Q:I recently purchased a really cute English bulldog puppy from a local breeder. She suggested I take my new puppy to the veterinarian's office for a well check up within the first couple of days of my purchase to confirm the good health of the little guy. I did and my veterinarian talked to me about brachycephalic airway syndrome in bulldogs and what to expect if I start to see signs. What exactly is that and do all bulldogs have it? Should I keep the puppy if it starts to snore or has problems breathing?

A: Brachycephalic airway syndrome refers to a condition having some level of respiratory distress caused by abnormal anatomy. Bulldogs are not the only breeds affected. Boston Terriers, pugs, Pekingese, French bulldogs, King Charles Cavalier spaniels, Persian and Himalayan cats all can be born with the condition. It is really more of a syndrome made up of four parts. Small nasal openings, elongated soft palates, everted laryngeal saccules and laryngeal collapse all can be parts of the syndrome.

Breeds listed previously that present with loud straining breathing and exercise intolerance, blue tinting of the mucus membranes of the mouth and even collapse are going to be highly suspected of having the syndrome. A good physical exam and a good laryngeal exam will confirm it usually. Chest X-rays are often used to rule out other conditions that can make breathing difficult for the pet.

Let's go through the four parts of the syndrome to better define the component and its treatment.

1. Small nasal openings - This is where the pet was born with nasal openings that are too small for sufficient air to enter the nose. Usually by 3 months of age you can tell if the openings are going to grow any larger. Some veterinarians may want to wait until the pet is a little older, but never any younger. This is very easily correctable with a surgical nose lift. A wedge of tissue is cut from the nose where it curls around on the bottom and removed. Stitches move the remaining parts of the nose outward, making the openings bigger.

2. Elongated Soft Palate - This is where there is too much tissue in the back of the throat that vibrates and gets in the way of airflow into the lungs. To diagnose this, you will need to have your pet sedated and your veterinarian will observe where the palate falls in the back of the throat. It should come just a few millimeters in front of the epiglottis or covering to the trachea. If it is hanging down like soggy socks, it needs to be corrected. Veterinary surgeons will use either a scalpel to shorten and sutures to sew or a laser and sutures to make that correction. Great care must be taken to try to minimize all swelling after surgery because it can lead to severe respiratory distress. Some veterinarians will refer these patients to a larger hospital for correction.

3. Everted Laryngeal Saccules. These are little saccules that are normally in crypts in the laryngeal region in the back of the throat. Over time and with increased respiratory efforts in addition to negative airflow pressure, theses saccules are pulled out to further contribute to airflow obstruction. They will be observed and diagnosed at the sedated laryngeal exam. A good surgeon can remove these by cutting them away. Again, great care must be made to guard against post surgical swelling and referrals are common.

4. Laryngeal Collapse. This is the end stage of the syndrome. There are not a lot of options at this point. The syndrome is so advanced at this point that surgery to correct broken down laryngeal cartilages just simply does not work. A permanent tracheotomy or breathing hole in the throat is the only option. Most owners do not feel comfortable with this option and decide to pursue no further treatment.

To answer the rest of your question, no, not all bulldog puppies will have this syndrome. But each puppy needs to be evaluated carefully as they grow. If you start to see signs and hear loud breathing then take your puppy to your veterinarian and ask for a laryngeal exam. This way you will know if you have to be concerned, what to expect, and your options for treatment.

Send questions for Dr. Allison Dascoli to "Ask the Vet," Charleston Daily Mail, 1001 Virginia St. E., Charleston WV 25301 or e-mail them to askthe...@dailymail.com. Comments or suggestions can be submitted the same way.