelines

Low Stress Handling:

Dr Sophia Yin, What professionals need to know about Low Stress Handling

Vetfolio Fear Free Certification and Resource Program

The Human Aspect:

Dana Atwood-Harvey, Death or declaw: dealing with moral ambiguity in a veterinary hospital

Joel Gavriele-Gold, When pets come between partners: how to keep love —and romance—in the human/animal kingdom of your home.

Risë Vanfleet, The human half of dog training: collaborating with clients to get results

David McRaney, Why we are unaware of how unaware we are.

References

[1]I will use the more common terms partial-toe amputation and declawing rather than phalangectomy in this article for easier reading. However onychectomy, while being the accepted veterinary term, is not a correct description of the procedure. Onychectomy is a human medical term referring to excision of a nail that does not involve cutting or altering the phalanges.

[2] See https://positivecattitudes.files.wordpress.com/2016/05/video-photo-shooting-tips.pdf for photo and video tips

[3] Dr. Kirsten Doub, the Utah Paw Project director, has a Facebook page at www.facebook.com/pawprojectutah

[4] See https://positivecattitudes.files.wordpress.com/2016/05/vets-willing-to-consult-w-other-vets-on-declaw-issues.pdf for a list of vets willing to consult about diagnosing problems and on paw salvage techniques

[5]See the resource section as a starting point to find materials and programs designed to remedy both problems.

[6] There is at least one study (Atwood-Harvey, 2005) about how “veterinarians and their staff are able simultaneously to define felines as subjects worthy of respect for their quality of life, protect their own self-identity as people who work toward the best interest of animals, and paradoxically support action toward felines that they find morally objectionable.”

Jacqueline Munera is a CCBC promoting positive perceptions about cats! She’s so passionate about this mission that she named her business Positive Cattitudes and spends her time dispelling the myth that cats can’t be trained. www.PositiveCattitudes.com