Internal Medicine
Internal Medicine overview
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- A comprehensive Internal Medicine Service – fully supported by other Specialists and staff including those in our Diagnostic Imaging, Anaesthesia and Soft Tissue Surgery teams
- We have a growing dedicated team:
- three RCVS or American boarded Specialists
- one Residency trained clinician
- supported by 2 dedicated medicine/high dependency Diploma Nurses and over 30 experienced RVNs
- Experienced clinicians committed to staying up to date by:
- participating in meetings both nationally and internationally
- providing CPD for the profession in a number of formats
- We are proud to offer referral appointments for chronic or more acute medicine cases with continuity of care, 24 hours a day,
365 days of the year - Hospitalised patients benefit from
24-hour veterinary and nursing care- quiet ward suitable for sick patients
- isolation unit for infectious patients
- dedicated cat ward
- superbly equipped Intensive Care Unit
- The Willows medicine team is happy to offer free telephone advice
Personnel
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Internal Medicine Specialists |
Internal Medicine Clinician |
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MA VetMB DVR DSAM FHEA MRCVS |
BVSc CertSAM DipACVIM |
BVSc CertSAM DipACVIM |
BVSc (Hons) GradCertVetStud MACVS (Small Animal Medicine) MRCVS |
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Internal Medicine Specialists
Jane Eastwood
MA VetMB DVR DSAM FHEA MRCVS
Kirsty Roe
BVSc CertSAM DipACVIM DipECVIM-CA MRCVS
Isuru Gajanayake
BVSc CertSAM DipACVIM DipECVIM-CA MRCVS
Internal Medicine Clinician
Amy Lam
BVSc (Hons) GradCertVetStud MACVS (Small Animal Medicine) MRCVS
Supported by 2 dedicated medicine/high dependency Diploma Nurses and over 30 experienced RVNs.
When and what to refer?
The medicine service is fully equipped to deal with a wide variety of acute and chronic problems in both dogs and cats. We are here to help with any medical challenge.
- Longstanding 'nightmares'
- More urgent/emergency cases
- We can be used as an 'overflow' facility when you are too busy to deal with a demanding or complex case on top of everything else!
The continuity of care we provide means referring veterinary surgeons, our patients and their owners all benefit from having access to a member of the Specialist team whenever needed.
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Gastrointestinal conditions including pancreatic problems |
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We are happy to see the full spectrum of gastrointestinal cases including:
We have a wide range of endoscopes to suit all sizes of cats and dogs both for upper gastrointestinal studies and for colonoscopy. |
Remy with his endoscopically removed festive F.B. 
Endoscopic view of duodenal ulceration (left) and gastric lymphoma (right) |
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Gastrointestinal conditions including pancreatic problems
We are happy to see the full spectrum of gastrointestinal cases including:
- Clinical cases with acute or chronic vomiting, poor or variable appetite, diarrhoea (of every colour and consistency!), unexplained weight loss or suspected abdominal pain
- Challenging cases or those failing to respond appropriately to treatment
- Cases where owners, or you, are becoming frustrated!
We have a wide range of endoscopes to suit all sizes of cats and dogs both for upper gastrointestinal studies and for colonoscopy.
Remy with his endoscopically removed festive F.B.
Endoscopic view of duodenal ulceration (left) and gastric lymphoma (right)
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Anaemia and /or coagulopathies |
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We are fully equipped to deal with cases of:
Rapid, life saving treatment is facilitated by:
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Cleo: severe immune-mediated thromobocytopenia (left) 
We are fully equipped to undertake emergency blood transfusions in dogs |
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Anaemia and /or coagulopathies
We are fully equipped to deal with cases of:
- Acute or chronic anaemia
- Unexplained bleeding including
- haematemesis and/or melaena
- epistaxis
- petechiation or ecchymoses
Rapid, life saving treatment is facilitated by:
- A full range of blood and blood products available on-site for transfusion
- In-house coagulation testing and cross-matching
Cleo: severe immune-mediated thromobocytopenia (left)
Rocko: severe haemolytic anaemia and jaundice (right)
We are fully equipped to undertake emergency blood transfusions in dogs and cats
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Liver problems |
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Diagnostic work up is performed in close association with our Specialist imaging team:
Appropriate levels of supportive care are given in collaboration with the Medicine/High Dependency nursing and Anaesthesia teams. |
Laparoscopic liver biopsy 
An ultrasound-guided Trucut liver biopsy |
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Liver problems
- Acute and severe – cases with vomiting, jaundice, collapse
- Vague and subtle – cases with weight loss and malaise – the 'not quite right' dog or cat!
Diagnostic work up is performed in close association with our Specialist imaging team:
- Ultrasound guided biopsy
- Laparoscopic biopsy
- Surgical biopsies
- Portal venography – CT or fluoroscopic
Appropriate levels of supportive care are given in collaboration with the Medicine/High Dependency nursing and Anaesthesia teams.
Laparoscopic liver biopsy
An ultrasound-guided Trucut liver biopsy in progress
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Respiratory disease |
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Our exciting combination of:
means we are well placed to deal with a wide range of respiratory problems – from coughing to dyspnoea. |
CT of a bronchial foreign body (arrowed) 
Foreign body – removed endoscopically |
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Respiratory disease
Our exciting combination of:
- Diagnostic imaging equipment
- including 16 slice CT and a range of rigid and flexible endoscopes
- Intensive care facilities
- Multi-disciplinary expertise
means we are well placed to deal with a wide range of respiratory problems – from coughing to dyspnoea.
CT of a bronchial foreign body (arrowed)
Foreign body – removed endoscopically
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Endocrine conditions |
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Many endocrine cases prove difficult to investigate and manage, and are often associated with concurrent disease. Referral of complex endocrine diseases allows us to help to:
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MRI of a pituitary mass in a dog with hyperadrenocorticism |
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Endocrine conditions
Many endocrine cases prove difficult to investigate and manage, and are often associated with concurrent disease.
Referral of complex endocrine diseases allows us to help to:
- Establish realistic owner expectations
- Develop management plans for the longer term
MRI of a pituitary mass in a dog with hyperadrenocorticism
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Nasal problems |
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Primary bacterial rhinitis is rare in dogs and cats. CT imaging combined with rigid and flexible rhinoscopy for biopsy is frequently required for optimal diagnosis and subsequent management. |
CT nasal turbinate + bone destruction - Cryptococcus |
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Nasal problems
- Frustrating chronic nasal discharge cases
- Acute problems such as suspected foreign body
- Chronic, acute or severe epistaxis
Primary bacterial rhinitis is rare in dogs and cats. CT imaging combined with rigid and flexible rhinoscopy for biopsy is frequently required for optimal diagnosis and subsequent management.
CT nasal turbinate + bone destruction - Cryptococcus
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Renal disease |
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Prognosis in renal disease often depends on whether an underlying cause can be identified and managed:
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Ultrasound scan – pyelonephritis in a puppy |
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Renal disease
- Acute and chronic kidney disease cases welcomed
Prognosis in renal disease often depends on whether an underlying cause can be identified and managed:
- A full range of investigative techniques is available
- Full patient support and intensive care are provided where required
- Clients fully informed of the prognosis, managing their expectations
Ultrasound scan – pyelonephritis in a puppy
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Nutrition |
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Our patients' nutritional requirements are managed by the medicine team, which includes our clinical nutritionist, Isuru Gajanayake.
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Parenteral nutrition is provided intravenously and is usually reserved for critically ill patients |
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Nutrition
Our patients' nutritional requirements are managed by the medicine team, which includes our clinical nutritionist, Isuru Gajanayake.
- Assessment and management of complex nutritional disorders
- Formulation of recipes for balanced home-cooked diets
- Enteral feeding techniques including the use of various feeding tubes
- Parenteral nutrition – made bespoke to patient requirements
Parenteral nutrition is provided intravenously and is usually reserved for critically ill patients
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Medical oncology and chemotherapy |
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Extensive experience in a wide range of chemotherapy protocols:
After discussing suitable protocols with owners we are always happy to assist in managing these cases in tandem with referring practices. |
Zante: between chemotherapy treatments for osteosarcoma |
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Medical oncology and chemotherapy
Extensive experience in a wide range of chemotherapy protocols:
- For referred cases with a known diagnosis
- For patients diagnosed after referral
- For patients seen by other services in the Willows team
After discussing suitable protocols with owners we are always happy to assist in managing these cases in tandem with referring practices.
Zante: between chemotherapy treatments for osteosarcoma
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The 'pyrexia of unknown origin' case |
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Differentials include:
The implications of giving inappropriate treatment before a diagnosis is confirmed can be serious. We are fully equipped and staffed to investigate and manage these cases. |
Ultrasound scan – a migrating grass awn 
CT of a subtle migrating FB tract in a Springer Spaniel |
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The 'pyrexia of unknown origin' case
Differentials include:
- A focus of infection
- Inflammation
- Neoplasia
- Immune mediated disease
The implications of giving inappropriate treatment before a diagnosis is confirmed can be serious.
We are fully equipped and staffed to investigate and manage these cases.
Ultrasound scan – a migrating grass awn
CT of a subtle migrating FB tract in a Springer Spaniel
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The unknown... |
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When a patient fits no specific category or when veterinary surgeons are unsure which service to refer to – we are never the wrong place to start! If patients need to be redirected to another service after initial assessment, this is easily achieved. |
Maisey: our first 450g of medicine patient – juvenile hypoglycaemia |
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The unknown...
When a patient fits no specific category or when veterinary surgeons are unsure which service to refer to – we are never the wrong place to start!
If patients need to be redirected to another service after initial assessment, this is easily achieved.
Maisey: our first 450g of medicine patient – juvenile hypoglycaemia
Why refer to us?
- Our Medicine team is highly experienced and 'Committed to excellence'
- Our clinicians have gone through rigorous training to work at Specialist level
- Our service is dedicated to the patient, client and referring veterinary surgeon:
- one hour consultations
- thorough assessment and discussion with the client
- listening to client concerns, such as:
- invasive diagnostic procedures
- costs involved
- quality of life issues
- all investigations and treatment performed with full owner education and consent
- superb diagnostic and patient care facilities
- 24 hour veterinary and nursing in-patient care, 365 days of the year
- full backing and support for the veterinary surgeon referring the case
- thorough and prompt reporting to both owners and referring vets at every stage
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