curly coated retriever club breed health survey 2014/2015
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CURLY COATED RETRIEVER CLUB BREED HEALTH SURVEY 2014/2015 Over the last few years, the Curly Coated Retriever Club have organised Breed Health surveys. These were basic, anonymous surveys to enable us to gain an insight into which conditions, diseases and illnesses most affected the Curly Coated Retriever in the UK. This survey differs in that it is more comprehensive and will ask for the dogs included to be named. The aim is to maintain, monitor and seek to improve the health of the Curly Coated Retriever. All information will be stored on the Curly Coated Retriever Club Health database. It is hoped that this survey will reach as many Curly owners in the UK as possible. We need to hear from owners of show dogs, working dogs and pet dogs. Owners need not be members of the Curly Coated Retriever Club to take part. Please inform everyone you know who owns a Curly and encourage them to participate. Please complete one survey form for each Curly you have owned in the last 10 years. It is just as important to complete surveys for dogs with no history of illness or disease as it is for those who have. Please be aware that information given within this survey may be shared with other Curly owners and the Kennel Club in order to protect the future of the breed. If you require more Survey forms, they can be downloaded from the Curly Coated Retriever Club website or can be requested directly from the Club Health Coordinator whose contact details are below. Thank you. CCRC Breed Health Coordinator; Mrs Gill May, 2 Shamrock Close, Walnut Tree, Milton Keynes, Bucks, MK7 7NS Tel 01908 691402 Email: gillmay.simbaroah@gmail.com _____________________________________________________________________________________ OWNERS DETAILS NAME: ADDRESS: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ TELEPHONE NUMBER: _______________________________ EMAIL ADDRESS: _______________________________ DOGS DETAILS (Please complete 1 survey per dog) REGISTERED NAME OF DOG: __________________________ PET NAME: __________________________ SIRE: __________________________ DAM: __________________________ DATE OF BIRTH: __________________________ SEX: ___________________________ COLOUR: ___________________________ NEUTERED: YES/NO GENERAL INFORMATION HAVE THE DOGS HIPS BEEN SCORED? IF YES, PLEASE GIVE THE SCORE YES/NO _______________________ HAVE THE DOGS EYES EVER BEEN TESTED? YES-ONCE/YES-MORE THAN ONCE/NEVER IF YES, PLEASE GIVE THE RESULT CLEAR/OTHERWISE* *PLEASE GIVE FURTHER DETAILS IF NOT CLEAR HAS THE DOG EVER BEEN TESTED FOR EIC (EXERCISE INDUCED COLLAPSE)? YES/NO IF YES, WAS THE RESULT CLEAR/CARRIER/AFFECTED HAS THE DOG EVER BEEN TESTED FOR GSD (GLYCOGEN STORAGE DISEASE)? YES/NO IF YES, WAS THE RESULT CLEAR/CARRIER/AFFECTED HAS THE DOG EVER BEEN TESTED FOR PRA CORD 1? IF YES, WAS THE RESULT YES/NO CLEAR/CARRIER/AFFECTED IF YOUR CURLY IS MALE; DOES HE HAVE TWO DESCENDED TESTICLES? IS HE CRYPTORCHID (NO TESTICLES)? IS HE MONORCHID (ONE TESTICLE)? HAS HE EVER BEEN USED AT STUD? *IF YES, HOW MANY LITTERS HAS HE SIRED? IF KNOWN, HOW MANY PUPPIES WERE BORN IN EACH LITTER? YES/NO YES/NO YES/NO YES/NO* _____________ _____________ IF YOUR CURLY IS FEMALE; AT WHAT AGE DID SHE HAVE HER FIRST SEASON? ARE HER SEASONS REGULAR? HAS SHE EVER HAD A PHANTOM PREGNANCY? HAS SHE EVER BEEN MATED? *IF YES, HOW MANY LITTERS HAS SHE HAD? HOW MANY PUPPES WERE BORN IN EACH LITTER? HAS SHE EVER HAD A CAESARIAN SECTION? *IF YES, HOW MANY OF THE PREGNANCIES RESULTED IN A ‘C’ SECTION? ______________ YES/NO YES/NO YES/N0* ______________ ______________ YES/NO* ______________ PREVENTATIVE TREATMENTS IS YOUR DOG VACCINATED ANNUALLY? DOES THE DOG RECEIVE FLEA PREPARATIONS? *IF YES, HOW OFTEN? DOES THE DOG RECEIVE WORM PREPARATIONS? *IF YES, HOW OFTEN YES/NO YES/NO* _____________ YES/NO* _____________ FEEDING IS THE DOGS MAIN FOOD DRY KIBBLE? YES/NO IF YES, PLEASE STATE BRAND ___________________ IS THE DOGS MAIN FOOD TINNED MEAT? YES/NO IF YES, PLEASE STATE BRAND ___________________ IS THE DOGS MAIN FOOD FRESH MEAT? YES/NO IF THE DOGS MAIN FOOD IS NOT COVERED BY THE ABOVE, PLEASE GIVE DETAILS OF WHAT YOU FEED. _______________________________________________ HOW MANY MEALS DOES YOUR DOG RECEIVE DAILY? ___________________ IS YOUR DOG FED FROM AN ELEVATED BOWL? YES/NO DOES YOUR DOG ALSO RECEIVE TABLE SCRAPS? YES/NO DOES YOUR DOG ALSO RECEIVE CONVENTIONAL DOG TREATS? YES/NO PLEASE GIVE DETAILS OF ANYTHING FURTHER YOU FEEL MAY BE RELEVANT TO FEEDING. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ HOUSING DOES YOUR CURLY LIVE IN THE HOUSE? YES/NO DOES YOUR CURLY LIVE OUTDOORS IN A KENNEL? YES/NO PLEASE GIVE DETAILS OF HOUSING IF NOT COVERED BY THE ABOVE ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ CONDITIONS CANCER HAS YOUR CURLY EVER BEEN DIAGNOSED WITH CANCER? YES/NO IF YES, PLEASE GIVE DETAILS; TYPE OF CANCER IF KNOWN _______________________________________________ LOCATION _______________________________________________ AGE OF DOG WHEN DIAGNOSED ___________________________________________ IF KNOWN, WHAT TREATMENT WAS ADMINISTERED? ______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ IF NOW DECEASED, DID HE DIE AS A RESULT OF THE CANCER? YES/NO BLOAT & GASTRIC TORSION HAS YOUR CURLY EVER BEEN DIAGNOSED WITH BLOAT? YES/NO* *IF YES, AT WHAT AGE? ____________________ HAS HE BLOATED ON MORE THAN ONE OCCASION? YES/NO* *IF YES, PLEASE GIVE DETAILS; ______________________________________________ _______________________________________________________________________ IF KNOWN, WHAT TREATMENT DID HE RECEIVE? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ IF NOW DECEASED, WAS IT AS A RESULT OF THE CONDITION? YES/NO HAS YOUR CURLY EVER BEEN DIAGNOSED WITH GASTRIC TORSION? YES/NO* *IF YES, AT WHAT AGE? _____________________ IF KNOWN, WHAT TREATMENT WAS ADMINISTERED? ___________________________ _______________________________________________________________________ _______________________________________________________________________ DID THE VET PERFORM A GASTROPEXY? YES/NO IF NOW DECEASED, WAS IT AS A RESULT OF THE CONDITION? YES/NO EPILEPSY & SEIZURES HAS YOUR CURLY EVER HAD A FIT OR SEIZURE? YES/NO* *IF YES, AT WHAT AGE WAS THE FIRST SEIZURE? _______________________ WAS EPILEPSY DIAGNOSED? YES/NO HOW REGULAR WERE THE SEIZURES? _______________________________________ _______________________________________________________________________ WHAT TREATMENT WAS ADMINISTERED? ____________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ IF NOW DECEASED, WAS IT AS A RESULT OF THE SEIZURES? YES/NO ALLERGIES HAS YOUR CURLY EVER HAD AN ALLERGIC REACTION? YES/NO* *IF YES, PLEASE GIVE DETAILS ______________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ FOOD INTOLERANCES HAS YOUR CURLY EVER BEEN DIAGNOSED WITH A FOOD INTOLERANCE? YES/NO* IF YES, AT WHAT AGE WAS HE FIRST DIAGNOSED? __________________ PLEASE GIVE DETAILS OF THE TYPE OF FOOD INTOLERANCE _______________________ ________________________________________________________________________ ________________________________________________________________________ HAS THE SITUATION NOW BEEN RESOLVED? YES/NO PLEASE GIVE FURTHER DETAILS IF APPLICABLE _________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ COAT PROBLEMS HAS YOUR CURLY EVER HAD A COAT PROBLEM? IF YES, AND WAS A BITCH, WAS IT RELATED TO HER SEASONS? WAS A VETERINARY DIAGNOSIS GIVEN? WAS ‘BLACK HAIR FOLICULAR DISPLASIA’ DIAGNOSED? YES/NO YES/NO YES/NO YES/NO PLEASE GIVE FURTHER DETAILS IF YOU ANSWERED ‘YES’ TO ANY OF THE ABOVE FOUR QUESTIONS. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ HEART MURMUR HAS YOUR CURLY EVER BEEN DIAGNOSED WITH A HEART MURMUR *IF YES, AT WHAT AGE WAS THE DIAGNOSIS MADE? _______________ IF DIAGNOSED AS A PUPPY, DID THE MURMUR IMPROVE OR DISAPPEAR? IF IT REMAINED, WHAT GRADE WAS THE MURMUR? ______________ YES/NO* IMPROVED/DISAPPEARED AUTO IMMUNE DISEASE HAS YOUR DOG EVER BEEN DIAGNOSED WITH AUTO-IMMUNE DISEASE OR AN AUTO-IMMUNE RELATED DISEASE? YES/NO* *IF YES, PLEASE GIVE DETAILS. ______________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ OTHER CONDITIONS PLEASE LIST IF YOUR CURLY HAS BEEN DIAGNOSED WITH ANY OF THE FOLLOWING; CONDITION PLEASE TICK IF ‘YES’ AGE AT ONSET RENAL FAILURE LIVER FAILURE HEART FAILURE PROLAPSED LARYNX MEGAOESOPHAGUS ARTHRITIS CONGENITAL CATARACTS CUSHINGS DISEASE ENLARGED PROSTATE HORNERS SYNDROME HYDROCEPHALUS OSTEOCHONDROSIS DISSECANS (OCD) PERIANAL ADENOMA STERILE JUVENILE PYOGRANULOMA SYNDROME TELESCOPIC BOWEL UNDER ACTIVE THYROID WOBBLERS SYNDROME ‘COT DEATH’ SYNDROME DIABETES FURTHER DETAILS IF APPLICABLE IF YOUR CURLY DIED AS A RESULT OF ANY OF THESE CONDITIONS, PLEASE GIVE FURTHER DETAILS INCLUDING AGE AT DEATH. ____________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ IF YOUR DOG IS NOW DECEASED AND DIED FROM A CONDITION, DISEASE OR ILLNESS OTHER THAN THOSE LISTED ON THIS SURVEY, PLEASE GIVE FURTHER DETAILS INCLUDING AGE AT DEATH. PLEASE CONTINUE ON A SEPARATE SHEET IF REQUIRED. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ IF THERE IS ANY FURTHER INFORMATION WHICH YOU FEEL IS RELEVANT TO THE HEALTH RECORD OF THIS CURLY, PLEASE ADD BELOW. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY. DATA PROTECTION ACT The Data Protection Act 1998 requires that data users (i.e. those persons who control the contents and use particular collections of data) register the purposes for which they hold such data. We would like to notify you of the following which have been drawn up with the guidance of both the Information Commissioner’s Office Booklet (April 2001) and the Kennel Club. The Kennel Club have asked the Curly Coated Retriever Club to keep details of the breed’s health. These records are held on the computer of a Committee member and will also be freely available. The information held will only be that which is requested in the Breed Health Survey form and information will be included a submitted. As the records have to be accurate, please check your submissions carefully. This information will be used to maintain up to date records of breed health (in accordance with KC rules and regulations). Data will also be presented at CCRC Annual General Meetings. Data kept must comply with the provisions of the 1998 act (updated 2008) even if exempt from notification. These require that data is; 1. Fairly and lawfully processed 2. Processed for limited purposes 3. Adequate, relevant and not excessive 4. Accurate DISCLAIMER The Curly Coated Retriever Club and the Breed Health Co-ordinator assumes no responsibility for errors which might appear in the resulting health database. All information will be reproduced as reported by the owner.
