Leave your gonads at the door.

Last week I said to my employer that I miss doing surgery (business has been much slower than usual lately), and the next day they called the new branch of the SPCA - conveniently located almost across the highway - to bring in cats in desperate need of sterilization. The SPCA is inundated with cats. We are not the cheapest clinic in the area, probably the most expensive after the emergency hospital, but we have a discount policy for the SPCA as well as for our clients: the "public service discount," meaning that spay and neuter are for the public's benefit and not just the owner's and the animal's. I will give these cats a chance at longer lives in people's homes, as they have no future unless they are spayed and neutered. Spaying and neutering has become the standard of veterinary care in the New World, so much so that people and vets who fail to do it are looked down upon as morally lacking. Of course, an exception is made for breeders - those who breed more or less healthy animals in good conditions.

The standard of care is a curious concept. It is supposed to be determined by the patient's best interests in terms of health and welfare. Our society does not accept packs of feral dogs or colonies of feral cats sharing living space with people - this is considered barbaric, unsanitary, and unsafe. But another way to look at them is no-kill shelters under the open sky, and this is how it works in many countries and communities where these animals are trapped, sterilized and vaccinated, and released. Not all of them, of course. Many continue to multiply, so the arrangement is far from perfect. Moscow has many colonies of feral cats who live in basements of apartment buildings (the city has no private homes, these are all brand-new and on the outskirts). They access the basements through small ground-level ventilation holes and live in safety and warmth by the hot-water pipes, taking care of any incipient rodent problem in the building. Packs of dogs live in the city parks and take shelter in subway entrances. The animals are fed by self-appointed caretakers. They are much smaller and thinner than the animals we are used to seeing in North America - they do not eat as much food and do not grow as big. Aggression is not an issue if the animals are not deliberately bothered by stupid or cruel people. But Russia is not a culture where the stupid are protected from themselves. The animals have each other's companionship, something shelter animals do not have even if they are fortunate to spend only a short time there before finding a home. In a shelter they smell and hear each other, but cannot interact, which I imagine contributes to considerable anxiety and stress. So there is no reason to think that these feral animals suffer any more, or even nearly as much, as millions of shelter animals awaiting adoption - or death. It is another culture's acceptance of the fact that some animals will never live in homes with humans, that this is an acceptable albeit imperfect way to live, and is no reason to destroy the animals.

What about health as a criterion of standard of care? We are taught in veterinary school that spaying and neutering are beneficial for the animal's health. Spaying a dog before her first heat pretty much protects her from breast cancer; after the first heat her risk of this disease increases but is still not very high if she is spayed before the second heat. After that, a spay is protecting her from pyometra and ovarian cancer but no longer from breast cancer. Dogs who are not neutered are at risk of developing prostatic hyperplasia that is often bad enough to squeeze the urethra shut so the dog can't pee. And there are, of course, behavioural issues that hormones contribute to - but habit and training have as much to do with this as hormones. We are also taught that a neutered male dog is more likely to develop cancer of the prostate than an intact one, but this latter piece of information is rarely if ever shared with owners when we discuss reasons for neuter. Stories of testicular cancer, urethral obstruction from prostatic hyperplasia, perianal tumours, and dogs getting hit by cars while seeking a date, are the usual fare dished out to owners in preparation for neuter. Cats may be a slightly different story. Spaying a cat has roughly the same benefits as spaying a dog, and neutering a male averts spraying and roaming. Recently I had the satisfaction but also the challenge of spaying an 8 year-old cat who had never had a litter. Her uterus was warped and her ovaries fragile as butter, tearing with the slightest pull - all that hormonal influence over the years! A confined tomcat makes a very unhappy animal indeed (which is quite different from a male dog kept from mating), while letting him outside guarantees that he will sow his seed and populate the world with more kittens. I don't know of any increased health risks for neutered cats compared to intact ones. Urethral obstruction is a frequent condition in neutered males fed dry diets, but we don't know how this compares to tomcats and whether they are at risk too - they don't stick around to be observed, or to survive when afflicted. All spayed and neutered animals have a tendency to put on weight much easier than intact animals, but - look at our human population. Obesity has more to do with how much a body, animal or human, is eating than with presence or absence of gonads.

So, what is it that really determines the standard of care - health, or demographics?