"If left to natural selection, these dogs wouldn't exist. These are a human-created breed — and breathing is really important."— Dr. Michael LoSasso, DVM, on French Bulldogs
Episode summary
Dr. LoSasso opens this episode by acknowledging that every breed has its medical detractions — veterinarians tend to focus on pathology, not upsides — but then dives into honest, detailed assessments of the breeds that require the most medical awareness from their owners.
His discussion of French Bulldogs and brachycephalic obstructive airway syndrome (BOAS) is the most thorough you are likely to hear from a practicing ER vet. He explains exactly what the four components of BOAS are — stenotic nares, elongated soft palate, everted saccules, and hypoplastic trachea — and why early surgical correction makes a real difference in quality of life and long-term health. He personally thinks French Bulldogs are adorable, but he would never own one.
His discussion of the Cavalier King Charles Spaniel is equally candid: the sweetest dogs he has ever met, and profoundly prone to valvular disease that often leads to congestive heart failure by age seven. He says many Cavalier owners are "very seasoned" — they've owned ten of them — and know what they're getting into. But first-time owners are often shocked.
"I have yet to meet an aggressive Cavalier King Charles Spaniel. But they are so prone to valvular disease that these guys are frequently in congestive heart failure by the time they're seven. We treat a physical problem medically, which is never going to be the ideal outcome."— Dr. Michael LoSasso, DVM
Dr. LoSasso's advice before getting any purebred dog
Talk to your veterinarian before you choose a breed — not after. Ask what conditions are common in that breed, what questions you should ask a breeder, and whether the breed fits your lifestyle and your ability to manage potential health costs. This conversation is significantly easier before you fall in love with a puppy than after.
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.
Dr. LoSasso explains that as these breeds have been selectively bred for shorter and shorter snouts, the soft tissue inside — the soft palate, the saccules, the trachea — has not changed in proportion. The soft palate, which is the end of the roof of the mouth, now extends past the airway opening, so when the dog breathes in, it is trying to pull part of the soft palate down into the trachea. This is brachycephalic obstructive airway syndrome (BOAS), and it affects breathing their entire lives, leading to heart problems and chronic lung disease from the constant extra respiratory effort.
Dr. LoSasso lists the four components: 1) Stenotic nares — nostrils that are too small, restricting how much air can enter. 2) Elongated soft palate — the soft palate extends into the airway opening and gets partially sucked into the trachea with each breath. 3) Everted saccules — small pocket-like structures inside the larynx that normally sit along the side of the airway but, due to the suction these dogs generate trying to breathe, get turned inside out and protrude into the airway. 4) Hypoplastic trachea — the trachea itself is too small. When all four factors combine, these dogs spend their entire lives working too hard to breathe.
Dr. LoSasso recommends considering surgery early rather than later. Widening the nostrils (stenotic nares correction) is not a difficult procedure, particularly with a CO2 laser. Trimming the elongated soft palate and removing everted saccules if present can dramatically improve breathing and quality of life. The more comfortable the dog breathes, the less strain on the heart and lungs over time. He says if you own a Frenchie or English Bulldog, having these procedures done proactively is a smart choice.
Cavaliers are highly prone to mitral valve disease — a valvular condition where the heart valve progressively deteriorates, eventually leading to congestive heart failure. Dr. LoSasso says these dogs are frequently in heart failure by the time they're seven years old. The frustrating aspect is that valvular disease is a physical problem, and veterinarians treat it medically — managing symptoms rather than fixing the underlying valve. In humans, valve replacement would be the answer. In veterinary medicine, it is available but not commonly accessible or affordable enough to be standard treatment.
Dr. LoSasso explains the concept of hybrid vigor: mixing breeds reduces the frequency of genetic diseases specific to each parent breed. A Heinz 57 mixed breed — thoroughly mixed with no identifiable dominant breed — tends to be less concentrated for any single disease profile. He notes they tend to live longer on average. However, a deliberate cross of two breeds with different genetic diseases exposes the offspring to both disease profiles (at lower frequency). The more thoroughly mixed the dog, the more the disease risks are diluted and the longer the typical lifespan.
Dr. LoSasso recommends talking to your veterinarian before choosing a breed — ask what conditions are common in that breed, what health testing reputable breeders should perform, and what costs you might face over the dog's lifetime. He is particularly frustrated by pet stores selling dogs for $8,000 that come from conditions known to produce sick animals, only for owners to immediately face hospitalization costs they cannot afford. Research the breed first; consult a vet; choose your breeder carefully.
JulieCan you explain why there are so many health challenges with French Bulldogs and similar breeds?
Dr. LoSassoThe challenge with asking veterinarians these questions is that we can come up with a list of health problems specific to almost any breed — there are genetic predispositions to different heart diseases, liver diseases, skin problems. Every breed has its detractions. The French Bulldog has become the most popular breed in the country, and from your veterinarian's perspective, you really need to know what you're getting into. As these dogs have been bred for shorter and shorter snouts, they are more and more prone to what we call brachycephalic obstructive airway syndrome — BOAS. Just because we've bred them to have shortened noses doesn't mean they don't have the same number of teeth wedged in there, sometimes sideways. Their soft palates are the same length they were when their noses were long. So the soft palate — the end of the roof of your mouth — actually extends past where the airway opening is. When they breathe in, they're trying to pull part of that soft palate down into their trachea. That creates a lot of breathing difficulty.
Dr. LoSassoBOAS is really made up of four different problems. First: stenotic nares — the nostrils are too small, so they have a hard time getting enough air in through the nose. Second: that elongated soft palate trying to go back into the windpipe. Third: everted saccules — inside the windpipe, right inside the larynx, there are these small pocket-like offshoots of the airway. Normally they're just alcoves off to the side. But because of the amount of suction these dogs create trying to breathe, they actually turn those pockets inside out — and now we've got something hanging in the airway creating further obstruction. Fourth: these dogs tend to have tracheas that are just a little bit too small. When you take all those factors together, these dogs are trying too hard to breathe their entire lives — and that increased pulmonary effort leads to more heart problems, chronic lung problems. A lot of that could be avoided if those nostrils were opened up, the soft palate trimmed, and those everted saccules removed. Breathing is really important.
Dr. LoSassoIn other words: if left to natural selection, these dogs wouldn't exist. They're a human-created breed. They're usually sweet little dogs. I personally think they're adorable. I would just never own one.
JulieWhat breed comes to mind as particularly medically fragile that surprises owners?
Dr. LoSassoThe love-hate relationship I have with the Cavalier King Charles Spaniel. These are the sweetest doe-eyed little dogs ever. I have yet to meet an aggressive one. But they are so prone to valvular disease that these guys are frequently in congestive heart failure by the time they're seven. A lot of people don't realize that when they get them. A lot of my Cavalier owners are very seasoned — they're like, 'Yeah, this is my tenth Cavalier.' It's awfully hard to have to say goodbye relatively early, because even medically managed, a valvular problem is a physical problem. If they were human, we would replace their valves. We don't have that available readily in veterinary medicine. We treat a physical problem medically, which is never going to be the ideal outcome.
JulieIs it true that mixed-breed dogs are overall healthier?
Dr. LoSassoThat's what we call hybrid vigor. You tend to decrease the number of genetic problems. Now, if you crossed a Doberman with a Cavalier — not that anybody would do that — you'd be exposed to the 47 different liver diseases specific to the Doberman and the Cavalier's heart disease. But the degree and frequency of those issues would be reduced compared to having a straight Doberman or straight Cavalier. The mixed breed, especially what we call the Heinz 57 — so thoroughly mixed I have no idea what's in there — those are the ones where the disease risks are most diluted. And we do tend to see them living longer.