Ultrasound uses very high frequency sound waves to produce images of internal body parts and other soft tissues in real time. It is the most widely used diagnostic tool in human medicine and is also commonly used at ASEH. The value of ultrasound is determined by the quality of the ultrasound unit and the capability of the ultrasonographer. The ASEH internal medicine specialists have had extensive training and years of experience in ultrasonography and use the most up to date technology.

Examples of applications of ultrasound at ASEH include:

1) Abdominal ultrasonography - Organs such as the liver and gall bladder, kidneys and urinary bladder, pancreas, gastrointestinal tract, and adrenal glands are routinely evaluated. Ultrasound provides very useful information in diagnosing abdominal masses, liver and gall bladder disease, kidney disease, bladder stones, pancreatitis and diseases of the intestinal tract. Ultrasound may be also used to evaluate blood flow in the abdomen and identify a common congenital liver problem call a portosystemic shunt.

2) Cardiac ultrasonography (Echocardiography) - Ultrasound evaluation of the heart is very useful in diagnosing congenital heart defects and evaluating acquired heart disease such as mitral valve disease and cardiomyopathies (heart muscle disease). Echocardiography is commonly accepted as necessary to best evaluate heart murmurs that commonly develop in dogs and cats as they age.

3) Other soft tissues, such as thyroid glands, the chest cavity, and soft tissue masses are often ultrasounded to better evaluate for cancer and infection.

 

The Medicine Team from left to right: Dr. Ludlow, Gina, Margaret, Brandi, Sarah and Dr. Smith.

Patient receiving intravenous partial parenteral nutrition (PPN)

Our mothers were right- when you’re sick you have to eat your chicken soup to get well. Even more importantly, we now recognize proper nutrition is critically important for the prevention and management of early disease. The same is true in our pets. Here at ASEH our internal medicine specialists have both completed residences not only in internal medicine but also small animal clinical nutrition. This training has provided both the knowledge for making the best nutrition recommendations for you pet and more importantly the sensitivity to recognize that proper nutrition should be instituted early. Our nursing staff also has extensive training and knowledge of the many pet foods available to our clients and is anxious to make recommendations for which diets are best and provide detailed recommendations for how much and when to feed our patients.

 

Malnutrition is very common in sick animal and is thought to affect up to 50% of hospitalized dogs and cats. Within days malnutrition can begin to have deleterious effects on immune function, healing and, most importantly, quality of life. While human patients will follow their doctor’s instruction to eat even though they don’t feel well or have a good appetite, it is impossible to convince a sick pet to eat if they don’t feel like it. At ASEH we have years of training and experience at providing the best possible care for the anorectic pet.

 

Options for nutritional support provided by the doctors at ASEH include the use of appetite stimulants to get our patients eating again, short-term feeding tubes when appetite stimulants are not effective, or long-term feeding tubes for those patients that will require prolonged nutritional support to recover from serious illness. We are also trained to formulate and use true intravenous nutrition (not just put glucose in the IV fluids) so that we can provide complete nutritional support for recovery of our patients who do not have a functional digestive tract.

 

Please contact us if you have any questions regarding your pet’s diet or nutritional support during its illness.

 

	Gastrostomy tube in place in a puppy. This tube goes directly into the stomach.		Cat with a naso-esophageal tube in place

 

Stomach tumor identified with endoscopy (arrow)

Endoscopy means to “look within” and describes a procedure to view inside the body. Biopsies may be taken, and foreign bodies may be retrieved during this procedure. Gastric (stomach) feeding tubes may be placed with endoscopy as well. These tubes may be needed in cases where nutritional support is indicated for short and long-term illness. When used by itself, the term endoscopy usually refers to the examination of the upper gastrointestinal tract (mouth, esophagus, stomach and duodenum). The advantage of endoscopy is simple. It is less invasive than surgery (no incision) and less expensive. The disadvantage of endoscopy is that sometimes larger biopsies are required to make a diagnosis and that the entire intestinal tract cannot be evaluated. Specialized forms of endoscopy are performed in certain cases and are named for the organs examined. For example, bronchoscopy evaluates the trachea and lower airways. Other forms of endoscopy are rhinoscopy (nasal passage), cystoscopy (urinary tract), vaginoscopy (vaginal vault), and colonoscopy (colon) Endoscopy services are available on a routine and emergency basis. It is a common outpatient procedure and generally requires only 12 hour fasting.

 

	Esophageal stricture		Gastritis inflammation of the stomach lining seen on endoscopy. Numerous mucosal erosions are present, causing the patchy appearance seen here.
	Rectal tumor identified during colonoscopy (arrow)

 

Postioning a patient for an MRI of the brain.

Magnetic resonance imaging is an important diagnostic tool for spinal cord lesions, and is the imaging method of choice for lumbosacral disease and brain diseases.

The advantage of MRI is that it can provide 3-dimensional information about the area of interest, with excellent soft tissue contrast resolution, and is non-invasive. Dogs and cats undergoing MRI need to have general anesthesia to ensure that they are still for the procedure.

After a thorough neurologic examination, the specialist in charge of your pet’s care will determine if an MRI is an appropriate diagnostic tool.

	MRI of a dogs neck showing a large herniated disc (arrow). The dog’s head is to the left.		Dr Smith and Tracy in the MRI control room

 

MRI of a dog showing a tumor adjacent to the spinal cord, causing neurologic problems. The 3 views allow a 3-dimensional assessment of the tumor, showing the advantage of MRI for evaluating spinal cord disease. The tumor shows up bright white. The arrow points to the tumor in all 3 views.

	Dorsal view		Transverse view
Saggital view

Example of a brain tumor (in the cerebellum) in a dog seen on an MRI. The image on the left is the “plain” scan, and the image on the right is after an intravenous injection of a contrast agent that enhances visualization of tumors.

 

	Transverse section of the head
		Eye
		Tumor after contrast injection
	Dorsal section of the head

Chemotherapy

Chemotherapy offered at Animal Specialty & Emergency Hospital:

Here at Animal Specialty & Emergency Hospital, Dr.’s Thomas Smith and Chris Ludlow are highly educated in Chemotherapy and their foremost concern is your pet’s well being. Our Internal Medicine technicians are experienced in caring for cancer patients and administering chemotherapy. They will make your pet’s chemotherapy experience as comfortable and as calm as possible.

Benefits of chemotherapy

Chemotherapy is a very successful treatment for certain types of cancer, including; lymphoma, osteosarcoma, and transmissible venereal tumors. Other cancers such as; mast cell tumors, and various types of leukemia may benefit from chemotherapy as well. Your pet’s type of cancer may not respond to chemotherapy. Dr.’s Smith and Ludlow will determine if your pet is a good candidate at your consultation appointment.

Our goal with chemotherapy is offering the best opportunity for remission, and improved survival, while at the same time preserving a good quality of life.

Risks and side effects

There are risks involved with any type of treatment for cancer. Symptoms are usually mild including; nausea, vomiting or diarrhea and can be treated with supportive care. Since we are a 24 hour facility, doctors and technicians are always available to treat these possible side effects. During your consultation appointment you will receive a handout on all the chemotherapy medications used and their possible side effects.

Usually these side effects are outweighed by the benefits of killing cancer cells.

The expense

Chemotherapy can be costly. The medications are the same used to treat human cancer patients, and most of the drugs are expensive. Another expense is the additional precautions and special equipment used in administering chemotherapy to prevent harm to the technician’s involved.

A detailed protocol sheet with the estimated weekly expense will be given to you at the time of your consultation.

 

What happens at the time of my pet's initial referral visit?

Please do not feed your pet after 10pm the night before the appointment, unless our staff has instructed you otherwise. Water is allowed.

Please make sure you bring any pertinent information with you on the day of your appointment. This could include, x-rays, blood test results, any medications and a referral form completed by your veterinarian. Your veterinarian may fax the written records and referral form before our visit.

Please arrive 15 minutes early to complete any forms needed.

If you are unable to keep your appointment, please give us a 24-hour notice.

Upon arrival, you will be asked to complete our client registration form (if not already completed prior to the appointment) by one of our front desk staff members. Depending on what service your pet will be seeing, you may be asked to complete additional forms. Client registration form

The doctor and his/her nurse will meet with you to discuss your pet’s medical history, condition and evaluate your pet with a thorough exam. The doctor may also perform a more thorough exam away from the exam room in one of our treatment areas. At this point, a written Diagnostic and Treatment Plan, and a Procedure consent form, will be presented to you before any additional tests are performed, or before your pet is admitted to the hospital.

For outpatient visits, payment in full is due at the time of the visit. If your pet is admitted to the hospital a deposit will be required.