"The big one that we see — and I think people wait too long on — is congestive heart failure. Older small dogs that have been coughing or their respiratory rate has been elevated for a couple of weeks before they say, 'Oh, today he's really struggling.'"— Dr. Michael LoSasso, DVM
Episode summary
In this episode, Dr. LoSasso and Julie tackle the question every pet owner faces at some point: is this actually an emergency? Dr. LoSasso explains that while Frisco Emergency Pet Care sees true emergencies around the clock, a small set of conditions genuinely cannot wait — and knowing those conditions before you are in the middle of one can change the outcome for your pet.
The conversation covers the conditions Dr. LoSasso sees most often in the ER, including several that catch owners off guard because they do not look dramatic until they suddenly are. Splenic masses — silent internal tumors that can rupture without warning — are one of the most heartbreaking cases the ER sees. One day the dog seems healthy; the next, the owner is making a decision they thought was years away.
Dr. LoSasso also discusses his background as a published author on end-of-life planning for pets, and why he encourages owners to have those conversations while their pet is still healthy — not at 2 a.m. in an emergency room.
"Splenic masses are kind of a ticking time bomb. Nobody knows they're there. They don't cause any clinical signs, they don't show up on blood work. And then one day that mass cracks open, and we have this older dog that was seemingly healthy, and suddenly they're bleeding into their belly."— Dr. Michael LoSasso, DVM
Key takeaway for pet owners
The conditions that look the least dramatic are sometimes the most dangerous. An older small dog with a slightly elevated respiratory rate, or a dog that seems just a little weak and uninterested in eating, may have a serious underlying condition. When something feels off about your pet — even if you cannot articulate why — that instinct is worth a phone call or a visit.
Questions answered in this episode
The following questions are answered by Dr. LoSasso in this episode, drawn directly from the conversation. These are real clinical answers from a practicing emergency veterinarian with 30+ years of experience.
According to Dr. LoSasso, the conditions that always warrant emergency care include difficulty breathing, sudden collapse, heat stroke (which can occur in Frisco as early as April 1, particularly in flat-faced breeds), seizures lasting more than 30 seconds, and any ingestion of an inappropriate substance — a sock, corn cob, or medications — because early removal leads to far better outcomes than waiting for symptoms to develop.
Dr. LoSasso says the most commonly missed emergency is congestive heart failure in older small dogs. These dogs often have an elevated respiratory rate and cough for weeks before owners recognize it as serious. By the time the dog is visibly struggling, the condition is advanced. He encourages owners not to ignore the older poodle or small dog that is breathing faster than usual or coughing regularly — early treatment is significantly more effective.
A splenic mass is a tumor on the spleen — often hemangiosarcoma — that grows silently for weeks to months without causing any clinical signs, without appearing on blood work, and sometimes without showing on X-rays. When the mass ruptures, it causes rapid internal bleeding. The dog goes from seeming healthy to collapsing and in crisis. Treatment options are limited to emergency surgery (with possible blood transfusion) or euthanasia. Dr. LoSasso notes this is one of the most devastating situations he encounters because owners had no warning.
Dr. LoSasso identifies Labrador Retrievers, Pit Bulls, and Golden Retrievers as the breeds most commonly seen with splenic malignancy in his practice. However, he notes splenic masses can occur in any breed.
Dr. LoSasso, who wrote a book on this topic in 2012, strongly recommends having end-of-life conversations when the pet is still healthy — before it is an emotional crisis. Questions to think through in advance include: Where do you want it done (general practice, emergency hospital, or in-home service)? Who needs to be present? What aftercare do you want? Having these answers ready means the experience can be more peaceful and you have more options — including in-home euthanasia services — rather than being limited to whoever is available at 2 a.m.
Dr. LoSasso says access to recent medical records and blood work is extremely helpful and can save money. If blood work was done that same day by the regular vet, the emergency hospital may not need to repeat it — saving the owner hundreds of dollars and allocating resources to treatment instead. He also notes that knowing the pet's current medications is essential, and encourages owners to ensure that whoever brings the pet in — including pet sitters or spouses — knows what medications the animal takes.
JulieWhen something suddenly goes wrong with your pet, how do you know if it's truly an emergency? Today we're breaking down the signs every pet owner should recognize.
Dr. LoSassoAt FEPC, just like at other emergency hospitals, we see not only true emergencies but we see anything that needs care after hours. But pet owners need to know there is a small set of conditions that we really need to see, including difficulty breathing. We occasionally see the sudden collapse, especially with heat stroke. Down here in Texas, I've seen heat stroke as early as April 1 — doesn't take much, especially the brachycephalic dogs, the smash-face dogs. Seizures that last more than 30 seconds. And the other thing we like to see right away is if they've ingested anything that's not appropriate, whether that's a sock, a corn cob, or medications — because if we can get those out of the body, it tends to go better long term.
JulieWhat are some of the most common red flags that owners should never ignore?
Dr. LoSassoThe big one that we see — and I think people wait too long on — is congestive heart failure. Older small dogs that have been coughing or their respiratory rate is elevated, typically for a couple of weeks before they say 'oh, today he's really struggling.' I definitely wouldn't ignore the older poodle that is having an increased respiratory rate and an increased respiratory effort. The earlier we start treatment on those, the more successful we can be.
JulieWhat about hidden emergencies — things that don't look dramatic at first?
Dr. LoSassoOne of the things I think is most devastating for pet owners are splenic masses. The challenge is that even though they've been present for weeks to months, nobody knows they're there. They don't cause any clinical signs. They don't show up on blood work. And then one day that mass cracks open and starts to either seep or really bleed, and we have these older dogs — typically Labs, Pit Bulls, and Golden Retrievers — that are suddenly bleeding into their belly. They get really weak, they don't want to stand up. People bring them in and say he's not eating, he just seems weak. And they've got no idea that what we're looking at is a tough choice: surgery with a possible blood transfusion, or we make the difficult decision to euthanize.
Dr. LoSassoIn emergency work, I would say 10 to 15% of what I see ends up needing to be euthanasia or is brought to us specifically for that reason. That's why I wrote a book about euthanasia in 2012. It wasn't so much about the process — it was about helping people to start making decisions in advance: where do I want it done, who needs to be present, what aftercare do I want? If you have those conversations when the dog is still healthy, it tends not to be that emotional a conversation, and you're better prepared when the time comes.
JulieWhat's the most important thing for whoever brings the pet to the ER to know?
Dr. LoSassoMake sure they know the animal's health, habits, and medications — and ideally have access to recent blood work. If blood work was done that same day at the regular vet, we may not need to repeat it, which keeps the bill down and means those resources can go to treatment instead. If you have access to a patient portal from your regular practice, that is a fantastic help for us — and for you.