Are These Dogs *Really* Cute?

Over the last few years, dogs like pugs, french bulldogs, and English bulldogs have become incredibly popular. It's hard to say why these dogs have taken society by storm, but their squishy face and bulging eyes can be interpreted as "cute." Not to mention their derp-y behaviour when jolting out of sleep and lounging around lazily. Everyone has seen those videos. Maybe you've shared and reposted a few, like you do with other cute animal videos you encounter online.

No harm done.

Or is there?

If you claim to be an animal lover, read through this article to know what's really going on behind the hype around brachycephalic dogs. Very few people know (or want to know) about the suffering these dogs live through.

This article is a revised version of a piece I wrote two years ago. A lot has happened since: I've graduated and can officially call myself a veterinarian; I've gained more clinical experience and witnessed several multi-level surgeries myself, and most importantly, I have researched on brachycephalia during my last year, giving me information to add to this article.

What is Brachycephalia?

There is a medical term for "flat-faced": brachycephalic. Yeap. It sounds complicated, so let me break it down. The word derives from the Greek words "brachy," meaning "short," and "cephalus," meaning "head." It mostly affects the front of a face, making brachycephalic beings have a "shorter snout." I think you can figure out the rest. Brachycephalia is a condition that humans can suffer from, too. I deliberately chose the word "suffer" because it is seen as a pathological condition among humans! And it actually is. But for some reason (that I will get into later) it seems to be an okay condition to have for dogs... huh... weird.

Let's get a bit more factual about this pathology named Brachycephalia!

Symptoms

When you think back on all dog cartoon characters like Disney’s Pluto or Dug from the movie Up, I’m pretty sure you have the image of a dog smelling on the ground or elongating their neck to sniff out a trail. Cartoons have led us to believe that the specialty of a dog’s nose is defined by its olfactory function. They’re not wrong. But the primary importance of the dog’s upper respiratory system lies in thermoregulation. Mammals have to keep their body temperature stable despite changing climatic circumstances. When it becomes too hot, humans start to sweat: vaporising fluids on the skin have a cooling effect. Dogs, on the other hand, do not sweat. They pant and increase the airflow through their nasal cavity (green circles in picture) so that heat can be emitted. It’s not hard to imagine that the large cavity of the German Shepherd on the left is way more effective than that tiny remnant of conchae nasales of the Pug. Furthermore, brachycephalic nostrils are narrow, so even less air actually enters the nasal cavity. I’m not sure whether you ever had a heat stroke, but take a few pugs, and I’m pretty sure one of them could tell you what that’s like. Brachycephalic dogs are incredibly prone to overheating and the amount of dogs brought to the clinic in the summer traditionally increases. Research says that 50 percent of brachycephalic dogs show heat sensitivity above a temperature of 19°C (66°F) and this gets worse when dogs start exercising (exercise here means: running or playing; activities that are considered as standard every-day in other breeds). In an article published by the Veterinary Journal, it is stated that 33 percent of evaluated dogs can't walk more than ten minutes in the summer before showing signs of exhaustion.

Another issue is the anatomical structure I marked in the red circle: the soft palate/velum palatinum. As seen in the picture, its main function is to separate nasopharynx from oropharynx—AKA it separates your mouth from your nose. You probably never knew this thing existed, let alone thought about it, but the velum is what hinders food to enter your nose when you swallow. The funny thing about brachycephalia is that, while the skull is so squished, other soft structures remain in their "normal" size, which means that in relation to the skull, tongue, and velum are too big. If you look closely at the red circle in the pug CT, the soft palate hangs down so much it is narrowing the pharynx immensely. This is also known as BOAS = Brachycephalic Obstructive Airway Syndrome. During waking hours of the dog, with no extra strain, the hanging velum is manageable. The real danger becomes apparent when dogs sleep. Or at least try to. With muscles relaxing in REM cycles, the soft palate just drops and literally blocks the airway by falling into the larynx. There are tons of videos of dogs awaking with a start in the middle of the night, and owners laughing about it. Stupidly enough, people get a good giggle from these videos because they think it’s "cute" when their pug jolts out of their sleep and looks around confusedly. What they don’t know is that their dog nearly just died from suffocation. With the soft palate blocking the entrance of the trachea, the dogs stop breathing. Their oxygen levels drop and at some point, the brain will send warning signals in order for the dog to wake up, hence the panicked and confused startle. For some dogs, this even gets so bad that they sleep with heads raised up or refuse to sleep at all because they’re simply scared. Yeah, it’s that horrible.

In case your brachycephalic dog snores: that’s the soft palate hanging down into the airway and vibrating during expiration. No, it’s not cute. It’s an airway obstruction!

In order for you to visualise what I am talking about, just in case you haven’t seen sleep apnea, here is a video.

This is an incredibly eye-opening video compiled by Jemima Harrison (producer of the investigative documentary Pedigree Dogs Exposed).

Even though your anatomical and physiological knowledge may virtually be zero, you will know that oxygen is essential for your metabolism. Brachycephalic dogs with above symptoms are chronically undersupplied with oxygen (chronic hypoxia), which means that a lot of metabolic stress is an addition to the respiratory symptoms. With bad metabolism, dogs tend to become overweight. (Yeap, those fat dogs you find so adorable are probably miserable in real life...) Also, in order to compensate for the little oxygenated blood, the heart has to work harder, making cardiomyopathies a probable outcome.

The worst part is that dogs with respiratory problems have difficulties moving around and get tired quickly. Therefore they are even more prone to obesity. And it’s the same as all those obese, sedentary, fat humans. The risk of cardiovascular diseases increases. Circulus vitiosus, really (and just to rub it in, don’t forget the orthopedic problems resulting from all those unnecessary extra pounds).

Alas, the troubles don’t end here. Brachycephalic dogs like pugs or shih tzus are prone to eye problems as well. Due to the weird skull conformation and the bulging eyeballs, hair constantly rubs into the eyes. Now imagine something incessantly scratching against your cornea and your eyelids being deformed (entropion/ectopion) too much so that it doesn’t really protect your eyes. Ulcers, keratitis, and conjunctivitis, just to name a few consequences. It's also not uncommon for eyeballs to just pop out. I'm not exaggerating. Especially shih tzus seem to have shallow eye sockets so that something as harmless as playing with other dogs can result in eye proptosis! (It's pretty disgusting.)

Brachycephalic dogs are all-rounders when it comes to diseases and health problems, so let’s lose a few words about their food intake. Dental deformation is probably illustrated quite well in the picture and doesn’t need further elaboration. Something more unpleasant is regurgitation of food. This is caused by the elongated soft palate that, when inconveniently situated, blocks not only the airways, but the esophagus as well, which means the dog can’t swallow his food and "pukes" it out again. Regurgitation in brachycephalic dogs is more common than you think.

Now, I could go on with more problems that result from breeding (for example the predisposition for pug Meningoencephalitis or a shih tzu’s pyloric stenosis), but I’ll just explain one more thing that I personally think is quite shocking. Did you know, that a lot of brachycephalic dogs cannot birth naturally anymore? Yes. You read correctly. Humans have bred these dogs so intensively that they can’t even give birth in a normal way!!! This is caused by two reasons: 1) The heads of brachycephalic dogs are relatively too big, making it hard for puppies to exit the mother’s birth canal, leading to dystocia. 2) The mothers have no stamina (due to the breathing problems) to actually be able to give birth naturally. A survey that was released in the Journal of Small Animal Practice in 2010 shows that five of the ten most frequent breeds to require C-Section are brachycephalic. To be fair, "only" 27.4 percent of pugs are in need of surgery during birth according to that study, and Pekingese fare higher with 43 percent. What’s really quite condemnable is the fact that a whopping 81 percent (!!!) of French bulldogs have to undergo surgery in order to give birth.

The Breeding of Defects

Believe it or not, this is actually a very accurate term when it comes to the breeding of brachycephalic dogs. Most of you will be familiar to Darwin’s concept of "Survival of the fittest," in which individuals with the most efficient and adapted traits are more likely to procreate and therefore alter the overall phenotype of a species to better the chances of survival in a certain environment. Having a short nose, a disproportionately elongated soft palate, and too little space in your cranium definitely work against the chances of a healthy life with good quality. In nature, creatures with features like that will simply die because their anatomical anomalies are lethal; sooner rather than later. Normally the strongest of a species will reproduce; for this illustration, that means those with a long snout and a good respiratory system. Crippled animals will not even get the chance to breed and pass on their unfavourable genes.

Now comes the preposterous part. Unfortunately, this planet hosts a fairly arrogant species: Humans. For some reason, they felt that they had to break nature’s law just because they can. They took dogs with short snouts and bred them deliberately. Out of these broods, they selected the pups with even shorter snouts and bred them, as well. Over centuries, the skull of these dogs deformed more and more. Yes. Deformed. These dogs are really a malformation of nature.

And for what? There is actually a federation that sits down and determines how a certain breed has to look like. Google FCI (Fédération Cynologique Internationale) and look at the PDF documents they have on each authorised breed. They have specific ratios and measurements set out for body parts. Only if a dog meets all of their criteria can it be acknowledged as pure breed, no matter how unhealthy and problematic their standard is. It’s perverted, in my opinion.

The Breeders

Without doubt, I am putting myself under fire with this passage. There is simply no way to satisfy everyone when writing about dog breeders and not make it look like I'm pointing fingers.

Here's two things we all can agree on:

1. Puppy mills should be eliminated. This term mainly describes breeding that is focused on monetary gain by producing as many puppies as possible, regardless of the mother's or the puppies' health. It goes without explanation why this is simply terrible for all parties involved.
2. Unsupervised backyard breeding is equally a model that we should be highly critical of. The dangers of breeding without proper knowledge and veterinary care result in future health issues, genetic disorders, and inbreeding—just to name a few points. This is mostly aimed at breeders that go for exaggerated features and/or colours that aren't recognised by dog breeder associations. It's just bringing this whole hype to a boil. As if it wasn't enough that these dogs suffer from BOAS and its results, people decided to mess up the genes even more to get other purely trend-oriented attributes. (Different colour of fur in Blue French Bulldogs, for example). It's ridiculous.

And here comes the tricky part...

Not all Kennel Club registered breeders sell healthy dogs, no matter what they claim. There. I said it. During my research project, I evaluated nearly 3000 emails from dog owners seeking (surgical) help from the ENT-section of my university clinic, describing terrible health issues that their pets suffer due to brachycephalia. Owners complained that breeders advertised their puppies to be freiatmend (translates to "free-breathing" AKA no breathing issues), but it turns out that after a year or two, their pet started collapsing in high temperatures. Can we say those breeders are inherently evil? Definitely not. But that's just the problem: with absurd standards of short snouts. There is no way to guarantee a dog's health!

In recent years, breeds like Retro-pugs have sprouted in Germany; an attempt to reverse certain unhealthy traits by "breeding back the snout." Although not entirely free from BOAS, it is definitely a step in the right direction.

Take it from the expert on brachycephalia himself, my professor Dr. Gerhard Oechtering (whom I have to thank for the picture). He strongly advises against buying brachycephalic breeds—especially pugs, French bulldogs, and English bulldogs. As the pioneer of the multi-level surgery to fix these dogs, he's seen more than enough to let you know that it's not a good idea to get one, despite the argument that they have "great personalities."

Something to Think About

How is it acceptable that humans create suffering dogs just to satisfy their need for "pure breed standards?"

Do you still think pugs and French bulldogs are cute when they snore?

In hindsight, isn’t it disgusting how these dogs are showcased in social media and nobody knows the horrible truth about what is going on?

This is not only a matter of animal welfare, but it’s a sickening case of human superficiality and arrogance.

You may have a brachycephalic dog yourself. Did you know all this before you got your dog? Or did you just buy one, because they’re "cute" and you got influenced by a celebrity parading their dog around? Your pet might not show these symptoms. Good for you! But know that there are thousands of dogs out there who are not as lucky as yours. There will be dogs who won’t make it through the summer because they won’t stand the heat, and dogs who will suffocate in their sleep. I'm not saying that pugs are collapsing left and right. The majority of them are, in fact, doing okay (except that 99 percent of them exhibit loud breathing noises). But the amount of suffering of brachycephalic animals is still an unnecessary number that can easily be avoided by simply not following the overrated "Pedigree standards."

Yes, these dogs have very lovable personalities, and it pains me to see these dogs suffer. I have interned at the ENT-section of my university clinic and most surgeries performed are on brachycephalic dogs. Consider this: You buy a dog for a couple of hundred Euros, only to spend another whopping three and a half grand to allow it to breathe. It's ridiculous, isn't it?

And this is where YOU come in.

In an era that is circled by social media, I am certain you have seen several "cute" Instagram pictures or reposted Tumblr posts that involved a pug with a hilarious caption. This may not sound like much, but I believe that this strong social media presence is what motivates ignorant dog "lovers" to acquire one themselves. Therefore, there is a "high demand" for these breeds, and this serves as a justification and excuse for breeders to keep breeding brachycephalic dogs.

You wouldn't believe the influence social media, Hollywood, and celebrities have! A little off-topic, but remember Paris Hilton and her Chihuahua? When they went viral in the late 2000s, people in California started buying Chihuahuas just to get in on the trend. Next thing we know, the animal shelters were flooded with Chihuahuas that were dumped after the craze died out. Similarly, the Clown Fish population in the wild suffered after Finding Nemo came out. Overexposing certain animals without context and giving them a large audience is always a bad idea, which is why, prior to the Finding Dory premiere, people were actively discouraged from buying the Blue Surgeonfish. And it seems to have worked. When do we start to call out and discourage the craze around flat-faced dogs?

So, next time a super squished pug face appears on your smartphone screen when scrolling through your timeline, remember about what suffering this dog is probably going through—for the sake of what? Human entertainment? A few likes? Its owners social position and recognition? Stop liking, reposting, hyping, and giving this trend such positive response. It will only lead to the breeding of even more malformed dogs! In theory, the less people are fascinated by these dogs, the less demand there is. In fact, if you want to share anything about these breeds, it should be the truth about their anatomical pathologies: a price they have to pay for self-given, inequitable, and unfounded human superiority.