Shih Tzu Breathing Problems

Overview

Breathing issues with Shih Tzu dogs, a brachycephalic breed, can be acute or chronic and are influenced by factors like weather and activity. These issues stem from their flat-faced structure, leading to compacted internal passages. While common in the breed, moderate to severe problems shouldn't be considered normal. Owners can often alleviate breathing difficulties, but veterinary intervention might be necessary in some cases.

This section will cover:

Brachycephalic Airway Syndrome
The main concerns: elongated soft palate, stenotic nares, and collapsed trachea
Reverse sneezing and its breathing spasms
Tips to improve your Shih Tzu's breathing

Brachycephalic Airway Syndrome

This is the term given to brachycephalic breeds such as the Shih Tzu that have breathing issues related to their body structure. It is a general term that includes at least one of the 4 health issues of stenotic nares, elongated soft palate, collapsed larynx (voice box) and trachea issues (abnormally small or collapsed trachea).

The 3 most common issues seen with the Shih Tzu are elongated palate, stenotic nares and tracheal issues. With 50% of Shih Tzu that do have airway syndrome, both elongated palate and stenotic nares are present.

The most common symptoms seen with Brachycephalic Airway Syndrome include:

Breathing difficulties (trouble catching the breath, etc.)
Panting
Trouble eating (gagging or regurgitating food)
Snoring
Noisy breathing (gasping, rattling, or wheezing noises)
Coughing (‘regular’ coughing and/or honking noises)
Exercise intolerance
Cyanosis (low oxygen levels in the blood may cause gums to turn blue) (in very severe cases)
Collapse, fainting (in very severe cases)

Now, we will look at the 3 most common conditions that fall under the category of Brachycephalic Airway Syndrome and then touch on breathing spasms due to reverse sneezing and steps you can take to help your Shih Tzu breathe better.

Elongated Soft Palate

What this is: The soft palate, located at the throat's back, can partially block the trachea in brachycephalic breeds like the Shih Tzu, due to their normal-sized palates in a compressed area, leading to breathing problems. Most Shih Tzu dogs have some degree of palate elongation, ranging from mild with no symptoms to severe, affecting their quality of life. Shih Tzu dogs with breathing issues as puppies should be checked for this, as moderate to severe cases are often noticeable early on and typically diagnosed by age 3.

Symptoms:

Newborn puppies may dribble milk from the nose when nursing
Excessive panting
Trouble eating (gagging or regurgitating food)
Noisy breathing (gasping, rattling, or wheezing noises)
Snoring
Excessive saliva
Symptoms may be more apparent during or after exercise or when excited
Cyanosis (low oxygen levels in the blood may cause gums to turn blue) (in very severe cases)
Collapse, fainting (in very severe cases)
Worsening symptoms as a dog grows older
In severe and extended cases, ligaments in the larynx may stretch, often to the point of collapse

How This is Diagnosed: In minor cases, when it is deemed safe, the vet will examine the mouth when a dog is awake. However, if a judgment call is made that the examination will cause a dog to become overly excited and this in turn will cause dangerous breathing problems, the dog will be sedated.

The veterinary surgeon may perform:

• Pre-anesthetic complete blood count and biochemistry

• Blood gases – to check blood pH and CO2 concentration

• X-rays – The vet will also be looking for a narrowed trachea and any heart abnormalities

Treatment:

Non-surgical - In minor cases, some changes can be made to help a Shih Tzu breathe better. This includes limiting the dog’s activity during hot weather, trying to avoid over-excitement and encouraging different sleeping positions via canines beds and pillows. However, in most cases in which the obstruction is causing breathing distress that interferes with the dog’s quality of life, surgery is recommended. And it is important to note that this issue often worsens as a dog grows older; in time ligaments in the lynx may stretch, and often to the point of collapse.

Surgical - Surgical treatment for elongated soft palate involves shortening the palate, usually after a Shih Tzu turns one year old to avoid repeat procedures due to growth. Tonsil removal may also be necessary and is typically done alongside the palate surgery. Laser surgery, which cauterizes as it cuts, is commonly used to reduce bleeding, swelling, and recovery time.

Post-op, only soft food should be provided to aid throat healing, including rice with minced chicken, eggs, oatmeal, and sweet potato, or softened dog food with warm water, gravy, or low-salt chicken broth. Healing generally takes 2-3 weeks.

Stenotic Nares

What this is: This is the medical term for pinched nostrils. This is caused by inherited malformation of the cartilage in the nose. Essentially, the nostrils are too small (too narrow). These narrowed breathing passages will cause a dog to have trouble taking in air. About 50% of Shih Tzu have stenotic nares to some degree and many of those that do, also have the previously mentioned elongated palate.

Although stenotic nares are present at birth, the symptoms of respiratory difficulty may not begin until a dog is several years old. Surgery is the treatment in moderate to severe cases.

Symptoms:

• Noisy, funny breathing (especially when the Shih Tzu breathes in)

• Exercise intolerance

• Cyanosis (blue appearance of the gums, due to lack of oxygen)

• Fainting (in severe cases)

How this is Diagnosed: Stenotic nares are relatively simple for the veterinarian to diagnose by simply looking at the size of the opening into the nostril.

However, there may be other issues that go along with this such as a soft palate or a collapsed larynx or trachea that are less obvious and typically require light, general anesthesia for diagnosis.

Treatment:

Non-Surgical: In minor cases, some changes can help:

1. Immediate discontinuation of a collar. A collar should never be worn again; on leash (this is also recommended to prevent this issue). A harness will be used any time the Shih Tzu is on leash.

2. Limit over-excitement. Keep things low-key, offer introductions to fun activities in a casual manner.

3. Weight loss. Though this is not a problem that is typical of this breed, if your Shih Tzu is overweight, weight loss is recommended as even a few extra pounds can compound the problem.

Note that mild cases can turn severe, so puppies and dogs should be monitored and assessed over time.

Treatment, Surgical: The surgical procedure for this involves widening the opening of the nostrils by removing a small piece of the wall of each nostril. This is done with a scalpel or a surgical laser.

• Argument for delaying surgery – Veterinarians who are not breed-specific may want to surgically fix this as soon as it is diagnosed. However, puppies may have more pronounced stenotic nares during the teething phase. As the puppy matures, the nose may open, allowing breathing problems to decrease. Therefore, with puppies that have minor cases, you may want to speak with the vet about waiting until the teething stage is complete.

• Argument for having surgery performed ASAP - Stenotic nares may cause a dog put effort into forcefully inhaling. Over time, this can cause the larynx to become weak. With moderate to severe cases, ultimately, the larynx may collapse, causing trouble breathing, sometimes to the point of being fatal.

Note, if a Shih Tzu has both elongated soft palate and stenotic nares, severe enough to cause difficulty breathing, surgery is almost always the answer.

Collapsed Trachea

What this is:

Collapsed trachea, a condition where the trachea's cartilage rings collapse, partially blocking the breathing passage, is more common in toy breeds. It can be genetic, triggered by neck pressure from collars, or acquired due to chronic respiratory, Cushing’s, or heart diseases. Collar use can worsen minor tracheal issues. While it can occur at any age, the genetic form usually leads to collapse by age 6.

Symptoms:

A distinctive cough, often referred to as a honking noise (like a goose) * This is the #1 sign and can be one of the most troubling symptoms. A dog may take a stance of extending his neck and spreading his elbows apart as if trying to cough something up.
Noisy breathing (gasping, rattling, or wheezing noises)
Gagging
Breathing difficulties (trouble catching the breath, etc.)
Exercise intolerance
Symptoms may be more apparent during or after exercise, when excited, or when breathing in cold air
Cyanosis (low oxygen levels in the blood may cause gums to turn blue) (in very severe cases)
Collapse, fainting (in very severe cases)

How This is Diagnosed:

Experienced veterinarians will immediately suspect this by the particular honking-type cough. X-rays are then taken to confirm. In some cases, x-rays will not show a tracheal collapse; however, a dog may still be treated for it. If you desire confirmation and x-rays are inconclusive, you can ask for a fluoroscopy, which allows real-time visualization of the trachea as a dog inhales and exhales.

Treatment:

Treatment, Non-Surgical: Studies, though ongoing, have shown that approximately 70% of dogs respond well to non-surgical treatment. And, all of these options should be explored, since surgery is quite drastic. This includes:

1. Immediate discontinuation of a collar. A collar should never be worn again; a harness will be used when on leash (this is also recommended to help prevent this issue).

2. Limit exposure to cold air. Take care on below freezing days to limit outdoor activity.

3. Limit over-excitement. Keep things low-key, offer introductions to fun activities in a casual manner.

4. Avoidance of exercise during heat/humidity. Moderate to heavy activity in hot (and especially humid) weather can make breathing difficult; even more so for those with collapsed trachea. Follow general care tips to limit exercise during the hottest parts of summertime days.

5. Weight loss. Though this is not a problem that is typical of this breed, if your Shih Tzu is overweight, weight loss is recommended as even a few extra pounds can compound the problem.

Treatment, Medications:

• Cough suppressants. Cough medications such as hydrocodone or dextromethorphan can help.

• NSAIDs (nonsteroidal anti-inflammatory drugs) such Rimadyl or Etogesic can help with pain and inflammation.

• Corticosteroids such as prednisone may be given to help reduce pain and inflammation. This may be given via an inhaler. This can only be given short-term without risk of severe side effects. Even short-term, there may be changes in thirst or appetite and risk of susceptibility to infections. A dog will need to be carefully monitored.

• Antibiotics. Secondary lower respiratory tract infections are a concern. Antibiotics will be prescribed as needed.

Treatment, Surgical: If non-surgical treatment does not produce any relief and if a dog is having extreme and severe breathing difficulties and/or is in a lot of pain, surgery is often recommended.

This involves using a mesh-type sleeve to reinforce the trachea, along with prosthetic polypropylene rings to form a tube that will not collapse. The success rate of this surgery is 75% or higher, though it is extensive and there are risks including bleeding, paralysis of the larynx (voice box), and/or severe internal swelling that can lead to death. This surgery is most often successful with dogs under the age of 6.

Breathing Spasms- Reverse Sneezing

What this is:

This is common with both brachycephalic breeds and with toy breeds, and therefore with the Shih Tzu. When a dog has a ‘normal’ sneeze, air rushes out of the nose; and with this, air rushes in. Since many Shih Tzu already have stenotic nares to some degree, this can make these spasms even more pronounced. Though it can be troubling to see and hear, and can make a dog anxious, reverse sneezing is typically not harmful to a dog.

Symptoms: There will be sudden episodes of loud, quick inhales. It’s often rhythmic in the way that hiccups are. While it can be mistaken for the honking noise of collapsed trachea, with reverse sneezing there will be consecutive snorting sounds. Yet, like collapsed trachea, a dog may take a stance of extending his neck and spreading his elbows apart, as if trying to cough something up.

The episode will generally be short, lasting only seconds to a few minutes. As soon as it is done, breathing will return to normal, and a dog will typically behave as if nothing is wrong. These may be random episodes every now and then or repeating episodes.

Triggers: It may happen out of the blue; however, some triggers include breathing in frigid air, having a rush of excitement, breathing harder due to physical activity, wearing a collar that is too tight, and/or breathing in an airborne irritant.

Treatment: Treatment for reverse sneezing in Shih Tzus, after ruling out brachycephalic airway syndrome, includes:

Cupping your hand over the mouth and nose for 15-20 seconds to regulate carbon dioxide levels.
Applying a dab of peanut butter on the dog's nose to prompt tongue extension, relaxing the throat.
Gently massaging the throat with soft, downward strokes to relax it.
Offering water or a snack to interrupt and stop the sneezing episode.

Recording a video of the breathing spasms for the vet can be helpful for diagnosis.

Allergies

Allergies can cause a dog to have some wheezing and other slight breathing issues, however there is almost always other symptoms such as itchy skin, rashes and/or water eyes. With others there may also be coat issues and/or runny nose. Since that is a huge subject in itself, if you suspect this, do check out Shih Tzu Allergies.

Breathe Better Tips for All Shih Tzu Dogs

Even if all serious conditions have been ruled out, a Shih Tzu may still have some minor breathing problems. And this, of course, can be frustrating and worrisome for owners who are being told that everything is normal, but they still see their puppy or dog having breathing difficulties.

There are some steps that you can take to help a Shih Tzu breath better:

1) Taking action to avoid overheating is key. Follow all summer care guidelines for the Shih Tzu. Limit exercise during very hot weather. Since daily exercise is very important for good, overall health, in the summer take walks early in the morning and then again about 1 hour before the sun sets, as these are the coolest parts of the day. Be sure to bring along water any time you are out and about with your dog and take frequent breaks in the shade.

2) Keep moisture in the air. For some Shih Tzu, breathing in very dry air can make breathing more difficult. The use of humidifiers can help with this. If you cannot set them up over the entire house, one placed near the dog’s sleeping area can be helpful for nighttime breathing problems.

3) The position in which your Shih Tzu rests and sleeps can cause issues, and this is particularly evident with snoring. The dog should have a quality, supportive bed in which his body does not sink into the mattress. In addition, placing a small pillow under his head to elongate the neck can help him breathe better at night.

4) If your Shih Tzu seems to have problems when excited, try to intervene before it reaches a point of affecting his breathing. This can include taking short breaks from play, making interval introductions to a new place or when meeting new people and distraction if a Shih Tzu is responding to a trigger.

5) A collar can cause breathing issues in two ways: if too tight, it constricts the neck and breathing passages (a good fit allows two fingers under it), and if used with a leash, it stresses the neck, potentially interfering with breathing and risking tracheal injury. Always use a harness instead.

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