The Dog Owners’ Handbook – a great (free) resource from the Kennel Club

The Kennel Club has recently published (online) a Dog Owners’ Handbook. It’s free and you can download it as a 74-page pdf file, as well.

It contains lots of good advice for novice owners and there’s information that more experienced owners will also benefit from.

KC Dog Owner Guide 2019

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International Canine Health Awards 2019

The International Canine Health Awards returned for the seventh year to celebrate some of the world’s finest researchers and scientists whose work has had a positive impact on the health and wellbeing of dogs.

The 2019 awards were run by the Kennel Club Charitable Trust and included substantial cash prizes donated by Vernon and Shirley Hill of Metro Bank, to go towards new or continued research.

The awards ceremony took place on Thursday, 30th May in Windsor at the start of the 4th International Dog Health Workshop. Professor Steve Dean, Chairman of the Trustees, was master of ceremonies and offered apologies from Mr & Mrs Hill who were unable to be in Windsor, although they (and their dog Sir Duffield) sent a video message to all the attendees. Mr Hill said “We are proud to support these important awards again, to fund research that may transform canine and human health by encouraging the same visionary thinking and innovation that Metro Bank champions. At Metro Bank, ‘Dogs Rule’”.

The four categories for the International Canine Health Awards were:

  • International Prize in Canine Health for outstanding contribution in the field of canine health and welfare with a prize fund of £40,000 for future projects. The award was presented to Dr Danika Bannasch who is Professor of Population Health and Reproduction at the University of California, Davis.
    She has made significant contributions to our understanding of of the genetic basis of many genetic disorders. She has been responsible for the development of DNA tests for 7 canine diseases including hormonal defect hyperadrenocorticism and chondrodystrophy.
  • Lifetime Achievement Award with a £10,000 prize fund was won by Associate Professor Gary Johnson from the Department of Veterinary Pathology at the University of Missouri. The award citation said that Gary Johnson is proof that it isn’t necessary for a vet to wield a scalpel or dispense a medicine to make a difference to animal health. His work on canine genetic diseases is reckoned to have saved the lives of many more dogs than most practising vets will manage during their careers. His lab was one of the first to adopt whole genome sequencing and, from 153 whole genome sequences, has identified 83 heritable diseases.
  • Student Inspiration Awards were split into undergraduate and postgraduate, with a prize fund of £10,000 for the post-graduate and £5,000 for the undergraduate winner. The post-grad winner was Adrian Baez-Ortega from Cambridge University who has been working in the field of bioinformatics – the combination of biology and information technology. His recent work has been on the evolution of canine transmissible venereal tumours. The under-grad winner was Nivan Mamak from Edinburgh University. In 2018, her vacation project was an investigation of paroxysmal dyskinesia in a family of Golden Retrievers. These student prizes aid further education costs, the development of these young people’s careers, or support a further project.
  • Breed Health Coordinator Award – with a £1,000 prize fund, went to Liz Branscombe (Flat-coated Retriever BHC). Liz is a registered veterinary nurse and, as well as acting as BHC, is also one of the KC’s team of BHC Mentors who spends time helping other breeds with their breed health improvement work. As well as working with her breed, Liz says an important part of her role is to pass on information from the breed community to the vet profession, which she has done as an author of articles in the vet press and as a regular public speaker.

After the final award was presented, it was great to see one of last year’s students, Alice Denyer, return to talk about how her prize had helped with her studies and research over the past year. Proof indeed, of the impact these awards can have in the real world!

Steve Dean concluded the presentations with further congratulations to the winners and thanks to the awards judges and KC team who staged the event. He then invited the assembled International Dog Health Workshop attendees to stay for a buffet dinner and celebratory drinks.

Nearly 20 years of DNA testing – what can we learn?

Doctors Tom Lewis (KC) and Cathryn Mellersh (AHT) recently published an Open Access paper where they analysed trends in DNA testing for 8 autosomally recessive conditions in 8 breeds. A headline in the Vet Times said “Study reveals ‘fantastic work’ of DNA testing”. The sub-headline stated that “A study has revealed responsible breeders are reducing the number of pedigree dogs at risk of often painful and debilitating inherited diseases by around 90%”.

This paper is exactly the sort of great work we have come to expect from the KC’s Health Team and their partners at the Animal Health Trust. I believe it could be one of the most influential papers that might be published this year because of its potential to influence breed health policy and strategy, as well as the behaviour of breeders and buyers.

I don’t want to dwell on the detail of the research; you can read that for yourself, here: https://goo.gl/PiQmMF – I want to discuss how and why this paper might be important. The study covers the results of 8 DNA tests in 8 breeds for the period 2000 to 2017. 2 of the DNA tests applied to 2 breeds, resulting in 10 test+breed combinations. The key metric used to measure progress was the Mutation Frequency which is more useful than simply counting the number or calculating the proportions of Clear, Carrier and Affected dogs. It is calculated as [(2 x No. of Affected) + No. of Carriers]/(2 x No. of dogs with a known result).

Measures of progress

Previously, many reports on the progress of DNA testing have simply shown the proportion of Clear, Carrier and Affected dogs tested each year and that’s what we used to report in our Dachshund Annual Health Report. However, as tests become more established, the KC is able to deduce the status of untested dogs and assign their hereditary status. For many tests we are now able to identify Hereditary Clear, Hereditary Carrier and Hereditary Affected dogs based on test results from their parents. That still leaves a proportion of dogs in the KC database without known or deduced status and the researchers acknowledged this in their analysis but were able to calculate a “worst case” view of mutation frequency in each breed. Those of us reporting on DNA testing in our breed should be asking the KC Health Team for Hereditary results so we can give a more accurate picture of the impact being made. The difference can be quite significant, for example 50% of the test results for PRA-rcd4 in Gordon Setters were “Clear” in 2017 but, when hereditary status is taken into account, 95% of the breed was “Clear”. When you’re telling the story of what’s been achieved, that’s a big difference.

Another aspect of the paper is the data on trends in uptake and usage of DNA tests. For most breeds, unsurprisingly, the peak uptake of DNA tests was around the time it became commercially available and subsequently tailing off. The one exception to this was Exercise Induced Collapse in Labradors where use of the test has grown steadily since its launch. The peak around launch may reflect the fact that breed club communities are often actively involved in developing a test and are therefore keen to make use of it as soon as it becomes available. The challenge for all of us in breed clubs is how to educate and influence those outside our community to make use of these tests.

The paper also shows that there is an inverse relationship between the size of a breed and the take-up rate of tests. The slowest rate of increase occurred in the 2 numerically largest breeds, Labradors and Cockers. In smaller breeds, it’s more likely that breed clubs have influence over a higher proportion of breeders. The Labrador/Cocker effect may also be related to the split of working, show and pet breeders, making it more difficult to reach a more diverse group of owners. It may also be the case that, in breeds where multiple DNA tests exist, like Labradors (5 tests according to the KC) and Cockers (4 tests), it is more difficult to persuade breeders to make use of what might be seen as “yet another test”.

Another consideration related to uptake of a test is breeders’ perception of the need to use it. The severity of the condition, its age of onset and how widespread affected dogs are in the population are all factors that individual breeders will consider when prioritising whether or not to use a test. In some cases, breeders simply don’t want to know despite the seriousness of a condition and prefer to bury their heads in the sand. All of this gets me back on my change management hobby-horse; it’s important to communicate much more than just the launch or availability of a new test.

Wider implications?

In some cases, the launch of a new test could actually make things worse in a breed. The paper notes the evidence of selection – breeders intentionally avoiding producing affected puppies. In some breeds we have seen unhelpful selection strategies such as Affecteds or Carriers being removed from the breeding population completely, when they could quite safely be mated to Clear dogs. Another unhelpful approach is when people rush to use the small number of Clear stud dogs available and we may end up with the so-called Popular Sire Syndrome and all the adverse consequences that go with that. So, while DNA tests do indeed have the potential to prevent the breeding of more affected puppies, breeders must consider the bigger picture of genetic diversity. Reducing the gene pool makes it even more likely that hitherto unseen recessive mutations will “pop up” as undesirable health problems.

There are over 700 inherited disorders and traits in dogs, of which around 300 have a genetically simple mode of inheritance and around 150 available DNA tests. This tells us that we should not rely on DNA testing to solve the “problem” of diseases in pedigree dogs.

This new paper therefore gives the KC and breed clubs an opportunity to educate (or re-educate) owners and breeders on how DNA tests can be used within an overall breed health strategy. As well as celebrating the fantastic work done by so many committed breed enthusiasts, the messaging needs to be wider than “DNA testing improves dog health”.

I also wonder to what extent this paper might cause the KC to review its policies on the registration system, particularly given that there have long been calls for responsible breeders to be recognised for their commitment. It’s no good saying that’s what the ABS is for when so many good breeders have chosen not to join. Last year, Our Dogs wrote “A Manifesto for Change”, directed at the KC Board. Among other things, it said there was a need to address (or justify clearly) long-standing issues related to the registration system such as the ABS, DNA identification and the requirements for health testing. I hope the Lewis & Mellersh paper provides part of the evidence-base for those discussions.

Longevity study – how long will my dog live?

How long will my dog live?

It seems a long time ago, but in 2014 the KC ran its pedigree dogs breed health survey with an online survey that attracted just under 50,000 responses. Among these were 5663 reports of dogs that had died. Now, that set of mortality data has been analysed and published in an Open Access paper: “Longevity and mortality in Kennel Club registered dog breeds in the UK in 2014”. The co-authors are Tom Lewis, Bonnie Wiles, Aimee Llewellyn-Zaidi, Katy Evans and Dan O’Neill; names that will be familiar to many readers.

There are some interesting findings in the paper and I’d like to share a few of those, this month.

The most commonly reported causes of death were old age (13.8%), unspecified cancer (8.7%) and heart failure (4.9%); with 5.1% of deaths reported as unknown cause. Overall median age at death was 10.33 years. Breeds varied widely in median longevity overall from the West Highland Terrier (12.71 years) to the Dobermann Pinscher (7.67 years). There was also wide variation in the prevalence of some common causes of death among breeds, and in median longevity across the causes of death.

What do dogs die of?

All dogs are going to die of something (!) so it’s perhaps good news to find that owners reported “old age” as the most common cause of death. Interestingly, “old age” as reported by the owners ranged from just under 6 years old to just over 22 years old. The median age of death under the “old age”category was 13.7 years.

At the recent Breed Health Coordinator Symposium, Dr Mike Starkey told us that 1 in 4 dogs will be affected by cancer so it’s probably not surprising to see Cancer (of unspecified types) as the second highest cause of death. The median age of cancer deaths was just over 10 years, again suggesting it is as most people would expect, a condition of older age. The range for age of death due to cancers was very wide: 2 months to 21 years.

What do different breeds die of?

It’s well-known that canine longevity varies considerably depending on the size of the breed; giant breeds have shorter lifespans while smaller breeds tend to live longer. Of particular interest to me was a previous VetCompass study that showed Miniature Dachshunds to be among the longest-lived breeds. This breed was subsequently chosen to be a long-lived representative in a genome-wide association study that Cathryn Mellersh (AHT) and other colleagues conducted to compare the genomes of long and short-lived breeds.

The latest paper shows data for “Within Breed Proportional Mortality” (WBPM). This is a way to look at the relative differences between the various causes of death for each breed where there were sufficient reports. (Unfortunately, from my personal point of view there were too few Dachshund reports to be included in this analysis).

This is where the paper gets really interesting. The data shows, for example that the WBPM for “old age” ranged from 3.85% in Bernese Mountain Dogs to 25.0% in Bearded Collies. In other words, significantly fewer BMDs die of old age than Bearded Collies. The WBPM for ‘cancer – unspecified’ ranged from 0.00% in Gordon Setters to 19.56% in Flat Coated Retrievers. The WBPM for ‘heart failure’ ranged from 0.00% in Whippets to 19.82% in Cavalier King Charles Spaniels. Again, these reflect what most people know about cancer risk in FCRs and heart disease in Cavaliers. The analysis also shows that Border Terriers had the highest WBPM for dying as a result of road traffic accidents.

This WBPM data enabled the authors to identify how individual breeds’ causes of death compared with the Overall Proportional Mortality (OPM) based on reports for all the dogs in the survey. Boxers and FCRs were the 2 breeds less likely to die of old age compared with the OPM. Cavaliers were less likely to die of cancers, compared with the OPM, but, as you would expect, were more likely to die of heart conditions. If your breed is among the 25 analysed in this way, it’s well worth looking at the data to see how it compares with your own experience.

Healthspan vs. Lifespan

Healthspan is an interesting concept that has become quite topical. A dog’s healthspan is the length of time it is healthy, not just alive. The paper says “Although death may be postponed by improved healthcare, extended longevity by itself does not necessarily imply an improved or even a good quality of life, so a delicate balancing act exists between longevity and acceptable quality of life.” This leads to challenging ethical debates about whether a shorter but healthy lifespan with a short, rapid decline to death, might be preferable to a longer life with long periods of illness and a slow decline to death. There is, inevitably, a difficult decision to be made by owners, with vets, about treatment options to prolong life, quality of life and when might be the right time to consider euthanasia.

The concept of healthspan means that longevity almost certainly means different things in different breeds. A giant breed would, typically, be expected to die younger than a toy breed but as long as the dog was healthy during that lifespan, most people would not consider there to be welfare issues. Conversely, long-lived breeds should not necessarily be considered as being “healthier”, particularly if much of their lifespan is subject to a debilitating illness.

4 categories of breed

The authors merged the results of longevity by breed with Within Breed Proportional Mortality (WBPM) and came up with 4 categories of breed:

  1. Long-lived with no specific cause of death at a raised proportional mortality (e.g. WHW Terrier, Bearded Collie, Gordon Setter)
  2. Long-lived with at least one cause of death at a raised proportional mortality (e.g. Labrador, Golden Retriever, Border Collie)
  3. Short-lived with no specific cause of death at a raised proportional mortality (e.g. GSD, Whippet)
  4. Short-lived with at least one cause of death at a raised proportional mortality (e.g. Flat Coated Retriever, Dobermann)Category 4 breeds are short-lived with serious, breed-specific, life-limiting conditions. Categories 1 and 3 are breeds where there is a wide variation in longevity associated with factors that apply across all dogs (such as size) and there is no obvious disease that accounts for death.

The paper concludes: “This study has identified individual breeds that have both a low median lifespan and also a high proportional mortality for one or more specific causes of death. Breeds with this combination are highlighted with potential welfare concerns that may need to be addressed.”

If your breed is one of the 25 breeds with causes of death with more than 50 reports, the paper is well worth reading and reflecting on what actions your breed clubs might need to be taking.


Please also read the comments by Dr Brenda Bonnett on this paper.

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How to create a culture of openness, trust and collaboration for breed health improvement

The annual KC Breed Health Coordinators’ Symposium held at Stoneleigh on 19th September was attended by about 130 people. For the second year, it was open to people who are not BHCs, so it was good to see some “friends of BHCs”, other health team reps and folks with a genuine interest in breed health improvement, taking the opportunity to attend.

Last year, the KC’s health team launched a BHC Mentoring Scheme and six of us volunteered to act as mentors. The Mentors were allocated a 30-minute slot at the end of the morning session for a Q&A with the attendees. We took some pre-prepared questions in case the audience was too shy to ask anything but we should have known that BHCs are generally a talkative and inquisitive group. So, despite us being the only barrier between them and their lunch, we fielded plenty of good questions and still managed to finish on time.

Interestingly, and perhaps unsurprisingly, the majority of questions were about “people issues”, rather than technical topics such as running surveys or developing screening programmes. We were asked questions about dealing with confidentiality, how to use anecdotal evidence of problems and how to get people to participate.

Offline, I was asked if I could say something about how to create a culture of openness, trust and collaboration. It’s a question I’ve been asked previously when I have spoken at workshops about the work we have done in the Dachshund breed. Unfortunately, we ran out of time in the Q&A but it gives me a good topic for this month’s column!

Avoid fanfares and pronouncements!

First of all, you don’t start off by saying either that you want to, or you are going to, create a culture of openness, trust and collaboration. That might seem counterintuitive but it’s deeds, not words, that count. You have to do things that are consistent with and that help to build the culture you want.

As an example, the first breed health survey we did was very informal, asked a few questions about known issues and didn’t ask for the dog’s or the owner’s names. It gave us valuable baseline data but, more importantly, it clearly signalled that we valued people’s input and there would be no witch-hunt. Our follow-on survey collected 500 responses, mostly from the show community and most of whom happily gave their name and their dog’s name. We built openness and trust by publishing our analysis quickly without breaching any confidentiality.

It’s also important to realise that having a team-based approach to health improvement is far more likely to succeed than having one or two people dictating what needs to be done and presenting fait accompli solutions to breed clubs and their members. If you want widespread collaboration, those people leading your health initiatives have to work collaboratively. Again, it’s leading by example. Our Health Committee members share responsibilities for work and we willingly allow individual breed clubs to take the lead on issues that are important to them. So, the Miniature Dachshund Club takes the lead on eye conditions, opening up a wider pool of potential helpers and routes to engage owners in screening programmes. Similarly, the Wirehaired Dachshund Club takes the lead on Lafora Screening. In 2010, this was led by their Chairman and a committee who felt passionate about doing the right thing for the dogs. 9 years later, there is new leadership at the club but constancy of purpose has meant that “unsafe” breeding has been reduced from 55% of litters to around 5%.

It’s always about the purpose

I recently attended the retirement celebration for the Director of a Charity I’ve worked with for many years. Her chair of trustees introduced her as “the amazing Tina”, which she is, because of what she has enabled the organisation to achieve under her leadership. Significantly and spontaneously, her first words to us in the audience were: “It’s never about the person, it’s always about the purpose”.

That’s exactly what I’d expect every one of our Health Committee to say and so would our many other volunteers and helpers. None of them do it for personal glory or advancement. Their behaviour also sets the tone for other people to get involved and work collaboratively. We have dozens of fundraisers who believe in the purpose.

As an aside, Martin Luther King managed to get a quarter of a million people to turn up in Washington to hear him speak in 1963. He didn’t have the benefit of social media to promote the event. In his speech, he said “I have a dream” and had been using that phrase previously. People turned up to hear about his dream. He didn’t say “I have a plan” and he certainly didn’t say “this is how I’m going to implement it”. How many people would have gone to hear that?

Rewards and punishments don’t work

In pretty much all of our health improvement work, we have ignored the people who don’t want to participate. We haven’t used threats to force them to get on board or unleashed witch-hunts to make them look bad. We have put more effort into making it easy for those who want to participate to do so. That has included using our health fund to subsidise screening programmes and even to offer free “research” screening sessions where we need to gather data about new or emerging conditions.

We don’t really use rewards either. People get certificates with screening results but, more importantly, they get the satisfaction that they have done the right thing for their breed. We make sure our regular communications shout about these good news stories to encourage others to participate.

Regular communication using a wide variety of channels is critical. Social media is an essential tool – the clue is in the title: it’s “social” and a great way to engage, educate and collaborate with breeders, potential owners and current owners. It’s timely, too. Use it to communicate why you are doing things, what you’re doing, what’s been achieved and how people can help. Our Pet Advisors spend huge amounts of time sharing data and evidence in Facebook Groups to counter the anecdotal nonsense that can get published.

How long will it take?

That depends! If you’re doing the right things, consistently, and your deeds match your words, I am convinced you can begin to make a difference within 18 months. That depends on having a team of like-minded leaders. One or two people can’t railroad change through on their own.

You won’t get it all right the first time. Try hard, fail fast. You’ll make mistakes and annoy some people. Sometimes you’ll get a completely unexpected negative reaction. Apologise and move on. There is no place for politics and grudges in breed health improvement. Work with the people who want to be worked with.

Author Libba Ray said “And that is how change happens. One gesture. One person. One moment at a time”.

How to get the best out of your Breed Health and Conservation Plan

Plans are nothing, planning is everything” – Gen. Dwight D Eisenhower

I expect most readers will be aware of the Kennel Club’s programme to develop Breed Health and Conservation Plans. This was launched in 2016 to ensure that, for every breed, all health concerns are identified through evidence-based criteria, and that breeders are provided with useful information and resources to support them in making balanced breeding decisions that make health a priority.

The first group of breeds included those in Breed Watch Category 3 (previously known as “high-profile breeds”, plus GSDs, Cavaliers and English Setters). We’ve heard relatively little about their BHCPs from the clubs and councils associated with them, so it’s difficult to know if and how they are working.

My breed, Dachshunds, is included in the second batch of breeds and I thought it might be useful to share our experience of the process and how we intend to make use of our BHCP.

Stage 1: Evidence gathering

Dr Katy Evans is the KC’s lead person on this project and her first task for each breed is to identify and review the published evidence of the state of the breed. The key inputs to this are:

  • The KC’s own health surveys (2004 & 2014)
  • Insurance data from Agria in the UK and Sweden
  • Genetic diversity data from the KC’s 2015 study led by Dr Tom Lewis
  • KC registration data
  • BVA screening programme data (e.g. eyes, hips, elbows), where such programmes exist
  • DNA test results, where tests exist
  • Reports from the RVC’s VetCompass project
  • Eye test data from OFA in the USA
  • Any data from health surveys carried out by the breed, itself
  • Peer-reviewed scientific papers
  • Results of any current research programmes initiated by the breed

This is a massive exercise to search for, collate and distil the evidence into a first draft paper for the breed to consider. Breed clubs owe a great debt of gratitude to Katy and her colleagues because, for the first time, we have all the available evidence relating to our breed in one place.

It is a “single source of the truth” for each breed. That doesn’t mean, however, that the summary report will give your breed the definitive prevalence for any particular health condition. You need to see the evidence base as the big picture which helps you to triangulate in on points of concern.

Stage 2: Prioritise

Findings from stage 1 are used collaboratively to provide clear indications of the most significant health conditions in each breed, in terms of prevalence and impact. This is the point where breed clubs and councils need to engage with the BHCP process. From a breed’s perspective, their Breed Health Coordinator (BHC) is the key point of contact between the breed and the KC. Every breed has to appoint a BHC and, often, there will also be a Health Committee. Both the BHC role and Health Committee are appointed to serve your breed and, in the case of Dachshunds, ours are accountable to our Breed Council. They act on our behalf, are accountable to the Council and are expected to put the interest of the dogs as their first priority (not politics).

We were invited to meet the KC team in July and 6 of our 10 Health Committee members were able to attend. This might sound, to some, like a lot of people to attend this meeting but I firmly believe that the breadth of experience among our delegates was invaluable for 2 reasons. Firstly, the discussions we had and the decisions we made were based on a wide range of knowledge across our 6 Dachshund varieties. No one person can know everything about the breed nor remember the history of how we got to where we are today. Secondly, the decisions made have to be a consensus because we, the Health Committee, have to justify the BHCP to everyone else in the breed. The quality of decision-making by our team far outweighs anything that any one of us could achieve, on our own.

Stage 3: Action planning

The process we followed at the meeting enabled us to arrive at a consensus and to agree priorities for action. Katy Evans led the discussions and took us through all the content she had collated. Although this might sound like a rather linear and dry approach, the discussions it generated were not “down in the weeds”. We had all had copies of the evidence to review prior to the meeting which meant we were able to make connections between the different areas as we worked through them in the meeting.

So, for example, a single paper on Colour Dilution Alopecia (CDA) led to a wide-ranging discussion covering Colour Not Recognised registrations (CDA occurs in Blue Dachshunds), the massive increase in popularity of Mini Smooth Dachshunds and the need for better data on skin conditions, in general. There were no surprises for us here but we have agreed actions on data collection in our forthcoming breed survey, actions for the KC to look at our list of registration colours, and actions for all of us to educate the Dachshund-buying public on the breed to try to shift demand away from Mini Smooths towards other varieties.

I think the fact that, as a breed, we have been very proactive in gathering data and working on improvements gave us a head start when developing actions for our BHCP. Nevertheless, we have been able to identify further work that will accelerate the rate of progress in current focus areas as well as initiate new actions in other areas. Some of those actions include:

  • Adding a recommendation to the ABS for IVDD Screening
  • Refining the content of our forthcoming Cancer and Health Survey to capture data on conditions identified in the BHCP
  • Adding Distichiasis as a point of concern under BreedWatch
  • Publishing guidance for judges, breeders and exhibitors on exaggerated conformation (length of body & ground clearance)

All of these will need to be publicised through appropriate channels to reach breeders, owners and judges.

Tips for other breeds

If your breed has not yet been through the BHCP process, I’d recommend the following, based on our learning:

  • Take a team of experienced breeders/owners to the planning meeting; they don’t need to be on your Health Committee but they do need to be advocates for improving your breed
  • Do your homework prior to the meeting by reading and reflecting on the evidence base presented by the KC; go with an open mind
  • Keep the big picture in mind; obsessing about single health conditions and DNA testing is not a recipe for long-term improvement when a lack of genetic diversity is probably the major challenge facing most pedigree dog breeds
  • Have a plan for communicating your actions; the BHCP document itself may not be the best format for sharing information widely to different audiences

I’ll end with a quote from Peter Drucker (Management Guru) – “Eventually, plans must degenerate into hard work”.