The perspective provided by Dr Silver adds to our collective appreciation of this problem, with specific reference to high-level (cervical), spinal cord injury, and how such an injury may affect ventilatory efficiency (secondary to paresis of the thoracic musculature). As noted by Dr Silver, ventilation may become less efficient, thereby increasing heat production, however, the increased oxygen uptake is small, and is unlikely to contribute significantly to whole-body metabolic heat production. Therefore, although these comments provide further insight into the lack of a thermoregulatory benefit for this panting-like response, they do not elucidate the mechanism for such a response remains uncertain.