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Expert Advice November 2016 Issue

Dear Doctor - Clinical exam for an older dog

The ins and outs of a clinical exam for an older dog

Q I often hear the term “clinical” exam, as in, ‘I can’t diagnose your dog without a clinical exam,’ but what does that mean, exactly? How does a clinical exam differ from a regular exam? I ask because I have a 10-year-old dog and it’s time for her clinical exam, but I’m wondering if she really needs one.
Amy Petronov
Chicago, illinois

Dear Mr. Petronov,
A A clinical exam is the doctor’s examination of a patient’s body (dog or human) in person, rather than, say, by phone or by looking over medical records. It’s the “show” part of a medical show-and-tell, and it’s a critical screening tool for catching disease early as well as ruling it out.

For a geriatric dog, a clinical exam will at the very least include the veterinarian looking at the following:

Mouth. The vet has to open the dog’s mouth and check for dental disease that wouldn’t otherwise be apparent. Early detection can help to nip a problem in the bud — for significantly less money than the cost of dental procedures once a problem has progressed.

Heart. The vet will undoubtedly listen to your dog’s heart with a stethoscope to see whether he can detect a murmur. That’s a sloshy, or slurpy, sound that can indicate that blood is flowing backwards through a heart valve rather than forward. Since valve disease is the most common kind of heart disease in dogs, catching it and treating it early will help insure that the pet has as many comfortable years ahead of her as possible.

Abdomen.The doctor will palpate (feel) your dog’s abdomen to check for a mass in the liver, intestines, or spleen, among other possible problems. (If a mass is detected, further tests will be conducted to determine whether it’s benign or malignant as well as the best treatment protocol.)

Body. You should always be on the lookout for new lumps or bumps yourself, especially on a geriatric dog. But the doctor needs to perform his own check. Sometimes there’s a bump on a hard-to-see or hard-to-reach spot like the inside of the leg, and it warrants professional consideration.

Eyes. On a clinical exam, a vet will look for both cataracts and glaucoma, both of which can impair vision. Glaucoma can also cause pain, not to mention blindness. (A cloudy lens in itself does not signify the presence of a cataract. A normal change of aging called lenticular sclerosis can create a cloudy lens as well. A dog who has it can still see reasonably well.)

Clinical wellness exams should go hand-in-hand with blood tests when it comes to geriatric dogs. One of those blood tests is called a complete blood count, or CBC, which measures the levels of white blood cells, red blood cell levels, and blood platelet levels. There are ranges for normal, and if a level falls outside that range, it could be a sign of illness and will prompt the vet to conduct further testing.

A second blood test typically run for older dogs as part of the clinical exam is a serum biochemical profile, also known as a chemistry panel. That measures a protein in the blood called albumin, which, if low, could be suggestive of kidney disease, gastrointestinal protein loss, or liver disease. The chemistry panel will also measure liver enzymes to check for liver dysfunction resulting from such problems as Cushing’s disease. Blood sugar will be looked at, too, as will creatinine and blood urea nitrogen. If either of those last two are elevated, kidney disease is suspected.

You, as dog “parent,” are not off the hook during the clinical exam. The vet will want a medical history since the dog’s last visit: has she been drinking more, urinating more, eating less? Has the sound of her bark changed? Does her coat look different? Does she seem disoriented? The answers to all of those questions will be taken into consideration as the vet determines where further probing for problems needs to be done.

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