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TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

If you have a pet, chances are, at some point, you are going to have to make medical decisions far more difficult than the ones people had to make in the past because there are more high-tech interventions for animal cancer, kidney disease, brain tumors, et cetera. And the diagnostic procedures and treatments are expensive.

My guest, Dr. Nancy Kay, is a veterinarian who co-founded a 24-hour emergency and specialty care center in Northern California, where she treats cats and dogs. Her new book, "Speaking for Spot," offers advice on how to make medical decisions on behalf of your dog, including decisions about chemotherapy, pain management and euthanasia.

Next week, she'll receive the 2009 Animal Welfare and Humane Ethics Award at the annual conference of the American Animal Hospital Association.

Dr. Nancy Kay, welcome to FRESH AIR. You know, having a dog is so different than it used to be, now that dogs get the same kind of high-tech screening and therapies that people do - MRIs, ultrasound, chemotherapy, radiation therapy -and it's expensive.

Like, illnesses, if you want to treat them, cost a fortune now for dogs. Give us an example, for instance, of what an MRI or an ultrasound costs for a dog.

Dr. NANCY KAY (Veterinarian; Author, "Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Longer Life"): Sure. An MRI scan is used very commonly to diagnose spinal-cord disease. For example, dachshunds are prone to slipped disks in their backs. Brain tumors are diagnosed with MRI scans, lung tumors, and the average cost of an MRI scan, at least here in Northern California, where the market may be a little bit more expensive than in other areas, would be approximately $2,500.

Now by the time that dachshund had surgery on her back to go in and remove the disk material, that may end up costing $6,000, $8,000.

GROSS: So if you want to have a dog, and you want to be a good human companion to your dog, are you committing yourself to spending thousands and thousands of dollars on dog health care when you're in a position of hardly being able to afford health care for yourself or your family?

Dr. KAY: Right. It's truly a relevant question today. Many people are struggling to even come up with the money to come in for a basic office visit.

What I encourage people to do is to really lay their financial cards on the table when talking with their veterinarians. The good news is in all but rare circumstances, there's almost always more options than simply one option.

Rarely does it boil down to you have to do this $5,000 procedure or put your dog to sleep. For example, the example I just mentioned, the dog with disk disease, one could proceed surgically, or one could try medical therapy, confining the dog and using anti-inflammatory medications - a far less expensive approach. It may not be an approach that works as well, but it's certainly an option.

I talk more and more with people about the possibility of health insurance for their pet, especially if they're of the frame of mind that they would want to do anything and everything possible for their dog or cat if they get sick. Then, health insurance might make a lot of sense.

An annual premium for a dog or cat is generally going to be in the neighborhood of about $300 to $400. So you just have to do the math, and certainly just as with human health insurance, it's really going to pay if something catastrophic happens.

GROSS: So are you finding there's more guilt with people who have - more feelings of guilt with people who have dogs now, because sometimes they're going to say no, I can't afford the treatment?

Dr. KAY: Yeah.

GROSS: And then you have to live with knowing that there's a treatment out there for your dog or an MRI that your dog should probably have, but you don't have the $2,000 or the $5,000 to spend.

Dr. KAY: Right. It's a fact of life. There's guilt associated with all of our economic problems right now, in every aspect of our lives, including trying to provide what we want for our children, provide what we want for our pets. So I'm definitely seeing that trend.

Guilt is quite pervasive amongst my clients. There's five normally accepted stages of the grieving process. Many people begin grieving the minute they hear that their pet is sick. It doesn't necessarily happen just after death.

And what I find with the clients that I counsel and work with, is in addition to the five typical stages of grief, guilt is often a huge part of it - that they didn't do enough, they didn't recognize things soon enough, they waited too long.

Guilt is huge amongst people who are trying to be good advocates for their dogs and their cats.

GROSS: Well, here's something that's a really difficult dilemma. If your dog is already fairly old and has developed, say, cancer.

Dr. KAY: Yes.

GROSS: And you as the vet decide that, you know, there should be tests, and then, you know, chemotherapy would likely help the dog, but it's going to be very expensive. So then the person whose dog it is has to decide, well, if the dog is only going to live for, say, two or three more years under the best of circumstances because they're already kind of old, is it worth the investment?

And then you hear yourself saying is my dog worth the investment, and you don't want to be thinking that way, but you kind of have to if you don't have the money to spend. How much money are you going to spend on a dog who's not going to live many more years?

How do you help people figure through really complicated questions like that?

Dr. KAY: Yes, well one of the things that I work really hard on myself, and when I lecture to other veterinarians, I avoid saying you should do chemotherapy, you should take these X-rays, you should do surgery to remove the tumor.

What I view my job to be is to present every single option that I think is a feasible option for the dog, that I think could make sense for the dog; spell out all the different benefits and potential risks, educate the people as to how much it's going to cost; and let them decide, based on what they know about their financial capabilities, and most importantly what they know to be true about their dog, to make the best decision.

The whole goal of this medical advocacy is to make informed decisions. And with having a lot of information and making an informed decision, the goal is to come up with the very best choice that's hopefully going to provide the best outcome for the dog or the cat. And secondly, and almost as important, is to make a choice that's going to provide the most peace of mind for the human at the other end of the leash or the person lugging the cat-carrier around.

When you mention age, many people often say, aw, he's 12 years old. I'm not sure that I should do that. And one of the points that I always emphasize is, rather than focusing on chronological age, I think it's important to focus on the functional age of the animal.

For example, Terry, you and I could both be 80-year-old women and both in need of a knee replacement. You might be a great candidate for that surgery, where I might be a horrible candidate for that surgery. In other words, there's no cut-off to say that any woman over 80 years of age will not have a knee replacement.

So for example, a 12-year-old golden retriever, who up until a week ago was going to the dog park and playing like a banshee and having a great old time, might be a great candidate to go in and remove a tumor in the spleen. Whereas a 10-year-old dog, that's really been struggling and having a hard time getting around, might be a poor candidate. Does that make sense?

GROSS: Yeah, it makes a lot of sense. You know, the first time that I heard that pets were getting chemotherapy and ultrasounds, I thought wow, that's crazy.

And then, you know, I - it's just, it's a fact of life, and it's probably not crazy. I mean, you…

Dr. KAY: It's wonderful.

GROSS: You love your animals, and you want to do everything for them, but this is kind of like revolution in veterinary medicine and in expectations of what to expect to hear when you bring your animal to the vet. I feel like asking, like how did that happen? When did it happen that all this high-tech medicine entered veterinary medicine?

Dr. KAY: Oh, it's been involving over the years, and in fact in some circumstances, we're even ahead of the human profession.

For example, we're doing - we're using stem cell therapy, regenerative medicine, way ahead of the human field because there aren't all the moral implications or religious-philosophical implications associated with doing so.

GROSS: So what are you doing with stem cell?

Dr. KAY: The most common use of stem cell therapy these days is in dogs with arthritis. It's also used a lot in horses, but I'm not as familiar with that. Basically, with a surgical procedure, some fat cells are harvested from the patient. They're sent off to a company that creates regenerative cells that are then infused back into the dog that manage to go into the joints and do some magic there.

It's proven to be wonderfully beneficial, and I think the applications are going to be growing exponentially in the near future.

You're right. I think client expectations are changing dramatically. More and more people expect to be part of the decision-making process. So that the way I view it, is that as veterinarians we are part of the dog's health-care team. But really, the human involved in the dog's life, the guardian of the pet, is the team caption.

And so it's a very different role than the typical, paternalistic, Marcus Welby model of health-care provision.

(Soundbite of music)

GROSS: My guest is veterinarian Dr. Nancy Kay. Her new book is called "Speaking for Spot." We'll talk more after a break. This is FRESH AIR.

GROSS: If you're just joining us, my guest is veterinarian Dr. Nancy Kay. Her new book is called "Speaking for Spot," and it's about how to be a good advocate for your dog, and she is about to receive the 2009 Animal Welfare and Human Ethics Award from the American Animal Hospital Association.

What's chemo like for a cat or a dog? Do cats get chemo, too?

Dr. KAY: Yes, they do. I really like the ability to talk about this because whenever I introduce the notion of chemotherapy to a client, the very next sentence out of my mouth is: Chemotherapy is a whole lot different in dogs and cats than it is in people.

Even though we're using the exact same drugs, dogs and cats - it's exceedingly rare that there's hair loss, and the likelihood of getting sick from chemotherapy is very low.

As frequently as people get sick from chemotherapy, that's as infrequent as dogs and cats get sick from chemotherapy. The truth be told, Terry, if treating - if the outcome of treating dogs and cats with chemotherapy was like it is in people - all the vomiting, all the hair loss, all the misery - I think you'd find very few veterinarians willing to do it.

GROSS: So what do you do to try to make the dogs you're giving chemo to comfortable?

Dr. KAY: Well, for my patients, there's a 10-cookie minimum per visit. So there's lots of cookies.

GROSS: What kind of cookies?

Dr. KAY: Dog cookies, dog biscuits. So they get fed a lot of treats while they're with us. The people who work in veterinary hospitals, the nurses, the receptionists, they're not doing that work to get rich.

Nobody's getting rich doing that. They love dogs and cats. They just love 'em. And so an animal comes in, they're going to be pet by all kinds of people. They're going to get all kinds of treats, all kinds of baby talk and attention.

So they're treated very well. That being said, not all animals are suitable candidates for chemotherapy. And whenever I counsel people about chemotherapy protocols, we really take the animal's personality into account.

For example, if a cat comes in and receives chemotherapy and then goes home and hides under the bed for two days, that's not reasonable.

GROSS: Now I could see what you said with dogs, that you're petting the dogs, you're talking to the dogs, you're giving the dogs the cookies. The dogs are kind of happy to be there.

Dr. KAY: Yeah.

GROSS: Cats I'm not so sure. I mean, cats hate going - my cat, anyways - hates going to the vet, hates being put in the carrier, knows there's something wrong just when the carrier gets taken out.

Dr. KAY: Right. You have to sneak the carrier out, right? Otherwise, your cat's going to disappear.

GROSS: And cats don't respond to treats the way dogs do, and they don't respond to petting from strangers the way dogs do.

Dr. KAY: Right.

GROSS: So what can you do to make a cat's experience a positive experience?

Dr. KAY: Right. Occasionally, we have cats that are really outgoing in a veterinary-hospital situation. In fact, one of the services we offer is an underwater treadmill for rehabilitation therapy, where you fill up a - basically, it looks like an aquarium fish tank - and fill it with water to let the animal paddle in there to develop muscle strength, non-weight-bearing muscle strength.

We even have a couple of cats that do that. But you're right, most cats are stressed out by hospital visits. So for most cats, what we do is we give them places away from barking dogs, and we give them things to hide in.

We have little cubbies they can hide in in their cage, and cats that are food-motivated, they like to eat almost no matter where they are. So there's plenty of food for them, as well.

GROSS: So what are your little cat hiding places like?

Dr. KAY: They're kind of like big hats. They're pouches, and they're made of fleece and fluffy material, and they can crawl inside those.

GROSS: The one thing you point out in your book that I think is important to mention is that, you know, dogs and cats don't know they have cancer, so they're not living with the anxiety that the humans are.

Dr. KAY: Right. They have perfected the art of living in the moment.

GROSS: So they might be in discomfort, but they're not, like, worrying and saying is this Stage 1 or Stage 2 of cancer.

(Soundbite of laughter)

Dr. KAY: Exactly.

GROSS: It's just a different experience for an animal.

Dr. KAY: In fact, if I am treating an animal with chemotherapy, and I know the cancer's gone, and the client is telling me that the dog still seems kind of droopy, I always ask: Is the dog sensing what you're feeling?

When we treat - let's say that we have a dog or a cat with lymphoma. That's a very treatable type of cancer, but we can't cure it. But what we can often achieve is a year of really good quality time. Sometimes we get two years. Sometimes we get three years.

So in screening whether or not this patient is suitable for chemotherapy, we talk about the animal's personality. We talk about the person's philosophy about treating cancer.

If they've just experienced the ravages of chemotherapy with a loved one, I can reassure them about chemotherapy until I'm blue in the face, but how can we expect them to face the notion of chemotherapy again for any of their loved ones?

We talk about the financial implications. We talk about will your work schedule allow you to come back and forth as frequently as you need to? And then the last thing that I address is will you enjoy the honeymoon?

Because we're doing this to provide really good quality time for you to share with your dog and cat. And if every waking hour is spent thinking about the fact that your animal has cancer and at some point will succumb to that disease, then should we really move forward?

GROSS: If you're just joining us, my guest is veterinarian Dr. Nancy Kay, and she has a new book called "Speaking for Spot," which is about how to be an effective advocate for your dog when it comes to your dog's health.

Now, pain management is a growing part of veterinary medicine, just as it is in human medicine.

Dr. KAY: Yes.

GROSS: And I know, like, when you have a problem that's pain-related, and you go to the doctor, you know, as a human being, the doctor asks you to rate your pain scale on a one to 10, and I always think that's hard to do, but you do your best.

You can't ask a dog or a cat to rate their pain. How do you evaluate how much pain a dog or a cat is in, and do you find that animals express their pain differently than humans do?

Dr. KAY: Yeah, that's - it's so challenging, but we work really hard on it, and I'm really proud of our profession. We've come such a long way in terms of pain management.

I'm kind of embarrassed to tell you, you know, I graduated veterinary school in 1982, and when we were doing, say spay and neuter procedures, we weren't providing any pain medication routinely for those patients, which is appalling for me to think about now.

What we do is, in our hospital setting, we actually have pain assessment every two to four hours, depending on the patient.

The indicators that are the best indicators for dogs and cats, as to how they're experiencing pain or whether they're experiencing pain, have to do with heart rate, respiratory rate and blood-pressure measurements.

So those are some three very tangible things we can be measuring to assess whether or not a patient is in pain. Sometimes we have to rely on giving pain medication and then seeing if the patient behaves differently.

One of the things I always take into consideration is how does an animal show that they have a headache? Let's say that an animal has a tumor growing inside its brain, well, it may have an awful headache. And that doesn't mean that the patient's vomiting or pointing to its head. Usually, that's an animal that's becoming reclusive, not nearly as social as he used to be, going off into a quiet room.

So Terry, this is one of the biggest challenges we face is to feel confident that we are giving appropriate pain medications. But the field of pain management has really expanded exponentially: acupuncture is used a lot for pain management, all different types of medications that can be given at home or in a hospital setting. We've come a long way.

GROSS: Is whimpering for a dog or meowing for a cat a sign of pain? Do you use that when you're assessing an animal's pain?

Dr. KAY: If an animal has a broken leg or a slipped disk in the back, you may be able to get them to vocalize when you press on that area. But especially for internal types of pain, there's not going to be much whimpering or crying, and people are often waiting to hear that. Dog owners, cat owners are often waiting to hear that before they bring their animal into the veterinarian, or especially before they consider euthanasia.

But dogs and cats don't necessarily manifest their pain by whimpering and crying. This raises another point that's near and dear to my heart.

One of the most common questions that I'm asked when people are trying to make their end-of-life decisions for their pets - which is always so difficult -they often ask, do you think that my dog or my cat is in pain? Because that's the main criteria they're using to determine when it's time to put their pet to sleep.

And animals don't necessarily have to be in pain to be suffering. What I encourage people to think about is: consider the case of the flu. If you're in bed with the flu, how miserable you feel.

If you were to feel like that day after day after day, you're suffering. You're not in pain, but certainly there's a huge element of suffering there.

GROSS: What of the medications that you use when treating pain in an animal? Is it the same as the human medication?

Dr. KAY: Yes, it is. There's the narcotic classification of drugs, and then there's a whole host of non-steroidal, anti-inflammatory medication, the equivalent of ibuprofen for people.

That being said, the human non-steroidal, anti-inflammatory medications can be very dangerous for dogs and cats. So you need to stick with the ones that are formulated specifically for them.

GROSS: Dr. Nancy Kay will be back in the second half of the show. Her new book about making medical decisions on behalf of your dog is called "Speaking for Spot." I'm Terry Gross, and this is FRESH AIR.

This is FRESH AIR. I'm Terry Gross, back with veterinarian Nancy Kay, author of the book "Speaking for Spot," which offers advice on how to make medical decisions on behalf of your dog. She treats cats and dogs at a 24-hour emergency and specialty care center in Northern California, which she co-founded. I'm sure one of the most difficult questions you're asked has to do with one of the most difficult decisions any person with a pet has to make, which is how do I know when it's time, if it's time, to put my pet to sleep. What are some of the things you say to help one of your clients think through that really difficult question?

Dr. KAY: There's a few things I encourage them to think about. One of the things that I recommended does your dog or cat still respond enthusiastically to the things that would normally excite him, such as, if we're talking about a dog, the jingle of the car keys, if we're talking about a cat, the can opener opening the can of cat food. Is he excited by the sight of a tennis ball, or dinnertime or the mention of his favorite words, the ones that you normally would have to spell out in order to avoid getting him excited?

Do the good days still seem to outnumber the bad days? That's real important. And then something that sounds a little bit corny and it's probably okay, because I'm in California, is to really go nose to nose and eyeball to eyeball with your cat or dog and have a look in your cat's or dog's eyes and see, is that same spark that you're used to still there? Sometimes that light flickers a little bit. And if their eyes are looking dull over a period of days, and I think that, too, is a really good indicator.

The key here is everybody wants to make the decision at just the right time. They don't want to act prematurely. They don't want to do it too soon. But what I tell my clients is is that some of the people who have the hardest time, who come to my support group, are people who feel like they waited too long. So I encourage people to avoid getting into that situation where they're going to have guilt and regret that they really waited too long.

GROSS: Do they allow their pet to endure suffering that they didn't need to endure?

Dr. KAY: Exactly.

GROSS: You have something in your book that I found so interesting, you say for animals who hate going to the vet, taking them to the vet to be euthanized is going to be just a horrible experience for them because they're going to die with the anxiety that they have…

Dr. KAY: Yeah.

GROSS: … for any vet visit. And you recommend asking the vet to euthanize the animal in the car, if the car is a place they like. Like, a lot of dogs love the car because it means they're going places. Have you done that, euthanized animals in the car?

Dr. KAY: Oh, yes. Absolutely, I think people don't realize that there's a lot of choices that they have in terms of the euthanasia process and how they want to handle that. And one of the choices has to do with location. You don't want the last minute of the animal's life to be in a place where they're really miserable. Now, if the animal is really weak and quite out of it, they may not even recognize they're in a veterinary hospital setting.

But many dogs feel like their cars or their trucks are their second home. So I'm very happy to go out, enter the vehicle and perform the euthanasia there if that's where the - my clients and their pets are most comfortable. And at-home euthanasias are also an option, and many veterinarians will do that for their clients. And if they're not available to do that, there's house call practitioners that'll go do that, as well.

GROSS: What are some of the things you've seen people do to reassure their animals as they're being euthanized?

Dr. KAY: Well, if they're still eating, there's a lot of food involved. There's a lot of stroking, a lot of loving, a lot of…

GROSS: I'm surprised about the food because I would think that it would be difficult, that it would make the process more difficult if an animal was digesting in the process. That's not a problem?

Dr. KAY: Well, have you ever been with an animal when it's been euthanized?

GROSS: I haven't.

Dr. KAY: Okay, do you mind if I tell you what happens?

GROSS: No, please.

Dr. KAY: So, many people are surprised about really what a quick pain-free simple process it appears to be. And it's kind of shocking sometimes how quick and simple it seems. What we do is we administer in the vein an injection that's in essence an overdose of an anesthetic agent. And for all practical purposes, it looks like the dog or cat is just going to sleep or going under anesthesia. And typically, it all occurs within about 15 to 20 seconds after administering the euthanasia solution.

So what we typically do, what I like to do is place a catheter in the vein. We have a nice room with a couch where people can hang out, and spend time, and feed cookies, and talk with their animals and spend as much time as they want before the euthanasia. And then, typically, when I'm administering the euthanasia solution, they're stroking, they're patting, they're crying, they're saying all the things that they really want to say to their dog or cat.

I'm sorry, I get a little teary-eyed talking about it sometimes. And if it's a dog that loves its food, then they're feeding dog biscuits. So it all happens very quickly. People are often surprised by how quickly it occurs.

GROSS: Is it hard for you to do it?

Dr. KAY: It is. It is difficult, but it's just part of my job. And I know that by being there, by being present and handling things in a very smooth gentle fashion that I'm making a very difficult situation for someone else a little bit easier. Some patients get to me a whole lot more than others, patients that I have known for years, or patients where I really know in my heart of hearts what that bond is between them and their human.

So, sometimes it's, sometimes it feels like a relief, you know, when an animal is really suffering. Let's say they're breathing or struggling to breathe and they can't get enough oxygen, and you administer the euthanasia solution and all that struggling goes away. And that feels like a huge relief. It really does, as though I've been unburdened somehow and the people there have been unburdened.

And I always tell people to stay as long as they like after the fact, because quite honestly, it just looks like their dog or cat are peacefully sleeping. And especially if an animal has been struggling, it can be a very peaceful time of closure.

GROSS: My guest is veterinarian Dr. Nancy Kay, author of "Speaking for Spot." We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is veterinarian Dr. Nancy Kay, author of the book "Speaking for Spot." We've been talking about how you help people make tough decisions, medical decisions about their animals. You've had a lot of animals yourself.

Dr. KAY: Yeah.

GROSS: And I know you've had to make tough decisions about whether to do an invasive procedure or just keep the dog as comfortable as possible, decisions about whether it was time to put an animal to sleep or not. Tell us the story of one of your pets who, one of your dogs who you've had to make a tough decision about whether to do - to move forward within an invasive procedure or not.

Dr. KAY: Sure. What I would probably do is tell you about Vinny, who is - he was one of our dogs. He passed away just over a year ago - a silly, goofy, lovable, wonderful golden retriever. And when he was eight years of age, my husband, who's also a veterinarian, felt a lump on the top of his head and it turned out to be a tumor that involved his skull bone. And the decision needed to be made, do we go ahead and try to remove that tumor?

And he had no symptoms whatsoever. And if we removed the tumor, then there was chance that we would be able to cure the disease, or at least prevent it from progressing as rapidly as it would otherwise, because as this skull tumor would grow, it would compress on his brain, and we'd end up with some neurological symptoms. Well, we decided to proceed with the surgery. To us that was - no pun intended - a no-brainer. And the surgery was wonderfully successful.

They removed what they thought probably was 95 percent of the tumor. And they had to remove a small portion of his brain. And for a golden retriever that might not be all that much of an issue.

(Soundbite of laughter)

Dr. KAY: But - and he went on and did great and was doing his usual Tigger routines, jumping up and flying through the air one day and tore his cruciate ligament, that's a ligament in the knee that large breed dogs are very predisposed to tearing. Well, then we had decide, do we do this knee surgery on him? We don't know if the skull tumor's going to grow back, but he's going to be a very lame dog if we don't do the surgery.

That was a little bit of a tough decision. And we did - we took our chances, we did the surgery. And he did great for another year before, yet, a different type of cancer caught up with him.

GROSS: And that cancer, were you able to do anything about that?

Dr. KAY: No, that was the life-ending cancer. He had a tumor on the base of his heart that we weren't able to fix. But the knee surgery in particular was challenging because we really didn't know if another major surgical procedure was worthwhile, if indeed, within a few months the tumor affecting the brain would grow back.

GROSS: So when you found out that your dog Vinny had a fatal form of cancer…

Dr. KAY: Yeah.

GROSS: Did you immediately put him to sleep?

Dr. KAY: His situation, believe it or not, made our decision-making a little bit easier because his cancer caused bleeding into the pericardial sac around his heart, which is a situation that a dog really can't live with. And so he went from being a dog that was normal and active to being a dog that couldn't walk, couldn't get up, was struggling to breathe. It was one of those situations where we really knew that we had no choice.

And as we typically do, my husband and I trade off who's going to be the one holding, who's going to be the one administering the injection. I will say that I keep expecting it to get easier, but it seems to, in fact, get a little bit harder each and every time.

GROSS: Which is the harder part for you, holding or injecting, or are they both equally hard?

Dr. KAY: They're both equally hard. The holding is hard because you're so connected with what's happening with your animal. The injecting is hard because you can't participate in the emotional aspect of it quite as much.

GROSS: When you lost your dog, when you put your dog to sleep, how long did it take before you wanted to adopt a new dog?

Dr. KAY: I really like this question because people often feel uncomfortable trying to figure out when to get their next dog.

GROSS: It's so true, I know.

Dr. KAY: Because one family member might say, let's go get a dog tomorrow, and another person it might take a whole year before they're ready. My husband and I, we had two dogs and they both died within six months of each other and we were dogless for the first time in 30 years.

And we, neither of us were really ready to get another dog. And then it just so happened that a little stray came into my hospital one day. She was dirty, smelly, skinny, she had horrible skin disease, she was in heat. The receptionist brought her back to our treatment room holding her well away from her body because she looked so gnarly and grungy. And there was just something about her eyes, and I took her home. And, in fact, she's the dog that's on the back cover of my book. Her name is Nelly. And she's been a wonderful fit with our family.

GROSS: Oh, I have to look.

(Soundbite of laughter)

GROSS: Oh, she's adorable.

Dr. KAY: She is. She's a little doll.

(Soundbite of laughter)

GROSS: Okay. So, you must be…

Dr. KAY: So we ended up getting a dog within about a month of losing our two dogs.

GROSS: Okay, and Vinny, the dog you were describing losing was a golden retriever. He was a big dog and this is a little dog.

Dr. KAY: Yeah.

GROSS: Have you had little dogs before?

Dr. KAY: No, we've gone little. Both of our current dogs are little dogs and it's really rather fun.

GROSS: What are some of the differences for you between a big and a small dog?

Dr. KAY: Bending down a lot more.

(Soundbite of laughter)

Dr. KAY: You know, golden retrievers are often pretty simple-minded dogs. The dogs I've had in the past have always been very, whatever you want mom, I'll be the perfect dog. And little dogs, you know, they - I think they in general can be a little bit more intelligent about things and manipulating their moms and dads. And so these two have been a little bit more of a challenge to train.

Gross: Can you talk a little bit about bedside manner as a veterinarian? Like when you're dealing with - you work with cats, too, right, or just dogs?

Dr. KAY: Oh yes.

GROSS: Yeah. Can you talk a little bit about bedside manner as a veterinarian? When you're dealing with a new cat or dog, whose personality you don't yet know, how do you introduce yourself and make yourself as non-threatening as possible to the animal?

Dr. KAY: Well, when I walk in the room, what I do to begin with, is I make contact with the client. And so I will introduce myself and shake their hand. And in the course of that 10, 15-second interaction, I know exactly what the personality of that animal is like. I liken it to probably a kindergarten teacher, you know, on her very first day of class. I would venture to guess by the end of that first class, she pretty well has each of her students pegged.

So just by looking, you get a sense of what that animal wants. And if it's a typical lab, the lab's going to be jumping all over you and very excited to see you. If it's a dog that's avoiding eye contact, then you know that you need a much softer approach. So I do not at all have the animal up on the exam room table until after I've introduced myself. I've greeted the animal if they want to be greeted, and then I've spent about 10 or 15 minutes talking to the client about what brings them in with their pet that day.

And I encourage them to - people to take their dogs off leash, or let the cat just wander around the room because I'm sitting down taking a medical history. And during that time, the cat or the dog is sort of investigating me, checking me out. And usually then they're much more receptive to me getting personal with them.

GROSS: My cat was once so upset at the vet and she was kind of fighting so hard that they put a little, like, pussycat straightjacket on her as a restraint.

Dr. KAY: Oh yeah.

GROSS: Do you ever use restraining devices on the animals?

Dr. KAY: Not so much. You know, we have a lot of really good chemical restraint. I don't like using what we call brute-acaine, which is, you know, a kind of brute force to hold an animal down. When I was in veterinary school, I love horses, and I went to veterinary school thinking I would become an equine practitioner. And then when I got in the stalls with some pretty hostile horses, I thought, what am I, nuts?

People could easily get hurt, you know. You're putting a twitch on the horse's nose or grabbing the horse's ear and then trying to do very painful things to them. I mean, truly, it was a physically dangerous profession. And then over the years, there's been a lot more chemical restraint.

The type of restraint that would be like a quick fix of Valium that you could then take away. So basically what I do is if I have a cat that is really stressed, I could hold your cat down, but why do that? Why make your cat so stressed? Why not give your cat the equivalent of a couple of martinis so that she doesn't really care what we're doing.

GROSS: Now, I want to end by asking you about the cover photo on your book "Speaking for Spot," the cover dog.

Dr. KAY: Sandy.

GROSS: Because there's a nice story behind that. Tell us the story of this dog.

Dr. KAY: Sure. Sandy was brought in as a stray to The Marin Humane Society. Marin County is just north of the Golden Gate Bridge. And Sandy was one of the first dogs in the pen pal program. What the pen pal program is is it's a relationship between a Marin Humane Society and San Quentin State Penitentiary. When The Marin Humane Society has dogs come in that need training and socialization, this sounds a little ironic I know, or they're recovering from some sort of disease, they'll send these dogs over to San Quentin State Prison to work with prisoners.

And the prisoners, it's a real privilege for them to be able to work with these dogs. They work on training them and socializing them. In Sandy's case, she was recovering from heartworm disease, so she had to be kept quite quiet. And she was just a crazy girl. She was wild with no manners. So she joined up with an inmate who taught her, I believe, 14 different commands. One of the commands was stay and the release from the stay command was the word parole.

(Soundbite of laughter)

GROSS: I like that.

Dr. KAY: And Sandy and her inmate managed to be released from San Quentin at the same time, and they actually lived together for about a year. And then that fellow had to move back east because of a death in the family and was unable to take Sandy with him. So Sandy went back to the Marin Humane Society and was adopted by a wonderful family who live in Marin County.

And I - Sandy's come to a number of my local book signings. The only quibble I have with her is she's about 10 pounds overweight, and I keep talking to her mom and dad about that.

GROSS: Well, that's such a great story. Dr. Kay, it's been great talking with you. Thank you so much for talking with us.

Dr. KAY: Thank you.

GROSS: Dr. Nancy Kay is the author of "Speaking for Spot." She's an internist at the animal care center in Rohnert Park, California. Next week she'll receive the 2009 Animal Welfare and Humane Ethics Award at the annual conference of the American Animal Association.

Coming up, we listen back to an interview with actress Natasha Richardson. She died yesterday after suffering head injuries in a skiing accident. This is FRESH AIR.

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