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  Home > VBS Faculty > James R. Mickelson > Canine And Equine Genetics Laboratory > Leonberger Polyneuropathy > Online Health Update
 

Online Health Update

 

Discounted LPN2 Result Request (Available through Sept 30th, 2014) 


 University of Minnesota
Leonberger Genetic Studies:

Health Update 


Reason for submission:

Health update only. 

LPN2 result request.  You will be invoiced $40 per dog.  Payment is required before results will be released. 

Promo Code:

Polyneuropathy affected dogs submitted to the University of Minnesota may be elidigible to receive LPN2
results at no cost with pre-approval. 

E-mail lpninfo@umn.edu for more information.

       Result Reporting (Choose ONE):

          E-mail 

          Fax 

Dog Information

Registered Name:


Call Name:

Registration number:


Birth Date (mm/dd/yyyy):

Date of Death (mm/dd/yyyy):

Breed:

Sire:


Dam:


Sex:
Male Female Intact Neutered/Spayed
 


Owner Information


Owner Name
Address
City, State, Zip
Country
Daytime Phone
Evening Phone
Fax
Email


Alternate Contact
Address
City, State, Zip
Country
Daytime Phone
Evening Phone
Fax
Email

 

Has this dog been diagnosed as being affected with polyneuropathy
and/or laryngeal paralysis. If yes, indicate how and by whom (biopsy, EMG,
nerve conduction study, laryngeal scoping, etc). If available, please attach a copy
of the test results to the reply email you will recieve upon completion of this form.
Yes: No:

Veterinarian who made the diagnosis
 

Name
Clinic
Street Address
City, State, Zip
Country
Phone
Fax
Email

Current Veterinarian, if different
 

Name
Clinic
Street Address
City, State, Zip
Country
Phone
Fax
Email

Help us provide the most accurate information and breeding recommendations
possible.  Please complete this section for each dog. 
 

Clinical Signs
 

Exercise Intolerance:
Yes:  No:
Age first noticed:

Laryngeal Paralysis
 

Changes in bark quality:
Yes:  No:
Age first noticed:


Difficulty breathing:
Yes:  No:
Age first noticed:


Difficulty swallowing:
Yes:  No:
Age first noticed:


Has your dog had a tieback surgery?
Yes:  No:
Age at time of surgery:


Feel free to elaborate on your answers to the above questions:

Polyneuropathy
 

Knuckling/Dragging toes:
Yes:  No:
Age first noticed:


Stumbling:
Yes:  No:
Age first noticed:


High-stepping gait:
Yes:  No:
Age first noticed:


Hitched gait:
Yes:  No:
Age first noticed:


Exaggerated stomping of the rear limbs:
Yes:  No:
Age first noticed:


Muscle atrophy
Yes:  No:
Age first noticed:


If yes, which limbs were involved?
Front Right
Front Left
Rear Right
Rear Left

Feel free to elaborate on your answers to the above questions:

 

Does your dog have a history of (check all that apply):

Arthritis

Diabetes

Heart Disease

Hip Dysplasia

Hypothyroidism

Seizures

Spinal Disc Disease

Torn Cruciate Ligament

Cancer (specify type below)

Would you like us to share your dog's DNA with the Broad Institute Cancer Study?
They need both affected and normal older dogs.

Yes
No

Please elaborate on any checked items (age diagnosed, method of diagnosis,
interventions taken, level of control achieved, etc.)


Does your dog have any other medical conditions or additional signs?
If deceased, please state the cause or circumstances of death.


 


I am willing to provide additional blood or cheek swab samples if needed for research.
Yes: No:

I am willing to consider donation of a nerve/muscle biopsy sample upon the death of this
dog, and I will discuss this decision with my veterinarian so that a notation is
placed in the file.
Yes: No:

 

This survey is for the purpose of Leonberger genetic health research; if necessary we may  
contact you for a phone interview or follow-up questionnaire. We may contact your veterinarian
for additional health information or to obtain a copy of test results mentioned above. The identity
of dogs and owners participating in this research will not be revealed.

 

I have supplied complete and accurate information, to the best of my knowledge.

Electronic Signature:

                     Date: 
 

Orthopedic Health Foundation Registration (OFA) - Available through Sept 30th, 2014.

Would you like us to register your dog's LPN2 test result with OFA at no charge (this will occur at the end of Septemeber)? 
 

 Yes, please upload LPN2 clear results. 

No thank you. 

 * LPN2 affected results can be recorded with OFA at no charge with a signed release sent directly to OFA.

Notes about the free LPN2 upload to OFA:

·     If you have checked that you would like your clear LPN2 results to be uploaded to OFA, our laboratory will forward these
results to OFA at no charge at the end of September.  

·     If you send LPN2 clear results to OFA on your own, you will be charged the normal listing fee of $15.  

·     Your dog must already have an entry with OFA (hips, eyes, LPN1, etc) for the LPN2 result to upload into OFA’s database at
no charge.  This is OFA's rule not the University of Minnesota's.  

·     LPN2 affected results can be registered with OFA at no charge at any time by: blacking out the LPN1 result (so you are not
billed for the LPN1 listing),
 signing the result report, and mailing directly to OFA.  
OFA requires a signed release form to post non-clear results.

·     If you have not submitted your LPN1 test result to OFA yet, you can register both LPN1 and LPN2 for the single listing fee of
$15 if they are sent in at the same time.

 

 


 

IMPORTANT INFORMATION:

 

You will receive an invoice for your LPN2 test result via e-mail from nelso554@umn.edu or klamp@umn.edu within 3 business days.                 

 

LPN2 results will be sent via e-mail from lpninfo@umn.edu upon confirmation of payment.

 

 

 

 

 

 
 

 

 

 

 

 



 

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