Internal Medicine

//Internal Medicine
Internal Medicine 2017-09-25T15:36:06+00:00

Internal Medicine

A board certified veterinary internal medicine specialist is a licensed veterinarian who has obtained intensive, additional training in understanding how your pet’s internal body systems function and in diagnosing and treating the many serious diseases that can affect the health of those systems. An internal medicine specialist has advanced training in the following disciplines:

  • Endocrinology
  • Gastroenterology
  • Hematology (blood)
  • Immunology
  • Infectious Diseases
  • Nephrology/Urology
  • Neurology
  • Respiratory Diseases
  • Oncology

While your general practitioner veterinarian can diagnose and treat many health problems, certain diseases and conditions require the care of a doctor who has had specialized, intensive training in internal medicine in order to provide the very best outcome for your pet.

*Within the discipline of veterinary internal medicine, there are also veterinarians who specialize further in Small Animal Medicine, Cardiology, Neurology, and Oncology.

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Abdominocentesis is the process of inserting a small gauge needle into the abdomen to evaluate if fluid is present and obtain a sample for further testing. This quick procedure can be done on an outpatient basis, does not typically require sedation and may be performed with ultrasound guidance. If excessive abdominal fluid is causing discomfort, abdominocentesis might also be recommended as a palliative treatment.
Arthrocentesis, also known as joint aspiration, is removal of fluid from a joint utilizing a hollow needle and syringe. Arthrocentesis is performed for either diagnostic or therapeutic purposes. Used as a diagnostic tool, fluid is drawn and analyzed to determine the underlying cause of excess fluid. A small amount of fluid in joints is normal, but when fluid builds up (joint effusion), it is usually the result of arthritis or related condition, and pain and swelling will develop. Arthrocentesis will then be used therapeutically to remove the excess fluid thereby reducing pain and swelling in the affected joint. As an example, Arthrocentesis (diagnostic and therapeutic) is performed on humans for a condition commonly known as “water on the knee,” usually resulting from arthritis.

Bronchoalveolar lavage (BAL) is a diagnostic test that can be done during bronchoscopy to obtain a sample of the fluid and cells within the airways. This sample can be tested to help determine the cause of airway disease. Some cancers and reasons for chronic bronchitis (allergic, chronic irritant or resistant infections) can be diagnosed by this method.


A colonoscopy is performed after a complete diagnostic work-up and therapeutic plan have failed to resolve problems linked to the lower intestine. To perform a colonoscopy, the patient is anesthetized and a flexible fiberoptic endoscope is passed into the colon. Air, passed through the scope, increases the view within the colon. Biopsies can be obtained by passing an instrument through an opening in the scope. A colonoscopy provides a valuable, non-surgical means to diagnose large bowel disorders. To perform a colonoscopy, it is important that the colon be clean of fecal matter so that the surface of the colon can be visualized. This often requires withholding food for 24 to 48 hours and giving your pet a solution to drink which “cleanses” the colon. Warm-water enemas may also be used to clear the colon. Most patients are discharged the same day of the procedure. The major symptoms and reasons to perform a colonoscopy are:

  • Chronic diarrhea
  • Blood in the stool (persistent hematochezia)
  • Study of a growth in the colon or rectum
  • Straining during defecation (persistent tenesmus)
  • Excessive mucus in the stool
  • Stools of significantly decreased or narrowed size


Urethroscopy is the endoscopic study of the urethra. Cystoscopy is the endoscopic study of the lining of the bladder. Usually these studies are performed together as one procedure. Both rigid and flexible scopes can be used to perform the exam. Rigid scopes are generally used for female patients. Small-diameter flexible scopes are used on male dogs. Biopsies of the urethral surface or bladder wall can be obtained by passing the biopsy instrument next to the scope, through the protective outer sleeve of the scope or through an opening built into the scope. This procedure requires little patient preparation outside of withholding food on the day of the procedure. In most cases, patients are discharged the same day the procedure is performed. The major symptoms and reasons to perform a urethroscopy and/or cystoscopy are:

  • Blood in the urine (persistent hematuria)
  • Persistent straining to urinate
  • Persistent vaginal discharge
  • Removal of bladder stones (cystic calculi or urethral calculi)
  • Biopsy of known bladder growth
  • Urinary incontinence
  • Study of congenital urinary tract problems

Liver shunts are portosystemic vascular anomalies causing some of the blood supply to be shunted away from the liver leading to deterioration of liver function. Our radiology, surgery, and internal medicine departments offer a collaborative approach to the diagnosis and management of this disease.

An Endoscope is used to remove foreign bodies from the esophagus, stomach, nasal cavity and airways. Examples of foreign bodies include coins, rocks, and bones.

An Endotracheal wash or transtracheal wash is a procedure used to evaluate lungs for infection (pneumonia), inflammation, or cancer. In smaller patients, like cats and small dogs, an endotracheal tube is inserted from the mouth into the trachea. In larger dogs, a needle catheter is passed directly into the trachea. Sterile saline is inserted into the lungs and a sample is then retrieved for analysis (cytology and culture).


Esophageal Stricture is a narrowing of the esophagus, the passageway from the throat to the stomach, which can result in regurgitation of food. This narrowed area can be dilated with the use of a flexible endoscope and a balloon catheter which stretches the inner lining (mucosa) of the esophagus. This procedure may need to be performed several times for adequate dilation of the esophagus.

An esophagoscopy is a procedure used to evaluate the health of the esophagus and may include looking for ulcers and removing foreign objects. During an esophagoscopy a fiberoptic camera is placed into the esophagus via the mouth while pets are under anesthesia.

A gastroduodenoscopy refers to an examination of the inner surface of the stomach and the initial portion of the small intestine (duodenum) using a flexible, fiberoptic endoscope. In addition to visual inspection, a gastroduodenoscopy provides the ability to obtain multiple biopsies from the lining of the small intestine and stomach.  Gastroduodenoscopies, therefore, provide an excellent tool in the diagnosis of multiple disorders of the intestinal system. Although general anesthesia is required, gastroduodenoscopies are generally a safe, non-surgical, non-painful procedure. Most patients are discharged the same day that the procedure is performed. The major symptoms and reasons to perform a gastroduodenoscopy are:

  • Persistent vomiting
  • Persistent weight loss due to a small bowel disorder
  • Black, tarry stools (persistent melena)
  • Chronic diarrhea due to a small intestine disorder
  • Vomiting blood
  • Possible stomach or intestinal blockage
  • Inability to chew or swallow normally (dysphagia)
  • Removal of foreign matter from the stomach or esophagus
  • Placement of a feeding tube

Hyperthyroidism is the most common hormone disorder in cats. It is caused by growths within the thyroid gland which lead to excess thyroid hormone in the body. Thyroid growths are usually benign but can be malignant in rare cases.

Common symptoms of hyperthyroidism include hyperactivity, weight loss and increased hunger. Some cats will become more vocal and thirsty, and many hyperthyroid cats also urinate more than usual. Occasionally, cats will not show any symptoms of hyperthyroidism but the disorder can be detected during wellness testing by your veterinarian.

Fortunately for your cat, this is a very treatable problem with several management options:

1) Methimazole (generic, Tapazole TM, FelimazoleTM) is a medicine which inhibits the production of thyroid hormone, thereby resolving symptoms of hyperthyroidism. This treatment is highly effective, readily available, and not very costly in the short term. The medication can be administered orally as a pill or liquid, or topically on the skin. This treatment must be monitored periodically to make sure it is working properly and not causing side effects. It is important to note that this treatment does not cure hyperthyroidism, but usually can control the problem as long as the medicine is given regularly as prescribed by your veterinarian.

2) Nutritional Therapy involves feeding a special diet, restricted in iodine content, which can help lower thyroid hormone levels.

3) Surgery can be performed to remove the abnormal thyroid tissue. This treatment has been effective in curing hyperthyroidism in many cats but is less popular recently as safer and simpler options are now readily available.

4) I-131 (radio-iodine) therapy is a form of nuclear medicine used to cure feline hyperthyroidism. This is a very simple, safe and highly effective treatment. The vast majority of cats treated with I-131 will be cured of hyperthyroidism. The American Association of Feline Practitioners considers I-131 to be the treatment of choice for hyperthyroid cats.

How does I-131 work?

The thyroid gland is the only part of the body that uses iodine, a nutrient that is essential to synthesize thyroid hormones. I-131 is a form of iodine that is radioactive. I-131 is given by injection and circulates in the blood until it is taken into the thyroid gland. In hyperthyroid cats, the cells within the abnormal nodules are actively making an abundance of thyroid hormone, but the normal thyroid tissue is suppressed and not making any thyroid hormone. Therefore, only the cells within the nodules will absorb the radioactive iodine. Once inside the abnormal thyroid cells, the radiation goes to work to destroy the abnormal cells. Small amounts of radiation will be emitted from your cat during the treatment, so strict isolation in our facility is required to keep everyone safe. Once the level of radioactivity is below a certain limit, usually within a few days, the cats are safe to go home.

Why choose Veterinary Referral Associates to perform I-131 on your hyperthyroid cat?

We are the only facility in Maryland to offer I-131 with 24-hour on-site doctor supervision of your hyperthyroid cat.

We are also the only facility in Maryland to offer board certified specialists to oversee your hyperthyroid cat’s care before, during and after the I-131 treatment.

We are the only facility in the mid-Atlantic area to offer a thyroid scan before I-131, which is useful to confirm the diagnosis of hyperthyroidism, confirm the location of the abnormal thyroid glands, and suggest if hyperthyroidism is due to a benign or malignant tumor. The results of the thyroid scan also help determine the dose of I-131 needed to treat your cat’s hyperthyroidism.

What is included in the I-131 therapy of my hyperthyroid cat at Veterinary Referral Associates?

A consultation with a board certified internal medicine specialist is an important first step in the treatment of your hyperthyroid cat at Veterinary Referral Associates. An internist will examine your cat and carefully review the medical history including all prior tests and treatments, especially those related to the diagnosis and treatment of hyperthyroidism. An internal medicine consult is important because hyperthyroidism tends to be a disorder of older cats that may have other age-related problems occurring at the same time. Your cat’s blood pressure will be evaluated as well; many hyperthyroid cats have high blood pressure due to hyperthyroidism or other problems.

I-131 is administered by specially trained personnel via injection (one shot) and then your cat is allowed to rest for several days until the levels of radioactivity are safe for him/her to rejoin your family. During the time your cat is here, we will visit him/her twice daily to provide fresh food, water and bedding, clean their litter box, check their levels of radiation, and also to provide some well-deserved tender loving care. While we cannot be with your cat for a long period of time because of radiation safety guidelines, we do have someone watching your cat to make sure they are safe and sound at all times through video monitoring. Cats are admitted on Monday mornings and discharged on Fridays. We will communicate the results of all of our exams, recommendations and treatment for your cat with your regular veterinarian.

What do I need to do once my cat is home from I-131?

Your cat can resume its normal routine at home with a few restrictions. For 17 days after your cat goes home from I-131, he/she should remain indoors and not sleep or sit near your head or on your lap. These recommendations are to protect you from the tiny amounts of radiation that are still being emitted from your cat during this time. Your cat can eat its normal diet and use the litter box as usual. Special recommendations on handling your cat’s waste during this time will be provided to you.

1, 3, and 6 months after I-131, it is recommended that you bring your cat back to Veterinary Referral Associates or to your veterinarian for post I-131 monitoring. The monitoring is helpful to make sure the I-131 treatment was effective in curing your cat’s hyperthyroidism, to evaluate if the thyroid levels are adequate, and that the rest of your cat’s body systems are functioning smoothly too.

For questions or further information about I-131 therapy, please call Veterinary Referral Associates and one of our staff members will be happy to speak with you about it.

Feeding tubes can be placed as a temporary or more permanent aid in the feeding of pets that can’t or won’t eat due to a variety of conditions. These tubes are placed either into the esophagus or into the stomach. Nutrition plans and follow up treatments are formulated by the internal medicine specialist.

Pets sometime present with Pleural Effusion, or fluid in the space between their lungs and chest wall, due to an underlying condition. During Thoracentesis, ultrasound guidance is used to insert a needle or catheter into the chest and draw the fluid out with a syringe. This sterile procedure can often make the pet more comfortable while our veterinarians are evaluating the cause of the fluid. The fluid obtained via Thoracentesis will be laboratory-tested as part of the process of discovering the underlying cause for the condition and arriving at a diagnosis and treatment protocol.

A stent is a tubular support placed inside a blood vessel, canal, or duct to either aid in healing or to relieve an obstruction or narrowing that has occurred in a structure. Patients with conditions such as tracheal collapse and cancer of the trachea may be candidates for placement of tracheal stents. Self-expanding stents are placed in a given patient with the help of our fluoroscopy unit, which is real time x-ray.

Urethral stent placement is a technique used for obstructive urinary tract diseases. Most commonly this technique is used in cases of cancer of the lower urinary tract. It buys some extra time in cases of terminal cancer of the urinary tract. It also increases survival time of patients with cancer in the urethra only. These cancers are usually not resectable and no effective treatment is available. Urethral stents can lead to temporary incontinence in female dogs. Its benefits usually last for 2-4 months, and occasionally much longer.