Please exclude any dog that was deceased prior to 2012.

Transcription

1 1. Owner Information (t Required) Please exclude any dog that was deceased prior to All data submitted in this survey will be included in aggregate reporting and analysis without reference to specific dogs or owners. Information gathered will be used to assess health problems and trends in our breed, thus guiding research focus. Data will stored within the Survey Monkey database, and accessed and analyzed by Leonberger Health Foundation International members or associated researchers only. This survey will take most people around minutes per dog to complete. Your time is appreciated! Please answer as many questions as you can. If you do not know the answer to a question, skip it and go to the next question. You will not be able to get back into the dog's entry after you finish the survey and mark, "DONE". If you would like to read through all the survey text (long version) before starting, a PDF copy is available on the LHFI website or via the link below LHFI Health Survey PDF (Google Drive) 1. Can we contact you? Yes 2. Owner Address (t Required)

2 2. Primary Owner Information (t Required) First Name: Last Name: Address 1: Address 2: City/Town: State/Province: ZIP/Postal Code: Country: Address: Phone: 3. Co-Owner Name (please ask co-owner if okay to include their name): 3. Leonberger Information * 4. Country of Birth (Required): * 5. Date of Birth (Required): Month/Day/Year MM/DD/YYYY

3 6. This Leonberger came from: Own breeding program Breeder Shelter or Rescue Organization Pet Store Rehome 4. Breeder/Kennel Name (t Required) 7. Breeder/Kennel Name (t Required): 8. Individual Leonberger Information Registered Name Registry # Registry Affiliation Call Name 9. Additional Registrations (foreign registration, former LCA registration, etc.) Registry # Registry Affiliation Registry # Registry Affiliation 5. Alive

4 * 10. Is this Leonberger still alive? (Required) Yes 6. Death 11. Date of Death: Month/Day/Year MM/DD/YYYY 12. Was this dog euthanized? Yes 13. Underlying cause of death 14. Cause of death confirmed by (check all that apply): Veterinary diagnosis Lab/Pathology results Necropsy te: Even if this Leonberger is deceased, please continue with the remainder of the survey, answering the questions for when this Leonberger was alive. 7. Overall Health

5 15. What is the overall Health of this Leonberger? (For deceased dogs, please answer about the overall health of the dog during its lifetime). 8. Fair/Poor Health 16. If overall health is fair or poor, at what age did health start to decline? 9. Diseases/Disorders - Please indicate the Diseases/Disorders this dog has had. Allergies 17. Does your Leonberger have any allergies? Show Choices 10. Diseases/Disorders - Please indicate the Diseases/Disorders this dog has had. Allergies Continued

6 18. Please check all that apply: Atopy (inhalant) Seasonal Atopy (inhalant) n-seasonal Drug Flea Mites Food Topical/Contact 19. Please provide details on any allergy disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 11. Diseases/Disorders Blood/Lymph 20. Does your Leonberger have any bloody/lymph disorders? Show Choices

7 12. Diseases/Disorders Blood/Lymph Continued 21. Please check all that apply: Idiopathic Thrombocytopenia Immune-Mediated Hemolytic Anemia 22. Please provide details on any blood/lymph disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 13. Diseases/Disorders Cancer/Tumors 23. Does your Leonberger have any cancer/tumors? Show Choices

8 14. Diseases/Disorders Cancer/Tumors Continued 24. Please check all that apply: Adenocarcinoma Brain Cancer Fibrosarcoma Hemangiosarcoma Leukemia Lymphoma Malignant Histiocytosis Mast Cell Tumor - Low Grade Mast Cell Tumor - Intermediate/High Grade Mammary Cancer (breast) Uterine Cancer Melanoma Osteosarcoma Bone Cancer (non-osteosarcoma) Prostrate Cancer Squamous Cell Carcinoma

9 25. Please provide details on any cancer/tumor disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 15. Diseases/Disorders Cardiac/Heart 26. Does your Leonberger have any cardiac/heart disorders? Show Choices 16. Diseases/Disorders Cardiac/Heart Continued

10 27. Please check all that apply: Congestive Heart Failure Degenerative Valve Disease Dilated Cardiomyopathy (DCM) Subaortic Stenosis (SAS) Arrhythmias (Irregular heart beat) Pulmonary Hypertension (PAH) Sudden Death Heart Tumor Coronary Infarct / Heart Attack 28. Please provide details on any cardiac/heart disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 17. Diseases/Disorders Dental/Jaw

11 29. Does your Leonberger have any dental/jaw disorders? Show Choices 18. Diseases/Disorders Dental/Jaw Continued 30. Please check all that apply: Extra Teeth Jaw Malformation Misaligned Teeth Missing Teeth (at birth) Plier bite Overshot bite Undershot bite Wry bite

12 31. Please provide details on any dental/jaw disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 19. Diseases/Disorders Ear 32. Does your Leonberger have any ear problems? Show Choices 20. Diseases/Disorders Ear Continued

13 33. Please check all that apply: Chronic ear infections Ear Hematomas Hearing loss/deafness Allergies 34. Please provide details on any ear disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 21. Diseases/Disorders Endocrine 35. Does your Leonberger have any endocrine disorders? Show Choices

14 22. Diseases/Disorders Endocrine Continued 36. Please check all that apply: Addison s Disease (Hypoadrenocorticism) Autoimmune Hypothyroidism Cushing s Disease (Hyperadrenocorticism) Diabetes Hypothyroidism Pancreatic Insufficiency 37. Please provide details on any endocrine disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 23. Diseases/Disorders Eye

15 38. Does your Leonberger have any eye problems? Show Choices 24. Diseases/Disorders Eye Continued 39. Please check all that apply: Cataracts, adult onset Cataracts, juvenile onset Distichiasis Ectropion Entropion Glaucoma Goniodisgenesis (Predisposition to Glaucoma) Lens Luxation Persistent Pupillary Membrane (specify type below if known) Progressive Retinal Atrophy

16 40. Please provide details on any eye disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 25. Diseases/Disorders Gastrointestinal 41. Does your Leonberger have any gastrointestinal problems? Show Choices 26. Diseases/Disorders Gastrointestinal Continued

17 42. Please check all that apply: Bloat/Torsion (Gastric Dilation-Volvulus) Chronic Diarrhea (of indeterminate cause) Gastritis Inflammatory Bowel Disease Megaesophagus Pancreatitis Intussusception Protein Losing Enteropathy 43. Please provide details on any gastrointestinal disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 27. Diseases/Disorders Kidney/Urinary

18 44. Does your Leonberger have any kidney/urinary disorders? Show Choices 28. Diseases/Disorders Kidney/Urinary Continued 45. Please check all that apply: Bladder Stones Chronic Urinary Tract Infection Kidney Stones Protein Losing Nephropathy Renal Failure 46. Please provide details on any kidney/urinary disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis:

19 29. Diseases/Disorders Liver 47. Does your Leonberger have any liver disorders? Show Choices 30. Diseases/Disorders Liver Continued 48. Please check all that apply: Chronic/Active Hepatitis Portosystemic Shunt (Extrahepatic) Portosystemic Shunt (Intrahepatic) 49. Please provide details on any liver disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis:

20 31. Diseases/Disorders Neurological 50. Does your Leonberger have any neurological disorders? Show Choices 32. Diseases/Disorders Neurological Continued 51. Please check all that apply: Degenerative Myelopathy Epilepsy Inherited Leonberger Polyneuropathy - 1 (LPN1) Inherited Leonberger Polyneuropathy - 2 (LPN2) Intervertebral Disc Disease Laryngeal Paralysis (not associated with LPN) Other Neuropathy Leukoencephalomyelopathy (LEMP)

21 52. Please provide details on any neurological disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 33. Diseases/Disorders Orthopedic/Skeletal 53. Does your Leonberger have any othopedic/skeletal disorders? Show Choices 34. Diseases/Disorders Orthopedic/Skeletal Continued

22 54. Please check all that apply: Chondrodysplasia Cruciate Ligament Injury (other than rupture) Cruciate Ligament Rupture Dwarfism Elbow Dysplasia Hip Dysplasia Hypertrophic Osteodystrophy (HOD) Osteoarthritis Osteochondritis Dissecans (OCD) Panosteitis (Pano) Patellar Luxation Shoulder Dysplasia Spondylosis 55. Please provide details on any orthopedic/skeletal disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis:

23 35. Diseases/Disorders Respiratory 56. Does your Leonberger have any respiratory disorders? Show Choices 36. Diseases/Disorders Respiratory Continued 57. Please check all that apply: Chronic Pneumonia Asthma 58. Please provide details on any respiratory disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis:

24 37. Diseases/Disorders Skin 59. Does your Leonberger have any skin disorders? Show Choices 38. Diseases/Disorders Skin Continued 60. Please check all that apply: Demodectic Mange Perianal Fistulas Pyoderma Hernia (Inguinal) Hernia (Umbilical)

25 61. Please provide details on any skin disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 39. Gender Specific * 62. What is the gender of your Leonberger? (Required) Male Female 40. Gender Specific Male 63. Is this male Leonberger neutered? Yes

26 41. Gender Specific Male 64. Age neutered? 65. Neutering was performed because of: Medical condition Breeding choice (e.g. disqualifying fault and unwilling to breed dog) Life-style preference Monorchid/cryptorchid (retain testicle) Already Neutered 42. Gender Specific Male 66. Does this male Leonberger have any reproductive disorders? Yes 43. Gender Specific Male

27 67. Please indicate if this male Leonberger has any reproductive disorders. Please check all that apply: Abnormal Sperm Low sperm count sperm Sperm Lacks motility Monorchid/cryptorchid (retain testicle) at 8 weeks Monorchid/cryptorchid (retain testicle) at Maturity Impotence (no interest in females in heat) Prostatitis Testicular Atrophy Testicular Torsion 68. Please provide details on any male reproductive disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 44. Gender Specific

28 69. Is this male Leonberger used for breeding? Yes 45. Gender Specific Breeding of Male 70. Please specify the following: Number of females bred naturally Number of artificial inseminations (AI, TCI and SI) Number of litters sired Number of puppies sired 71. If puppies were sired, were any puppies monorchid/cryptorchid at 8 weeks? Yes 46. Gender Specific Female 72. Is this female Leonberger spayed? Yes

29 47. Gender Specific Female 73. Age spayed? 74. What type of spay was performed? Ovariectomy Hysterectomy Ovariohysterectomy 75. Spaying was performed because of: Medical condition Breeding choice (e.g. disqualifying fault and unwilling to breed dog) Life-style preference 48. Gender Specific Female 76. Does this female Leonberger have any reproductive disorders? Yes 49. Gender Specific Female

30 77. Please indicate if this female Leonberger has any reproductive disorders. Please check all that apply: Difficulty in whelping/distocia Insufficient milk Irregular heats Failure to conceive Fetal Death (before birth abortion) Fetal Resorption Mastitis Metritis Pyometra Unsuccessful Breeding 78. Please provide details on any female reproductive disorder(s) including how diagnosed (vet, lab/pathology reports, owner diagnosis, etc.) the age at diagnosis, treatment(s) and prognosis: 50. Gender Specific Female

31 79. Is this female Leonberger used for breeding? Yes 51. Gender Specific Breeding of Female

32 80. Please specify the following: Number of times bred naturally Number of artificial inseminations (AI) Number of transcervical inseminations (TCI) Number of surgical inseminations (SI) Number of litters whelped naturally Number of litters via caesarian sections Number of puppies born to this female Number of puppies to survive to 8 weeks Number of monorchid/cryptorchid puppies at 8 weeks Number of stillborns Number of wobblers Number of fading puppies Number of swimmers Number of puppies with hernias Number of puppies with cleft lip Number of puppies with cleft palate

33 52. Temperament Disorders 81. Does this Leonberger exhibit unusual temperament characteristics or aggression? Yes 82. If yes, what type? Mild Moderate Severe Dog aggression Aggression towards people Loud noise fear (e.g. thunderstorms, fireworks, etc.) High prey drive Shyness Separation anxiety (destructive behavior when left alone) Extreme anxiety 83. If aggressive toward people, please specify (check all that apply) Fear based Food/treat oriented Specific (e.g. men wearing baseball caps and dark sunglasses) Stranger Toy/possession oriented Unexplained

34 84. If dog aggressive, please specify (check all that apply) Dominance/status conflict based Fear based Food/treat oriented Leash based Opposite sex based Same sex based Toy/possession oriented Unexplained 53. Surgical Procedures 85. If this Leonberger has had any surgical procedures not previously listed in this survey, please list them here with the reason(s) for the procedure(s) and the age of this Leonberger when the procedure(s) was performed

35 54. Health Maintenance Diet 86. What is the primary diet of this Leonberger (choose only 1)? Commercial Dry (Kibble) Commercial Grain Free Commercial Canned Commercial Raw Home Prepared Cooked Home Prepared Raw Mixed (e.g. kibble + raw) 87. If commercial, please specify primary brand(s): 88. What other foods does this Leonberger receive (check all that apply)? Commercial Dry (Kibble) Commercial Canned Commercial Raw Commercial Treats Home Prepared Cooked Home Prepared Raw Home Prepared Treats Table Scraps

36 89. Does this Leonberger receive supplements? Yes If yes, please list the types of supplements and dosages: 55. Health Maintenance Vaccinations

37 90. This Leonberger received the following vaccinations as a baby puppy (check all that apply): Parvovirus Distemper Rabies Bordetella (kennel cough) Canine Adenovirus (CAV-2) Leptospirosis Coronavirus Influenza Canine Herpes Virus 91. Please indicate subsequent vaccinations this Leonberger has had and how often each vaccine is administered: Annually As needed based on titers Other Distemper Parvovirus Canine Adenovirus (CAV-2) Bordetella Leptospirosis Coronavirus Lyme disease Giardia Parainfluenza Influenza Rabies

38 92. Has this Leonberger ever had an adverse reaction to a vaccination? Yes If yes, please describe the adverse reaction: 93. Do you run titer tests on this Leonberger? Yes If yes, please specify how often titer tests are completed. 56. Health Maintenance Preventative Treatments 94. Does this Leonberger receive any preventative treatments? Seasonally Year-Round Heartworm preventative Flea/Tick preventative Gastropexy (stomach tack) 57. Health Testing

39 Please indicate health tests this dog has undergone. If multiple rating agencies have been used, indicate ratings from each agency. If multiple tests have been performed at a single agency, indicate the most recent rating. For example, if the dog has had his hips evaluated by both OFA and PennHip, please list both. However, if he has had multiple thyroid test evaluated by OFA, provide the most recent result. 95. Hip Dysplasia: Rating: Rating Agency: 96. Elbow Dysplasia: Rating: Rating Agency: 97. Cardiac Rating: Rating Agency: 98. OFA Cardiac - Type of Exam Performed: Yes ECG Done Echo Done 99. Thyroid Rating: Rating Agency: 100. Eye Rating: Rating Agency:

40 101. LPN1 Genetic Test Clear (NN) Carrier/At Risk (DN) Affected (DD) 102. LPN2 Genetic Test Clear (NN) Affected/Susceptible (DN) Affected/Susceptible (DD) 103. LEMP Genetic Test Clear (NN) Carrier (DN) Affected/Susceptible (DD) 104. Other health testing (please specify type, rating/result and rating agency) 58. Other Information

41 105. Is there any other information you would like to add about your Leonberger's health?