Dedication v
About the Author xxii
About the Primary Author of Video Content xxiii
Preface xxiv
Acknowledgments xxvi
About the Companion Website xxviii

PART 1 Examining the Feline Patient

1 Setting the Stage: Feline-Friendly Practice 3
1.1 Challenges Faced in Feline Practice, 3
1.2 Finding Solutions to Increase Cat Visits: The Emergence of Feline-Friendly Handling Practices, 5
1.3 Key Principles of Feline-Friendly Practice, 7
1.4 The Role of Sound, 17
1.5 The Role of Tactile Stimulation, 19
1.6 The Role of Scent, 20
1.7 The Role of Advance Preparation, 22
1.8 Examination Room Etiquette: Accessing the Cat, 22
1.9 Recognizing Body Language, 25
1.10 Feline-Friendly Handling, 27
1.11 Other Feline Handling Tools, 32
1.12 The Hands-Off Physical Exam, 36

2 Patient Identification and Assessing the Big Picture: The Body, the Coat, and the Skin of the Cat 39
2.1 Forms of Identification, 39
2.2 The Role of Nutrition in Maintenance of Feline Health and Body Condition Score (BCS), 41
2.3 Assessing Hydration, 47
2.4 First Impressions and Coat Inspection, 50
2.5 Identifying Coat Colors and Coat Patterns, 53
2.6 Assessing Coat Quality, 60
2.7 Inspecting the Skin, 67
2.8 Inspecting the Claws, Paw Pads, and Toes, 74
2.9 Inspecting the Mammary Chains, 76
2.10 Additional Tools that Facilitate Inspection of the Skin, 78

3 Examining the Head of the Cat and Associated Vital Structures 82
3.1 Skull Shape, 82
3.2 Facial Symmetry, 86
3.3 The Eyes and Accessory Structures, 89
3.4 The Ears, 129
3.5 The Nose, 141
3.6 The Vibrissae, 145
3.7 Extraoral Examination, 145
3.8 The Intraoral Examination, 152

4 Examining the Endocrine and Lymphatic Systems of the Cat 169
4.1 Evaluating the Thyroid Gland, 169
4.2 Assessing the Lymphatic System, 174

5 Assessing the Cardiovascular and Respiratory Systems of the Cat 180
5.1 Introduction to the Thoracic Cavity, 180
5.2 The Feline Cardiac Patient, 181
5.3 Assessing the Cardiovascular System Prior to Auscultation, 185
5.4 Cardiothoracic Auscultation, 188
5.5 The Feline Respiratory Patient, 198
5.6 Assessing the Respiratory System Prior to Auscultation, 202
5.7 Understanding Normal Airway Sounds, 210
5.8 Auscultating the Airway, 211
5.9 Understanding Adventitious Airway Sounds, 211
5.10 Using Airway Sounds to Corroborate Percussive Findings, 212
5.11 Purring as an Obstruction to Auscultation, 212
5.12 Veterinary Wearables for Vital Signs, 212
5.13 Other In-House Support for Vital Signs, 214

6 Examining the Abdominal Cavity and External Genitalia of Cats, with a Brief Introduction to Pregnancy and Neonatal Norms 218
6.1 Overview of the Digestive Tract as it Pertains to Presenting Complaints, 218
6.2 The Esophagus, 229
6.3 Visual Inspection of the Abdomen, 229
6.4 Superficial Palpation and Auscultation of the Abdomen, 230
6.5 Deep Palpation of the Abdomen, 234Contents xiii
6.6 The Upper Urinary Tract, 249
6.7 The Lower Urinary Tract, 254
6.8 The Male Reproductive Tract, 263
6.9 The Female Reproductive Tract, 269
6.10 Neonates, 276

7 Examining the Musculoskeletal System of the Cat 284
7.1 Muscle Condition Score (MCS), 284
7.2 The Skeleton as a Whole, 287
7.3 Key Components of the Axial Skeleton to Appreciate on Physical Examination, 288
7.4 Key Components of the Appendicular Skeleton to Appreciate on Physical Examination, 291xiv Contents
7.5 A Deeper Dive into the Appendicular Skeleton: The Forelimb, 304
7.6 A Deeper Dive into the Appendicular Skeleton: The Pelvic (Hind) Limb, 311

8 Evaluating the Nervous System of the Cat 325
8.1 Assessing Mentation and Differentiating it from Behavior, 325
8.2 Assessing Posture and Abnormal Head Positions, 328
8.3 Assessing Coordination, Gait, and Voluntary Movement: Paresis Versus Paralysis, 333
8.4 Assessing Postural Reactions, 335
8.5 Dyskinesias, 338
8.6 Evaluating Spinal Reflexes, 338
8.7 Assessing Cranial Nerves, 341
8.8 Assessing Nociception, 346

PART 2 Examining the Canine Patient

9 Setting the Stage: Dog-Friendly Practices 353
9.1 The Human–Animal Bond and Addressing the Clinical Challenge of When that Bond Breaks, 353
9.2 The Low-Stress Handling Movement, 355
9.3 Fear Free Certification, 357
9.4 The Dog-Friendly Clinic Scheme, 357
9.5 A Fresh Start: Building Dog-Friendly Practices into the Clinic, 358
9.6 Considerations About White-Coat Syndrome, 360
9.7 The Role of Scent, 361
9.8 The Role of Advance Preparation, 363
9.9 Examination Room Etiquette: Setting the Tone for Initial Veterinary Interactions with the Dog, 363
9.10 Recognizing Body Language, 365
9.11 Creative Approaches to Challenging Interactions with Canine Patients, 371
9.12 Other Canine Handling Tools, 372
9.13 The Hands-Off Canine Physical Exam, 376

10 Patient Identification and Assessing the Big Picture: The Body, the Coat, and the Skin of the Dog 379
10.1 Forms of Identification, 379
10.2 Body Condition Scoring, 380
10.3 Assessing Hydration, 388
10.4 Patient Signalment, Breed Designation, and Breed-Specific Legislation (BSL), 390
10.5 First Impressions and Coat Inspection, 391
10.6 Identifying Coat Colors and Coat Patterns, 393
10.7 Assessing Coat Quality, 399
10.8 Inspecting the Skin, 404
10.9 Primary Skin Lesions in Canine Patients, 408
10.10 Secondary Skin Lesions in Canine Patients, 412
10.11 Miscellaneous Skin Lesions, 414
10.12 Hyperkeratosis, 416
10.13 Skin Folds, 416
10.14 Nails and Paw Pads, 419
10.15 Skin Incisions, 423
10.16 Mammary Glands, 423

11 Examining the Head of the Dog and Associated Vital Structures 427
11.1 Skull Shape and Associated Welfare Concerns, 427
11.2 Facial Symmetry, 434
11.3 The Eyes and Accessory Structures, 436
11.4 The Ears, 462
11.5 The Nose, 471
11.6 The Vibrissae, 474
11.7 The Extraoral Examination, 475
11.8 The Intraoral Examination, 481

12 Examining the Endocrine and Lymphatic Systems of the Dog 498
12.1 Evaluating the Canine Thyroid Gland, 498
12.2 The Typical Presentation of Thyroid Neoplasia in the Dog, 499
12.3 The Pathophysiology of Canine Hypothyroidism, 499
12.4 The Typical Presentation of a Hypothyroid Dog, 500
12.5 The Atypical Presentation of a Hypothyroid Dog, 501
12.6 Assessing the Lymphatic System, 501
12.7 Examining the Submandibular Lymph Nodes, 502
12.8 Examining the Superficial Cervical or Prescapular Lymph Nodes, 502
12.9 Examining the Popliteal Lymph Nodes, 502
12.10 Feeling for Lymph Nodes that are not Typically Present in Healthy Patients, 503

13 Examining the Cardiovascular and Respiratory Systems of the Dog 506
13.1 Introduction to the Thoracic Cavity, 506
13.2 Congenital Heart Disease in the Dog, 506
13.3 Acquired Heart Disease in the Dog, 509
13.4 Assessing the Cardiovascular System Prior to Auscultation, 512
13.5 Cardiothoracic Auscultation, 516
13.6 The Canine Respiratory Patient, 523
13.7 Assessing the Respiratory System Prior to Auscultation, 529
13.8 Understanding Normal Airway Sounds, 531
13.9 Auscultating the Airway, 531
13.10 Understanding Adventitious Airway Sounds, 532
13.11 Using Airway Sounds to Corroborate Percussive Findings, 532
13.12 Panting as an Obstruction to Auscultation, 533
13.13 Veterinary Wearables for Vital Signs, 533
13.14 Other In-House Support for Vital Signs, 533

14 Examining the Abdominal Cavity and External Genitalia of Dogs, with a Brief Introduction to Pregnancy and Neonatal Norms 536
14.1 Overview of the Digestive Tract, 536
14.2 The Esophagus, 541
14.3 Visual Inspection of the Abdomen, 543
14.4 Auscultation of the Abdomen, 544
14.5 Superficial Palpation of the Abdomen, 544
14.6 Deep Palpation of the Abdomen, 548
14.7 Examining the Perineum and Performing the Rectal Examination, 557
14.8 The Upper Urinary Tract, 560
14.9 The Lower Urinary Tract, 562
14.10 The Male Reproductive Tract, 567
14.11 The Female Reproductive Tract, 573
14.12 Neonates, 579

15 Examining the Musculoskeletal System of the Dog 585
15.1 Muscle Condition Score (MCS), 585
15.2 The Skeleton as a Whole, 587
15.3 Key Components of the Axial Skeleton to Appreciate on Physical Examination, 587
15.4 Key Components of the Appendicular Skeleton to Appreciate on Physical Examination, 589
15.5 A Deeper Dive into the Appendicular Skeleton: The Forelimb, 596
15.6 A Deeper Dive into the Appendicular Skeleton: The Pelvic (Hind) Limb, 603
15.7 Hygromas, 614

16 Evaluating the Nervous System of the Dog 619
16.1 Assessing Mentation and Differentiating it from Behavior, 619
16.2 Assessing Posture and Abnormal Head Positions, 622
16.3 Assessing Coordination, Gait, and Voluntary Movement: Paresis Versus Paralysis, 626
16.4 Assessing Postural Reactions, 627
16.5 Dyskinesias, 631
16.6 Evaluating the Spinal Reflexes, 632
16.7 Assessing Cranial Nerves, 634
16.8 Assessing Nociception, 638

Accompanying Video(s), 642
References, 642

Appendices 643
Appendix I: Reference Intervals for Temperature, Pulse, and Respiration (TPR) for Canine and Feline Patients: Adults and Neonates, 643
Appendix II: Medical Documentation and Templates for Documenting Physical Exam Findings, 646
Appendix III: Tips for Performing the Comprehensive Physical Exam, 664

Index 667