Internal Medicine

Internal Medicine focuses on the diagnosis and (nonsurgical) treatment of diseases of the internal organs.

Medical Disorders We Diagnose and Treat

• Diabetes Mellitus - Failure of the pancreas to regulate blood sugar. Signs include increase urination, water consumption, and appetite. Weight loss can be a sign as well. To confirm a urine and blood sample will be obtained.

• Diabetic Ketoacidosis - When there is not enough insulin in the body to control glucose (sugar) levels. This is a medical emergency. Signs include but are not limited to increased water consumption, urination, lethargy, vomiting, and decreased appetite.

• Diabetes Insipidus - Pets will present with an increased water consumption and need to urinate more frequently. This disorder prevents the body from conserving water and releasing too much of it.

• Feline Hyperthyroidism - Middle to older-aged felines can have hyperthyroidism due to an increase in production of thyroid hormones. A blood sample will be obtained to confirm diagnosis. Treatment can include medication or radioactive-iodine therapy. Signs can include weight loss, ravenous appetite, increase in water consumption and urinations, and vomiting.

• Canine Hypothyroidism - Impaired production and secretion of the thyroid hormones. Weight gain, lethargy, flaky skin, and exercise intolerance can be noted. A blood sample will be obtained to confirm diagnosis with medical therapy.

• Hyperadrenocorticism (Cushings Disease) - Overproduction of glucocorticoid (hormone) in the body which can cause increased water consumption and urination, increase of appetite, a distended abdomen, hair loss and thinning of the skin. To diagnose, we perform a series of blood tests, obtain a urine sample, and perform an abdominal ultrasound. If positive, there are a few treatment options that can be discussed.

• Hypoadrenocorticism (Addison’s Disease) - Deficiency of adrenocortical hormones. Most commonly seen in young to middle-aged dogs. Blood work will be obtained to confirm diagnosis before medical therapy is started.

• Immune-Mediated Hemolytic Anemia (IMHA) - The immune system mistakenly produces antibodies that will attack the pets red blood cells causing pale gums, weakness, shallow or rapid breathing, increase in pulse, loss of appetite, weight loss, and black or tarry stools. After diagnosis, hospitalization and medical therapy maybe suggested.

• Immune-Mediated Thrombocytopenia (ITP) - The pet’s body attacks its own platelets which causes delayed blood clotting. This can cause bruising, bleeding, and anemia. Supportive care along with medical management can be done after diagnostics are performed. If it is confirmed your pet does have ITP, we will discuss discontinuing vaccines and performing titers.

• Evan’s Syndrome - When a patient has IMHA and ITP. This syndrome will destruct platelets and red blood cells. Typically, small breed canines are affected by this disease. Aggressive treatment will be discussed if the patient has Evan’s Syndrome.

• Esophageal/Gastric Ulceration - Irritation and injury to the mucosal barrier of the stomach and/esophagus which could be caused from a number of reasons. Inappetence, vomiting, regurgitation, hematemesis (vomiting of blood) are some common signs. Diagnostics are preformed to rule out disease and medical therapy would be given.

• Feline Hepatic Lipidosis - Known as fatty liver disease, this is the most common liver disease in cats. It has been noted that obesity could increase the risk of Hepatic lipidosis. Symptoms to look for Jaundice (yellowing of the skin, whites of eyes, or gums, change in behavior, vomiting/diarrhea, and lack of appetite. Diagnostics would be preformed with medical therapy, food change, and possible weight loss.

• Cholangiohepatitis (Gall Bladder Infection/inflammation) - Inflammation of the liver and bile ducts. Although seen more in cats, dogs can be affected by this disease as well. Painful abdomen, jaundice (yellowing of the skin, eyes, and gums), fever, decreased appetite are all signs for which to watch. Pending the severity after diagnostics, out-patient therapy may be performed. In severe cases, hospitalization may be needed.

• Acute and Chronic Liver Disease - Acute liver disease is the dysfunction occurring in the absence of known preexisting liver disease. Acute liver disease has been linked to with adverse drug reactions, food additives, neoplasia, environmental toxins, metabolic disease, injury, and infectious diseases. Weakness, inappetence, increased urination and water consumption, vomiting, and depression can be noted. Initial diagnostics would include blood work, radiographs, ultrasound, and a urinalysis. Medical management can be done to help patients with acute liver disease. Chronic liver disease occurs because of long-term damage to the liver. Supportive therapy and food change will be suggested to maintain a good quality of life pending the severity of the disease.

• Splenic Disease - The spleen is the largest lymphoid organ that acts like a filter for the body. There could be a few reasons why the spleen becomes enlarged with the most common being a splenic tumor. Lethargy and weakness along with collapsing, fever, pale gums, abdominal distension, inappetence, rapid breathing, elevated heart rate are all signs to watch for. Diagnostics would include blood work, radiographs, and ultrasound. Pending the cause of the disease and treatment include medical therapy, surgery, or oncologic intervention.

• Feline Infectious Peritonitis (FIP) - Is a viral disease caused by certain strains of the feline coronavirus. Initially exposed felines do not show any obvious symptoms. Some cats may demonstrate mild upper respiratory symptoms (sneezing, nasal discharge, and watery eye). Other symptoms include depression, weight loss, ill thrift hair coat, fever, and inappetence.

• Pancreatitis - Most common exocrine pancreatic disease in both cats and dogs. Dogs can exhibit anorexia, vomiting, abdominal pain, dehydration, diarrhea, and lethargy. Cats can exhibit anorexia, dehydration, weight loss, abdominal pain, fever, and lethargy. In house diagnostics and more specific blood samples to be sent to an outside lab can be performed. Pending results diet change, medical management, and possible hospitalization will be recommended.

• Small and Large Bowel Disease - Chronic disease that affects the intestines where the lining becomes inflamed. Symptoms include diarrhea or soft stool, vomiting, and weight loss. Diagnostics can be done to rule out other disease process, medical therapy, and food trial.

• Neurologic Disease - Can be caused by congenital defects which some could be inherited or others caused by environmental factors. Diagnostics such as blood work and imaging will be recommended for diagnosis and treatment plan. Further diagnostics may need to be performed at a specialty hospital (CT scan and MRI).

• Lymphoma - The most common neoplasia in cats and dogs. Patients may present with enlarged lymph nodes, depression, lethargy, weight loss, vomiting, and decreased appetite. A fine needle aspirate of the nodes, blood work, radiographs, and ultrasound should be performed to get an idea where the disease process is at. After all diagnostics are performed, oral medication or chemotherapy will be discussed as options for the patient.

• Parvoviral Infection - Canine parvovirus in an infection that is highly contagious in dogs. The most common symptoms are vomiting, diarrhea, fever, weight loss, and lack of appetite. A parvo snap test will be performed to confirm diagnosis. After confirmation, aggressive treatment will be completed which includes blood work, fluid hydration, medical therapy, and hospitalization.

• Lymphangiectasia - An intestinal disease where the lymphatic fluid of the body is leaked into the gastrointestinal tract. It is a malabsorption disease that is not commonly reported in cats. Symptoms include weight loss, intermittent vomiting, diarrhea, low lymphocyte count, low cholesterol count, and protein loss. Diagnostic testing to confirm, medical therapy, and a proper food change will be suggested.

• Perianal Fistulas - A tunnel like formation in the skin and tissue that surround the anus. Painful defecations, constipation, straining to defecate, diarrhea, blood in the stool, excessive licking or oozing around the anus can be noted. Medical treatment and possible surgical intervention will be recommended.

• Acute Renal Failure - Sudden onset of kidney dysfunction. Symptoms can include but are not limited to lethargy, vomiting, abdominal pain, inappetence, and diarrhea. Large amounts of urine may also be noted. Blood work and a urinalysis will be performed to review the kidney function. Pending the results a treatment plan will be constructed and that could include fluid therapy, food change, and medication.

• Chronic Renal Failure - There are many different causes to chronic renal failure and by the time the patient demonstrates symptoms the cause may never be known. Symptoms can include increased water consumption and urination, vomiting, diarrhea, lack of appetite, depression, pale gums, and weakness. Blood work and urinalysis will be performed to confirm diagnosis; although there is not a cure for chronic renal failure fluid therapy while hospitalized can help the patient while a treatment plan is being discussed. A change of diet and supplements may be recommended.

• Pyelonephritis - Inflammation of the kidneys due to bacteria. Symptom can include abdominal pain specifically where the kidneys are located, fever, increased urination and water consumption. Blood work, urinalysis, radiographs, and ultrasound could be recommended to determine severity. Aggressive medical therapy and possible food change to correct the infection and provide relief.

• Urolithiasis (Bladder Stones) - Disease caused by the presence and effects of uroliths (stones) or excessive crystals/calculi in the urinary tract. The stones can form in the kidneys, urethra, or bladder. Symptoms would include increase water consumption and urination, pain upon palpation of the abdomen, difficulty urinating and blood noted in the urine. Radiographs would confirm the presence of stones. Blood work and a urinalysis would be performed to rule out any other disease process. Surgical correction and a diet change would be recommended.

• Urethral Obstructions - Stones or calculi can often become stuck in the urethra causing a blockage. Symptoms can include small, frequent urinations, straining to urinate, blood in the urine, drips urine instead of a stream, and urinating inappropriately. This is very painful and could cause the patient to lose their appetite. If not corrected this can be fatal. Radiographs and blood work will be performed. Placing a urinary catheter and trying to flush the stones back in the bladder will be conducted so they can be surgically removed. After surgery, a new diet will be suggested as well as medical therapy short term for relief. The stones will be sent out to a lab to determine type.

• Hypertension - Hypertension means high blood pressure and can be the result of an underlying disease. A non-invasive blood pressure will be obtained prior to any diagnostics performed to get the most accurate measurement. Medical therapy and a recheck of the blood pressure will be suggested pending lab results.

• Congestive Heart Failure (Feline HCM, Dilated Cardiomyopathy, Mitral Valve Disease) - Occurs when the heart is unable to pump an adequate amount blood, causing an increase in pressure and fluid. That fluid will then leak out into the lungs or elsewhere in the body. Symptoms can include fluid buildup in the abdomen (ascites), gums are cyanotic (blue/gray) due to poor oxygen flow, staggering/fainting, and weight loss. Blood work and radiographs are performed to determine course of action. Treatment will depend on severity.

• Arrhythmias - Arrhythmias are an abnormal heart rhythm. This can include an abnormal heart rate, irregular beat/pattern, or the electrical signal for the heart to beat is coming from an atypical site. Arrhythmia’s are typically noted in patients with heart disease. Symptoms can include weakness, fainting, reduced blood flow to the brain, kidneys, or other organs, and could result in death if not treated. Diagnostics including blood work, radiographs, and an ECG will be suggested before potential referral to see a cardiologist. Medical therapy will then be introduced pending the type of arrhythmia.

• Pericardial Effusion - Pericardial Effusion is an abnormal accumulation of fluid or blood in the pericardial sac of the heart. It can be a result from infectious, toxic, traumatic, cardiovascular, metabolic, or neoplastic causes. Patients will present with a sudden onset of lethargy, respiratory difficulty, decreased appetite, abdominal distention, weakness/collapse. Radiographs will be obtained to confirm the diagnosis. Removal of the fluid will be done via pericardiocentesis. After removal of the fluid and decrease of pressure, supportive care is given while a treatment plan is conducted.

• Musculoskeletal Disease - Musculoskeletal Disease affect the patient’s ability to move properly. There could be several reasons for musculoskeletal disease with the most common being skeletal and joint disorders. Imaging will be conducted to along with blood work to decide a treatment plan.

• Polyarthropathy (Nonsurgical Joint Disease) - Most commonly known as arthritis which causes cartilage and bone destruction. Symptoms can include a stiff gain, lethargy, weakness, and inappetence. Blood work and imaging will be conducted with recommendations on medical therapy and supplement support.

• Seizures (Epilepsy, Secondary to Brain Tumors, Inflammatory) - These are abnormal electrical activity in the brain. When this occurs you may see involuntary movements and a loss of consciousness. There can be many factors in what causes a seizure including metabolic disease, electrolyte imbalances, hypertension, and glucose abnormalities. It is important to keep a log of when the patient has a seizure, signs, and how long it takes place. Blood work will be performed with possible medical therapy pending on the on the seizure disorder.

• Idiopathic Vestibular Disease (Old Dog) - Idiopathic Vestibular Disease (Old Dog) is a sudden, loss of balance. Symptoms can include circling, head tilting, falling or rolling to one side, abnormal position of the eyes or drifting eye movements, stumbling, vomiting, and motion sickness. It is unknown why this occurs. Blood work to rule out any underlying disease will be performed. It is best to keep your pet in a safe, quiet resting spot until it has passed. Medical therapy may be recommended to help with symptoms.

• Portosystemic Shunts - Also known as a liver shunt is when an abnormal connection forms between the portal vein and another vein causing blood to bypass the liver. Symptoms included poor muscle development/stunted growth, circling, head pressing, and disorientation. Blood work will be performed with imaging and surgical correction pending the shunt.

• Oncology (Diagnosis and Chemotherapeutic Treatment of Cancer) - The study of cancer. After diagnostic testing (blood work, imaging, +/- cytology/biopsy) to confirm cancer a treatment plan of supportive or chemotherapy care is discussed. Continued monitoring and quality of life is discussed on a regular basis.