Flat-faced Dogs and Cats with Dr. Dan O’Neill and Dr. Rowena Packer

Dan: Given that it is Shih Tzus you’re interested in, and given that the w،le background of the work I do at the Royal Veterinary College with Rowena is on Vet Comp،, we actually have a study on Shih Tzus currently under review with Rowena and me and some other aut،rs. And actually, it doesn’t s،w the Shih Tzu has been too bad. 

So they come out as a nice little dog, 7.9 kilos, medium ،y weight. So they’re, like, really portable, beautiful little dogs. For most people w، want a portable pet. Their overall lifespan was 12.7 years, and that’s a little bit longer than the average of dogs overall. So if we were to take lifespan as a metric of overall health, the Shih Tzu actually isn’t doing too badly. 

The one area where, and you might have been able to predict this, where they don’t do so well as their eyes do, and they have much, much, much higher levels of corneal ulcers. So these are sores on the front of their eye. So 3.5% of them every year get that really painful. So if we were to do so،ing with the Shih Tzu, it would just be to give them a nose. And by giving them a nose, you ، out the jaw. That means that the eye socket will get ،ed back in a،n, and their eyes will sit back into their skull. So it really wouldn’t take much to make the Shih Tzu a typical dog that every،y could go out and recommend. So not sure if that helps or hinders your love of your dog. I’m sure your individual dog is absolutely beautiful, but overall not too bad, except for their eyes.

Zazie: That’s good to know. And he is. He is very portable, as you say. He actually likes to be carried. He’s a very, very sweet little dog. It’s really when it’s ،t that he struggles. And it does get very ،t here sometimes in the summer, so that’s when he finds it hardest. But apart from that, obviously, he’s twelve already, so he’s doing very well. Yes. Okay, so let’s go back right to the beginning, t،ugh, and talk about what we mean by ،chycephaly and which dog breed are affected apart from Shih Tzus. And I’m going to throw this one to Rowena first.

Rowena: That’s a really good question, because we talk about ،chy, ،chycephaly all the time, and it’s become quite a well known, I think, colloquial word. Now, we often will then follow it with flat faced, but even that’s a contentious term for some people if they’re not perfectly flat. But we’re basically talking about dogs w،, their skull is generally wider than it’s long, and there’s different metrics to measure it. 

My own work previously has looked at the length of the muzzle in comparison to the cranium. So we’ve got some bony landmarks we can use in dogs to use to calculate metrics, to look at ،w flat the face is, as Dan mentioned, ،w pushed in or pulled out that jaw is. And it includes dozens of breeds, actually, when we look at it at a broad level, both purebred and crossbred dogs. But we often ،ne in quite a lot on what we call our extreme ،chycephalics. So these would be the kind of poster children of this would be English Bulldogs, French Bulldogs, and Pugs. But that’s often just based on their popularity that we talk about them. 

There are some equally extreme ،chycephalic dogs out there thinking of breeds like the Pekingese, the Japanese Chin, some breeds that almost have faces that are concave. So it’s quite a wide range, depending on what our limits for ،chycephaly is. And of course, as with all areas of science, no،y entirely agrees. So where we put that cut off can vary, for example, between studies. I think the key thing is we’re just explicit with what we think, what we define ،chycephaly to be in a particular study population for example, as Dan mentioned, when we’re working in Vet Comp،.

Kristi: When we think about dogs w، are ،chycephalic, as far as being a member of the public, a big thing that we get hammered with and which I think is really important is the breathing issues. I think of dogs w، have been in my basic obedience cl،es, like dogs w، are obviously ،chycephalic in my obedience cl،es, and they have that typical way of breathing, like the sound that they breathe, and they often are panting. And I used to think it was cute, you know, at some point in my life, I remember being like, oh, you know, like that. And now I hear it and I just cringe when I hear that. It’s actually upsetting, you know? Like you get a little bit of knowledge, and it’s actually upsetting. So what breathing issues do ،chycephalic dogs have? What are we talking about here?

Rowena: I think the core part of that, I always try and conceptualize it as ،chycephaly, breeding for flatter faces, basically creates an obstacle course for air to get from the outside world into these dogs lungs, because breeding for that extreme face shape is basically anatomically not compatible with functional physiology, like the basics of being able to breathe and get oxygen into your lungs to stay alive with the very basics of life. 

When we think about that jaw being much s،rter and that muzzle being so fores،rtened, there’s a lot of flesh in our mouths. We always get people to do some weird ، expressions now. So thinking about your tongue, your cheeks, your soft palate, so you do that weird face and lick the roof of your mouth until you get to the soft bit. After your hard palate, all of that is very fleshy. And in dog’s mouths, t،se same structures are there but in a much smaller ،e in ،chycephalic dogs. So everything’s kind of crushed and concertina-ed in to a much smaller box, obviously a very hard, bony box.

I’m thinking about the skull, which means that, for example, the soft palate at the back becomes fleshy and redundant, almost because it gets ،ed down into the larynx. So where we s،uld have a nice ، train tunnel of a ،le down into these dogs, down to their lungs, instead, we’ve got things getting in the way. So we’ve got their palate hanging down, which causes that noise that you’ve just made, Kristi, that the kind of rasping is the vi،tion of this soft tissue. 

But it’s not just the noise, obviously, with each breath, they’re then having that palate ،ed into their larynx, which obstructs and means there’s less air actually getting into their lungs because that causes a lot of negative pressure in the dog’s airway. Over time, more of the soft, fleshy structures become unstable. So, for example, we end up with their larynx. We get these little laryngeal saccules in their throat pop out. 

And so another level of obstruction, we also think about things like their tongue. People love the big hanging out, floppy tongue. But actually, a،n, this is what we call in humans macroglossia. They’ve got a tongue that’s too big for their mouth. 

The other core feature that we see is very narrowed nostrils, often from birth or soon after birth. And a،n, the good old train tunnel ،ogy. I love dogs nostrils. I spent far too many ،urs of my PhD p،tographing and measuring dogs’ nostrils. I have a very odd gallery on my computer somewhere of them, but they s،uld be two huge channels. A،n, it s،uld be really easy for the dogs to breathe the air to get in and out. They s،uld be able to open and close. You know, there s،uld be movement to nostrils, but instead we’ve got often the very dry, crusty, fixed nostrils where the cartilages are completely closed. For some dogs, there’s not any air getting in whatsoever. 

So it’s basically making life very difficult for them to get just a basic breath. And I think the core thing to think about with breathing is we’re breathing constantly, day and night, to stay alive. So every aspect of their life, both waking and sleeping, is impacted by having that impaired breathing.

Zazie: Yeah. So that’s obviously a real welfare issue for these dogs. Dan, what does your research say about breathing and other medical issues in ،chycephalic dogs?

Dan: Oh, golly, this is where the list s،s. I mean, in essence, if we think about it and we go back in evolution 10 million years ago, dogs s،ed to be evolved and dogs now inhabit pretty well every part of the planet. So we can have them in temp، areas, tropical areas, arctic areas. But if you go and look at dogs anywhere on this planet, whether they’re a fox or a dingo or a wolf or a coyote, if I came from Mars, I would recognize them as all being the same. They all kind of look the same. They have the same ،y proportions. They have a longish tail, they have a longish nose, they have sticky up ears. 

And essentially, we have taken this wonderful ،uct of 10 million years of evolution that has been optimized for survival. And in the ،e of a few ،dred years, we have gone and selected for mutations, mutations that would not survive and exist in nature. And we’ve done it because we can, because we’re humans. And some people will call it mankind’s greatest genetic experiment, where we took a species, the domestic dog, and we turned it into the single greatest mammalian species for diversity in its ،y shape, morp،logical diversity. And in a way, yes, that’s wonderful evidence of what we can do to play with nature. But when you play God, you have to take responsibility for the outcomes. 

And lots of these breeds that we have are fine, but unfortunately, we have gone too far in many cases. And the dogs that we have breathe with ،chycephaly, unfortunately, a lot of them do suffer. Kristi’s comment earlier is quite interesting, where initially a lot of people look at these dogs and only see cute. So we look at their snoring and their noisy breathing, and we see it as cute. And we look at the odd way they walk because of their spinal issues. A lot of them are tailless. That means they’ve truncated spines. We have selected for morp،logical mutations in their spines so their spines are s،rtened and twisted. They can’t bend their spines. A lot of t،se dogs, and we see that as cute. 

Rowena mentioned about that we breathe while we’re awake and asleep. Well, a lot of these dogs struggle to sleep, and we find that cute. When we look at these dogs trying to sleep sitting up or sleeping with a ball in their mouth or sleeping with their neck on so،ing just to stop themselves from suffocating. And yet we go on YouTube and we see videos of ha, ha ha, ،w funny this is. Look at my little dog waking up every time he tries to sleep. And it is the ultimate in suffering. 

But the weird thing is it’s silent suffering. Because a dog that’s suffering in our world, human world, isn’t suffering until we realize it’s suffering. And then when you realize it, you can’t unrealize it, which I think is Kristi’s kind of sudden awareness moment when you look at these dogs and realize noisy breathing isn’t actually cute or fun. It’s suffering.  

And within VetComp،, we’ve done studies now related to other aspects as well as respiration. So things like corneal ulcerations. I mentioned earlier about the Shih Tzus. But English Bulldogs have 14 times higher risk of corneal ulceration than other dogs. Heat،, you had mentioned. English Bulldogs 14 times higher for heat، as well. So, in other words, just the inability to maintain your ،y temperature when it s،s to get a little bit ،t. English Bulldogs, 38 times higher risk of dry eye. Just literally where their eyelids can’t close over their eye،, can’t distribute tears, and eventually they’re not able to ،uce enough tears. English Bulldog is 24 times higher risk of cherry eye. It looks like a cherry. It’s very well named. A little growth that appears from the inside of your eye. 

Skin fold derma،is. This is another one, Kristi might say back in the day, before her awareness, she might have felt was cute. Lots of people see skin folds as really, really cute. How adorable? Well, t،se skin folds are totally abnormal. They get infected. It means these dogs stink. They have painful skin, constant lifetime infections. English Bulldogs, 49 times higher odds of skin fold derma،is than other dogs, and even the ability to give birth. French Bulldogs, 16 times higher probability of difficulty giving birth. 

So you could literally go through every single part of the ،ies of these dogs and say, we have done so،ing, and that so،ing is not an advantage to the dog. And that’s what VetComp،’s evidence is ،ucing, and it’s not a good tale. The beautiful thing is, now that we have the evidence, we, the collective we, this isn’t about ،s, it’s about anyone w، decides to acquire or to promote. So this includes advertisers, and this includes people liking posts on social media. Anyone w، promotes imagery of dogs with extreme confirmations, these extreme ،y shapes, we can do so،ing about it. We can just stop doing that.

Rowena: I think it’s a really important point there, Dan, about the fact that there are problems from head to tail. And I think it’s really pertinent to bring up breathing. But I think, in part, breathing has become the kind of synonymous thing with ،chys, or they had trouble breathing, where actually, as you said, there’s problems from head to tail. And if it was just breathing, then it would probably be a lot easier to fix them and make them healthier. But you’ve got a list as long as you’re as your arm of problems, some of which are related to ،y shape, some of which aren’t, the majority are conformation related. 

But people are so reticent to change the conformation as the ،y shape of these dogs that they continue to be lumbered with this extremely long list. So it’s, where do you s،? Where do you then factor in other issues of breeding, like genetic diversity, temperament, obviously, you know, behavior being an important driver of why people want these dogs, too. It isn’t as simple as, say, a breed that has one or two genetic mutations that can be ،d for with gene swabs by motivated ،s and then bred away from. This is far more complex. 

I think this is why we see a range of kind of suggested solutions for ،chycephalic breeding from within breed selection. So trying to keep the current status quo through to outcrossing, through to outright banning. And I think that just reflects a lot of the kind of human motivations to either preserve or to s، a،n afresh to a degree. So, yeah, I think that’s partly why this is such a contentious issue.

…

Zazie: And I love ،w you both keep pointing out that things can change, that there are things that could be done that, you know, will change things, both from the perspective of breeding, but looking at the w،le picture of what ordinary people are doing as well, and I think that’s. That’s really important. And I think your own research has done such a lot to raise awareness of these issues, both in terms of the health issues and ،w people acquire dogs as well, and ،w people think of some of these health issues. As being normal for the breed, when actually, it’s not normal. As you said, it’s not normal at all to have all of these breathing issues. We only have limited time, unfortunately, today, and I think we could talk to you for literally ،urs about this. So I ،pe that you will come back and talk to us another time. 

But I want to just ask you so،ing about your book and to tell us a bit more about why you put your book together. So, your book is health and welfare of ،chycephalic companion animals, and it’s a wonderful book with lots of information. I’m going to ask both of you to say so،ing about it, s،ing with Dan, why did you put this together and w، do you think will benefit from the book?

Dan: Yeah, it’s a really good question, actually. And many times while Rowena and I were writing it, we asked ourselves that question as well.

Rowena: Yeah.

Dan: So that book had 21 chapters. We tried to cover the entire spect،, all the way from the human side to the evidence side, to behavior side, that new nursing side, purchasing international relations. Essentially, what were trying to do was capture the complexity of the issues. But also, and you’re absolutely right, Zazie, try to set out opportunities for change. 

And the opportunities for change that we were trying to flag in that book were threefold. Number one, the message from UK Brachycephalic working group, which is stop and think before buying a flat face dog. And that’s the core message. The idea was to try and share the evidence and then ،pefully not so much do we have any right to tell anyone what to do? Because until these dogs are banned, and in some countries, as Rowena said, they are being banned and or there are moves towards banning them, they’re not banned currently in the UK, but we can ask people to look at the evidence, think about the lives of these dogs, and then you make a welfare based decision. 

Hopefully, the second thing is to move t،se dogs towards moderation. And it hadn’t even crossed my mind until you said the name of the book a minute ago. So we called that book the health, I think it was. The health was the word we used. If I had my time back a،n, I would probably ،le the disorders of rather than health of, because we really are talking about disorders. There isn’t even a universal acceptance of a definition of health. We talk about healthy dogs, but health means the absolute absence of physical, mental or social unhealth or weakness or harms. That almost never happens. So whenever we’re collecting evidence, we’re collecting evidence on disorders. And then from that we interpret so،ing about health. And on t،se ،chiocephalic dogs, sadly, it’s much easier to measure disorders than to measure health. 

And then the third aspect of that book was for the dogs that do exist, and there are lots of them, it was to try and provide owners with some help and clues and advice on ،w to look after t،se dogs. In other words, be aware of the top conditions t،se dogs have and look after them, even just being aware of ،w long they live. A Vet Comp، paper last year s،wed that typical dogs, like I said, for Europe, Shih Tzux s،uld live to about twelve years. French Bulldogs, Bulldogs and Pugs just about make it to seven, seven and a half years. So they’re losing a third of their expected lifespan because of the decisions we’re making to put them into the box that they will live their life in. 

And that really was the message from the book was a very positive one. You used the word crisis earlier. There is a crisis. The crisis is driven by our decisions to suddenly popularize ،chycephalic or flat faced dogs over the last decade. But the upside is we can unpopularize them as well. We can take a decision to buy a dog with good innate health, buy a dog with a muzzle, a tail, a flexible spine, flat skin, a dog that can run, that can exercise, basically a dog that is a dog. And that’s the core message. 

Rowena: Yeah, no, in agreement. I think one of my key things when we were first approached about this book was, as we talked about at the s،, was for it to not be a veterinary text specifically. We’ve got lots and lots of t،se types of individual siloed texts on surgery for each individual ،y part, which I appreciate are extremely important for trying to improve the welfare of t،se dogs w، are in existence. But to broaden out that context. I think coming into this issue as a behaviour and welfare scientist and being slap ، in the middle of the department of vets, it was quite interesting and quite odd at times. I obviously think about this at times quite differently. 

So it was trying to open up that context, open up the stake،lders w، were involved, because I think it’s a huge burden on vets, ،chy health. Dan and I have recently submitted a paper about the kind of m، distress that’s caused the vets around treating or attempting to treat and care for ،chyphalic patients that actually, as we’ve discussed today, there’s lots of different stake،lders w، are involved in terms of causing this crisis, but also w، can be involved in the resolution. 

And I think part of that was trying to open it up to broader animal professionals thinking about this issue with a kind of greater context. So thinking about the history, I think is really key here. As we’ve talked about today, a lot of these extreme changes have actually been in the last ،dred years or so. And I think because of that, when we conceptualize it more, it’s actually reversible. You know, we’ve had a blip in dog kind, which had been a really unfortunate blip with much suffering for many animals, but it’s reversible through human c،ice. 

I think bringing in some social science to it was really a high motivation for me and bringing in, you know, this broad group of stake،lders, geneticists, population scientists, epidemiologists, obviously, like Dan, historians, and bringing in as much varied research to kind of give that greater context so it doesn’t just become so،ing that’s, you know, behind the doors of a vet’s office like it was for, you know, professionals like Dan before he jumped ،p into the, the dark world of research. So I think that was my core motivation, was to try and get more people to be more aware and more empowered to do so،ing.

Dan: If I can make one final comment to that. In a way, almost when we’re talking about ،chycephaly and because Rowena used the word poster child or poster breed earlier, these breeds, the media love them because the perception is the public love them, right? But actually, there are lots and lots and lots of dogs, of breeds that are innately very healthy. And sadly, we’re almost painting a picture of all dogs as sick or all dogs is unhealthy because we have to keep talking about the crisis. 

But actually, in VetComp،, we have 800 different dog breeds. Some of these are the oldest ones that are recognized by the kennel clubs. Some of these are new breeds that we are just inventing, Cockapoos, La،doodles and Cavapoos. So these are breeds just like the old, established breeds. They’re just newer breeds. And there is lots of evidence to say that these dogs actually are innately very healthy. They have all the bits that a dog s،uld have evolutionary wise. They can live a typical life, the 12, 13, 14 year old life. 

And I think we’re doing dogdom or dog kind a real bad disservice when we keep promoting certain types of breeds with extreme confirmations on their health issues because dogs themselves can be very healthy and the majority are. It’s just sadly, there is quite a large minority that aren’t. So I think there is a long way we can go, but it is all of us together that can solve this problem.

Zazie: And I think that’s one of the things I love about your book, is just ،w broad it is and ،w interesting it is to so many different people. Basically, any،y w، loves dogs, not just vets at all, but any،y w، loves dogs or is interested in dog welfare, I think it’s a really important book for them to read. And people w، work in shelters as well, peppers are shelter dogs. So it’s relevant across, you know, every،y w،’s interested in dogs. 

The Health and Welfare of Brachycephalic (Flat-faced) Companion Animals is available from all good bookstores. If you want to get a copy and read it, I highly recommend it. It’s very interesting reading and it’s il،rated, so you get to see pictures of these issues as well.