Finessing the feline physical

In human medicine, the physical examination has seen technology gradually usurp what once was the Gladstone bag–wielding, house call doctor of the 19th century and, later, the exam room physician. A 2012 meta-analysis showed that general physical exams did little to reduce morbidity and mortality in human patients.¹

However, this is not the case for animals, thanks to their inability to verbalize what ails them—and to questionable observational skills some owners apply to filling in those critical blanks.

According to Lauren Demos, BVMS, DABVP (Feline), chief veterinary officer at Pettable and past president of the American Association of Feline Practitioners, physical exams are at the core of what veterinarians do. In her Fetch dvm360® virtual conference lecture, Demos related the physical exam as the process of obtaining objective, anatomical, physical findings through observation, palpation, auscultation, and sometimes percussion; this information, she said, should be integrated with the patient’s history, particularly current clinical signs and household issues.

Preparing for the exam

With physical exams being such an important component of pet health—especially for cats because they are unlikely to reveal the signs of illness—veterinarians must outwit the feline instinct to avoid exploratory processes. What do we do with the patient who slips through our hands, turns away from us, crouches, stiffens, conceals, bats, and lurches? We’ve got to streamline.

First, maintain a catcentric environment in the hospital. Minimize general activity, smells, and noises ranging from music to door slams, Demos advised. “Things that people are not aware of, cats are so acutely aware of and can be acutely sensitized to,” she said.

Second, equip each exam room with the necessary tools and supplies so that once the cat enters, the work is quick and seamless. Include these key items:

• Stethoscope (neonatal stethoscopes are best suited to the higher frequency of feline heartbeats)
• Thermometer
• Ophthalmoscope
• Otoscope
• Scale
• Exam table
• Clock
• Note-taking equipment/supplies

Third, ready the cat for examination. For fractious cats, muzzles, gloves, nets, and cat bags are useful. But towels, Demos said, are perhaps the most effective and client-friendly restraint tool. Gabapentin (100 mg per cat), which brings calm to even the fieriest felines, can be dispensed 2 to 4 hours in advance of the appointment.

Tranquility can sometimes be achieved with pheromones sprayed on towels and carriers. For some cats, however, full sedation is the only option that renders them safe to handle (see Cat Personalities 101).

Feline exam fundamentals

The initial steps in the exam include gathering the patient history from the owner, obtaining vital signs, and performing a visual exam. Here are some tips:

• History-taking: What is the problem, and how long has it been going on? Why is the client bringing the cat in now for this problem? Are other signs occurring, such as coughing or vomiting? What about diet and medications? Recent changes in the household? Updates on previous or chronic conditions?
• Temperature, pulse, respiration, and body weight:
  • Temperature is impacted by stress/travel.
  • Pulse should range from 160 to 206 beats per minute (up to about 300 beats per minute in hyperthyroid cats).
  • Respiration should be less than 20 breaths per minute (up to 30 breaths per minute in cats with cardiac disease).
  • Body weight trends are important. Weight loss without dietary change is significant. Kittens normally weigh 1 lb per month of age until age 6 months.
• Visual exam: While taking the history, observe the cat’s appearance, gait, behavior, and mentation, as well as its use of senses (vision, hearing, and smell).

Once all the heavy lifting—from reviewing the chart to passively observing the cat—is completed, the final component is the physical exam. It should also be the shortest part, at less than 5 minutes. “The less you touch the cat, the better,” Demos said. “Don’t release your hand from the cat until you’re done with the exam.”

Developing a rote, streamlined process aids in achieving this goal. It also improves quality, she added. “Having a process through which you travel helps you to standardize this and hopefully decrease the risk that you’re going to miss something.”

Demos follows the same procedure every time. With the cat standing on the exam table facing her, she works from head to tail:

• Mouth (left side, right side, incisors/canines, open mouth)
• External ears
• Submandibular lymph nodes/thyroid
• Limbs/paws/claws/pads
• Heart/lung auscultation
• Abdomen (kidneys, liver/stomach, bladder, stool quality, presence of fat/fluid/masses)
• Skin/haircoat
• Tail/perineum/anal glands
• Genitalia

She then performs an ophthalmic exam, starting with the anterior eye to evaluate the cornea, sclera, nictitans, and conjunctiva. In the subsequent fundic exam, she looks for retinal detachment and hyperreflectivity, vascular translucency, and signs of trauma and parasitism.

Most cats dislike internal ear exams, so Demos saves this for last. Using an otoscope, she examines the ear canal and ear drum, looking for things like ceruminoliths, scar tissue, and granulomatous changes.

She recommends having an assistant present during the exam to prevent the cat from backing away. To put a stop to purring, which hampers auscultation, she suggests moving the cat to a different room, picking the cat up, occluding the nostrils, or waving an alcohol-soaked gauze near the nose.

Feline exam frequency

Annual physicals are recommended for adult cats (>1 year), whereas senior cats (>11 years) should be examined every 6 months. Kittens are typically examined in conjunction with their vaccine series through 16 weeks of age. Demos identified the neglected juvenile phase as 6 to 8 months of age. Because this is the stage where problems may begin manifesting, she advocated getting cats back in during this period to check that permanent dentition has erupted properly, flag juvenile gingivitis, and rule out problems like retroviruses and ear mites.

Customized schedules should be created for cats experiencing chronic conditions:

• Weight loss: Regular weight checks
• Hypertension: Blood pressure reading 2 to 4 weeks after medication has begun
• Chronic renal failure: Blood work every 4 to 6 months
• History of pyelonephritis: Urine studies every 3 to 4 months

Despite their secretive nature and distant demeanor, cats can reveal themselves to physical exams built on advanced planning, speed, and economy of touch.

Joan Capuzzi, VMD, is a small animal veterinarian and journalist based in the Philadelphia, Pennsylvania area.

Reference

1. Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev. 2019;1(1):CD009009. doi:10.1002/14651858.CD009009.pub3