September, 2018

Ten years ago, I examined this handsome cat at a nonprofit spay neuter clinic.

This week’s Journal of the American Veterinary Medical Association (JAVMA) contains an article about the people and the animals who use nonprofit spay neuter clinics. The full title of the study is Characteristics of clients and animals served by high-volume, stationary, nonprofit spay-neuter clinics. I conducted this study along my co-authors Julie Levy and Jan Scarlett, two superstars of shelter medicine who were both great collaborators and great mentors on this project.

The data for the study comes from surveys of thousands of clients bringing their cats or dogs to stationary spay neuter clinics all over the US over the course of one year.

If you were lucky, you may have seen me presenting the results of this study in 2015 at the North American Veterinary Conference or at the SAWA/National Council on Pet Population research day. Below, I’ll describe the study using some graphics from these original presentations (which are more colorful and varied and less copyrighted than those in JAVMA). We have a press release available on the Million Cat Challenge website too, which you might want to check out to learn more about the study and its interpretation.

The Study Clinics

We wanted to be sure to include clinics and clients from all over the US, in case there were regional differences in the types of clients or pets who use spay neuter clinics. Similarly, we wanted to be sure to include different times of year, in case there was a seasonality to clinic patients. In order to make sure we chose clinics from all over, we divided the US into 4 regions (actually, the Census Bureau did the dividing) and tried to get proportional representation from each region. Here is what that looked like:

Once we selected the clinics, we asked them each to survey all clients bringing cats or dogs to the clinic during four specific weeks over the course of a year. Clients would fill out a survey for up to two animals and answer questions about themselves as well as about their pet. We didn’t ask feral cat caretakers or shelters and rescues to fill out surveys, and we also didn’t get surveys from clients whose pets arrived at the clinic in transport vehicles.

The Animals

Overall, about half of the 12,901 animals that clinics saw during the study weeks were brought to the clinic by owners, and the other half consisted of shelter animals, ferals, and animals arriving by transport vehicle.

Again, only the drop-off at clinic animals were eligible for the study. About 2/3 of these animals (4,056 animals) ended up being included. Among those, there was a pretty equal split between males and females, and between dogs and cats.

The ages of animals varied, but overall, felines were being altered younger than canines:

The age and species composition varied somewhat around the US, with the Northeast having more cats, and the West having more dogs.

Among the adult female patients, 28% of the cats and 17% of the dogs had had a previous litter. Most of these cats (66%) had only had one litter, whereas just over half of these dogs (51%) had two or more litters before being spayed.

Previous Veterinary Care

The animals, especially the cats, had limited previous exposure to veterinary medicine. For most of these pets, this was their first time seeing a veterinarian.

Even more alarming from a public health perspective, very few of the cats over 4 months old had ever received a rabies vaccination. The dogs were more likely to have had a rabies vaccine, which we attributed to licensing requirements and the availability of rabies vaccine clinics.

The Clients

We asked clients to share their annual household income, and found that most clients’ incomes fell below the national median household income, and below each of the regional median incomes. This was true whether they were bringing dogs or cats or both to the clinic, although cat owners tended to have lower income than dog owners:

We found similar income distributions among all regions, with the lowest client incomes in the Northeast, where the clinics also see more cats:

The Reasons

We asked clients why they were choosing to get their pets neutered now, and also why they chose to come to the spay neuter clinic. They were allowed to choose as many answers as they liked.

Population control, avoiding heat, and behavioral reasons were the top choices for both cat and dog owners when asked reasons for getting their pet neutered now:

Cost, recommendations, and reputation were the top reasons why clients chose the nonprofit spay neuter clinic instead of other options:

The Takeaways

Even though most of the study clinics didn’t screen for income, the majority of the people and animals that they served fell into the low income demographic, with about a quarter of clients falling below the poverty line. We can also see from the survey results that the majority of these pets had never seen a veterinarian before. For the most part, nonprofit spay neuter clinics are reaching the people who most need their services and who would likely not get those services elsewhere, or who would struggle to pay for those services if they did receive them elsewhere.

Penniless Pussycat is in need of a low cost clinic

Also, remember that client-owned animals only made up about half of the patients that participating clinics saw during the study period. These clinics also spayed or neutered thousands of homeless animals during the study weeks: remember that 24% of the clinics’ patients were shelter animals, and another 18% of the patients were feral cats. Even though these animals weren’t included in the study, they are a huge part of the work that nonprofit spay and neuter clinics do and should always be factored in to the value of what clinics provide.

As a spay neuter vet, I was also happy to see that clinics enjoyed a good reputation among clients such that reputation and referrals from friends were two of the top three reasons clients gave for choosing the clinic. So clients feel that they are getting not just an affordable service, but a high-quality service as well.

Within the last few months, I suddenly have become middle aged, or at least my eyes have. I’ve been using readers (“cheaters”) the past few years occasionally for reading, and had found them necessary during feline physical exams in order to age the little kittens by their tiny incisors, but it was only this spring that I found that I needed my glasses in surgery as well. Perhaps I could have held out longer if I used swaged-on suture, but threading the needle with my cassette suture was getting challenging.

So I put on my glasses for surgery and could immediately see nothing though the fog. That was an easy fix though– fog-free mask, fitted to the bridge of my nose. These masks have a foam strip along the bridge of the nose that has the added bonus of absorbing sweat on those 80+ degree surgery days.

Yes, they actually work! As long as you shape the metal strip to the bridge of your nose.

But then came the next problem. When I put on my plastic $5 reading glasses and started surgery, I found that, in order to look through the lenses, I had to bend my neck downwards at a greater angle than usual. If I tried to look down with just my eyes, I ended up looking at the bottom of the plastic frame and the small space below it rather than through the lens.

Surgery with no glasses. My neck is bent at a 35-36 degree angle.

With my plastic framed reading glasses, I have to bend my head more in order to avoid having my vision interrupted by the lower frame of the glasses. My neck is at 40 degrees.

The extra angulation really seemed to be uncomfortable for my neck and shoulders, so I tried sliding the glasses further down my nose, “geezer style.” That improved the angle of my neck, but it was a little uncomfortable across my ears and definitely insecure. The glasses would slide on the slick surface of the mask, and there was even one time when they slid off in the middle of surgery. Fortunately I was able to catch them in my hand before they landed in the middle of a cat.

Plastic glasses worn far down on my nose, “geezer style.” My neck angle is just 34 degrees, but the glasses slip.

So I did what all good modern humans do: I appealed to the internet for help. Or, specifically, to some spay-neuter and shelter veterinarian groups that I’m a part of. Suggestions ran the gamut from progressive lenses to loupes to better patient positioning.

Loupes

The idea of wearing loupes in surgery has intrigued me. Ergonomists often suggest them as a way to decrease neck angle, and it seemed that, if I was requiring corrective lenses anyway, I might as well use something that would further help with my neck angulation.

But the thing about loupes is that even if you find ones that you can adjust to a very steep declination angle, it’s still your eyes (or, your extraocular muscles) that are making the adjustment. There is no fancy prism or deflection in the lenses of the loupes– they just force you to turn your eyes downward in order to view through the magnifying lenses. So in that way, it seems that there is nothing that loupes can do regarding angulation that can’t be achieved with your eyeballs and a regular pair of glasses. It’s just a matter of getting those glasses low enough.

Loupes can be really helpful if you need that extra magnification. Here, Dr. Sandy uses a flip-up loupe (plus face shield and LED light) while doing dental work on a dog.

Of course, if you need the extra magnification, loupes can be great. Dr. Sandy let me try on a few pairs of hers and I found the magnification to be way more than what I wanted for spays, and the field of view to be much narrower than I would like. She also told me that there would be about a month’s learning curve in using them. So, I decided to avoid loupes for now.

Progressive Lenses

It turns out that it’s possible to get progressive lenses that have no correction on top, but that have a near-distance correction on the bottom. Since I don’t need glasses for distance vision, I hadn’t considered progressives. But this would be a way to have lenses that allow close vision for surgery, and that have the clear glass on top so I could see the monitors or look at the other people in the room.

Generally progressive lenses would require a prescription, but a local eyeglass store suggested it may be possible to find them online without a prescription (since they are essentially drugstore readers with glass above).

Half Glasses

But it seemed to me that progressive lenses with no correction on top would just be a way to avoid always looking over one’s glasses at people. So why not find some half glasses designed to fit as low on the bridge of my nose as possible? That way when I look down I’m still looking through lens, and when I look up I’m looking over the glasses.

I like the light weight and thin metal construction of these glasses. The ear pieces are fine enough that they don’t get all mixed up with my surgery cap and mask ties and irritate the tops of my ears. And the bridge of the glasses sits right down on my nose so that they are as low as possible. Basically, they are like the bottom half of a progressive lens. This sort of glasses is available online, or, as luck would have it, at the South Station Terminal in Boston, where I found mine.

Wearing half glasses in surgery. My neck is at 37 degrees and my glasses aren’t sliding off my face.

So for now I’ve solved my vision-in-surgery problem. Maybe once I reach the age where my vision stops changing, I’ll spring for a pair of progressives, but for now I’ll be looking over my glasses at you.

Month: September 2018

Who uses Spay Neuter Clinics?