Canine Dysautonomia Research Survey (CD)
This survey is meant to obtain information on dogs that have been diagnosed or highly suspected cases of canine dysautonomia. This survey is administered by the Wyoming State Veterinary Laboratory (WSVL) and University of Wyoming. Questions with regards to this survey maybe directed to Dr. Brant Schumaker, Epidemiologist with the WSVL (theschu78@gmail.com). The time impact of this survey is 20 minutes.


We are interested in biological and environmental samples:

*Blood
*Serum
*Urine
*Soil

These can be sent to us from either yourself or your veterinarian. Please contact Dr. Schumaker (theschu78@gmail.com / 307-766-9970 ) for shipping instructions and account numbers.

WSVL
Brant Schumaker / CD Research
1174 Snowy Range Road
Laramie, Wyoming 82070

How did you hear about this survey?
Your answer
Your Name: (Not Required)
Your answer
Email Address:
Your answer
Physical Address:
Your answer
Zip code of affected animal: *
Your answer
Relationship to animal: *
Name of animal: *
Your answer
Age of affected dog (months): *
Please provide age in months only. If exact age is unknown, please estimate.
Your answer
Sex of animal: *
Is animal sexually intact?
Breed(s): *
Your answer
When did clinical signs start? *
MM/DD/YYYY
Your answer
When was a CD diagnosis made? *
MM/DD/YYYY
Your answer
Number of litter mates:
To the best of your knowledge, were any of the litter mates affected by CD?
Birthplace of animal: *
Your answer
How was animal acquired by current owner? *
Your answer
Predominant environment: *
Predominant use of animal: *
Main use of property: *
If ranch, what animals were/are present on the property?
Your answer
If farm, what animals were/are present on the property?
Your answer
Other animals on property: *
Required
Chemicals used on property: *
Required
Please list specific chemicals used:
Your answer
Please list all supplements and medications. *
List brands and dosing schedule
Your answer
Please list all vaccines and other prescription treatments (e.g. deworming). *
Also list dates and brands used (lot numbers as well if available).
Your answer
How was diagnosis made? *
Required
Please state which pharmacologic testing took place and the results:
Your answer
Please list clinical signs that were noted and date of onset and severity:
Your answer
Please list what histology was completed:
Your answer
Is the animal still alive? *
If the animal is not alive, when did the animal die?
MM/DD/YYYY
Your answer
How did the animal die?
Veterinarians Name, Address, and Phone number *
Your answer
Was a necropsy done? If so where, when, and who.
Your answer
What is the dog's diet? *
What is the brand of the diet?
Your answer
What is the dog's housing? *
Animal's water sources: *
Required
Any recent construction or digging on property? *
If yes, please describe (When, what):
Your answer
Is the animal known to consume dirt or rocks? *
Any wildlife exposure? *
If yes, please describe:
Your answer
Any recent consumption of wildlife? *
If yes, please describe:
Your answer
Any travel within or outside of your state? *
If yes, please describe:
Your answer
Any insect (spiders, ticks, etc.) bites on affected animal, other animals on property, or humans?
If yes, please describe:
Your answer
Any other information you feel might be helpful:
Your answer
May we contact you should we need further information?
Please supply preferred contact information:
Your answer
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