Mastiff Health Survey

General

Is this an update to an earlier form? Yes No

State or Country: Owner's name (optional):
Owner ID:   Telephone (Optional):  
(the ID fields allow us to avoid duplicates, make updates and enable us to contact you in case of errors - we recommend using your e-mail address or your phone number, or you can enter your own made up ID if you prefer)

Mastiff ID:
(this field is used to avoid duplicates and allow updates ONLY - we recommend using the Mastiff's registration number, but you can enter your own made up ID if you prefer)

Mastiff's Country of birth:

Sex:  Male Female               Date Of Birth: // (mm/dd/yy)

Mastiff's overall general health:     Excellent       Good      Fair      Poor      Bad

If health is impaired, at what age did your Mastiff start to have significant health problems? 

Titles:

Has this Mastiff ever been bred?  Yes No
Spayed/Neutered?  Yes No    Age at altering: 
Why spayed/neutered?
 

Mortality

Is this Mastiff living?  Yes No

Age at death:       or Date Of Death: // (mm/dd/yy)

Cause of death:

Was an autopsy performed to determine cause of death?  Yes No
Euthanized?  Yes   No
Why?

Medicines

Medication(s) administered for prevention or treatment (name the brands) of parasites, and any adverse reactions:
Flea Preventive
Flea Treatment
Tick Preventive
Tick Treatment
Giardia Treatment
Heartworm Preventive
Heartworm Treatment
Adverse reactions:

Vaccinations

  Vaccinations your Mastiff normally receives: Rabies  Bordetella  Distemper  Lyme   Parvo  Lepto
                                                                              Hepatitis Nosodes    Titres only   Others specify: 
Adverse reactions:

Symptoms:

Diet

What type(s) of food does your Mastiff eat?
Dry  Canned   Brand if commercial: 
Homemade Raw (Bones And Raw Food)
Do you supplement your Mastiff's food?   Yes No
List supplements:

Anesthetic

Was your Mastiff ever anesthetized/sedated?  Yes No

For what procedure(s)?

What anesthetic/sedative was used (if known)?

Did your Mastiff have any adverse reaction to the anesthetic/sedative?

Hips

Was your Mastiff x-rayed to evaluate hips?  Yes No     Age(s) at evaluation:

Hip surgery required?  Yes No    How many?

If your Mastiff's hips have not been x-rayed please skip to the next section.

OFA Status (check one):    Normal:   Excellent    Good    Fair   
Indeterminate:  Borderline     
Dysplasia (degree of finding)  Mild    Moderate    Severe     
Findings: 

OFA Prelim Status:  Age: Normal:  Excellent    Good   Fair     
Indeterminate: Borderline     
Dysplasia (degree of finding)  Mild    Moderate    Severe     
Findings: 

GDC Status (check one):    Unaffected:   Excellent    Good     Acceptable     
Affected (finding/degree arthrosis)  L    R


PennHIP DI: L: R:
Other (note registry/vet/other)

Status (e.g. 0/2, 10/20): L    R

Elbows

X-rayed to evaluate elbows?  Yes No     Age(s) at evaluation:

Surgery required?  Yes No    How many?
If your Mastiff's elbows have not been x-rayed please skip to the next section.

OFA Status:    Normal:   left    right      
Dysplasia (grade and finding):  L    R

OFA Prelim status:    Age: Normal:   left    right      
Dysplasia (grade and finding):  L    R

GDC status:    Unaffected:  left right     
Affected (finding/degree arthrosis)  L    R

Other (note registry/vet/other)
Status (unaffected or dysplasia with degree of findings) L    R

For the following selections, please check any that apply. Feel free to write in notes or comments. Where applicable, please indicate how the diagnosis was made, by lab test, by vet, or by yourself (lab, vet, self).

Miscellaneous

01. Vagina hyperplasia     Surgery(s) required?   Yes No
02. Uterine prolapse 03. Umbilical hernia 04. Cleft lip or palate
Miscellaneous Notes:

Gastrointestinal

05. Irritable bowel syndrome 06. Intussuception
07. Bloat              Age:    How Often:  Died of bloat?  Yes No           
Surgery(s) required?  Yes No 08. Vomit or regurgitate more than 4-5 per year
09. Regurgitates or vomits food            Bile only?  Yes No 10. Megaesophagus 12. Eats feces 13. Pica (eating non-food items)
Gastrointestinal Notes:

Skeletal

14. Hypertrophic Osteodystrophy (HOD) 15. Osteochondritis Dessicans (OCD)   location:
16. Panosteitis age: months    Duration: months 16. Spondylosis age: years
17. Cruciate Ligament tears  type of surgery:  successful:
18. Patellar Luxation 19. Arthritis Location: Age at onset:
20. Spinal Myelopathy
21. Cervical Vertebral Instability (wobblers)  Was a mylogram performed? Yes No
22. Luxating Tarsus (hock)
23. Invertebral Disk Disease
24. Lateral Torsion of the Hind Feet
25. Crooked tail (kink)
26. Other:        
27.Were any surgeries required? Yes No    Number?             
Description:            

Skeletal Notes:

Nervous System

28. Cerebellar Degeneration
29. Hepatocerebellar Degeneration
30. Meningitis (check one or more):    Viral   Bacterial   Aseptic    Age at Diagnosis:
31. Hydrocephalus
32. Hypomyelination (tremblers)
33. Epilepsy
34. Seizures  Controlled by meds? Yes No   Age at first seizure:
35. Fly snapping behavior  Was a cause determined? Yes No            
Description            

  36. Other:
Nervious System Notes:

Eyes

37. Entropion     Number of surgeries:
38. Ectropion      Number of surgeries:
39. Ectopic cilia 40. Cataracts     Age at diagnosis:     Type:
41. Progressive Retinal Atrophy (PRA)      Age at diagnosis:
42. Retinal Dysplasia     Type?    Folds    Geographic    Detachment
42. Persistent Pupilary Membranes (PPM)   Number of strands: 1-2 3-5 6 or more
43. Other eye problems:
44. Eye examination during the past 12 months       
Results:
Eye Notes:

Ears

45. Ear hematomas
46. Chronic ear infections        Type: 
47. Other ear problems:
Ear Notes

Skin:

48. Chronic Hot Spots   Cause (if known):
49. Seborrhea
50. Demodectic Mange
51. Sarcoptic Mange
52. Persistent Staphylococcal Infection (Pyoderma)
53. Allergies      Type:
54. Interdigital Cysts
54. Sebaceous Cysts
55. Sebaceous Adenitis
56. Pemphigus Foliaceus
57. Calcinosis Circumscripta
58. Histiocytomas
59. Systemic lupus erythematosus (SLE)
60. Alopecic Syndromes (color dilution)
61. Uveodermatologic Syndrome
62. Other:
Skin Notes:

Cancer

63. Mammary gland
64. Skin, subcutaneous tissue   Location:
65. Mouth
66. Osteosarcoma
67. Leukemia
68. Lymphoma
69. Fibrosarcoma
70. Hemangiosarcoma
71. Cutaneous histiocytosis
72. Systemic histiocytosis
73. Malignant histiocytosis
74. Mastosarcoma   Location:
74. Squamous Cell Carcinoma
74. Bladder
74. Kidney
74. Thyroid
75. Other
Age at diagnosis of any above
Treatment:

Cancer Notes:

Blood

76. Anemia
77. Hemophilia
78. von Willebrand's Disease - How diagnosed:
79. Factor I Deficiency (Dysfibrinogenemia)
80. Selective IgM deficiency
81. Autoimmune Hemolytic Anemia
82. Idiopathic Thrombocytopenic Purpura
83. Polyarteritis Nodosa
84. Other:
Blood Notes

Endocrine (hormone producing) system

85. Diabetes
86. Pancreatitis
87. Cushing's Disease
88. Addison's Disease
89. Pituitary disorder
90. Hypothyroidism Age: Medication:  
91. Hyperthyroidism
Endocrine Notes:

Kidneys and Bladders

92. Cystitis (Bladder Infection)    How many?
93. Familial Glomerulonephropathy
94. Stones     Type:    Cystine    Sturvite    Other
95. Incontinence
96. Renal dysplasia
97. Other:
Kidney Notes

Liver Problems

98. Portosystemic    Shunt Surgery?      Yes No
99. Chronic Active Hepatitis (NOT infectious)
A0. Other:
Liver Notes

Heart

A1. Mitral Valve Defect A2. Tricuspid Valve Defect
A3. Stenosis Type:
A4. Murmurs
A5. Patent Ductus Arteriosus
A6. Other:
Heart Notes:

Respiratory

R1. Kennel Cough
R2. Pneumonia
Respiratory Notes

Reproductive Problems

Females

A7. Irregular Heats         Months Between Heats:
A8. Refusal To Accept Male
A9. Failure To Conceive  How many times:
B0. Fetal Death (Before Birth)
B1. Fading Puppies
B2. Vaginal Infection
B3. Pyometra
B3. Herpes
B4. Mastitis (Bad Milk)
B4. Metritis (Uterine Infection)
B5. Difficulty Whelping       
Description       


B6. Reabsorbed litters?     How many?             
How diagnosed?
B7. Other:
Number of litters:
Number in litters
Number of whelps alive after 24 hours
How was the litter whelped: (N)atural,
(C)-section,
(U)nplanned c-section		 N
C
U 		N
C
U 		N
C
U 		N
C
U 		N
C
U 		N
C
U
Hours in labor prior to surgery
# whelped naturally prior to C-section
Of those delivered by C-section, # that survived

Males

C1. Lack Of Interest In Female
C2. Impotence (Inability To Breed Willing Female)
C3. Sterility (No Sperm)
C4. Abnormal Sperm
C5. Undescended Testicle(s)
C6. Other Testicular Abnormality:
C7. Genital Infection
C8. Prostatitis
C9. Other:
Reproduction Notes

Immune System

D0. Mastiff diagnosed with a condition in which immune failure was suspected.            
What was the condition:            
How was the diagnosis made:            
At what age was the diagnosis made:
Immune System Notes:

Temperament


How would you describe your Mastiff's temperament from 0-12 months of age? (Check all that apply):
01. Very Shy 07. Aggressive
02. Timid 08. Dog Aggressive
03. Reserved 09. Bit a Person
04. Confident 10. Rage Syndrome
05. Protective 11. Afraid of Men
06. Friendly 12. High Prey Drive
07. Very Friendly 13. Afraid of Other:


How would you describe your Mastiff's temperament from 13-24 months of age? (Check all that apply):
01. Very Shy 07. Aggressive
02. Timid 08. Dog Aggressive
03. Reserved 09. Bit a Person
04. Confident 10. Rage Syndrome
05. Protective 11. Afraid of Men
06. Friendly 12. High Prey Drive
07. Very Friendly 13. Afraid of Other:


How would you describe your Mastiff's temperament after 24 months of age? (Check all that apply):
01. Very Shy 07. Aggressive
02. Timid 08. Dog Aggressive
03. Reserved 09. Bit a Person
04. Confident 10. Rage Syndrome
05. Protective 11. Afraid of Men
06. Friendly 12. High Prey Drive
07. Very Friendly 13. Afraid of Other:


Temperament Notes:


Please include any additional comments about this Mastiff :


Does your Mastiff have any ongoing or chronic medical problem not covered on this survey?   Yes No

If yes, please elaborate:



To submit your data press here:            To reset the form, press here: .
MCOA Health Committee:
Co-Chairs:
Anna May (951) 704-6022 mastiff@iinet.com  
Jenny Zinn-Boyce (562) 425-8354 jzinnboyce@aol.com    

Members:

Jan McNamee (330) 648-9427 windfallmastiffs@hughes.net 
Dr. Bill Newman (814) 623-9377 dansdad@pennswoods.net  

Subcommittee chairs:

Cancer - Jenny Zinn-Boyce (562) 425-8354 jzinnboyce@aol.com
Cystinuria - Beth Nichols (262) 859-0347 bethmastiff2@aol.com 
Cystinuria - Lisa Edwards-Filu (845) 477-0233 darkmstf@yahoo.com
DNA - Mary DeLisa (303) 929-5529 mwhipple75@aol.com
Health Awards - Karen Flocker (480) 632-5240 mastiffmom@cox.net
Hip - Elbow Dysplasia  Tammy Sholes (828) 428-3355 nicochri@bellsouth.net
PRA - Carla Sanchez (951) 696-4169 CARLACHEZ@aol.com
Seizure Disorders - Doreen Dysert (503) 348-9347 ddysert@hughes.net

Established in 1997 by Constance Parker.