Performing the Small Animal Physical Examination offers an easy-to-follow guide to successfully executing a thorough physical exam in cats and dogs, with nearly 1,000 clinical photographs depicting step-by-step details.
* Provides comprehensive, practical information on the physical examination in small animal patients
* Presents nearly 1,000 color photographs with step-by-step details of the procedures and principles
* Offers advice on preparing the examination room, useful tips, and concrete guidance for examining each body system
* Outlines a systematic, in-depth approach to the initial examination in dogs and cats
* Supports new and experienced veterinarians and veterinary technicians alike in performing a thorough basic exam
Setting the Stage: Feline-Friendly Practice
1.1 Challenges Faced in Feline Practice
Every 5 years, the American Veterinary Medical Association conducts a national survey to track trends in pet ownership. In 2012, the number of owned cats exceeded the number of owned dogs in the United States by over four million . Yet despite their growing popularity and the increased perception that cats are members of the family, cats remain underserved when it comes to veterinary care [1-4].
By their own admission, cat-owners are less likely than dog-owners to pursue annual wellness examinations. According to the Bayer Veterinary Care Usage Study, a four-phase analysis of companion animal practice, only 37% of cat-owners over a 12-month period visited a veterinary clinic for routine examination . Indoor-only [2, 5] and aged populations  were at increased risk of escaping veterinary medical attention. The former were perceived as being less likely to succumb to illness , and the overall value of the veterinary wellness visit was lost on cat-owners, 83% of whom believed their cat to be in "excellent health" . Were it not for vaccinations, many cat-owners would not pursue routine veterinary care at all .
The Bayer Veterinary Care Usage Study concluded that cat-owners' reluctance to seek veterinary medical care is multifactorial . One major driving force is lack of owner education [2, 6]. Many cats are unplanned acquisitions: "I didn't necessarily find the cat, the cat found me" . As a result, cat-owners may receive limited, if any, initial guidance as to when to pursue veterinary care . By contrast, dog-owners tend to plan the introduction of a new pet into the household and are more likely to seek out instructions on proper care from breeders and shelters.
Many cat-owners are unaware that routine wellness care is essential . Further compounding the issue is that cats effectively mask subtle signs of illness. Cat-owners often find it difficult to determine when their cat is sick [3, 8]. When cat-owners do recognize illness, over one-third of them look to the Internet for veterinary medical advice rather than pursue veterinary medical attention [5, 6].
Of those cat-owners who do perceive value in preventive medicine, the toll that veterinary visits take on the cat and cat-owner alike represents a significant barrier to follow-up care . Cat-owners view the veterinary visit as an ordeal, the stress of which begins well before the client and cat ever set foot in the clinic [2, 6].
Owners must first capture the cat, which is easier said than done. The cat may hightail it at the sight of a cat carrier or aggressively resist being confined to it. As a result, cat-owners look forward to this aspect of the veterinary visit the least , yet of those surveyed, only 18% had been instructed by the veterinary team on how to decrease transportation-associated stress .
Once confined to the cat carrier, the cat may vocalize for the duration of the journey to and from the clinic. Upon arrival to the clinic, cats become visibly stressed in the waiting room, especially when their space is encroached upon by other patients. When they finally reach the examination room, their tolerance may be sufficiently limited .
To summarize their veterinary experience, the Bayer Veterinary Care Usage Study asked 1938 cat-owners to create a collage representing their veterinary experience. The majority of cat-owners used pictures from horror films . Fifty-eight percent of cat-owners described their cats as hating veterinary visits .
This perception of the veterinary experience adversely impacts the profession's ability to attract and retain cat-owners and to provide consistent, high-quality medical care. The veterinary visit is undoubtedly a source of feline stress, the net result of which may be provoked aggression. When cats are fractious, the veterinary team is unable to examine them thoroughly. Feline stress may artificially create abnormal physical examination findings such as tachycardia and tachypnea. The intensity of the stress response may also induce abnormalities in routine screening and other diagnostic tests. Stress hyperglycemia is common, and can be challenging to differentiate from diabetes mellitus without additional testing. If stress is not recognized as the culprit for these abnormalities, the veterinary team may use the test results to support a diagnosis that is inaccurate. This places the patient at increased risk of being subjected to irrelevant or inappropriate treatment plans [10, 11].
Of equal concern is that cats' behavior in the home appears to be altered for some period of time after the veterinary visit. Cats may become standoffish after visiting the clinic, and this may last for several days . In addition, the residual effect of the veterinary visit may transiently impact inter-cat dynamics in multi-cat households. The hospital-goer is not always welcomed back into the fold with open arms, and inter-cat aggression may ensue.
As a result of the many challenges that cat-owners face when committing to a veterinary visit, most prefer to avoid the clinic altogether . This, combined with feline resistance, represents two significant obstacles to cats receiving veterinary care.
1.2 The Emergence of Feline-Friendly Practice
As a result of feline and owner resistance, cats are a largely untapped resource for the veterinary profession: between 2001 and 2011, annual feline visits decreased by 14% .Hence cats represent a rich opportunity area to increase veterinary revenue. Practice management tools may help to capture this underrepresented population through the use of social media and by relying upon business metrics more effectively to identify patients with lapsed appointments . However, without addressing cat-specific issues surrounding the veterinary visit, marketing campaigns focused strictly on data may not be as effective.
The concept of feline-friendly practice emerged from the realization that the burden is on the veterinary profession to adapt to cats, not the other way around. Cats are not small dogs. Cats have different behavioral, physiological, medical, and psychological needs. Furthermore, owners hold different expectations when it comes to their care . The American Association of Feline Practitioners developed the Cat Friendly Practice program to cater to this distinct population of companion animals . Although practitioners are not required to participate, those who do are provided with the tools necessary to adopt a feline-centered practice philosophy . It is hoped that participating institutions will elevate their approach to feline care in order to attract, medically manage, and retain cat-owning clientele.
1.3 Key Principles of Feline-Friendly Practice
Feline-friendly practice philosophy centers on an understanding of normal cat behavior and communication. Cats are often misunderstood, especially when it comes to our perception of how cats respond to conflict [13, 14]. Cats are by nature solitary: prior to domestication, they lived and hunted alone [13, 14]. Hence they avoid altercations with other cats rather than engage in conflict whenever possible [13-15]. This explains why the provision of escape routes and hideaways is so important when dealing with inter-cat aggression in the home . Cats need to feel that they can get away. They need both to be able to hide a visual source that is distressing to them and to be themselves hidden from view (Figure 1.1). Cat trees with hideaways that have a separate entrance and exit are preferred so that cats do not become trapped by an aggressor.
Figure 1.1 Cat tree demonstrating a hideaway with a separate entrance and exit.
Cat trees and shelves are also used to create a buffer between cats in shared living quarters. This vertical space serves a dual function: an elevated escape route or a way to increase distance between cats . Cats are able to seat themselves where they feel comfortable based upon their preexisting social hierarchy (Figure 1.2).
Figure 1.2 Cat tree demonstrating how vertical space allows cats to share living space. Source: Courtesy of Bianca J. Hartrum.
One can take these same principles and adapt them to feline-friendly practice by creating a clinic setting in which cats are minimally exposed to other cats and other species . The ideal feline-friendly practice has a designated cat-only waiting room (Figure 1.3).
Figure 1.3 Separate waiting area designated for cats.
Preferably, shelving is provided to keep carriers off of the ground to build a sense of security through the simulation of vertical space .
When at all possible, the practice should structure its appointment schedule to minimize wait times. When unforeseen circumstances extend the wait, feline patients should be directed into cat-only examination rooms as soon as possible.
If the examination rooms have windows facing the interior of the corridor, blinds may be installed to reduce visual stimuli (Figure 1.4).
Figure 1.4 Blinds installed in cat-designated examination rooms may...