The Complete Physical Exam
This is from an excellent article first appearing on VetStreet.com. To read the original, click here.
Despite advancements in veterinary medicine, routine physical exams remain a mainstay because they allow veterinarians to establish baselines, catch any changes and monitor treatment effectiveness.
“People sometimes assume we’re not doing very much,” says Dr. Patty Khuly. “Actually, we’re doing quite a bit.”
What Are They Looking For?
Your veterinarian checks your animal system-by-system, moving geographically across his body. Here’s how:
“Entering the room, your pet shouldn’t be bumping into walls or stumbling. He should not be hanging his head low. He should have a happy and curious or normal-nervous posture — tail either straight out or down, head up, looking around,” says Dr. Rebecca Ruch-Gallie, from the veterinary teaching hospital at Colorado State University.
Your pet's body should be equally divided, with symmetry of structure in his face, eyes, nostrils, muscle mass, etc. This check usually includes a body condition score, which assesses your pet’s weight (underweight, normal weight, overweight, or obese).
Eyes, ears, mouth.
Your veterinarian thoroughly checks your pet's eyes for problems such as cataracts, corneal abrasions and infections. She checks his ears for debris, inflammation or odor, which can indicate infection or parasites. Inside the mouth, your vet looks for injuries as well as dental disease (tartar, gum redness, missing or broken teeth), oral masses, mucous membrane color (mouth tissue should generally be a healthy pink) and capillary refill time — a rough assessment of your pet's blood circulation.
Many lymph nodes site just under your pet's skin. Swelling of lymph nodes can indicate disease. Most lymph nodes should not be noticeable, especially those near the face and the knees. “We don’t expect to feel those. When we do, we begin thinking things like sepsis (widespread infection) or more likely, lymphoma (a form of cancer),” says Dr. Khuly.
Lungs and heart.
Your vet wants to hear smooth sounds of air moving in and out of your animal's lungs. “If we hear dead spaces (no noise), that’s a concern,” says Dr. Ruch-Gallie. “If we hear moisture — crackles or wheezes — that’s also a concern.”
It takes from 30 seconds to a few minutes to really listen to your pet’s heart for rate and rhythm. “If I listen longer than 20 to 30 seconds, people start to get really nervous, assuming there’s something wrong. So, I often talk to them between the right and left sides, so they don’t notice how long I’m spending,” Dr. Khuly says. In particular, your veterinarian is listening for a normal heart rate and rhythm, as well as murmurs that can change the normal lub-dub sound into something like lub-ssshh-dub.
Abdomen and internal organs.
Checking your pet’s internal organs by feeling (or palpating) the abdomen is both a skill and an art. “It’s really something where you have to lay your hands on a lot of dogs and cats before you get comfortable with what normal feels like and what’s abnormal,” says Dr. Ruch-Gallie.
Essentially, your veterinarian checks the liver’s size, location, and edges to make sure they are not swollen or rounded. She may do the same with the spleen. She also checks the large and small intestines for excess gas, fluid or masses.
On most cats and many small dogs, your veterinarian also checks the kidneys for size, shape and location. In bigger dogs, the kidneys are tucked up high, almost under the ribs, so they are harder to reach.
Bottom and private parts. Inside your animal's rectum, using a gloved, lubricated finger, your veterinarian checks a joint between the pelvis and the hips for pain, along with the lymph nodes and anal sacs. On a male pet, she checks the prostate. Your vet also looks for any discharge or swelling in your pet’s genital area.
Skin and hair coat.
Overall, the skin and hair coat reflect nutrition, parasite status and overall health. “We usually start with the skin around the eyes, ears and lips,” Dr. Khuly says. “We look at all those junctions between the haired skin and mucous membranes. Those are big areas where things can go wrong.”
If your pet has flea problems, the skin might be inflamed in the rump region, above the tail, where your vet looks for the classic triangular appearance of allergic irritation.
Dr. Ruch-Gallie likes to give a patient a good scratch all over his head and body. It calms your pet and gives Dr. Ruch-Gallie a chance to feel for skin growths and watch for any spots of particular itchiness, which might mark problems. Staining between pads on the feet often comes from licking, which can indicate allergies or irritation.
With major joints, the spine, and the tail, your veterinarian watches for any signs of pain upon being touched. “Sometimes pets are not comfortable with us handling them in a particular spot,” says Dr. Ruch-Gallie. “If I notice that consistently, I mark it in my chart so I know it’s not necessarily a pain response, but rather, a normal behavior for this particular animal.”
How Often Are Exams Needed?
Pets age at various rates depending on species and breed. The old idea of every human year equaling seven for pets isn’t quite true because a stable period gets sandwiched between a quick growth spurt in youth and a faster aging later in life. To help identify any potentially life-threatening medical conditions as early as possible, your veterinarian will usually recommend your pet visit her at least once a year for a routine wellness exam, and more often as he enters his senior years.
Your pet's health conditions dictate exam frequency, as well. A checkup might be needed every week or two following a new diagnosis, then less frequently depending on the condition being monitored.