Breadcrumb Home Disease Research Degenerative Myelopathy Health Update Form General questions Name of Owner Dog"s Call Name Dog"s Registered Name Registration Number Dog"s Sex Male Female Dog"s Date of Birth Degenerative Myelopathy Questions: Has your dog been diagnosed with Denerative Myelopathy (DM, aka ALS?) Yes No Was DM in your dog diagnosed by a veterinarian? Yes No What was the date that your dog began showing signs of DM? Is your dog still alive? Yes No If NO, when did your dog die? What was the cause of death? How long has your dog been showing signs of DM? - None -1-3 months4-8 months9-12 months13-18 months19-24 months24-36 monthsMore than 36 months Which of the following tests were done to make the diagnosis of DM? Tests Spinal radiography (X-rays) Myelogram (contrast X-ray) CT (CAT) scan MRI No diagnostic test, clinical symptoms only For the above tests, please list any that returned abnormal results Spinal radiography (X-rays) Myelogram (contrast X-ray) CT (CAT) scan MRI No abnormal results For any abnormal results, please list findings: Please describe the FIRST symptoms of DM in your dog (please click all that apply): One rear leg weaker than other Dragging toes Falling in rear legs Tremors in rear legs Pain in back Please describe the CURRENT symptoms of DM in your dog (if deceased, symptoms at time of death): Weakness in one rear leg Loss of muscle in rear legs Weakness in both rear legs Loss of muscle mass over entire body Unable to support weight in rear legs Urinary incontinence Unable to move rear legs Fecal incontinence Weakness in front legs Difficulty swallowing Unable to support weight in all limbs Pain in back Unable to move all limbs Other symptom (please specify): When (approximate date) was your dog unable to stand in the hind limbs and needed assistance walking? When (approximate date) did your dog have difficulty walking in the front limbs? Do you know of relatives of your dog who are diagnosed with Degenerative Myelopathy? Yes No If yes, please check all that apply: Sire Dam Sibling Grandparent Other family member (please specify) If you did not provide a pedigree copy with the original sample, please send a copy of the pedigree if it is available. - None -Pedigree was sent with original samplesPedigree attachedPedigree will be mailed/emailed separatelyPedigree unknown/not available Please feel free to provide any other information you feel would be useful for the researchers below: