Nancy Kay's Blog

When people learn that I’m a veterinarian, their faces often light up with a smile. They may have a story such as, “I always wanted to be a vet, but organic chemistry sabotaged my plan.” or, “I love my veterinarian. She saved my dog’s life!”

Not all responses are so affirming because not everyone is happy with their veterinarian. And that’s okay. The reality is, not all veterinarians do a good job (same as in human medicine). I certainly had a few vet school classmates I wouldn’t let near one of my own sick animals with a ten-foot syringe.

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

The relationship between you and your veterinarian is an important one. Consider yourselves teammates working to keep your pets comfortable and healthy. Choosing the right veterinarian is a significant decision, and is why I included the chapter, “Finding Dr. Wonderful and Your Mutt’s Mayo Clinic” in my book, Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life.

How can you know if a vet’s performance is unworthy of your patronage? Here are five red flag indicators to prompt you to consider looking for someone new:

1. Your veterinarian is a 100 percent do-it-your-selfer, refusing to enlist help from other veterinarians, particularly specialists, within the community. Gone are the days of All Creatures Great and Small when it was reasonable for one doctor to handle all medical maladies, great and small. Advances in diagnostic and therapeutic technologies have made it impossible for any one individual to be proficient at everything. If your family veterinarian hasn’t been able to arrive at a diagnosis, your pet’s condition is worsening or not improving in spite of therapy, or has recommended a complicated procedure, enlisting help from another veterinarian makes really good sense. If such discussion is not forthcoming, your vet is likely a do-it-your-selfer.

2. Your veterinarian prefers telling you what to do rather than discussing options. This “paternalistic” style of communication hinders your ability to ask questions and make well-informed choices. Sentence starters from your veterinarian such as, “You need to…”, “You should…”, “You have to…”, or an unsolicited, “If I were you I would…” are all clues that you may be workong with a paternalistic provider. It’s fine for veterinarians to weigh-in with some “what-would-I-do” advice, but such opinions shouldn’t be forthcoming from the get-go.

3. Your veterinarian doesn’t comply with current professional standards. For example, veterinarians who insist on a full slate of vaccinations without considering their patient’s lifestyle. Why vaccinate for Lyme disease if there’s no potential exposure to ticks?

4. Your veterinarian has made a significant error while working with your pet—a botched surgery, a missed diagnosis, or a medical prescription error. Yes, mistakes happen, and they warrant some face time with your veterinarian. Not only should your vet take responsibility, they should provide a prompt and honest explanation of what happened. If this isn’t the case, time to look elsewhere.

5. You or your pet simply don’t feel comfortable with your veterinarian. Does your normally delightful dog transform into Kujo the minute your vet walks into the exam room? Do you feel uneasy asking questions and openly discussing your worries or concerns? Pay attention to your observations and gut feelings. If it doesn’t feel right, it probably isn’t right.

If you are planning to transfer to another veterinary hospital, you may be concerned about how to do so gracefully, without hurting your vet’s feelings. To this I say, what’s more important, your pet’s health and your own peace of mind or your veterinarian’s feelings?

To expedite a smooth transition, obtain a copy of all of your pet’s medical records, including: doctor’s notes, laboratory test results, imaging studies (ultrasound, X-rays), and vaccination history. This should be a no-hassle process because you are legally entitled to these records. If asked why you are moving on, I encourage you to provide an honest, constructive response.

As the captain of your pet’s health care team, it is your responsibility to determine who your teammates will be. Choose them wisely and remind yourself that the opportunity to care for you and your pet is a privilege that should be well-deserved.

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

There are a half dozen or so diseases I truly despise, and degenerative myelopathy (DM) is one of them. DM causes slow, progressive damage to a dog’s spinal cord resulting in paraplegia—paralysis of the hind legs. Sadly, there is no effective treatment.

Decades ago, when I was just a pup, veterinarians referred to DM as German Shepherd Myelopathy. We thought the disease was unique to this breed. In fact, DM occurs in purebred and mixed breed dogs of all shapes and sizes. The two breeds most commonly affected are German shepherds and corgis. I find this fascinating because I’ve always thought of corgis as German shepherds on short legs.

Early symptoms typically begin at around eight years of age and are subtle, resembling a nondescript gait abnormality. The symptoms progress slowly over the course of months to even years. From beginning to end, dogs with DM typically remain alert and animated. Symptoms typically progress as follows:

Initial: Loss of coordination (ataxia) in the hind legs, dragging the hind feet causing wearing down of the toenails, hind end weakness (difficulty climbing stairs, jumping up into the car, going for walks).

Intermediate: Knuckling of hind feet (weight bearing on the tops of the feet rather than their undersides), difficulty supporting weight with hind legs, inability to walk without support, urinary and/or fecal incontinence.

Advanced: Paraplegia (paralysis of hind legs), weakness in front legs.

DM does not appear to cause pain for the dog directly. Discomfort can occur because of overuse of other body parts attempting to compensate for the hind end weakness.

A mutation of the SOD1 gene causes DM, an inherited disease with a recessive mode of inheritance—in order for a dog to be affected, both dam and sire must pass down the mutation. What remains unknown is why some dogs who have this “double mutation” never develop symptoms of DM.

Genetic testing is available to determine an individual dog’s SOD1 mutation status and is available through several laboratories. Testing identifies dogs that are normal (have two normal copies of the gene), those who are carriers (have one normal copy of the gene and one mutated copy), and those who are at risk for development of DM (have two mutated copies of the gene). DNA testing does not diagnose DM. This is because not all dogs with two mutated copies of the gene develop DM.

Responsible breeders use DNA testing for DM to help assess whether a particular dog is suitable for breeding purposes. If contemplating purchasing a German shepherd or corgi pup, it’s important to request DM test results for the dam and sire of the litter. If the parents have not undergone screening, it’s reasonable to test the puppy prior to purchase.

DM is a “rule-out diagnosis”. This means that a presumptive diagnosis of DM is made by ruling out other causes of spinal cord disease (e.g., herniated intervertebral disk, tumor, infection, trauma). Sadly, the only way to definitively diagnose DM is via a spinal cord biopsy, collected during a post-mortem (autopsy) examination.

There is no known treatment that significantly alters the course of DM. Diligent nursing care, prevention of pressure sores, rehabilitation therapies like swimming and stretching exercises, massage, acupuncture, monitoring for urinary tract infections (immobilized dogs are more prone), and using specialized equipment such as booties, slings, harnesses, and wheelchairs can enhance the quality of life for affected dogs.

Sadly, dogs with DM become so debilitated that most owners eventually opt for euthanasia. Exactly when to euthanize is a highly individualized decision based on how adaptive, both physically and psychologically, the involved dog and human(s) are. Some dogs thrive in a well-fitted doggie cart/wheelchair. For the human caretaker, in addition to the emotional toll that DM takes, there is a great deal of lifting, carrying, and cleaning involved. Everyone responds differently to this challenging situation.

Letting go of a beloved four-legged family member is never easy, but it can be particularly heartbreaking when DM is the cause. Affected dogs typically have good appetites, are free from pain, and their minds remain sharp as ever.

Degenerative myelopathy and Lou Gehrig’s disease share similar symptoms, and both involve an SOD1 mutation. However, they are not identical in that they affect different parts of the central nervous system. Nonetheless, DM serves as a canine model that may ultimately prove to be valuable in learning more about therapeutic interventions for ALS.

After reading this, it’s probably obvious why I despise degenerative myelopathy! It’s impossible to treat and, short of an autopsy exam, impossible to definitively diagnose. And euthanizing a dog who is pain free and with normal personality intact takes a huge emotional toll.

Have you known a dog with degenerative myelopathy? Please share your story.

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Here is an opportunity to hear me talk about medical advocacy for our pets in an interview with Chad from Humane World for Animals (formerly Humane Society of the United States). Enjoy!

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

I hope you enjoy this “just for fun” story.

On October 17, 1989, while many were preparing to watch the third game of the World Series between the Oakland A’s and the San Francisco Giants, I was at work at my veterinary hospital in Oakland, California. As I examined Cinder, a lovely cocker spaniel, and her litter of pups born that very day, without warning, the room began violently rocking and rolling. The light fixtures swayed and the exam table across the room. I remember thinking that a great crevasse was going to open and my patients and I would free fall into it. I truly believed my life was about to end. (Keep in mind, this was my very first earthquake experience.)

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Those of us in the exam room that day were all just fine. Cinder had her second litter on October 20, 1991, another date that rattled Bay Area nerves to the core. The Oakland Hills fire erupted into an inferno of devastating proportions. Approximately 3,500 dwellings were burned.

Cinder’s owners and I were shocked by the coincidence. We all agreed it was time to spay Cinder with hopes of staving off any more Bay Area natural disasters!

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

I’ve got some good news and some bad news. First the bad news.

The 2026 Horrible Hundred List was just released. Assembled annually by Humane World for Animals, this list names 100 puppy mills with horrific violations.

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

The states that made this year’s Horrible Hundred list include Illinois, Indiana, Iowa, Kansas, Minnesota, Missouri, Nebraska, New York, Ohio, Oklahoma, Pennsylvania, and Wisconsin.

Missouri leads the pack with 31 kennels listed. No great surprise, given that Missouri hosts more puppy mills than any other state.

Examples of documented violations include: excessive feces in cages, flies and rodents, underweight dogs, unvaccinated dogs, transporting underage dogs (less that 8 weeks), cage sizes that are too small, forcing dogs to urinate and defecate where they eat and sleep because of lack of space, food contaminated with feces, surgeries performed without veterinary supervision, heavily matted fur, no access to water, untreated medical issues such as severe dental disease and broken limbs (one dog had two broken front legs). This list could go on and on, but I think you get the picture.

The United States Department of Agriculture (USDA) runs oversight on puppy mills, yet more than half of the Horrible Hundred breeders are USDA licensed. Gives you a sense of the job the USDA isn’t doing.

Many breeders on the Horrible Hundred list are linked to the American Kennel Club (AKC). Tells you where the AKC stands on the topic of puppy mills. The more puppies registered, regardless of where they come from, the more in AKC’s bank account.

Approximately 50% of the Horrible Hundred breeders are repeat offenders (again, failed USDA oversight).

Here’s the good news! Colorado just passed the “Pistol the Pomeranian Protection Act” banning the sale of puppies and kittens in pet stores. Pistol, who passed away in 2025, was a puppy mill survivor cared for by Colorado House Majority Leader Monica Duran. The bill goes into effect on January 1, 2027.

Other states that have banned the sale of pet store puppies include California, Maryland, Maine, Washington, Illinois, New York, Oregon, and Vermont.

Join efforts in your state to follow Colorado’s example. Reach out to your senators and representatives. Ask them to vote for the Puppy Protection Act to improve care standards at USDA-licensed dog breeding operations and the Better CARE Act allowing the Department of Justice to step in and work with the USDA to charge or shut down breeders that violate the Animal Welfare Act.

Educate others about puppy mills. You can begin by sharing this newsletter.

Never purchase a puppy from a pet store!

Never purchase a pup online without visiting the kennel and meeting the mama dog!

Share my book, , with children, friends, neighbors, librarians, and teachers. Want a signed copy? Just let me know.

Donate time and/or money to organizations that work to end the suffering of puppy mill dogs. Leave a comment if you would like some suggestions.

Who can you educate about puppy mills?

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Heartworms are long, spaghetti-like worms that set up housekeeping within the right side of the heart and the pulmonary arteries (vessels that transport blood from the heart into the lungs). Left untreated, heartworm disease results in lung disease and heart failure.

The American Heartworm Society recently released 2025 data identifying the incidence of disease within the United States. Note that the “average number of cases per reporting clinic” was over the course of 2025.

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

For the first time, Texas is at the top of the list of heartworm incidence. The number of cases has also grown significantly in the Florida Panhandle, southwest Florida, the central Carolinas, and southern Illinois.

Compared to prior American Heartworm Society data, the overall incidence of heartworm disease in the U.S. is rising. Here are some explanations:

The number of mosquito species known to transmit heartworm has increased, and documentation shows some of the most common species migrating north and west from the southern United States.

Changes in climate have created more warm, humid environments that sustain mosquito populations.

When owners move with their heartworm-positive dogs, they introduce a new reservoir for infection into areas not previously significantly affected.

Heartworms infect coyotes, foxes, and wolves, thus increasing the number of vectors for transmission.

Absolutely!

No matter where you live within the United States, your dog is at risk for heartworm exposure. Without it, particularly in the heartworm hot spots, you are forcing your dog to play Russian roulette.

Not only is heartworm disease treatment costly, it is zero fun for both dog and owner. If your dog is not on preventive medication, I encourage you to schedule a discussion with your veterinarian.

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

I was a young veterinarian when I met Martha, a kind, soft-spoken woman devoted to Murphy, her nine-month-old cocker spaniel. Martha told me that three other veterinarians had already run a myriad of tests, but nothing was found to be amiss. According to Martha, the other veterinarians thought Murphy was normal, and she was a hypochondriac.

Martha confessed that were no clear-cut symptoms. Yet, she was certain that something was troubling her beloved dog. His appetite and activity level at home were normal, and there had been no vomiting, diarrhea, coughing, or sneezing. It was while Murphy was on his daily walks that something felt off to Martha. He was a bit less exuberant than normal.

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

I examined Murphy from teeth to toenails, hoping for the clue that would help guide the diagnostic process. I reviewed all the laboratory test results and X-rays previously generated. Still nothing. Was Martha truly a hypochondriac? After listening to her and observing her body language, my intuition told me otherwise. I admired Martha’s calm perseverance. After being turned away three times, here she was in her ongoing efforts to be an effective medical advocate for her dog.

Though Murphy did not have a heart murmur, based on the possible change in his energy level, I suggested an echocardiogram—an ultrasound examination of his heart.

Lo-and-behold, this study revealed the abnormality responsible for Martha’s concern. Murphy had a birth defect called a patent ductus arteriosus (PDA). The ductus is a normal blood vessel in the developing fetus that closes off shortly after birth. In some puppies, this ductus remains open, causing abnormal blood flow that can ultimately result in heart failure.

In most PDA’s, the abnormal flow moves from the left side of the heart to the right side and causes a loud heart murmur, which Murphy did not have. This typical PDA can be corrected, and the dog goes on to live a normal life.

Murphy’s PDA was atypical—the abnormal blood flow moved from the right side of the heart to the left. This “reverse direction” does not cause a heart murmur, the reason the three veterinarians before me had been stumped.

Sadly, there wasn’t a feasible way to correct this reverse-direction PDA, meaning Murphy’s symptoms would progress.

When I explained the diagnosis to Martha, she cried. She told me her tears were a combination of sadness and relief that her concerns had finally been validated. She was grateful that the search for a diagnosis was over and she now knew what to expect.

Martha and Murphy enjoyed another 18 months of good quality time together. When his symptoms intensified and he was euthanized, Martha sent a note letting me know and thanking me for having believed in her.

For decades (and I won’t specify how many!) I’ve remained profoundly indebted to Martha for teaching me a valuable lesson. She taught me that no one knows my patients better than my clients, and it pays to trust their instincts, gut feelings, and intuitions about their pets. When they sense something is wrong, their hunches deserve my attention and investigation.

I’ve thought about Martha and Murphy hundreds of times while evaluating animals with ill-defined or subtle symptoms. Martha’s perseverance was truly inspirational.

Have you ever had a hunch that something was wrong with your pet even though there were no obvious symptoms? If so, how did things pan out?

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Take a look at the photos below. Cute kids with cute dogs, right? What’s not to love? Now take a closer look. See any reason for concern?

I think this dog’s eyes express apprehension/concern. I’ll bet his heart rate is elevated.

Notice the girl’s hands. Many dogs detest having their feet handled.

Look at how close this little girl’s face is to this dog’s mouth. If he loses his patience and bites rather than removing himself from the situation, the result could be devastating.

Does this dog look happy and comfortable in this situation? I think not.

Again, see where this child’s face is in relation to the dog’s mouth?

Yes, it’s unlikely that a puppy, a Labrador pup to boot, is gonna care what’s happening here. But messing with any dog of any age while they’re eating is 100% disrespectful to the dog.

Serious bite wounds are often a result of resource guarding, and food is a resource many dogs take very seriously.

Climbing on a dog like this is the epitome of disrespect.

This Labrador may not care much, but the dog certainly doesn’t look happy in this photo.

Based on this dog’s uncomfortable expression, I sense he’s thinking, “Please don’t come any closer.”

Once again, notice the proximity of the dog’s mouth to the child’s face.

Now, this is an image that I love! The dog appears content and is with this child by choice. The kiddo is petting him in a very respectful manner.

Max was a favorite patient of mine—a huge, gentle St. Bernard. When he came in to see me, he was accompanied by his owner Beth and her two young kiddos who had no qualms about treating Max like a beanbag chair. They flopped all over him. Yet Max never complained.

Twice, I explained to Beth that I was concerned about how the kids were treating Max. She was convinced Max enjoyed it as much as the kids.

Imagine my shock when Beth scheduled an appointment for Max to be euthanized. The poor dog finally snapped and caused severe damage to the face of one o f the children. This was heartbreaking for everyone involved. Thankfully, Beth allowed me to re-home Max to a household without young children.

Please share your thoughts on these photos. Do you think I’m being overly cautious? Any words of wisdom about the combination of dogs and children?

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Wagging tails are great, right? They convey so much happiness. But sometimes, wagging tails can be problematic. Watch this video of a tail that operates like a constant metronome. Imagine if we could harvest all that wag as an energy resource!

Ever observed wagging tails upend flower vases and knock over beverages? People living with these waggers must “tail-proof” their homes!

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Ever been slapped across your thigh by a tail that stings like a whip? And the more you react, the more the dog wags? Ouch!

Veterinarians commonly deal with tail tip trauma, aka “happy tail syndrome.” It’s caused by repeated whacking of the tail against a firm surface such as a wall, door, or refrigerator. The blood loss isn’t a significant issue and rarely is the wound very painful.

No big deal, right? Wrong! A seemingly simple problem is anything but.

How do you prevent the tail of a happy dog from becoming a living paintbrush, spattering red around your home, creating a personalized CSI crime scene? Immobilizing a dog’s tail is pretty much impossible as is keeping a bandage in place.

How do you prevent the dog from licking and chewing at the tail tip long enough to let it heal?

Once the sore heals, how do you prevent it from recurring?

There are several things worth trying:

Stop the bleeding with 5-10 minutes of pressure over the wound.

Use an Elizabethan collar to keep the dog’s mouth away from the tail tip (must be a very large collar).

Try to prevent wagging against hard surfaces. (Happen to have a padded room?)

Bandage the tail. Keep in mind that a bandage covering just the tip is likely to slide right off. Consider running it up the length of the tail.

Secure a protective cover, such as an empty syringe case, over the bandage.

Sedate the dog to lessen the amount of tail wagging.

Extreme as it may sound, amputation of the end of the tail is the treatment of choice if other tactics fail to work or if the problem is recurrent. The tail revision (partial amputation) need not be as extreme as a Rottweiler or Australian shepherd look. Rather, the post-op appearance can be more the length of an Airedale or Vizsla tail—short enough to prevent it from banging against hard surfaces.

Have you ever had a dog who wagged its way into a problem?

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

The Dog Aging Project is a monumental research undertaking that has enrolled more than 50,000 dogs. The purpose of the project is to determine the impact of genetics, lifestyle, and environment on canine longevity.

The Dog Aging Project has already completed several studies. Undoubtedly, there will be more to come. Here’s a handful to get you started.

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Gastric dilatation-volvulus (GDV), aka, gastric torsion, is a horrific disease in which the stomach twists on itself. Picture a fanny pack. One of the straps represents the esophagus that carries food from the mouth to the stomach. The other strap represents the duodenum that transports food out of the stomach. Now, imagine holding both straps and twirling the pack on itself (crimping the straps). Not only does this obstruct outflow from the stomach, it crimps off important blood vessels.

Without emergency surgery (and sometimes even with it) the patient succumbs.

Research from the Dog Aging Project determined that dogs with increased risk for GDV were purebred, were male, had a body weight > 40 kg (88 pounds), had a low body condition score, and were Poodles/Poodle mixes. There was no increased risk associated with fearful or anxious behavior, neuter status, age at the time of neutering, diet type, or the number of meals fed per day.

The composition of 1,726 home-prepared (homemade) diets varied widely. Ingredients included: meats, vegetables, fruits, grains, nuts, seeds, and oils. Only 6% of these diets were nutritionally complete according to the Association of American Feed Control Officials adult dog maintenance standards.

For those of you who are strongly against commercially prepared dog food, remember, I’m just the messenger!

Researchers evaluated the diets of 27,478 dogs. Home-prepared diets were associated with higher odds of gastrointestinal, liver, and kidney diseases compared to dogs eating an extruded diet (kibble). A commercial raw diet was associated with higher odds of respiratory disease compared to an extruded diet.

Remember, I’m just the messenger!

Researchers discovered that dogs and humans share some of the same biomarkers (a measurable substances in the body) that are predictors of mortality. The researchers concluded that, given their relatively short lifespan, dogs may be an extremely valuable translational model to understand the underlying molecular causes and consequences of age-related human mortality.

Canine cognitive syndrome is widely recognized as the doggie version of dementia. Researchers showed that, just as in people, dogs’ physical activity is associated with better cognitive outcomes.

There appear to be parallels between Canine Cognitive Dysfunction (CCD) and Alzheimer’s Disease (AD) in people. Both are associated with excess accumulation of the protein amyloid within the brain tissue. In this study, dogs with more severe CCD symptoms had higher concentrations of amyloid within certain areas of their brains (evaluated post-mortem).

I recently wrote about the anti-aging drug, rapamycin and the Triad Study (Test of Rapamycin in Aging Dogs). Can’t wait to see these results.

Want to enroll your dog in the Dog Aging Project and/or the TRIAD study? The only prerequisite is that you have a reasonably accurate sense of when your dog was born. Click here to learn how to enroll.

Best wishes to you and your four-legged family members for abundant good health,

Dr. Nancy

drnancykay.com

Speaking for Spot - Dr. Nancy Kay is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.