The core elements of internal medicine are history taking, physical examination and diagnostics i.e. laboratory tests and imaging studies. We always prefer that the owner is present when a physical exam is performed so that a thorough history can be obtained. When a person goes to visit their doctor, the first question that is often asked is “how are you feeling?” We as veterinarians rely very heavily on the history that you, the owner provide us with regarding your cat’s ailment. We need you to tell us what the main issues or complaints are regarding your cat. How long have these problems been going on? Are these recurrent problems or new ones? Are there other cats (or sometimes even dogs or people) in the household with similar or identical complaints? Is your cat an indoor or outdoor cat? What is your cat’s diet? Is your cat up to date with their vaccines? Is your cat taking any medications, supplements or homeopathic products? Sometimes this history will allow us as veterinarians to focus on a particular area of the body, but most often a complete physical examination is necessary.
A complete physical examination proceeds as follows. We commence with an examination of the mouth focusing on the teeth, gums and tongue. There is not much to do for an examination of the nose other than to look for swelling and for discharge from the nostrils. The eyes are next examined for swelling, inflammation and redness. The eyes should be compared with each other for symmetry, especially the pupils. If abnormalities are discovered or if there is concern regarding the cat’s vision, then the retina should be examined with an ophthalmoscope. The ears both the outer and the ear canal, with the help of an otoscope, are next examined for skin problems, ear mites, yeast infections as well as polyps and growths. As our examination usually proceeds from front to back, next up are the lymph glands in the neck which we check for swelling and pain. The thyroid glands are also located in the neck and are checked for growths and enlargements (a very common problem in cats greater than ten years of age).
We all know that a stethoscope is used to examine the heart. Specifically we are listening and counting the heart rate. We also listen to hear if the heart is beating regularly or if there is an abnormal rhythm. Finally we listen for heart murmurs or abnormal heart sounds. The stethoscope is also used to listen to the lungs for problems with breathing. When a physician examines us with a stethoscope, we are often asked to disrobe and to breathe deeply. Unfortunately our feline patients can’t remove their hair and usually don’t respond to our requests for them to breathe deeply, therefore it is imperative that clients refrain from talking while the doctor is using the stethoscope. As we proceed from front to rear, next is the fine art of abdominal palpation or using one or both hands to feel the organs in the cat’s abdomen. As veterinarians, we are fortunate that with cats we can feel most of the organs in the abdomen very readily and gain enormous amounts of information in doing so about your cats’ internal organs and what is ailing them.
The skin & hair of the cat is next examined. We look at the skin and hair especially around the perineum (the rectal and genital area), the face and the underbelly. If the cat is showing any signs of weakness or lameness the appropriate limbs and joints are examined. Your cat is then weighed and if your cat is sick i.e. depressed, lethargic, suffering from weight loss, decreased appetite, vomiting etc. we usually take its temperature and check for dehydration.
After a good history is taken and a thorough physical exam is completed often a diagnosis can be made right in the office and appropriate medicines dispensed. If however the doctor can’t make a diagnosis in the exam room, he/she will often suggest lab tests and/or imaging services to help elucidate the situation.