Why a Physical Exam is So Important

I love running diagnostics as much as the next guy. But it's days like the one I had earlier this week that remind me that there is no better test than a physical exam!  Now, having said that, there are MANY times when I cannot tell what is wrong just by looking, feeling and listening..ie you can't diagnose kidney failure or Lyme disease or Feline Leukemia WITHOUT blood tests.


The other day a dog came in "ADR" - for those NOT In the vet world that means "ain't doing right" and yes, THAT is used in vet medicine. Some use NDR (n=not). 
This is all the owner can report sometimes..a non-specific thing but they just KNOW their pet is off. They are usually very right. And they are often picking up on subtle things too.


This was a middle aged large breed dog with nothing really major going on clinically - just down a bit on eating, lethargic, a little trembling at home..nothing crazy though. And in the exam room, the dog was wagging her tail and still bright and alert. 


Then I listened to her chest and heard something that REALLY concerned me - her heart sounded like it was literally RIGHT up against the left side of her rib cage. I couldn't really hear good heart sounds on the right side. Normally, we DO hear louder sounds on the left vs the right but this was beyond normal. It can take years and many dogs/cats to really "get" normal instilled in your brain to the point that something SHOUTS at you like this! I knew in MY HEART that something was physically displacing the heart TO the left...ALL the way to the left. 


I didn't want to be right because, uh..that doesn't happen for any good reason. The best case scenario would be some sort of diaphragmatic hernia with abdominal contents IN the chest cavity - at least that could be surgically corrected. But this dog had no history of any trauma (and that takes pretty BIG trauma in a large dog). And then the history had been one of waxing/waning - she'd be off, then sorta ok, etc.   


I knew when I ordered the chest x-rays it wouldn't be good. The dog had a VERY large mass on the right side of her chest - visible on both views but glaringly obvious on the VD view (dog on her back showing us really clearly the left and right lung fields).  


Unfortunately, this wasn't the only "bad news" case that day where I was "right" based on my gut and the exam.