When it comes to tough choices for our dogs and cats, few decisions weigh heavier than the amputation decision. That’s why Dr. Nancy Kay joined us for Tripawd Talk Radio #131, a conversation about how to make medical choices for our animals. We also celebrate her new book, A Dog Named 647.
Trying to Make the Cat or Dog Amputation Decision? Dr. Kay Explains What to Consider.
Today we’re having helpful conversation for anyone who is wondering is amputation is a good choice for their cat or dog.
We also celebrate her pawesome Substack blog, Speaking for Spot, and the launch of Dr. Kay’s new book, A Dog Named 647. This important story gently teaches middle-grade kids about how puppy mills prioritize profits over the physical and psychological wellbeing of dogs.
Dr. Nancy Kay, DVM, is a longtime friend of Tripawds and an award-winning veterinarian who has a lot to teach us about being our pet’s best medical advocate. She was our guest many years ago in a 2012 Tripawd Talk Radio episode.
What You Will Learn in This Tripawd Talk Episode
Dr. Kay is one of the first voices who taught us how important it is to advocate for our pets. So if you’ve ever walked into a vet clinic feeling overwhelmed or unsure what questions to ask, you’ll love this episode!
Know what to think about when your vet recommends amputation for your pet.
Get practical tips, real-world examples, and a gentle reminder that it’s okay to slow down, ask questions, and trust your gut when making veterinary care decisions.
Plus, Dr. Kay shares how you can gently help educate middle-grade kids about puppy mills, through her brand-new book, A Dog Named 647. This middle-grade story gently tackles the tough truth about puppy mills through an age-appropriate story that kids can’t put down.
Get a Dog Named 647 on Dr. Kay’s website and at independent book stores!
Connect & Learn More from the Tripawds Community
Facing the cat or dog amputation decision? You’re not alone. The Tripawds Support Circle is here for you:
https://tripawds.circle.so
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Subscribe to Tripawd Talk wherever you get your podcasts!
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Transcript: From the Dog Amputation Decision to Animal Welfare Education, Dr. Nancy Kay Explains How to Advocate When Our Pets Need It Most
TRIPAWDS: Dr. Kay It has been years since we talked, and I am so excited to chat with you again. I just I want to start by saying that you were the very 1st veterinarian who really taught me the importance of advocating for your pet at the clinic. Up until speaking for Spot. I was the typical pet parent who went in with the white coat syndrome and just let just didn’t question anything and let things happen instead of taking a more active role as a participant in my pets lives. So I just have to thank you for all of the great work you’ve done over the years.
DR. KAY: It’s so great to be here, although we haven’t really seen each other in the past. I feel like we’re old friends, because we’ve kind of stayed in contact over the years.
Catching up with Dr. Kay
TRIPAWDS: Definitely. And it’s just it’s nice to see all of the work that you’ve done advocating for animals. And we’re going to talk about everything that you’ve been up to, and we’re also going to talk about making the amputation decision for your pet.
First tell me what you’ve been up to, since Speaking for Spot.
DR. KAY: Well, I worked as an active veterinarian up until about 8 years ago, then retired. I’ve been writing pretty much the entire time, mostly blogging on a very regular basis. And now I’ve transitioned the blog over to Substack.
And then I really got turned on to the idea of educating children about puppy mills. I was inspired by Greta Thunberg, who, your listeners may know. She was a kid who got very involved and became a vocal advocate in terms of the climate change that’s happening on our planet.
What Are Puppy Mills and Why Kids Need to Know
DR. KAY: I’ve been disappointed in what my generation and your generation other adults have not been able to accomplish in getting rid of puppy mills, and maybe I should step back and explain.
A puppy mill is a large commercial breeding facility. If you think of factory farming, of chickens or cows, this is factory farming of dogs. And basically profit is prioritized over the physical and psychological well-being of the dogs. So I listened to Greta Thunberg and admired her, and I thought, ‘I need to write a book about puppy mills for middle graders.’ It’s that age range where they’re just sort of coming out and looking at the social issues around themExpanding out into the world a bit.
Behind the Scenes of A Dog Named 647, Educating Kids About Puppy Mills
DR. KAY: And so, as you know, Speaking for Spot was non-fiction, and that’s what I’d written. So I tried to write a book for middle graders, a non-fiction book for middle graders about puppy mills. I tried several different tactics, and with each one found myself thinking ‘If I was a middle grader I would never want to read this book!’
It had to be done through fiction. I spent a good amount of time educating me myself about writing fiction, and that book has been in the works for eight years, working with critique groups, learning so much.
I had twelve different middle grade beta readers read it. This book is called ‘A Dog Named 647,’ and less than half of those middle graders had ever heard of a puppy mill before. So that made me feel great like, ‘Oh, okay, this book might really accomplish something!’
TRIPAWDS: Adults do not realize the problems that come along with these dogs. Not just for the poor dogs, but for the generations after them. And I loved the Substack that you wrote recently, where you kind of went undercover at a puppy mill.
DR. KAY: Oh, a dog auction, yeah!
TRIPAWDS: Tell us a little bit about that.
DR. KAY: Well, there’s a few dog auctions in the Midwest, and it’s where puppy millers come to trade dogs, and maybe they’re unloading some dogs, or maybe they want to buy some dogs. And it is run just like a livestock auction, the exact same way.
I can read so much into the eyes of these dogs. And having been inside puppy mills now, I’ve been inside five puppy mills, I would get so fed up having to rewrite my book one more time, and then I just think about the expressions in those dogs’ eyes, and felt like I just have to do this.
TRIPAWDS: I loved that post, and I’m going to put a link to it in the show notes. I think that’s a great age for kids to start learning about this, so we will absolutely be happy to promote that book.
DR. KAY: And I did write a recent Substack on cognitive dissonance and puppy mills.
TRIPAWDS: Yep, I think that’s where it came into my head again. It’s been a while since I was thinking about that, but your Substack is awesome.
Making the Dog Amputation Decision: You are the Team Captain
TRIPAWDS: You can help us go step by step on how to decide if this is a good decision or not, because we always say it’s not right for every animal. There are some situations where you don’t want that animal on three legs. But how do we know?
A lot of us turn to our vets and we want them to answer “What would you do?” So let’s talk about that a little bit. What are some of the factors that should be taken into consideration when we’re trying to decide?
DR. KAY: So, alluding to what you just talked about in terms of the care medical care for our pets. Guess what? We’re the team captains. And we have a lot of people on the team. We may have a rehab therapist. We have this veterinarian, the surgical veterinarian.
There’s a bunch of team players. But we’re the team captain, and that’s as it should be, because we know our pets better than anyone else can possibly know our pets.
DR. KAY: I just want to put that out there to begin with.
If someone asks, and they ask all the time, “What would you do if he were your dog?” and I would say, “Well, I can tell you what I would do with my own dog, but that has no relevance to what you would be doing with your dog.”
Factors Vets (and Us) Need to Consider Before Amputation
DR. KAY: One of the first things I encourage people to go back to, and the two big reasons that limbs are amputated: one, osteosarcoma, or some other type of malignancy, and two, trauma.
I think what’s important is to think about:
What was the baseline quality of your pet’s health and happiness before the limping began, or before the car accident?
Because if your dog was, you know, ten years old, a large breed dog not getting around very well, not very active and playful, that’s an important thing to consider. Because the surgery is not going to restore your dog back to anything at all better than that baseline quality of life was. And for a while it may make it worse during the recovery.
So I think that’s something really important to talk with your veterinarian about. “How is my dog’s overall overall health?” Has there been progressive kidney failure? Has he been dragging his back legs a little bit? Has he lost some of his conditioning to do exercise?’ So that’s a consideration.
Another big consideration to me is the dog’s body condition score.
TRIPAWDS: Oh yes!
DR. KAY: Obesity is gonna make the recovery so much more difficult for a dog. Because we’re shifting all the weight to three legs rather than four legs.
Something else, I consider, is it a front leg or a back leg?
We know that front legs carry about 60% of the animal’s weight, and the back legs carry approximately 40%. So when I see a tripod, and it’s a back leg amputation, I always feel a little bit better for that dog.
DR. KAY: Dogs with front leg amputations, especially if they’re really big, thick dogs, you know, I’m thinking of a Rottweiler kind of, or a heavy pit bull, that might be harder on them. So that that’s important to know. I think it’s really important to know.
So what’s the health of the other legs?
If we’re gonna remove a back leg, but the left hind leg has a bunch of arthritis in the knee from an old cruciate ligament tear, or has massive hip dysplasia in that hip, and it was the right one that was carrying the dog for the most part, amputation is likely not a good idea.
TRIPAWDS: . . . it reminded me of a good quote that an orthopedic surgeon told us once which was ‘Amputation gets rid of a problem now, but it creates a chain of problems later on down the line. And whether that’s during recovery or a year later or two years later, a dog will always pay the price eventually of having one less limb.’ So, as you were saying, it’s important to take the whole picture into consideration.
DR. KAY: I’m not sure I like that, because I would worry that that could talk people out of doing an amputation when it’s a really good choice for an animal.
TRIPAWDS: Oh! Tell me a little bit more about that. That’s interesting.
DR. KAY: Yes, so with osteosarcoma, we know that they’re gonna live, maybe another year post-amputation. But people always say, “That’s too short of a time!” And yeah, but it’s one-tenth of your dog’s overall lifespan, that’s putting it in different terms.
And right now with the osteosarcoma, your dog is in a lot of pain. And what if we can get rid of that pain? And your dog can just go launching itself along the beach?
You know I’m thinking of dogs that are in really great shape. They’re athletes. And they have a huge heart. So I would worry that what that surgeon said could talk people out of an amputation.
Now, long-term effects probably won’t apply, because with osteosarcoma they’re not going to live in to the realm of long-term effects.
DR. KAY: Trauma, that’s a whole different discussion that I think that we should have. It kind of segues into the point that I was going to make, which is:
What is your dog’s personality like?
And is your dog, that German shorthair, or your Border Collie? You know that they just want to run, and they’re hopefully nice and lean, and they take it in stride (no pun intended again!).
When I was practicing we didn’t think much about phantom playing the way that it’s thought of now. From what I’ve read, about 34% of dogs experience some degree of phantom pain or nerve pain, post amputation. And there’s medications and physical therapies that can be used to help with that.
It depends on what shape your dog is in. And what’s your dog’s personality like? If I was going to undergo some significant treatment on a dog or put them through some significant treatment, if it was an Afghan or a Collie, I really help dissuade the clients.
Because those are dogs that just give up. They just give up and roll over. They’re not gonna try hard, you know? So that’s what I mean by what is your dog’s innate personality like? Is your dog a sparky fighter? Or is your dog truly a couch, potato?
So this sounds a little woo woo and “out there,” but I really do recommend going eyeball to eyeball nose to nose with your dog, and spending some significant amount of time searching for answers about what your dog might really want to do.
Thinking About Amputation for Osteosarcoma vs. Other Cancers
DR. KAY: We know that osteosarcoma and other types of bone tumors can be excruciatingly painful, and that’s because the periosteum, which is the lining of the bones. They have millions of nerve endings, which is why bone cancer is so painful in dogs as it is in people.
Yet some of them, it’s unpredictable which ones will respond beautifully to pain medication just beautifully. So if your dog happens to be one of the lucky ones, then maybe amputation would be put on the back burner.
DR. KAY: Amputation is very unlikely to prevent metastasis of the cancer in the future, because if you’re thinking “Well, if we get the leg off, the cancer is not going to come back.” Unfortunately, that’s not the case. By the time the cancer has been diagnosed, even if chest X-rays are clean and clear, it’s going to find its way back in 98% of cases within a year.
And then the other thing, I always encourage my clients to think about when they’re making a truly big decision, and amputation is a big decision, ‘Can you change your mind if you don’t like what you see?’
Well, with amputation, no, you can’t change your mind. But if you were to say ‘I just want to try medical treatment and see how it goes,’ you can always change your mind and opt for amputation if things aren’t going well.
TRIPAWDS: Yeah, we do tend to see that quite a bit like in the case of a soft tissue sarcoma that, you know, has a resection done.
The vet gets it off, and then, if it comes back we’re right where we started, but at least we got some good quality time. Then we’ll see how how the dog responded to that surgery and that pain medication.
Most of us don’t even really know what our dogs are like on pain medication until they go through something like this, and that is a really tough thing to manage for a lot of dogs.
We have seen in our community that pain management during recovery is probably the biggest issue, because it really is kind of unpredictable. The way some dogs like you said will do great. They’ll respond to the formula for pain, medication for an amputation, and then other dogs. It just doesn’t touch them.
DR. KAY: Exactly, exactly. And you bring up a good point, which is, I think we should differentiate when I talk about a bone cancer, osteosarcoma, that’s cancer in the bone. That’s the one that’s gonna come back within a year in 98% of the cases. Unless treated with chemotherapy, which might give them a little bit more time.
Soft tissue sarcomas are a whole different ballgame that can have a much better prognosis. Soft tissue sarcoma means it’s a malignancy within the muscles, not in the bone, or in the tissue underlying the skin. So that’s a that’s a different ballgame.
Trauma Cases: When to Save the Leg or Amputate
TRIPAWDS: What about if you have a dog who is in a hit by a car, let’s say, and you have to decide. ‘Do I want to try to save this leg with surgery and pins and an external fixator’ and all that? Or should we just amputate now? I mean, how do you make that decision? Because it’s really expensive to try to save a leg! How do you know, that’s actually going to pay off.
DR. KAY: Right, and it’s relatively inexpensive to amputate. So you speak with the hopefully surgical specialist who’s doing the work on repairing the leg that looks like dynamite went off. Get an experienced vet to predict what the outcome of the surgery will be (asking):
What’s the likelihood it’s going to work?
What’s the likelihood that my dog will be able to use the leg normally again?
I would hope that your veterinarian could give you kind of percentage odds. You know, “I think there’s a good 75% chance that this is going to heal with some work on your part and expense on your part, and he’ll be able to walk and run and play again.”
It’s important to try to pin the surgeon down on what he or she thinks.
If people make a decision just based purely on cost, there can often be a lot of guilt associated with that. So I tell people ‘Pretend that you are Rupert Murdoch, or suppose it’s somebody really rich, and money is not even a concern.’
If you divorce yourself from that concern, think about the decision you would make on behalf of your dog. Because sometimes people are surprised they recognize “Oh, even if I didn’t have to pay for the surgery, I still would opt for amputation rather than this very involved surgery that has a 50% chance of returning my dog to normal function. And if it doesn’t work, then we’re probably back to the amputation question of amputation.”
DR. KAY: If you have a dog that’s in pretty terrible shape, obese, very old acting not just a number. My current dog is 17 years of age, and he goes hiking with me still. So not chronological age. But basically, how does your dog seem behaviorally?
All those factors are going to impact either option that you take. So I think it’s sitting down with a veterinarian that can give you his or her really honest impressions of the prognosis and the work that goes into helping a dog save a leg.
It’s a lot more than the work that goes into helping a dog with an amputation recovery. Because there’s going to be broken bones and mangled tissue, and that’s just the nature of the beast.
TRIPAWDS: We have seen some of those recoveries where you’re not just dealing with the leg. You’re dealing with other injuries that the dog had during the accident, and then the chance that there could be an infection that happens. And so then you’re dealing with the caring for wounds that can be really awful to deal with.
DR. KAY: And something else that I typically advise people about is “Put yourself out into the future. Let’s say six months from now. If you did the amputation, and you didn’t try fixing the leg. How are you going to be feeling about that? How will you be able to live with yourself, knowing you made that decision?” “
By the same token, if you decide to try to salvage the leg, and it goes well, we know how you’re gonna feel. But what if it doesn’t go well and you have to resort back to amputation? How are you gonna feel?
What can you live with most easily? What’s going to give you the best peace of mind? Play out the different scenarios out into the future.
It’s like trying to decide if chemotherapy is the right choice, too
TRIPAWDS: It’s it’s a very similar thought process for deciding on chemotherapy as well.
So when you’re dealing with osteosarcoma, you know there’s there’s never a one-size-fits-all answer for every situation, everybody’s story is different. Everybody’s dog is different. And you have to do what you can live with, and know that in the end, no matter what.
Let’s say with osteosarcoma, we know it’s going to come back. Can you live with the fact that you did or did not give your dog chemotherapy? What if your dog gets really sick from the chemotherapy (which doesn’t happen all that often)? But when it does, can you live with seeing your dog having the side effects? These are things we never expect to face when we bring dogs into our lives.
DR. KAY: Well, the other thing about chemotherapy is one of my questions always is, “If you don’t like what you see, can you stop it?” And that’s very true with chemotherapy.
So if you say, “Yeah, I’m gonna try that 1st injection.” But if I have a vomiting lethargic dog on my hands, who’s sick for a week after the injection, which is rare, then you can say “No more of that!” Or if my dog is just so traumatized going into the Veterinary hospital again.
DR. KAY: Go eyeball to eyeball with your dog. Do some soul searching. You can always stop it if you don’t like what you see. (That’s) not true with an amputation.
TRIPAWDS: So correct. Yeah, you can’t put that leg back on!
What About When There’s Amputation Opposition in the Pack?
TRIPAWDS: What about, this is kind of a curveball question, because I didn’t give it to you ahead of time. But what about when you and your significant other or the other decision maker in the Pet’s life don’t agree? This is a situation we see happen quite a bit.
DR. KAY: That’s really tough. In my book, Speaking for Spot, I tell a story about my old old golden retriever. We discovered a liver mass and trying to decide, should we remove it or not? And we really weren’t sure what kind of cancer it was.
This is back in the old days when we didn’t do much in the way of non-invasive diagnostics. We were fortunate because we were both on the same page. But if you’re not both on the same page, then it’s a matter of degree in my mind on a scale of one to ten.
How adamant are you about doing this amputation on a scale of one to 10? How opposed are you to doing the amputation? If one is a one, and the other is a six. You can kind of compare notes that way. As in any relationship, you know, there’s compromise. So you may not ever really be on the same page, but you agree on a way forward.
TRIPAWDS: Yeah. And I think that’s where it comes back to, both of you having that heart to heart with your dog. I don’t think that’s woo woo at all. I mean, I we spend so much time and so much energy on our pets, and like you said we know them best. So what would prevent us from actually looking into their eyes and knowing what they would want to do?
I do think that in a lot of cases there are situations where we, as humans, have a hard time putting their needs first.
DR. KAY: You’re right.
TRIPAWDS: We cannot stand the thought of being without our pet.
DR. KAY: It’s like fighting for their needs and their wants and their purpose really. What is their purpose in in this world? And in your life? And the lives around them? Were they meant to be here for 14 years? Maybe the last 4 were just kind of not very happy ones?
What is Your Dog’s Job Description?
DR. KAY: You brought up another point that I do think is important in making a decision about amputation, and we’ve touched on a little bit. But what is your dog’s job description?
So if you have the Border Collie who lives to be chasing sheep, is that something that your dog will still be able to do? If your dog’s job description is snuggling in bed with you at night, is that something your dog will be able to do? If your dog has to swim in any source of water (three-legged dogs can swim remarkably well) …
TRIPAWDS: Yeah and they don’t swim in circles, either!
DR. KAY: Correct! So by amputation, will you potentially be taking away the thing your dog loves most in life? It’s food for consideration.
TRIPAWDS: It is, it is. And there is a new normal that once you make that decision, if you go forward with it, you have to be okay with that new normal. For us and a lot of people, those those long, two hour walks that you used to take together, they’re not going to happen with a dog who’s missing a leg. And there are ways to manage, that, like dog strollers. We have a stroller for Nellie. She’s 75 pounds, and we push her around.
DR. KAY: My gosh!
TRIPAWDS: It’s awesome, it’s great! And that is one way that she is able to get out and still enjoy life. There are things we can do, but it takes management and time, and you being okay with with it. So yeah, it’s a tough decision, and nobody can make it for us.
Making the Hardest Decision of Our Pet’s Lifetime
DR. KAY: Stepping up to be your dog’s medical advocate is tough, especially if it’s making decisions about euthanasia. You didn’t realize when you adopted that adorable puppy, that it would be part of the job description.
TRIPAWDS: Yep, and it’s something we try to avoid for so long.
But eventually all of us will get there with our pets. And boy, that’s that’s when Speaking for Spot comes in really handy. I think if you can get that book, if every new dog owner had that book in their hand, and kept it on their shelf for their dog’s life, things would be so much easier along the way.
Learning how to be an advocate at all stages of your dog’s life is what they really want from us. Really they don’t want a lot from us. They just want a human that’s going to respect their needs and their desires, and, like you, said their job in this world.
DR. KAY: Yes, I’ve had several people tell me that those with a copy of Speaking for Spot, that they’ve used the help from the book with their own pets, but they’ve also used it to help themselves in their own medical visits with their doctors.
TRIPAWDS: I would say so absolutely. I think it is still just as relevant as the day it came out, and I think you published it at a time when we really did start questioning. Nicely, sometimes firmly, but just really, you know, being respectful of our physician and our veterinarian’s role in our life, but also standing up for ourselves.
DR. KAY: Right, and recognizing that we have a choice in who we select to take care of our pet’s health.
How to Find Dr. Kay and Her Book, a Dog Named 647
TRIPAWDS: Absolutely. And now you’re teaching a whole other generation about advocating for these amazing dogs and knowing the real truth about these puppy mills. It’s a full circle kind of book that you’ve put out here, Dr. Kay And we’re so happy to help promote it.
DR. KAY: Thank you.
TRIPAWDS: Seriously. Tell everybody where they can get your your books.
DR. KAY: So my website is DRNANCYKAY.COM. The books are going to be available, they launch in September, and will be available on all the online booksellers. But I would love it more if you went into your independent bookseller, and said “Oh, you don’t have this book, I hear it’s a great book. Can you order it?”
TRIPAWDS: Yes!
DR. KAY: Also, if you have kids, I’m developing a web page now for an organization called Kids United for Animal Welfare.
So they’ll not only be learning about puppy mills, but they’ll be learning about egg production, and what happens to all those little baby male chicks that aren’t going to be layers? What happens to those birds? Ugh! And dogs and pigs, and yeah, all all of that, without preaching ‘Don’t eat meat.’ I’m not gonna do that, it’s just it’s what I do. As a veterinarian. I just give you the facts.
TRIPAWDS: That’s what we need. And that’s what we are so grateful for. When when you’re done with that website, please let us know, and we’ll get the word out.
DR. KAY: I will!
TRIPAWDS: Thank you so much for being here Dr. Kay It’s it’s a real joy to talk to you again, and we will be seeing you on the Internet.
DR. KAY: Great. I’m a huge fan of yours. Keep up the good work.
TRIPAWDS: Thank you.
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