You’re sitting in the veterinary exam room, waiting to get your dog’s vaccines updated before you leave for vacation. But before the vaccines can be given, the vet first checks over your dog from nose to tail. Just what exactly are they doing during this process?
First, there’s a legal issue to address. In the state of Texas, veterinarians are only allowed to diagnose and treat patients with whom they have a valid veterinary-client-patient relationship, also known as a VCPR. A VCPR essentially means that the veterinarian accepts the responsibility of caring for the patient, and the client agrees to follow their recommendations for care. That doesn’t mean it’s the vet’s way or the highway, just that you generally think your vet is competent enough that you’re willing to take their advice. It also requires that the veterinarian see the pet on a regular basis to have an understanding of their health, which the Texas Veterinary Board has said must be done at least once annually. If you’ve ever tried to get a refill from a vet that hasn’t seen your pet in over a year and were denied, that’s why. You no longer had a valid VCPR in the eyes of the veterinary board.
So at a bare minimum, the annual check up for your pet is a legal requirement that ensures that your veterinarian has enough information to competently treat your pet. However, when done well, the exam can provide invaluable information that can help you keep your furry, fluffy, or scaly little one happy and healthy.
What’s the vet really doing when they conduct an exam? Let’s run through all the things your vet is checking:
General demeanor: While it may seem that the vet is just chatting at first, be sure they are taking in a lot of information about your pet from the moment they enter the room. This starts with assessing your pet’s behavior. Veterinarians, especially those with Fear Free training, are skilled at interpreting the subtle body language cues your pet is giving out. Some of our patients are goofy, exuberant, and happy to see us, rushing to the door to jump up and ask for treats. Others are terrified, huddled in the corner, avoiding eye contact, and trembling. We need to assess all the signals our patients are sending to help them feel more comfortable and ensure the safety of the veterinary team. Keep in mind, most bites at the vet office aren’t the result of aggression, but a reaction to fear, anxiety, and stress. The vet is also trying to determine how the patient feels. Are they tense and painful? Are they lethargic or tired? Are they confused or disoriented. These little clues help us figure out what’s going on internally.
Eyes: The eye is a complex structure with many layers. A good eye exam starts on the outside and moves in: skin around the eyes, eyelashes, whites of the eye, cornea (the clear surface where a contact lens sits), anterior chamber (the fluid-filled portion on the front of the eye), iris (the part of your eye that is colored brown, blue, hazel, etc.) and pupil (the black hole in the center of the iris), and retina/fundus (the back of the eye as seen through the pupil). Not only is the vet looking for diseases of the eye, they are also looking for clues about the rest of the body. The eyes can tell us how old the stray dog is, they tell us that the guinea pig has diabetes, or that the cat has a viral infection.
Ears: The external ear flaps are checked for dermatologic issues, and the ear canals are inspected for ear mites, debris, pus, or evidence of infection. Sometimes tumors, growths, cysts, or polyps are present in the ear and require treatment.
Mouth, teeth and gums: If the patient allows, the veterinarian will inspect the teeth and gums. Here is where we often find some serious problems. Dogs, especially small breed dogs, are prone to periodontal disease and tooth infections that typically require extractions of the affected teeth as they age. Dogs are also prone to dental trauma and tooth fractures that eventually lead to infection. Cat’s teeth should be screened for evidence of periodontal disease, but also gingivitis and a painful disease called feline oral resorptive lesions. Some species, such as rabbits and guinea pigs, have teeth that grow constantly throughout their lives, so the teeth are constantly changing and can be prone to severe abnormalities. Dental disease is also common in bearded dragons, sugar gliders, and hedgehogs, so having your exotic pet seen by a knowledgeable vet every 6-12 months is critical.
Nose: The only normal discharge from the nose should be clear. White or bloody discharge from the nose always indicates a disease and should be investigated. External examination of the nose is often limited. If nasal disease is suspected, the vet may recommend x-rays, or even better, CT.
Lymph nodes: Not all animal species have lymph nodes. Those that do have a large number of these structures throughout the body. Lymph nodes process fluid that drains from the body systems and help coordinate an immune response. Many lymph nodes are either internal within the body or too small to feel. However, in many species, there are some lymph nodes that can almost always be felt. If you’ve ever seen your vet using their fingers to check under the lower jaw, in front of the shoulders, in the armpits, or behind the knee, you’ve seen a lymph node exam. Enlarged lymph nodes can indicate infection or inflammation of a nearby body part, or in some cases, a cancerous process.
Abdominal palpation: Each species is a little different here, but generally speaking, the veterinarian will use their hands to feel the edge of the liver, the spleen, both kidneys, the stomach and intestines, and the urinary bladder. Organ enlargement is noted, as are any masses. If the abdomen feels abnormal, typically additional testing, such as x-rays and/or an ultrasound, will be used to gain more information about the abnormality.
Musculoskeletal system: The muscles and bones are touched, and the joints put through range of motion. Puppies and kittens are screened for developmental problems such as elbow and hip dysplasia. Middle aged animals are most prone to ACL tears and trauma. Older animals are screened for signs of arthritis (loss of muscle, decreased range of motion, creaking or swelling in the joints). If your pet is nervous, pulling on the legs can worsen their anxiety, so if there aren’t any specific concerns, this part of the exam may be more minimal for your little one.
Rectum and external genitalia: Embarrassing we know, but it’s important to check the anus, anal glands, and genitalia for problems. Again, how thorough an exam we can perform will depend on your animal’s temperament. A rectal exam may be indicated for animals with infected or impacted anal glands, bloody stool, straining, urinary tract disease, or for unneutered males.
Skin and coat: The skin is checked for redness, bumps, hair loss, or evidence of fleas or other parasites. Many dogs suffer from allergic dermatitis, so their feet, belly and rump are checked for signs of inflammation.
Thoracic auscultation: First, the veterinarian listens over the heart. The stethoscope is placed over each of the four heart valves to listen for a murmur. The heart rate is assessed, and if possible, pulses are checked simultaneously to ensure that blood is pumping effectively throughout the body. The lungs are then auscultated on both sides of the body, both high and low, to screen for evidence of pulmonary diseases such as asthma, pneumonia, or fluid.
Optional exam components:
Gait analysis: If your pet is being checked for limping or lameness, the vet may want to watch them walk. For dogs, this entails an assistant walking the dog back and forth in front of the vet on a leash. For rabbits, cats, and exotic species, this is often just allowing the pet to move around the room. Cats are particularly challenging as they often just sit in one place and pout, making the orthopedic assessment a little more difficult!
Neurologic exam: A full neurologic exam is not typically performed during a wellness exam, but if your vet suspects a neurologic problem, additional tests are done. Lights are shined in the eyes and the vet will tap gently on the patient’s face near the eyes and nose. The vet will typically open the mouth and touch the tongue to observe your pet’s ability to swallow. The vet may also ask your animal to perform a series of strange movements (walking like a wheelbarrow with the rear feet off the ground, hopping around on one leg, hitting the knee with a little hammer, etc.) The results of these tests and observations help tell the veterinarian where within the nervous system the problem lies so the appropriate tests can be ordered.
There you have it! A complete veterinary physical exam. Given that our patients can’t talk to us, and that in some cases our only diagnostic test result will be the physical exam itself, veterinarians work hard to gain as much information as possible from your pet’s body so we can share this information with you and work together to keep your pet happy and healthy!
So make sure your pet gets a complete physical exam at least once every year with your vet (twice annually may be recommended for exotic species, patients with chronic disease, and senior citizens!)
Stay healthy out there!