The importance of a complete physical examination cannot be stressed enough.  A thorough initial patient exam can give you an excellent baseline for a healthy patient, confirm past medical history, or reveal issues that were previously unknown.  Such was the case at my clinic recently.

The importance of a complete physical examination cannot be stressed enough.  A thorough initial patient exam can give you an excellent baseline for a healthy patient, confirm past medical history, or reveal issues that were previously unknown.  Such was the case at my clinic recently.

• A newly rescued mixed breed dog was presented for an initial examination and a second opinion due to a decreased appetite.
• The dog had been adopted from an animal shelter only a few days prior and was also seen for a preliminary check up at another animal hospital.   (By the way, this is not a post or the arena for throwing other animal hospitals or rescue organizations under the bus, it is merely an example of the absolute necessity of a good patient evaluation.)  🙂
• The new owners had reported that the rescue organization and the other animal hospital had given their new dog a clean bill of health with the exception of likely needing a dentistry in the near future.
• Upon presentation a moderate swelling was seen underneath the right eye, she had severe dental tartar, and a noticeable foul odor from her mouth.  The rest of her physical examination was unremarkable.

Swelling under right eye

•  At first glance and given the history one can easily assume that this is very suspect of a tooth root abscess.  Unfortunately, there was more going on in this little gal’s mouth than was previously thought.

Severe tartar

• 
• When the patient’s mouth was opened to check for any abnormalities in the oral cavity an ulcerated soft tissue mass was seen in the upper right jaw.  For a better inspection the patient was sedated and skull rads were taken
• Carcinoma of the mouth was the diagnosis.

In this skull rad you can appreciate the bone loss of the upper right jaw.
The decision was made to humanely euthanize the patient due to the severe infiltration into the jaw and the fact that the patient was already having difficulties eating.  The outcome for this patient would not have changed had she been diagnosed a few days earlier at either the rescue organization or the initial animal hospital, however it does drive home the importance of a complete patient examination. 

As a technician you should always bring to the doctor’s attention anything you find while working with a patient, as sometimes you may find abnormalities or masses etc, that your doctor may not have caught.  Often times while shaving a leg for a catheter or placing a urinary catheter petechia will be revealed, or while trimming nails on a very hairy paw a swollen or infected toe will be discovered, etc.  Although 9 times out of 10 your doctor has already seen the problem and documented it in the chart.  But for that rare time they don’t,  you have the opportunity to help the patient and your doctor by alerting them to a possible unknown issue.