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

What are the disorders that tend to affect brachycephalic (flat-faced) pets, and what can be done to help with guests Dr. Dan O'Neill and Dr. Rowena Packer of the Royal Veterinary College.

By Zazie Todd PhD

Watch episode 17 of The Pawsitive Post in Conversation below or on Youtube, listen below or via your favourite podcast app (including Apple), or scroll down to read a transcript of the highlights.

About this episode

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We talk about the health issues faced by flat-faced (brachycephalic) dogs and cats and why these breeds are still to popular with Dr. Dan O'Neill and Dr. Rowena Packer of the Royal Veterinary College.

We start by talking about what we mean when we talk about brachycephalic dogs. Pugs, Bulldogs, and French Bulldogs are the poster children for these breeds and get the most attention, but we also get some surprising good news about Shih Tzus.

When dogs are bred for flat faces it means they can struggle to breathe. Dan and Rowena talk about the health issues these dogs can face and the effects it has on their lifespan. 

We talk about their co-edited book, The Health and Welfare of Brachycephalic (Flat-Faced) Companion Animals: A Complete Guide for Veterinarians and Animal Professionals. The book covers a wide range of information and we talk about how the intended audience is not just vets but anyone who cares about these dogs.

And there's a note of optimism as we talk about what would make a difference to the welfare of flat-faced dogs.

Finally we talk about the books we're reading:

The Signal and the Noise by Nate Silver

Nudge: The Final Edition by Richard H. Thaler and Cass R. Sunstein

Letters From a Lady Rancher by Monica Hopkins

Bookworm: A Novel by Robin Yeatman

The books are available from all good bookstores and my Amazon store.

About Dr. Dan O'Neill and Dr. Rowena Packer

Dr. Dan O’Neill is a veterinarian with a PhD in veterinary epidemiology. He is Associate Professor in Companion Animal Epidemiology at the Royal Veterinary College in London. And he co-leads the VetCompass Programme as a research tool for a wide range of welfare-related studies and as a teaching resource for large numbers of undergraduate and post-graduate projects.  Website

Dr. Rowena Packer has a PhD on inherited disorders related to extreme conformation in dogs is currently the Lecturer in Companion Animal Behaviour and Welfare Science at the Royal Veterinary College. Her main research interests are the impact of health on behaviour, cognition and welfare, with a focus on chronic inherited diseases in the dog, and the knowledge, beliefs and decision-making of companion animal owners, and how to improve them in line with animal welfare. Website  Twitter

Highlights of the episode about flat-faced dogs and cats

This interview has been lightly edited for content and style.

Dan: Given that it is Shih Tzus you're interested in, and given that the whole background of the work I do at the Royal Veterinary College with Rowena is on Vet Compass, we actually have a study on Shih Tzus currently under review with Rowena and me and some other authors. And actually, it doesn't show the Shih Tzu has been too bad. 

So they come out as a nice little dog, 7.9 kilos, medium body weight. So they're, like, really portable, beautiful little dogs. For most people who 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 something with the Shih Tzu, it would just be to give them a nose. And by giving them a nose, you suck out the jaw. That means that the eye socket will get sucked back in again, 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 everybody 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 hot that he struggles. And it does get very hot 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, though, and talk about what we mean by brachycephaly 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 brachy, brachycephaly 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 who, 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 how flat the face is, as Dan mentioned, how 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 hone in quite a lot on what we call our extreme brachycephalics. 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 brachycephalic 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 brachycephaly is. And of course, as with all areas of science, nobody 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 brachycephaly to be in a particular study population for example, as Dan mentioned, when we're working in Vet Compass.

Kristi: When we think about dogs who are brachycephalic, 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 who have been in my basic obedience classes, like dogs who are obviously brachycephalic in my obedience classes, 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 brachycephalic dogs have? What are we talking about here?

Rowena: I think the core part of that, I always try and conceptualize it as brachycephaly, 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 shorter and that muzzle being so foreshortened, there's a lot of flesh in our mouths. We always get people to do some weird facial 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, those same structures are there but in a much smaller space in brachycephalic 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 sucked down into the larynx. So where we should have a nice big black train tunnel of a hole 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 vibration of this soft tissue. 

But it's not just the noise, obviously, with each breath, they're then having that palate sucked 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, again, 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 again, the good old train tunnel analogy. I love dogs nostrils. I spent far too many hours of my PhD photographing and measuring dogs' nostrils. I have a very odd gallery on my computer somewhere of them, but they should be two huge channels. Again, it should be really easy for the dogs to breathe the air to get in and out. They should be able to open and close. You know, there should 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 brachycephalic dogs?

Dan: Oh, golly, this is where the list starts. I mean, in essence, if we think about it and we go back in evolution 10 million years ago, dogs started to be evolved and dogs now inhabit pretty well every part of the planet. So we can have them in temporal 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 body proportions. They have a longish tail, they have a longish nose, they have sticky up ears. 

And essentially, we have taken this wonderful product of 10 million years of evolution that has been optimized for survival. And in the space of a few hundred 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 body shape, morphological 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 brachycephaly, 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 morphological mutations in their spines so their spines are shortened and twisted. They can't bend their spines. A lot of those 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 something just to stop themselves from suffocating. And yet we go on YouTube and we see videos of ha, ha ha, how 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 VetCompass, 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. Heatstroke, you had mentioned. English Bulldogs 14 times higher for heatstroke as well. So, in other words, just the inability to maintain your body temperature when it starts to get a little bit hot. English Bulldogs, 38 times higher risk of dry eye. Just literally where their eyelids can't close over their eyeballs, can't distribute tears, and eventually they're not able to produce 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 dermatitis. 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, those 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 dermatitis 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 bodies of these dogs and say, we have done something, and that something is not an advantage to the dog. And that's what VetCompass's evidence is producing, 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 breeders, it's about anyone who decides to acquire or to promote. So this includes advertisers, and this includes people liking posts on social media. Anyone who promotes imagery of dogs with extreme confirmations, these extreme body shapes, we can do something 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 brachys, 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 body shape, some of which aren't, the majority are conformation related. 

But people are so reticent to change the conformation as the body shape of these dogs that they continue to be lumbered with this extremely long list. So it's, where do you start? 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 tested for with gene swabs by motivated breeders 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 brachycephalic 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 start again afresh to a degree. So, yeah, I think that's partly why this is such a contentious issue.

...

Zazie: And I love how 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 whole 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 how people acquire dogs as well, and how 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 hours about this. So I hope that you will come back and talk to us another time. 

But I want to just ask you something 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 brachycephalic companion animals, and it's a wonderful book with lots of information. I'm going to ask both of you to say something about it, starting with Dan, why did you put this together and who 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 spectrum, 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 hopefully 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 those 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 again, I would probably title 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 something about health. And on those brachiocephalic 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 how to look after those dogs. In other words, be aware of the top conditions those dogs have and look after them, even just being aware of how long they live. A Vet Compass paper last year showed that typical dogs, like I said, for Europe, Shih Tzux should 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 brachycephalic 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 start, was for it to not be a veterinary text specifically. We've got lots and lots of those types of individual siloed texts on surgery for each individual body part, which I appreciate are extremely important for trying to improve the welfare of those dogs who are in existence. But to broaden out that context. I think coming into this issue as a behaviour and welfare scientist and being slap bang 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 stakeholders who were involved, because I think it's a huge burden on vets, brachy health. Dan and I have recently submitted a paper about the kind of moral distress that's caused the vets around treating or attempting to treat and care for brachyphalic patients that actually, as we've discussed today, there's lots of different stakeholders who are involved in terms of causing this crisis, but also who 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 hundred 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 choice. 

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 stakeholders, 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 something that's, you know, behind the doors of a vet's office like it was for, you know, professionals like Dan before he jumped ship 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 something.

Dan: If I can make one final comment to that. In a way, almost when we're talking about brachycephaly 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 VetCompass, 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, Labradoodles 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 should 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 how broad it is and how interesting it is to so many different people. Basically, anybody who loves dogs, not just vets at all, but anybody who loves dogs or is interested in dog welfare, I think it's a really important book for them to read. And people who work in shelters as well, peppers are shelter dogs. So it's relevant across, you know, everybody who'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 illustrated, so you get to see pictures of these issues as well.