Internal Medicine

A veterinary internal medicine specialist is a veterinarian with advanced training and expertise in the diagnosis, treatment and prevention of diseases and conditions of the gastrointestinal, respiratory, endocrine, circulatory, nervous and urogenital systems. Internal medicine specialists also have expertise in infectious disease diagnosis and treatment. At CVRC, our internal medicine doctor is trained in the use of ultrasound, echocardiography, and endoscopy.

A board certified veterinary internal medicine specialist is a veterinarian who has obtained intensive, additional training in internal medicine and has been certified by the American College of Veterinary Internal Medicine (DACVIM). The advanced training and education required for this certification includes:

  • A veterinary degree (three to four years of undergraduate college, followed by four years of veterinary school).
  • One year rotating internship in veterinary medicine and surgery.
  • Three years of advanced internal medicine training (residency).
  • A series of rigorous examinations covering all aspects of internal medicine.

Philosophy:

When your pet needs the care of a veterinary internal medicine specialist, years of intensive training and education will be focused on helping your pet to enjoy the best quality of life possible. Internal Medicine is best described as the specialty discipline that aims to solve complex and multi-disciplinary medical conditions. As such, specialists are trained to be problem-solvers and figure out how all the pieces of a puzzle fit together. Internists evaluate problems in depth to gain any clue possible into the illness of your pet. With appropriate diagnostics, care and follow-up, we will help your pet live a longer, happier and healthier life.

What is an emergency/specialty hospital and how is it different than my primary veterinarian?

A specialty hospital does not offer any routine or preventative care. Our veterinarians have advanced training in specific disciplines such as surgery, oncology, internal medicine, emergency and critical care medicine, physical rehabilitation and neurology among others. We also have equipment that most primary veterinarians don’t have such as CT scans, MRI, endoscopic equipment, and specialized surgical tools. We work closely with your primary veterinarian to offer these services to you.

What services are offered? 

The following list is just some of the services available through CVRC's Internal Medicine Department:

  • Diagnostic Imaging including: digital radiography, ultrasound, echocardiography, fluoroscopy, CT, and MRI
  • Flexible and rigid endoscopy
  • Full in-house laboratory including blood chemistry, hematology, coagulation profile, urinalysis, and cytology
  • Full complement of external laboratories for advanced testing
  • In-house pharmacy with full complement of oral and injectable medications to treat disease or symptoms
  • Dedicated Intensive Care Unit staffed 24 hours a day
    • Oxygen support
    • Advanced Fluid Therapy
    • Continuous patient monitoring including: electrocardiogram (ECG), blood pressure (indirect and direct arterial), oxygen saturation, temperature, and capnography (CO2 monitoring)

What types of advanced diagnostics and procedures are offered?

Gastroenterology – the study of the mouth, esophagus, stomach, intestines, liver, gallbladder and pancreas. Typical conditions include inflammatory bowel disease (IBD), food allergies, hiatal hernias, polyps, foreign bodies, gastroesophageal reflux disease (GERD) or cancers.

  • Nutritional consultation
  • Endoscopy: utilizing small and flexible endoscopes to examine and obtain (in a minimally invasive way) biopsies of the larynx, oropharynx, esophagus, stomach, duodenum, ileum and colon. Also to retrieve foreign objects that your pet may have ingested.
  • Minimally invasive colonic polyp removal
  • Minimally invasive placement of feeding tubes

Respiratory Medicine – the study of the upper and the lower respiratory tract. Diseases include nasopharyngeal polyps and cancers, chronic rhinitis (inflammation), nasopharyngeal stenosis, laryngeal paralysis, collapsing trachea, tracheal hypoplasia (congenital disorder), fungal infections of the nasal passages and lungs, feline asthma, chronic bronchitis, and infectious pneumonias.

  • Endoscopy: utilizing small flexible and rigid endoscopes to examine and obtain in a minimally invasive way biopsies of the upper respiratory tract (rhinoscopy), and to examine the lower airways (bronchoscopy)
  • Airway secretion collection for diagnosis of lower airway diseases and infections
  • CT Scan or MRI of the upper and lower airway tracts
  • Tracheal stenting for collapsing trachea and tracheal cancers (stents placed into the trachea without surgery)
  • Oxygen therapy

Endocrinology – the study of multiple glands of the body (parathyroid, thyroid, adrenal, pancreas, pituitary and hypothalamus glands). Common endocrine diseases include diabetes mellitus, diabetes insipidus, adrenal tumors, hyper and hypoparathyroidism, hyper and hypothyroidism, Cushing’s disease, Addison’s disease, as well as excessive drinking and urinating.

  • Comprehensive testing, diagnosis, and treatment of a variety of advanced endocrine disorders
  • Glucose curves to assess proper diabetic control
  • Fine needle aspirates (obtaining cells using a small needle by ultrasound guidance) and ultrasound-guided biopsies of organs to obtain samples to diagnose conditions in a minimally invasive way
  • Ethanol ablation of parathyroid tumors

Nephrology/Urology – the study of the kidneys, ureters, bladder, prostate, and urethra. Conditions that are diagnosed and treated include acute and chronic kidney failure, kidney and bladder stones, prostatitis and prostate cysts, bladder polyps, kidney infections, congenital kidney diseases, urinary incontinence and urethral/bladder/prostate cancer.

  • Cystoscopy: using small rigid or flexible scopes to visualize and obtain biopsies of the lower urinary tract
  • Percutaneous cystolithotomy (PCCL): bladder and urethral stone removal with a much smaller incision into the bladder and using cystoscopy
  • Urethral stenting: stents placed in urethras to relieve obstructions causes by cancers
  • Antegrade pyelograms and intravenous pyelograms: diagnostic techniques using a dye (contrast) and fluoroscopy to better visualize the urinary system
  • Urethral collagen injections: for incontinence using cystoscopy

Hematology dedicated to the diagnosis and treatment of diseases of the blood (containing red blood cells, white blood cells, platelets, proteins, clotting agents) and its precursors. Diseases include hemophilia and congenital/hereditary diseases, bleeding disorders, hemolytic anemias (destruction of red blood cells by the animal’s immune system caused by infectious agents), infectious and destructive platelet disorders, and bone marrow disorders.

  • Bone marrow aspirates and biopsies: to evaluate blood product precursors and diagnose blood disorders
  • Treatment of coagulation disorders
  • Blood product transfusions and typing of your pets’ blood type
  • Treatment of various types of anemia using erythrocyte stimulating agents: medications such as darbepoetin used to stimulate red blood cell production (for example: anemia caused by kidney disease)

Infectious Diseases – is the branch that aims to diagnose and treat infectious agents that may afflict cats and dogs. In certain instances, these diseases can be transmitted from one pet to another, from a vector (such as ticks) to animals, and even from pets to humans (zoonosis). Infectious diseases include: Leptospirosis, Influenza, Herpes, Lyme, Babesiosis, Rocky Mountain Spotted Fever, Anaplasmosis, Ehrlichiosis, and rickettsial agents, among others.

Interventional Medicine – a relatively new branch of veterinary medicine. It aims to provide minimally invasive procedures to treat common problems in animals. Interventional Medicine involves using stents placed in areas to keep them open (trachea for tracheal collapse, urethra for cancers), endoscopy and fluoroscopy (to diagnose diseases and guide the placement of stents).

  • Tracheal, nasopharyngeal and urethral stents
  • Urethral collagen injections to treat urinary incontinence

What should I expect during my visit?

If you are a new client to CVRC, we encourage you to fill out our New Patient Registration Form ahead of time online, or bring the form with you. Otherwise, please arrive to your appointment approximately 10 minutes early to complete this form in our office. If you are transferring for continued care from your primary veterinarian, please come to CVRC at your earliest convenience.

Internal medicine consultation usually begins with your family veterinarian diagnosing a disease or condition that requires advanced expertise, diagnostics, therapeutics, and patient monitoring. A full history, medical record review, and complete physical examination are performed. After examination and discussion, an initial treatment plan will be presented for the diagnostic workup and/or treatment.

Our internal medicine specialist will communicate with you during the work-up or treatment process to keep you informed on your pet's progress. We will also communicate with your primary veterinarian during this process to ensure a collaborative treatment plan for the care of your pet. Upon discharge, you will be given a printed visit summary with the diagnosis, treatment recommendations, and follow up care.  A full report will be sent to your family veterinarian the same day. We welcome your progress reports, questions and concerns any time and will maintain an ongoing relationship with your primary care doctor to ensure the best experience for you and the best care for your pet.

What should I bring to my visit?

First and most importantly, bring your pet to all visits. You may be instructed to withhold food and water from midnight the night before your appointment to allow for certain diagnostic testing. If your pet is on any medications, please let us know and we will advise you whether or not to administer them on the morning of your appointment. Also, please bring a list of all medications, strengths and dosages, or the pill vials. Records, including recent laboratory work, can be faxed or emailed to us from your primary care veterinarian prior to the appointment. If your pet has had any x-rays taken recently, please bring those with you as well. We can request records and digital x-rays on your behalf from your family veterinarian once you have scheduled a visit with us.

How much does it cost for a consultation with the internal medicine specialist?

Our specialist consultation fee is $105.  After an assessment by our specialist, you will be provided with a detailed medical treatment plan, including all costs recommended and anticipated.  You and the specialist will review this and determine the best course of action for you and your pet.

Do I need a referral?

While referrals are recommended to see one of our specialists, they are not required.  It is always better to speak to your veterinarian about a referral so we can collaborate with your veterinarian to ensure the best care for your pet.

Will you keep my family veterinarian informed of the care my pet receives at CVRC?

We work closely with your primary veterinarian and ensure they receive copies of all medical records. We also communicate via phone and they have the ability to access a portal into our medical record system. 

What is ultrasound?

Ultrasound is a diagnostic tool used to obtain more detailed information about internal body structures. Ultrasound machines use sound waves administered by a small handheld device called a probe, waves are reflected back to the probe, and a computer formats these into visual pictures on a monitor for the clinician to review. Ultrasound is painless and noninvasive.

Ultrasound is a modality that requires significant training and experience by the clinician to achieve an accurate diagnosis and interpretation of the study.

How is ultrasound performed?

After being thoroughly examined by one of our doctors, your pet is positioned appropriately on the ultrasound examination table. For most patients, sedation or anesthesia is not required. The area of interest is clipped to allow the probe to make contact with the skin. The study is performed and interpreted by one of our trained clinicians. The procedure takes approximately 30 minutes to perform. Ultrasound is painless and noninvasive. 

What is ultrasound used for?

Applications for ultrasound include:

Evaluation of the abdominal organs, including the stomach, liver, spleen, pancreas, gastrointestinal tract, lymphatic system, kidneys, urinary tract, and endocrine organs

Pregnancy evaluation

Imaging of thoracic and abdominal masses

Imaging of fluid accumulation in the abdomen or thorax

Imaging of the neck, including thyroid and parathyroid glands

Imaging of blood vessels and flow, in and around the heart, and throughout the body

Imaging of the eye (for masses and retinal detachment)

Assessment of internal injuries after trauma (called an AFAST/TFAST scan)

Minimally invasive techniques to obtain samples of organs for diagnosis of illnesses and cancers (fine needle aspirates and ultrasound-guided biopsies).

Will my pet need to be sedated or anesthetized for an ultrasound?

Ultrasound is painless and noninvasive. For most patients, sedation or anesthesia is not required. Certain advanced procedures (biopsy or aspirate) may require sedation or anesthesia for patient comfort and compliance.

Are there special instructions I need to follow for my pet's ultrasound appointment?

For abdominal ultrasound with the internal medicine specialist, please withhold food after midnight the day prior to the ultrasound.  Water is ok to offer until the appointment.  If your pet is on any medications, please contact us regarding whether or not to administer them on the day of the ultrasound.

What is endoscopy?

Endoscopy is a minimally invasive technique that uses flexible and rigid scopes to visualize internal structures of a patient, including the upper and lower gastrointestinal tract, nasal passages, respiratory tract, and urinary tract.

How is endoscopy performed?

After a full physical examination, the patient is sedated or anesthetized. A specialized scope is passed into the area of interest (gastrointestinal, urinary, or respiratory tract), and a camera hooked up to the scope displays live images of these structures. Using special instruments, biopsy samples can be obtained, as well as foreign material removed.

What is endoscopy used for?

Endoscopy is used to visualize the gastrointestinal, respiratory and urinary tract, and to obtain diagnostic tissue samples to diagnose conditions affecting these body systems. Polyps can be removed. Endoscopy can also be used to extract upper gastrointestinal foreign material, and to assist in placement of feeding tubes. 

Will my pet need to be sedated or anesthetized for an endoscopy?

Anesthesia or sedation is required to allow for the passage of an endoscopy into the area of interest. We use the most up to date and safest anesthetic agents, preanesthetic laboratory screening, tailored anesthetic protocols, and state of the art monitoring equipment to ensure safety for your pet before, during, and after anesthesia.

What is echocardiography?

Echocardiography is a type of ultrasound that uses special probes and software, as well as requiring advanced training, to perform real time imaging of the heart and surrounding structures. At CVRC, echocardiograms are performed by our board certified specialists, who have undergone extensive education and training in echocardiography to aid diagnosis and treatment of all cardiac-related diseases.

How is echocardiography performed?

After being thoroughly examined by one of our doctors, your pet is positioned appropriately on the echocardiography examination table. For most patients, sedation or anesthesia is not required. The area of interest is clipped to allow the probe to make contact with the skin.  The study is performed and interpreted by one of our trained clinicians. The procedure takes approximately 30 minutes to perform.  Echocardiography is painless and noninvasive. 

What is echocardiography used for?

Echocardiography is used to diagnose the following conditions:

Pericardial effusions

Dilated cardiomyopathy

Mitral regurgitation

Hypertrophic cardiomyopathy

Pulmonary stenosis

Ventricular septal defects

AV valve dysplasia

Patent ductus arteriousus

Developmental defects

Pulmonary hypertension

Heartworm disease

Heart based masses

Advanced feline restrictive cardiomyopathy

Right to left shunts

Atrial septal defects

AV valve stenoses

Coronary artery defects

Occult dilated cardiomyopathy

Cor triatriatum

Persistent left cranial vena cava

Canine hypertrophic cardiomyopathy

Feline diastolic dysfunction

Will my pet need to be sedated or anesthetized for echocardiography?

Echocardiography is painless and noninvasive. For most patients, sedation or anesthesia is not required. Certain advanced procedures may require sedation or anesthesia for patient comfort and compliance.

What is a CT Scan?

CT Scan is a non-invasive imaging modality that performs 360, cross-sectional imaging of our patients. CT Scan uses x-ray technology to acquire these images, but does so with vastly increased detail and sensitivity, allowing us to visualize structures as small as 1-2mm in size. 

Our helical, 4-slice CT scanner is able to perform imaging studies much faster than older, conventional scanners that are often found in veterinary medicine. Using newer equipment and software, we are able to perform most studies in less than a minute (actual scanning time). This reduction in time also comes with increased quality and sensitivity: advantages that translate to shorter anesthetic times for our patients, even the ability to perform some studies under a light plane of sedation.

How is CT performed?

After being thoroughly examined by one of our doctors, your pet is sedated or anesthetized and placed on the CT imaging table. The CT technician positions the patient and programs the CT computer for the desired type of study. The patient table then advances through the CT gantry (which is a large, donut shaped opening) while an x-ray tube and sensors rotate at high speed around the patient. Usually, the scan is performed twice, the second time with administration of an intravenous contrast agent that highlights blood vessels and other structures. These images are reconstructed on a computer console attached to the CT machine, then reviewed by our specialists.

What is CT used for?

Brain Trauma with suspected fracture, acute intracranial injury in an unstable patient

Spine – Fractures, mineralized disc rupture, neoplasia

Nasal Cavity & Sinuses – Chronic nasal discharge and/or sneezing, nasal distortion/deformation, neoplasia

Orbit/Ocular – Orbital trauma with suspected fracture, neoplasia

Head/Neck – Dental-related neoplasia, head/neck trauma with suspected fracture

Thorax Metastatic screening, primary lung neoplasia, pneumothorax, lung lobe consolidation, chronic pneumonia, pleural effusion, mediastinal disease

Abdomen – Upper urinary tract evaluation, ectopic ureter, renal/ureteral calculi, clarification and surgical planning for large organ masses (including liver, spleen, kidney, GI tract), investigation of suspected portosystemic shunts

Musculoskeletal – Elbow dysplasia, suspected incomplete ossification of the humeral condyles, complex fractures

Neoplasia – Surgical planning for tumor removal or debulking, Lung metastasis screening

Cardiovascular – Pulmonary embolism

Other – General trauma

Does my pet need to be sedated or anesthetized for a CT Scan?

Anesthesia or sedation is required to perform a CT Scan. We use the most up to date and safest anesthetic agents, preanesthetic laboratory screening, tailored anesthetic protocols, and state of the art monitoring equipment to ensure safety for your pet before, during, and after anesthesia.

Will my pet need to stay overnight?

Depending on the nature of your pet's disease or condition, the diagnostics or treatments performed, and their timing, your pet may or may not need to stay overnight. For general medical workups, overnight hospitalization is generally not necessary. Our doctor or veterinary nurse will discuss the expected hospital stay during admission to the hospital.

Is someone going to be caring for my pet 24 hours a day?

All patients have round-the-clock care. We always have doctors and veterinary nurses on premises to monitor and care for your pet. No pet is ever left unattended. 

Can I visit my pet while they are hospitalized?

We always allow owners to visit with their pets. Please call and speak with your doctor or nurse so we can coordinate a time that is best for your pet and you. We try to limit visits to twice a day for 15 minutes as to not interfere with your pet's treatment. It is generally discouraged to visit on a day when your pet underwent general anesthesia as sometimes this can be disruptive to their recovery. 

If you feel there is an extenuating circumstance, please discuss this with your doctor.  

When is it best to call to check on my hospitalized pet?

It is best to call after 10 am to receive an update. The doctors are in rounds from 8 am - 9 am every morning. After rounds, every patient is examined by their doctor. If the situation warrants, we will call you before this time.

Can I bring special items from home (blankets, tee shirts, toys, etc.) to keep with my pet during their hospital stay?

Yes, you are welcome to bring things from home to make your pet feel more comfortable. Please note, however, we cannot always guarantee the return of these items as they may get soiled, lost or damaged.

Should I bring my pet's prescription medications and/or prescription food when my pet is being admitted to the hospital?

In an emergency situation, the priority is for you and your pet to get to CVRC. Once it is determined that your pet is going to be hospitalized, you may bring all prescription medications your pet is currently receiving. We carry most common medications if this is not feasible. Our doctor will determine if these should be continued during your pet's stay. 

We have a full range of diets to feed our hospitalized patients.  However, if your pet is on a prescription or special diet we will gladly feed that if you provide it for us.

Is it normal that my pet has not had a bowel movement after being hospitalized?

It is common for pets to not have a bowel movement for the first 24-72 hours after returning home. However, this is not the case with all conditions so please refer to your discharge instructions.   

The changes in their defecation pattern are often due to a different eating schedule in the hospital and some medications can contribute to this.  If you are concerned, your pet seems uncomfortable, or is trying to defecate but is unable (straining) please call us.

Is it normal that my pet has been urinating more frequently after being hospitalized?

It is common for pets that were on IV fluids to have increased urine production. Therefore, they may need to urinate more frequently. This may last for 24-48 hours. If they are straining or not producing urine, please call us immediately.

Is it normal that my pet has not urinated, or is having trouble urinating, after being hospitalized?

This is not normal as most animals will urinate within 24 hours of returning home. If your pet is not urinating, or having difficulty while urinating, please call us immediately.   

Is it normal that my pet has slept all day after being hospitalized?

Pets sleep cycles in the hospital environment are altered so it is not uncommon for them to be tired when returning home. This may last for 24 hours. If your pet appears listless, unable to ambulate, or you are concerned please call us. 

Will my pet need to wear an e-collar (lamp shade type) after returning home from the hospital?

An e-collar prevents a pet from licking an area we want to protect until it is healed. This may be a wound, irritation or an incision. Please refer to your discharge instructions for specifics.

When do my pet's sutures/stitches need to be removed?

Generally we remove sutures 10-14 days post placement. Please refer to your discharges instructions for specifics. 

Do I need to pay to have my pet's sutures removed after having surgery at CVRC?

Suture removal is done complimentary for all patients that had a surgical procedure. If further procedures (x-rays, bandage changes, additional diagnostic tests, etc.) or additional medications are indicated there will be applicable fees. 

My pet feels warm to the touch. Does that mean he/she has a fever?

Not necessarily. Dogs and cats have a higher body temperature than people so they often feel warm. You can purchase a rectal digital thermometer (doesn’t need to be animal specific) and obtain your pet's rectal temperature. This is the most accurate assessment. Normal temperature for dogs and cats is 99.5—102.5 degrees Fahrenheit.