The Critical Details of a Physical Exam

by Shawn Finch, DVM

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Do you ever wonder what goes into a wellness exam when you bring your dog to the veterinarian? I imagine it appears as though we pet your dog, listen to his heart for a moment and perform whatever vaccinations or other care he needs and move on. In actuality, much observation and interpretation goes into that examination that you and your pet may never realize. Until now that is…

Mona Lisa

I start by spending time talking with you, because…I like you, and I am honored you have brought your pet to me!  I also need a thorough history on your dog – lifestyle, diet, exercise, housemates…anything that could help us both as a a team provide the best possible care.  While we discuss your dog, I try to not make eye contact with him, cute as he is, and I get down on his level and allow him to greet me.  Even if we know each other, but especially if we do not, these few moments are crucial in setting a positive and non-threatening tone for your dog.

Before the examination officially even starts, I am gauging his neurological and orthopedic status – how he sits, stands and walks and interacts with his environment.

I am gauging his mood and stress level.  Will an exam be less scary on the floor or the table?  Will it take more time to earn his trust?  Do I need to be playful or gentle?  Does he want to be talked to and doted on or does he want the visit over as quickly as possible?

Next, I will either sit with him on the floor or gently lift him onto the exam table.

I pet him from head to tail, feeling for healthy skin and coat, any bumps or painful areas or other abnormalities.  I check his body condition – whether he is an appropriate weight and how developed or atrophied his muscles are.

I feel over the neck, back, shoulders and hips – some of the more common areas for arthritis and injury.  I am checking  for pain and the ability to move well.

I pet his forehead back to check the whites of his eyes and pet his lips back to check his mouth.

I inspect all the teeth, feeling for tender areas, gauging the amount of tartar present, and looking for fractured teeth, discoloration or tooth root exposure.  I examine the color of the gums and gently press them to see how quickly they turn white and then turn back pink again and whether they are moist or dry.  On a puppy, I check the progression of baby tooth development and replacement by adult teeth and check for a cleft palate.

I examine the rest of the face – Are the eyes clear?  Is there ocular or nasal discharge?  Can he breathe well through his nose?  Is everything symmetrical?

I pet under the opening of both ears.  If an ear infection is brewing or present, the vertical canal will almost always be tender.  I turn the ear flaps inside out one at a time.  I smell the ears and look for redness, discharge and excess hair.  I look at the skin on the underside of the ear flap and feel if the flap itself is thicker than it should be.

I feel five paired sets of external lymph nodes, mainly to see if they are bigger than they should be.  The ones I routinely check are under the jaw, in front of the shoulders, in the arm pits, in the inguinal area (on the inner side of the back legs near the abdomen) and behind the knees.

I feel the abdomen for abnormal lumps or pain.  I gently lift and drop the skin over the scruff to check for adequate hydration.

On a puppy, I will check the belly button and inguinal area for hernias.  On a boy puppy, I will check for the presence of one or both testicles in the scrotum.

I check the nails to make sure they are healthy and an appropriate length and check between the toes for moisture or redness.

I look at the tummy and armpits and groin area for redness or itchiness.  I pet the fur “backwards” over the head and back and sides to look for parasites (fleas, ticks or lice) and any skin abnormalities.

I listen to the cranial and caudal lung fields on both sides.  I count the breaths per minute and make sure the breathing is even and clear.

I listen to the heart on the right side and then the left side.  I count the beats per minute and determine if the rhythm is normal or abnormal and if there is a murmur and if so, what kind of murmur and how pronounced on a scale of one to six.

Then I say “Your dog is perfect” or “Your dog is perfect, and I found these abnormalities that we should address…” and we go from there.  If need be, I continue the examination, focusing on areas, ears, eyes, joints or whatever else, that need more attention.  Only then will we take the next steps of any needed testing and treatment.

More and more, I have been trying to do examinations “out loud.”  As your dog’s person, I think it is good to let you know what all goes into examining your friend.  And I believe that in wellness, but even in disease, every detail of wellness – every positive exam finding – is a detail to be celebrated.

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