The General Health Exam

Re: The General Health Exam

Nicola Lawlor — Sun, 04 Sep 2011 22:50:39 GMT

[quote user="Stephen Courtney"]

Approach to a general health exam:

1. Visual inspection as animal comes into the consult room.

2. Weight checked, recorded, compared with previous visits. While this is happening, friendly interrogation about general well being, appetite and toielt and thirst, exercise tolerance. any specific concerns?

3. Start at the nose and work backwards. Look at everything, feel everything, have a sniff. Good look at teeth and ears and any skin folds, palpate and manipulate everything. check the coat, look for fleas and other parasites.

4. auscult chest, while feeling pulses.

5. Abdominal palpation

6. Look under the tail. Inspect genitalia. May or may not do anal glands or rectal/ vaginal exam - depending on history and presentation etc.

Variations on the theme are common however! I should be able to do this well within a couple of minutes. Discussing findings can take a lot longer, then coming up with a plan, estimates etc....

[/quote]

Pretty much this also, but all cases individual. Obviously a lot harder to examine eyes and ears of the bouncy or aggressive patients etc but also some owners have specific concerns or there are issues that need further discussion/examination etc.

Re: The General Health Exam

Evelyn Barbour-Hill — Sun, 04 Sep 2011 18:50:43 GMT

What Stephen said, except that I don't weigh them.

I cannot see the point of taking the temperature as a fixed part of the routine.

I hope I would detect something more subtle than a "football-sized tumour" on abdominal palpation. Of course palpation can only to a certain extent be taught, it has to be learnt. Owners sometimes ask me "What are you feeling for?" and I answer "I'm not feeling for anything, I'm feeling the abdominal organs because it's the only way to examine them" or words to that effect. Palpate all the readily-accessible lymph nodes I can think of: if there were one enlarged, it would be a pity to miss it.

I don't use an ophthalmoscope every time (but I'm wondering if I should); but I do on older cats and on any animal if there is a query about the eyes. The otoscope, only if there is concern about the ears.

Obviously every animal has its teeth and mouth examined properly.

At least ten minutes are allowed . This gives plenty of time for the client to mention any problems or concerns they have, whether they volunteer them (especially when I have my stethoscope in........ but that phenomenon is another thread!) or I draw them out in conversation. Sorry if this sounds a bit too, but five minutes is just not enough.

Re: The General Health Exam

Anonymous — Sun, 04 Sep 2011 17:54:04 GMT

Would you include checking the rectal temperature? If so, cats as well as dogs?

Do people generally use tools (e.g. otoscope and ophthalmoscope) as part of standard general health exam?

I've seen some practices that advise bringing a (fresh-ish) urine sample for dogs and doing dipstick and refractometry as part of standard, but does anyone this side of the Atlantic take a blood and urine sample for 'minimum database' every year?

I always feel rather self-conscious when a vet student is watching and asks what I'm checking for when I examine a healthly animal prior to vaccination: I poke the abdomen (brief deep abdominal palpation) and explain that the only thing I'm likely to pick up on is a football-sized tumour, then I do the 'lymphoma check' on the superficial lymph nodes and query in my head whether routine palpation of the prescap's is really necessary...

I find myself doing a lot more talking (and listening of course!) in the general health exam these days and probably less poking / probing as a result - not sure if this is a bad habit developing or not...

Topics for discussion that are most frequent and take the longest are probably:

Weight loss and diet
Behavioural problems (usually aggressive towards other dogs, separation anxiety or barking)
Chronic / recurrent otitis
Teeth-stuff

Re: The General Health Exam

mariette asselbergs — Sun, 04 Sep 2011 16:20:07 GMT

In my (cheap) dentist they have a very efficient system: while sitting in the waiting room you have to fill in a general health checklist of questions, and I think that this could be very efficient for us. We don't need to spent time weighing a pet the owner can do that. Essential questions about drinking, vomiting and diarrhoea, worming and flea control, stamina, seasons, behaviour, itchiness, eye and ear trouble, coughing, lumps and bumps, etc, all of this the owner can check off, and we don't have to waste expensive time on it. Especially if all of it can be ticked off as no problem. It even serves to make the owner aware of what kind of things to look out for.

To me the health check varies totally with age, and may be some notorious problem breeds. But with a bouncy 2 year old lab, or wriggly staffy I am not worried to do the basics and vaccinate. As age progresses I do pay more and more attention to kidneys, diabetes, possible pyo's, lumps and bumps. To be honest, fleas, worms, anal glands, itchy ears, smelly mouths, weight problems, none of them would keep me from vaccinating.

If the owner feels they are a problem then they come consulting me with a problem. If I detect them during a vaccination but the owner had not seen them as a problem, then I can feel I am acting in the interest of the animal's welfare, but to be provokingly honest, I am also serving my business selling all the stuff for these very minor problems am I not? Again gold standard can go very far these days, but many people are happy with basic standard. Think of the difference when buying a second hand ford fiesta or a new mercedes. In the last case the seller will spend hours with you, friendly chatting away, gold standard but you pay for it too.

Re: The General Health Exam

James Laidlaw — Sun, 04 Sep 2011 15:15:00 GMT

[quote user="Stephen Courtney"]

Approach to a general health exam:

1. Visual inspection as animal comes into the consult room.

4. auscult chest, while feeling pulses.

5. Abdominal palpation

6. Look under the tail. Inspect genitalia. May or may not do anal glands or rectal/ vaginal exam - depending on history and presentation etc.

Variations on the theme are common however! I should be able to do this well within a couple of minutes. Discussing findings can take a lot longer, then coming up with a plan, estimates etc....

[/quote]

What he said.

Re: The General Health Exam

Stephen Courtney — Sun, 04 Sep 2011 15:10:36 GMT

Approach to a general health exam:

1. Visual inspection as animal comes into the consult room.

4. auscult chest, while feeling pulses.

5. Abdominal palpation

6. Look under the tail. Inspect genitalia. May or may not do anal glands or rectal/ vaginal exam - depending on history and presentation etc.

Variations on the theme are common however! I should be able to do this well within a couple of minutes. Discussing findings can take a lot longer, then coming up with a plan, estimates etc....