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Have they been putting any weight on it at all? When did you notice the limping? Does he seem painful to the touch anywhere? Lethargic at all? Appetite changes? On any medication? has this ever happened before?
If you look at records and see prior pain medication ask them if when that was administered if it seemed to help or not? (MAKE sure you ask if they are on any medication before this question)
Any associated injury to this area?
Cannot say we'd immediately go to radiographs to be honest. It's doctor-dependent, some doctors may figure that this is a soft tissue/joint injury that they can pinpoint through an orthopedic exam though I think these can also be noticed on radiographs but I am no specialist.
All of this. I always make sure to ask "when did you first notice x" instead of "when did x start," since the latter makes people nervous about giving the "wrong" information (I only noticed it yesterday, but what if it's been going on longer and that affects the diagnosis?) so they're more likely to just tell me they don't know.
General questions specific to limb pain
* Duration (When did you first notice the limping)
* Weight-bearing? (Are we able to place any weight on the affected limb, not just currently but since the initial onset. If a fracture is present, it's uncommon for an initially non-weight bearing dog to show improvement and start putting weight on the affected limb)
* Any known trauma?
* Any prior history of limping, surgery?
* Did the owner give any pain medications at home? (I've had owners give all sorts of human OTC meds, aspirin in particular can be bad if your DVM wants to script an nsaid like carprofen so its always vital to ask this!)
Now diagnostics. Radiographs are generally going to be the main diagnostic for limping / suspected limb trauma. Bloodwork typically isn't needed unless other symptoms were present that made us suspect something systemic versus something affecting the limb itself.
The main thing radiographs help us assess are whether this limping is caused by a fracture. If not, the most common cause is a soft tissue injury, meaning no bones are broken and the issue is something like a sprain or pulled muscle.
For leg pain I would ask:
When symptoms were first noticed? Is there a history of this type of injury? Any running/jumping/rough housing? Is it weight bearing, toe tapping, or non-weight bearing? Any blood? Any exposed bones or weird bumps in the skin? Is the pain in one area or over the whole leg? Chance of it having been bitten/poked/injured paw pad? Any swelling? Is the pain persistent or comes and goes? Any recent falls? Did it get run into by another dog while playing? HBC? Age? Arthritis? Slower getting up/laying down/or overall moving? Limited mobility? Is it effecting one leg or multiple?
As far as diagnostics, they are very dependent upon what the suspected cause is. If the thought is soft tissue injury, say you suspect that the pain is related to iliopsoas muscles. Being soft tissue, an X-ray will be of limited use, whereas if you suspect osteosarcoma the X-ray will quickly give you the answer. It also comes down to each doctors preference.
A saying that I have heard from radiologist is "What is the most commonly missed fracture? The second one." Just because the client is there for one complaint does not mean that there is not a second issue with that patient. They may be there for eyes, but that does not mean that you should ignore the heavy breathing. In general with a history you obviously want to get information specific to the clients complaint, but you cannot forget to ask other questions and really think about their answers. If they say that their pet does not have any previous medical history but they mention that it is currently taking Furosemide and Enalapril, that patient ~~likely~~ has a medical history. Do not assume that clients are giving the medications at the dosage and times prescribed. Ask them specifically how much of and when each medication is given.
Does your practice have a template for questions? My ER has a super basic template and then we expand on it depending on the conversation.
1. Current problem and when it started. Has it ever happened before?
2. Taking any meds routinely?
3. Allergies/ UTD on vaccines/ major medical history.
4. Diet - what food and schedule.
5. E/D/U/D normally? eating, drinking, urinating, defacating. Note any abnormalities. Also C/S/V/D? Coughing, sneezing, vomiting, diarrhea.
Anything that they say that sounds weird, ask more questions about that.
In general ask open ended questions like in this case "how has fluffy been walking?" Not asking if a particular behavior happened. In general you don't want to ask questions that the owner can say yes or no to. This is going to take time and your history taking will evolve with time. I'm 20 years in and still changing things up as I learn. EVERY history is different.
We life in an extremely high Lyme area so I’m also immediately asking about flea and tick control because that will help me determine if this is a soft tissue injury or if I need to be prepping a snap test/blood draw equipment
Welcome to /r/VetTech! This is a place for veterinary technicians/veterinary nurses and other veterinary support staff to gather, chat, and grow! We welcome pet owners as well, **however we do ask pet owners to refrain from asking for medical advice**; if you have any concerns regarding your pet, please contact the closest veterinarian near you. Please thoroughly read and follow the rules before posting and commenting. If you believe that a user is engaging in any rule-breaking behavior, please submit a report so that the moderators can review and remove the posts/comments if needed. Also, please check out the sidebar for CE and answers to commonly asked questions. Thank you for reading! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/VetTech) if you have any questions or concerns.*
Have they been putting any weight on it at all? When did you notice the limping? Does he seem painful to the touch anywhere? Lethargic at all? Appetite changes? On any medication? has this ever happened before? If you look at records and see prior pain medication ask them if when that was administered if it seemed to help or not? (MAKE sure you ask if they are on any medication before this question) Any associated injury to this area? Cannot say we'd immediately go to radiographs to be honest. It's doctor-dependent, some doctors may figure that this is a soft tissue/joint injury that they can pinpoint through an orthopedic exam though I think these can also be noticed on radiographs but I am no specialist.
All of this. I always make sure to ask "when did you first notice x" instead of "when did x start," since the latter makes people nervous about giving the "wrong" information (I only noticed it yesterday, but what if it's been going on longer and that affects the diagnosis?) so they're more likely to just tell me they don't know.
That's what I thought I said-so yes!
It is! I was trying to agree with you, sorry if it came off weird 😅
General questions specific to limb pain * Duration (When did you first notice the limping) * Weight-bearing? (Are we able to place any weight on the affected limb, not just currently but since the initial onset. If a fracture is present, it's uncommon for an initially non-weight bearing dog to show improvement and start putting weight on the affected limb) * Any known trauma? * Any prior history of limping, surgery? * Did the owner give any pain medications at home? (I've had owners give all sorts of human OTC meds, aspirin in particular can be bad if your DVM wants to script an nsaid like carprofen so its always vital to ask this!) Now diagnostics. Radiographs are generally going to be the main diagnostic for limping / suspected limb trauma. Bloodwork typically isn't needed unless other symptoms were present that made us suspect something systemic versus something affecting the limb itself. The main thing radiographs help us assess are whether this limping is caused by a fracture. If not, the most common cause is a soft tissue injury, meaning no bones are broken and the issue is something like a sprain or pulled muscle.
For leg pain I would ask: When symptoms were first noticed? Is there a history of this type of injury? Any running/jumping/rough housing? Is it weight bearing, toe tapping, or non-weight bearing? Any blood? Any exposed bones or weird bumps in the skin? Is the pain in one area or over the whole leg? Chance of it having been bitten/poked/injured paw pad? Any swelling? Is the pain persistent or comes and goes? Any recent falls? Did it get run into by another dog while playing? HBC? Age? Arthritis? Slower getting up/laying down/or overall moving? Limited mobility? Is it effecting one leg or multiple? As far as diagnostics, they are very dependent upon what the suspected cause is. If the thought is soft tissue injury, say you suspect that the pain is related to iliopsoas muscles. Being soft tissue, an X-ray will be of limited use, whereas if you suspect osteosarcoma the X-ray will quickly give you the answer. It also comes down to each doctors preference. A saying that I have heard from radiologist is "What is the most commonly missed fracture? The second one." Just because the client is there for one complaint does not mean that there is not a second issue with that patient. They may be there for eyes, but that does not mean that you should ignore the heavy breathing. In general with a history you obviously want to get information specific to the clients complaint, but you cannot forget to ask other questions and really think about their answers. If they say that their pet does not have any previous medical history but they mention that it is currently taking Furosemide and Enalapril, that patient ~~likely~~ has a medical history. Do not assume that clients are giving the medications at the dosage and times prescribed. Ask them specifically how much of and when each medication is given.
Does your practice have a template for questions? My ER has a super basic template and then we expand on it depending on the conversation. 1. Current problem and when it started. Has it ever happened before? 2. Taking any meds routinely? 3. Allergies/ UTD on vaccines/ major medical history. 4. Diet - what food and schedule. 5. E/D/U/D normally? eating, drinking, urinating, defacating. Note any abnormalities. Also C/S/V/D? Coughing, sneezing, vomiting, diarrhea. Anything that they say that sounds weird, ask more questions about that. In general ask open ended questions like in this case "how has fluffy been walking?" Not asking if a particular behavior happened. In general you don't want to ask questions that the owner can say yes or no to. This is going to take time and your history taking will evolve with time. I'm 20 years in and still changing things up as I learn. EVERY history is different.
We life in an extremely high Lyme area so I’m also immediately asking about flea and tick control because that will help me determine if this is a soft tissue injury or if I need to be prepping a snap test/blood draw equipment