Microsoft word - health_survey.doc

American Chinese Crested Club Inc.
Health Survey
The American Chinese Crested Club, Inc sponsors this Health survey. The purpose of this survey is to compile information regarding health and genetic issues of the Chinese Crested dog. This survey is designed for every Chinese Crested enthusiast, regardless of how many dogs you own. The completed survey with its accompanying information will be used to prioritize research targeted to improve the overall health and sturdiness of the This is a confidential survey. You need not give us your name or email address.
You do not need to sign this form or identify yourself or your dogs. Please answer all
questions as completely as possible. If you do not wish to answer any questions in detail, skip them. Please try to answer the more general questions. The survey is designed for each person to fill out one survey about his or her personal experience with the Chinese I. General Information
A. What are your interests in Chinese Cresteds? (Circle all that apply.) B. How long have you been involved in the breed? __ 1-5 years __6-10 C. Where is your current place of residence (Circle only one) North D. If living in North America, in what state do you live? ______________ E. How many male Chinese Cresteds live with you? ______________ F. How many female Chinese Cresteds live with you? _______________ G. How many neutered or spayed Chinese Cresteds live with you? ______ H. How many hairless Chinese Cresteds live with you? _______ I. How many powderpuff Chinese Cresteds live with you? ________ K. Below please list the age and primary cause of death or the six most recent Chinese Cresteds you have owned.
L. Please list what you consider to be the three most prevalent diseases or
genetic disorders in this breed, in order of importance (1= most M. If you are a breeder please answer the following questions: • How many years have you been a breeder? ___________ P. How many litters have you bred through: • Artificial insemination, fresh semen? • Artificial insemination, frozen semen Q. What type of breeding do you use most frequently. Circle only one.
II Testing Information
A. Do you radiograph hips for hip disorders? D. Do you “BAER” test ears for hearing? E. Do you have a Veterinarian check patellas? F. Which preventative care tests do you perform? III Health Conditions
Because this is a fact finding questionnaire, below is listed in detail the conditions, diseases and disorders that are known to occur in canines. Please take the time to identify any health conditions you have personally experienced with Chinese Cresteds you have owned or bred. Mark the specific condition by placing an H if it occurred in a hairless dog, a P if it occurred in a powder puff dog, or an X if you have experienced it in both varieties.
Elbow hygroma (moist condition of the skin) Pyoderma (bacterial skin infection with pus-filled lesions) Sebaceous adenitis (inflammation of a gland) Spiculosis (hard/abnormal hair follicles) Warts (hard, horny projections of the skin) Auto Immune Hemolytic Anemia (the immune system attacks its’ Rickettsial Disease (lymes disease, rickets, rocky mountain spotted Thrombocytopenia (abnormally small number of platelets in Von Willebrand’s Disease (reduced factor VIII in the blood _____ Cushing’s Disease (abnormal condition due to adrenal or pituitary Addison’s Disease (primary hypoadrenocorticism) Diabetes Mellitus (excessive sugar in the blood and urine due to Hypothyroidism (deficient activity or the thyroid gland) Pancreatitis (inflammation of the pancreas) Coccidiosis (single-cell intestinal parasite) Chronic Non-specific gastritis (chronic vomiting which can be Eosinophilic Enteritis (intestinal inflammation with elevated Esophageal Diverticula (outpuouchingof esophagus) Gastric Dilation and Volvulus (bloat /torsion) Giardia Infection (intestinal protozoal infection) Hemorrhagic Gastroenteritis (acute onset of bloody diarrhea) Intussusception (intestine turns inside out on itself) Lymphocytic-Plamacytic Enteritis (a form of inflammatory bowel Lymphangiectasia (dilation of lymphatic vessels with loss of Megaesophagus (abnormally dilated esophagus) Perianal Fistula (fistulic traces around anus) Perineal Hernia (hernia pouch containing intestinal loops lateral to Peritonitis (inflammation of the membrane that lines the abdomen) Pica (hunger for substances not fit for food) Ulcer (a break in skin of mucous membrane) Ulcerative Colitis (bloody mucoid diarrhea) Cholangiohepatitis (inflammation of liver, bile duct, gall bladder) Copper Hepatopathy (liver disease due to copper storage Gastrinoma (gastrin-secreting tumor associated with Lollinger- Amyloidosis – Hepatic / Renal (protein deposits in liver and Hepatic Encephalopathy (nervous system abnormality due to liver Chronic Active Hepatitis (chronic liver inflammation / infection) Portosystemic shunt (liver disease caused by abnormal blood Steroid Hepatopathy (liver inflammation due to corticosteriod use) Glycogen storage disease (abnormal storage of starch in the liver) Epiphora (excessive watering of the eyes due to tear production Prolapsed gland of the third eyelid (cherry eye) Cardiomyopathy (disease of the heart from unkown or obscure Cleft Palate (a fissure or cleft in the roof of the mouth) Malocclusion (wry mouth teeth don’t meet in front) Oral Papilomatosis (tumor or wart of the mouth) Retained Baby Teeth (teeth that have to be removed because they failed to fall out when adult teeth emerged) Adenocarcinoma (cancer originating in glandular epithelium) Firbrosarcoma (cancer of the fibrous tissue) Hemangiopericytoma (a vascular tumor composed of spindle Hemangiosarcoma (a cancerous skin lesion comprised of blood Lymphosarcoma (cancer of the lymph glands) Malignat Melanoma (a form of skin cancer) Mammary Cancer (cancer of the mammary glands) Squamous Cell Carcinoma (cancer of the epithelium, usually Osteoarthritis (degenerative joint disease) Eclampsia (coma and unconciousness during or directly after pregnancy characterized by edema, hypotension and proteinuria) Epididymitis / orchitis (inflammation of the testes) Hermaphroditism (presence of gonadal tissue for both sexes) Pyometra (an accumulation of pus in the uterine cavity) Sub involution of placental attachment sites Umbilical Hernia (an out pouching of skin over the “Belly Inguinal Hernia (an out pouching of skin in the area of the Amyloidosis (a starch build up in the kidneys) Glomerulonephritis (inflammation of the kidney) Thank you for participating with this survey.
IN THE SPACE BELOW, PLEASE INCLUDE ANY EXPERIENCES THAT YOU HAVE HAD WHICH MAY NOT BE COVERED IN THIS

Source: http://accc.chinesecrestedclub.info/forms/health_survey.pdf