The value of stethoscoping every patient

RE: The value of stethoscoping every patient

Martin Atkinson — Wed, 13 Sep 2017 09:54:06 GMT

[quote user="Michael Woodhouse"]Be realistic. The actual number is meaningless, although I would note it in a small animal if clinically relevant - dog with a HR of 30. I simply don't believe you can create a magical baseline for an animal based on a snap measure at some point,[/quote]I do agree, I will note if I think its tachycardic, in expected normal range or bradycardic. We had a cat in yesterday which had a history that fitted hyperthyroidism and expected it to be tachycardic but it was obviously bradycardic so I performed an ECG. Its HR was 90 which is bottom end of normal but it had 3rd degree heart block.

RE: The value of stethoscoping every patient

Michael Woodhouse — Wed, 13 Sep 2017 01:04:24 GMT

[quote user="Gillian Mostyn"]Not very useful if a different vet subsequently sees the animal.... or if you're trying to assess whether there has been any deterioration in cardiac function since it's vacc last year.... both numbers are likely to be 'normal'.[/quote]

I bet you good money if you took the heart rate of a patient 5 times over the consult you'd get 5 different numbers. Do you really believe there is sufficient sensitivity in a HR to say the dog is deteriorating because this year it is 76 and last year it was 64? What if it was getting excited by a cat in the waiting room? Had less time to settle in the room etc?

Be realistic. The actual number is meaningless, although I would note it in a small animal if clinically relevant - dog with a HR of 30. I simply don't believe you can create a magical baseline for an animal based on a snap measure at some point, whether that's biochem or some vital sign.

I think we need to go back to the flawed thinking thread with this and the cure cow before diarrhoea comment earlier.

RE: The value of stethoscoping every patient

Anthony Todd — Tue, 12 Sep 2017 18:04:52 GMT

[quote user="Gillian Mostyn"]Not very useful if a different vet subsequently sees the animal[/quote]

Really relevant if the animal hates "different vet" and bit him/her last time, so this time muzzles the arstard....

RE: The value of stethoscoping every patient

Gillian Mostyn — Tue, 12 Sep 2017 15:01:17 GMT

[quote user="Michael Woodhouse"]I can't remember the last time I actually counted a heart rate, but I will get an almost instant impression of 'normal, 'slow' or 'fast'. [/quote]

Not very useful if a different vet subsequently sees the animal.... or if you're trying to assess whether there has been any deterioration in cardiac function since it's vacc last year.... both numbers are likely to be 'normal'.

RE: The value of stethoscoping every patient

Anthony Todd — Tue, 12 Sep 2017 11:11:54 GMT

[Far from pretending to be wise or a know all]

I was taught to push, with closed fist, just below and in front of the right ilial mound and a fluid squishy sound always indicated on-coming diarrhoea in cattle, presumed salmonella.

We used to see a fair few "salmonella" infections where I/V neomycin powder in saline [I think] was always curative if given early enough.

Used to sit on the left scapula of downer cows with my left hand on the heart and feel it come up as the calcium borogluc. was fluttered in and the response to ear-flicking was assessed......

Amazing what my distant memory can do, but yesterday is a problem,,,,

RE: The value of stethoscoping every patient

peter chalkley — Tue, 12 Sep 2017 11:09:51 GMT

I think this has 2 sides.

clinical use and client perspective.

clients expect you to listen to the heart, regardless of presentation and I have been questioned as to why I haven't on things such as impacted anal glands!

clinically, its hard to justify not doing it. its free, it takes up 60 seconds. (maybe less....)

if you detect a slow heart rate in sick dog, a fast heart rate, an irregular heart rate, a new murmur, irregular sounds or difficulty auscultating at all you may pick up something that is pre clinical signs. you might notice SFA, but at least you have listened and said everything is fine.

do we need it every time, no, should we do it, probably!

RE: The value of stethoscoping every patient

mariette asselbergs — Tue, 12 Sep 2017 00:48:53 GMT

Michael I think you only get to your sort of confidence by spending years auscultating thoroughly and carefully.

Mariette

RE: The value of stethoscoping every patient

Michael Woodhouse — Tue, 12 Sep 2017 00:44:35 GMT

[quote user="mariette asselbergs"]I always auscultate patients thoroughly,[/quote]

I don't. I see it rather like driving - I will do most of it on auto-pilot and generally anything abnormal jumps out pretty quickly. If I'm not happy then I listen harder. I'll often listen to a cows rumen with one bud in my ear an the other against my cheek whilst I get some history.

I can't remember the last time I actually counted a heart rate, but I will get an almost instant impression of 'normal, 'slow' or 'fast'. A watch is not practical with farm work and I leave my phone in the car.

RE: The value of stethoscoping every patient

mariette asselbergs — Tue, 12 Sep 2017 00:23:43 GMT

Maybe it is because i am old and was a large animal vet for a very long time, but I have always found the use of a stethoscope extremely useful. Not just listening to the heart, but lungs and abdomen too. I always auscultate patients thoroughly, because it helps to know what sounds normal and then find the thing that sounds odd. I find it weird that vets would think it just a gesture and meaningless.

Mariette

RE: The value of stethoscoping every patient

Eilidh Corr — Mon, 11 Sep 2017 20:45:20 GMT

[quote user="David Mills"]You mean cardiac? Because that certainly isn't reflected in study figures.[/quote]

Well, no, I meant generally. But then I work in a practice where labradors, spaniels and terriers are overrepresented and we probably have quite a low annual vaccination rate! You're absolutely right, estimation is so vague it's as good as useless. Audit would be lovely but really I have enough to fit into my ten minutes in my overbooked busy mixed practice so I'll reserve that extra effort for areas where we have a problem (we do record caesarean section information following a spell of bad outcomes - no conclusions were reached and the problem appears to have resolved so in the event it was not that useful, but once a habit is formed ...).

RE: The value of stethoscoping every patient

Beats — Mon, 11 Sep 2017 19:11:06 GMT

[quote user="Bob Russell"]

[quote user="Alistair Graham-Evans"]

I know I am a bit pedantic but I believe stethoscope is a noun and not a verb

[/quote]

Not pedantic.

To stethoscope (used as a verb): I stethoscope, you stethoscope, we stethoscope?

The process of stethoscoping??

I listen to a dogs chest sounds or auscultate but I never stethoscope!

Sorry to bicker but this one is a verb too far!

My English skills let me down on occasions (usually through carelessness) therefore I rarely grumble about peoples grammar or spelling. Not this time though!

[/quote]

Not where I saw this thread going... but if curious:

stethoscope v. (trans.) to apply a stethoscope to, examine with a stethoscope.

1840 A. Ewing in A. J. Ross Mem. (1877) 66 He would be much better able to judge if I would allow him to stethoscope me.

1865 Spectator 30 Sept. 1084 He has been repeatedly stethescoped, and his lungs pronounced perfectly sound.

perhaps we could have our own better definitions though based on this thread:

to auscultate: to listen carefully, usually in a quiet room, with the aim of assessing for unusual heart sounds, murmurs and arrhythmias in a patient suspected of having a cardiac abnormality - typically done with a stethoscope.

to stethoscope: the process of briefly plugging one's ears due to the external noise and commotion, then applying or waving a stethoscope near a dog's chest while thinking about what one is doing; thought to increase the dog owners perception of the vet and the sum of money they are willing to part with.

RE: The value of stethoscoping every patient

David Mills — Mon, 11 Sep 2017 13:30:37 GMT

[quote user="Eilidh Corr"]I'd estimate I find an abnormality on 25% of healthy adult dogs presented to me.[/quote]

You mean cardiac? Because that certainly isn't reflected in study figures.

Why estimate? Very easy audit to do. I think you'd be surprised by the results.

RE: The value of stethoscoping every patient

Bob Russell — Mon, 11 Sep 2017 11:13:56 GMT

[quote user="Alistair Graham-Evans"]

I know I am a bit pedantic but I believe stethoscope is a noun and not a verb

[/quote]

Not pedantic.

To stethoscope (used as a verb): I stethoscope, you stethoscope, we stethoscope?

The process of stethoscoping??

I listen to a dogs chest sounds or auscultate but I never stethoscope!

Sorry to bicker but this one is a verb too far!

My English skills let me down on occasions (usually through carelessness) therefore I rarely grumble about peoples grammar or spelling. Not this time though!

RE: The value of stethoscoping every patient

Martin Atkinson — Mon, 11 Sep 2017 09:21:06 GMT

If it does nothing else the client sees you doing something for their money. They don't always realise that you are giving the animal a clinical examination when you're just using your hands and eyes.

I'm not sure that finding an abnormality in a young healthy dog of a not-at-risk breed is overly significant but is much more so in cats. IME a third of young cats with a cardiac murmur will progress to ATE or cardiac failure within 3 - 5 years so I'm much more proactive in investigating these.

RE: The value of stethoscoping every patient

Julie Innes — Mon, 11 Sep 2017 08:47:32 GMT

I do it pretty much every time, unless its specifically eg a skin exam. It's force of habit, doesn't hurt the animal, sometimes throws up something useful and, most importantly, gives me a couple of minutes peace without the client yapping all sorts of irrelevant stuff at me . Also, it gives the clients reassurance that you are examining their animal "thoroughly"

RE: The value of stethoscoping every patient

Alistair Graham-Evans — Mon, 11 Sep 2017 03:01:36 GMT

I know I am a bit pedantic but I believe stethoscope is a noun and not a verb

RE: The value of stethoscoping every patient

Evelyn Barbour-Hill — Mon, 11 Sep 2017 02:42:50 GMT

I refer to this process as auscultation, not as stethoscoping.

RE: The value of stethoscoping every patient

Alistair Graham-Evans — Mon, 11 Sep 2017 00:54:44 GMT

I find that while I have the stethoscope in my ears it gives me invaluable thinking time without interruption from the client. However I do not routinely take the temperature of clinically normal animals coming in for routine treatment - is this bad!?

I have worked as a locum at clinics where temperature recording of every animal that crossed the threshold was mandatory and discovered that most of the animals hated visiting those premises and the range of temperatures in normal animals was huge - especially after getting excited in a car in Queensland - up to 39.5 is quite common.

RE: The value of stethoscoping every patient

Eilidh Corr — Sun, 10 Sep 2017 14:24:30 GMT

[quote user="Beats"]How often do you feel a healthy adult dog should be stethoscoped?[/quote]

I think an annual check is more than adequate, unless you're monitoring a murmur. The EPIC study is what will change things. I'm really not sure how I'm supposed to persuade clients to treat their clinically well pet though - it is easy to get them on board once the signs of CHF are obvious but the perceived benefit of medicating an externally well dog is intrinsically less, that's a tricker one. Especially since we've all happily been withholding medication from these MVD dogs, sometimes for years, without known detriment. I suspect this is an area where reading the client's agenda will be an essential skill

RE: The value of stethoscoping every patient

Anthony Todd — Sun, 10 Sep 2017 10:21:53 GMT

[quote user="Beats"]probably justification enough for me[/quote]

The stethoscope, and listening to the heart, has enormous benefit in the owners mind whereas asking about water consumption, probably, clinically, much more important, is brushed off as inexplicably incidental.

Why do you think most doctors, and many vets, wander round with a stethoscope round their neck, carefully styled, depending on which uni they attended.

In the same way "an injection" is regarded as an absolutely essential therapeutic act; treatment is regarded as totally inadequate without it.

RE: The value of stethoscoping every patient

Beats — Sun, 10 Sep 2017 09:45:33 GMT

[quote user="Eilidh Corr"]I probably find an abnormality which prompts me to advise the client that we should take some action in less than 3%[/quote]

Assuming the action has a sufficiently beneficial outcome (and is only rarely and mildly detrimental) then that's probably justification enough for me. My feeling is that I probably advise action in significantly less than 1 in 33 healthy adult dogs stethoscoped, but my feeling is usually a poor reflection of what i actually do. I wonder if anyone has numbers on this stuff these days with all that data that is collected?

How often do you feel a healthy adult dog should be stethoscoped?

RE: The value of stethoscoping every patient

Eilidh Corr — Sun, 10 Sep 2017 08:25:31 GMT

Anyway I think the perceived benefit is greater than the actual benefit, from the client's perspective anyway.

RE: The value of stethoscoping every patient

Eilidh Corr — Sun, 10 Sep 2017 08:23:32 GMT

I'd estimate I find an abnormality on 25% of healthy adult dogs presented to me. I probably find an abnormality which prompts me to advise the client that we should take some action in less than 3%. Although the EPIC study is theoretically going to bring the latter figure into question.