2000 Akita Health Survey A Collaborative Effort of the Akita Club of America and
The Purdue University School of Veterinary Medicine, Section of Clinical Epidemiology

(Dr. Larry Glickman, Head)

The Akita Club of America (ACA) and the Purdue University School of Veterinary Medicine would like your participation in a survey to identify the frequency of health related conditions of Akita dogs. This information will be useful in prioritizing health research resources and will provide a baseline against which to measure the impact of future breeding and health promotion programs. All information collected will be tabulated by Dr. Glickman at Purdue University and a report of the findings submitted to the ACA for distribution to its members. All responses will be kept confidential, i.e.; the names of the respondents will be kept anonymous and separate from the responses. The Akita Club of America Health Committee assisted in the design of the questionnaire. The success and accuracy of this health survey depends on a high rate of cooperation.

Please take the time to complete one questionnaire for each eligible dog and return it promptly to:

2000 Akita Health Survey
c/o Professor Larry Glickman
Purdue University School of Veterinary Medicine
West Lafayette, IN 47907-1243

Please feel free to make copies of this survey as needed. Additional copies may also be downloaded from the ACA's web page at http://www.akitaclub.org. The deadline for responses is June 1, 2000, after which time your questionnaire will not be included. However, earlier responses are appreciated since this will expedite submission of the final report to the ACA.

Thanks for your participation in this most important study. If you have any questions concerning this survey, please call Linda Wroth at (510) 233-2135 or email her at lwroth@ix.netcom.com.

Selecting Dogs for Entry into the 2000 Akita Health Survey

Each household may enter up to 5 dogs in this survey. Eligible dogs are those which were alive on January 1, 1995 and for which you know their life history. These dogs can either be alive now or have died since January 1, 1995. If you owned more than 5 dogs on January 1, 1995, arrange them according to the month of birth and select the first 5 for inclusion. Please complete a separatesurvey form for each of the dogs entered.

General Owner Information

1. How many Akitas were living with you on Jan. 1, 1995: ____
2. How many Akitas are currently living with you: ____
3. How many years have you been in the breed: ____
4. What are your primary interests: (Check all that apply)

____ Breeder	____ Show	____ Obedience		____ Agility
____ Field Trials	____ Tracking	____ Search & Rescue		____ Rescue
____ Companion/pet	____ Hunting	____ Assistance/ Therapy	____  Other (specify)  _________________

5. What three diseases or health-related conditions do you feel are of most concern for Akitas? Write one number that corresponds to the respective disease from the table below on each of the following three lines: (a)=highest concern

(1) Cancer (neoplasia)	(9) Allergies
(2) Elbow/hip dysplasia	(10) Autoimmune diseases
(3) Gastrointestinal diseases	(11) Eye diseases
(4) Heart disease	(12) Behavior problems
(5) Thyroid diseases	(13) Ear diseases
(6) Epilepsy/seizures	(14) Kidney disease
(7) Eye diseases	(15) Neurologic diseases
(8) Skin/coat diseases	(16) Other, specify ______________________

Please fill out a separate form for each Akita

2. General Dog Information

1. Date of birth: ____ month ____ day ____ year
2. Sex: ____ male ____female

Neutered ____ no ____ yes
If yes, date of surgery ____ month ____ year

3. Lineage: please check appropriate boxes for the lineage of this Akita's dam and sire

	Japanese	American	Mixed
Dam
Sire

Place of birth for this Akita: please check one choice, and specify if choice is 'Other'

Please use the codes for 'Color' and 'Supplemental Descriptors' from the table below and
write the desired code in the following spaces:
 

Color _____	Supplemental Descriptor _____
1) Black	1) Black Mask
2) Brown	2) Black Mask, White Markings
3) Red	3) Black & White Mask, White Markings
4) Fawn	4) Pinto-for self masked or white masked
5) Silver	5) Pinto, Black Mask
6) White	6) Pinto, Black & White Mask
7) Black Brindle	7) Less than one third body color
8) Brown Brindle	8) White Mask
9) Red Brindle	9) White Mask, White Markings
10) Fawn Brindle (or Blue Brindle)	10) White Mask-for dogs that are self  masked with white markings
11) Silver Brindle
12) Brown, Black Overlay
13) Red, Black Overlay
14) Fawn, Black Overlay
15) Silver, Black Overlay
16) Black, Brown Undercoat
17) Black, Red Undercoat
18) Black, Fawn Undercoat
19) Black, Silver Undercoat
20) White, Red Shading

4. For bitches only, has this dog ever had a litter: ____ yes ____ no

If yes, please complete following table:
 

Litter #	Month/Year	# Live born	# Still born	# Weaned	# Euthanized* (congenital defects)	Breeding (use code below)
#1
#2
#3
#4

For Breeding, please use the following code:
1=natural; 2=artificial insemination-fresh semen; 3=artificial insemination-chilled semen
4=artificial insemination-frozen semen
*If puppies were euthanized due to congenital defects, what kind of congenital defects occurred?
 

Congenital Defect	Yes	No
Micropthalmos
Cleft palate
Wobbler's syndrome
Other (specify) _______________________

5. Where did you obtain this dog:

____ bred yourself	____ breeder (kennel)
____ breeder (home)	____ adopted from private owner
____ shelter or rescue	____ pet store
____ service dog	____ other (specify) ________________________

6. For what purpose was this dog bred?

____ conformation	____ companion/pet
____ obedience	____ agility
____ tracking	____ herding
____ assistance	____ therapy

7. State or country in which this dog spent most of its lifetime: _____________________
8. As a puppy (< 9 months), what rate of growth did you try to achieve:

____ maximum ____ average ____ slow ____ don't know

9. As a puppy (< 9 months), would you characterize your dog as:

____ obese

____ overweight

____ average/optimum

____ underweight

As a puppy (< 9 months), was your Akita fed puppy food: ____ yes ____ no

If yes, at what age was your Akita switched to adult food? _____ months

10. As an adult (>9 mo.), what was the dog's usual: ____ weight (lb.) ____ height (in)
11. As an adult (>9 mo.), would you characterize your dog as:

____ obese ____overweight ____average/optimum weight ____ underweight

12. As an adult (>9 mo.), would you characterize your dog as:

____ large boned ____ medium boned ____ small boned

13. Please record the number of times each food type was fed in the appropriate boxes, based on your dog's adult (9 mos.- 7 yr.) and senior (>7 yr.) diet:

Type of Food	Frequency of Feeding
	Daily		Weekly		Monthly
	Adult	Senior	Adult	Senior	Adult	Senior
Dry
Canned
Home prepared
Table scraps
Other (specify)

14. For the commercial foods fed daily for the longest period of time, write in the code for the first four ingredients as stated on the label. Do not include water as an ingredient.

Dry Food Codes

Red meat (meal/by product) - e.g., beef, lamb, venison

White meat (meal/by product) - e.g., chicken, turkey, pork, duck

Plant origin - e.g., soy, rice, corn, wheat, millet, oat, potato

Fiber/fat

Fish or fish meal

Eggs

Other

Dry Food codes 1)________ 2)________ 3)________ 4)_________

If you do not have the label available, what is the

Brand _________________ & Specific Food Type ________________
 

Canned Food Codes:

Red meat- e.g., beef, lamb, venison

White meat- e.g., chicken, turkey, pork, duck

Plant origin - e.g., soy, rice, corn, wheat, millet, oat, potato

Meat by product

Other

Canned Food codes 1)________ 2)________ 3)________ 4)_________

If you do not have the label available, what is the

Brand _____________ & Specific Food Type ___________

15. Check the home prepared foods fed daily or weekly, and indicate whether or not the food was cooked or served raw:

Home Prepared Foods Fed:	Frequency			How Prepared
		Daily	Weekly	Cooked	Raw
(1) Vegetables
(2) Fruit
(3) Red meat (e.g., beef, lamb)
(4) White meat (e.g., chicken, turkey, pork)
(5) Fish
(6) Other meat (e.g., venison)
(7) Yogurt				NA
(8) Eggs
(9) Pasta
(10) Bones
(11) Dairy				NA
(12) Other (specify) ____________________

17. Please check the boxes based on the supplements given your dog as an adult (9 mos.- 7 yr.) and senior (>7 yr.):

Type of Supplement	Supplements Given
	Daily		Weekly		Monthly
	Adult	Senior	Adult	Senior	Adult	Senior
Vitamin / Multivitamins
Minerals
Cartilage supplement (e.g., glucosamine)
Food Supplement (e.g., vinegar, garlic)
Other (specify)  ________________

Type of water used most of the time (> 50% of the time) - Please select one type:
 

	Water Treatment
Type of Water	Filtered		Chlorinated		Softened
	Yes	No	Yes	No		Yes	No
Municipal
Well
Bottled
Other (specify)________

18.On average, how many shows a year did/does this dog attend (choose a typical year during which the dog was actively competing):
 

____ agility

____ obedience

____ tracking

____ conformation

19.How is your dog primarily housed (more than 50% of the time):

____ in a crate in the house ____ kennel (indoor) ____ free in the house

____ kennel (inside/outside) ____ fenced yard ____ garage

____ Other (specify)____________________________________
 

19. Does your dog sleep on your bed

____never ____sometimes ____usually

20. What is the current vital status of this dog:

____ alive ____ died ____ euthanized

21. If died, date of death: ____ month ____ day ____ year

Cause of Death Codes for Question 22

(1) Malignant neoplasm (cancer)  ·Use the table from part IV Health Related Conditions: Malignant Neoplasms to obtain the codes for Type of Tumor & Location of Tumor

(2) Old age, dementia

(3) Heart failure

(4) Kidney failure

(5) Liver failure

(6) Gastric dilatation volvulus (bloat)

(7) Musculoskeletal / arthritis

(8) Autoimmune disease

(9) Neurological / epilepsy

(10) Trauma

(11) Infection

(12) Endocrine disease

(13) Other (specify) _____________________

(14) Unknown

22. If died, what was the cause?

Part IV Health Related Conditions - Malignant Neoplasms:

• Type of Tumor Code _____
• Location Code _____

23. If died, was the above cause of death verified by a veterinarian: ____ yes ____ no
24. If died, was an autopsy performed: ____ yes ____ no
25. Age at death of parents: Dam ____ years ____ unknown  Sire ____ years ____ unknown

Personality and Temperament

How would you rank your dog on a scale of 1 to 10 for each of the following characteristics?
Please circle one number in each row:

                                        Never (Low)                Sometimes                         Always (High)
 

1. Active or energetic (activity level)	1	2	3	4	5	6	7	8	9	10
2. Excitable	1	2	3	4	5	6	7	8	9	10
3. Aggressive to dogs	1	2	3	4	5	6	7	8	9	10
4. Aggressive to people	1	2	3	4	5	6	7	8	9	10
5. Submissive to dogs	1	2	3	4	5	6	7	8	9	10
6. Submissive to people	1	2	3	4	5	6	7	8	9	10
7. Fearful of people	1	2	3	4	5	6	7	8	9	10
8. Fearful of environmental changes*	1	2	3	4	5	6	7	8	9	10
9. Happy	1	2	3	4	5	6	7	8	9	10
10. Trainable	1	2	3	4	5	6	7	8	9	10

* Environmental changes include thunder, guns, firecrackers, other loud noises, etc.

IV. Health Related Conditions

• For the Malignant Neoplasms (Cancer) question on the next page, use the codes from the following table.

First select a code for the Tumor Type and then select a code for the Location.
Write these two codes in the chart on next page.
 

Codes for Tumor Type	Codes for Location
Adenocarcinoma	A. Bladder
Chondrosarcoma (cartilage)	B. Bone
Fibrosarcoma	C. Brain
Hemangiosarcoma	D. Digits
Interstitial cell tumor	E. Eye
Liposarcoma	F. Heart
Lymphoma (Lymphosarcoma)	G. Intestine
Malignant giant cell tumor	H. Kidney
Mast cell tumor	I. Liver
Melanoma	J. Lung
Mesothelioma	K. Lymph nodes
Myeloma	L. Mouth
Neuroblastoma	M. Muscle
Neurofibrosarcoma	N. Nasal cavity