Common Pug Health Concerns
Written by: Shawn Finch, DVM
Allergies
Good overall health will keep your Pug’s immune system strong and perhaps cut down his or her likelihood of developing allergies. However, allergies probably have a strong genetic component, and many environmental factors are outside of our control. So if your Pug does have allergies, it is not due to anything you should have or should not have done. Maintaining overall health will still help as you manage those allergies.
The signs of allergies may mimic other conditions, so it is important to have your pet evaluated by your veterinarian when problems arise. Itchiness is the most common sign of allergies. Other signs of potential allergy problems include skin irritation, rashes, moist dermatitis (“hot spots”) and hair loss. Ear infections, especially recurring ones, may also be an indication of an underlying allergy problem.
Two main classifications of allergies plague our pets: environmental allergies and food aversions. Common environmental allergens include fleas, dust mites, trees, pollens and grasses. Environmental allergens will be more bothersome to pets in some regions than others, so if you move, your pet’s symptoms may worsen or (hopefully) subside.
To diagnose environmental allergies, a serum test or intradermal skin test may be done. Once testing is completed, hypoallergenic shots can be prepared containing small amounts of the offending allergen(s). These are given every few days in slowly increasing increments, with the goal of gradually desensitizing the immune system to the allergens until they are no longer a problem.
The serum and intradermal skin tests that correlate wonderfully to environmental allergens unfortunately have a low rate of coloration for food aversions. The only direct diagnostic test for food aversions is a food trial.
Food aversions are almost exclusively protein-related. Your veterinarian will recommend a specific diet to be fed exclusively, a novel protein diet (commercial or homemade), or a hydrolyzed protein diet. Strict adherence will make or break the food trial. If symptoms of allergies disappear over the course of the trial, the diagnosis is “official” and you may add foods back in one at a time. If a reaction is seen, that food will need to be avoided in the future. Sometimes there are only one or two offenders, and sometimes a pet does the best on a very restricted diet. However, dogs don’t usually mind restricted diets, and it is worth whatever diet maneuvers need to be done to keep your pet healthy and comfortable.
Allergies are often treated symptomatically, either exclusively or in conjunction with more direct treatments. Supportive treatment may include anti-histamines, steroids, medicated baths, diet changes, fatty acid supplements, chiropractic and acupuncture. Use all treatments carefully and in full cooperation with your veterinarian.
Our goal when treating any disease is always a complete cure. However, with allergies, it is more realistic to aim for chronic management and the lowest effective amount of medicine. If our allergic Pug is comfortable and happy, we have succeeded.
Anal Glands
All dogs and cats have anal glands. They are small (peanut to grape-sized) sacs near their bottoms, at about 4 o’clock and 8 o’clock, if their butts were clocks.
The purpose of anal glands is probably to mark territory. The anal glands secrete a small amount of thick liquid when an animal defecates. If the opening of the anal glands always stays patent and the glands empty completely when the animal defecates, and the anal glands never become infected, you may never notice anal glands at all.
Pugs have a conformation that sometimes lends itself to incomplete expression of the anal glands, and thus they are more prone to anal gland problems than some other dogs.
When the anal glands do not empty completely, they can become enlarged. At this point, manual expression completely treats the problem. If this is not done, the glands can become uncomfortable. At this stage, you may notice your pet licking or scooting. Manual expression is still completely curative.
If the glands are not expressed, they may become infected. At this point, manual expression is still helpful, but the glands may need to be flushed, and your Pug may need antibiotics. And finally, chronically infected anal glands may rupture. This is a painful condition that needs to be treated right away. In severe or very painful cases, sedation or anesthesia may be needed to treat the gland completely.
In some cases, anal glands may be surgically removed. It may be necessary to consult a surgical specialist. When the entire gland is removed, obviously, no further trouble will be had with anal glands. However, possible complications of surgery include pain, infection and temporary or permanent fecal incontinence.
There may be a link between allergies in dogs and anal gland problems. We are not sure if allergic dogs, being itchy, are more bothered by swollen glands, or if the opening of their anal glands becomes inflamed with the rest of their skin and then occluded, or if there is some other link. If your pet has chronic anal gland problems, be sure to note any skin or ear issues also, all of which may be linked to allergies.
Your Pug’s veterinarian will teach you to express anal glands if you would like. It is a technically simple procedure. However, of the many people I have taught the procedure, every single one of them has come back and had me express their pet’s anal glands after one try. The grossness factor just makes it worth the money spent!
Have your Pug’s anal glands checked every three to six months. After a few check-ups, base the frequency of anal gland expression on your veterinarian’s recommendation. May you never have to deal with anal glands whatsoever, except for perhaps the occasional anal gland expression.
Coprophagia
Coprophagia. Just giving you a different word to use when you do not want to tell your friends that your adorable puppy is a poop-eater.
Do not be embarrassed! It is so common that it almost deserves its own page in a standard puppy scrap book. The question I field most often about this issue is “Why?” This is usually not a dietary deficiency issue. It is usually not related to complex anxiety problems. Pet owners have not caused it by training or not training their pets a certain way. Brace yourself, you will not like the answer. Dogs are coprophagic because they LOVE the taste of poop.
Coprophagia is normal, it is natural, all puppies (and some dogs) do it. But you do not have to live with it. As obsessed as I am with medical wellness, the grossness factor is almost as good as a reason to discourage this behavior. As you know, pugs are very similar to Boston Terriers in that they do not give normal puppy kisses. They lure you close with their cute faces then lick the roof of your mouth. So having a Pug with coprophagia is simply not acceptable!
The biggest medical risk to a pet with coprophagia is infection (if eating feces from another animal such as a wild bunny or indoor cat friend) or reinfection (if eating his or her own feces) of intestinal parasites. So first and foremost, make sure your dogs AND cats are regularly being tested and treated for intestinal parasites. And now on to habit reshaping…
Ask your veterinarian about oral taste deterrents. Products are available that are odorless and tasteless when eaten, but bitter when passed. The pet whose poop is being eaten is the one who should be treated. For example, if your puppy is eating his own poop, you would treat him. If he is eating the cat’s poop, you would treat the cat. This seems unfair, but hopefully, your pet will not even notice the medication and will not know he or she is being treated.
Make sure feces are removed from the yard as soon as possible, and cat litter is cleaned as soon as possible. This may require hiding around the corner with a scoop or a bag while your pet potties. Once your pup has developed new habits (like NOT eating poop), you will be able to relax your vigilance.
Coprophagia is frustrating but very treatable. Retraining with taste deterrents and environment controls usually can be done within a week. If your pet is especially stubborn, take heart in knowing that if we can not retrain our pets, they WILL almost always outgrow the habit. My professional advice is that you should wait on puppy kisses until then.
Dental
Pugs develop plague and tartar more quickly than many other breeds, and often have more severe secondary problems. Acclimate your Pug to having his or her mouth checked. This will pave the way for future brushings, and prepare your pet for when you may need to check the mouth for a foreign body or a painful area or just assess their mouth for overall health.
The best way to prevent dental problems is to brush your pet’s teeth daily. This is also the most time consuming and annoying way to prevent dental problems. If you can do it consistently, you may be able to avoid yearly dental cleanings under anesthesia. If you can do it inconsistently, you may limit the severity of dental disease, and be able to increase the intervals between dental cleanings.
Other things may help limit dental disease, most notably things your pet can chew. Always weigh the risk of broken teeth or material becoming lodged in the intestinal tract against the benefit that would be attained. Bones are generally considered unsafe. Kongs, rawhides, rope toys and dental chews such as Greenies and Nylabones are relatively safe, but their use should be supervised.
Special (prescription or non-prescription) diets may help mechanically remove plaque. Dental rinses and some foods contain enzymes or binders that break down plaque before it is allowed to harden into tartar.
Oral exams should be done by your veterinarian every six months, and, of course, more often if you have concerns. If any areas of pain or infection are present, or if tartar build-up is significant, your veterinarian will probably recommend a dental cleaning. This is the same cleaning you or I would receive at our dentist, including gum pocket measurements, tooth scaling and polishing. However, pets are placed under general anesthesia so they are completely immobile, they will not be frightened and a thorough job can be done.
Before your pet’s dental cleaning, your veterinarian will obtain a health history, perform a complete physical exam and run preanesthetic laboratory tests, including a complete blood profile.
Your pet will be anesthetized and maintained on gas anesthesia. Intravenous fluids will be given, your pet will be monitored by an anesthetist aided by machines to measure his or her heart and respiratory function and blood pressure, and a second person will perform the dental work. A veterinarian will be present at all times, and will assess the mouth and do any extractions if needed. Dental procedures are among the most common anesthetic events in most veterinary hospitals and can be done with minimal risk. Pets typically go home later the same afternoon.
Dental disease can cause oral infections, infections in other organs, and significant pain. Do all you can between dental cleanings to minimize dental disease, and have dental cleanings done as often as needed. With good oral care, at home and by the veterinary team, most problems caused by dental disease can be mitigated or avoided all together.
Ears
Pugs are prone to ear infections at a higher rate than dogs in general. They are also susceptible to allergic otitis, inflammation of the ear canal caused by allergies that predisposes them to infectious otitis. And their ears are floppy! This allows moisture to be more easily trapped in the ear canal of Pugs than in the ear canals of their pointy-eared friends. Evidence is not conclusive, but this too may predispose poor Pugs to ear problems!
While owners of other dogs will need to occasionally check their pets’ ears, Pug owners will need to be vigilant. If your veterinarian says your pet’s ears are healthy, immediately lift an ear and look and smell. That beautiful pink color? That is normal! The lack of debris? Perfect.
If your veterinarian says your pet’s ears are unhealthy, immediately lift an ear and look and smell. Notice the painful, swollen red canal, the black yuck and the wet-dog-gone-bad smell. Work with your veterinary team to bring your Pug back to optimal health, and be on the lookout for these signs in the future!
Regular ear cleanings will help keep your Pug’s ears healthy. Use only ear cleaner labeled for dogs, preferably one that your veterinary team hands to you. Peroxide is not safe. Alcohol stings. Water just creates a moist environment. You need a pH balanced, non-irritating effective cleaner with a drying agent.
Choose a water-resistant environment in which to clean your Pug’s ears, perhaps in the bathroom or outdoors. Pour the cleaner into one ear until it reaches the top of the ear canal. The ear canal goes down vertically a bit, and then just behind the hinge of the jaw, goes in towards the center of the head horizontally. So picture that you have just filled an “L” shaped tube with cleaning solution. Gently squish the ear canal so the solution agitates in the canal a bit.
Now stand back. Close your eyes. Close your mouth. Aren’t you glad you listened to me? Your face is wet, but your eyes do not sting! And you do not have a mouth full of Pug ear wax! You are welcome.
After your Pug shakes the excess cleaner out, use a cotton ball to gently wipe what is left on the inside of the ear flap and the part of the canal you can see. Continue until you get a clean cotton ball. Repeat the same process on the other ear.
You can use cotton swabs to gently clean the crevices of the ear flap and outer ear canal, but do not use them in the ear. Swabs will not hurt the fragile ear drum, as it is protected by its position at the end of the “L” shape of the canal. However, it is easy to accidentally pack wax and debris into the ear canal with a swab. The debris that is out of reach will most likely be removed by the ear cleaner itself.
Clean your Pug’s ears after baths and swimming and otherwise every two to four weeks. This will keep excess wax at a minimum, and if not completely prevent, at least minimize the number and severity of ear infections. Also, if an infection is brewing, you are much more likely to catch it before it becomes chronic.
Eyes
Some of the features that make Pugs the cutest also predispose them to health problems. Chief among them are their adorable bug eyes. The biggest problem with Pug eyes is that, because of their anatomy, they are not as protected as those of other dogs.
Pugs have eyes that protrude more than other dogs. The bulbs of their eyes are not always adequately covered by their eyelids, causing incomplete blinking some or all of the time. The bones of their eye sockets are set farther back than other dogs. Their muzzles are short, providing very little mechanical protection in comparison to longer-muzzled dogs.
The conformation of Pugs predisposes them to proctosis, or an eye popping out of the socket. As alarming as this condition appears, it is usually treatable when dealt with right away.
Exposure keratitis is a problem most Pugs deal with on some level. Their corneas adapt to excess exposure caused by incomplete blinking and sometimes inadequate tear production by allowing pigment to form where their corneas should be clear. This is non-painful and is not a problem unless the pigment migrates over the area where their pupil is, obstructing sight.
Many Pugs suffer from keratoconjunctivitis sicca (KCS) or “dry eye.” This is a problem of inadequate tear production exasperated by excess exposure to the air. It is treatable but is a lifelong condition.
Because Pugs are unable to blink as efficiently as other dogs, and their eyes are anatomically more vulnerable than most, they are at a bit of a higher risk to corneal scratches and ulcers. Scratches and ulcers are diagnosed with an examination and special stains.
Pugs are also prone to conjunctivitis, an inflammation of the soft tissue surrounding the eye. It is similar to “pink eye” in us, but not contagious. The signs are identical to other painful/itchy eye conditions.
Signs that indicate your pet should be seen by your veterinarian include excess blinking, inability to open an eye completely, ocular discharge and pawing at the face.
Healthy Pugs without eye disease may be kept comfortable with rewetting drops that can be bought over the counter, and they may help with certain eye conditions, but check with your veterinarian before using any eye drops. One over the counter medication that may seem benign, Visine (tetrahydroziline), is dangerous and never indicated for dogs.
Many eye diseases are treated with eye drops or ointments prescribed by your veterinarian. He or she will be able to show you how to effectively administer medication. Often these medications provide some level of instant relief, and if accompanied by a treat, may not cause your Pug distress, which is good, because they often need to be administered several times a day!
If you are at all concerned about an eye issue, the best course is to get your Pug to his or her veterinarian as soon as possible, as eye diseases are often painful and can progress rapidly.
Ortho
Pugs are chondrodystrophic, meaning their bones are proportionally shorter and twistier than other breeds. This, along with other genetic predispositions, makes them more susceptible to some orthopedic problems, including luxating patellas, intervertebral disk disease and Legg–Calvé–Perthes disorder.
Luxating Patellas
These can happen traumatically, but are most often congenital, meaning Pugs are born with shallow stifle (knee) grooves and patellas (knee caps) that move out of their groove, either to the outside (laterally luxating patellas) or to the inside (medially luxating patellas). They are graded by severity. Mild cases may not be debilitating or painful, and observation may be all that is needed. Moderate cases may be treated with joint protectants or anti-inflammatories. Severe cases may need surgical intervention for return to function, pain relief and avoidance of future arthritis. Surgery is done by qualified general practitioners or board certified veterinary surgeons. The groove for the knee cap is made deeper, and the knee is ideally returned to optimal function and comfort.
Intervertebral Disk Disease
This disease has some genetic and conformation predisposition. The odds of having problems can be increased with excess weight or traumatic injury. In Intervertebral disk disease (IVDD), one or more disks between vertabrae are compressed, putting pressure on the spinal cord and/or spinal nerves, compromising function and causing significant pain. The disease is treated medically or surgically (by a surgical or neurological specialist), and with strict rest until healing has occurred.
Possible outcomes include (hopefully) complete healing, healing with risk of reinjury, healing with chronic pain, and healing with neurological deficits. Neurological deficits can include gait changes, proprioceptive deficits (inability of a pet to gauge where he or she is positionally-this can range from almost imperceptible to severe), urination or defecation abnormality, paresis or paralysis. If pain and neurological deficits can be managed, a pet can have a great quality of life.
Legg–Calvé–Perthes disorder
This is a disease with a genetic basis in which the head of the femur (the ball of the hip socket) is disfigured. It is diagnosed with examination and radiographs (x-rays) and treated with surgery.
Many of these problems have a genetic component, but keeping your Pug fit and at a healthy weight will minimize their risk of orthopedic problems, and possibly minimize the severity of the problem if they do have issues.
Paws
Interdigital cysts can be a problem for any dog, but Pugs may be more disposed to them, and dogs who have spent time on wire grating often develop interdigital cysts secondary to the irritation caused by the wiring. Broken toes are another risk of living on wire flooring.
Wire grating is NEVER an appropriate substrate for sensitive pet paws, but is often used in puppy mill situations to fit too many dogs into too small of an area. It is illegal as a flooring material for pets in many communities, including Omaha.
Sometimes interdigital cysts will occur without prior foot trauma, and sometimes they will mimic other diseases, such as tumors or foreign bodies in the foot. If a “cyst” seems to be growing or is not healing, have it checked by your veterinarian.
Many times interdigital cysts will resolve without treatment. Make sure your Pug is not uncomfortable or favoring one paw over the others. If all else seems well, keep an eye on your Pug and call your veterinarian at the first sign of the problem worsening.
Watch for discomfort, discharge, enlargement of the cyst and failure to resolve in ten to fourteen days. Your veterinarian may remove or lance the cyst and/or prescribe antibiotics or foot soaks. He or she will also rule out other causes of swelling between the toes, so be sure to have your Pug seen if the problem does not resolve or if it worsens.
Respiratory
Pugs are brachycephalic (literally “broad headed”). The upper respiratory system of Pugs is not as efficient as that of mesochephalic (normal) or dolichocephalic (“long headed”) dogs, and many of the breathing problems Pugs are prone to are due simply to the inability of air to travel smoothly from the outside atmosphere to the lungs. Our job as Pug lovers is to make that journey as smooth as possible, and thus minimize breathing issues as much as possible.
Pugs often have stenotic nares, meaning their nostrils are smaller and not as fully open as other dogs’ nostrils. They have a shorter snout which means they also have a shorter, more compressed sinus system. Their soft palate, which is behind their hard palate, or roof of their mouth, is longer than that of other dogs, and also goes back farther into their pharynx. The soft palate may cause no problem at all, or may interfere with breathing by blocking the opening to the lower respiratory system. Often their laryngeal saccules (small membranes near their larynx, or voice box) may be inverted, which could be a primary issue or secondary to chronic negative pressure due to the other respiratory issues.
All of these will at best make your Pug a snorer, a snorter and a reverse sneezer, and in the worst cases will cause respiratory issues that can be very serious.
Some of the issues Pugs face are potentially surgical. If your Pug has stenotic nares, a veterinarian who does nasal surgery (usually a general practitioner) can reshape the nostrils under general anesthesia to create more comfortable air flow. If this is done at a young age, often secondary problems of elongated soft palate and everted laryngeal saccules can be avoided. If these also are problems (your veterinarian can check for you), they can also be surgically corrected, either by a general practitioner or a board certified veterinary surgeon.
Weight management will be the number one variable you will be able to control in keeping your pet’s respiratory system healthy. If your Pug is fit and at a healthy weight, he or she will be better able to deal with the shortcomings of the respiratory system. Your Pug will be even more heat-sensitive than other dogs, so be over-protective in warm weather. Exercise is important, but watch carefully for any signs of discomfort and let him our her rest or discontinue an activity that is causing respiratory distress. Keep him or her cool and well hydrated.
Control what you can, and have treatable problems treated. Keep your Pug at a healthy weight and be very watchful for respiratory discomfort. May your snoring, snorting, reverse-sneezing Pug always be completely healthy and fully oxygenated.
Skin Care
Dogs shed or need haircuts. Pugs shed very, very well. A high quality diet will help minimize shedding, but your Pug will still shed. Brushing your Pug at least weekly will contain some of the shedding, but will also keep the skin healthy with the gentle stimulation of brushing and redistribute the skin’s oil along the hairs.
A slicker brush can be used, but a Furminator is even better. This is a brush based on the grooming clipper blades that gently works out the loose undercoat. It is the most effective brush I have found. The one precaution you will need to take is be careful about brushing one area of skin over and over, as excessive or rough brushing can cause skin irritation. If you are concerned, spread a good brushing over two or three days.
Bathe your Pug regularly, every two to four weeks is ideal. Any more often (unless prescribed by your veterinarian for a medical condition) may cause skin dryness. Use a puppy or dog shampoo, massage it into the coat well and rinse completely. This too will keep hair follicles healthy, so shedding is as minimal as possible, and will also contain some of the shedding to bath time.
When you are bathing your Pug, make sure you gently wipe the crevices of his or her wrinkles with a soft cloth. Make sure they are dried completely. Pay special attention to the wrinkles around your Pug’s eyes. These can be extra prone to moisture problems, as tears may collect here. If needed, wipe these wrinkles out daily with a pet-specific wipe, being careful to avoid the eyes themselves. If the wrinkles seem red or have any discharge, make sure you get your Pug in to see your veterinarian as soon as possible. After bath time is a good time for nail clipping and ear cleaning.
When your Pug is dry, check his or her wrinkles for moisture. They should be as dry as the rest of your Pug. Moisture at the worst is a sign of a skin problem and at the best, predisposes your Pug to skin problems in the future.
Pugs have wrinkles around their eyes and muzzle, over their shoulders and around their tail base. The depth of the wrinkles varies from dog to dog, but can be accentuated by excess weight. Keep your Pug at an ideal weight, and wrinkle problems will be minimized.
Weight
Every problem Pugs are prone to is magnified if they are carrying extra weight. Breathing issues become more severe. Joint issues become more painful. Even wrinkles become deeper! Obesity may even worsen conditions that may seem unrelated, such as allergies and other immune problems.
Unfortunately, pugs are also genetically prone to being overweight. This does not have to become a hopeless cycle. Start now to keep your Pug fit and at an appropriate weight, and you will minimize and perhaps even eliminate many problems in the future.
Pugs should be broader at the shoulder and chest than most dogs, but their body condition should be muscular. They should have a slightly tucked in waist, and ribs that can be felt, but not seen. Weight loss, if indicated, should be guided by your veterinarian and spread over several months.
Provide your Pug with a high quality diet, perhaps a low fat version of his normal food. Consult with your veterinarian as you formulate his feeding plan while he is losing weight and once he is in great shape. Your veterinarian can also give you ideas on treats and between meal snacks. Consider weight loss goals and your pet’s preferences. Some treats to consider are green beans, carrots, chicken and low fat commercial treats.
Walk your Pug as often as you can. Once or twice a day is ideal. Playing fetch, running in the yard and swimming, if he or she enjoys these activities, are also great, but walks will most likely be the crux of your exercise program. Base the length and intensity of the first walks on your Pug’s fitness level. Do not push them beyond what they are able to do comfortably.
Remember that all dogs are prone to heat stress, and Pugs and other brachycephalic dogs are more sensitive than most. If your pet seems at all uncomfortable during exercise, be grateful that though they may be overweight, they are still portable and can be scooped up and carried home if needed! Have water available on your walk, and a cool place to rest inside after exercise.
Over weeks and months you can increase the duration and intensity of exercise until you are both in peak condition.