TRADITIONAL MEDICINE :: PHYSICAL EXAM

Diagnostics: Physical Examination

(1) General

Most physical exams start with a tech taking down notes on weight and vitals like temperature, pulse rate and respiratory rate, but we'll also include impressions along the lines of "bright, alert and responsive" (abbreviated as BAR) or "depressed," "quiet," "recumbent" and/or "unresponsive." This is also when we note "body condition score," to denote the pet's degree of heaviness or thinness, as the case may be.

(2) The Head

On the head we look at ears, eyes, noses, mouths and teeth. We check for discharge, normal appearance of structures, details on dentition and periodontics, character of the mucous membranes to assess hydration, etc.

(3) Skin and Coat

Taking in the condition of the coat and skin may seem like it doesn't take much time but some pets have such dense hair that getting to the level of the skin in key areas can be like wading through a forest of fur. Finding fleas, ticks and lumps is extra tough on these pets, especially if they have a large surface area. Most vets will also check for hydration here by tenting the skin over the shoulders.

(4) The Chest

This is when we pull out our stethoscopes and apply them to your pet's chest. But that's not all we're doing. We try and alter your pet's breathing pattern with our hands on their noses and mouths and feel the pulses as they relate to the beats of the heart. Twenty to thirty seconds of this is a bare minimum but some vets will listen for several minutes. Be patient with us when you see us do this, and try to hold your tongue in the process (we're usually trying to ignore you if you feel the need to interject during the chest exam).

(5) Circulatory

This is sometimes done as part of steps #1 and #4 where we check mucous membranes for their refill time and when we feel pulses during our chest exam to make sure they synchronize well with the heartbeat.

(6) Orthopedics

The orthopedic portion of the exam includes a variety of steps: Assessing the symmetry (or lack thereof) of the musculature, observing how the pet moves/ambulates and physically manipulating limbs and their joints. We will also address the spine individually, feeling down every intervertebral junction to identify painful spots.

(7) The Abdomen

Palpating the abdomen is not easy in some cases. Some pets hold their abdomens tightly, refusing to allow you a good feel. (If that is the case, I will usually come back to it for a second pass.) What we are feeling for is the size and texture of the organs and the possible presence of abnormal masses. Sometimes we can't feel much, though, even if a pet lets us, and usually that is because they're overweight or obese.

(8) Lymph Nodes

We will usually go out of our way to feel all the peripheral lymph nodes that are typically palpable: in the neck, in front of the shoulders and behind the knees. We will also check those spots where enlarged lymph nodes will make themselves known (but are otherwise not palpable).

(9) Neurological

The neurological exam is always the hardest for me. I will typically evaluate the cranial nerves as part of the head exam and address some basic reflexes but beyond that I really don't do muchÑunless it is a case where serious neurological disease is present. Even then, I will only check a few more reflexes, as all my serious neurological cases require a neurologist.

(10) The Invisible Intangibles

These are the issues you may not notice us addressing specifically by looking and touching but which make themselves known through our olfactory system and via our instincts, that almighty sixth sense we like to think we cultivate with experience.