Exams

What is the purpose of doing an exam on my cat every year?

They look healthy to me. 

Yearly exams, and for older cats, semi-annual exams, are extremely important to catch a large number of disease processes before they make your cat sick enough for you to notice.  Cats are masters at hiding illnesses or any signs of weakness.  By the time you can tell that your cat doesn't feel good, they really don't feel good.  They may have felt that way for awhile, they are just finally to the point where they can't hide it anymore.

When we do an exam, we don't just look at the cat, say, "looks good!", and call it a day.  We examine each body system in detail, and can tell a lot just by what we see and feel.

Eyes.  We look at both eyes for symmetry.  We check to see that the pupils are equal and responding to light normally.  We look at the third eyelids for signs of redness and inflammation that could indicate an upper respiratory infection or other inflammatory issue.  We look at the upper and lower eyelids to check for swelling, or signs of eyelashes growing abnormally and rubbing against the eye.  We look at the corneas for signs of ulcers or scratches, and behind them for signs of cloudiness.  We look at the irises for signs of excess melanin pigment.  We look at the back of the eye at the retina for signs of high blood pressure, or systemic inflammation.  They say the eyes are the windows to the soul.  They can also indicate a lot about general health.

Ears.  We look at the outside of the ears for hair loss or scabs that can be an indication of allergies or ear irritation.  We swab the wax in the ears looking for signs of ear mites or infection.  If we feel that there is something going on with the ears, we will also look into the ear canals with the otoscope to see if the eardrum is intact, and for any abnormal swellings or inflammation.

Nose.  We look at the nose for signs of nasal discharge indicating an infection, viral or bacterial, and for symmetry to rule out nasal tumors.

Oral.  This is a big one.  We see a lot of dental disease in cats of all ages, even young cats, and because cats tend to mask pain or discomfort, you won't necessarily know that they have a tooth root abscess, or a resorptive lesion similar to a cavity. 

Cats can also get what is called stomatitis, which a hypersensitivity reaction to the plaque in their mouth.  This an extremely painful condition.  We see many cats with severe painful dental disease and owners have no idea because their cats haven't shown any signs of the pain that they are most definitely feeling.  We also look at the color of the gums - if they are pale, it can indicate anemia or heart disease.  If they are too dark red or brownish, it could indicate toxin ingestion.  We look for any abnormal swellings that could indicate an abscess or a tumor.

Head and neck.  We feel around the head and neck area looking for scabs that can indicate allergies.  We feel the submandibular lymph nodes that sit just under the back of the jaw looking for swelling that can indicate an infection or inflammation.  We palpate for any abnormal swellings that could indicate an abscess or a tumor.  We palpate the thyroids to feel for enlarged thyroid glands that could indicate hyperthyroidism.

Heart.  We listen to the heart for any abnormalities.  Normal cat heart rate at home is about 120 - 150.  Normal cat heart rate at a stressful place like a veterinary clinic is about 150 - 220.  Heart rates faster than 220 that don't slow down can potentially indicate heart disease.  We listen for a normal steady rhythm.  An abnormal rhythm could indicate either heart disease or an electrical abnormality in the heart.  We also listen for the sound of a heart murmur.  Heart murmurs indicate that the blood is not exiting the chambers of the heart correctly, which can be an indicator of heart disease.

Lungs.  We listen to the lungs for any abnormalities.  Normal lungs sounds should be consistent in all of the lung fields, and should not obstruct being able to hear the heart sounds.  If the lung sounds are more pronounced than usual, it could be an indication of asthma.  If we hear any abnormal sounds such as crackles or wheezes, it could be an indication of a lung infection such as pneumonia.  We also watch the breathing rate and effort.  If your cat is breathing too fast, or is using abdominal muscles to breathe, that can also be an indication of a lung disorder.  Some of these are things that you might notice at home, but they can come on so gradually that you don't notice that they are breathing harder until suddenly they are in respiratory distress.  We try to catch things like that before your cat suddenly can't breathe.

Abdomen.  We palpate the abdomen to basically see inside of it with our fingers.  We shouldn't normally be able to feel the liver.  If we can palpate it easily, then it is enlarged.  We palpate the kidneys to make sure that they are normal sized.  Enlarged kidneys can indicate a variety of things including acute kidney failure.  Small kidneys can indicate chronic kidney failure.  We can't feel an empty stomach, but if it is full of food or a hard or large foreign body, we can generally feel that.  We feel the intestines to make sure that they aren't abnormally thickened, which can indicate intestinal parasites, inflammatory bowel disease, or worse.  We should not normally be able to feel the mesenteric lymph nodes in the abdomen that drain the abdominal organs.  If we can feel them, then there is some inflammatory process going on that we need to investigate.  We palpate the colon to make sure that your cat isn't constipated.  We palpate the bladder to make sure that it is normal in size, not distended or thickened from urinary issues.  We can feel if the abdominal muscles are normal in strength.  If they are extremely weak or have a 'grainy' feel to them, that can be an indicator of a disease process.

Skin/coat.  We look at the overall coat to see if your cat is still grooming normally.  If not, that can be an indicator of arthritis, or another disease process.  We palpate the skin looking for any abnormal lumps or bumps that could be a skin tumor or abscess.  We check for common parasites such as fleas and lice.  We look at the skin itself looking for redness or scabs that could indicate an allergy or a disease process.

Anal sacs.  We always check the anal sacs to make sure that they are not overly full.  Cats, like most animals, have 2 anal sacs that empty at 4:00 and 8:00 on the edge of your cat's anus.  There are several oil glands that empty into these sacs that fill them with a very potent smelling oil.  Normally when they defecate, their stool pushes on these sacs emptying them onto your cat's stool.  This is just another way for animals to mark their territory, and it is also why animals always sniff each others rear ends when they meet - they are familiarizing themselves with the other animal's signature scent.  However with some commercial foods, and with just the natural aging process, cats can have smaller than normal stools which may result in the anal sacs not being emptied normally each time the cat defecates.  The moisture in the oil is reabsorbed, but the sebum; the thick part of the oil, stays in there and just gets thicker and thicker until finally the sac is so full that it ruptures, resulting in a painful nasty draining abscess.  We check those sacs during every exam, and if they are full, we empty them to avoid a potential rupture down the road.

Most of these things that we look at during an exam are not things that you are routinely checking at home and that your cat will most likely never give you an indication if there is a problem in that area until they are really sick.  We very commonly find health issues in cats during routine exams while it is still early in the process, and we can make a significant difference in either curing the disease process, or at least significantly slowing it down to give your cat the longest best quality of life that we can.  That doesn't mean that we can find every disease process during an exam, that is what testing such as blood work, x-rays, etc. are for, but there are a lot of things that we can find to improve your cat's quality and longevity of life, even in young cats.