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This guide helps you triage; it does not replace your veterinarian's exam. When in doubt, call us at 514 223-1197.
This page is about dogs
A cat who has gone flat, or who is hiding somewhere he never hides, is more urgent than a lethargic dog, not less: he is not sleeping in, he is withdrawing. Do not apply any of this to a cat. If your cat has switched off, call us, or a 24/7 emergency centre if we are closed.
Go now: the signs that cannot wait
Any single one of these is enough. You do not have to tick several, and you do not have to decide which is worst. Do not wait to see if it passes, do not wait for morning: go to the clinic during our opening hours, or to the nearest emergency centre if we are closed, and call on the way so they can expect you.
Read the list in two passes. First what you can see tonight. Then what you already know about your dog, which counts just as much: on a page about a flat dog, half the reasons to leave are not visible, they are known.
What you can see
- His gums are pale, white, grey, bluish, or on the contrary brick red across their whole surface in a dog who looks feverish. Gently lift his lip and look at the gum just above a canine tooth: in a dog who is well, it is pink and moist. Pale or white means he is short of red blood cells, often because he is bleeding somewhere, and usually on the inside, where you will never see a drop. Grey or bluish means he is short of oxygen. Pale, grey or bluish gums confirm the emergency, but they are a late sign: do not wait to see them before you leave.
- He cannot stay standing, he is staggering, or he collapsed. He is very flat: he cannot stay standing, he is weak, he barely responds. And if your dog collapsed once and got back up on his own, it still counts, even if he looks fine now: a dog who goes down and comes back is not a dog who is well, he is a dog who had an episode. If he is still flat while you are reading this, it is now. If he is completely back to himself, it is the same day, no discussion.
- His belly is swollen, hard, or very painful to the touch. He is pacing, he cannot find a position, he keeps looking at his flank. In a large dog, a swollen hard abdomen with unproductive retching: every minute counts.
- He tries to vomit again and again and almost nothing comes up. A little foam or drool may come out: that still counts as unproductive retching, especially if his belly is swelling or tightening and he cannot settle. That is the picture of a gastric torsion, and it is a race against time.
- He is breathing fast at rest, with effort, with his belly heaving on every breath, or with his neck stretched forward. A dog panting after exercise or in the heat is a different thing; this one is lying quietly and still breathing badly. A dog who refuses to lie down, elbows out and head low, is breathing badly too.
- Yellow is showing on his gums, on the whites of his eyes, or inside his ears. Urine that has turned dark, the color of strong tea, counts the same.
- Blood: he is vomiting blood, bright red in quantity, or brown-black grains that look like coffee grounds, which is digested blood. Black, tarry stools count the same, and all the more so if he is on a prescribed anti-inflammatory.
- He is trembling, seizing, disoriented, or he is pressing his head into a wall or a piece of furniture and staying there. That last one looks harmless and is not: a dog who rests his forehead against a surface and stops moving is a picture seen with brain and liver problems.
- He is cold to the touch, ears and paws, when your home is not cold. In a flat dog, being cold is not a comfort detail, it is a circulation sign.
What you already know about him
- He took a knock in the last 48 hours: a car, a fall, a fight, a door, a shoulder-check from a big dog at the park. Major trauma, hit by a car or a fall from a height, is seen now, even if the animal seems fine. A dog who was fine yesterday and is flat today after an impact is one of the most regularly missed pictures of internal bleeding.
- It is hot, or he has just exerted himself, or he was shut in a car, a sunroom, a garage, a shed or a yard with no shade. A dog who goes flat in the heat or after a long walk is heatstroke until proven otherwise. And in this case only, you do not leave immediately: you cool him first with cold water, the whole body, with moving air, then drive while you keep cooling. The full method is on our dedicated page.
- He may have swallowed something toxic: chocolate, grapes or raisins, sugar-free peanut butter or gum containing xylitol, cannabis, a human medication, antifreeze, a mushroom from the yard, compost. Do not make him vomit, and bring the packaging or a piece of the plant.
- She is unspayed and was in heat a few weeks ago: pyometra, an infection of the uterus, often starts as a flat dog who stops eating and drinks a great deal. There is not always a visible discharge, and it is precisely the form without discharge that is the more dangerous one.
- He is followed for Addison's disease, or he has had episodes of weakness that resolved on their own: an Addisonian dog who goes flat, especially after a stress such as boarding, travel, a thunderstorm or surgery, can tip into a crisis. That is not something you watch at home.
- He is treated for Cushing's disease with trilostane or mitotane. His own page already publishes the instruction, in its "never do this" list, and we are not rewording it: "Give the usual dose if your dog is already unwell (poor appetite, vomiting, weakness, lethargy): these can signal dangerously low cortisol. Stop the medication and contact us immediately." In plain terms: do not give the next dose, and call us.
- He is diabetic and on insulin: call us before the next injection, even in the evening, even if it is due in an hour. Do not decide on your own to give the dose or to skip it. If he is also weak, disoriented, vomiting, breathing fast, or his breath smells oddly sweet: leave right now.
- He is a puppy, and above all a puppy whose vaccine series is not finished. Everything moves faster in him, and a flat puppy is now, not tomorrow.
One is enough
You do not have to work out which of these matters most. If one of them speaks to you, go. Two lines are the exception and ask you to call before you leave, and they say so in their own text: the dog treated for Cushing's and the diabetic dog. If you are unsure, call anyway: triage is our job, not yours. Outside our hours a 24/7 emergency centre answers, and describing the situation on the phone commits you to nothing.
A swelling belly and unproductive retching have their own page, because that is the picture where every hour counts: gastric torsion.
In the heat or after exertion, the exception to leaving right away: cool him first, drive second.
For poisons, the first steps by product: toxic foods and plants, chocolate calculator, the emergency page.
Lethargy on its own cannot be triaged. Lethargy plus something can.
This is the most useful thing anyone can tell you tonight, and nobody has said it to you straight: "lethargic" means almost nothing on its own. That is not a failure of your observation, it is the nature of the sign. A dog switches off when he hurts, when he has a fever, when he feels sick, when he is short of red blood cells, when his heart is working too hard, when a hormone has run out, and also when he simply ran too much yesterday. From the outside, all of those dogs look alike.
So we ask you something else, and it is far easier to answer: what else is there? Look for it in the table below. The second sign is specific, and it is the one that sets the clock.
Three reading rules, before the table
- There is no row in this table that says "watch him". That is deliberate, and it is not an oversight. A triage table with a "watch" box always ends up being read as the default box, and that is exactly the box a lethargic dog gets lost in. The lowest tier on this page is an appointment.
- Two different rows do not average out, they escalate. A dog who is limping and drinking more than usual is not "two small problems": he is a dog we want to see today, not this week. When two rows speak to you, always take the more urgent of the two, never the average.
- Tier 1 is already settled. If you recognized your dog in the wall above, this table no longer applies to you: you are leaving. It starts below that.
Today, without letting the day go by
These do not necessarily mean the overnight emergency, but they do not go through a watching phase either. Call us, or take the first available appointment without letting the day go by. If we are closed and you are unsure, a 24/7 centre will tell you whether it holds until morning.
| What you see on top of the lethargy | What it can mean |
|---|---|
| He has stopped eating entirely. | Flat plus a complete refusal is the most common and the most telling pair. A dog who has stopped eating altogether is not watched over several days.My dog stopped eating |
| He is vomiting. | Digestive, but not only: a foreign body, pancreatitis, an Addisonian crisis and a pyometra all start this way.My dog is vomiting |
| He has diarrhea. | Same reading: the gut is talking, but the cause may be elsewhere.My dog has diarrhea |
| He is limping, stiff all over, or the limp moves from leg to leg. | A limp plus a fever is a sick dog, not an injured one. A limp that moves between legs also points to tick-borne disease, well established in southern Quebec.My dog is limping |
| He seems feverish: shivering, seeking cool floors, trembling. | An infection somewhere. Hot ears mean nothing; what counts is the whole picture. |
| He is straining to urinate, producing little, or there is blood in his urine. | Urinary tract, prostate, kidneys. A dog straining without producing is never watched at home.Blood in the urine |
| He is drinking much more and urinating much more than before. | Diabetes, kidneys, Cushing's, pyometra in an unspayed female. This is a change, not a habit: it counts. |
| He is coughing, or he runs out of breath far sooner than he used to on walks. | Heart or lungs. Count his resting breathing before you call, we will ask.Counting breaths at rest |
| An ear that smells, an ear that is discharging, or he is shaking his head and scratching at it. | An ear infection hurts a great deal and can switch a dog off completely. Common, treatable, and not something to sit out over a weekend. |
| His head is tilted, he circles, he loses his balance, his eyes flick on their own. | Vestibular syndrome, inner ear, or something in the brain. Dramatic, not always serious, and never triaged from the living room.My pet is losing balance |
| A red eye, an eye held shut, a running eye. | A painful eye does not wait until tomorrow: call us during our opening hours, and outside our hours it goes to a centre open 24/7. Do not put any drops in.My pet has a red eye |
| A new lump, a wound that will not heal, a mass that has changed. | To be examined, and never squeezed or handled.A lump under the skin |
| He had an anesthetic, surgery or a dental in the last few days. | Reduced appetite and some flatness in the following 12 to 24 hours are expected. Beyond that, or with real lethargy, follow your discharge sheet and call us.Post-operative care |
| He started a medication this week, or his dose changed. | Call before the next dose, and stop nothing on your own, apart from the two exceptions written in section 5. |
| You have several dogs and another one is unwell too. | A contagious infection or a shared exposure (bin, compost, standing water, a spilled product) changes the reasoning entirely. Tell us straight away. |
An appointment, and we make it this week
These are the pictures that build over weeks or months. They do not call for the emergency room, and they do not call for waiting until the next vaccine either.
| What you see on top of the lethargy | What it can mean |
|---|---|
| He has lost weight without you changing what he is fed. | Weight that drops on its own is always information, never a success. Kidneys, liver, gut, cancer. |
| He has gained weight without eating more, he seeks out warmth, his coat is thinning on both sides. | The classic hypothyroid picture, and the one most often blamed on age.Hypothyroidism in dogs |
| He drinks more, his belly has rounded out, he pants a great deal, his coat thins symmetrically. | The Cushing's picture.Cushing's disease |
| He does this every so often and it always passes on its own. | Tell us in exactly those words. That is the description of Addison's disease, and it is valuable information.Addison's disease in dogs |
| He gets up slowly, hesitates at stairs or the car, no longer jumps into the boot. | Pain, almost always joint pain. A dog in pain withdraws and switches off: he does not cry out.Osteoarthritis in dogs |
| He sleeps by day and paces at night, seems lost in a room he knows, forgets his house training. | Possible cognitive dysfunction, but it is never "just age" until an exam has ruled out a treatable cause.Cognitive dysfunction in dogs |
| His back legs drag, his nails wear on the top, he knocks his hindquarters into things. | Something in the spinal cord or the nerves. A dog who wants to move and cannot is not a tired dog. |
| His breath has changed, he chews on one side, he drops his kibble. | A painful mouth. Plenty of dogs keep eating with teeth in terrible shape, so appetite proves nothing here.Bad breath |
And if no row speaks to you?
Then you are the reader of the next section, and it is the most important one on the page. Do not skip past it: "nothing else" is not good news in itself, it is simply the least informative version of the problem.
What you can check tonight, and what it actually tells you
Maybe you are looking for a second sign and cannot find one. Here are five things you can look at yourself, right now, with nothing but your hands and your phone. But read the rule that governs all five first, because it matters more than the five put together.
The one-way rule
Everything you can check at home only works in one direction. These observations can send you out the door. None of them can keep you home.
Pink gums do not prove he is not bleeding. Quiet breathing does not prove his heart is fine. A normal temperature does not prove there is no infection. A dog who gets up for you does not prove he is not in pain. Each of these checks can raise the urgency; none of them lowers it.
That is why we give them to you anyway: the worst outcome of this page is a dog who stays home. These checks exist only to catch the one who should have left.
1. His gums
Gently lift his upper lip and look at the gum just above a canine tooth. In a dog who is well, it is pink, moist and glossy.
- Pale, white, grey or bluish: go. No call first, no second check.
- Bright red or brick red across the whole gum, away from the tooth line, in a dog who seems feverish or has been hot: go as well. A gum that is red only along the teeth, in a thin band against them, is something else: that is gum disease, and it is an appointment.
- Pink: that is good information, keep it for us. It closes nothing.
- Dry or tacky under your finger rather than slippery: note it and tell us, it says something about hydration.
Three cautions. Plenty of dogs have naturally pigmented gums, mottled or fully black: on them this check does not work on the gum at all. Look instead at the inside of the lower eyelid, easing the skin under the eye down, or at the underside of the tongue. If you cannot get a look, that is not a failure: it is one more reason to call rather than decide. And never force open the mouth of a dog who is in pain or confused: you risk a bite, and seeing nothing would prove nothing.
One tip for later, and it is the best on the page: photograph his gums tonight, and photograph them again on a day when he is perfectly well. Normal pink varies a great deal between dogs, and the only comparison that truly counts is with himself.
2. His breathing at rest
Watch him breathe while he is lying quietly, not hot, not just after moving. Normal breathing at rest is almost invisible and silent: a slight movement of the chest, no sound, no push from the belly.
What is not normal, and what counts whatever the number: the belly pumping hard on every breath, the neck stretched and the head low, the elbows held out, the nostrils flaring wide, noisy breathing, and a dog who refuses to lie down.
You can also count: one breath is one in and one out, count for 30 seconds and double it. At rest, most dogs breathe fewer than about 30 times a minute. Our dedicated guide explains the technique and what we do with the number, and it carries one instruction worth remembering: if your dog is breathing with effort, do not recount, go.
3. Weak, or lethargic? They are not the same thing
This is the most useful distinction in the section, and it takes one observation. Call him from another room, or rustle the treat bag. Once, not all evening, and not at all if a sign from the wall is present: in that case you test nothing, you leave.
- He does not get up and does not try. He looks at you, he may even wag, but he stays put. That is lethargy: something is taking away the wanting, or making him nauseous, feverish or sore.
- He tries to get up and cannot, or he gets up and goes back down, or he moves unsteadily, or he drags his hindquarters. That is not lethargy, that is weakness, and it changes the reasoning completely: muscles, nerves, spinal cord, circulation, blood sugar.
- He does not react at all to the thing that always gets a reaction: stop there and call us.
A dog who wants to move and cannot is never watched at home, even if he seems calm and comfortable otherwise. And above all: do not take him out for a walk to wake him up. A dog with abdominal pain, a dog bleeding internally and a dog with heatstroke will all seem to follow you, and all three get worse walking. If your dog already lives with a diagnosed mobility problem, our guide on helping him up covers the daily handling; it does not replace the call for new weakness.
4. Temperature: what we can honestly tell you
Hot ears, a dry nose, a warm nose: none of it means anything. Not one of the three indicates fever in a dog, and plenty of people decide to stay home on the strength of a wet nose.
Taking a dog's temperature is done rectally, with a thermometer, and on a dog who is flat, sore or confused that is neither easy nor free of bite risk. So we publish no protocol and no threshold here: when in doubt, the clinic can take his temperature. With us it takes seconds.
And above all, the essential part: a normal temperature removes nothing. A dog bleeding internally, a dog in an Addisonian crisis and a dog with a gastric torsion can all have a perfectly normal temperature, or a low one. A fever raises the urgency; the absence of one does not lower it.
5. Film him. Twenty seconds.
This is the most useful thing in the whole section, and almost nobody thinks of it. Lethargy is the one symptom that vanishes in the exam room. A dog who has not moved off the sofa in eight hours arrives here, smells thirty smells, hears another dog, gets a shot of adrenaline, and stands there with his tail up for the whole consultation. You leave feeling you were not believed. This happens every day, and it is nobody's fault.
So film him now, as he is: lying down, called by name, getting up if he gets up, walking three steps. Twenty seconds is enough. It is genuine clinical data, and it is often what changes what we look for first.
And if you have one from a year ago, bring that too. You will see the difference on your phone screen before we see it on the exam table.
And if there really is nothing else?
You have read the wall, you have looked through the table, you have checked his gums and his breathing, and there is nothing. Just a flat dog. This is the most common situation on this page, and it is also the one where we owe you the most honesty.
So let us say it plainly first: "nothing else" is not reassuring in itself. It does not mean there is nothing. It means what you can see is not enough to triage on, and that is precisely why the triage now moves to something else: time. Two completely different situations hide behind the same sentence, and they are not handled the same way.
It started today
If your dog is a healthy adult and all of the conditions below are true at the same time, you can keep him quiet until we open, rechecking him actively, and call us at opening.
All of these conditions at once
- A healthy adult, no known illness and no current medication.
- Nothing from the wall, in either block. Reread the "what you already know about him" block in particular: that is the one people skim.
- Nothing from the table in section 2, at either tier.
- He gets up when you call him, he moves normally, he is not unsteady.
- He ate his meal and he is drinking as usual.
- His gums are pink and moist: neither pale, nor brick red away from the tooth line.
- He breathes quietly at rest, without effort, with no push from the belly.
- Nothing has gone missing in the house: no toy, no sock, no chewed packaging, no dropped medication, no tipped-over compost.
- He is not a puppy, not a senior, not a toy breed, not a large deep-chested dog, not a flat-faced dog, not an unspayed female, and he has never had heatstroke. The full list is in section 7, and that list is the one that counts.
- He has taken no knocks: no car, no fall, no fight, no heavy body-check at the park.
- He has not been hot and has not done anything unusually strenuous in the last three days. A dog who goes flat a day or two after a big hot day or a long walk does not belong in this tier: he gets seen.
- He has had no vaccine and no new medication in the last 24 hours. A dog who is a bit flat the day after a vaccine is expected; a dog who is properly flat, whose face is swelling, who has hives or who is going weak, is a call right now.
- And this is counted in hours, not days.
What "keeping him quiet" means
No long walk, no running, no ball, no dog park, no play with the other dog in the house. Outside on the lead for toilet breaks only, then back in. Fresh water always available. A quiet room, at normal temperature, where you can see him.
You are not watching him: you are rechecking him
This is the difference between a plan and a delay, and it fits in one sentence. "Watching" means glancing over from the sofa now and then, and that is how a whole night passes with nothing seeming to change while everything changes. Rechecking is something else.
Two hours after reading this page, repeat exactly the checks from section 3: gums, breathing at rest, does he get up when you call him. Then again before bed. Write down the time and what you saw. If anything has moved the wrong way, you do not wait for morning.
In the morning you call, even if he seems better
That sentence is not negotiable and it is not excess caution: it is the instruction we already publish for a limp watched at home. A dog who was genuinely switched off for an evening and is better by morning is a dog who had something. Most of the time a short call is enough to reassure you. Sometimes it is the first episode of a pattern that will come back, and the fact that it resolved on its own is exactly the most important thing you can tell us.
This is not a delay to spend
This tier is not a reserve of time you are entitled to use up. It is the limit past which you stop looking and pick up the phone. A single signal cancels it, at any hour of the night. And if you have the slightest doubt about even one condition on the list, the list does not apply to your dog: call.
A Friday evening is not a waiting room
More than sixty hours pass between Friday evening and Monday morning. A pyometra, an Addisonian crisis, a mass bleeding into the abdomen or an infection do not pause for the weekend, and the dog who arrives on Monday almost always arrives sicker than the one we would have seen on Friday. If we are closed, call a 24/7 emergency centre: they will tell you whether it is now, today, or an appointment. You do not have to decide alone.
It has been going on for weeks
The most dangerous sentence on this page
"He is slowing down."
It is dangerous because it is gentle, because it sounds like an observation and works like a conclusion. Once it has been said, everyone stops looking. So let us be clear: getting older is not a disease, and it is not a diagnosis either. A dog who is slowing down has not been given an answer. He has been given a description of what you can see, with the word "age" attached to it.
And slow lethargy is exactly the ground of the diseases this page is a front door to. Cushing's, hypothyroidism, Addison's disease, immune-mediated anemia, heart disease: not one of the five arrives on a Tuesday evening. They settle in, they blend into aging, and they treat far better the earlier they are named.
The year-old video test
You do not have to take our word for it. Open your phone gallery, go back to last summer or to Christmas, and find a video where your dog is walking, playing or greeting you. Watch it.
What you are about to see, nobody in the house could see live: the change spread over enough months for you to adapt to it daily, one small adjustment at a time. You shortened the walk, you stopped throwing the ball, you help him into the car. Each of those was reasonable. Together, they erased the curve. If the video hurts, bring it. It is real data, and it is often what triggers the workup.
What people describe as "age", and what is not
Not one of these changes is a normal effect of getting older. Each is a reason to book an appointment, and each has causes that can be treated.
- He sleeps noticeably more, and he sleeps more deeply.
- He no longer comes to greet you at the door.
- He no longer takes the stairs, no longer jumps into the car, no longer gets on the sofa.
- He no longer plays with the other dog in the house, or he turns away from him.
- He lies down on walks, or he turns for home on his own.
- He has put on weight without eating more, or he has melted away without you changing his ration.
- He seeks out warmth, he shivers in a room where he never used to.
- His coat is dull, or it is thinning on both sides of his body.
- He pants at rest, without having been hot or having run.
- He is restless at night, he circles, he seems lost in a room he knows.
- He drinks more, and he asks to go out at night.
The marker for this section
A dog who has been flat for three weeks is not a dog to watch. He is a dog with something nobody has named yet.
That does not mean it is serious, and it does not mean the emergency room. It means lethargy that has lasted has passed the point where watching adds anything. The question is no longer "will it pass", it is "what is it". And that question is answered with an exam and a blood test, not with time.
And if you feel guilty for not seeing it sooner
You did not miss it through neglect. You missed it because the change was slower than your memory, and because you did exactly what someone who loves their dog does: you adapted to him. Nobody is going to hold that against you here, least of all us. The only thing that matters now is today's date.
Give him no medication, and what actually helps while you wait
Faced with a switched-off dog, the temptation is to give him something to take the edge off while you wait. That is the well-meant act that brings us the most poisoned dogs, and on this page it is more tempting than anywhere else, because lethargy looks like pain and we all have a tube of painkiller in the cupboard.
What you never give
Ibuprofen (Advil), naproxen (Aleve)
Toxic to dogs, and even more so to cats. Stomach ulcers, digestive hemorrhage, kidney damage. "My dog looked like he was in pain, so I gave him an Advil" is the most common sentence behind these cases. Veterinary anti-inflammatories exist precisely because ours do not suit them.
Acetaminophen (Tylenol)
Toxic to a dog's liver and blood. No safe home dose. In cats it is worse still: fatal, from a single tablet, and there is no safe dose at all.
Aspirin
No human aspirin, not as a stopgap, not just this once.
Pepto-Bismol
It contains a salicylate, the same family as aspirin. Never without instruction, and it turns the stools black, which masks exactly the sign of digestive bleeding we were looking for.
Gravol, Imodium, antacids, antihistamines, leftover prescriptions
Never without instruction. And Imodium is particularly risky in dogs of herding lines, who often carry a genetic quirk that makes them very sensitive to that kind of molecule.
A painkiller your dog has had before
This is the trap specific to this page. The box has his name on it, the dose was right eight months ago, and yet: an anti-inflammatory given to a dog who is bleeding, dehydrating or whose kidneys are struggling makes worse exactly what we are trying to treat. And it masks the pain that would have told us where to look.
A leftover antibiotic
Half a course from last time does not treat an infection, it distorts the testing and complicates what comes next.
Another animal's medication
Same apparent diagnosis, same weight, same household, it is never enough.
The only two exceptions, and they run the other way
These are the only two situations where we would rather you hold a dose before you have even spoken to us.
- He is on a prescribed anti-inflammatory and he loses his appetite, vomits, or passes black tarry stools: stop the medication and call us. Those are possible signs of a digestive ulcer. Black stools are in the emergency wall too, and the wall is what commands.
- He is treated for Cushing's disease with trilostane or mitotane and he is flat, weak, off his food or vomiting: do not give the next dose, stop the medication and contact us immediately. The full instruction is in the emergency wall.
In both cases: you hold, you call, you do not restart on your own.
What actually helps while you wait
The list is short, and that is honest: lethargy has no home remedy. What follows is there to avoid making things worse and to give us good information.
- A quiet room, at normal temperature, where you can see him. Not a cold basement, not a sunroom.
- Fresh water always available, never forced. Note whether he is drinking more than usual or not at all: both interest us.
- His usual meal, a small portion, once. Do not push, and do not bring out human food to tempt him: a fatty meal is a classic trigger for pancreatitis, and a nauseated dog links a food to feeling awful very quickly.
- Take him out on the lead for toilet breaks only, and look at his urine and his stools. "He has not passed a stool since yesterday" and "his urine is very dark" are real information.
- Write down the time you noticed the change, and the time of each recheck.
- Walk the house: a toy, a sock, a wrapper, a medication container, a torn bin bag.
- Film him, as explained in section 3.
What harms
- Do not walk him to wake him up. This is the most common move and one of the riskiest: a dog who is bleeding, torsing or overheating will seem to follow you.
- Do not force-feed him and do not syringe food into him. If his gut is blocked or his pancreas inflamed, nothing should go in by mouth before he is examined.
- Do not fast him on your own initiative either. If resting the gut helps, the veterinarian will say so, and will say for how long.
- Do not make him vomit on your own initiative. Making a dog vomit at the wrong moment, and above all a dog who is already flat, can make things worse; hydrogen peroxide, often recommended online, causes stomach ulceration and can be inhaled. In dogs, only your veterinarian or an animal poison line can guide you, and only in specific cases. The numbers are on our poisons page.
- Do not bathe him in ice water if he has been hot, and do not drape him in a wet towel that will warm up. The right method is on our dedicated page.
- Do not stop or change any current treatment apart from the two exceptions above.
Already given him something tonight?
No blame: it is what someone trying to help does, and plenty of people do it. But do not do it again, and call us now rather than tomorrow, with the packaging to hand. Tell us what, how much, and at what time. It does not shock us at all, and it is information we need to interpret what we are seeing and to choose what we can safely give him next.
Get your call ready (2 minutes)
- Since when exactly? A few hours, or are you realizing it has been weeks?
- Does he get up when you call him, or does he try and fail?
- His gums: pink, pale, yellow? His breathing at rest: quiet, or with effort?
- Has he eaten, drunk, urinated, passed a stool in the last 24 hours, and what did it look like?
- What changed this week: food, a move, boarding, a new medication, a recent anesthetic, a long walk, a very hot day, table scraps, the bin?
- Has an object, a toy or a medication container gone missing?
- Has he taken a knock, a fall, a fight, even two days ago?
- Is she an unspayed female, and when was she last in heat?
- His known illnesses, his current medications, and the time of the last dose.
- Do you have a video of him today, and one from a year ago?
And to give him his actual medications?
A flat dog is also a dog who will no longer take his tablets in a mouthful.
Why a dog goes flat
A dog does not decide to switch off. When he does, something is pushing him there, and that something is what we look for. Here are the leads, arranged by what you can observe at home. They are not here for you to choose from: they are here so you recognize yours and can name it to us on the phone.
The pain you cannot see
This is one of the most common causes of lethargy in dogs. It is also the most missed, for a simple reason that needs saying once and for all: a dog in pain almost never cries out. He withdraws, he goes quiet, he sleeps more, he stops coming to greet you. That is often all you get to see. Waiting for a whimper before you believe in pain is waiting for a sign most dogs will never give.
The back and the neck
A dog with a sore back is often taken for a tired dog. What we look at: he holds his head low, he hesitates to shake himself, he will not lift his head for a treat, he walks in short stiff steps, he cries when you lift him under the belly, he trembles. In long-backed breeds this pain can progress to something in the spinal cord, and then every hour counts.
The abdomen
Abdominal pain switches a dog off completely, often before any other sign. He holds his back arched, he refuses to have his belly touched, he stretches repeatedly as if praying, he cannot find a position. That posture also belongs to gastric torsion, and that is exactly why it sits in the wall at the top rather than in a drawer.
The joints
Osteoarthritis is the silent pain par excellence. It does not look like a clear limp: it looks like a dog who hesitates at the stairs, who gets up in two stages, who no longer jumps into the boot, who lies down on walks. A dog already diagnosed with arthritis can also have a flare: knowing his disease does not lower the urgency by a notch, it only shifts it.
The ears
An ear infection hurts a great deal. A dog who shakes his head, scratches at his ear, whose ear smells or is discharging, can be completely switched off by that alone, and be himself again within days once treated. It is one of the most common and most fixable causes of lethargy in dogs.
The mouth
A fractured tooth, a root abscess, a badly inflamed gum. What we look at: he chews on one side, he drops his kibble, he drools, his breath has changed, he turns his head sharply while eating. And the reverse reasoning counts just as much: plenty of dogs with a mouth in terrible shape keep eating without showing a thing. Appetite proves nothing here.
Blood, heart and breath
This drawer gathers the causes that starve the body of oxygen. They produce a spectacularly flat dog, and they are the ones where the gums speak loudest.
Anemia: he is short of red blood cells
An anemic dog is weak, he runs out of breath over nothing, his heart races, and his gums go pale. In dogs, one of the most important causes is a disease in which the immune system destroys the red cells itself: immune-mediated hemolytic anemia. It can build over days or tip all at once, it sometimes brings yellow gums and dark urine, and it is a medical emergency.
The bleeding you cannot see
This is the most important paragraph on the page for the owner of a big middle-aged dog, so we will write it plainly. A mass can grow on the spleen with no sign at all for months, then bleed into the abdomen. The typical picture: a dog who collapses or suddenly goes very weak, sometimes with a belly that swells, often with pale gums, and who partly recovers on his own within an hour or two. That apparent recovery is what costs lives, because it gives exactly the permission to wait until tomorrow. A dog who has collapsed once is seen the same day, no discussion, and right away if he is still weak or flat.
The heart
A dog in heart failure tires faster, sometimes coughs, breathes faster at rest, eats less, and becomes much quieter. The night-time cough and running out of breath on walks often come before everything else. A dog with a known murmur who goes flat is not a dog who is getting old: he is a dog to reassess.
The airways
In an older large-breed dog, a voice that changes, noisy breathing on exertion and a marked intolerance to heat point to laryngeal paralysis. These dogs cope very badly with summer.
Hormones, the great pretenders
These are the diseases that imitate aging perfectly. They settle in slowly, they almost never have an identifiable first day, and once named they often treat very well. If you are the reader of the section on weeks, this is where you may recognize yourself.
Addison's disease
It is called the great pretender, and it is the disease this page most wants you to know about. The typical picture: a dog who is off, who goes flat for a few days, sometimes with vomiting or diarrhea, then who becomes normal again on his own. Then it happens again a few weeks later, often after a stress: boarding, travel, a thunderstorm, surgery. It most often affects young adult or middle-aged dogs. If you recognize yourself in "he does this every so often and it always passes", tell us in exactly those words: it is valuable information, and it is a disease that treats very well once named. Between episodes an Addisonian dog can look entirely normal, and that is precisely what delays the diagnosis.
Hypothyroidism
When the thyroid stops making enough hormone, the whole body slows down. The picture: lethargy, less spark, the impression that the dog aged all at once, weight gain without eating more, seeking out warmth, a dull coat shedding on both sides of the body, and repeated ear or skin infections. It is the most deceptive sign of all, because it gets blamed on aging. Worth noting, and its own page says so plainly: there is no emergency at onset, these signs call for an appointment, not the emergency room. Which does not mean waiting until next year.
Cushing's disease
An excess of cortisol, the stress hormone, which ends up affecting nearly every organ. The picture: intense thirst, more frequent urination, a belly that rounds out, heavy panting, symmetrical hair loss, muscle weakness, poor heat tolerance. And one remark that matters on this page: Cushing's usually gives a dog who eats more, not less. A Cushingoid dog who loses his appetite and goes flat, above all if he is already on treatment, is a dog we want to hear about right away.
Diabetes
He drinks a lot, he urinates a lot, he loses weight despite a good appetite. A diabetic dog who goes flat, weak or disoriented, or whose breath smells oddly sweet, is not observed: you call before the next injection.
Infection, fever, and what circulates in Quebec
Tick-borne disease
Ticks are well established in southern Quebec, including the Montreal area, and their range is spreading. A dog who goes outside here is an exposed dog, even if he never sets foot in a forest, and they are not only a summer problem: they can be active as soon as the temperature climbs above about 4 degrees. The possible signs of Lyme disease are exactly the ones that bring a reader to this page: stiffness, limping, fever, poor appetite, lethargy, swollen lymph nodes. Anaplasmosis and ehrlichiosis give neighboring pictures. Two important things: these signs can appear in the weeks, even the months, after a bite, and most people have never seen a tick on their dog. So do not go looking for a tick before you call, and conclude nothing from not finding one.
Leptospirosis
A bacterium spread in the urine of wild animals, raccoons in particular, which survives in standing water, puddles and mud. A city dog is not safe from it, and Montreal has a healthy raccoon population. It gives a flat, feverish dog who vomits, whose drinking and urinating change, sometimes with yellow gums, and it attacks the kidneys and the liver. There is a vaccine, and where it belongs in your dog's protocol is a conversation for an appointment, not a subject for a triage page.
Pyometra
An infection of the uterus in an unspayed female, most often in the four to eight weeks after her heat. She is flat, she stops eating, she drinks much more and urinates more. There can be purulent, foul-smelling vulvar discharge, but not always: when the cervix is closed there is nothing to see from the outside and the pus builds up inside. That is the more dangerous form, and it is the one that gets missed when people wait to see discharge. It is a surgical emergency.
An abscess, a dental infection, a urinary infection, a prostate
All of them can switch a dog off, all of them treat, and none of them can be found from the living room. A bite abscess can also appear only days after a fight, when the original wound looked like nothing at all.
The organs that wear out
The kidneys
In an aging dog, look for what changed before the lethargy: is he drinking much more, is he asking to go out at night, has he lost weight without you noticing, has his breath changed? A nauseated dog comes to his bowl, salivates, then turns away.
The liver
Loss of appetite, vomiting, lethargy, and sometimes yellow on the gums or the whites of the eyes. A dog who presses his forehead into a wall and stays there belongs in this drawer as much as in the emergency wall.
The gut
An appetite that turns fussy over weeks, weight that drops, loose stools or vomiting every so often, and a dog who becomes quieter. That history explains the past, it does not excuse tonight.
Cancer
In an older dog, lethargy that settles in alongside weight loss, swollen lymph nodes or a new intolerance to exercise is among the pictures we have to rule out. It is not the most common explanation, and naming it here serves one purpose: to stop you waiting another three weeks.
The head
In an older dog, sleeping by day, pacing at night, circling, seeming lost in a familiar room and forgetting house training point to cognitive dysfunction syndrome. The crucial point, and our senior guide already says it: it is never just age until an exam has ruled out a treatable cause.
Summer, toxins, and what he was given
Heat
This is the seasonal branch of the page, and it has an urgency of its own. In dogs the leading cause of heatstroke is not the car, it is exertion in hot weather: a long walk or a play session in full heat is as dangerous as an overheated vehicle. And humidity counts as much as the thermometer, so a muggy day is more dangerous than it looks. A dog who goes flat after a summer outing, who is panting hard, who is unsteady or whose gums are bright red, gets cooled before he gets driven. And the trap that follows, which is the real subject of this page: a dog can seem to recover from heatstroke, then deteriorate over the following hours or days. Lethargy that shows up a day or two after a big hot day is not tiredness.
Something toxic
Chocolate, grapes and raisins, xylitol, cannabis, a dropped medication, antifreeze, a mushroom from the yard, the compost bin. Lethargy is very often the first visible sign, before any vomiting.
A medication started in the last few days, or a dose that changed
Note the date, call us before the next dose, and stop nothing on your own. The only two exceptions are written in section 5, and they concern the prescribed anti-inflammatory and the Cushing's treatment.
A recent anesthetic, surgery or dental
Some flatness in the following 12 to 24 hours is expected. Beyond that, or with real lethargy, a fever or a wound that is changing, follow the discharge sheet you were given and call us rather than relying on this page.
Yesterday's vaccination
Yes, a dog can be a bit flat, have a lump at the injection site and eat less in the 24 to 48 hours after a vaccine. That is known and expected. What is not: a dog who is properly flat, who vomits, whose face is swollen, who has hives, or who is going weak. That is a call right now, not an ordinary reaction.
Stress
A move, building work, a new baby, someone leaving the household, a stay in boarding, a thunderstorm, fireworks, the death of another pet in the house. Stress and grief genuinely change a dog's behavior, and a dog can be authentically flattened by a change in his life. But two things. One: a sick dog withdraws exactly like a sad dog, and from the outside it is the same dog. Two: finding an explanation does not replace the call. "He is depressed" is a diagnosis of exclusion, and it is made after the exam, not before.
The dogs with no margin
The tier in section 4 is already a maximum. For the dogs on this list it does not apply: you call the same day, on the first real day of lethargy, even if everything else looks normal. And if we are closed, you call an emergency centre rather than waiting for us to open.
- The puppyAnd above all one whose vaccine series is not finished. His reserves are tiny and the infectious diseases of young dogs move fast.
- The toy breedChihuahua, Yorkshire, Pomeranian, teacup Bichon. In them, lethargy with trembling can be a drop in blood sugar, and that moves fast.
- The older dogHis lethargy is almost never his age, and he has less reserve to absorb whatever is causing it.
- The large deep-chested dogGreat Dane, German Shepherd, Standard Poodle, Labrador, Boxer. In them, lethargy with a belly that looks different is treated as a possible torsion until proven otherwise.
- The big middle-aged dogAbove all if he has collapsed once, even briefly: that is the same day, and right away if he is still weak or flat. See the paragraph on the bleeding you cannot see, in the second drawer.
- The flat-faced dogBulldog, Pug, Boxer, Shih Tzu. They cope badly with heat and get into breathing trouble faster than others.
- The diabetic dog on insulinCall before the next dose. Do not decide on your own to give it or to skip it.
- The dog treated for Cushing'sOn trilostane or mitotane. See the instruction in the emergency wall: you do not give the next dose, and you call.
- The Addisonian dogOr the one who has already had episodes that passed on their own.
- The dog followed for a chronic illnessKidneys, liver, heart, gut, thyroid, or on medication, above all an anti-inflammatory.
- The unspayed femaleAnd the pregnant or nursing female.
- The dog with a recent anesthetic, surgery or dentalFollow the discharge sheet and call us rather than relying on this page.
- The dog who has already had heatstrokeThe risk stays high all through the warm season, and a past episode does not protect him.
And if his lethargy looks like a known effect of his treatment
Tell us anyway. That is exactly the kind of information that changes a dose, and it is never yours to decide alone.
What we look for, and how
"Lethargic" is not a diagnosis, it is a front door, and it is the widest one in canine medicine. Here is what actually happens when you arrive, so you know what to expect and why we ask you so many questions.
The history, and why it matters more here than elsewhere
On this page in particular, what you tell us weighs as much as what we feel. "It happens every so often over the last six months and it always passes" points to a completely different disease from "he was normal this morning". That is why the call-preparation list exists, and why the video counts.
The exam
We take his temperature, look at his gums and assess his circulation, palpate his abdomen centimeter by centimeter, listen to his heart and lungs, check his lymph nodes, look in his mouth and ears, move his neck and back, and watch him walk. Often that alone is enough to point us: a painful or distended abdomen, a palpable mass, enlarged lymph nodes, a new murmur, an infected ear, a fractured tooth, neck pain.
Blood pressure
We check blood pressure here, in dogs as well as cats, on an awake animal, with no needle and no anesthesia: a cuff, a quiet room, several readings averaged together. It is not automatic at every visit; we do it when the picture calls for it, and it belongs in the workup of a pet who is getting older, in both species. The reading needs a few quiet minutes before the first measurement. If the pressure is running high, we explain what it means for your animal, we build a treatment plan with you, and we schedule a follow-up check to track it.
The laboratory
This is the central test on this page. A blood sample answers a lot of questions: a complete blood count, that is the red cell number, exactly what anemia drops; biochemistry for the kidneys and liver; and the electrolytes, because sodium and potassium are often what give away Addison's disease. Often, not always: some of these dogs have perfectly normal electrolytes, which is one of the reasons we sometimes ask for a second workup a few weeks later. Depending on the case we add a urinalysis, a thyroid level, a specific pancreatic test, a tick-borne disease test, or the hormone testing for Cushing's.
When the results come back
Some tests are run here, in our own laboratory, and the result sometimes comes back during the visit itself. Other samples go to an outside laboratory. How long it takes depends on the test and on where it goes: ask your veterinarian which of the two applies and how long to expect, that is the question to ask when the sample is taken.
Imaging
A chest and abdominal radiograph settles a great deal: the size of the heart, fluid in the lungs, a gut that does not look the way it should, an enlarged uterus. Ultrasound does two very different jobs here. During our opening hours, our team can take a focused look on the spot to answer a single question, such as whether there is free fluid in the abdomen, and that fluid can be tapped or drained right here when it is called for. The full organ by organ ultrasound is a separate, planned appointment, and it also takes place here: either with our own team, or with a specialized imaging team that travels to us.
What follows
Most often, support for pain and nausea, fluids, a clear plan and a recheck date. Sometimes surgery, during our opening hours, when an infected uterus has to come out or a bleed has to be stopped.
And if we talk about hospitalization
Hospitalization here is day hospitalization: your pet is admitted, treated and rechecked on site during our opening hours, and a stay can run over several days, with a recheck each day. We do not provide continuous medical monitoring overnight. When an animal needs to be watched without a break, we stabilize first, then we arrange the transfer to a 24/7 centre, with the full record. In every case, we tell you at admission what the plan is for the night.
And if we find nothing?
That is a good result, and it happens often. A normal exam and a normal workup in a lethargic dog are not a wasted visit: they take the emergencies off the table, they let you sleep instead of watching your dog until three in the morning, and they create a baseline we will compare everything that comes later against. Nobody will hold it against you for coming.
One honest caveat: "we found nothing today" does not mean "there is nothing". Some of these diseases only declare themselves on a second workup, two or three weeks later, once the blood has had time to change. If your dog stays flat, come back. That is not starting over for nothing, it is exactly how a great pretender gets caught.
Frequently asked questions
The questions that come up most on the phone, and two people do not always dare to ask.
He is sleeping more than usual but he gets up when I call him. Can I wait until tomorrow?
There is nothing else: no vomiting, no limping, he is eating. How do I know if it is serious?
How do I check his gums, and what does it actually tell me?
He had a long walk yesterday, or it was hot. Surely that is all it is?
It is the evening and you are closed. Do I wait until morning?
He is 11 and he has been slowing down for months. That is just age, isn't it?
He has been flat for two or three weeks but he is still eating. Can it wait for his next vaccine?
Can I give him something in the meantime, for pain or fever?
My cat has gone flat, or he is hiding. Does this page apply to him?
Is he dying?
Also worth reading
The triage, in three sentences
Pale gums, collapse, a swollen belly in a large dog, labored breathing, unproductive retching, something toxic swallowed, a knock taken, an unspayed female, an Addisonian dog, a dog on trilostane, a diabetic dog, a puppy: go now. If there is a second sign, that sign sets the clock, and the lowest tier on this page is an appointment, never a period of watching. And if there really is nothing else, time decides: a few hours gets rechecked and called about in the morning, a few weeks gets examined.
Your dog is not himself and you are hesitating to bother us?
Stop hesitating: hesitating to call is already a reason to call. We triage together, and if an appointment is enough, we will tell you so right away.