Published 11/30/2019
John Keating, MD, FAAOS

Surgeon Responds to Controversy Surrounding Surgeons for Strays

Editor’s note: The following letter is in response to feedback John Keating, MD, received from the veterinarian community after the article “Animal Rescue: Orthopaedic Surgeon Helps Stray Animals in Need of Surgical Care” was published in the June issue of AAOS Now. The article described his nonprofit, Surgeons for Strays, which treated injured homeless animals or those in shelters.

On July 12, 2013, a veterinarian in residence at Fulton County Animal Control, called me. She had two beautiful dogs, both homeless strays with orthopedic injuries picked up by an animal-control officer. She said that Fulton County did not have the $4,000 to $5,000 needed to treat the dogs. She also said it was getting harder for her to euthanize pets simply for lack of funds, and she wondered if I, as an orthopaedic surgeon and animal lover, could help. Apparently, she had found me through someone in the animal welfare community who knew I am an animal lover and that I was an orthopaedic surgeon looking for ways to help dogs and cats.

I said I’d try to help. The bigger of the two dogs had a supracondylar femur fracture and contralateral hip dislocation. The other dog had an old, open femur fracture, age unknown, but clearly not acute.

I approached a family friend who is a veterinarian and asked if we could assist him to try to save the two doomed homeless pets. He agreed to provide his leadership, facility, anesthesia, and perioperative medications. One of my orthopaedic residents volunteered to come along, as we had no scrub technician, circulator, nor detail rep. We used explanted hardware we retrieved from human patients. It was hot, sweaty work in unfamiliar surroundings with none of the bells and whistles we have in our usual operating rooms (ORs), but we fixed the one dog’s femur and did a femoral head osteotomy (FHO) on the other hip. The dog with the open fracture was already infected and required an amputation. The first dog was adopted by the friendly vet, and the “tripod” went to a rescue agency and was eventually adopted.

The radiographs from the first dog’s supracondylar femur are being shown on the internet as examples of our lack of AO technique. I have a video of this dog dragging me across the parking lot six months postoperatively, happy as a clam and strong as a tractor. Apparently, he was able to heal despite the “iffy” radiograph.

In the beginning, we received all of our calls from the Fulton County vet who knew we were a resource that would fix homeless strays with orthopaedic injuries. With the help of this vet, not one of these animals was put down, and they all went on to find forever homes through local rescue agencies.

Somehow, word got out that our team would step up to try to save homeless pets to keep them from being euthanized, and we began to get calls from people or rescue agencies that found injured strays and didn’t know what to do with them.

In the subsequent six years, we have saved dozens of strays in need who were then placed in loving homes. We have had two postoperative amputations (two infected open fractures) and an animal that underwent FHO and was still limping several months postoperatively who went on to amputation. These animals required amputations but were not put down. We have saved many limbs that could have been amputated. We have had to euthanize zero of the dozens of animals who were on death row when we were consulted.

I have adopted two of the animals I treated: Chester, an American ringtail cat that had an FHO, and Little Junior Parker, a chihuahua who had an open reduction internal fixation of the femur and amputation of a front leg brachial plexus injury.

Junior is a particularly poignant story. A couple were driving down I-75 in Atlanta and saw something fly out of the car window in front of them. They stopped and saw that it was a discarded dog. They took him to a vet who, in turn, contacted a rescue agency. The organization then called us, and we fixed him. He was then adopted by a great family in Florida, but six months later, he bounced back; his forever family had perished the weekend before from carbon monoxide poisoning. I told the rescue agency that I would foster him until he got back on his (three) feet. A week later, he became an official member of my family.

We receive videos, pictures, and Christmas cards every year from the families of the animals we saved from sure death. It is the most rewarding work imaginable.

Our rules are very simple:

  1. The injured animal has to be homeless. We do not operate on animals with homes regardless of the financial situation.
  2. There is a veterinarian present 100 percent of the time (without a single solitary exception in the history of our program).
  3. The rescue agencies that bring the animals to us agree to take them back after they’re treated and help find them homes.

We use plates, screws, and pins, which are explanted from our human patients. To date, we do not have a surgical industry sponsor or a grant, although individual hospitals and representatives have been generous enough to give us superannuated equipment and supplies, such as retired Bovies, gowns, drapes, sutures, and surgical instruments. We have bought the rest at our own expense.

Simply stated, Surgeons for Strays’ purpose is:

Mission statement:
Our goal is to fix unadoptable, broken pets, then adopt them into loving homes.

All homeless pets who can be adopted should be adopted. There are currently many wonderful pets in shelters with grievous orthopaedic injuries who will be euthanized for lack of funds. It is a sad fact that the vast majority of pets with serious orthopaedic injuries will be put to sleep. We, as orthopaedic surgeons committed to animal welfare, will provide that service to those wounded pets to make them adoptable and will work to place them in loving homes. We work with local shelters and animal services to treat their injured dogs and cats by providing free orthopaedic surgery in conjunction with local doctors of veterinarian medicine.

A core of Board-certified orthopaedic surgeons have joined together to work under the supervision of local vets to take on the care of injured homeless pets to save them from death row and get them adopted. We have developed relationships with shelters and animal services who contact us when they take in animals with grievous orthopaedic injuries, and we coordinate with veterinarians to get these animals to one of the vet clinics where we perform surgery, using equipment and expertise we donate. Once a pet is fixed and rehabilitated, we work with our partners, local adoption agencies, to arrange a loving home for the pet.

We believe:
Pets are living, dependent beings and, as such, deserve our attention and care. No pet who is adoptable should be killed simply because he is injured. Pets who are adoptable deserve loving, caring families in stable, caring homes. Pets are good for us. They make us better people. They improve our communities. And they make the world a better place.

Current state of affairs

In September, Surgeons for Strays received a heads-up that local veterinarians were mobilizing when they read about Surgeons for Strays’ mission. The friendly vet who notified us said that he knew one of the people involved. He assured us this was a very good orthopaedic veterinarian, a fair guy, and someone who was open to listening to what we had to say.

I met two veterinarians in an attempt to hear and be heard. I was 50 percent successful.

I began our meeting by explaining who we are and what we do. I shared the information provided herein, including that we only treat homeless animals with assistance from a veterinarian 100 percent of the time—no exceptions ever.

I then asked how we could work together to save more doomed animals.

There was a leitmotif that ran through the entire meeting: They repeatedly pulled up a postoperative radiograph to decry the AO technique. They repeatedly attacked us for being arrogant and attempting to wander out of our lane into the animal world. I tried to remain nondefensive, while insisting that we save many dogs and cats that would otherwise be euthanized.

I pointed out that we were operating in a limited environment. They said that veterinarians don’t need radiographs for their orthopaedic surgery, which may be true, but I assured them that they still have more resources in the OR than the one we used.

The one vet said it was outrageous that we were using animals so our residents could “practice.” I noted that my residents have thousands of cases under their belts by their chief resident year; I have done tens of thousands of cases. We have cadaver labs anytime we need practice. Comparatively, orthopaedic vets do a three-year fellowship spread out over six years and are expected to see or participate in 400 cases.

I offered to be a go-between between us (the many rescues we help who are in desperate need of orthopaedic help) and veterinary orthopaedists; we could collect the injured animals from the rescue agencies, and we could provide perioperative medications and care, and the vets could perform the surgeries (because they want us to stop doing so), and then we could help get the animals adopted.

“We’re never going to work together,” the vet said.

That night, I found dozens if not hundreds of gut-wrenchingly insulting, hateful messages on our website. Clearly, I attended what I thought was a meeting for some mutual understanding, but it was actually a carefully laid ambush. This attack on us personally, professionally, and morally was so violent and immediate that it was obviously prepared weeks in advance. Interestingly, when I fled the email account to escape that hateful assault, I stumbled upon an article published that night in Time magazine: “Veterinarians Face Unique Issues That Make Suicide One of the Profession’s Big Worries.”

In that article, two reasons for suicides in the veterinary community were highlighted: Vets have to euthanize healthy animals at an alarming rate, and they are cyberbullied by their clients. The irony was inescapable.

At 7 a.m. the next day, we shut down the Surgeons for Strays Facebook page and website and dissolved the 501(c)(3) in an effort to mollify the veterinarian community.

I’m not sure what would have satisfied the cyberbullies, but that wasn’t it. They redoubled their efforts over the next two weeks, reaching a crescendo of nuttiness by sending their mendacious account of what they misrepresent that we do (along with my cell phone number) to The Guardian.

Over the next two weeks, the cyberbullying expanded exponentially. In addition to the internet silliness, one of the vets I met with went on television and again obsessed over nonconsequential issues, while ignoring the core of the matter: Dozens of dogs and cats who were ignored by the veterinary community were saved by us. In addition, he announced that we had been “shut down,” as if some governmental agency had swooped in and demanded we stop saving animals. This is as much a fabrication as most of the rest of his interview.

He also started an online petition to boycott Synthes (the No. 1 implant-maker in the world). What did Synthes have to do with any of this?

It is simply not possible for me to discuss all of the scurrilous, mendacious, and defamatory things this cabal of cyberbullies posted over the next two weeks. Rather than make a case, they concocted ad hominem attacks on people they do not know.

As the fury of these online attacks intensified, I began to recognize what we call in our literature lateral violence—people under stress redirect their frustrations by becoming abusive and bullying others. There is clearly an undercurrent of dysfunction in this inappropriately “outraged” community. Euthanizing healthy animals is unhealthy for the people who have to do it.

I still have one question: What can we do together to save more vulnerable, hurting dogs and cats?

Here’s my final comment to the veterinarian community: You clearly do not like us and refuse to work with us. So, what are you going to do to save more dogs and cats? Because it’s hard for us to answer the phone and tell a little girl who found a cat with a broken leg in the street in front of her house that we’ll let that cat be euthanized when there’s an alternative.

John Keating, MD, is an Atlanta-based orthopaedic surgeon who created Surgeons for Strays, a 501(c)(3) nonprofit dedicated to the healing of injured stray animals who would otherwise face continued pain—or euthanasia.