Does Your Pet Really Need A Complete Physical Exam?

The following article was written by Dr.Elizabeth Bradt and reprinted with her permission for PetVetJournal.

“Hey, Doc, can you just give my dog a Rabies vaccine without the physical? I know she’s healthy because she is eating, doing her business and taking a walk every day.”

Every veterinarian has fielded this request a zillion times. We are asked why we do physical examinations just before pets go under anesthesia. Why do we do a physical exam on a pet each day it is hospitalized? Why we do a full physical exam when it is obvious the cat is limping on a particular leg or your dog has a football-sized mass hanging off its side. Anyone can see the problem. Why pay for a physical?

 If you are a pet owner who has had little exposure to veterinary medicine, this is a reasonable question. To a veterinarian, who has studied through four years of college and at least four years of veterinary school, the question is ludicrous. Every course that we take and all that we study leads to or stems from the baseline of the physical examination. We study every system of the body in gross anatomy and internal medicine, and relate everything we learn to the physical examination.

Veterinarians are taught to use all our senses in examining an animal. We listen through our stethoscopes to their heart rate and rhythm, as well as listen for the breath sounds and rate and location. We listen to the detailed history the owner gives to get a sense of the animal and what may lead to illness or health.

We use the sense of touch when we palpate all the lymph nodes to make sure they are the normal size, check the thyroid gland and feel for lumps in the skin and in the subcutaneous tissue. We palpate deep in the abdomen to feel for enlarged spleens, abnormally thickened or painful bladders, constipation or gas in the GI tract or pain in different quadrants of the abdomen. We use sight to check their behavior, stance, gait, and mentation and search the skin for parasites and masses. We examine the front of the eye and deep in the eye with magnification to detect cataracts, retinal degeneration and many other eye diseases. We use our sense of smell to detect ketosis of the breath secondary to diabetes and the odor of kidney failure, anal-gland bowel or urinary issues.

Every diagnostic test we perform occurs only after a problem has been found on physical examination.

Hospitals that are certified by the American Animal Hospital Association must comply with more than 60,000 standards to maintain excellence in veterinary medicine. Many of those standards relate to the physical exam.

Each body system, such as mouth and nose, heart and vascular system, musculoskeletal, urogenital, skin, lymph nodes, nervous system, and abdomen, must be checked. Findings must be written down for each body system. Diet and weight must be recorded and reviewed to make sure the pet is on a proper diet. General body condition as far as underweight, normal or obese must be recorded on a numerical scale. An assessment of the animal’s pain score on a numerical scale is now required on every physical exam. If a proper physical examination is not recorded in a pet’s record, a practice can lose its certification.

The reason we do a physical exam is to assess the continuously changing state of your pet’s physiology. Small lumps, heart murmurs, ear infections, incorrect diets, parasites, allergies and a host of other problems that start small can be caught before they turn into larger and more costly issues. Some veterinarians are now advising “twice a year for life” physical exams to stay on top of problems. A dental infection, mass or kidney disease detected at 6 months or a year may be much simpler and less costly to treat than a problem ignored for a couple years .

When your pet is ill with an obvious problem such as toxic ingestion, a seizure or a bite wound, we do a complete physical exam from nose to tail. Veterinarians are trained to avoid being hijacked mentally by the obvious problem by performing a consistent physical exam of each body system before we approach the problem area. If we get caught up in the horrible bite wound that must be cleaned and sutured and don’t complete the physical exam, we might miss a parasite infestation, ear infection or painful dental disease. Because one part of the body affects all the others, the new findings will have an effect on how the obvious problem is treated.

Since your pet has a constantly changing physiology from day to day, we will perform a physical examination just before your pet undergoes anesthesia, even if it was seen two days ago for the problem, to make sure it is safe today to have the procedure performed. For the same reason, sick animals that are hospitalized receive an exam daily.

Physical examinations by a veterinarian are required by AAHA before administering core vaccines such as distemper and rabies to dogs and cats. Your veterinarian will decide if each vaccine is appropriate for your pet’s lifestyle and age, and choose the vaccines that are safest for your pet. If the pet that is mildly sick with enlarged lymph nodes or a fever of unknown origin receives vaccines because these conditions were missed, it may not mount a good immune response to the vaccine. If the immune system is battling a raging infection elsewhere in the body, it will not be able to make new antibodies to the vaccine. Unfortunately, the funds spent on a discounted batch of vaccines without a physical exam at a vaccine clinic may go to waste or, even worse, harm your pet.

A number of people, including some veterinarians and many non-veterinarians, are starting online businesses diagnosing and treating pets without ever laying hands on them. This is a very risky business both for the pet, who may not be diagnosed correctly, and the veterinarian who may be sued for malpractice. In Texas, a veterinarian with an online business went before the 5th Circuit federal court of appeals claiming that he should be able to diagnose and treat over the Internet.  The judge ruled against him, stating:

“The requirement that veterinary care be provided only after the veterinarian has seen the animal is, at a minimum, rational; it is reasonable to conclude that the quality of care will be higher, and the risk of misdiagnosis and improper treatment lower, if the veterinarian physically examines the animal in question before treating it.”

This is the link to the AVMA summary of the case:

http://atwork.avma.org/2015/03/27/federal-court-upholds-physical-exam-requirement/

Dr. Elizabeth Bradt is a 1986 gradute of Tufts University’s Cummings School of Veterinary Medicine and the owner of All Creatures Veterinary Hospital in Salem, MA.