Internal Medicine

Whilst we always try to keep patients in the clinic for as short a period of time as is appropriate, most patients referred to the internal medicine service will need to stay in overnight and sometimes for several nights.

The reasons for this are: first, we often have to wait overnight for one set of test results before knowing how we will proceed the investigation or treatment the following day and second, because sometimes we have to see how well a patient responds to treatment before we think we can let them come home. However, we have a full team of night vets and nurses who are up and working to make sure they are cared for, safe and happy.

The first and most important thing we do is a review of what has happened before we meet you and your pet and then we will perform a detailed clinical examination during your consultation. After this, we will almost always undertake a series of blood and urine tests and sometimes faecal tests.

Depending on what the problem is, we then may obtain X-rays, an ultrasound scan, a CT scan or sometimes an MRI scan, but these are not always necessary. If the problem relates to the intestines, lungs or urinary system, we may use an endoscope to investigate these and if the problem relates to the blood, we may also obtain a bone marrow sample.

All procedures will be explained to you before we do them to make sure you understand what we think we need to do and why.

X-rays in cats and dogs are exactly the same as X-rays in human medicine. The patient sits or lies down on a special table situated below the X-ray machine and it takes around 0.2 seconds. At Granta Veterinary Specialists we have a digital X-ray system, meaning that we can see the images really quickly and where necessary, work with colleagues around the world to ensure our interpretation of them is correct. As a general rule, X-rays are extremely safe for the patient but as the operators we have to take special precautions to make sure we don’t expose ourselves to too many each year.

A CT scanner is basically a large X-ray machine that spins quickly through 360 degrees around the patient taking X-ray images from all different angles as it spins. Through this we obtain much more detailed images than we can with routine X-rays, and have the ability to create 3D images. At Granta Veterinary Specialists, we have one of the most modern CT scanners currently available anywhere, a “64-slice” machine made by Philips and it is a frontline CT scanner in many human hospitals around the world.

MRI scans are different, because they do not use X-rays to obtain the images, but rather some extremely clever physics linked to how the spin of electrons in molecules change when they are exposed to a magnetic field. MRI scans give exquisite detail of soft tissue structures and especially of the brain and spinal cord. At Granta Veterinary Specialists we currently have an MRI scanner visit us twice a week but we will be investing in a new sort of scanner called a “1.5 Tesla zero-helium” machine, again made by Philips. MRI scans are extremely safe to the patient but we do need to know if your pet has a metallic implant, such as a microchip or orthopaedic implant as these can interfere with the quality of the image. We would also not perform an MRI scan on a dog who has a pacemaker fitted.

Ultrasound is different again, as this works like a ship’s sonar system; the ultrasound machine passes very high frequency sound waves into the patient and listens for the echo. By measuring the time it takes for the echo to come back and the strength of the echo, it can tell the difference between different tissues and the image is formed. Ultrasound is completely safe in every patient but it has limitations in that it cannot “see” through bone or air, whereas all of the other modalities described above can.

As pet owners ourselves, we totally understand that no-one likes their pet coming home from the vet having been clipped or to have some bald patches. However, clipping the hair in some areas is essential to enable us to keep all of our procedures sterile where required, or to maximise the accuracy and acuity of some ultrasound images. Some places therefore that we almost always clip are:

• On the underside of their neck (for blood sampling)
• On one of both front legs if they need to have an intravenous catheter placed
• On the underside of their abdomen (tummy) for most abdominal scans
• Just behind their armpit if we need to ultrasound their heart or chest

Therefore, we will ask permission from you to clip as necessary. We will clip as little as possible and we will aim to make it look as neat as possible.

It depends on what we have to do. For simple tests like blood and urine sampling, we almost always do this slowly and calmly to avoid the need for any sedation, but if a patient is really nervous then we may discuss that it will be less stressful if we use sedation. For procedures like X-ray and ultrasound we usually do administer sedation to make sure that:

1. Our patients are not worried or stressed by having to lie still with us for 30-45 minutes
2. To help keep them relaxed and therefore help us obtain the very highest quality images we can, as quickly as we can.

For procedures like a CT or an MRI scan, or a skin or bone marrow biopsy, it would be more usual for the patient to be fully anaesthetised because they cannot move during these procedures and we are not allowed to be in the scanner with them to help them stay still! However, we have an amazing Anaesthesia Specialist working with excellent, highly qualified nurses who are extremely experienced in anaesthesia to ensure that we will do everything we can to make this as safe and stress-free as possible.

All endoscopy procedures are performed under full anaesthesia as explained below.

A fine needle aspirate, often referred to as an “FNAB”, is a simple technique in which we insert a hypodermic needle into a tissue or structure of interest and then remove a small sample of cells through the needle for analysis at the laboratory. It is usually very quick and simple to do so that it often doesn’t require any sedation, but if we are sampling a tissue, such as the liver or spleen, then we would do this under sedation using an ultrasound machine for guidance.

FNAB’s can be a quick and simple way to obtain valuable information on what is wrong, but they do not always give us as much information as either an endoscopic or surgical biopsy, so we will always advise you on what is the most appropriate test and technique to perform.

An endoscope is basically a small camera mounted on the end of a flexible tube that we can gently pass into the stomach, intestines, lungs and sometimes up into the bladder to look inside the organ in real time and, if required, we can then go on to obtain small biopsy samples of anything abnormal.

Unlike in human medicine, we always perform endoscopy under a full general anaesthetic. Although endoscopy isn’t actually painful, humans report that sometimes it can feel unpleasant. We want our patients to feel no discomfort and giving them a full anaesthetic is the best way to do this. Just a quick note: biopsy results usually take around five days to come back from the laboratory, so if appropriate and possible, we usually send patients home after their procedure but before we have all of the results and then we will discuss the results over the phone, or in person, as soon as they are available.

There is a national blood bank in the UK for dogs called “The Pet Blood Bank”. The Pet Blood Bank works with volunteer owners across the country who offer and allow their dogs to give blood, just like human volunteers do for us in the NHS. Because dogs have blood groups, we will work out what blood type your dog is and then obtain a matched sample from a donor that will have been fully screened to make sure that the transfusion is safe.

As demand often exceeds supply, we always use this resource carefully. If there is no blood available at the blood bank, then we can use local canine volunteers to donate samples but only after they have undergone thorough health checks to make sure they are well enough and suitable to donate.

Unfortunately, there is no similar national service available in the UK for cats, but there are companies in Europe that offer a similar service, we can also use local feline donors if available, and we work with other local Specialist centres to obtain feline blood for transfusion as required.

We will usually discharge your pet with the medication they require in the short-term, but after this you have several different choices depending on what is most convenient and appropriate for you:

1. We can request that your primary care vet provides you with the ongoing medication your pet needs
2. Either we, or possibly your primary care vet, can provide you with a written prescription to enable you to obtain the medication from an on-line or high street pharmacy if it is available through this route. Please note that it is normal for there to be a charge to provide a written prescription
3. We at Granta Veterinary Specialistscan provide you with repeat prescriptions, which you will be able to request through our website

It is important to note for any vet to provide repeat prescriptions, they are required to examine the patient at regular intervals. This interval does vary depending on the medication, however, so this is something we can discuss with you as necessary.

The answer to this depends somewhat on whether we have reached a diagnosis, or whether we are waiting for some test results to come back.

Either way, however, we will undertake a discharge consultation to explain what we have done and the plan going forward. We will also provide you with a written discharge letter, and a copy will be sent to your primary care vet.

If further follow-up appointments need to be made, which is often the case for patients in the Internal Medicine service, we will typically arrange these at the time of discharge or once we have all test results back.

Some of the conditions we manage in the Internal Medicine service require long-term medication or monitoring. In this situation, we will work closely with your vet and arrange mutually convenient times if you need to see us regularly.