Yes, your pet must visit the veterinary office
Physical exams are vital to the veterinary-client-patient relationship. Learn how to explain their value to pet owners.
Lately, veterinary clinics are getting more calls from pet owners asking for prescriptions and other treatments for their pets without an exam. The request may be for an antianxiety medication for travel for a pet we’ve never seen, or for a refill of an antibiotic or anti-inflammatory for a pet that hasn’t been to the clinic in over a year. When we correctly answer “no,” we face disappointed clients who may accuse us of just wanting to make money. They sometimes even imply that we all have luxury cars in the parking lot (spoiler alert: we don’t).
Although clients don’t generally like to be told they have to bring their pet to the clinic, explaining the value of a physical examination—a vital part of the veterinary-client-patient relationship—can help.
More than any blood test or radiograph, a physical exam makes use of the veterinarian’s and veterinary technician’s extensive education and knowledge. So what does our training help us notice that clients may not? What is the purpose of the various parts of a physical examination? Let’s go through the process and look at how veterinary staff could explain each step and convince a pet owner of the value of a trip to the clinic.
A complete health history and observation from a distance
The veterinary technician and veterinarian walk into the room to learn and observe the health history. This may seem like just a conversation—one that could have happened on the phone—but while this process is happening, the technician and the doctor are observing the animal and allowing them to grow more comfortable with the unfamiliar surroundings. The fact that your pet sees you talking to the scary people in scrubs instead of running away helps them feel more confident. We look at how they are standing, resting, and moving, looking for signs of pain and other abnormalities. We look at their coats, noticing any pattern of baldness and whether the fur is dull or shiny. Are they squinting 1 or both eyes? Holding their ears down? When they pant, can we see tartar on their teeth or gum inflammation? Do they have what we call a “pendulous” abdomen—a potbelly appearance?
Temperature, pulse rate, respiration rate, and weight
If the technician has not already, the doctor will likely take a rectal temperature at this point. Although this may seem rude, it is important to know if a fever is developing. It is also essential for us to measure your pet’s pulse and respiration rates and to get an accurate and current weight.
The physical exam: The head and neck
Now the veterinarian starts the hands-on physical exam. Every doctor has a slightly different approach, but many start at the front of the animal and work their way back. The doctor examines the eyes and nose, looking for discharge, noting its color and consistency. Using an ophthalmoscope, we shine a light into the eyes, looking at the pupillary light reflex or whether the animal’s pupils contract equally and normally. The doctor may also test a palpebral reflex—touching around the eye and watching for a quick blink in response. We look for redness of the conjunctiva and sclera and for any evidence of problems affecting the cornea or deeper structures within the eye. Then the doctor will often switch the head on their tool and examine the ear canals.
Now that we’re through with examining the eyes and ears, the veterinarian will look in your pet’s mouth. They’ll examine the teeth for tartar, the gums for gingivitis, and the entire oral cavity for any inflammation, wounds, or masses. We’ll evaluate the mucous membranes for dehydration and cardiovascular function. Pale, brick red, or blue tinged mucous membranes are all signs of severe disease and require immediate attention. A full oral exam is impossible on an awake animal (they just won’t listen when we tell them to say “ahh”), but the veterinarian or technician can determine if a dental cleaning or full oral exam under sedation is needed.
Next, most doctors will palpate the submandibular lymph nodes, located just behind the jaw. These nodes are not often visible and can be hard to locate, but swelling or changes in texture can indicate the need for further diagnostics to rule out inflammation or cancer. During the exam, the veterinarian will typically palpate numerous lymph nodes throughout the animal’s body.
The physical exam: The chest and abdomen
After examining the head and neck, many veterinarians will then use their stethoscope to auscultate the heart and lungs. They will listen to the rate, rhythm, and character of the heartbeat. Simultaneous palpation of pulses alerts the doctor to abnormalities in blood circulation. They may move the stethoscope bell to the trachea to listen to referred upper airway noise and may palpate the trachea to elicit a cough (a collapsing trachea can often be diagnosed this way).
While they are examining the midsection of your pet, the doctor will likely move their hands over the entire body. Although doing this may look like normal petting, we’re feeling for masses, skin problems, and overall body condition.
Abdominal palpation is an important next step in the physical exam. Veterinarians are trained to feel for swelling, thickening, and masses in the abdomen. If your animal is relaxed enough to allow it, most doctors will spend a minute or 2 performing a deep abdominal palpation. They can feel the intestines, bladder, kidneys, and sometimes the liver and spleen. This is a skill that takes years to perfect but is invaluable at determining if further diagnostics, such as radiographs or ultrasonography, are necessary. The technician will watch the reactions of the pet during this palpation and alert the doctor if any twinges of pain are noted.
The doctor will likely palpate your pet’s spine. Again, the veterinary technician watches the patient’s face carefully, looking for subtle indications of pain. The doctor may do a quick neurologic exam, flipping the feet over and watching how quickly they are moved back into a normal position. This tests proprioception, or the ability to know where one’s limbs are.
The physical exam: The hind end
Now that the doctor has reached your pet’s hind end, they will likely run their hands or a comb through the fur in front of the tail as this is a favorite spot for fleas. It’s also important to look under the tail for masses and evidence of abnormal stools and urinary or reproductive abnormalities. Older, intact male dogs should undergo a rectal exam to check for prostate enlargement, and intact female dogs may receive a more thorough reproductive exam.
The veterinarian will palpate your pet’s legs and perform a thorough musculoskeletal examination when needed. They may test the range of motion of the hips and watch for any signs of pain or stiffness. Additionally, the doctor may ask the technician to walk or jog the animal in straight lines or circles to perform a gait evaluation at the end of the stationary physical exam. Typically, this will only be done if lameness is reported.
The physical exam guides diagnostic and treatment recommendations
We will discuss any findings with you during or after the physical exam and recommend appropriate diagnostic testing or treatment. For example, if an ear canal is inflamed, we may need to swab your pet’s ear and perform a cytologic examination on the sample to determine what types of microorganisms are present. This is essential information before we can recommend the right medication.
Conclude your discussion with the client with a reminder that it is the clinic’s goal to partner with them in the care of their animal and we can only do this safely, effectively, and legally after a physical examination.
Sara Beth Speziok, MPH, is a fourth year veterinary student at the University of Florida College of Veterinary Medicine.
Editors note: All veterinary technician content for this month is supported by Banfield Pet Hospital.