Abtc.org

Survey of All Belgian Tervuren
Including a subset with gastric carcinoma (stomach cancer)
Please complete the following questionnaire for all Belgian Tervuren that you have owned (and that lived with
you) in the years between and including 1990 and 2010. The back of the survey (page 4) is blank and can be used
to write in additional information. This study has been approved by the American Belgian Tervuren Club (ABTC)
board and the ABTC Health Education Committee, and is being sponsored by the ABTC.
List the following information for each dog that you currently own. If you need additional space, please use theback of the survey (page 4). Write in the title “Living dogs”and list your additional dogs with the followinginformation. Neuter status refers to the sex of the dog (female=F, female spayed=FS, male=M, malecastrated=MC). For each dog that you owned in 1990 or more recently, but has since died, please list the following information. Ifyou need additional space, please use the back of the survey (page 4). Write in the title “Dogs that have died” andlist your additional dogs with the following information. Neuter status refers to the sex of the dog (female=F,female spayed=FS, male=M, male castrated=MC). Please clearly mark any dog that was confirmed or suspected tohave had stomach cancer.
Have any of the dogs that you have owned been diagnosed with and/or died from suspected or confirmed stomachcancer? There may be a few additional questions that arise once we start to look at the data collected. Please provide yourname and contact information for us to contact you in the future, if we have additional questions pertaining to thisstudy. Contact information is confidential and will only be used to obtain additional information for this study. Individual information will not be disclosed, and all information will be presented in a grouped format.
Your name:Phone number(s):Email address:Snail mail address: If you have never had a dog with stomach cancer, you have completed this survey. Thank you for your
participation.
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The remainder of this survey deals with stomach cancer in the Belgian Tervuren. Please continue if you
have had a dog that was diagnosed with stomach cancer (confirmed or suspected) in the years between and
including 1990 and 2010.
If you have had more than 1 dog affected by stomach cancer, please fill out a separate survey for each dog. If youneed additional survey documents, please ask a study representative for additional copies of the form. Completingthe remainder of the survey should only take 5-10 minutes. If you don’t remember all the details, please completewhat you can. We will contact you or your veterinarian later, if we need to. What is/was the AKC registered name of your dog which has/had stomach cancer? If your dog is/was notAKC registered but is/was registered with a different registry, please list his/her registered name and theregistry/country in which the dog was registered. If your dog was not registered, but you know his/herparentage, please list the name of his/her sire and dam.
When you think back on your dog’s course of disease, what was/were the earliest clinical signs that younoticed with your dog? (Please check all that apply.) As time went on, what clinical signs did your dog exhibit? (Please check all that apply.) Which of the following diagnostic tests were performed ultimately leading to the diagnosis of stomachcancer in your dog? (Please check all that apply.) CT (cat) scan of the abdomen to evaluate the stomach Aspirates of the mass with evaluation of the sample Endoscopy (gastroscopy) to visualize the mass Biopsies of the mass taken during endoscopy (gastroscopy) Surgery to evaluate the stomach or to remove the mass Biopsies of the mass taken during a surgery Autopsy/necropsy after my dog was euthanized Was a definitive diagnosis of stomach cancer obtained by biopsy or by examination of samples aspiratedfrom a stomach mass (tumor)? Please check all answers that apply to your dog.
G Yes, a definitive diagnosis of stomach cancer was obtained by biopsy or examination of aspirates of the mass (tumor) while the dog was alive.
G Yes, a definitive diagnosis of stomach cancer was obtained/confirmed after euthanasia and an autopsy/necropsy with analysis of tissue taken from the stomach mass (tumor).
G No, a diagnosis of stomach cancer was not confirmed but was suspected based on the presence of a mass (tumor) in the stomach. Biopsy samples or aspirates taken duringendoscopy did not yield a definitive diagnosis of stomach cancer. G No, a diagnosis of stomach cancer was not confirmed but was suspected based on the presence of a mass (tumor) in the stomach. Biopsy samples taken during surgery did not yield adefinitive diagnosis of stomach cancer. G No, a diagnosis of stomach cancer was not confirmed but was suspected based on the presence of a mass (tumor) in the stomach. No aspirates or biopsies were taken.
Did you treat your dog that had stomach cancer? If your answer to this question is no, please proceed to question 11.
If you did treat your dog, which of the following treatments were provided? (Check all that apply andcircle the medication that was given, if it is listed.) Steroids (Prednisone, Prednisilone, Triamcinalone, other) Antiemetics (Reglan=metaclopramide, Tegretrol=thorazine, Cerenia, ,Zofran, other) Gastric protectants (sucralfate=Carafate, Pepto-bismol, other) Treatment for heartburn/antacids (Tagamet, Pepsid, Zantac, Tums, other) Pain medications (Tramadol, Rimadyl, Deramaxx, Prevacox, fentanyl patch, Surgical exploration with removal of the mass Chemotherapy following surgical removal of the mass Chemotherapy without surgical removal of the mass Other-please list medications not listed above Did the treatment that you tried initially improve the quality of your dog’s life? Yes G No G If your answer to this question is no, please proceed to question 11.
If your dog’s quality of life improved after treatment was initiated, how would you rate your dog’s qualityof life during the time that you saw improvement? Please estimate the length of time for which this improvement in quality of life was sustained.
Improved quality of life was sustained for How long did your dog live from the time of diagnosis to the time that he/she was euthanized? It may be useful to obtain additional information about your dog’s diagnosis and treatment. If you don’t mind thatyour veterinarian be contacted about your dog with stomach cancer, please provide contact information. If youdon’t have all of the veterinarian’s contact information readily available, please complete what you can. Theveterinarian can be located by several methods using available databases.
Veterinarians name (first and last, if possible):Name of Hospital or Clinic where your dog was treated:City in which the animal hospital is located:Veterinarian’s phone number: If your survey is to be returned by US mail, please send it to: Dr. Cathy GreenfieldUniversity of IllinoisCollege of Veterinary Medicine1008 West Hazelwood DriveUrbana, IL 61802 Thank you very much for your participation in this study. This valuable information will be used to help determinethe characteristics of stomach cancer in the Belgian Tervuren. Data will be complied and presented to themembership in the Tervuren News Tales and/or on the ABTC website and will be submitted as a manuscript forpublication in a widely circulated veterinary journal.

Source: http://www.abtc.org/images/stories/health_ed/gastric%20adenocarcinoma%20study/Gastric_Survey.pdf