The Physical Exam: Not a Lost Art

As veterinarians, we are trained in the art of the physical exam: Using our senses of sight, smell, touch and hearing to identify abnormalities within the different organ systems.Through this problem solving process, we then eliminate or place certain diseases lower or higher on our list as we attempt to find the cause of the disease and select the appropriate treatment. I am continually reminded of this while working with on-farm staff that there are many opportunities to perfect both diagnosis and treatment of common diseases on the dairy. It is not uncommon for me in a training session or when asked for a second opinion to find cows with missed diagnoses. These were easily found diseases that were missed because someone failed to complete the physical exam. We are fortunate that for the dairy cow, we can focus our efforts on a few key organ systems, diagnose the likely disease and use proven treatment protocols. Sure, we can have diseases of the heart, kidney or other less commonly affected organ systems, but if we concentrate on five key areas or systems, we are likely to find the correct diagnosis for a dairy cow. These include: ✔ Uterus ✔ Udder ✔ Lungs ✔ GI tract (mostly rumen and abomasum) ✔ Metabolic I do not want to over-simplify disease diagnosis. But if we think of the most common diseases in the transition dairy cow, we can (and should) successfully treat her if we narrow it down to this list. For example, if the cow is 100 days in milk, we can very likely rule out metritis as a diagnosis. We must be careful, however, in assuming a disease can’t exist in a certain cow and not perform a complete physical exam. This is where we will miss a key finding and often make the wrong diagnosis. For example, the assumption a fresh cow that is unsteady on her feet with cold ears must have milk fever and does not have mastitis. We skip checking her quarters, miss the correct diagnosis and provide the wrong treatment. Remember to check all systems even if it is unlikely. So back to our above list. Let’s add some likely diseases to our categories. ✔ Uterus: retained placenta, metritis, cancer (less likely) ✔ Udder: mastitis ✔ Lungs: pneumonia ✔ GI tract: displaced abomasum, indigestion ✔ Metabolic: ketosis, milk fever Pretty easy, yes? Again, I do not want to over simplify this process, but if you keep these key systems in mind while performing a complete physical exam, you should be able to make a correct diagnosis in a few minutes. Multiple systems can also be affected. For instance, a cow with mastitis can also have ketosis, or a cow with ketosis can also have a DA. Therefore, don’t stop your exam at the first finding. Collect all the information from the exam and use your problem solving skills. If in doubt, get that second opinion exam from an on-farm colleague or your veterinarian. Fine tuning the diagnosis and correct treatment of disease will improve treatment outcomes, reduce drug use and costs and decrease the risk of residue violations on the dairy. At your next herd health check, ask your veterinarian to review the complete physical exam with your dairy’s animal health treatment crew. A timely diagnosis and treatment will likely lead to an improved outcome for the cow.    Note: This story appeared in the September 2017 issue of Dairy Herd Management.