C09996375 / invoice 10000

HISTORYCharlie presented with a rash on his groin (present for about 2mth) and lameness in front right and back left legs following rough play with his sister for 1-2weeks. The lameness has improved over the last few days. He is going through a fussy eating stage where he prefers treats over his kibble and no longer eats vegetables. He has one retained testicle. O gave dog one of their other dog's Apoquel tablets - no change.Appetite: Reduced - currently in fussy stage, prefers treats over kibble, stopped eating vegetablesDUD NAD.Vomiting: None reportedSneezing or coughing: None reportedMobility and exercise tolerance: Recent lameness in front right and back left legs following rough play, now improvingOBJECTIVE EXAMINATIONDemeanour/Mentation: BARBCS: 4/9Hydration: MM pink & moist, CRT <2secDental: Grade 0/4 periodontal diseaseOral exam: NADEyes: Clean and NAD. Full ophthalmologic exam not performedEars: Clean externally, NADCardiac auscultation: rhythm normal. No murmur detectedThoracic auscultation:  regular, NAD on chest auscultation, normal effortAbdominal palpation: NAD and comfortableIntegument: Erythematous papules on ventral abdomen lateral to prepuce and on prepuce.Musculoskeletal: Moderate resistance on extension of left hip, no resistance to palpation of forelimbs or RH. Possible mild thickening of R stifle.Peripheral lnn: WNLNeurological: BAR, a full neurological exam not performedRectal: not performedLABORATORY:- Sticky tape impression cytology: neutrophils+++, clusters of cocci++ASSESSMENT/DDX:- Bacterial dermatitis on ventral abdomen - possibly due to underlying skin allergy - atopy, food allergy or contact allergy- Possible hip discomfort DDx soft tissue injury, hip dysplasia- Cryptorchidism (one retained testicle)TREATMENT:- Cephalexin 1000mg PO BID for 2wks- Pyohex Medicated antibacterial shampoo - daily for one week, then 2-3 times weekly for next couple of weeks, wet area, lather, leave for 10 minutes then rinsePLAN:Hip radiographs to be considered at time of desexing if lameness persists - with CC for Pennhip scoring due to ageDesexing recommended at 12+ months of age to include removal of retained testicle and consideration of gastropexy (recommended)Monitor response to antibiotic treatment for skin infectionConsider Cytopoint injection if pruritus persists after infection clearsDiet trial with hypoallergenic (RC Anallergenic) diet may be considered at 12 months of age if skin issues recurRecheck as needed based on response to treatment

BAR - lovely temperament pupears/eyes/teeth NADgood growthHR 100=PR, chest clearabdo palp NADLNs wnlstill only one teste descended - recommended desexing at 12 months rather than later to avoid sertoli/testicular cancergiven final puppy C4o has worming/preventatitves at home

- 10.7kg (up from 9.4kg at last visit)- Chewing on rocks - counselled on risks of obstruction and dental damage - switch to appropriate chew toys- Plays with other dog (Ava) - Excellent temperamentPast Medical History:- Cryptorchid - only one testicle descended- No inguinal or canal testicle palpable- Will need earlier neutering if second testicle doesn't descend by final puppy vaccinationPhysical Examination:- Good general condition- One testicle palpable, second non palpable- No other abnormalities notedImpression:- Healthy German Shepherd puppy- Cryptorchid (unilateral)Management Plan:- Second puppy vaccination given today (10-12 weeks) C4 and oral BB- Final puppy vaccination in 4 weeks (14-16 weeks)- Advised can walk in safer areas (concrete/asphalt in full sun)- Avoid wet areas near water courses- Continue socialisation - backyard play with mother-in-law's 6-month-old poodle appropriate- Consider puppy socialisation classes at clinic when available- Monitor for descent of second testicle- Consider earlier neutering if testicle remains undescended---Patient Summary- Cryptorchidism: One Undescended TesticleUnilateral cryptorchid with one testicle still in abdomen- Will need monitoring and likely earlier neutering if testicle doesn't descend by final vaccination- Puppy Vaccination ScheduleSecond puppy vaccination given today at 10 weeks- Final vaccination in 4 weeks (14-16 weeks of age)- Full immunity develops 2 days after final vaccination- SocialisationGood temperament noted- Safe socialisation with family poodle recommended- Consider clinic puppy classes when available- Behavioural ConcernsChewing rocks noted- Divert to appropriate chew toys to prevent dental damage and obstruction riskKey Takeaways- Continue monitoring for descent of second testicle- Can begin limited walks in safe areas (concrete/asphalt in full sun)Next Steps- Return in 4 weeks for final puppy vaccination (14-16 weeks of age)- Consider puppy socialisation classes at clinic when available