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Frequently Asked Questions: Internal Medicine

Internal Medicine at VRC

 

Why does my pet need to see an internal medicine specialist?

Most patients that present for evaluation to internal medicine have complicated ailments that may be difficult to diagnose or treat. Our goal is to help discuss with you your diagnostic options, do everything that we can to get an answer to what is going on, and treat your pet in a way that will provide the best outcome possible.  The initial consultation will simply be to discuss your pet’s condition and all options regarding how to proceed.

How is my pet going to do during/after treatment?

Many patients that have complicated diseases/disorders can respond to treatment in different ways. This means that we often need to initiate treatment, monitor your pet’s responses, and adjust treatment based on what we see.

Does my pet have to receive diagnostic testing?

We encourage diagnostic testing as it can play an important role in allowing us to make proper medical recommendations and treatment adjustments for your pet. A definitive diagnosis gives us the best likelihood of a successful treatment. If you decide not to pursue diagnostic testing, we can try to treat your pet’s most likely condition(s) without a definitive diagnosis. It is important to understand that if we are treating your pet without a definitive diagnosis it is impossible to predict how they will respond.

Can my veterinarian do the follow up treatments?

Absolutely, we always work closely with your veterinarian. Many clients travel from a long distance and it is difficult for them to continue to make trips back for recheck blood work, weight evaluations, x-rays, etc. If you are going to follow-up with your veterinarian, we ask that you request diagnostic updates to be faxed to us so that we can continue to monitor them. We will then fax our medical recommendations, based on the information provided, to your veterinarian and (s)he will get in touch with you to discuss any changes to the treatment plan.

Can I get the prescription medications from my veterinarian?

We would be happy to fax any necessary paperwork to your veterinarian to fill a prescription as long as the medication is in stock and a valid Veterinarian-Client-Patient relationship exists. This means that your pet has seen a particular primary veterinarian for visits and check-ups on a regular basis (typically within one year).

Can I get my pet’s prescription medications from a human pharmacy?

As long as the recommended medication or a suitable substitute is available as a human prescription, we would be happy to fax a prescription to a local or online pharmacy of your choice. Given that the cost of human medications fluctuates with time and across pharmacies, we recommend that you do some price shopping.  The same is true for online prescription purchases.

Do I need to fast my pet for the appointment?

Generally your pet does not need to be fasted prior to the appointment. If your pet will need to be fasted for specific tests or anesthesia, we will discuss fasting recommendations during the first appointment. If your veterinarian thinks that your pet will need anesthesia the day of the appointment or has recommended fasting, please contact us to discuss options.

Frequently Asked Questions: Cardiology

Cardiology at VRC

 

How can I detect heart complications and diseases in my pet?

Regular check-up appointments with your family veterinarian are essential in making sure that your pet is heart-healthy.  In many cases, your family veterinarian will be able to detect a heart complication through listening to the beat patterns, X-rays, EKGs, and/or performing routine blood tests. If an abnormality is found, he or she will refer you to a Cardiologist at VRC.

What symptoms might my pet display if he or she is experiencing a heart problem?

If your pet has progressing heart disease, he or she may show observable symptoms. In dogs, these symptoms include gagging cough, fainting, weakness or reluctance to exercise, rapid resting or sleep breathing rates (more than 30 breaths per minute), and abdominal swelling. Cats may faint, have an increased rate of abdominal breathing, experience lethargy, painful limbs or limb paralysis, and they may hide more than usual. Be sure to make an appointment with your family veterinarian as soon as possible if you witness any combination of these symptoms in your pet.

What is a cardiac consultation at VRC like?

A cardiac consultation at VRC consists of a thorough evaluation of the heart and includes a physical exam, echocardiogram (test that displays real-time heart structure and function imaging), Doppler ultrasound, blood speed studies, and electrocardiogram (test that monitors the heart’s electric activity). At VRC, we utilize state-of-the-art equipment to perform all tests, which are each essential in effectively evaluating your pet’s heart.

Can I be present during my pet’s cardiac examination?

Yes, we encourage you to be with your pet during his or her cardiac consultation. This will help your pet feel calm and comfortable, and also allow you to observe the heart tests being performed. After the exam, please feel free to ask any questions that you may have about the consultation and your pet’s heart health.

Can I pick and choose which cardiac tests are performed on my pet?

No, we perform the same cardiac tests with each consultation. Our carefully selected series of tests are needed to decide the best medical treatment for your pet and to determine whether or not further diagnostic procedures are required.

Are the cardiac tests painful for my pet?

Not at all! All of our tests are completely noninvasive. The ultrasound has a massaging action that is completely painless and our EKG clips are nothing like what is used in human medicine; they are surprisingly comfortable. Your pet will be gently positioned on the side of a towel and will be awake and comforted throughout the entire procedure. The vast majority of pets require no sedation and there are no side effects to these tests. Many patients look forward to their visits with our team and have become close friends with our staff members!

Do the tests leave any bruising or physical marks on my pet?

Not at all! Your pet will look exactly the same and no one would be able to tell that he or she was in the hospital if you don’t tell them. We don’t even need to shave your pet for these tests, as we use alcohol to mat down the hair instead; a completely painless coupling gel is also applied for use during ultrasounds.

Can my pet’s heart condition be treated?

For the most part, if your pet is diagnosed with and treated for heart disease early on, he or she has a good chance at successful symptom management and living a long, healthy life. Once your pet is diagnosed, we have an extensive medical arsenal and will do what we can to provide your pet with a good quality of life for as long as possible. If your pet is diagnosed with a congenital heart defect at birth, surgery may be feasible to correct the condition. Early detection and a personalized treatment plan from a veterinary cardiologist will help manage your pet’s disease and improve his or her overall quality of life. Even advanced heart disease and heart failure may be treatable, so it is never too late for your pet to get a cardiac consultation.

You have recommended that my pet take medication. How do I fill this prescription?

At the end of the exam, the drugs that your pet needs can be dispensed at VRC.  In many cases, your prescription can be filled at almost any pharmacy, so please feel free to price shop; however, a popular cardiac drug called VetMedin must be filled at a veterinary source. You can also utilize our online pharmacy with Vets First Choice for hundreds of guaranteed products and convenient shipping right to your home.

Frequently Asked Questions: Surgery

Surgery at VRC

 

Why do I fast my pet if surgery is not scheduled for the same day?

We ask that you fast your pet in the event that additional diagnostics need to take place. When your pet has eaten, it can sometimes change the results of a test so to get the most accurate information possible, fasting may be necessary even if your pet is not having surgery that day.

Will my pet experience discomfort before, during, or after their surgical procedure?

The level of discomfort your pet may experience all depends on the type of procedure that is taking place. For minor procedures, there may be little to no pain involved. For more advanced procedures, there may be some discomfort. However, we are very proactive about using medications to relieve pain and discomfort for your pet. When necessary, we provide medication before, during, and after the procedure that will allow your pet to feel comfortable and safe.

Is anesthesia safe for my pet?

Anesthesia is considered extremely safe in the veterinary field. Our trained doctors and nurses monitor your pet throughout the entire procedure to ensure his/her comfort and safety. We are experienced in providing anesthesia to all pets including higher-risk patients with sensitivities such as old age and weakness; heart, kidney, and liver disease; as well as other critical and/or unstable conditions. Anesthesia is such a valuable tool in veterinary medicine and you can rest easy knowing that your pet is in highly experienced hands at VRC.

How will my pet react to anesthesia and pain medication?

Every pet reacts differently to anesthesia and pain medication. Constipation is normal for 3-5 days after your pet’s surgery as long as there is no obvious straining. Decreased appetite and lethargy is also normal as long as they are eating small amounts. If you have a question regarding your pet’s behavior after a surgery, please give us a call at (610)647-2950.

What kinds of physical restrictions will be placed on my pet after surgery?

Physical restrictions placed on your pet after a procedure will depend on the type of operation that took place. Often, we recommend that your pet refrain from running, jumping, or any excessive activity until the first recheck. You can accommodate your pet by arranging his/her living space to include everything (s)he might need at a close distance. This will reduce his/her need to exert too much energy or movement, which helps result in a speedy recovery. You will receive more specific home care instructions upon your pet’s discharge from VRC.

Why is exercise restriction so important?

For the first two weeks, exercise restriction is essential for incision, muscle, and tissue healing. It prevents the incision from opening and causing complications. To maximize the success of your pet’s surgery, following discharge instructions regarding follow-up care is very important. This way, your pet can get back to their normal selves in no time! If you have any questions about your discharge instructions, please feel free to give us a call.

What care is involved with my pet’s surgical site?

Specific instructions with how to care for your pet’s surgical site will be included with your discharge paperwork before you leave the hospital. Every pet is different, which is why we provide care instructions that are catered specifically to your pet’s individualized needs. If you have any questions regarding the follow-up instructions you were given, please give us a call.

I live far away. Do I have to come back to VRC for rechecks?

We do suggest that you return for a recheck so that we can assess the healing process. However, we understand that not everyone lives close to our facility, so you can speak to your VRC surgeon about having your primary veterinarian perform the recheck exam. We always keep your primary veterinarian involved with the status of your pet throughout his/her time spent at VRC, which allows for a seamless transition from specialty to primary veterinary care.

Frequently Asked Questions: Dentistry and Oral Surgery

Dentistry and Oral Surgery

 

What is Dental Radiography?

Dental radiographs, more commonly referred to as x-rays, are necessary to see what lies under the gums and within the teeth and bone. Obtaining good quality dental radiographs and properly interpreting them requires advanced training. Clinical examination of each tooth with dental instruments is also essential, since not all dental lesions are visible radiographically.

What oral pathology can be detected and treated at VRC?

  • Malocclusion
  • Tooth-to-soft tissue trauma
  • Ulcers/ excessive redness
  • Missing teeth
  • Crowded or extra teeth
  • Growths or swellings
  • Discolored, non-vital teeth
  • Fractured or chipped teeth
  • Open pulp chambers
  • Draining tracts
  • Caries (“cavities”)
  • Loose teeth
  • Gum recession
  • Deep periodontal pockets
  • Hair entrapment
  • Calculus

Why is an anesthetic evaluation necessary?

It is impossible to see the entire mouth while your pet is awake as many pets are uncooperative during an oral examination, especially if they are experiencing pain. A thorough evaluation requires dental radiography, a trained eye, and plenty of examination time spent with complete visibility of the entire mouth to spot hidden problems. Our dental specialty service can offer the same thorough evaluation for your pet that you expect from your own dentist.

What are the some consequences of oral disease?

Pain

Pets will suffer silently with tooth infections rather than appear weak. Dogs or cats that have fractured teeth with exposed pulp will develop pain, even if their behavior does not reflect this. Periodontal disease can also lead to painful abscesses. Studies show that 27% of dogs have fractured teeth, and 9% of these teeth have pulp exposure. Early infections can only be prevented or identified early with a thorough evaluation of the mouth and dental radiographs.

Unhealthy chewing habits are a common cause of broken teeth. Never provide chew toys that you cannot break with your hands, or that you cannot dent with your finger nail. If your dog is prone to aggressive chewing, check frequently for broken teeth.

Systemic Disease Associations

In humans, periodontal disease is linked to heart disease, diabetes, and low birth weight babies. Similar links between poor oral health and more serious diseases also exist for our pets. Gum infection and inflammation by-products seep into the blood stream where it negatively affects the liver, kidneys, and heart muscle. The more oral infection is present, the worse the effects.  This is why it is so important to have your pet’s mouth regularly evaluated.

Tumors

Oral growths in pets are not uncommon. If seen in time, the treatment prognosis is good. The longer they persist and the larger they become, the more difficult they are to treat.

Bone Loss

In small dogs, the teeth are disproportionately larger for their mouths compared to big dogs. The resulting dental crowding leads to tooth overlap, rotations, and the creation of havens for trapped infection that fosters periodontal disease (the loss of tooth-supporting bone). This bone loss can cause problems such as spontaneous jaw fractures in pets of any age. Simply looking at the front teeth in an awake pet will give very few clues as to the advanced periodontal disease developing under the gums in the back of the mouth. The dental x-rays  that we use can give us insight into the areas of the mouth that we cannot see.

Behavior Changes

Owners frequently remark how playfulness returned to their older pets after the treatment of painful dental disease. If just one bad tooth can ruin your mood, just imagine having numerous painful teeth!

What signs might my pet show if they are having a problem with his/her teeth/mouth that requires medical attention?

Pets will conceal oral pain as much as possible, so their dental disease may be very advanced before it is noticeable. Eventually, signs such as bad breath, dropping food, jaw or face swelling, loose teeth, pus, gum recession, very red and inflamed tissues, and bleeding can be a clue that they are experiencing pain in their mouth.

Are dental procedures painful? Safe?

It is impossible to perform necessary gingival probing and dental radiographs without anesthesia. Anesthesia, local nerve blocks, pain medication, and meticulous surgery all are part of minimizing discomfort. Properly performed and monitored anesthesia with intravenous fluids and body temperature support is extremely safe. At VRC, we have extensive experience performing dental procedures with anesthesia on pets from all walks of life. Ultimately, your pet’s long term health and comfort is greatly enhanced by eliminating dental disease.

How long do these procedures last?

The one bad tooth you’ve noticed in your pet’s mouth is often the tip of the iceberg in terms of what dental disease is present. After the oral assessment and dental x-rays, the findings are discussed with you (while your pet is under anesthesia) before any surgery. Please keep in mind that it may require several hours to correct a lifetime of progressing disease. That is why safe anesthesia is our highest and first priority, and why we are so often entrusted by referring veterinarians to handle their older, smaller, and medically frail patients.