Delayed Closure or Hernia?
Most so called "hernias" are actually delayed closure of the umbilical or inguinal (groin) area. We call it a hernia, because at that time, that is what it is. Sometimes I do not mention on my website if a puppy has a inguinal or a umbilical hernia at first because some of the time it is actually already closed by the time they go home. If small, sometimes they are closed by 8-12 weeks. If It seems as if it won't be closed when the puppy is old enough to go home, I feel it is important for you to know. You really can not tell the difference between a true hernia or a delayed closure unless the hernia is severe, but if as the puppy gets older and the hernia is getting a little better as he/she grows, then most likely you are just dealing with a delayed closure. A true hernia will not get better or if it does it is much much later (after 6 mos of age). Sometimes a breeder just simply knows based on experience that a particular dog has puppies that just simply are a little slower at closing up...that being said most breeders will not continue to breed a dog that has continually thrown inguinal hernias or delayed closures that doesn't close up shortly after they are ready to go their new homes. 
Umbilical Hernias
Umbilical hernias really are of little concern and are very common in the Shih Tzu breed. They usually show up at around 2-5 weeks of age and a lot of them will close on their own by around 6 mos of age (delayed closure). If it is large enough that it is "in the way" then it probably should be closed up when the puppy is spayed/neutered if it hasn't closed on it's own, very large hernias should always be closed up so the muscle doesn't close up around it and cause internal injury (however this is very rare to have a umbilical hernia that is large enough to become strangulated). A lot of Vets will do it free of charge or for a small fee as long as they are already spaying or neutering the dog. An umbilical hernia is usually a small soft bump where your puppies umbilical cord was (their belly button) and for whatever reason the muscle failed to close up. There are a couple of reasons why a puppy gets an umbilical hernia. Because of a shih tzu's uneven bite, sometimes the moms tend to have a harder time "cutting the cord" and will tug, pull or even chew to close to the skin or sometimes a difficult delivery and the puppy had to be pulled out. Most breeders will not allow the mom to chew the cord as to prevent a hernia. If you get hernias consistently from the same dog and the breeder has cut the cords and not allowed the mom to chew them, then this is most likely inherited (but could be from the mom or dad or the combination of both) Sometimes they just simply pop up out of no where.
Inguinal Hernias
An inguinal hernia is the result of abdominal organs, fat or tissue protruding through the inguinal ring. Inguinal hernias are skin-covered bulges in the groin area. They can be bilateral, involving both sides, and unilateral, involving only one side. Inguinal hernias are more common in females than males, but do occur in both sexes. As with umbilical hernias a lot of inguinal hernias will shrink and disappear as the puppy grows, although you must keep an eye on the size of the hernia. I recommend you push the tissue back into the cavity a couple of times a day or whenever you notice it "sticking out". Small Inguinal hernias are of little concern and do generally close up on their own. As with an umbilical hernia, if it hasn't not closed up on it's own by the time it is time to spay or neuter your puppy, then I recommend to have a vet close it up at that time. Very Small inguinal hernia's usually would be fine if left, but I recommend to play it safe and just have it fixed when the puppy is spay/neutered. Large inguinal hernias if ignored could potentially cause a health concern for the dog if the muscles closes up around the hernia and strangles it. However this would not happen if you are pushing in the bump and you get it corrected if it is still present by 6 mos of age. Inguinal Hernias can be a big deal to a breeder as a female that has had an inguinal hernia that didn't close on it's own should never be bred as that area will be weak and could potential be a major health risk when whelping puppies.Quick note on repairing hernias: Some breeders will have hernias repaired before going to their new home when the puppy is young. This may sound very good and I am sure the breeders mean well, however..... after consulting my veterinarian and based on my own opinion and views......... a surgery on any puppy less than 4-5 mos old (actually any age for that matter) is very risky. I do not think it is a good idea nor very safe to have a young puppies hernia repaired before going to their new home (unless it is a life threatening situation). Since some heal on their own, there is no sense in risking the health of a puppy on an unnecessary surgery or having to have two surgeries when it could be done with just the one surgery.
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 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 puppies gums are swelling off and on from the teething process. Some puppies can't hardly breath out of their noses at all during 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 breath through their noses and cause health concerns will generally go away with time. 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. If the puppies Stenotic Nares are so severe that they can not breath at all or very very little through their nose, and it is obviously causing lethargic behavior or other health concerns, then I would say surgery would probably be needed, however if a puppy can breath through the nose enough to lead a normal life (except for maybe a lot of snorting and snoring :) ) Then I would wait to have surgery done until the puppy is over a year old as it is a possibility as they mature that they could outgrow the condition. Some Vets are way to 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 chooses to do so (just my disclaimer).
Hair issues/Prapso puppies
Not every Shih Tzu's hair is the same. they do not shed, but some Shih Tzu's do lose hair more than others. Not every shih tzu grows hair at the same rate. Some have flowing long tails in no time, others it takes longer and some Shih Tzu simply wont grow their tail hair to the ground. Some shih Tzu's have hair that would never come out and sometimes their hair can be more easily pulled out. All of which could be normal, however if you want a show dog, you will want to make sure that your puppy has the hair for it :)There is one Condition that I believe is quite common, yet a lot of breeders do not know about it or realize their puppies have it. I feel strongly people should be educated about it. They are called Prapso puppies, I am attaching an article I wrote concerning this interesting phenomenon.
Prapso puppies:
Occasionally in a litter of perfectly healthy and wonderful Shih Tzu puppies you will get a puppy that seems to be a little different as far as their hair growth goes. You generally don’t notice this until the puppy is around 6 weeks old and sometimes later depending on whether you have a partial or a full Prapso puppy. Most people have not heard of this condition and it used to be primarily thought of as a Lhasa Apso Condition, because that is where it was seen most often. They called them “smooth haired” Lhasa’s. The word “Prapso” started in Australia. From the phrase “perhaps an Apso” This “condition” however is not limited to the Lhasa Apso. It is periodically seen in the Shih Tzu as well as other Tibetan breeds.
So just what is a Prapso? Prapso puppies are an interesting occurrence. They are perfectly healthy little babies. A Prapso puppy will mature faster than his litter mates, usually will open their eyes earlier than normal, They will get a full set of teeth much earlier than their littler mates. In general they tend to have a more rambunctious personality. They also for whatever reason are thought to be slightly smarter than other dogs of their breed. But what is most noticeable is their shorter than average hair for their breed. In a full Prapso they will have shorter smooth hair, generally over their entire body however their muzzles and legs are generally shorter than their body, a Lhasa Apso looks almost identical to a Tibetan Spaniel if he/she is a full Prapso puppy. You can also have a partial Prapso, which is what I have seen in the Shih Tzu. A partial Prapso will generally have longer hair on the body, but it may not grow to the ground like a flowing show coat. There may be long hair on the face and head where your typical top knots can be done, but generally right around the muzzle will stay short and the legs will be shorter than the body, They can grow longer than a “smooth hair” look, but generally will not grow as long as typically seen on a Shih Tzu, but their hair will still have a straighter/smoother appearance with a slightly different texture than a typical Shih Tzu. Prapso puppies/dogs make excellent pets. You get the loving, fun, playful and loyal personality of the Shih Tzu without all the hard work of the long coat and profuse hair. If you keep your shih tzu in the shorter coat then the shorter hair is a non-issue.
Prapso’s are not uncommon. The problem is a lot of breeders do not know about this condition and as a result does not recognize the signs. Reputable breeders that are aware of this will simply sell the Prapso as a pet and educate potential buyers about how their puppy will be different. However, some not so reputable breeders know exactly what a Prapso puppy is and choose not to tell buyers that the particular puppy they are interested in is a Prapso. A buyer can and usually will be very confused and disappointed in their puppy if they are not educated about this condition. If the buyer is looking for a show-quality Shih Tzu, the puppy or dog could then suffer from the results of a disappointed buyer, he could wind up in a shelter or worse homeless. A loving pet owner could spend unnecessary time and money and mental anguish trying to figure out what is “wrong” with their puppy . The Prapso puppy makes an absolutely wonderful, smart, affectionate, playful, somewhat low maintenance alternative to their breed standard counterparts. People that have owned Prapso’s are known to ask for another one as they realize what a joy they really are. The Prapso puppy is nothing to be ashamed of.
On the breeder side of things, obviously, most breeders do not produce a Prapso puppy on purpose. They can just “pop up” every once in a while and no one really knows why. There are a lot of breeders that have had a litter or more with a Prapso puppy. There are theories that the Tibetan spaniel was mixed into the Lhasa and Shih Tzu breed many many years ago in Tibet, and they are the result of this practice. Some people just believe it is a genetic mutation that for whatever reason results in this characteristic. Regardless, it is not recommended to pull a dog that has produced a Prapso out of a breeding program, however it is advised that the particular breeding not be duplicated. A female that produces Prapso’s is very limited in the amount of puppies she can produce and because of this should just be bred to a different male, because more than likely she wouldn’t produce a Prapso puppy when bred to a different male. A male that produces Prapso puppies should be handled a little more careful as obviously they can produce many many offspring. Litters that a male produces should be closely tracked and bred carefully. There are those breeders that have actually got requests for another Prapso and therefore have purposely produced Prapso’s. This has been seen mostly with the full Lhasa Prapso’s as you get the temperament of the Lhasa, without the hassle of all the hair. This would generally be frowned upon with most show breeders, however most breeders each have their own reasons as to why they breed and what their goals are for their programs.
In the end a Prapso puppy is a perfectly healthy pet that can bring you years of love and affection.
Open Fontanel
An open Fontanel is the puppies soft spot on the top of the head. Typically soft spots close by the time the puppy reaches 2-3 months of age and some close right away. Sometimes you will have a puppy that the skull never quite closes all the way. This is usually of little concern and can be very common in the smaller/imperial Shih Tzu's. If the soft spot is unusually large and never heals over then you do have to be careful with the puppies head, just like a newborn baby. It isn't common that a soft spot is large enough to cause a concern. If it is so large that extra caution has to be taken then you need to look at other health concerns that could cause the opening to be extra large. Luxating Patella (loose knee)
This is a condition in which the patella/knee dislocates. The luxating Patella under most circumstances often has no or very mild symptoms. Luxating Patella can and does happen periodically especially in the smaller breeds, but is generally mild. Not all luxating Patella need medical intervention. Luxating Patella has different grades. Grades 1-2 is considered very mild and the puppy could very likely grow out it or will cause no long term effects or complications (this is most common). Grades 3-4 Should probably be addressed by a veterinarian. They could potentially be more serious and need medical intervention and could potentially cause more long term damage. 
