Veterinarian's quick study of how-to article saves choking dogs

Veterinary Partner and K9 Medic credited for presenting external extraction technique

November 8, 2021 (published)
Photo courtesy of Dr. Kristie Williams
Dr. Kristie Williams of West Hills Animal Hospital & Emergency Center in Huntington, New York, captured national attention for using an external extraction technique to save two choking dogs.

For more than a year, a browser tab on Dr. Kristie Williams's cellphone featured an article on a little-known maneuver to dislodge balls from the airways of overzealous canine retrievers. 

So when two separate cases of choking canines were rushed on Oct. 17 to West Hills Animal Hospital & Emergency Center in Huntington, New York, where Williams works, the veterinarian knew just what to do. She pulled up the how-to on external extraction technique, published by the educational site Veterinary Partner, for a quick review.

"I had never done it or had seen it done," she recounted in an interview with the VIN News Service, a division of the Veterinary Information Network, which also publishes Veterinary Partner. "The first call I received that Sunday was that a dog was choking on a ball. I told her, 'I know of this crazy technique. I'll try to use it.' "

The doberman arrived conscious, his airway only partially obstructed by a tennis ball lodged in the back of his throat. The dog was sedated and positioned on his back, belly up. Williams straddled the dog's rib cage, and using the external extraction technique described by Veterinary Partner, she palpated his throat to locate the object. Making a diamond shape with her hands, she used her thumbs to push the ball down and then up, in a J-shaped motion.

The ball emerged from dog's mouth.

Coincidentally, 20 minutes later, a second, more dire choking case arrived unannounced. The pit bull was blue, with a rubber lacrosse ball fully blocking his airway. He was near death.

"There was so much swelling, trauma, saliva, there was no way to get my hands or fingertips around it," Williams recalled. "I jumped on him and did the same procedure, and it worked."

Both dogs fully recovered.

Unbeknownst to Williams, staff members at the practice recorded the heroic efforts. The veterinarian posted the videos to a private Facebook group of doctors in human and veterinary medicine for educational purposes, where it generated acclaim and applause. Many have shared the videos elsewhere on Facebook and TikTok, where it racked up millions of views and attracted attention from television news programs, including CBS's Inside Edition.

"It's crazy how fast this has spread," Williams said. "There are tons of people who've come to us to say, 'We're throwing away every ball in the house for safety reasons.' It was a stroke of good faith that I had that Veterinary Partner article, saw the technique and could use it."

History of how-to article

Video courtesy of Dr. Kristie Williams
Dr. Kristie Williams, with the help of support staff, used external extraction technique to dislodge a tennis ball from the throat of a German shepherd. The video, recorded by tech attendant Jordy Oriantal, was uploaded last month to TikTok, where it generated 30 million views, and other social media platforms.

If you can eliminate the preventable deaths, you can make a difference.

That's a motto of Dr. Robin Van Metre, a co-author of the life-saving Veterinary Partner article, written in 2018. She's practiced emergency medicine for more than 20 years and is an instructor for K9 Medic, a company that teaches handlers how to give emergency medical care to working dogs and family pets. 

The fact that Williams' demonstration of the extraction technique has gone viral makes Van Metre "over-the-moon happy." In situations where working or pet dogs have had an airway obstruction after choking on a ball, owners often attempt to retrieve the ball from their mouths. This can result in injury to the owner's hand and even the loss of fingers, Van Metre said. Other techniques, such as using forceps to grab a ball, often are unsuccessful.

The Veterinary Partner article on external extraction, she said, was written in response to heartbreaking losses. "Month after month, we'd hear of another dog choking on a ball," Van Metre said. "There are only a few precious minutes to remove an obstruction."

Video courtesy of Dr. Kristie Williams
Less than an hour after saving the doberman, Williams used the same technique on a pit bull whose airway was blocked by a lacrosse ball. Both dogs survived. Video of the procedure was captured by veterinary technician Valerie Wicks.

Prevention, she said, is the best way to avoid a tragedy. Van Metre advises owners to assess the size and shape of the balls their dogs play with. "Ideally, a ball on a rope is the safest option," she said. 

Origin of external extraction technique

James Alfred Wight, best known by his pen name James Herriot, first described the technique in his memoir "All Things Wise and Wonderful," published in 1977. But some credit Dr. Tim Crowe, a board-certified veterinary surgeon and founding member of the American College of Veterinary Emergency and Critical Care, with executing the external extraction technique and teaching it to colleagues.

At age 74, Crowe operates a mobile practice in Georgia and hosts remote rounds on emergency and critical care procedures. Reached by phone, he recalled coming up with the extraction technique in 1991 while brainstorming with a friend, Dr. John Anderson, now deceased, who had a patient with a ball stuck in its airway. The ball had a hole in it and was deflated enough that the dog could still breathe, so Anderson removed it with forceps.

But the situation got Crowe and Anderson thinking about what to do when a ball gets stuck behind the palate, and the dog can't dislodge it. "He and I kind of talked about it and thought that maybe there was a way to push it out, rather than going in through the mouth."

Soon after, Crowe got a chance to put the technique into action. "I had a German shepherd that came in struggling with a ball in his airway, so I pushed back there, and the tennis ball came shooting out of his mouth," he said.

Crowe and Anderson wrote their findings in a first aid manual that was never published, but their techniques were featured in a pet first aid video series for police officers and other first responders.

Van Metre, with K9 Medic, said her organization has spent years practicing the trajectory J-stroke technique on hundreds of cadavers to work out exactly how to eject a trapped object.

"We've had several reports of successful execution in the real world," she said. 

This story has been changed to add that James Alfred Wight described the external extraction technique in an edition of his memoirs.

VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email

Information and opinions expressed in letters to the editor are those of the author and are independent of the VIN News Service. Letters may be edited for style. We do not verify their content for accuracy.