Internal Medicine Offered at BARC in January 2023

Internal medicine is the discipline within veterinary medicine that works with diagnosing and treating problems of the internal organs. Internal medicine therefore includes management of such areas as the respiratory tract, digestive system, kidneys, bladder, hormones, liver, and blood cells. Internal medicine specialists (internists) see patients that have conditions such as chronic cough, nasal discharge, vomiting, diarrhea, kidney failure, diabetes mellitus, anemia, immune-mediated disease and many more. Internists use modalities such as blood tests, x-rays, CT scans, ultrasounds, and scoping procedures to diagnose conditions.

What is an internal medicine specialist?

An internal medicine specialist, or internist, is someone who has done specialized training in this field. In addition to four years of veterinary school training, internists have three years of residency training in this field. Often times, they have participated in an internship prior to residency training as well. The three years of residency training immerses prospective internists in the field, where they can grow their knowledge and skills in this area. Residents are also required to publish in peer reviewed journals, as well as pass two rigorous exams before they are board certified as internal medicine specialists. With the additional training and expertise in this field, internists are available to primary care veterinarians when they need additional advice on a patient or do not have the advanced diagnostics available to them to take the next step for that pet.

What does an internal medicine consultation look like?

When you first meet with your pet’s internist, he/she will take a thorough history, spend time reviewing results of previous tests, and examine your pet thoroughly. The doctor will then speak with you about different possibilities for your pet’s symptoms and discuss with you the plan for definitive diagnosis and treatment. Diagnosis is often not straightforward and may require multiple steps, sometimes with multiple visits involved. Depending on the disease process, once the diagnosis or suspected diagnosis is arrived at, the resulting treatment plan may also involve multiple visits and changes of approach overtime.

Gastrointestinal Disease

Many cats and dogs have chronic issues with vomiting, diarrhea and weight loss. This can be caused by a number of conditions affecting the lining of the GI tract. Internal Medicine often utilizes endoscopy to explore the cause of these problems.

Endoscopy allows a visual examination of internal organs and body parts without invasive exploratory surgery. In the case of gastrointestinal endoscopy, a long flexible scope is inserted into the GI tract (from the mouth and/or anus) to visualize the reachable area and take small biopsies of the lining of the stomach and/or intestines.

Management of chronic GI problems can often involve some trial and error as you and your pet’s doctor try various therapies and medication dosages to determine the best plan. Often times, this plan is adjusted over time as the pet’s condition changes as well.

Endocrine Disease

Is your pet drinking more water than normal? Are they anxious at night, pacing and agitated? Are they losing weight despite a good appetite?

These are all potential signs that they may have a metabolic imbalance caused by an endocrine disorder like diabetes, hyperthyroidism, or hyperadrenocorticism (Cushing’s Syndrome).

Internal Medicine can help to figure out which disorder is the driving force for the problem, often by utilizing various endocrine function tests. These are blood tests that help to determine whether the endocrine hormones are working as they should be. Once the diagnosis is made, your internal medicine doctor can help start medications for the disorder and fine-tune those medications over time to help your pet feel better.

Respiratory Disease

The respiratory changes that can happen in our patients range from their nasal passages down to inside the lungs. This whole pathway can experience inflammation, infection, and even cancer. When problems are present in the respiratory tract, you may notice your pet sneezing, coughing, breathing differently, or experiencing nasal discharge.

Internal medicine specialists use tools such as CT scans, x-rays, and endoscopy to visualize and obtain samples from the affected area. In respiratory disease cases, a combination of long flexible endoscopes and shorter rigid endoscopes may be used to investigate the problem.

Hematology

If your pet is anemic or having bleeding problems, he or she may benefit from the help of an internal medicine specialist.

Hematology is the area of medicine concerning the various components of the blood stream, such as red blood cells, platelets, and white blood cells. Using the complete blood count to initially assess these cells, further tests an internist may do include more extensive testing of the blood, screening for infectious diseases, or sampling the bone marrow.

Many times the immune system is the culprit and helping to manage the immune system attacking of these cells is important.

Immune Mediated Disease

Immune-mediated disease occurs when the immune cells of the body start to see the patient’s own body as foreign and begin to attack the pet’s tissues. Immune-mediated disease can show up as a fever without a known cause, swollen sore joints, a decrease in the number of red blood cells and/or platelets, or swollen/sore muscles around the face.

Despite the fact that a trigger for this process is often not found, your doctor will thoroughly investigate possibilities for an underlying cause to treat. If a reason for the immune-mediated process is not found, then treatment with medications to suppress his/her immune system and slow down the attack will be started for your pet.

Internal medicine is very comfortable with the variety of drugs needed to help control the immune system and can help to find the right cocktail for your pet.

Liver Disease

Liver and gallbladder problems may show up as elevated liver values on bloodwork. Sometimes these bloodwork findings are entirely incidental, showing up on routine lab work. Other times the pet is feeling ill, often with vague signs like inappetence, vomiting, or weight loss. As the problem becomes more severe, the patient’s skin may start to yellow.

When your pet’s internist sees your pet for a liver problem, abdominal ultrasound is often part of the diagnostic plan. Additional lab work may also be done. Ultimately, it often requires getting a sample from the liver to diagnose the underlying problem.

Neprhrology

As patients age, the organ function can start to deteriorate. Kidney disease is a very common sequalae in older pets and the sooner we can intervene the better. Modifying diet and additional medications can help support the kidneys and keep them working for longer.

To investigate the health of the kidneys, an Internist may do lab work, x-rays, ultrasound, a blood pressure check, a contrast study or a CT scan.

Urinary Tract System

Is your pet drinking more water than normal? Are they having accidents in the house? Is the blood present in the urine? These are all potential signs that the bladder or urethra may be involved in their disease process.

We usually want a sterile sample from these patients to help understand if this happens to be an infection versus a tumor. If you are coming from your appointment, please inquire whether it is ok to let your pet urinate when you arrive or if a sample should be taken before they urinate.

Endoscopy of the urinary tract can reach up to the bladder, using a small flexible scope or rigid scope. This can allow for visualization of any abnormalities along the inside of the bladder, urethra and vagina in females, as well as collection of small biopsies.

Critical Care

Internists will sometimes work closely with emergency veterinarians to diagnose and manage critical patients. These are patients with severe, life-threatening problems that require them to be hospitalized with constant monitoring throughout the day and night. These pets may be experiencing severe hormonal imbalances, trouble breathing, acute bleeding, or severe dehydration.

Bridge Animal Referral Center is not able to see critical patients at this time, as we do not have 24-hour care to ensure these pets are continually monitored and treated throughout the night. Our Internist is available for phone consultations though as a doctor to doctor consult if they are hospitalized somewhere that doesn’t have an Internist and needs an expert opinion on next steps.