Questionnaire for breeders and owners

This questionnaire is optional and need not be completed should you decide not to participate. Your information below will be kept confidential and held in accordance with applicable data protection legislation and regulations.  Any respondents to the questionnaire must be over 18 years of age. 

BACKGROUND

We have recently identified a number of Welsh Terriers with a suspected movement disorder. The primary aim of this questionnaire is to collect information about movement disorders (paroxysmal dyskinesias) specifically in the Welsh terrier breed with a long-term objective of investigating a possible genetic cause and/or the effectiveness of specific treatment or management options.  Movement disorders are abnormal, self-limiting episodes that are characterised by:

-       periods of abnormal limb and body movements ;

-       involving abnormal body/trunk posture such as sustained limb elevation particularly of one of the front legs;

-       remains conscious/awake, but may appear distressed/anxious;

-       may be distressing to witness;

-       sometimes described as seizure-like episodes;

-       with signs exhibited for no specific length of time (i.e. could be seconds or last hours).

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* 1. Please provide the date the form was filled in (day/month/year)

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* 2. Gender of dog

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* 3. Age of dog: (Years/ [and months if possible])

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* 4. Does your dog have any concurrent medical complaints requiring on going treatment? Please list any current medication.

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* 5. Has your dog ever experienced any episodes that appear to be consistent with the signs and abnormal behavior described above? (Please note that if the answer to this question is No, no further questions need to be answered but please still submit your questionnaire)

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* 6. When did the abnormal episodes occur for the first time? Please provide approximate date if known (month/year).

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* 7. Can you predict when an episode will occur or is about to occur? For example, do these episodes appear to have a particular trigger (e.g. sudden movement/exercise/stressful situations/ excitement)?

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* 8. Do the abnormal episodes involve any periods of unusual limb movements (e.g. lifting or holding their legs up) or body positions (e.g. bending/ writhing of the body)?

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* 9. Does your dog usually remain standing during the episodes? Does he/she end up lying down on his/her side? Or does he/she maintain a sitting position?

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* 10. On average, how long do episodes typically last?

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* 11. On average, how many abnormal episodes does your dog have per month?

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* 12. During an episode, is your dogs’ mentation (awareness of his or her surroundings and/or ability to interact with you) affected? Can he/she acknowledge an intervention such as calling his/her name or offering food, for example?

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* 13. Does your dog ever urinate/defecate/salivate during these episodes?

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* 14. Does your dog behave normally when not experiencing an episode (i.e is he/she otherwise his/her normal self in between)?

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* 15. Was there a change in your dog’s diet prior to the onset of the episodes? If so, please describe below.

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* 16. Does your dog ever have any other clinical signs associated with the episodes (including gastrointestinal signs, such as vomiting, diarrhea or audible stomach noises/flatulence)?

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* 17. In relation to the number of episodes, their duration and severity since onset, do you think the episodes are:

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* 18. Is your dog receiving any treatment, specifically to treat the episodes (including any diet trials/ medication)?

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* 19. To the best of your knowledge, please list the treatment your dog is receiving/your dog has received in the past and/or the details or any specialist diets or diet trials.

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* 20. To the best of your knowledge, what was the duration of treatment? If the treatment is ongoing, please estimate the start date of the treatment.

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* 21. Did you observe whether the treatment provided altered the frequency or duration of episodes? Please describe the effect on A) frequency and B) duration in the space below.  

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* 22. In your opinion has the condition negatively affected your dog’s quality of life?

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* 23. How is your dog’s quality of life now – rated from 1 to 10? 
10 = Ideal/could not be better
5 = Adequate, but could be better
1 = Poor/could not be worse

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