Complete physical exams

Or, "if you don’t look, you don’t find".   When a client presents a pet with a problem they are concerned about, it’s very tempting to go right to that problem.  After all, that’s why they’re here, right?  Unfortunately, unless I go about the pet’s examination in a systematic way, I’m liable to miss something because I just failed to look at it.  Heaven knows it’s easy enough to miss things when you DO look for them —  I see only this brief snapshot of the animal’s life.

Often the client may become impatient while I ask about the pet’s diet, housing, exercise, bathing, and other elements of history.  Why don’t I just look at that infected toe?  Why do I save the problem they came in for until the very last thing?

I don’t want to miss things.  I would feel pretty badly about it if the pet came in with four problems and I failed to notice three of them.  That’s why I start at the front and work my way back, looking at eyes, ears, mouth, and throat.  Then I listen to the heart and lungs, followed by an all-over "touchie-feelie".  Finally I comb through the hair with a flea comb, examining the skin and looking for flea-droppings. 

If I went straight to the area of complaint, I might forget to look at some part of the rest of the animal.  Often the most pressing problem in the client’s mind is just the tip of the iceberg, with several related difficulties being part of that same problem.  Sometimes the client perceives something other than the problem’s true nature (as in the dog straining with a urinary blockage, which the client mistakes for constipation).  If the problem is painful, poking the pet’s sore place first can make it a bit difficult to finish the examination.  Finally, the client is unlikely to let me forget their main complaint, since that’s why they came in the first place.

Here’s kind of a cool example of what I might have missed today.  Considering how few Scottish Terriers we see, it’s a bit unusual to see two in one day.  One came in because of a growth on a toe, which we needed to biopsy.  The other had a skin problem which it refused to let the owner examine, as it was so uncomfortable.  Both dogs had one normal ear canal, and one ear canal that was inflamed and clogged with wax and debris, with such a hard plug near the eardrum that it required anesthesia to remove it.  If we hadn’t done a complete exam, not only would we have missed that cool coincidence, but the dogs would have gone home with problems that should have been handled.

So have a little patience when I ask whether your broken-leggedy dog has been taking heartworm preventive.  We can’t do his X-ray until the pain medicine kicks in anyway, so we might as well make good use of the time.

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