Internal Medicine

Veterinary Internists are the experts who are trained to identify and treat uncommon and complicated medical disorders. The specialty of Internal Medicine includes gastroenterology, hepatology, endocrinology, infectious diseases, urology & nephrology, respiratory medicine, hematology & immunology, and geriatrics. 

An Internist, also known as an Internal Medicine Specialist, is a veterinarian who, after graduating from an accredited veterinary college, has completed an advanced and intensive three-year clinical training program then subsequently passed two sets of board examinations. Upon doing so, the status of Diplomate of the American College of Veterinary Internal Medicine (ACVIM) is conferred upon the veterinarian.

Problems for which a pet may be referred to an internist include:

  • Enigmas and challenging cases
  • Vomiting, decreased appetite, regurgitation, and lethargy
  • Diarrhea, hematochezia (blood in the feces), and tenesmus (straining to defecate)
  • Liver disease and increased liver values
  • Endocrinopathies (diabetes, Cushing syndrome, hyperparathyroidism and hypoparathyroidism, hyperthyroidism, Addison’s disease, etc.) and endocrine neoplasia (adrenal tumors, insulinoma).  Additional information about diabetes and Cushing syndrome is below.
  • Polyuria (increased urine volume), polydipsia (increased drinking), pollakiuria (increased urination frequency), stranguria (straining to urinate), dysuria (difficulty urinating), hematuria (blood in urine), urinary tract infections, and urolithiasis (bladder and kidney stones)
  • Kidney dysfunction, proteinuria (protein in the urine), and azotemia (increased kidney values)
  • Hypertension
  • Coughing, sneezing, reverse-sneezing, gagging, nasal discharge, epistaxis (nasal bleeding), increased respiratory noise, and difficulty breathing
  • Hyperlipidemia (high triglycerides and/or high cholesterol)
  • Anemia (low red blood cell count), polycythemia (high red blood cell count), leukopenia (low white blood cell count), leukocytosis (high white blood cell count), and thrombocytopenia (low platelets)
  • Laboratory abnormalities of electrolytes, calcium, glucose, protein, blood cells, liver values, kidney values, cholesterol, urine protein, etc.
  • Geriatrics:  Internists are particularly well suited to manage the medical needs of patients when multiple organ systems are affected as is common is older patients.  Additional information about geriatrics is below.
  • Fever of unknown origin and infectious diseases
  • Patients who have not responded to therapy as desired

What does an internist do?

  • Critical evaluation of prior diagnostics and prior treatments
  • Thorough hands-on evaluation of the patient
  • Laboratory testing to include both routine and advanced diagnostics
  • Imaging: ultrasound, radiographs, CT scans, fluoroscopy
  • Advanced diagnostic procedures:  endoscopy, bone marrow aspiration, ultrasound-guided biopsies and aspirates, laparoscopy, continuous glucose monitoring of diabetics, etc.
  • Interventional procedures:  structure dilation, foreign body removal, urolith removal, rhinoscopic fungal treatment and debulking of tumors, feeding tube placement, etc.
  • Medical management for both at home and in-hospital for very ill patients
Geriatrics

Improvements in health care have allowed our pets to live longer. Medical conditions often arise in their later years. Older patients commonly are afflicted with more than one disease process. Examples include kidney disease, heart disease, liver disease, hypothyroidism, Cushing’s disease, diabetes, and intestinal disease. Individually, management of these ailments may be routine. However, very commonly, these comorbidities or their treatments may impact one another. Geriatrics is branch of internal medicine focused on understanding and treating these maladies as they affect elderly individuals. Through an understanding of pharmacology and physiology, it is often possible to manage all of a patient’s symptoms to restore or maintain an excellent quality of life for very long periods of time. We take great pride in helping your old friends.

Diabetes

Diabetes is a common disease in dogs and cats. Very often, diabetes is easily controlled. However, just as in diabetic humans, some diabetic dogs and cats do not respond to standard insulin therapy. These patients may suffer from a second disease process that is affecting diabetes or they may have an intrinsic metabolic anomaly. We love these challenging cases. We have expertise in the use of both veterinary-specific and human insulins. We also utilize the most advanced tool for evaluating diabetics: continuous glucose monitoring systems (CGMS). The CGMS is a device the size of a watch-face that is worn by the patient for up to 14 consecutive days. During this time, the patient’s glucose is measured every 5 minutes without having to be pricked with a needle each time. This is a powerful tool for understanding how a patient responds to insulin and how a patient is affected by insulin during sleep.

Cushing syndrome (hyperadrenocorticism)

Hyperadrenocorticism (Cushing’s disease) is one of the most common endocrinopathies in dogs. It is also one of the most manageable. Through medical management, normalization of adrenal function can be achieved in nearly all patients and adverse side-effects are infrequent. Control of Cushing’s disease improves patient’s quality of life and has been shown to lengthen lifespan.