Internal medicine

Upper repiratory system

• Rhinoscopy
• Nasopharyngeal endoscopy
• Nasal and/or dental radiographyires
• Nasal mucosa biopsies
• Sampling for bacterial/fungal cultures

Lower respiratory system

• Tracheal and/or bronchial endoscopy
• Endoscopy guided bronchoalveolar wash for cytologic analyses and cultures

Digestive system

• Gastroduodenoscopy
• Colonoscopy
• Proctoscopy
• Digestive mucosa biopsies

Urinary system

• Urethrocystoscopy
• Vesical mucosa biopsies

• Digital radiography
• Fluoroscopy
• Oesophagogram
• Digestive baryum series
• Excretory urogram
• Urethrocystoscopy
• Double contrast cystography

Internal medicine is a branch of small animal medicine that covers many entities including gastrointestinal, hepatic, pancreatic, urinary, respiratory, hematologic, oncologic and neurologic, reproductive disorders. Conditions that are not part of internal medicine are surgical conditions such as orthopedics, spay, etc.. as well as eye, skin and heart diseases. It is then a broad spectrum type of specialty.

More practically, a clinician in internal medicine will consult animals that present with signs of:

• vomiting, diarrhea, nausea, decreased appetite, difficulty defecating, abdominal pain
• difficulty urinating, blood in urine, urine leakage
• jaundice
• coagulation disorders, anemia
• increased urination and micturition
• altered mental status, circling, convulsions, tremors, neck pain, weakness, lethargy
• difficulty breathing, coughing, sneezing, exercise intolerance
• fever
• shifting lameness
• a mass on the skin, in the abdomen or the thorax

What is a board certified specialist?

A boarded specialist is a veterinarian who has completed a specific training in a specific specialty. A small animal internal medicine specialist has performed after his DVM degree at least a general rotating internship followed by a residency training. The residency training is a 3-year program during which the clinician will only see cases related to his specialty and learn how to manage complex cases as well as to perform specific diagnostic and therapeutic techniques. To become boarded, a specialist must at least complete his/her residency and pass the board examination of his specialty.

Why does my pet need a board certified specialist?

A specialist can then offer its expertise in the management of conditions that otherwise could be difficult to diagnose or to treat in your pet.

For example, Rusty was referred for an additional evaluation of sneezing and nasal secretions. The most useful tests in this situation are a CT scan associated with an endoscopy of the nasal passages. The diagnosis was made: aspergillosis with involvement of the frontal sinus. In this case, the referral by the rDVM gave access to the patient to more advanced diagnostic techniques and the expertise of a specialist to perform and to interpret it. Without this technology it would have been difficult to really figure out what was going on with Rusty's nose.

As far as treatment, difficult to regulate diabetes in dogs and cats are also a frequent reason for referral. Lily was referred to us because of a non-response to her insulin therapy. Some underlying diseases can make diabetes hard to regulate. After evaluation of the case, diagnostics were performed that showed that she had an underlying endocrine disease called Cushing's disease. Since we started her treatment for the Cushing's disease, Lily's blood glucose has been back to more appropriate values.

Why does my pet need to be fasted for the appointment?

Several reasons:

• some blood tests need to be run on a fasted sample because lipid that would be present in the blood after a meal could compromise the measurement and the interpretation of the results for the targeted molecules measured in the blood
• in some situations we might want to compare values of a molecule present in the blood before and after a meal (for example: bile acids in case of liver disease)
• if an ultrasound of the abdomen is needed, the presence of food and air mixed in the stomach could impair greatly the visualization of other organs in the abdominal cavity such as the pancreas or the identification of a gastrointestinal foreign body
• your pet might need a sedation to have some examinations performed: to avoid vomiting and possible aspiration of a vomited food into the airways, we ask you to bring your animal fasted for its own safety

You should not fast your dog if this is a puppy of less than 3 months or if it is a diabetic treated with insulin. Talk to our receptionist if you are unsure about any contraindication to fast your dog or cat. Most animals are doing fine with skipping the morning meal! Don't worry, they will be fed as soon as the necessary procedures are done!

When we talk about fasting, it means that we ask you to remove the food bowl before midnight the night before the appointment. Please let the water available up to the appointment time as some animals could become severely dehydrated with some conditions if water is withheld for a prolonged period of time.

What are specific diagnostic techniques that are offered at CVL that could not be done with my referring veterinarian?

• Scanner of the head, chest, abdomen or bones
• Endoscopy including rhinoscopy, bronchoscopy, upper and lower gastrointestinal endoscopy, cystoscopy
• Sampling techniques such as ultrasound guided biopsies, laparoscopy
• Ultrasound of the abdomen and of the thorax

What are specific treatment techniques that are offered at CVL that could not be done with my referring veterinarian?

• 24h and 365d care with an in-hospital doctor at any time caring for your pet
• Oxygen therapy
• Continuous ECG monitoring
• Placement of feeding tubes
• Topical treatment of nasal aspergillosis
• Balloon dilation of esophageal stenosis
• Tracheal stent placement for tracheal collapse
• Urethral stent placement for urethral urinary cancer