Dear Dr. Kay……

As a change of pace I thought it might be fun to share a few questions I’ve received from readers like you. I hope that they, along with my responses, are of interest and who knows, you may just learn something new.

Patient restraint

From Alice:

When vet technicians are asked by the veterinarian to hold a dog for examination, vaccination, drawing a blood sample, etc., they often do their best to completely immobilize the dog by getting it in a lock-hold and clamping down hard. I try to train my dogs to cooperate with minor veterinary procedures, with good success. Yet it is often difficult to persuade a vet/vet tech to give the dog a chance to be a willing participant. Can you offer some guidance about when it’s reasonable for me to make this request and what would be the most effective way to convince the vet/vet tech to give it a try? Also, when is it appropriate for the client to hold/restrain the dog? I realize vet techs have training that the owner does not, but I hate handing my dogs off to the vet tech to hold when I’m right there in the room with the vet. By far, the most stressful part of the vet-client relationship for me is being forced to hand off the dog to vet techs. Gah, I’m getting stressed out just writing this! Your thoughts?

My response:

Hi Alice. Those of us who have worked with plenty of animals in a veterinary hospital setting know that flexibility is the key to great restraint- comfortable for the pet and safe for everyone who is working with that animal. Some animals do best when restrained on their sides, some while sitting, some while standing, and others while lying down sternally. Some do best with a humane muzzle or something covering their eyes so they can’t see what’s going on. Others react strongly to a muzzle or blindfold. Some animals need to be held firmly while, for others, less is more. So application of a “one restraint fits all” approach doesn’t make good sense. We should attempt to be successful with each and every patient we see.

Some owners want to be involved with restraint of their pets. I know plenty of vets who are dead set against this for fear of liability should the owner become injured, and I can’t say as I blame them. I do encourage owners to be present, but I generally discourage them from performing restraint unless they are clearly experienced and I get a good strong sense that their pet will be okay with this.  A special finesse is often required to effectively restrain a pet in a veterinary hospital setting.  And, it feels lousy if an owner gets hurt in the process.  Simply having the owner in the room and visible is usually adequate in terms of providing a “calming presence”.

I find that recruiting the owner to help restrain is consistently useful and practical when I’m working with law enforcement dogs (and these dogs are typically muzzled for whatever we do per their handler’s recommendation).

So, how can you ask your veterinarian to be more receptive to doing things differently? I encourage a respectful conversation about this. Schedule a meeting time. Let the doctor know what your observations have been and how others (like me) feel about this topic. The late great Dr. Sophia Yin has written a wonderful book about in-hospital restraint techniques. The title is Low Stress Handling, Restraint, and Behavior Modification. Consider purchasing a copy for your veterinarian. Best of luck!

Urinary accidents- behavioral versus medical

From Debra:

Hi Doctor. My question is about dogs marking inside. I just rescued a 2.5 yr old neutered Pug. I have 2 spayed female mutts at home, one is 16 yrs, the other is 3 yrs. All 3 dogs are non-alpha type dogs. My females are both shy and not aggressive or domineering in anyway. Day 3 after I brought the new Pug home, I caught him marking twice and redirected him outside, and I saw evidence 3 other times. He is successfully using a doggy door. I got some bellybands and kept them on him for a week or so and the markings stopped. But now it’s started up again 4 weeks later, mostly when he is left alone for more than 2-3 hours and always in the same place near the back door on the tile floor of kitchen and bathrooms. I went back to the bellybands, and also moved his food bowl right to the place where he was marking as it was pretty nearby anyway. I’m firm with him about listening to me, sitting before eating and staying off the furniture. I have no other issues with him. Is there ANYTHING else I can do? I read somewhere that I should start feeding him first before the other two dogs so that he would feel dominant and the marking would stop. Any truth to this? I do feed him last, within seconds of the other dogs, but he is last. Oh, and his foster and previous owner said he did NOT mark in their homes. And I am thoroughly cleaning markings after I find them. Thanks!!

My response:

Hi Debra. First and foremost, congratulations and kudos to you for rescuing your new dog. I encourage you to set up an appointment for the new guy with your veterinarian for a thorough physical examination and urine testing. An underlying medical issue such as bladder stones or a urinary tract infection could be the cause of what you are describing. If he gets a clean bill of health, I recommend moving on to a savvy dog trainer or behaviorist for help. Back to basics crate training may be in order. Feeding this new guy earlier than the established two is certainly an easy thing to try. And then when the other two are eating, you can be outside with the new guy praising the living daylights out of him every time he urinates in the appropriate spot. I hope this helps get you started. Let me know what you figure out.

Cost concerns

From Deanna:

Hello Dr. Kay, and thank you for answering my question! I have two senior dogs who have visited a holistic vet regularly throughout their lives (and at great expense: titers instead of vaccines, regular check ups, visits at every hint of a problem, etc.). I recently suspected one of my two dogs had a bladder infection. After urinalysis, it was confirmed and she suggested a course of antibiotics and a follow up test to make sure the infection was gone. I was shocked when the vet charged me again for that follow up test — a total of nearly $175 including drugs. Now it looks like he’s developing another infection, and there is no way I can visit this vet every 3 months at that price! Is it customary to charge this much for treating a chronic ailment? What is the best way to express my feelings about this as a regular customer, or do I need to look for another vet? We’ve gone to her for 11 plus years but I just can’t afford her care at this rate, which is a shame.

My response:

Hi Deanna. I always encourage people to lay their financial cards on the table, and I recognize that this can be difficult to do. Remember, what you and your veterinarian have in common is a desire to preserve your dog’s health and comfort for as long as possible. Rarely is there only one option for successfully managing a patient. It behooves you to learn what other less expensive options exist. Additionally, if affordable, consider investigating why your dog is having recurrent bladder infections. If they can be prevented, you will likely save a good deal of money.

Sooner rather than later

From Al:

I’ve told all the dog people I know that Speaking for Spot is one of those great books where you say, “Geez, I wish I had this when we were going through all the stuff we went through with our dogs” and they need to get it. And that there’s a lotta stuff in there that it’s taken most of us 10-15 years or more of not always so pleasant experience and several dogs to learn, or that we didn’t learn even with all that experience. Somebody can save themselves a whole lotta time and grief by just getting it, reading it now, and being way ahead of the game.

My response: Thank you Al for this wonderful feedback. I wrote Speaking for Spot because I am passionate about people becoming savvy and effective medical advocates for their pets. This is not the first time I’ve heard, “I wish I’d had your book back then…..” Thanks for sharing your enthusiasm with the dog people you know.

Do you have a question you’d like to ask me? If so, please post it here.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at,, local bookstores, and your favorite online book seller.


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7 Comments on “Dear Dr. Kay……

  1. I recently had my 10 year old mixed breed dog to the vet for his annual exam and vaccines. He can be a bit nippy so I take my own muzzle and put it of him as we enter. I am a retired vet tech (25 years) and have worked at this same office. The vet tech put her hand out to touch my dog as soon as I entered the exam room and I had to tell her not to. I then wanted to hold my dog during the exam and both the tech and the vet got all up in arms about it. I understand liability but really!!

  2. Veterinary Medicine Incorparated
    I was happy to see my request a number of months ago fulfilled in the blog post about small vets becoming corporatized. Failing to respond till now I just found that I could not respond to that blog as comment submissions were closed. But here is my two cents:

    Yes, I see the few ‘pros’ but it is sad to see professional small businesses, with very good personal care for pets, whom already adhere to high standards be swallowed up by ‘corporatization’. Sure with picture technology and research in abundance for the advancement of pet care seems like a good ‘business centralization’ concept but watch out for big money lobbyist who will start to turn things worse in Washington, D.C. This is heading down the road of human health care…are we the better for it in the last 8 years health-wise, financially and accessibility? Plus, one of the great things about capitalism is choice and competition which drives the quality of care. This is not going to benefit the consumer overall.

  3. Hi Linda and thanks for your question. It sounds like your dog has pica, the habit of eating inappropriate things such as rocks, dirt, articles of clothing, etc. While this can be a behavioral issue, I’m in favor of first ruling out an underlying medical issue. Sometimes gastrointestinal, kidney, or liver disease will cause pica as will a hormonal imbalance called Cushing’s Disease. Also keep in mind that, although it appears that the stones are passing her gut, it only takes one to cause a serious gastrointestinal obstruction. I encourage you to have your dog evaluated by your veterinarian. In the meantime, do your best to prevent her from eating any more stones. Best of luck. Dr. Nancy

  4. In the last few weeks my dog starting eating large stones almost an inch in size. Her poo is loaded with stones. I don’t know if it is a nutrition issue or psychological problem or what. Any thoughts? Thank you

  5. Hi Elizabeth and thank you for the great question. It’s quite common for people to walk on eggshells when discussing obesity in someone else’s pet, particularly when the owner happens to also be obese. There are some “tricks of the trade” for discussing this in a direct fashion without offending anyone. For starters, I try to use any term pertaining to being overweight as a noun rather than an adjective. So rather than saying “overweight dog” I would say “dog with a weight issue.” Next, I try to gather information about how many calories and how much exercise the animal gets. Many people don’t know how much is too much or how much is too little. If they read feeding instructions provided by the pet food manufacturer, just about guaranteed they will be feeding too much. So, education is key here. Lastly, I know that the thing the owner and I have in common is the desire for their pet to be healthy. Knowing that we are on the same team typically makes discussion about a weight issue much more palatable.

  6. This is more of an owner related question than a pet question, so feel free to opt not to answer if you wish. Is there some way to speak to owners who are overfeeding their dogs to the point of obesity? I know the vets involved are trying. I know this is about the owners’ psychological issues. It’s awful to see dogs struggling so unnecessarily. Is there anything that can help?

  7. My first dog was a terrier mix that went bonkers when restrained…. when I was in the room. My vet had the idea to ask me to leave the room and she settled right down. He also suggested a behaviorist to work with me to practice the things that happen during visits, and that helped her settle down too. For a few weeks before an annual I put her on a table and held her, pinched her, and whatever else I could imitate, with lots of treats in-between.

    With my blind dogs, putting my hand in front of their nose settles them down. They just need to know I was there.

    I have occasionally “helped” restrain a dog but I think what I’m really doing is just reassuring my dog by putting my hand on them on the other side from the tech.

    I give the tech the benefit of the doubt, since they have probably developed a better sense of dog body language than I have. Unless my dog is pitching a fit I don’t interfere, and even then I do owner things, not tech things.

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