The Complete Physical Examination: What Is It?
There are several basic types of physical examinations, based on your pet's health and age and ongoing progress in a medical or surgical treatment plan. They all have many similarities and also some unique differences tailored to your pet.
Puppy and Kitten Exams
Keeping track of your rapidly growing and changing puppy or kitten is imperative to allow the doctors at the Animal Clinic at Thorndale to intercede quickly if any problems arise. On the initial examination, we will complete a full physical examination, nose tip to tail tip, using the stamp on the record as shown below for the annual examination. We will discuss with you a number of medical and surgical issues, including vaccinations appropriate for your pet and the time table for those vaccinations, parasites, both internal and external such as intestinal parasites and heartworm disease, and flea and tick prevention specific to dogs and cats, common zoonotic diseases, congenital defects, appropriate diets, some basics in behavior training, including house and litter box training, biting and jumping, spay and neutering, to mention a few. We recommend that, even in apparently healthy growing puppies and kittens, the doctor complete a physical examination at least every other visit through the puppy or kitten series of vaccinations. If problems arise, more frequent examinations may be warranted. Generally, we will schedule your next expected visit before you depart for home, and continue to preschedule your appointments until the puppy/kitten series is complete. Thereafter, we will send you a reminder card in the mail or by email to let you know when the next annual visit is expected.
Annual Physical Examination
This is the most common examination for pets. Once they have moved on past the puppy and kitten phase, we send you a reminder when your pet is due to be scheduled for its next annual examination. In the past, the vaccination schedules for the prevention of the most common diseases dictated the need for the annual examination. Recent evidence supports the administration of some core vaccines every three years after the first year booster vaccination. There are important exceptions and we will do our best to keep your pet on track for which vaccines are due with our reminder system. Because annual examination reminders occasionally become out of synchrony with the vaccination reminders, we always suggest you telephone ahead to check which services are due when scheduling an appointment.
Regardless of whether your pet is due for a vaccination, it should have a physical examination at least yearly. Pets unfortunately age more quickly than humans. Skipping a yearly examination could be like skipping 5-15 years of your own life. Many illnesses can be detected early and successfully treated based on annual examination findings and appropriate diagnostic screening tests. Dogs and cats are not like humans in that they cannot tell you if they are ill. In fact, evolution has designed them to cleverly hide signs of illness. They certainly get many different diseases and parasites than their human counter parts. It is always amazing the number of potentially manageable problems that can be detected early on routine examinations. Be proactive in your pet's care. You can potentially save a life and give better quality to years. Geriatric dogs and cats should be seen at least every 6 months and have more extensive testing, just as in the geriatric human world.
Think of the annual physical examination as a systems check, tip of nose to tip of tail.
Patient Description: This includes your pet's breed, age, hair coat length and color, any identifiers such as tattoos or microchips, spay or neuter status, and prior surgical procedures. This is a permanent part of your patient's record and we will always check to be certain the patient presented for the examination is the one described.
Patient history:The first part of the examination is actually the patient history. This is the owner's report of how the pet has been doing. We will ask you a number of basic questions about diet, appetite and thirst, exercise, elimination habits, noticeable changes in activities, respiratory issues like coughing and sneezing, changes in the skin, ears, nails, eyes, etc, limping or other mobility problems, growths appearing or changing in size or consistency, and travel to other areas of the country or other countries. You may not know all the answers, but the more complete the information you provide, the better we will be able to assess your pet's health.
This is a basic acronym for Subjective, Objective, Assessment, and Plan which is the basis for medical record keeping and allows the veterinarian to formulate treatment plans and assess patient progress.
We will get an overall subjective assessment of your pet's attitude and general appearance. The history can contribute to this assessment because animals often behave differently in our office that they do in the safe confines of your home.
Our hospital actually uses a "stamp" on the patient's record that the doctor will check off or notate deviations from normal. This stamp allows for consistency between doctors and helps assure that the objective examination was complete:
_____ Wt. (lbs) _____ R.R _____ Feet
_____ Eyes _____ Resp. _____ Lymph
_____ Ears _____ GI _____ Repro
_____ Nose _____ Musc/Skel _____ Urine
_____ Mouth _____ Neuro _____ Anals
_____ MM/CRT _____ Skin _____ Temp.
_____ HR _____ Endo _____Other
MM/CRT=mucous membranes and capillary refill time; HR=heart rate; CV =cardiovasular system; RR=respiratory rate; Resp= respiratory system; GI=gastrointestinal system; Musc/Skel=musculoskeltal systems, Neuro=neurologic systems; Endo=endocrine systems; Lymph-lymphatic system; Repro=reproductive system;Urine=urinary system.
Each system entails a number of different components. For example, the respiratory system starts at the nose and mouth, travels through the neck and into the chest to the far reaches of the lungs. The urinary system begins at the kidneys, and travels through the ureters, bladder, and urethra and surrounding structures. We may or may not record a temperature or express anal glands in pets, depending on their history and symptoms.
The Doctor will assess your pet's overall health. On a healthy annual examination, the doctor will let your know your pet is doing well and plan to see you at the next recommended visit. If any problems or impending problems are found, the doctor will formulate an individual plan customized for your pet. This may include further diagnostics, lifestyle changes, specific medications or surgical recommendations.
Physical Examination for a Health Concern
Because our pets cannot communicate directly with their doctors, the owner is the patient advocate. The "presentment or presenting complaint" is often a list of problem(s) or symptoms that the owner has noticed. This may be very vague, such as "just not doing well", or very specific, such as they broke the dewclaw toe nail on the right front paw. Based on whether the problem is imminently life threatening, minor, or somewhere in between, the doctor may address the specific problem first or go to the overall health assessment. Unless your pet has had a complete physical examination recently, and also only if the problem is deemed minor, the doctor will perform a complete examination (using the stamp above). Many health problems are associated with related problems and underlying causes. The physical examination is often essential to correctly diagnose your pet's problem and develop a correct treatment plan. Frequently, additional diagnostic testing will be needed to objectively examine and assess your pet. Blood tests, fecal examinations, radiographs, and/or screening ultrasounds may be warranted. Some problems will need the expertise of board certified veterinary specialists or intensive care in a 24 hour facility. Be assured that our veterinarians will refer you to the best area specialists when deemed in your pet's best interests.
Progress Report Telephone Calls and Medical Progress Examinations
Some problems just don't seem to go away as quickly or completely as we would like. Some problems cannot be cured (such as allergy or arthritis) but can be successfully managed. We make every effort to have our doctors available throughout your pet's lifespan to answer questions, repeat medical progress examinations, and perhaps change assessments and treatment plans as your pet's responses change. There is no one size fits all program in veterinary medicine. Over time, more subtle causes of a non-specific problem may come to the surface. If your pet is doing well on a medical progress telephone call, we would like to know. That information becomes an important record of what treatments successfully worked for your pet. If a treatment is not succeeding as planned, promptly informing our doctors can prevent unwanted discomfort for your pet and allow us to reassess and redirect the treatment plan before things progress. Certainly, if new problems arise, we want to be informed as quickly as possible. Remember, you are the one at home with your pet on a day to day basis. You are our patient's best advocate. The better informed your pet's doctors are, the better the care you and we will be able to give.
Our goal at the Animal Clinic at Thorndale is to provide the best care possible for your pets. Routine physical examinations are an important part of your pet's health care. Even apparently healthy pets benefit from annual examination and appropriate testing. As our pets age or develop medical problems, more frequent examinations will be needed. Your pet cannot talk, but you can certainly be in their corner and help us to help you provide them with many healthy and enjoyable years of life.