Manchu Shih Tzu Society

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After some brief research from breeders, exhibitors and owners, it seems that many people are coming across a few health issues relating to breathing problems within our breed. Many of these it would seem derive from non-researched matings, which as we all know can be easily rectified by a good sensible breeding practice.

Here are a few articles I have found online and will be crediting the authors accordingly. Please note some of the information is from the USA .....


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 four health issues, stenotic nares, elongated soft palate, collapsed larynx (voice box) and trachea issues (abnormally small or collapsed trachea). The three 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 fast – This may worsen when the dog is excited and/or in hot weather

• Panting – The Shih Tzu may have episodes of breathing fast and heavy

• Trouble eating – The dog may gag or even regurgitate food

• Snoring – The degree of snoring may vary depending on the humidity level in the house and the position in which the Shih Tzu is sleeping. 

• Noisy breathing – There may be gasping, rattling or wheezing noises

• Coughing – During an attack, the dog may inhale in such a way that sounds like coughing or the Shih Tzu may have an actual cough; sometimes sounding like honking noises. 

• Exercise intolerance – Not only may breathing become difficult when the dog is active, it may force him to stop, as he gasps for breath. 

• Collapse – In very severe cases, the dog may collapse.

Reverse sneezing

This is a very good description about a condition in which the dog seems to be unable to get its breath and begins to honk or snort. It is most often caused by a slightly elongated soft palate that “sticks” until the dog takes a deep breath through its mouth. The most effective way to stop this is to put a finger over the dog’s nostrils, thereby forcing it to breathe through its mouth. Sometimes just a hug and some reassurance will do the trick! Unlike more serious problems found in brachycephalic (short-faced) dogs, reverse sneezing in the Shih Tzu is quite common and is not life-threatening. (Quintessential Shih Tzu)

Elongated Soft Palate

The soft palate is the flap of skin at the back of the throat. If the palate is too long it can partially block the entrance to the trachea, or windpipe. This increases airway resistance which can lead to breathing problems. Just about 10% of Shih Tzu have elongated soft palate, again due to the facial structure of the breed. It can range from very slight which causes no symptoms at all, moderate which will cause some problems to be noticed and severe which interferes with the dog’s quality of life. Shih Tzu’s with breathing problems as puppies should be examined for this issue, because with moderate or severe elongated palates, signs are noticeable when the Shih Tzu is young and it is most commonly diagnosed by the age of 3 years old. 


The Symptoms


• Newborn puppies may dribble milk from the nose when feeding

• Excessive panting

• Unable to calm down quickly when excited

• Choking on food

• Spitting up whole pieces of food

• Loud, raspy breathing when overheated 

• Snoring

• Excessive saliva

• Fainting from lack of air (in extreme cases)


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 - 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 canine 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. It is important to note that this issue often worsens as a dog grows older, in time ligaments in the lynx may stretch, often to the point of collapse. 


Surgery involves shortening the palate. Many vets prefer to do this after a Shih Tzu has reached the age of 1-year-old. This is because the palate may still grow when a pup is still maturing and if done too early, another procedure may be required at a later date. Sometimes a dog may need to have his tonsils removed and the vet should do this during the palate clip if required. Laser surgery is now the most common way to shorten the palate. It cauterizes as it cuts, which decreases bleeding and swelling, and shortens recovery time.



During post-op recovery, only soft food should be given to allow the throat time to heal. This can include rice with minced pieces of chicken, eggs, oatmeal and sweet potato. Dog food can also be softened with warm water, warmed gravy or warmed low-salt chicken broth. Healing time varies, but the typical healing time is between 2-3 weeks.

Pinched Nostrils and Teething

Shih Tzu puppies often have slightly pinched nostrils that generally open with time. The bubbly discharge from a Shih Tzu puppy’s nose is NOT serious if the discharge is clear and watery and the dog is otherwise thriving. This problem is most acute during the teething stage, even the nostrils of a dog that has difficulty simultaneously eating and breathing or is lethargic at this time may open satisfactorily as the dog matures.

*** Pinched Nostrils and Teething go together ***

Teething Problems

Some puppies in this breed experience teething trouble. The noses swell and pinch off some and they may have a little clear discharge. They make some snorting and snuffling sounds. They will usually outgrow this after the adult teeth come in. If they are playful, active,  eating and drinking well, they are ok.  If they can’t eat or drink well and are lethargic or the discharge changes colour, they may have developed infection and need to be checked and treated.  Most Shih Tzu pups are fine after teething  and it is recommended not letting any surgery be done until after adult teeth are in.

Many Shih Tzu puppies noses will become tight during the teething phase, it will often cause them to snort and mouth breathe. This will go away usually around 12-16 weeks of age sometimes longer. It is very different the Stenotic Nares (Pinched Nostrils). Which is noticed from birth. 

Stenotic Nares on the other hand are completely different and are present at birth.  From the time the baby is born he has difficulty breathing through his nose and struggles with nursing from early on due to the inability to breath and eat at the same time (this can happen with tight nostrils also, however the pup is generally almost weaned by this time).  Some of the time (but not always) surgery will need to be done on Stenotic Nares as the puppy may always have this issue and over time could cause other health concerns.  However, even with Stenotic Nares the puppy can outgrow the condition.  It is advisable to wait and  have surgery done when the puppy is over a year old, as it is a possibility that as they mature, they could outgrow the condition.  Some Vets are way too eager to perform surgery, when it may not be needed, however,  I am not a Vet and you should never take my advice over a vet unless you yourself choose to do so (just my disclaimer).

Tight Nostrils or Stenotic Nares?

Tight nostrils are very VERY common in the Shih Tzu breed.  A lot of people think that tight nostrils and Stenotic Nares (pinched nostrils) are the same thing.  In reality, they are very different.  Tight Nostrils will generally come on when the puppy is teething and sometimes not go away until the adult teeth have fully come in (even up to a year old).  Sometimes it will come and go as the puppy’s gums are swelling off and on from the teething process.  Some puppies can hardly breath out of their noses at this time, but as long as they are active and eating and drinking normally it is of little concern.  Never have surgery done on a puppy that just simply has tight nostrils as it will eventually go away.  Some dogs will have tighter nostrils than others and some will snore and snort more than others during their entire life, but tight nostrils to the point that they can't breathe through their noses and cause health concerns will generally go away with time.

Breathe Better tips

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) Take 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 night time 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 problems in two ways. If too small, it can constrict the neck and breathing passages; collars should be loose enough for you to easily slip two fingers under it. If a leash is connected to the collar, this puts stress on the neck, which not only can interfere with breathing, but can also lead to tracheal injury, particularly with a Shih Tzu that is already prone to this congenital condition. Always use a harness instead. 

Authors, "Quintessential Shih Tzu" & " Allthings SHihtzu"