The Meowing Vet is gonna let pet owners in on a little secret… Wanna know the most important part of your dog or cat’s trip to the vet? Curious about your veterinarian’s most vital and reliable tool? It’s a thorough physical exam! Discover why your vet requires a physical exam prior to certain procedures and how much knowledge about your pet’s health can be gained through a proper physical examination. Read more…
Why is a veterinary physical exam so important?
Your seemingly healthy dog or cat‘s annual vaccines are nearly due, yet your veterinarian specifies that your pet must have a physical exam prior to being vaccinated. Annoying, right? You may be just as frustrated when your vet declines to refill a prescription that improved your pet’s skin last year. Before prescribing the medication, your vet requires that your pet have a physical exam although your pet was just at the clinic less than a year ago! What a waste of time and money, right? Wrong!
A physical examination (PE) is an invaluable resource that provides veterinarians insight into the health of their patients, who cannot speak and explain what may be troubling them. You may be unfamiliar with what knowledge is gained through a physical exam because your own physician may not always perform one. That’s because you can tell your own doctor where you hurt, but our dogs and cats cannot verbalize where their pain lies. Much like pediatricians, veterinarians oftentimes rely on silent clues to unveil what’s ailing their patients. In the wild, your dog and cat’s ancestors would hide signs of illness or injury, which can be construed as signs of weakness by predators and other members of the pack. Modern-day pets can also mask their discomfort when sick or injured. Therefore, a regular check-up with your veterinarian can grant him or her the opportunity to “play detective” via a physical exam and reveal your pet’s true health status.
For instance, you assume that your cat is overall doing well at home (perhaps eating a bit less this past week and sleeping slightly more) and should therefore be healthy enough to receive her vaccines without the cost of a physical exam. However, your vet declines to administer the vaccines without an exam first, so you comply… and fortunately too! Your vet discovers that your cat has a high fever due to an unruptured skin abscess. Your cat’s abscess is treated, and your vet recommends that you return next week for the vaccinations. Why? Vaccinating a sick animal can not only decrease the potency of the vaccine’s protection but can also seriously worsen your pet’s health if already in a sickly state. A timely physical exam just prevented you from wasting money on vaccines that may not work at that given time, and most importantly, your pet’s health was improved.
Routine exams can also help your vet discover an emerging problem as early as possible, allowing further diagnostic tests or treatment to be initiated ASAP before a bigger problem devolves. For example, a routine physical exam revealed that your dog has enlarged lymph nodes that you had not noticed. Your vet recommends that the lymph nodes be tested, and your worst fears are realized when the diagnosis comes back as cancer. However, with prompt chemotherapeutic treatment, your dog’s life is preserved. Physical exams save lives, people!!! So before your vet moves onto bloodwork, a urinalysis, or X-rays, a physical exam is at the top of the diagnostic toolkit.
What information is my veterinarian silently gathering during my pet’s physical exam?
You may wonder what your vet is doing when he or she is feeling of your dog or cat and listening to your pet’s chest, usually all while making small talk. Though it may not seem like your vet is doing much, he or she is quickly gathering information about your pet’s entire body. Your vet isn’t merely petting your dog or cat; your vet is palpating: systematically feeling of all your pet’s vital structures and organs to check for irregularities. Proper restraint of your pet by a veterinary staff member is imperative, since remaining still and in the right position will aid your vet in performing a more thorough and accurate exam. So please don’t be offended if your vet suggests that a veterinary assistant rather than you (the pet owner) restrain your animal. (It’s also a safety measure as well.)
Through their physical exams, veterinarians are like human computers, quietly and quickly gathering a plethora of medical information about your pets. Look how much knowledge can be gained from a veterinary physical exam! ⬇
- Mentation and behavior: Your dog or cat’s mental state and general demeanor will be the first thing your vet notices upon greeting you and your pet in the exam room. Is your pet aggressive or anxious? Depressed or non-responsive? Your pet’s body language provides so much insight into his or her overall health and can quickly alert your vet to an emergency if present.
- Gait and movement: Based on how your pet is moving, your veterinarian can be clued in to specific injuries and illnesses. For example, if your dog is hesitant to move due to pain, Lyme disease may be the culprit. Is your Chihuahua puppy holding her head down? She may have atlantoaxial instability of the cervical spine (neck). Does your dog have super straight back leg conformation? He may be predisposed to patellar luxation (“floating kneecaps”). Is your cat scratching? Fleas, mites, or a food allergy may be to blame. Is your pet bumping into things in the exam room? Visual deficits may be present. Based on your vet’s findings, he or she may wish to follow up your pet’s physical exam with more specialized examinations, such as an orthopedic, neurologic,or ophthalmic exam (read more below).
- Body condition: Your pet’s general appearance can also inform your vet to that animal’s overall well-being. For instance, is your pet’s fur shiny and healthy-looking or full of hair mats? Has your pet stopped grooming, which can be a sign of illness? Moreover, is your pet a healthy weight? In addition to your dog or cat’s actual weight measured on a scale, your vet will palpate your pet to assess fat coverage and muscle mass to determine your pet’s body condition score (BCS). Obesity as well as being underweight each present its own set of health problems.
Body temperature: The top three vital signs your vet monitors are TPR: temperature, pulse, and respiratory rate. So it’s no surprise that a temperature reading with either an aural (ear) or rectal thermometer is required for a complete physical exam. Our doggies and kitties run slightly warmer than we do. The normal body temperature for a dog or cat ranges from roughly 100.5°F-102.5°F (38.5°C-39.2°C). An abnormally high body temperature (hyperthermia) can be a sign of fever or post-seizure activity. Low body temperature (or hypothermia) can lead to dangerously low heart rate as well as the cessation of other body organ functions.
- The Face: eyes, ears, nose, and mouth: We vets are doing a lot more than merely staring lovingly into your dog or cat’s adoring face. Alright, ya got me. We definitely do a lot of internal squealing at the cuteness of our patients, yet we do so much more during a physical exam: We observe the face for symmetry (no facial drooping, which can be a sign of a neurologic problem), ear movement, eye health (no redness or signs of discomfort or vision loss, symmetrical pupil size, etc.). An otic exam (or ear exam) is typically performed during a regular physical exam as well, allowing your vet to observe your pet’s ears for malodor and other signs of infection (like redness and discharge), parasites (such as ear mites), and aural tumors. A cursory ophthalmic exam (eye exam) is also performed, though a more specific eye examination (learn more below) may be required in some cases. Moreover, the nose is also examined for signs of bleeding (epistaxis), normal air flow, nasal discharge, and mucocutaneous health (i.e. free of autoimmune skin diseases such as canine discoid lupus erythematosus).
Next, your veterinarian adorns one of his or her many hats as a vet by acting as a dentist to observe your pet’s mouth and teeth. Not only does your vet check for signs of dental disease, but oral and pharyngeal tumors, foreign bodies that can lodge around the base of the tongue (quite common in kitties), as well as function of the larynx can also be detected through this portion of the physical exam. While examining the oral cavity, veterinarians also make note of the color of the gums (i.e. mucous membrane color), which should be a healthy pink color. Red gums can be a sign of sepsis or shock; pale white gums are a sign of anemia (dangerously low red blood cell count); yellow gums (icterus or jaundice) occur due to high bilirubin levels in the blood secondary to liver and gallbladder disease or the destruction of red blood cells (hemolysis); blue gums are a sign of poor oxygen levels in the bloodstream (cyanosis); and mottled or bruised gums (i.e. petechia or ecchymosis, respectively) can be a sign of a bleeding disorder. Your vet will also apply pressure to your pet’s gum, temporarily blanching it of color, and then count how many seconds the color takes to come back. This test is the capillary refill time (CRT) and should normally be less than 2 seconds. Prolonged CRT can indicate poor circulation or dehydration. Feeling the gums is also helpful to assess your pet’s hydration status, as dry (or tacky) gums can be a sign of dehydration.
- Thyroid gland: The thyroid gland, which controls metabolism is located in your pet’s neck region near the throat. In many felines with hyperthyroidism, the thyroid gland becomes enlarged and can be felt as a “thyroid slip” when your veterinarian expertly palpates your cat’s neck region.
- Heart and lungs: Even before ausculting our patients (i.e. listening to your pet’s heart and lungs with a stethoscope), we observe your pet’s breathing at a distance. While panting may be normal for some anxious or excited dogs, panting (i.e. open-mouth breathing) is a sign of an emergency in cats (often caused by heart failure or asthma) and requires prompt therapy. Before using our stethoscope, we watch and listen to other signs of how your pet is breathing. Loud high-pitched noises (i.e. stridor)? That can be a sign of a collapsing trachea or laryngeal paralysis. Snoring-like sounds (a.k.a. stertor)? Maybe that’s just the expected noise that a brachycephalic (or flat-faced) dog such as an English or French bulldog may make. Is your pet holding his or her neck down with the elbows held outward when breathing? This can be a sign of difficulty breathing (dyspnea). Dyspnea can be caused by fluid-build up in and around the lungs due to congestive heart failure or cancer, pneumonia, lung collapse or lung lobe torsion, bleeding in the chest cavity, pulmonary tumors, or an inhaled foreign body.
After observing your dog or cat breathing, your vet will count the respiratory rate (number of breaths per minute) and listen to each quadrant of the chest to listen to lung sounds (harsh sounds can be a sign of inflammation while being unable to hear lung sounds can mean that there is fluid build-up around the lungs, i.e. pleural effusion). You may also notice your veterinarian listening to your pet’s trachea (or windpipe). Yep; there can be respiratory problems there too, such as canine kennel cough. Your vet may gently press in on the trachea to elicit a cough to assess tracheal sensitivity.
Additionally, your vet will also auscult your pet’s heart, counting the heart rate (while also feeling for your pet’s pulse in a hind limb blood vessel near the groin) and rhythm, careful to listen for any arrhythmias (abnormal rhythm) or murmurs (abnormal beats). For example, does your puppy sound like a washing machine when you put an ear to his chest? He may have a murmur due to a hole in the heart, called a patent ductus arteriosus (PDA), requiring surgical correction. The presence of any abnormal vessel pulsation in the neck (i.e. jugular pulses, a sign of heart disease) is also monitored.
Full disclosure: Thoracic auscultation will take a bit of time. Your veterinarian needs to concentrate to be able to hear all the subtle sounds in the chest, so please do your vet a favor by remaining silent when he or she is listening with a stethoscope. Also, please refrain from petting or patting your pet during this portion of the physical exam; a thump to the chest when your vet is ausculting your pet can be confused for an abnormal heart sound. Public service announcement completed. Peace out. ✌
Panting and purring can also impair your vet’s ability to auscult properly, so you may observe a veterinary assistant gently holding your dog’s mouth closed to stop the panting or by running a bit of water from the nearby faucet to stop your cat from purring as your veterinarian is listening.
Click here for our article on the basics of canine and feline cardiac disease. ❤
- Abdominal internal organs:
- Gastrointestinal tract: Your veterinarian will be able to detect a painful abdomen as well as abnormal fluid in the abdominal cavity, which can be a sign of right-sided congestive heart failure, low blood proteins (hypoproteinemia), or peritonitis, or internal hemorrhage. Your vet will also gently follow your pet’s digestive tract from stomach to bowel to feel for signs of distension (due to excess gas or fluid), inflammation, GI tumors, or an ingested foreign body.
- Liver: The liver is already a comparatively large organ in the abdomen, but your vet will feel for abnormal size. A diffusely enlarged liver can be a sign of a many liver diseases like acute hepatitis, hepatic lipidosis, copper storage hepatopathy, and neoplasia (cancer). In contrast, a small liver (which admittedly is best diagnosed upon X-ray rather than physical examination) can indicate a portosystemic shunt (PSS) or end-stage cirrhotic liver failure. Depending on their size, liver tumors can also typically be detected upon physical exam.
- Spleen: A large spleen is typically quite worrisome. Certain infections can cause the spleen (which plays a role in the immune system) to enlarge. However, splenic hematomas or tumors (such as hemangiosarcoma) are relatively common disorders of the spleen in dogs, and your vet will carefully palpate the spleen in at-risk canines. Additionally, if your dog or cat required sedation with certain medications (such as acepromazine), the spleen may also transiently enlarge, which may be observed during your vet’s physical exam.
- Pancreas: A normal pancreas (which plays a significant role in digestion as well as maintaining normal blood sugar) isn’t likely to be palpable (or easily felt) upon a physical exam. However, a severely inflamed and painful pancreas, as can occur with pancreatitis (which is often secondary to your pet consuming fatty foods he or she shouldn’t eat) is often palpable.
Urinary and reproductive systems: A physical exam will include palpating the kidneys for signs of pain or enlargement. (Note: Kidneys are more easily palpable in felines while only the left kidney is likely to be felt in most dogs.) Kidney disease can alter the size of your pet’s kidneys and can alert your vet to a problem. The bladder is also to be examined. A very inflamed and thickened bladder wall can indicate a urinary tract infection (UTI), the presence of urinary stones (uroliths), or bladder cancer. A very large or painful bladder can indicate a urethral blockage, as can occur with stones and FLUTD (feline lower urinary tract disease). The reproductive system of intact (i.e. unspayed) female dogs and cats is also palpated to detect a pregnancy or signs of abnormal uterine enlargement, as can occur with pyometra (uterine infection, which can rapidly become a surgical emergency). (Spay and neuter your pets, folks!)
Externally, the genitalia is examined. Your vet will observe your female pet’s vulva for signs of being hooded or recessed, urine scalding, or vulvar/vaginal discharge. Your male pet’s scrotum (if he has not been neutered) will be checked for testicular irregularities (including a cryptorchid or un-descended testicle as well as testicular torsion or cancer), and his prepuce and penis will be examined for signs of discharge or other disorders. The perineum and anal region of both male and female dogs and cats will also be checked for intestinal parasites (such as tapeworm segments), masses (such as perianal tumors, hernias, and fistulas as well as anal gland abscesses), as well as normal anal tone (normal nerve function rather than incontinence). During most canine physical exams, your vet should also perform a rectal exam with a gloved finger to check for any internal anorectal masses and to assess the prostate in male dogs in order to rule out benign prostatic hyperplasia (BPH), prostatitis, and prostatic cancer. A rectal exam is imperative in geriatric dogs, and should be a part of a nearly every physical exam.
- Skin and coat: Hot spots? Itchy or greasy skin? Blackheads? Thinning or missing hair? Skin tumors or an enlarged mammary gland? Umbilical hernia? Obvious external parasites (ticks and fleas)? Nails too long and clacking on the floor? Your vet will carefully observe and palpate your dog or cat’s entire body to note abnormalities in your pet’s skin and coat, which can be a harbinger of systemic problems such as canine hypothyroidism, hyperadrenocorticism (Cushing’s disease), or nutritional deficiencies. To assess your pet’s hydration status, veterinarians will slightly lift the skin at the back of the neck to see how long it takes to snap back into place (skin turgor test). A delayed skin tent can indicate dehydration.
- Lymph nodes: Your vet will run his or her hands along your pet’s body from neck to hind limbs to feel for any lymph node (gland) enlargements. Veterinarians should always examine the most common external lymph nodes (which function as part of your pet’s immune system). These glands are located at each side of the throat (the nearby salivary glands will also be palpated for irregularities), near the chest or under the armpit, near the groin, and behind the knee of each hind limb. Enlargements may indicate nearby or systemic infection, inflammation, or cancer. Lymphoma, one of the most common cancers in dogs and cats, can cause multiple lymph nodes to enlarge all over the body, so routine check-ups and physical examinations by your vet can allow for the earliest possible diagnosis and treatment. (Have I said this enough?: Physical exams can save lives!)
Specialized Exams
Based on the findings of your pet’s physical examination, your veterinarian may perform more advanced exams that focus on a particular body system: the orthopedic, neurologic, and ophthalmic examinations.
- Orthopedic exam: If your dog or cat has been limping or displaying signs of pain when moving, your vet will likely wish to perform a more in-depth examination to hone in on your pet’s suspected orthopedic problem. Even before taking radiographs (or X-rays), your vet will want to narrow down your pet’s ailment to a certain location. Some problems are obvious, such as a visibly broken limb. Other problems are more subtle, however, and require the skill of a veterinary orthopedic exam (or ortho exam) to be diagnosed. Your vet will oftentimes start by having your pet walk back and forth on a non-slip surface to observe the gait. Based on your pet’s comfort and tolerance level, your vet may wish to administer an injectable sedative and pain medication to facilitate the ease of the manipulation portion of the ortho exam. Your vet will likely maneuver the joints around an affected area as well as palpate the muscles, bone, tendons, and ligaments around this region. Problems such as polyarthropathy (swollen joints), fractures, bone tumors, cruciate ligament injury, meniscal tears, luxating patella (“floating kneecaps”), hip dysplasia and other types of osteoarthritis, as well as hip luxation can often be diagnosed based on orthopedic exam alone.
- Neurologic exam: If your pet is displaying signs of back pain or other limb abnormalities (such as scuffing a foot) and yet an orthopedic exam does not yield an orthopedic (i.e. muscle or skeletal) cause for the problem, your vet will wish to perform an neurologic exam. During a neurologic exam (or neuro exam), your pet’s reflexes are checked as well as conscious proprioception (i.e. Is your pet aware where his or her feet are positioned?). Abnormalities in a neuro exam mean that communication with your pet’s nervous system is impaired. This could be due to a nerve, motor neuron, spinal cord, or brain problem. In addition to testing your pet’s ability to walk and move his or her limbs, your vet will also palpate along the spine for conscious recognition of pain. Spinal cord injuries such as intervertebral disc disease (IVDD) and fibrocartilagenous embolism (FCE) as well as other illnesses such as meningitis, degenerative lumbosacral stenosis, and cervical spondylomyelopathy (or Wobbler syndrome) are all investigated during a neuro exam.
A neurologic exam also involves observing your dog or cat’s cranial nerve function. The cranial nerves are 12 nerves that arise from the brainstem and are responsible for a multitude of important functions, especially around your pet’s face. The ability for your pet to see, hear, smell, swallow, and hold his or her face and ears in a normal position are all due to normal function of various cranial nerves. For example, abnormal eye position and movement as well as a droopy face can be signs of a neurologic condition.
Furthermore, your vet will observe your pet’s behavior to detect brain problems (or lesions). For instance, head pressing*, a head tilt, or circling in one direction when walking can all mark a brain abnormality. Based on your pet’s neuro exam findings, your vet will be able to roughly pinpoint which region of the brain or spine your pet’s problem is. (*Please note, if your pet is head pressing, i.e. pushing his or her head into a wall or standing facing a corner, this is a medical emergency!!! Take your pet to a veterinary facility immediately!)
- Ophthalmic exam: When your pet’s cranial nerves are examined during a neurologic exam, the eyes are cursorily studied, including your pet’s visual ability, the position and movement of the eyes, and pupil size. An ophthalmic exam (a.k.a. ophtho exam or eye exam) investigates the eyes in much more detail, involving a specialized magnifying lens to examine the optic nerve and blood vessels in the retina at the back of the eye (i.e. a fundic exam). Why is checking retinal vessels so important? High blood pressure (hypertension), as can occur in conditions such as chronic kidney disease, hyperadrenocorticism (Cushing’s disease), and feline hyperthyroidism, can lead to bleeding in the back of the eye and sudden blindness. Through an ophthalmic exam, your vet may be able to detect this emerging problem before full vision loss occurs. If your pet is displaying signs of visual deficits, your vet will also rule out cataracts, or cloudiness of the lens of the eye, as can occur in dogs with diabetes mellitus. The eyelids are also inspected for any abnormal shape. (Are they drooping? Rolling in and rubbing on the surface of the cornea?)
Ophthalmic and neurologic exams somewhat overlap in that each may involve a pupillary light reflex (PLR) test. The PLR test uses a bright penlight to ensure that your pet’s pupils constrict normally when exposed to light and then dilate as expected when the light source is removed. Abnormal results can indicate an abnormality with the nerves of the eye. A similar test is the dazzle reflex. Additionally, a menace response is also performed. A hand or object is suddenly moved toward your dog or cat’s face to see if he or she can blink appropriately in defense. The menace response tests both for vision (Can your pet see the object moving towards them?) as well as the nerve function of the eyelids (If you pet can see the object, do the nerves going to the eyelid receive the signal to blink?).
An ophthalmic exam also involves monitoring your pet’s intraocular pressures (IOP). High IOP can be a sign of glaucoma, a painful eye condition that inevitably leads to blindness. Gentle pressure may also be applied to the eyeballs (globes) to check for retrobulbar masses (tumors behind the eye). Your vet may also wish to check your dog or cat’s tear production. Dry eye (i.e. keratoconjunctivitis sicca, or KCS, meaning failure to produce enough tears) can cause ulcers in your pet’s cornea. If your pet is squinting his or her eye closed, your vet may already be suspicious of corneal ulcers or other causes of inflammation or infection of the eye (such as uveitis). Abnormal hair growth around or in the eye as well as some eyelid disorders can also cause corneal ulcers and are detected during an ophthalmic exam. In such cases, a special fluorescent stain (such as green fluorescein or pink/red Rose Bengal stain) may be applied to the eye. If the stain seeps into areas of the cornea (or outer surface of the eyeball), this area signifies a corneal ulcer, which requires prompt treatment.
See how much information your pet’s own body can tell your veterinarian before other tests are required?! So much knowledge about your dog or cat’s health can be gained through a physical examination. Trust me: don’t squabble when you see the physical exam charge on your veterinary bill; the exam is well worth your time and money. Physical exams can save lives!
– Maranda Elswick, DVM
The Meowing Vet encourages you to schedule routine veterinary wellness check-ups, including a physical exam. Younger, healthy animals should be examined annually while geriatric dogs and cats as well as pets with chronic illnesses should receive a check-up at least every 6 months.
Visit back later for an upcoming article on how to reduce your pet’s (and your own!) anxiety when journeying to the vet’s office and how make your veterinary visit less stressful.
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