The Complete Physical Exam

Despite advancements in veterinary medicine, routine physical exams remain a mainstay because they allow veterinarians to:

• Establish baselines
• Catch any changes
• Monitor treatment effectiveness

“People sometimes assume we’re not doing very much,” says Patty Khuly, VMD, a doctor at Sunset Animal Clinic in Miami, Florida. “Actually, we’re doing quite a bit.”

WHAT ARE THEY LOOKING FOR?

Veterinarians check pets system by system while moving geographically across the body. Here’s how:

Mental state/behavior. “Entering the room, pets shouldn’t be bumping into walls or stumbling. They should not be hanging their head low. They should have a happy and curious or ‘normal nervous’ posture—tail either straight out or down, head up, looking around,” says Rebecca Ruch-Gallie, DVM, from the veterinary teaching hospital at Colorado State University.

Symmetry.Pets should be equally divided, with symmetry of structure in the face, eyes, nostrils, muscle mass, etc. This check usually includes a body condition score, which assesses a pet’s weight (underweight, normal weight, overweight, or obese).

Eyes, ears, mouth. Veterinarians thoroughly check pets’ eyes for problems. They check their ears for debris, excess hair, and inflammation or odor, which can indicate infections or parasites. Inside the mouth, they look for injuries as well as dental disease (tartar, redness), broken teeth, oral masses, and capillary refill time—where they press on the gums until they turn white and then count how long it takes for the gums to turn pink again when pressure is released.

Lymph nodes. Many lymph nodes lie just under the skin. Swelling can indicate disease. Most lymph nodes should not be noticeable, especially those over the face and the sides of the body. “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. Veterinarians want to hear smooth sounds of air moving in and out of the 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 30 seconds to a few minutes to really listen to a pet’s heart for pump function 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, veterinarians are listening for a normal heart rate and rhythm, as well as murmurs that change the normal lub-dub sound into something like lub-ssshh-dub.

Abdomen and internal organs. Checking a 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, veterinarians check the liver’s size, location, and edges to make sure they are not swollen or rounded. They do the same with the spleen. They also check the large and small intestines for excess gas, fluid, or masses.

On most cats and many small dogs, veterinarians can also check 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 the rectum, using a gloved and lubed finger, veterinarians check a joint between the pelvis and the hips for pain, along with the lymph nodes and anal sacs. On male pets, they check the prostate. On all pets, they also look for any discharge or swelling in a pet’s genital area.

Skin/haircoat. Overall, the skin and haircoat reflect nutrition, metabolism, 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 a pet has flea problems, the skin might be inflamed in the rump region, above the tail, where veterinarians look for the classic triangular appearance of allergic irritation.

Dr. Ruch-Gallie likes to give her patients a good scratch all over the head and body. It calms the pets and gives her a chance to feel everything and watch for any spots of particular itchiness, which might mark problems. Staining between pads on the feet comes from licking, which also indicates irritation.

Painful areas. With major joints, the spine, and the tail, veterinarians watch for any signs of pain at 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, the American Veterinary Medical Association recommends that all dogs and cats visit their veterinarian twice a year for routine wellness exams.

Health conditions dictate exam frequency as well. Checkups might be needed every week or two following a new diagnosis, then become less frequent depending on the condition being monitored.

Time for a Veterinary Visit?

As the person who spends the most time with your pet, you need to know what’s normal for her. That way, if something changes, you’ll notice and can let your veterinarian know. When you first get a new pet, examine her from nose to tail, and make a point of periodically reexamining her. Below are some signs that something isn’t right.

MENTAL STATE & BEHAVIOR

• Abnormal sleep patterns
• Aggression
• Loss of balance
• Seizures
• Sluggishness

LUNGS & HEART

• Coughing
• Exercise intolerance
• Fainting
• Nasal discharge
• Shortness of breath

DIGESTIVE SYSTEM

• Abdominal pain or swelling
• Diarrhea or constipation
• Loss of appetite or increased appetite
• “Scooting” the rear across the floor
• Vomiting

MUSCLES & BONES

• Difficulty rising or using stairs
• Limping or lameness
• Swelling

URINARY & REPRODUCTIVE TRACTS

• Difficult, painful, or bloody urination
• Excessive drinking and/or urination
• “Spraying” or not using the litterbox
• Unusual discharge from the penis or vagina

SKIN & HAIRCOAT

• Excessive scratching or licking at the skin
• Lumps and bumps that last more than a few days or get bigger
• Skin lesions
• Unusual hair loss

GENERAL

• Sudden weight loss or gain
• Unusual swelling on the neck beneath the jaw, on the front of the chest, or behind the knees

EYES, EARS, & MOUTH

• Appearance of third eyelid
• Bumping into things (e.g., furniture)
• Eye inflammation and/or discharge
• Ear inflammation and/or discharge (often smelly)
• Broken or loose teeth
• Discolored teeth
• Inflamed or pale gums
• Mouth odor

Normal Vital Signs in Dogs and Cats

Dogs
Temperature: 100–102.5°F
Pulse: 100–130 beats/minute (small), 80–100 beats/minute (big)
Respiration Rate: 18–34 breaths/minute

Cats
Temperature: 100–102.5°F
Pulse: 140–220 beats/minute
Respiration Rate: 16–40 breaths/minute

A Basic Blood Chemistry Panel

Basic “blood work” typically checks these values:

• Complete blood count, or CBC (anemia or infection)
• Electrolytes (level and quality of hydration)
• General metabolism, including glucose levels
• Kidney function
• Liver function
• Pancreas levels
• Thyroid levels

Veterinary-specific laboratory equipment is used to measure these chemical values from blood serum, which floats to the top when tubes of blood are spun in a centrifuge. They provide a snapshot of how the pet’s body is functioning. “This is where four years of veterinary school and however many years of veterinary experience you have come together,” says Dr. Ruch-Gallie. “We’re taking bits and pieces from the blood work and putting it together with the physical exam to get the big picture.”