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Internal Medicine

Internal Medicine

 

Internal Medicine overview

  • 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 dedicated Specialist-led medicine team:
      • five RCVS/European/American boarded Specialists
      • supported by two 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 ICC approved Cat Friendly cat ward
      • superbly equipped Intensive Care Unit
  • The Willows medicine team is happy to offer free telephone advice
  • 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:
    • five RCVS/European/American boarded Specialists
    • supported by two 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 

Internal Medicine Specialists

Kirsty Roe - American Specialist in Small Animal Internal Medicine   Isuru Gajanayake - American Specialist in Small Animal Internal Medicine, American Specialist in Small Animal Nutrition   Stephanie Lalor - Small Animal Medicine Clinician   Fergus Allerton - Small Animal Medicine Clinician   Andrew Kent - Small Animal Medicine Clinician
                 

Kirsty Roe  

BVSc CertSAM DipACVIM
DipECVIM-CA MRCVS

 

Isuru Gajanayake

BVSc CertSAM DipACVIM DipECVIM-CA DipACVN MRCVS

 

Stephanie Lalor

BVetMed(Hons) MANZCVSc DipECVIM-CA MRCVS

 

Fergus Allerton

BSc BVSc CertSAM DipECVIM-CA MRCVS

 

Andrew Kent

BVSc DipECVIM-CA MRCVS

 

Internal Medicine Specialists

 

Kirsty Roe - American Specialist in Small Animal Internal Medicine

Kirsty Roe
BVSc CertSAM DipACVIM DipECVIM-CA MRCVS

Isuru Gajanayake - American Specialist in Small Animal Internal Medicine, American Specialist in Small Animal Nutrition

Isuru Gajanayake
BVSc CertSAM DipACVIM DipECVIM-CA DipACVN MRCVS

Stephanie Lalor - Small Animal Medicine Clinician

Stephanie Lalor
BVetMed (Hons) MANZCVSc MRCVS

Fergus Allerton - Small Animal Medicine Clinician

Fergus Allerton
BSc BVSc CertSAM DipECVIM-CA MRCVS

Andrew Kent - Small Animal Medicine Clinician

Andrew Kent
BVSc DipECVIM-CA 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.

 

 

TOP

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.

Remy with his endoscopically removed festive F.B. 

Endoscopic view of duodenal ulceration (left) and gastric lymphoma (right)

Endoscopic view of duodenal ulceration (left) and gastric lymphoma (right)

 

TOP

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.

Remy with his endoscopically removed festive F.B. 

Endoscopic view of duodenal ulceration (left) and gastric lymphoma (right)

Endoscopic view of duodenal ulceration (left) and gastric lymphoma (right)

 

 

TOP

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)

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

We are fully equipped to undertake emergency blood transfusions in dogs
and cats

 

TOP

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)

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

We are fully equipped to undertake emergency blood transfusions in dogs and cats

 

TOP

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

Laparoscopic liver biopsy

An ultrasound-guided Trucut liver biopsy in progress

An ultrasound-guided Trucut liver biopsy
in progress

 

TOP

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

Laparoscopic liver biopsy

An ultrasound-guided Trucut liver biopsy in progress

An ultrasound-guided Trucut liver biopsy in progress

 

TOP

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)

CT of a bronchial foreign body (arrowed)

Foreign body – removed endoscopically

Foreign body – removed endoscopically

 

TOP

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)

CT of a bronchial foreign body (arrowed)

Foreign body – removed endoscopically

Foreign body – removed endoscopically

 

TOP

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

MRI of a pituitary mass in a dog with hyperadrenocorticism

 

TOP

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

MRI of a pituitary mass in a dog with hyperadrenocorticism

 

 

TOP

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

CT nasal turbinate + bone destruction - Cryptococcus

 

TOP

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

CT nasal turbinate + bone destruction - Cryptococcus

 

TOP

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

Ultrasound scan – pyelonephritis in a puppy

 

TOP

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

Ultrasound scan – pyelonephritis in a puppy

 

TOP

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

Parenteral nutrition is provided intravenously and is usually reserved for critically ill patients

 

TOP

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

Parenteral nutrition is provided intravenously and is usually reserved for critically ill patients

 

TOP

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

Zante: between chemotherapy treatments for osteosarcoma

 

TOP

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

Zante: between chemotherapy treatments for osteosarcoma

 

TOP

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

Ultrasound scan – a migrating grass awn

CT of a subtle migrating FB tract in a Springer Spaniel

CT of a subtle migrating FB tract in a Springer Spaniel

 

TOP

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

Ultrasound scan – a migrating grass awn

CT of a subtle migrating FB tract in a Springer Spaniel

CT of a subtle migrating FB tract in a Springer Spaniel

 

TOP

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

Maisey: our first 450g of medicine patient – juvenile hypoglycaemia

 

TOP

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

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