Interview with Dr. Karen Fling: Annual Exams from the Veterinarians Point of View

Recently, I had the opportunity to speak with Dr. Karen Fling through an amazing organization called Partners for Healthy Pets, whom I met at Blog Paws last month. Partners for Healthy Pets strives to improve the lives of our companion animals though preventative veterinary medicine.

“Preventative Care is essential as food and love”

Partners contacted me and we brainstormed how I could share with my readers the importance of annual exams. We thought an interview with a Partners for Healthy Pets affiliated veterinarian, and spokesperson, would be perfect!

Dr. Fling provides veterinary services at East Lake Veterinary Hospital and East Lake Cat Care Center in Dallas, Texas. Additionally, she works as a spokesperson for Partners for Healthy Pets. To learn more about Dr. Fling watch her video below.

Some of you may remember that I wrote about the importance of annual exams when my blog was just a baby in August 2013, which you can read here. Since it was one of the first things I decided to write about, I think its fair to say that preventative medicine is at the top of my list for pet parent education. Therefore, I took this opportunity to expand on my original post, and try to pose questions that would benefit pet parents everywhere. Additionally, we have a lot of Real Life Examples available for your information, which I will be sure to point out in each section. Below is my interview with Dr. Fling.

1) Can you share with my readers the basic breakdown of the annual exam? Many owners see veterinarians looking over their animal, but they don’t always know what they are looking for, and why.
Many owners don’t realize that when your veterinarian is “petting” your animals, they are actually feeling muscle tone, checking lymph nodes and looking for things like parasites or tumors. Also, as they are glancing at your pet while gathering history, they are studying things like gait or their overall demeanor as a part of the annual exam. When your pet is roaming around on the floor, your veterinarian is observing to check your pet’s mobility, range of motion, and energy. Also, as your vet is “petting” your animal, they are actually feeling for lumps and bumps, and irregularities in their lymph nodes.
Veterinarians perform what is called a Head to Toe exam:
Mouth & Teeth: Because the enamel on pet teeth is much thinner than human enamel, we need to make sure their teeth are checked regularly for damage that may cause discomfort. When checking your pet’s mouth, your veterinarian is checking for calculus, breaks, and chips on your pets’s teeth. Cats are very prone to tip fractures on their canines due to the jumps they make on and off furniture. Additionally, 93% of chips on cat canine teeth lead to pulp cavity exposure! Teeth with exposed pulp need extraction or a root canal! An exposed pulp can cause extreme pain and discomfort and often need to be extracted. Your veterinarian is also checking for tarter build up. Often times a difference in the tarter on the teeth may indicate that they chew more on one side than another, which could lead to discoveries such as tooth abscesses. Lastly, your vet is also checking gum color, which can be indicative of internal health of your pet.
Your vet is also looking for other things like tumors, which can easily hide in the mouth. Real Life Example: I worked with a 1 year old Rottweiler who had a squamous cell carcinoma cancer in her mouth under her tongue. Since she came in for an annual exam, we were able to capture the tumor early enough to remove it, and although the tumor turned out to be malignant, she was able to live another year. The knowledge of the tumor was power for the owner who was able to make her last year very special.
Ears: It is important not only to flip back the ear flap and look inside the ears, but to check them with an otoscope. A dog’s ear is L-shaped (see below), so many items and infections can hide from the naked eye. In particular, your veterinarian is looking for infections and foreign bodies such as foxtails and ticks.
Photo courtesy of

Photo courtesy of

Feel Body: You vet is also feeling over your pet’s body to check for lumps and bumps, and changes in muscle tissue. Additionally, differences in muscles can be indicative of arthritis or joint discomfort your pet may be experiencing.
2) Typically, I share with owners that the annual exam is so important because our pets age so much faster than we do. Is there anything else I should emphasize when speaking to owners?
Indeed animals do age faster than we do, and changes can happen so quickly. Additionally, when a vet hasn’t seen a pet in a while, changes in the pets overall health and appearance may be more obvious to them than to someone who is living with them.
It is important to remember that animals do hide illnesses as a survival instinct (cats are particularly good at this), so it is imperative to complete laboratory testing on a regular basis as well.  Early detection of kidney disease can be paramount in helping save a pet’s life. Typically, if kidney disease can be detected early, dietary changes can be sufficient in doubling the life expectancy. In contrast, late detection can lead to a grim diagnosis and a much shorter life expectancy.
Photo courtesy of

Photo courtesy of

This annual laboratory testing includes bloodwork, urine testing, fecal testing and especially heartworm testing. The American Heartworm Society recommends annual testing in addition to monthly heartworm preventative. The diagnosis for heartworm can be lethal, and every day a pet goes without treatment increases their risk.  Real Life Example:  the first case of heartworm I can recall was a young, seemingly healthy Doberman, who was playing fetch with their owner, when suddenly he collapsed and passed away instantly. This pet had heartworms and while exercising, the heartworms blocked a vital artery. Annual testing for heartworm disease could have prevented such a sudden end to this pet’s life.
3) What is the most common development you experience when performing annual exams (I.e lumps and bumps, or dental plaque)?
Obesity can be seen in over 50% of patients that visit my clinic. Bringing your pet to see your veterinarian can allow your pet to be accessed with a body condition score, which will be helpful for those pet parents who believe their pet is at a healthy weight, when indeed they could afford to lose a few pounds. Managing obesity can prevent conditions like diabetes and can add significant years to the life of your pet and avoid long term medical problems and expenses.
The second most common development we discover is dental disease. The majority of pets have periodontal disease by the age of 3, and many pet parents are unaware that regular dentals can improve quality and length of life. The mouth is the gateway to infection and bacteria in the body, so it is a great place to start preventing disease!
Lastly, lumps and bumps are very common to discover on annual exams, especially as pets age. Real Life Example:  An owner decided to remove a small lump on their dog’s muzzle, because the dog was already getting a dental. The small and seemingly insignificant lump turned out to be a malignant (cancerous) sweat gland tumor and the surgery was a curative treatment in this case, which was great news since the pet was still so young!
4) What was the most unusual development you discovered during an annual exam?
Real Life Example: Once, an owner brought their puppy in for the last set of puppy shots and they asked for a “worm shot”. A history revealed that their puppy vomited after eating every meal. Well, it turned out that the puppy was actually regurgitating and it was because he had megaesophogous, (which can cause aspiration pneumonia) that was caused by an abnormal aortic arch in his heart. The puppy ended up having thoracic surgery that would save his life.
5) Can you think of a time when an annual exam lead to a discovery that saved the animals life?
Real Life Example: Once, when a dog was brought in for an annual exam, I found enlarged lymph nodes in a dog, which turned out to be lymphoma. Due to early detection, the dog was able to be treated with chemotherapy and responded tremendously and went into full remission.
Real Life Example: A kitten was brought in for its final set of booster shots, and I noticed her gums were white. It turned out the kitten had a blood parasite and immediately needed a blood transfusion, which saved this kitten’s life along with treatment with an appropriate antibiotic.
Real Life Example: At an annual exam, I ran bloodwork on a 4 year old cat who ended up having a high BUN/CREA levels (kidney levels). Initially, due to the pet’s age, I thought it was a fluke so I ran a recheck on the bloodwork. When the levels came back even higher than before, this cat was diagnosed with severe kidney disease. Initially, it seemed to be a blessing that the owners had four of her kittens as well, and so they believed they had a kidney donor. They took the kittens and mama cat (who needed a kidney transplant) to UC Davis to find a match. When none of the kittens turned out to be a match, it seemed like all hope was lost. Then, UC Davis happened to have a donor cat available for a kidney transplant. The 4 year old kitty received her new kidney, and the family adopted the donor cat!
6) Since pocket pets lives tend to be shorter on average than dogs and cats, how often do you recommend they see a vet?
Pocket pets should see the vet at least every 6 months to check their health. Different pocket pets have different things to look out for. Rabbits and chinchillas need their teeth checked regularly for malocclusion (teeth not naturally grinding down), and rodents need to be checked for tumors on a regular basis. The longer a disease is gone untreated, the more expensive and invasive the treatment will be.
7) How can owners prepare for annual exams (I.e paying attention to water intake, writing down the kind of food they eat, etc)?
Not only should owners know what kind of food their pets eat, they should also bring in the bag of food. I like to counsel my clients on how to read a food label. For example, many foods advertise as being for “all stages of life”, but there are requirements necessary for older dogs and cats that may not be included. Additionally, owners should bring in treats so that we can do an FDA search for recalls.
Fresh stool samples and urine are always helpful. So the veterinarian can evaluate stool quality and check for microscopic parasites.
Also, be sure to write down subtle changes in mobility, itchiness, water intake, and appetite. All of these details help your vet to be a better detective.
Feel free to download this Pre Annual Exam PDF I created for pet parents to prepare themselves for an annual exam MKHPPre Annual Exam Q
8) What should parents of senior pets pay attention to, in addition to normal changes?
In addition to everything mentioned above, make sure to not write off subtle changes in your pets activity or health as “aging”. Real Life Examples: I saw an older Husky mix who had slowed down a bit according to her owners and they noticed that she had started whining a lot at night, they thought it must be due to her getting older. It turned out when she had her physical exam, we found a slab fracture on her right premolar that has very painful. After she had her painful tooth extracted, she had a huge turnaround in energy and no longer cried when she went to bed.
9) Any take home messages for my readers?
Listen to and look at subtle changes in your pet. If your pet is due for an annual exam, please schedule one today. Early detection and prevention can cost 2-9 times less than treating an advanced disease. Currently, 20% of dogs and over 30% of cats are not seeing vets annually as compared to 5 years ago. Partners for Healthy Pets is focusing on turning around those numbers!
I want to thank Dr. Fling for her time and for working to improve the lives of our pets every day!
Partners for Healthy Pets provides excellent pet parent information and resources, such as AAHA and AVMA approved veterinary lists, and healthy check up reminders, which you can access here.
Now go schedule those annual exams!

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3 Comment

  1. Reply
    M. K. Clinton
    June 20, 2014 at 5:19 pm

    I really enjoyed speaking with the Partners for Healthy Pets representatives in Las Vegas too. I also spoke with AAHA reps and came home to find Bentley a accredited vet. It made a huge difference! This is a super interesting post. Thanks!!
    M. K. Clinton recently posted…KONG is KingMy Profile

    1. Reply
      June 22, 2014 at 8:30 am

      I haven’t spoken with AAHA yet, but they are on my outreach list. 🙂 I loved working with Partners, I thought it was so cool that they set me up with an interview 🙂

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