SKYE TERRIER HEALTH SURVEY 2008

SKYE TERRIER CLUB OF AMERICA

1.0. Your Contact Information (Optional except Country)
Owner's name: 
Address: 
City,State,Zip: 
E-mail: 
Country (Mandatory field): 

2.0. Your Skye's Identification Information
Registered name: 
Date of Birth: 

2.1 This Skye is
Male
Female

2.2 Is this Skye spayed/neutered?
Yes
No
Age when spayed/neutered (in years)

2.3 Ear carriage
Prick ear (upright ears)
Drop ear (hanging ears)
Other, please describe ear carriage

3.0. General Information


3.1. Where did you obtain this Skye? Tick the appropriate box.
Breeder/Exhibitor (including Self)
Breeder, Type Unknown
Pet Shop
Rescue
Other, please specify

3.2. Is this Skye living?
Yes
No
Age at death (in years)
Primary cause of death

3.3. The general health status of this Skye is
Excellent
Good
Average
Poor

3.4. Has this Skye been in veterinary care because of a health related problem or disease?
No
Seldom than once a year
Once a year
Once a month
Several times a year
More frequently

3.5. Vaccinations used?
Check all that apply.
Adenovirus 1
Adenovirus-2 (hepatitis)
Bordetella
Coronavirus
Parvovirus
Distemper
Giardia
Lyme
Parainfluenza
Rabies
Other, specify

3.6. With the exception of rabies, how often do you vaccinate this Skye?
Annually
Every 2 years
Every 3 years
Other, specify

4.0. Diagnostic Testing

4.1. Which preventative tests do you perform
Blood work
Dental checkup
Fecal
Heartworm
Other

4.2. Do you use heartworm preventative?
Yes
No

4.3. Brand used
Heartguard
Interceptor
Iverhart
Revolution
Sentinel
Other

4.4. Have you ever experienced a problem with this heartworm preventative?
Yes
No

4.5. Have you ever experienced a problem with any heartworm preventative?
Yes: Brand name
No

5.0. General Health Conditions
The list of conditions is not comprehensive and includes the ability for you to include conditions that have affected this Skye.
Please identify with a check mark, all conditions experienced.

5.1. Blood Disorders
Autoimmune hemolytic anemia
Bleeding Disorders
Clotting Disorders
Other

5.2. Cancer/Tumors
Basal Cell Tumors
Bone tumors
Hemagiosarcoma
Lymphosarcoma (cancer of the lymph glands)
Malignant melanoma (a form of skin cancer)
Mammary cancer (cancer of the mammary glands)
Mast cell tumors
Ovarian tumors
Testicular cancer
Other
Other

5.3. Dental
Scissor bite
Level bite
Overshot
Undershot
Wry mouth
Gingivitis (gum infection)
Lack of full dentition, indicate which tooth missing
Premature tooth loss
Retained teeth as puppy
Linguoversion (base narrow canines)
Other

5.4. Digestive System
Anal sac inflammation
Bloat (Gastric Dilation)
Chronic active hepatitis (liver inflammation/infection)
Cophrophagia (stool eating)
Inflammatory bowel disease
Liver disorders
Liver shunt, type
Maldigestion
Pancreatitis
Other

5.5. Ears
Ear infections
Hearing problems
Other

5.6. Endocrinology
Addison's disease
Cushing's disease
Diabetes mellitus (sugar diabetes)
Hypothyroidism (deficient activity of the thyroid gland)
Other

5.7. Eyes
Eyes CERFd
Eyes not CERFd
Eyes clear, date of latest examination
Cataracts
Conjuctivitis
Dry eye
Glaucoma
PRA (progressive retinal atrophy)
Cilia aberranta
Lens luxation
RD (retinal dysplasia)

5.8. Heart
Congestive/chronic heart failure
Dilated cardiomyopathy
Heart valve disease
Other

5.9. Kidney/Urinary
Acute renal disease/failure
Chronic renal disease
Bladder stones (cystic calculi)
Urinary tract disease/problems
Urinary infection
Other

5.10. Musculoskeletal

5.10.1. Do you radiograph for hip disorders?
Yes
No
Hip dysplasia, grade

5.10.2. Do you have a veterinarian check patellas?
Yes
No
Examination result

5.10.3. Do you radiograph (x-ray) forelimbs?
Yes
No

5.10.4. Did this Skye limp as a puppy?
Yes
No

Myopathy
Premature Closure
Elbow dysplasia, grade
Other

5.11. Nervous system
Epilepsy/Seizures
Herniated disc
Other

5.12. Respiratory
Lung/respiratory symptoms not related to heart condition
Frequent coughing (non-infectious)
Coughing (infection)
Other

5.13. Skin and Nails
Abscess
Allergies resulting in skin condition
Autoimmune skin disease
Contact Allergies (e.g. fleas)
Cysts
Demodectic Mange
Dietary Allergies (e.g. food)
Hot spots
Inhalant Allergies
Lipomas
Nail infections
Sarcoptic Mange
Seborrhea
Staph Infections
Tumors of the skin
Yeast infection
Other

5.14. Reproductive
Abortion - spontaneous
Cryptorchidism
Dystocia (whelping difficulty)
Eclampsia
False pregnancy
Herpes virus
Infertility - Female
Infertility - Male
Mastitis (inflammation of the breast)
Prostate disease
Pyometra
Reabsorption
Uterine Inertia Primary
Uternie Inertia Secondary
Poor libido (lack of sex drive)
Other

5.15. Has this Skye produced offspring having
Cleft palates
Fading puppy syndrome
Hernia
Hydrocephalus
Kinked tail at birth
Kinked tail during puppyhood
Swimming puppy syndrome
Deafness
Other