Sometimes when watching a vet do an exam it looks like they are just petting the animal and poking around a little bit. Ever wonder what they are really doing? We interviewed veterinarian, Dr. Carolynne Cash, to find out just what she’s looking for when conducting a wellness exam. As it turns out, those vets are doing quite a lot!
Where do you start?
I use a systemic approach called a “head to toe” approach. Taking a good history about the patient is essential for a through annual wellness exam. Sometimes the pet’s temperament makes the exam difficult. If they are too aggressive or scared I cannot tell if there is pain or manipulate the legs because they are very tense. If the pet is too friendly or playful it is hard to listen to heart and lungs. In these cases the history provided by the owner or a previous vet helps immensely.
What kind of history is helpful?
History includes information about any known illnesses or trauma as well as any chronic issues like coughing, and any known vaccine reactions. Information about the pet’s environment is helpful. Are they an indoor pet? Are they outdoor only? Who are their housemates? Do they have any behavior issues? I also like to know about their diet and any issues with eating, drinking, urinating, or defecating. Do they have any ‘bumps’ or ‘lumps’ that the owner has noticed? Plus anything else the owner is concerned about.
What areas do you focus on during an exam?
I start with nose and face; looking for symmetry (or lack there of). Then I check the mouth. There I’m looking at color of tongue and gums. I gently press on the gums to check capillary refill time. If blanching and then red again takes under 2 seconds they are normal. I look for any masses or ulcers in oral cavity and assess the general condition of teeth, gums, and breath odor. I check their swallowing reflex and watch closely for signs of any pain when mouth is touched or opened.
Next I move on to their ears. I check from the outer canals to the eardrum for any discharge and I look for swelling of ear drum. When looking at their eyes I’m checking for the symmetry of the pupils which should be the same size. I also check that they have the same pupillary light reflex (PLR) that we do where the pupils constrict in the light. You can check this on your pet yourself but don’t stress them out. An abnormal PLR indicates a problem with the eyes or the brain. I also look for any cloudiness in lens, or cornea, any matting or build up of the tear layer, redness in the “whites” of the eye, called the sclera. I look for normal appearance of vessels in the sclera: tiny vessels indicate anemia, a yellow color indicates a liver issue. I check out the color and condition of the conjunctiva which is the tissue between the eyelid and eyeball. Hmm, that takes much longer to explain than to do.
Where do you look after checking the head?
I move to under the jaw or neck area and move down to the armpit area or axilla. I check the muscle tone as well as the size of the animal’s lymph nodes. I’m looking for any lumps or bumps and testing if there is any pain with gentle manipulation. When I get to the chest I listen to the heartbeat. Normal heart rate for a dog is 60-120 beats per minute. For a cat it’s 90-150. I also listen to the rhythm of the heart and the air movement in all four lung quadrants. When listening to the lungs the air movement should be even without crackles or dullness. This is usually tricky with dogs who are panting. Sometimes I have my assistant gently hold their muzzle shut and blow a little puff of air on the dogs nose while I listen with the stethoscope. We do this for a purring cat, too. I gently compress the chest to check for pain while observing their respiratory rate and depth.
What else needs to be examined?
I gently palpate the abdomen to check for any masses, pain, enlarged organs, or fluid build up. I also check the mammary tissue. Then I check the backline for symmetry. I check for pain by applying increasing pressure down the long muscles of the back but not directly on the spine. I check all the joints in the legs, shoulders, and hips for good range of motion. That’s how easily they flex and extend. While manipulating the legs and joints I watch for any signs of pain. While pet is walking or moving I check for limping symmetry of movement.
After that I take an overall look at the skin, hair and nails. I look for hair loss, lesions, lumps, and any changes in color or thickness of skin. I make sure to check for external parasites. The coat should be even with a slight shine. Lastly I check the genital area and anal glands. I look for abnormal discharge, color, masses, or sores. And that’s the end – no pun intended!
Is there anything else you would like us to know about annual exams?
Basically I am looking for problems. When the vet says “that’s interesting” it is not the best news. So when your pet gets the all clear he is really passing a lot of tests. For the pet & owner a “non-interesting” physical exam report is great. An annual physical is probably the most important part of the yearly visit for your pet so issues can be addressed early. For example finding and treating a mild ear infection before it turns into a major problem or catching and addressing a heart murmur so you will be aware of what signs need to be treated. Especially with the heart, early treatment can both improve your pets quality and length of life.