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-274881-1388819C.A.N. Survey? Clinical Animal Nutrition for DogsA System Approach to Identifying Vitamin and Mineral Imbalances and Organ DistressRestricted to Professional Veterinary Use. A design of IVE, Inc. 2016PATIENT_______________________________ AGE _________ Weight ___________OWNER _____________________________ DATE ______________Put a number in the box in front of the symptom only that applies to your dog. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.00C.A.N. Survey? Clinical Animal Nutrition for DogsA System Approach to Identifying Vitamin and Mineral Imbalances and Organ DistressRestricted to Professional Veterinary Use. A design of IVE, Inc. 2016PATIENT_______________________________ AGE _________ Weight ___________OWNER _____________________________ DATE ______________Put a number in the box in front of the symptom only that applies to your dog. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.GROUP ONE - SYMPATHETICDry mouth, eyes, noseVomits with excitementIsolates away from family or petsKeyed up, fails to calmTends toward aggressionAfraid of storms, fireworksNervousFear biterDoesn’t adapt easily to routine changeUnable to relax, startles easilyHigh anxietyObsessive compulsive behaviorSCORE GROUP ONE: Number marked =Number divided by 36 = % GROUP TWO - PARASYMPATHETICJoint stiffness with rising Subject to infections Poor circulation, sensitive to cold Always seems hungry Eyes or nose watery Moist body, often an odor Couch potato-like attitude Eats dirt Sleeps more than used to Slow starter, slow mover Constipation, diarrhea, alternating Little interest in anythingSCORE GROUP TWO: Number marked =Number divided by 36 = %GROUP THREE – CARBOHYDRATE METABOLISM, SUGAR HANDLINGTrembles, episodes of weakness Urinating large amounts Weight loss Seizures Hungry often, eats fast Behavior changes Disoriented at times Change in appearance of eyes Increased water consumptionIncreased sleeping, decreased activityCannot lose weight even with dietOverweightWheat, corn, rice, barley, oats in dietEats fecesPasses a lot of gasSCORE GROUP THREE: Number marked =Number divided by 45 = %GROUP FOUR - CIRCULATION Exercise intolerance Cough, especially at restSwelling in rear legs Significant loss of muscle mass Seems disoriented at timesDifficulty breathing Fainting, collapse Rear legs tremble, weakShortness of breath History of heartworms Enlarged heartHas had pneumonia more than once SCORE GROUP FOUR: Number marked =Number divided by 36 = %GROUP FIVE – HEPATIC, GALL BLADDEROn meds over long timeAllergiesStands with back arched Stool watery or diarrheaSeizures, tremorsElevated cholesterol, triglycerides Appears bloatedChange in appetiteElevated liver enzymes, lipase Lethargic, depressed, restlessFrequent anestheticsItching or squinting eyes Increased sheddingFood sensitivitiesOcular dischargeRed eyes or earsAnal Sac problems, ScootingRubs at ears or faceSporadic vomit/diarrhea Licks or chews at feet or anusCrusty lip soresGeneral itchinessRed tummyGasSCORE GROUP FIVE: Number marked =Number divided by 72 = % GROUP SIX - DIGESTIONVomits after fatty meal History of pancreatitisIntermittent vomitingHalitosis Recurrent diarrheaExcessive or chronic eye drainage Pale-colored stool Rancid odor to stoolPoor coat Stomach distress common Belches, regurgitationRecent intestinal parasites SCORE GROUP SIX: Number marked =Number divided by 36 = %C.A.N. Survey? Clinical Animal Nutrition for Dogs – Page 2GROUP SEVEN – A – Thyroid GlandsIncreased shedding Oily, greasy coat, body odorDepression, mentally dullThinning, sparse coat, bald spotsWeak pulseExercise intolerantWartsElevated blood cholesterolBack/neck problems Dry, scaly skinFatty tumorsIncreased pigment to skinObese or can’t lose weightStiff gaitWeak knee ligamentsSCORE GROUP SEVEN A: Number marked =Number divided by 45 = %GROUP SEVEN – B – Pituitary GlandFailing memoryWeight gain around rear end, fat padsAbnormal heat cycles of intact females Abnormal thirstNeutered male retains sexual activity Pigment spots to skin SCORE GROUP SEVEN B: Number marked =Number divided by 18 = % GROUP SEVEN – C – Adrenal Glands, HyperactiveExcessive water consumptionPanting more than used to, excessiveMuscles seem weakIncreased urinationLethargicDistended abdomenThin skinPacingChange in behavior Decline in arthritic symptomsWeak knees Thinning fur SCORE GROUP SEVEN C: Number marked =Number divided by 36 = % GROUP SEVEN – D – Adrenal Glands, HypoactiveWeaknessSlow heartIntermittent anorexiaDepressionWeak pulseCollapseSCORE GROUP SEVEN D: Number marked =Number divided by 18 = %GROUP EIGHT – Musculoskeletal (Calcium / Magnesium Metabolism)Older dogDifficulty getting up and downLosing muscle tone in legs or backHistory of any joint surgeryArthritic, degenerative joint diseaseHealing fracture in bodyBack or disc problemsHas had ligaments damagedSuffering from a sprain or strain Bone spurs or enlarged jointsRapidly accumulates tarter on teethDifficulty supporting weightSCORE GROUP EIGHT: Number marked =Number divided by 36 = %GROUP NINE - RenalAbnormal or frequent urinationHistory of bladder stonesLeaking urineHistory of bladder infectionsLicking at penis or vulvaWants to go outside more oftenReduced renal function Cries when urinatingProstate enlarged High blood calcium or phosphorus Elevated vitamin D14 or more years old SCORE GROUP NINE: Number marked =Number divided by 36 = %GROUP TEN – ImmuneIncreased sheddingSkin crawlsFrequent infectionsRed bumps to skinPoor fur qualityOdor that returns shortly after bathScabs, sores, or crusts to skinBody or ear odorMoist or heat under front/rear legs Dandruff, flakingShakes head or rubs at earsChanged skin appearanceHas had cancerExperienced a vaccine reactionSevere dental infectionSCORE GROUP TEN: Number marked =Number divided by 45 = %C.A.N. Survey? Clinical Animal Nutrition for Dogs – Page 3 GROUP ELEVEN – Pain Lameness, abnormal gaitPlaying lessWobblyWithdrawn, hidingLess interested in going for a walkShifting weight off area of bodyReluctant to moveChange in mood, grumpyLicking excessively an area of the body Dislike or intolerance of handlingHunched back or sway backRestlessness; pacingOverall activity less than normalGroaning, moaning, gruntingLower or tilted head or earsLooks depressedWeeping, red, cloudy or squinting eyesTemperamental, yelp or growl at othersHanging or tucked tailHeavy panting, increased heart rateChange in?toileting habits?Decreased appetiteChange in appetite & type of food willing to eatRecent surgery, dental infectionLicking inanimate objects?(can often be a sign of intestinal pain)SCORE GROUP ELEVEN: Number marked =Number divided by 50 = %SCORE / TALLY Primary Group:% Secondary Group:%Tertiary Group:%IMPORTANTTO THE OWNER: Please list below the five main physical and or health complaints for this dog in order of importance:1. ___________________________________________________________________________________________________________________2. ___________________________________________________________________________________________________________________3. ___________________________________________________________________________________________________________________4. ___________________________________________________________________________________________________________________5. ___________________________________________________________________________________________________________________OTHER COMMENTS YOU WOULD LIKE TO MAKE: ................
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