ADVANCED DIAGNOSTICS: Abdominal Ultrasound is an active imaging technique using the same technology that is used on pregnant women. It allows small detail evaluation of soft tissue internal organs of the belly, such as the liver, spleen, kidneys, and gastrointestinal tract. Ultrasound is not as useful for the evaluation of the lungs and bones. Ultrasound provides more “small picture” information but does not provide the “big picture” overview that x-rays allow. Because of this, x-rays and ultrasound are sometimes recommended together to obtain the maximum amount of information.
X-rays and ultrasound are noninvasive and painless, and positioning depends on the type of x-ray that is being performed. While most patients do not require sedation, it is important for the patient to be still so that diagnostic images can be obtained. Because of this, sedation is needed for some particularly active or nervous patients. Although x-rays involve the use of radiation, the risk of cancer is very low, and the benefits of appropriate imaging in sick patients far outweigh the risks.
ADVANCED DIAGNOSTICS: Blood Gas Analysis – The sampling of venous or arterial blood in order to obtain information regarding a patient’s acid base status. This yields information regarding ventilation, oxygenation, and metabolic physiology by measuring how much oxygen, carbon dioxide, acids and bases are present in blood. This can give us important information about how well our oxygen supplementation is working and can tell us about lung and kidney function.
ADVANCED DIAGNOSTICS: Bone Marrow Aspirates – Evaluation of the bone marrow may be recommended if your pet is experiencing changes in the red blood cell, white blood cell, or platelet numbers. There are a variety of cancers, infectious diseases, and other things that can specifically infiltrate or damage the bone marrow, which can be life-threatening. Bone marrow aspirates and core biopsies can be critical to clarify and treat patients accordingly.
ADVANCED DIAGNOSTICS: Cystocentesis – Cystocentesis involves the use of a needle to obtain a urine sample aseptically directly from the bladder. This is the gold standard method in determining whether or not a patient has a urinary tract infection.
ADVANCED DIAGNOSTICS: Electrocardiography – This is a noninvasive means of recording electrical changes in the heart over a period of time. It is used to measure the rate and regularity of heart beats and can provide information regarding the size and position of heart chambers. Abnormal heart rhythms can occur from primary heart disease or can occur secondary to electrolyte abnormalities, low oxygen levels, pain/trauma, sepsis/infection, and/or reperfusion injury.
ADVANCED DIAGNOSTICS: Fine Needle Aspirates – Fine needle aspiration, otherwise known as a fine needle biopsy, involves sampling of various lumps, bumps, fluid and/or organs. Cells and fluid are obtained with a needle and are evaluated using a microscope to make a diagnosis. These samples are often submitted to veterinary pathologist that specializes in the study of cells and tissue.
ADVANCED DIAGNOSTICS: Joint Taps – Lameness or painful swellings over the joints can indicate an infectious or immune-mediated type of arthritis. This can affect one joint or multiple joints and can also be a manifestation of other systemic diseases. Differentiating between the different causes of joint disease is critical for us to treat them appropriately. If your pet has signs consistent with joint disease, arthrocentesis (“joint tap”) may be recommended to obtain a fluid sample for evaluation.
ADVANCED DIAGNOSTICS: Limited Echocardiogram – This is a non-invasive method for evaluation of the heart utilizing ultrasound to assess heart chamber size and contractility. Limited echocardiogram can also be used to evaluate for fluid around the heart within the pericardium which can result in a life-threatening impairment of cardiac output.
ADVANCED DIAGNOSTICS: Transtracheal Wash – A transtracheal wash involves the placement of a tube into the windpipe followed by “washing” the upper airways with sterile fluid, which is then collected and submitted for evaluation. This procedure is sometimes performed to help clarify upper airway diseases and can be helpful in the diagnosis of infectious, inflammatory, and cancerous diseases of the respiratory system.
ADVANCED DIAGNOSTICS: Ultrasound Guided Biopsies – The sampling of tissue or cells from an area using a needle with the guidance of ultrasound.
ADVANCED THERAPEUTIC MODALITIES: Blood Transfusions – Critically ill patients may have life-threatening bleeding or diseases resulting in destruction or loss of blood and blood components (plasma, albumin, clotting factors). Transfusions may require blood typing, cross matching with pre-screened blood donor products and always necessitate careful monitoring for transfusion reactions. Common reasons for blood transfusions include hemorrhage, toxin ingestion (many rodent baits cause life-threatening bleeding), immune mediated disease and cancer.
ADVANCED THERAPEUTIC MODALITIES: Centesis – Medical terminology used to indicate sampling or removal of fluid, cells, or air from a body cavity, cyst, mass or organ.
ADVANCED THERAPEUTIC MODALITIES: Central Line or Sampling Catheter – Central venous catheters are long intravenous catheters that are placed aseptically through the jugular vein into the cranial vena cava. The catheter can then be used to deliver fluids, intravenous nutrition, monitor central venous pressure and obtain blood samples without additional venipuncture. Long sampling catheters can be placed aseptically into specific peripheral veins which can then be used to obtain frequent blood sampling with minimal patient stress.
ADVANCED THERAPEUTIC MODALITIES: Chest Tube Placement – A chest tube is a flexible tube that is placed through the chest wall into the pleural space (space within the chest outside the lungs). This is placed in order to manage disease or trauma resulting in air or fluid leakage into the chest cavity. Chest tube placement and management require 24-hour care by a well-trained hospital team.
ADVANCED THERAPEUTIC MODALITIES: CPR (Cardiopulmonary Resuscitation) – Cardiopulmonary Resuscitation is an emergency procedure performed to restore spontaneous circulation in a patient that has stopped breathing and/or their heart has stopped beating effectively. Early recognition of impending cardiopulmonary arrest and rapid initiation of CPR by a well-trained hospital team is crucial in order to maintain oxygen delivery and intact brain function.
ADVANCED THERAPEUTIC MODALITIES: Indwelling Urinary Catheter – Aseptic placement of a urinary catheter may be needed for nursing care in recumbent or paralyzed patients, in order to monitor urine output in acute or chronic kidney injury, or in order to relieve and maintain patency of the urethra after removal of stones/sediment.
ADVANCED THERAPEUTIC MODALITIES: Intubation – Respiratory emergencies may require placement of an endotracheal tube in order to unobstruct the large airways and deliver oxygen. Intubation is required for general anesthesia.
ADVANCED THERAPEUTIC MODALITIES: Mechanical Ventilation – Mechanical ventilation is used in the emergency and critical care setting when respiratory failure is impending. The main indications for mechanical ventilation include continued hypoxemia or hypoventilation despite oxygen supplementation and respiratory fatigue in our patients due to excessive work of breathing. In mechanical ventilation a machine is used to assist the hypoxemic patient by eliminating either some or all of their work of breathing. Intensive nursing care and monitoring of the patient are crucial components of mechanical ventilation.
ADVANCED THERAPEUTIC MODALITIES: Oxygen Therapy – Oxygen supplementation increases the content of oxygen in the blood that results in improved delivery of oxygen to the tissues of the body. Oxygen can be supplemented by many methods including passive flow-by delivery, a tight-fitting face mask, an oxygen hood, nasal and nasopharyngeal catheters, intratracheal oxygen supplementation, oxygen cages, and mechanical ventilation.
ADVANCED THERAPEUTIC MODALITIES: Temporary Tracheostomy – Patients that present with severe upper airway obstruction requires emergency placement of a temporary tracheostomy tube. Upper airway obstruction can occur secondary to laryngeal paralysis, laryngeal and pharyngeal edema, tracheal foreign bodies, neoplasia and brachycephalic airway syndrome. Alternatively, a temporary tracheostomy may be placed to facilitate mechanical ventilation.
Blood Tests and Urinalysis – Blood and urine tests are often the first things that are recommended when a pet is not feeling well. Samples are easy to obtain, and the information provided by these results can be invaluable in assessing your pet’s internal organ function and overall health. While generalized blood and urine panels are usually recommended as a starting point, more specialized testing may also be recommended based on these results and on your pet’s clinical signs.
Bone Marrow Aspirates and Core Biopsies – Evaluation of the bone marrow may be recommended if your pet is experiencing changes in the red blood cell, white blood cell, or platelet numbers. There are a variety of cancers, infectious diseases, and other things that can specifically infiltrate or damage the bone marrow, which can be life-threatening. Bone marrow aspirates and core biopsies can be critical to clarify and treat patients accordingly.
Chemotherapy – Chemotherapy can be used alone for cancers/tumors that affect multiple areas of the body, such as lymphoma, leukemia, and metastatic tumors. Chemotherapy can also be used in combination with surgery and/or radiation therapy to slow or stop localized tumors from spreading to other areas of the body when this is a concern. Different chemotherapy protocols are used for different cancers/tumors, so the plan will be individualized to meet your pet’s needs.
Comprehensive Examination and Evaluation – At the time of your initial consultation, our Oncologist will perform a thorough physical exam, review all medical records, discuss your pet’s diagnosis, and answer any questions that you have. Further recommendations regarding diagnostics and treatments will be made as indicated. Not all cancers are created equally, so the plan will be individualized to meet your pet’s needs.
Consultation and Physical Examination – At the time of your pet’s initial consultation, our Internal Medicine Specialist will review all previous medical records and diagnostic tests that have been performed. He will also perform a thorough physical examination, which is a very important step in formulating a diagnostic and treatment plan for your pet.
Consultation and Referral for Advanced Imaging – Occasionally, three-dimensional imaging, such as CT or MRI may be recommended to obtain additional information about a tumor/cancer prior to moving forward with treatment. These modalities may be recommended to look for subtle changes that may not be picked up with standard x-rays alone and are particularly important in planning for radiation therapy and in planning for surgeries in some delicate areas. A referral to an imaging center can be provided if indicated.
Consultation and Referral for Radiation Therapy – Radiation therapy is sometimes recommended to kill any remaining microscopic tumor cells that may be present near the surgical scar when a tumor cannot be completely removed with a good margin of normal tissue. It is also sometimes used as a palliative treatment, or a treatment aimed at improving pain and quality of life. Different radiation protocols are used for different cancers/tumors, and a referral for radiation therapy can be provided if indicated.
Coordination for Oncologic Surgery – Surgical removal with a good margin of normal tissue is the first step in treating many localized tumors. If surgery is recommended for your pet, we will discuss this with our surgeon and work with you to schedule this in a timely manner. For most patients, a few days/nights of hospitalization are recommended following surgery for close monitoring and pain control.
Courtesy Phone Consultations for Referring Veterinarians – Phone consultations are offered to primary care family veterinarians Monday-Thursday during regular business hours. Basic diagnostic and treatment options, as well as cost estimates, can be discussed during these consultations. Referral for a consultation is encouraged for any client/patient interested in advanced cancer diagnostics and treatments.
Diagnostic Imaging – Diagnostic imaging refers to pictures that veterinarians use to look inside the body to obtain additional information beyond what can be obtained from a physical exam alone. The most common imaging modalities that are used to evaluate the internal organs in veterinary patients are x-rays and ultrasound. Ultrasound provides more “small picture” information, but does not provide the “big picture” overview that x-rays allow. Because of this, x-rays and ultrasound are sometimes recommended together to obtain the maximum amount of information.
Diagnostic Tests for Confirmation of Diagnosis and Cancer Staging – Further diagnostic testing is often needed in order to make definitive treatment recommendations and to determine prognosis. Diagnostic recommendations may include but are not limited to lab work, x-rays, ultrasound, fine needle aspirates, biopsies, and/or advanced imaging, such as CT or MRI.
Electrochemotherapy – Another new novel therapy is being used for treatment of superficial tumors. This is a modality that is widely used in Europe in exchange of radiation therapy. Surgery is usually pursued first and if the margins are close or “dirty”, electrochemotherapy may be able to be used to clean up what was left behind.
Emergency Advice for Established Clients – The oncology team is available during normal business hours. Our emergency service is open 24 hours a day, 7 days a week if you have after hours concerns or questions. The oncology service is on call to answer questions about existing oncology patients and can be contacted by one of our emergency doctors if needed. Weekend and after hours new oncology referrals are handled on a case by case basis.
Endoscopy – Endoscopy is a procedure that allows for more advanced, non-invasive evaluation of the interior of a hollow organ or cavity of the body with an instrument called an endoscope. An endoscope usually consists of a rigid or flexible tube with a camera and a light source that projects images from inside the area being examined onto a screen for the doctor to visualize. The most common areas examined with endoscopy are the gastrointestinal tract, bladder, nasal passages, and main and upper airways.
Hospice Care for Patients with End-stage Cancer – Saying goodbye to a beloved family member can be difficult. The oncology team is here to help guide you during this difficult time and can help your pet to maintain a good quality of life and live comfortably until natural death or euthanasia occurs. This may include but is not limited to pain management, nutritional advice, urinary bladder management, end of life care, and referral to a support group.
Immunotherapy – Treatments that modulate how the immune system works can be administered to stimulate or suppress certain immune functions that play a role in the body’s ability to recognize and fight cancer. Options for immunotherapy are currently very limited in veterinary medicine, but there is ongoing research in this area. Oncept™ (cancer vaccine for melanoma), imiquimod cream, and metronomic chemotherapy are three examples of how immunotherapy can be used in veterinary medicine.
Joint Taps – Lameness or painful swellings over the joints can indicate an infectious or immune-mediated type of arthritis. This can affect one joint or multiple joints and can also be a manifestation of other systemic diseases. Differentiating between the different causes of joint disease is critical for us to treat them appropriately. If your pet has signs consistent with joint disease, arthrocentesis (“joint tap”) may be recommended to obtain a fluid sample for evaluation.
Management of Addison’s Disease – Addison’s disease results from a deficiency in the corticosteroid hormones that are produced by the adrenal glands. While patients can initially experience an “Addisonian crisis,” most patients can be easily managed with hormone supplementation following diagnosis. There are occasionally cases of “atypical Addison’s disease” that result from a deficiency in only one type of hormone. If you or your family veterinarian suspect that your pet may have Addison’s disease, our Internist can provide guidance in the evaluation and treatment of these patients.
Management of Chemotherapy Side Effects – Chemotherapy is generally very well-tolerated in dogs and cats. Side effects are rare but can include lethargy, decreased appetite, vomiting, diarrhea, and drops in the white blood cell and platelet counts. Often, these side effects can be treated on an outpatient basis, but hospitalization for more intense supportive care is occasionally recommended.
Management of Chronic Gastrointestinal Disease – The mouth, esophagus, stomach, intestine, and pancreas are all organs that make up the gastrointestinal (GI) tract. Clinical signs of GI disease can include anorexia, weight loss, drooling, vomiting, diarrhea, straining to defecate, and blood or mucous in the stool. While things like dietary indiscretion can cause acute but generally transient signs, chronic or ongoing symptoms should be investigated, and referral to an internal medicine may be recommended for advanced diagnostics and ongoing care.
Management of Complicated Diabetes Mellitus – Diabetes mellitus is a common disease in veterinary patients that is characterized by a deficiency of the hormone insulin. While most dogs and cats can be easily managed with daily insulin injections and dietary modifications, other concurrent disease processes can make regulation difficult. If your pet is having complications or has diabetes that is not well-controlled, referral to our Internist for further diagnostics and management is an option.
Management of Cushing’s Syndrome – Cushing’s disease results from an overproduction of the hormone cortisol by the adrenal glands. Many patients with Cushing’s syndrome are well-regulated and easy to manage. However, patients with Cushing’s syndrome that are not controlled often have other concurrent disease processes. When a patient has multiple diseases, it can be challenging to clarify and difficult to know what treatment will be most effective. Our Internist has specialized training to address this type of problem.
Management of Immune-Mediated Disease – When a pet’s immune system begins to attack his or her own body, severe organ and tissue damage can occur leading to fever, lethargy, decreased appetite and a variety of other clinical signs. The most common “immune-mediated” or “autoimmune” diseases that occur in veterinary medicine include those that affect the red blood cells, platelets, joints and multiple organ systems. Diagnosis is often difficult, and treatment can be life-long, so ongoing management by an internal medicine specialist may be recommended.
Management of Kidney Failure – Kidney failure is a common disease that occurs in dogs and cats, and both acute and chronic forms are possible. Acute kidney failure occurs quickly and can sometimes be reversed with treatment, whereas and chronic kidney failure develops over time and is irreversible but can be managed with appropriate therapy. There are up to a dozen different types of treatment that our Internist can prescribe based on your pet’s individual needs that may stabilize the disease or improve quality of life.
Management of Liver Disease – The liver is an important organ that filters and removes harmful toxins and by-products from the body, so diseases that affect the liver can cause severe and life-threatening complications. If your pet has clinical signs or blood work changes that are consistent with liver disease, referral for further diagnostics and long-term management may be recommended.
Management of Other Endocrine Disorders – The endocrine system is the system of glands that secrete different types of hormones directly into the bloodstream to regulate things like metabolism, growth and development, and tissue function. Common endocrine disorders, including diabetes mellitus and diseases of the adrenal glands, are discussed elsewhere. Diseases of the thyroid gland, parathyroid gland, and a disorder called diabetes insipidus are other endocrine problems that can occur in veterinary patients. These can be more difficult to diagnose and manage, and referral to our Internist may be recommended.
Management of Persistent Respiratory Disease – The nose, nasal cavity and sinuses, larynx, pharynx, trachea (windpipe), bronchi, and lungs are all organs that make up the respiratory tract. Clinical signs of the respiratory disease include coughing, nasal discharge, increased respiratory effort, and “snoring” or noisy breathing. When these signs are ongoing and have no responded to other treatments, further investigation is warranted, and your pet may be referred to an internal medicine specialist for advanced diagnostics and ongoing care.
MINIMALLY INVASIVE: Endoscopic Foreign Body Removal – The removal of ingested objects from the esophagus, stomach, trachea and lower airways. Endoscopic foreign body removal allows less invasive retrieval of foreign material without the morbidity of surgery. This technique uses special gastroscopes and bronchoscopes to remove commonly swallowed objects like coins, rocks, socks, and bones.
MINIMALLY INVASIVE: Ultrasound Guided Aspirates – An ultrasound uses sound waves to obtain images of your animal’s organs and body cavities. When abnormalities of organs or fluid is detected within a body cavity a sample can be obtained with the use of the ultrasound for evaluation, detection of disease, and to guide appropriate treatment.
Nutrition and Placement of Feeding Tubes – Nutrition is a very important part of the ongoing care that we provide for our pets. While most healthy pets thrive on a balanced commercial diet, special prescription diets and feeding tubes are sometimes recommended to assist with the management of chronic disease processes. Our Internist is well-trained in nutrition and can provide recommendations as well as arrange for a consultation with a board-certified veterinary nutritionist if appropriate.
NUTRITIONAL SUPPORT: Enteral Nutritional Support – Sometimes a patient cannot eat any or enough food because of an illness. Other patients may have a decreased appetite, difficulty swallowing, or some type of surgery that interferes with eating. The goal of enteral nutrition, or tube feeding, is to provide our patients with appropriate energy intake in order to avoid the consequences of malnutrition.
NUTRITIONAL SUPPORT: Feeding Tubes (esophagostomy, nasogastric, jejunostomy, gastrostomy) – Feeding tubes remove the variable of voluntary intake and allow our patients to obtain adequate calories by delivering a prescribed amount of a specific diet through the feeding tube. Tubes can be placed through the nose into the stomach (nasogastric) in a mildly sedated patient or under anesthesia directly into the esophagus (esophagostomy), stomach (gastrostomy) or small intestines (jejunostomy).
NUTRITIONAL SUPPORT: Parenteral Nutritional Support – Nutrition is provided to the patient through an intravenous route. Parenteral delivery of nutrition is performed when the patient cannot tolerate enteral feeding. Parenteral solutions provide energy, protein, water-soluble vitamins and electrolytes. Partial parenteral nutrition is delivered through a routine aseptically placed intravenous catheter while total parenteral nutrition is delivered through a larger aseptically placed central venous catheter.
Small Molecule Inhibitors – Small molecule inhibitors act selectively against molecular targets expressed in some tumors and can interfere with tumor growth and progression. This is also a growing area of interest in veterinary oncology, and the oral drugs Palladia® and Kinavet-CA1® are commercially available and approved for treatment of mast cell tumors in dogs. They are also occasionally used for other tumor types.
SURGICAL PROCEDURES: Abdominal Exploratory – There are several reasons to recommend an abdominal exploratory in dogs and cats. Foreign body ingestion is a common cause for recommending surgery. Many materials are visible on x-ray images, however, sometimes they cannot be identified and surgery may still be recommended based on clinical signs. Biopsies can also be performed. Other causes for exploratory include abdominal masses, gastric dilatation-volvulus, and the presence of free abdominal fluid.
SURGICAL PROCEDURES: Closed Suction Drains – There are several techniques for draining potentially harmful fluids, such as blood, pus, and tissue secretions from wounds. Such fluids interfere with wound healing and often promote infection. Drainage aids the healing process by removing dead spaces where fluids collect and allows tissues to heal together. Closed-wound suction is accomplished with a device that creates a gentle negative pressure to drain away undesirable exudates.
SURGICAL PROCEDURES: Minor Surgical Procedures – Procedures such as wound exploratory, wound/laceration closure, abscess drainage, and other minor procedures can be performed. Heavy sedation or general anesthesia is needed to perform these procedures. Cultures for infection, wound drains, and bandages are often used in combination, depending on the cause for the procedure.
SURGICAL PROCEDURES: Splints – Trauma to the limbs can cause fractures of bones or luxations of joints. In some patients the bones or joint can be reduced/realigned and a splint placed to immobilize the leg and allow the tissues to heal. Fractures sometimes can be treated with splints, however often require surgery for adequate healing. In these latter cases, splints will be used to temporarily immobilize the leg until surgery can be performed. Splints however can cause pressure sores and wounds if not cared for properly.
SURGICAL PROCEDURES: Wound Management – Trauma is often associated with fighting or some type vehicular injury. Many wounds are able to be cleaned and closed initially, but others may require prolonged bandaging and wound care. At times drains need to be used, especially in contaminated wounds, such as bite wounds. Referral to a surgical specialist may be advised if extensive wounds are present.
Tracheal and Urethral Stenting – A stent is an expandable metal tube of mesh that is designed to stretch outwards, much like a child finger trap toy. It can be placed into hollow tubes, such as the trachea (windpipe) and urethra (allows for urination), when obstruction is present to improve comfort and ease of breathing and urination when other treatments have failed. Our Internist has undergone special training in stent placement and can facilitate this procedure for your pet if appropriate.
Transtracheal Wash – A transtracheal wash involves the placement of a tube into the windpipe followed by “washing” the upper airways with sterile fluid, which is then collected and submitted for evaluation. This procedure is sometimes performed to help clarify upper airway diseases and can be helpful in the diagnosis of infectious, inflammatory, and cancerous diseases of the respiratory system.