Belgian Shepherd gastrointestinal research - signs of gastric disease

The purpose of this questionnaire is to identify signs of gastrointestinal disease, for a study concerning gastric cancer in Belgian Shepherds (Tervuren, Groenendael, Laekenois, Malinois).

You can participate in the study if your dog has presented, either chronically or occasionally, signs or symptoms of disease of the digestive tract.

Some of the respondents to the survey, especially those with dogs over 8 years of age, may be invited to visit the Teaching Hospital for further examination, free of charge. In such cases, the owner will be contacted by telephone for arrangements.

We hope that you participate in the study by filling out the questionnaire.

Thank you very much in advance for your participation.

Identification

Owner's name

Address

Country

Phone (including country code)

E-mail

Dog's official name (Pedigree)

Dog's registration number

Dog's birth date

Lineage within Belgian Shepherd breed

Select	Tervueren Groenendael Laekenois Malinois

In case the dog in question is no longer alive,

select:	dog died naturally dog was euthanised

Age at death:

Cause of death / reason for euthanasia:

Feeding habits

Which of the following alternatives best describes how often food is offered to / consumed by your dog?

Select	once a day twice a day three times a day more often food is always available

Diet / main food source

If your dog's main food source is a commercially available, ready-made food,

select:	dry dog chow canned dog food dog sausages frozen raw / BARF

If your dog's main food source is homemade,

select:	table lefovers (for human consumption) food cooked specifically for the dog raw food

If the actual diet is a combination of different food sources, or different from the options given, please specify:

If you use a commercial dog food, what is the brand / product most often used?

Does your dog receive food prescribed by a veterinarian for health issues?

	yes	no
Select:

Yes. Please specify:

Does your dog get any treats aside from the usual food?

	yes	no
Select:

Yes. What?

How often do you think your dog eats less than expected / refuses to eat?

Select:	never less often than once a month once a month 2-3 times a month once a week 2-3 times a week more often then 3 times a week

Gastrointestinal problems

Does your dog ever vomit?

Select	yes no I am not sure

How often do you think your dog vomits?

Select:	only very rarely less often than once a month once a month 2-3 times a month once a week 2-3 times a week more often than 3 times a week

If your dog vomits, it usually happens:

it usually happens:	with an empty stomach shortly after eating (food contents)

Does your dog present retching or gagging?

yes

How often?

I am not sure

Does your dog eat grass?

yes

How often?

I am not sure

Does your dog lick surfaces or objects?

yes

How often and what?

I am not sure

Has your dog eaten items not regarded as food (earth, feces, wood, toys etc.)?

yes

How often and what?

I am not sure

Has your dog lost weight?

yes

How much?

What was the timeframe?

I am not sure

Has your dog presented abnormal feces (including bloody or black feces)?

yes

Please specify:

How often?

I am not sure

Has your dog presented difficulty passing feces?

yes

How often?

I am not sure

Any abnormal findings in blood tests?

Anemia

yes

I am not sure

What other changes in blood tests have been found?

Has your dog been diagnosed with any chronic disease?

yes

What?

I am not sure

Is your dog undergoing treatment or medication?

yes

Please specify:

I am not sure

Belgian Shepherd gastrointestinal research - signs of gastric disease

Identification

Feeding habits

Gastrointestinal problems

Behaviour

Tietojen lähetys