Laser Declawing (the truth)

By Kirsten Doub, DVM State Director of the Paw Project-Utah.

Paw Project-Utah has been doing paw surgery on cats with fragments. Clearly these cats with “pebbles in their shoes”, fragments of a mutilated bone that they have to walk on, and nails regrowing under the skin are in pain. The P3 fragments are left behind when the declaw is performed with a pair of unsterile Resco nail trimmers. A very imprecise, quick and dirty way to do 8 amputations in a few minutes. Proponents of declawing tout the laser declaw as a humane alternative. We are here today to show you why the laser is just as bad. It may not leave behind P3 fragments in as high numbers as the Rescos but it can cause thermal injury to P2 and set up these cats for painful osteomyelitis.

What is osteomyelitis?

Osteomyelitis is inflammation and destruction of bone caused by bacteria, mycobacteria, or fungi. Common symptoms are localized bone pain and tenderness with constitutional symptoms (in acute osteomyelitis) or without constitutional symptoms (in chronic osteomyelitis). Diagnosis is by imaging studies and cultures. Treatment is with antibiotics and sometimes surgery. Osteomyelitis is caused by:

• Contiguous spread from infected tissue or an infected/non sterile instrument.
• Bloodborne organisms (hematogenous osteomyelitis)-not common with declaw unless cutting instrument is dirty. 
• Open wounds (from contaminated open fractures or bone surgery).

This is what declawing is all about! Declawing is an amputation; a bone is being removed. Most declaw surgery sites are not sutured shut. They are just glued shut with non sterile surgical glue. Trauma, ischemia, and foreign bodies predispose the paw to osteomyelitis. Osteomyelitis may also form under deep pressure ulcers. This is how it works:

• Declawing = Osteomyelitis waiting to happen.
• Trauma = The amputation, trauma to the P2/P3 joint space
• Ischemia = A restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue. Proponents of the laser declaw technique talk about how it is more humane because there is less bleeding post op. With the laser declaw the tissue is burned and cauterized making it less likely to become inflamed and bleed. Any good surgeon knows that blood supply is essential to wound healing. So without that blood supply, ischemia can easily result.
• Foreign bodies = The GLUE that they use during the amputation does not belong in a cat paw. It is a foreign body. It isn't sterile and can migrate from the incision site and attach to the surface of P2 or into the joint space where it can incite a foreign body response.
• Pressure ulcers = Those paw pad abscesses and callouses we are always talking about! P2 is not a bone designed to bear weight. The paw pad if cut during the declaw will not be able to function as a perfect cushion for P2. Even if not cut, the paw pad over time can callous and abscess from having to cushion a pointy bone (P2) instead of a flat one (P3).

Pathophysiology

Osteomyelitis tends to occlude local blood vessels, which causes bone necrosis and local spread of infection. Infection may expand through the bone cortex and spread under the periosteum, with formation of subcutaneous abscesses that may drain spontaneously through the skin. If treatment of acute osteomyelitis is only partially successful, low-grade chronic osteomyelitis develops. It is common for most cats to go home post declaw without pain meds, let alone antibiotics. When a joint space has been compromised, as it is in EVERY declaw, antibiotics are warranted to prevent osteomyelitis. Additionally, a one time injectable antibiotic is not acceptable to treat infections in the joint space. Bone infections require aggressive antibiotics that are administered until the infection has cleared.

How do I know if my cat has osteomyelitis?

Patients with acute osteomyelitis of peripheral bones usually experience:

• Weight loss.
• Fatigue fever
• Localized warmth, swelling, erythema, and tenderness.

Radiographs of the declawed paws are the only way to definitively diagnose osteomyelitis. Reminder: declawing is not a nail trim! It is an amputation!!! Declawing ALWAYS involves trauma to the joint space, no matter the surgical technique used.

So what does this mean for a declawed cat?

Well, we aren't talking about pressures sustained for 3-4 hours. We are talking about pressures sustained for the ENTIRE CATS LIFE! Additionally, when we show images of paw pads that are abscessing or callousing that look painful, that is only the beginning of the damage that is going on below the surface of the skin. The deeper tissues surrounding P2 are also like it's inflamed and infected as well as the periosteum of P2. Thus, we can assume that any declawed cat with a paw pad callous or abscess is likely to get osteomyelitis from the deep pressure sore as some point if that pressure is not relieved.

How can we relieve the pressure?

Rochelle - declawed cat

We can’t put P3 back! So we have to treat these cats medically.....and some of these cats may need treatment for life. Which brings us to the PPU cat we want to highlight this week:

Meet Rochelle. She is a victim of declaw surgery. She doesn't have bone fragments, but she has painful osteomyelitis. For her to live as pain free and comfortable as possible, this is her medical plan:

• Royal Canin Mobility support diet.
• Therapeutic Laser once a week. This deep penetrating infrared laser addresses bacteria, inflammation, and infection deep in the tissues.
• Cosequin on food once a day. This supplement helps in maintaining the joint health in the paws.
• Clindamycin by mouth twice a day for 20 days minimum (needs to be continuous), then recheck x-rays. This is an antibiotic that will help clear up the infection in her paws.
• Torb/Val syrup and gabapentin regimen for pain. The torb/val syrup is an opioid painkiller. The gabapentin is a prescription pain medication that helps with extremity pain. Give both as needed.
• TriCOX UC II joint supplement soft chews, 1/2 a chew a day.