napstablook my love

While there is certainly a lot that could be said about the practice of breeding purebred dogs, a lot of attention has focused on extreme brachycephalic faces, and the Brachycephalic Airway Syndrome (BAS) this causes, and rightly so. Many inherited problems in purebred animals have been selected accidentally, but the extremely shortened faces of brachycephalic dogs have been selected deliberately to appear to human aesthetics, to the marked detriment of these dogs.

What is brachycephaly and Brachycephalic Airway Syndrome (BAS?)

Brachycephaly is a term used to describe skulls as being broader and shorter than typical for their species. You can use the cephalic index to compare skulls between members of the same species, or between closely related species (don’t bother trying to use this as an indicator of race). There is obviously a spectrum between skulls that are longer than average, about average, and shorter than average, but it is those that are much shorter than average which we are concerned with in this article, because they are suffering with brachycephalic Airway Syndrome.

Not all brachycephalic dogs have BAS, but the shorter their muzzle, the more at risk they are.

Brachycephalic Airway Syndrome is a collection of conditions where there is excess soft tissue within the shortened airways, making it difficult for the dog to breathe for its entire life. This causes significant suffering, imaging trying to go about your day but you can only breathe through a plastic straw.

Is X breed Brachycephalic

Lots of them are, you can find an incomplete list here.

But is it bad?

The more extreme the brachycephally, the more likely the individual is to have Brachycephalic Airway Syndrome and suffer because of it. A mastiff or a rottweiler might be brachycephalic, but (hopefully) not to the same degree as a pug or french bulldog.

What happens with BAS?

Imagine you’ve taken a perfectly normal dog head, and shortened the bones of the face while keeping the same amount of soft tissue, forcing it to be packed into a smaller space, because that’s what we’ve done with these brachycephalic dogs. And the more soft tissue we pack into the reduced space inside the skull, the less space there is for air, which is rather important for the whole ‘breathing thing’.

Stenotic nares: On the outside, you can see nostrils that are pinched shut, already restricting the flow of are before it even enters the dog. Surgery can be done to open these nostrils.

Long soft palate: Because everything in the mouth is crowded, these dogs often have a long soft palate, a flap of flesh that prevents food entering the airway. If it is too long in the dog, it will flap and close off the airway even when they’re not eating, and can swell to become even more obstructive over time. Surgery can be done to resect the long soft palate also.

Hypoplastic trachea: If the trachea (windpipe) is undersized relative to the rest of the dog, there is no surgical remedy for this. Affected dogs are also often prone to collapsing trachea, where the cartilage of the trachea collapses when the dog breathes heavily, and frankly most dogs with BAS will breath heavily a lot of the time.

Everted laryngeal saccules: A normal laryngeal saccule is a bulging of flesh either side of the larynx, but in dogs with BAS who are breathing hard for much of their life, they can be sucked inside out (everted) which occupies even more space in the already restricted and crowded airway and makes the dog struggle further to breathe.

Hypertrophic Nasal Turbinates: That shortening of the skull I mentioned earlier? Does not apply to the complex lacework of bone that usually occupies the nasal sinuses, moistening inhaled air and allowing for a sense of smell. Some of these dogs have their nasal turbinates pushed backwards into their airway, or grossly thickened from constant suction of the airways.

Gastric reflux/vomiting: The constant struggling to breathe results in increases negative pressure within the thorax, which makes these dogs prone to gastric reflux and vomiting. Some of them also have hiatal hernias (stomach herniating into the thorax) to make it even worse. And if they inhale they inhale that vomit, they’re not built well enough to cope with that aspiration pneumonia very well.

And these are not the only structural issues bred into these dogs by selective breeding, only the ones associated with the flattened faces.

Isn’t that enough?

So what’s the solution?

Longer faces, obviously, and we need breeders and breed clubs to get on board with this, and start prioritizing the health and welfare of these dogs. We love them, right? They deserve to breathe by default, not just after thousands of dollars worth of surgery.

But 'longer’ is subjective. Perhaps we should be pushing to demand a minimum muzzle length, or a maximum skull width to length ratio? Or alternatively, disqualify dogs that have muzzles too short for their teeth. If we define 'too short’ as 'not enough room in your skull for all your teeth sit straight’ then there should still be plenty of room for the airway

Look at this very familiar example of a normal muzzle and a brachycephalic muzzle, and note the severe distortion of the dental alignment, particularly of the premolars and carnassial teeth in green and blue. If rotated teeth disqualified dogs in the show ring, and therefor from breeding, that should prevent the extreme brachycephalic features that are becoming more popular, and their associated suffering.

Videos from the University of Cambridge, additional information available on their website.

None.

“See something, say something” is an important piece of advice in a lot of situations, and suspected inappropriate medical behavior is no exception.

In their 2014 paper, Healthcare Serial Killers as Confidence Men, Lubaszenka and colleagues conducted an extensive literature search and found reports of 58 distinct healthcare serial killers with enough details for analysis. These do not include healthcare professionals who [only] murdered individuals outside of the healthcare setting, cases “clearly intended as euthanasia or physician-assisted suicide,” or cases from natural disasters. Literature search was restricted to cases from 1970-2010 in Europe and the Americas.

Of the 40 cases for which cause of initial investigation into patient deaths was known, in 12 cases - 30% of the cases - investigation into and ultimately capture of the serial killers was because of co-workers reporting suspicious behavior. That is more than the combined number of cases investigated because of statistics (i.e. number of patient deaths/near deaths), patient complaints, and family complaints.

Several times, employees were dismissed, but don’t be dissuaded. I mean, don’t go accusing anyone who’s ever made some medical mistake of being a serial killer, but don’t be afraid to report something because you’re not sure, or because you don’t want to get in trouble. In this case, a Type I error is definitely preferable to a Type II error.

Healthcare serial killers are typically very well liked by patients and patient-families. Here’s a terrible example:

“Nurse Beverly Allitt… reportedly was quite close to the families of her patients and was often praised by parents of sick children on her excellent bedside manner and heroic efforts to save their dying children (Davis, 1993; Davis, 2010; Ramsland, 2007). In one particular instance, she attempted to kill twins Katie and Becky Philips with an overdose of insulin but only succeeded in killing Becky and leaving Katie brain damaged (Davis, 2010). The parents of Katie and Becky were so grateful for Allitt’s efforts to save Becky that they unknowingly made the woman responsible for their child’s death the godmother of their surviving child (Davis, 2010).” [Luzbaszka et al., 2014]

I’m still in shock from last night. The first time I was hands on in a code. I keep seeing the bruised and mottled skin, the IO needle in a tiny leg, the way limbs moved with each compression. I’m acutely aware of my own heart and how it beats without assistance. As I’m holding my phone with two hands to type, I’m feeling an ache from using my hands in a very different way.

I almost don’t recognize my fingers.

But these fingers didn’t fail the patient. I wasn’t useless, standing frozen in the way in the chaos. At first I fetched- someone called out for a washcloth, for alcohol pads, for the code cart- and my hands delivered what was needed. I tore my attending’s wrist brace off when it got in the way of her movements. My hand comforted the stricken nurse, gave a soft touch to the frightened family. I found the IO drill when it went missing, I grabbed cords wrapped around distracted staff and freed them without disrupting their actions. And when the moment came, these hands kept blood pumping through tiny veins.

Tonight I held life in my hands

It felt like twigs snapping

Watching numbers on a screen

Counting squeezes

My heart beating faster

Than yours could

Tonight I looked death in the face

And found I could not be defiant

But defiance was less important than hope

Persistence repetition epinephrine

Ventilate compress sweat

Pray breathe pray call the chaplain

And then, breathing again

But pulse still too slow

More compressions

Color returning, organized chaos

Each moment with a faster pulse

24 minutes to ROSC

A bedside baptism for a tiny miracle

PICU on the phone for report

Other patients are complaining about the wait

And there are results to be read

Notes to be written

Discharges to be signed

But tonight I saw how fragile life is

And felt it crack beneath my fingers

Because to keep a heart beating

No offence taken. It’s difficult to get all my thoughts out when I only have a little time spare before work when this issue is so big, so complex and not only hasn’t improved in a decade, I think the brachycephalic dog issue is actively getting worse. And I think social media is a significant factor in this.

‘What you want us to do’ depends on which ‘us’ you mean, Anon, because I can’t tell whether you’re part of the vet industry or the general public, but both read this blog so stick with me for a moment.

Breeders generate these dogs. If at this stage they are still breeding dogs with extreme brachycephalic faces then they are doing it for financial rewards and prestige, not for the health of the dogs. There’s been a decade to change, they could have done so. So we need to take away their rewards for continuing to produce these dogs.

There are some legislative options, like mandating a minimum muzzle to skull ratio of any dog that is to be bred, or enforcing a maximum dollar value that a dog may be sold for (some ‘rare’ colours of popular brachycephalic breeds sell for over $4k, the most ridiculous I have seen being $15k), but these are not things that the average Tumblr user can influence.

If we could just stop people wanting to buy these dogs, that will reduce their demand and therefor financial reward for the breeders creating them. And that is something we can do, but it takes repeated, regular effort.

Once somebody has purchased one of these dogs, they’re too late to influence. We want to influence them before they’ve made that purchasing decision, which is where general public opinion comes in.

- Change the dialogue from ‘That Boston is cute’ to ‘That Boston has a nice personality, shame about its difficulty breathing’. - Express disappointment when advertisers or media use brachycephalic animals in marketing or shows, and express this opinion to other people. When they ask why, elaborate.- Talk about how cute other breeds are with appropriate noses, praise them instead while ignoring or lamenting the unfortunate brachycephalic ones.- This applies on social media too, but back up your views with health concerns for the dog. It’s important not to be seen as picking on the dog, but rather to be feeling sorry for it.- If you own one and people comment that something is cute, eg the snorting, reinforce that you love your dog BUT these features are not cute, they cause difficulties or suffering.- In short, taking away the social reward for owning these dogs, and encouraging other types of dogs, particularly for those that haven’t made up their minds about what sort of dog they want to own.

In a vet clinic we can also:- Reinforce the fact that these features like snorting that are considered ‘normal for the breed’ are in fact not normal and are pathologies, discuss their consequences and potential surgical treatments.- Not share pictures of these dogs on our Facebook or clinic websites, even if staff think they’re cute.- Not give breeder discounts for caesarians, vaccinations or any other care. Are you kidding when they’re selling pups for $3k each?

The old guard that have been ‘breeding X for 25 years’ wont change, but we can change demand, particularly by educating younger generations and those that have not yet bought a dog.

The thing about Petblr is that Petblr is already more informed than the general pet owning public, and especially more informed than your typical first time would-be dog owner about to purchase their first pet. Petblr assumes a lot of knowledge on people that is just not common knowledge, after all it’s hard to remember what the general public might not know when you’re surrounded by knowledgable people all the time. But it’s the future first time pet owners that need to be reached.

Of course people should research before they get a pet, but these first time pet owners don’t know where to research, they think listening to the breeder is enough. They don’t know about these issues or what they could have done instead. We need to keep trying to reach out to the less invested public, and social media may well be the best and cheapest way to do that. I didn’t even see any ads from the combined RSPCA and AVA advertising campaign.

This puppy will need about $2,500 spent on airway surgery for it to have a shot at breathing decently, ignoring its other problems.

It arrived with a ‘health care sheet’ advising the owners of the problems, like needing airway surgery but others as well, and presented them as normal for the breed.

It also presented with a certificate that said “In my opinion this dog is healthy” signed by a vet when this brachycephalic dog is obviously not. As a profession we should not be caving to pressure to do this.

No offence taken. It’s difficult to get all my thoughts out when I only have a little time spare before work when this issue is so big, so complex and not only hasn’t improved in a decade, I think the brachycephalic dog issue is actively getting worse. And I think social media is a significant factor in this.

‘What you want us to do’ depends on which ‘us’ you mean, Anon, because I can’t tell whether you’re part of the vet industry or the general public, but both read this blog so stick with me for a moment.

Breeders generate these dogs. If at this stage they are still breeding dogs with extreme brachycephalic faces then they are doing it for financial rewards and prestige, not for the health of the dogs. There’s been a decade to change, they could have done so. So we need to take away their rewards for continuing to produce these dogs.

There are some legislative options, like mandating a minimum muzzle to skull ratio of any dog that is to be bred, or enforcing a maximum dollar value that a dog may be sold for (some ‘rare’ colours of popular brachycephalic breeds sell for over $4k, the most ridiculous I have seen being $15k), but these are not things that the average Tumblr user can influence.

If we could just stop people wanting to buy these dogs, that will reduce their demand and therefor financial reward for the breeders creating them. And that is something we can do, but it takes repeated, regular effort.

Once somebody has purchased one of these dogs, they’re too late to influence. We want to influence them before they’ve made that purchasing decision, which is where general public opinion comes in.

- Change the dialogue from ‘That Boston is cute’ to ‘That Boston has a nice personality, shame about its difficulty breathing’. - Express disappointment when advertisers or media use brachycephalic animals in marketing or shows, and express this opinion to other people. When they ask why, elaborate.- Talk about how cute other breeds are with appropriate noses, praise them instead while ignoring or lamenting the unfortunate brachycephalic ones.- This applies on social media too, but back up your views with health concerns for the dog. It’s important not to be seen as picking on the dog, but rather to be feeling sorry for it.- If you own one and people comment that something is cute, eg the snorting, reinforce that you love your dog BUT these features are not cute, they cause difficulties or suffering.- In short, taking away the social reward for owning these dogs, and encouraging other types of dogs, particularly for those that haven’t made up their minds about what sort of dog they want to own.

In a vet clinic we can also:- Reinforce the fact that these features like snorting that are considered ‘normal for the breed’ are in fact not normal and are pathologies, discuss their consequences and potential surgical treatments.- Not share pictures of these dogs on our Facebook or clinic websites, even if staff think they’re cute.- Not give breeder discounts for caesarians, vaccinations or any other care. Are you kidding when they’re selling pups for $3k each?

The old guard that have been ‘breeding X for 25 years’ wont change, but we can change demand, particularly by educating younger generations and those that have not yet bought a dog.

The thing about Petblr is that Petblr is already more informed than the general pet owning public, and especially more informed than your typical first time would-be dog owner about to purchase their first pet. Petblr assumes a lot of knowledge on people that is just not common knowledge, after all it’s hard to remember what the general public might not know when you’re surrounded by knowledgable people all the time. But it’s the future first time pet owners that need to be reached.

Of course people should research before they get a pet, but these first time pet owners don’t know where to research, they think listening to the breeder is enough. They don’t know about these issues or what they could have done instead. We need to keep trying to reach out to the less invested public, and social media may well be the best and cheapest way to do that. I didn’t even see any ads from the combined RSPCA and AVA advertising campaign.

Everything below is posted with liberty and credit to Jemima Harrison and the PDE blog, with the sole purpose for this information to spread as far as possible.

Time to get tough

It is… • soon to be 10 years since Pedigree Dogs Exposed • five years since The Advisory Council on the Welfare Issues of Dog Breeding highlighted the issues linked to head conformation in brachycephalic breeds • 18 months since the publication of research (funded by the kennel club) spelling out the link between stenosis (pinched nostrils) and respiratory issues, especially in French Bulldogs • a year since a veterinary petition demanding urgent reform for flat-faced dogs • almost a year since the Kennel Club set up the Brachcycephalic Breeds Working Group in response to that petition .. and of course I have highlighted the issue of pinched nostrils endlessly here on this blog. Endlessly.

And yet… the picture at the top is one the Kennel Club has used as the ideal depiction of the French Bulldog in its new edition (2017) of its Illustrated Breed Standards. And it isn’t a one-off. Here’s the one the KC has used for the Boston Terrier standard.

The Bulldog.

And the Pug.

Dogs are as near-as-damn-it obligate nose breathers. And even if they can supplement by mouth-breathing when they are awake, they are unable to do so when they are asleep, meaning thousands of these dogs live lives of interrupted sleep as they have to wake up in order to not asphyxiate. Study after study has shown that these dogs pay the price for not being able to pull in a decent lungful of air and that starts with the nostrils. These pictures are all the proof you need that the Kennel Club is not taking this issue seriously; that at its very core the KC is paying nothing more than lip-service to the demands for reform by the veterinary profession and animal welfare campaigners. At one of the first meetings of the Brachycephalic Breeds Working Group, then KC Chairman Steve Dean expressly said that he didn’t want “changing the breed standards” to be at the top of everyone’s list of actions that could be taken. And indeed, it hasn’t been. There have been some new measures.  The KC continues to fund brachy research. There is also now a brachy learning resource available on the KC website, the promise of better education of judges and a breed club commitment to educate better about the importance of keeping brachycephalics slim. There are also now health schemes for the Bulldog, French Bulldog and the Pug which do test for respiratory issues. All this is welcome. But, bottom line, the Kennel Club continues to bat for the breeders who do not want the basic phenotype to change because it’s the breeders that pay their wages. Of course the simplest, quickest remedy is to give these dogs back some muzzle - to help not just with breathing issues, but to help protect their eyes from trauma and to give their teeth some room in their overcrowded mouths (a Pug here compared to an Australian Shepherd).

The problem is that breeders are wedded to flat faces, particularly in Pugs and Bulldogs. They talk about the perfect “layback” - which essentially means that the nose should not interrupt the line between the forehead and tip of the dog’s chin. In fact, there’s a new book out on the Pug head (yours for only $159) which reminds everyone that the word Pug comes from the latin for “fist” and that this is the shape the Pug’s head should be in profile - i.e. totally flat.

Here’s a reminder from a top UK show breeder of what the Bulldog’s head should look like.

As you can see, a  protruding nose or a less severe underbite is considered a fault.

There was a big review of breed standards following Pedigree Dogs Exposed but it was mostly to add vague qualifiers such as, in the Pug standard,  "relatively" short rather than just short when describing the length of the muzzle. This gives the breeders way too much wiggle room.  We need proper metrics - a defined minimum skull/head/muzzle ratio and we need to find more profound ways to change their minds about what constitutes their breed in their eyes.

Large open nostrils are a requirement in brachy breed standards, but this is widely ignored because other points of the breed are considered more important. There would be outrage if a Frenchie with one lop ear or a Bulldog with a liver-coloured nose won in the show-ring, but dogs with slits for nostrils continue to be made up to champions.

Meanwhile, on my CRUFFA group, whenever you post a picture of more moderate examples of the breed, current of historical, the breeders heap scorn. A few days ago, one breeder insisted that the dog featured in this famous painting of a Pug by Carl Reichert, dating from the late 19th century, was a crossbreed.

Same for these ones. Mongrels, the lot of them.

She admitted that the eye-white showing was undesirable but preferred the look of this Crufts dog.

Today, this was posted on a public Facebook page by one French Bulldog breeder in response to a plea by vets for more moderate dogs.

(My bolding below)

To those who say you cannot rebuild Rome in a day I say… rubbish. There are already more moderate versions of these breeds out there being bred by breeders more interested in health than the current fashion. 

For more than 10 years, I have called for moderation and hoped it would come from the breeders. But  I now know it won’t. If we want anything more than a wee bit of tweaking round the edges, then we need to demand it.

It is time to get tough. These dogs suffer - not all of them all the time but too many of them too often. 

Brachycephalics live a third less long than non-brachy dogs. Fifty per cent have significant airway disease. Almost all struggle to cool themselves. Most Bulldogs still can’t mate or give birth naturally. Pugs have 19 times the risk of developing corneal ulcers.  All suffer from very low genetic diversity. And so on.

Today, Bulldogs, French Bulldogs and Pugs make up one in five of the dogs registered with the Kennel Club - up from one in 50 in 2005.

Yesterday, a new petition was launched asking for a ban on brachycephalics.  Over 20k people signed it in the first 24 hrs.

Have we reached a tipping point?  With your help.

I haven’t been able to blog much recently because I am busy finishing off a television series for BBC2. But I have taken time out to write this because the new breed standard pictures made me so angry.

So please… Although it’s moderation I want, not a ban, sign the petition. Make your feelings known to the Kennel Club (see here). Complain if brands or media use generic pictures of brachycephalics to sell their wares.

Vets: thank you so much for all that you are now doing, but please keep the pressure on.

And, of course, to everyone out there - please don’t buy that puppy.

It is not safe to buy a Pug, Bulldog or French Bulldog. Not safe for them and not safe for your wallet.

They do it all the time, but it’s not normal and we can’t continue to facilitate that mindset. Stertorous breathing (that obnoxious snoring while awake) is NOT normal and it’s important to let owners know that this conformation can result in serious health problems.

And I’m glad the message is getting through, but it’s not getting to the right places.

I get asked about retromops every time this discussion comes up. I have never seen a retromop or a brachy breed deliberately bred to have a longer muzzle in vet practice, not in all the years I’ve been working. I see people with their newly purchased pug/boston/frenchie about twice a week, with faces as horrifically flat at those above.

“The breeder said they were healthy dogs!” The breeder was talking out of their butthole and walked away with thousands of your dollars.

People buying these dogs just want ‘the look’. The people breeding these dogs ‘to standard’ also want ‘the look’. But it comes to the detriment of the dogs themselves.

Even the RSPCA and the AVA running a joint ‘Love is Blind’ campaign reached nobody. It made no difference.

I hate to say it, but after all these years of voluntary self regulation, maybe we do need to legislate a minimum muzzle to skull ratio. Because what is happening now just isn’t working. Just look at the developing ‘American Burmese’ ‘breed’.

A real Burmese cat above. An American Burmese cat below.