TERRY GROSS, host:
This is FRESH AIR. I'm Terry Gross.
It's Animal Week on FRESH AIR, and we'll be talking about animals in the wild, in backyards and homes, in prisons and on Broadway. If you have a pet, chances are at some point, you're 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 available for animal cancer, kidney disease, brain tumors, etc., and the diagnostic procedures and treatments are expensive.
My guest, Dr. Nancy Kay, is a veterinarian who co-founded a 24-hour emergency specialty care center in California, where she treats cats and dogs. Her 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.
Dr. Nancy Kay, welcome to FRESH AIR. Here is something that's a really difficult dilemma: if your dog is already fairly old and has developed, say, cancer.
Dr. Nancy Kay (Veterinarian; Author, "Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Longer Life"): 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.
GROSS: 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 them, 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, anyway - 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 are 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 medications - 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: My guest is veterinarian Nancy Kay, author of the book "Speaking for Spot." More after a break. This is FRESH AIR.
(Soundbite of music)
GROSS: Let's get back to our interview with Dr. Nancy Kay. She co-founded a 24-hour emergency specialty care center in California, where she treats cats and dogs. Her book "Speaking for Spot" offers advice on how to make difficult medical decisions on behalf of your dog.
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 recommend is: 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, then 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 the people - 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: Did 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: OK. 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 them 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, struggling to breathe, and they can't get in 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: We'll hear more from veterinarian Nancy Kay in the second half of the show. Her book and blog are called "Speaking for Spot." I'm Terry Gross, and this is FRESH AIR.
(Soundbite of music)
GROSS: Let's get back to our interview with veterinarian Nancy Kay. She co-founded a 24-hour emergency specialty care center in California, where she treats cats and dogs. Her 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.
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.
(Soundbite of laughter)
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, about whether to do, to move forward with an invasive procedure or not.
Dr. KAY: What I would probably do is tell you about Vinnie, 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 8 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 remove the tumor, then there was a 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, but...
(Soundbite of laughter)
Dr. KAY: ...and he went on and did great and was doing his usual Tigger routine, 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 to decide, do we do this new 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. So...
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 Vinnie had a fatal form of cancer...
Dr. KAY: Yeah.
GROSS: ...did you immediately put him sleep?
Dr. KAY: His situation, believe it 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 in 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, and it's troubling.
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 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 Nellie...
GROSS: Oh, I have to look.
(Soundbite of laughter)
Dr. KAY: ... and she's been a wonderful fit with our family.
GROSS: Oh, she's adorable.
Dr. KAY: She is. She's a little doll.
(Soundbite of laughter)
GROSS: OK. So, you must be...
Dr. KAY: So we ended up getting a dog within about a month of losing our two dogs.
GROSS: OK and Vinnie, the dog you were describing losing, was a golden retriever. He was a big dog, and this is a little dog. Have you had little dogs before?
Dr. KAY: Yeah, we've - 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: Now, I want to end by asking you about the cover photo on your book "Speaking for Spot," the cover dog.
(Soundbite of laughter)
GROSS: Because there's a nice story behind that.
Dr. KAY: Sandy.
GROSS: So 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, it's a relationship between the 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)
Dr. KAY: And...
GROSS: I like that.
(Soundbite of laughter)
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 wasn't able 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've - 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 co-founded a 24-hour emergency specialty care center in California. Her book and blog are called "Speaking for Spot." Our interview was recorded in March. Coming up on Animal Week, what Alex the parrot taught us about how animals think, and what they're capable of comprehending.
This is FRESH AIR.