Schipperke Health Survey

General Information

Schipperke Club of America Breed Health Survey

General Information

This health survey’s purpose is to evaluate the health of the schipperke breed for three reasons: 1. To analyze the data for the schipperke owners’ information; 2. To present to AKC for Canine Health Information Center (CHIC) participation; and 3. To determine what information needs to be included in an open health registry. Specific information from this survey will not be used on the health database. For that purpose, separate forms will be used.

All schipperke owners/breeders are being asked to participate. Owners or breeders may submit information. If information is submitted on puppies that have died before being registered, state that fact.

The survey is divided into the two sections: Some Info About You and the Breed and Health Questions About Your Dog(s) If you identify yourself, you only need to fill out the section about “you” once even if you submit dogs at different times. If you do not identify yourself please include this each time you send in dog surveys. Please do the dogs you have or have had in the past 5 years first and send them in as promptly as possible.

No identification of individual dogs will be made public. Only summaries of the data will be. If you supply the dog’s name and registration number it will only be used to be sure the same dog is not entered twice. If you choose not to identify your dogs, please give the last five digits of the dog’s registration number so duplicates can be eliminated. Also please coordinate your efforts with co-owners and breeders in order to reduce the number of duplicate submissions.

If you have a dog with a problem and can’t decide what category from the disease code sheet to use, write the information you know under comments. Include the symptoms, tests run with results, and diagnosis if known.

This survey is being made available to pet people as well as show/breeder people. The information will be very skewed if breeders do not contribute. Information on all schipperkes is important in assessing schipperke health and in determining the future of this breed.

Please copy the “Health Questions About Your Dog(s)” as needed. Please fill out one of the forms labeled Health Questions About Your Dog(s) for each of the dogs - including healthy ones -that you own or have owned.

Please return one personal information form, plus one form for each dog you have owned, to: Shirley Quillen, 250 Main St . E., Ashville, OH 43103. You may cut and paste these forms into or attach them to an email, and email them to her at SchipperkeHS@aol.com

Owner/Breeder Information

Schipperke Club of America Breed Health Survey

Owner/Breeder Information

This survey can be anonymous but we do want to have your opinions and know something about your involvement with this breed. Items marked with an * are required. Others are voluntary.


Your Name(optional): __________________________

Your Kennel Name(optional): ___________

* In which US State, or other country, do you live? ______
Your address(optional):_________________

*How long have you had Schipperkes? ___________

*Primary Interests / Reasons for having a schipperke (please check all that apply)
Breeder __ Companion __ Exhibitor __ Obedience __ Agility __ Other(name) ____________

*How many schipperkes do you currently have living with you, if any? _____

*How many schipperkes have you owned in the past, if any? ______

*In your experience, what is the average lifespan of the breed in years? _____

What do you include in your routine vaccination program:_______

How often do you vaccinate puppies? _______
Adults? ______________________

Do you have your dogs on heartworm preventative? Yes / No

Do you use herbal / holistic preparations for health? Yes / No
For Supplements: Yes / No

Do you feed commercially prepared dog food? Yes / No
Raw? Yes / No Combination? Yes / No



*Please list 3(or more) diseases, in order of importance, that you consider to be the most detrimental to the breed (please use the codes wherever they apply):
_____________ _____________ ______________


*Please list 3 (or more) diseases, in order of importance, that you think are most prevalent in the breed (please use the codes wherever they apply):

_____________ ______________ _______________


*Please list 3 (or more) diseases, in order of importance, for which you feel all dogs should be tested (please use the codes wherever they apply):

_____________ ______________ ________________



*Will you participate if the SCA has an open health registry/database? Yes / No

*Will you be willing to post abnormal health conditions/test results as well as normal ones? Yes / No


Additional Comments:




Please return one personal information form, plus one form for each dog you have owned, to: Shirley Quillen, 250 Main St . E., Ashville, OH 43103. You may cut and paste these forms into or attach them to an email, and email them to her at SchipperkeHS@aol.com

Individual Dog Information

Schipperke Club of America Breed Health Survey

Health Questions About Your Dog(s)

Dog’s Registered Name (optional):___________________________________

*Last 5 digits of dog’s reg. no.: __________

Dog’s Registration Number (optional): __________

*Dog’s Sex: ___
* Date neutered if neutered: ______

*Dog’s month & year of birth: _______
*Dog’s month & year of death if applicable: ____

Cause of Death* _______
Was cause of death Owner or Veterinary Diagnosed? ___________*



*NO DISEASE Check here:

*Disease Codes:
*Age at Onset:
*How/Who Diagnosed?:
(Self, Veterinarian, Someone else such as breeder or other knowledgeable person.
Treatment?:


*Disease Codes:
*Age at Onset:
*How/Who Diagnosed?:
(Self, Veterinarian, Someone else such as breeder or other knowledgeable person.
Treatment?:


*Disease Codes:
*Age at Onset:
*How/Who Diagnosed?:
(Self, Veterinarian, Someone else such as breeder or other knowledgeable person.
Treatment?:


*Disease Codes:
*Age at Onset:
*How/Who Diagnosed?:
(Self, Veterinarian, Someone else such as breeder or other knowledgeable person.
Treatment?:



*Has this dog been MPS111B tested? Yes / No
Results: Normal Carrier Affected
Is this dog “Clear by Pedigree”? Yes / No

*Has this dog ever been CERFed? Yes / No

OFAed? Thyroid __, Hips___, Patellas ___,
Other(name) ___________________________
(include non registered tests here, ie other thyroid)

* Is this dog from a pet store? Yes / No
Rescue? Yes / No
Pedigree unknown? Yes / No
From show stock (at least half of dogs in last 3 generations are champions)? Yes / No

*Has this dog ever had any infectious disease including tick borne diseases? Yes / No
If yes, describe under comments.

*Has this dog ever been injured? Yes / No If yes, describe under comments.

*Has this dog ever gone to a veterinarian for any reason not covered in this survey? Yes / No
If yes, describe under comments.

Breeding: How many (if any) litters has this dog produced? _____________ How many (if any) puppies has this dog produced? ___________How many of those puppies survived to age 8 weeks? __________

Comments / Remarks (Include any condition you can not match to a code. Include the symptoms, tests run with results, and diagnosis if known)




Please return one personal information form, plus one form for each dog you have owned, to: Shirley Quillen, 250 Main St . E., Ashville, OH 43103. You may cut and paste these forms into or attach them to an email, and email them to her at SchipperkeHS@aol.com


Code Sheet

Cancer
100. Other (name if possible)
101. Hemiangiosarcoma
102. Lymphosarcoma
103. Mast Cell Tumors
104. Melanoma
105. Osteosarcoma
106. Squamous Cell Tumors

Heart
200. Other (Name if possible)
201. Cardiomyopathy
202. Heart Murmur
203. -Patent Ductus Arterious
204. -Tetralogy of Fallot
205. -Unidentified
206. -Ventricular Septal Defects
207. Pulmonary Stenosis
208. Subaortic Stenosis
209. Valve Dysfunction

Skin
300. Other (name if possible)
301. Allergies (describe)
302. Autoimmune - name type if can
303. Demodex ("Mange")
304. Pigment Abnormalities
305. Sebacious Cyst
306. Seborrhea
307. Thyroiditis
308. Red hair / coat
309. Alopecia X
310. External parasites – name if can

Oral Cavity
311. missing teeth
312. Epulus
313. Excessive tarter
314. Melanoma
315. Tooth loss
316. Retained puppy canines
317. Gingivitis

Ear Problems
318. deafness
319. ear infection
320. aural hematoma

Endocrine (Hormone) Other
400. Diabetes Mellitus
401. Pancreatic Insufficiency
402. Hypo/Hyperthyroid
403. Storage Diseases

Sensitivity (state what type of reaction and specify to what)
404. vaccine
405. drug
406. insect control product
407. Other

Gastroenterology
500. Other (Name if possible)
501. Bloat
502. Esophageal Disorders
503. Irritable Bowel Syndrome
504. Large Bowel Disease
505. Small Bowel Disease
506. Portal systemic shunt or name other shunt

Blood
600. Other (Name if possible)
601. Hemophilia A
602. Hemophilia B
603. Inherited Hemolytic Animas
604. Non-regenerative Anemia
605. Platelet Abnormalities
606. von Willebrand's Disease

Kidney/Liver/Urinary
700. Other
701. Bladder Disease (cystitis)
702. Kidney Disease - Hereditary Nephritis
703. Kidney Disease - PCKD
704. Hepatic (Liver) Disease
705. Urinary Tract Disorder

Neurology
800. Central Nervous System
801. Head Tilt
802. Nerve Degeneration
803. Paralysis
804. Tremors
805. Wobbler's Syndrome
806. Seizures – state whether more or less than monthly, petite or
grand mal, and if controlled by treatment or not.
807. Brain Tumor

Ophthalmology (Eyes)
900. Other (Name if possible)
901. Cataracts
902. Progressive Retinal Atrophy
903. Retinal Disease
904. Retinal Dysplasia
905. Primary Lens Luxation /Subluxation
906. Glaucoma
907. Secondary Lens Luxation/Subluxation
908. Narrow Drainage Angles
909. Microphthalmia
910. Distichiasis

Orthopedic (Bones)
1000. Other (Name if possible)
1001. Arthritis
1002. Elbow Dysplasia
1003. Hip Dysplasia
1004. Hypertrophic Osteodystrophy
1005. Legges-Perthes
1006. Osteochondritis Dessicans (OCD)
1007. Panosteitis
1008. Patellar Luxation

Reproduction (MALE)
1200. Other (Name if possible)
1201. Abnormal Semen
1202. Congenital Defects
1203. Cryptorchidism
1204. Lack of Libido
1205. Lack of Semen
1206. Monorchidism
1207. Testicular Atrophy

Reproductive (FEMALE)
1100. Other (Name if possible)
1101. Abnormal Puppies
1102. -- Cleft Palates
1103. -- Hydrocephalus
1104. -- Incomplete Abdominal Closure
1105. -- Failure To Walk (Swimmers)
1106. -- Abnormal Bite
1107. – Umbilical hernia
1108. – Inguinal hernia
1109. -–Other, Specify
1109M Midline Defects
1110. Cesarean Section
1111. Chronic False Pregnancies
1112. Difficulty in Whelping
1113. Failure to Carry to Term
1114. Failure to Conceive
1115. Insufficient Milk
1116. Irregular Heat Cycles
1117. Mastitis
1118. Poor Mothering Instinct
1119. Primary Uterine Inertia
1120. Pyometra
1121. Small Litters

Behavior & Temperament
1300. Other
1301. Aggression
1302. Shyness
1303. Obsessive-Compulsive
1304. Rage Syndrome

Other
1400 Hernia – umbilical
1401 Hernia – Inguinal
1402 Cushings
1403 Addisons
1404 Impacted/Infected Anal Gland
1405 Phantom Tail