Veterinary Specialty Consultation

When a pet presents a veterinarian with a particularly challenging or complex situation, a veterinary specialist can provide additional insight into the problem(s) through the use of advanced medical knowledge as well as specialized diagnostic techniques. This information provides your veterinarian with the additional information needed to make a diagnosis and formulate a treatment plan.

 

Abdominal Ultrasound

Why Choose WTVS for Ultrasound:
Animal ultrasounds are becoming more readily available in the veterinary field. It can, therefore, be challenging to decide who should perform your pet’s ultrasound. At WTVS, our veterinarians use their expertise as board-certified specialists to not only perform a thorough ultrasound but also interpret the findings and provide insight on the case from a specialist’s perspective. In other words, their experience and expertise in ultrasound combined with years of advanced specialty training and certification allows them the advantage of seeing the whole clinical picture from a unique and holistic perspective. Our specialists can also use ultrasound to perform guided tissue samples using a needle, which provides fluid and tissue for further analysis.

In contrast, many other facilities perform an ultrasound but are unable to interpret the images themselves. Consequently, these images are sent to a third party (radiologist or internist) for interpretation. In these cases, the specialist never sees or lays hands on your pet and is limited to the images they are given.

About Veterinary Ultrasound:
Ultrasound has become a widely used tool in veterinary medicine to evaluate the liver, biliary tract, spleen, kidneys, adrenal glands, GI tract, pancreas, abdominal lymph nodes, urinary tract,
peritoneal space, and reproductive organs. Abnormal fluid accumulations, masses/nodules, organomegaly, and other abnormalities are generally identified in much greater detail with ultrasound than can be appreciated with routine radiology. In addition, ultrasound-guided fine needle aspiration (FNA) allows precision sampling at a much lower risk than blind aspiration. Sedation is only rarely needed to perform abdominal ultrasound and/or ultrasound-guided FNA.

What makes an Ultrasound with WTVS Unique?
● Each Ultrasound is performed and interpreted by a WTVS internal medicine specialist, hands-on with immediate results.
● As the ultrasound evaluation is performed by the Internist, your concerns and your pet’s condition are observed first-hand.
● Our ultrasound machines provide enhanced image quality, allowing detection of small and subtle lesions.
● We offer urgent consultations with same-day ultrasound evaluation for critical patients.
● We work directly with your primary veterinarian to act as a team in your pet’s care.

Ancillary testing that may be recommended with abdominal ultrasound:
1. Fine needle aspiration with cytology – This procedure involves inserting a needle into the area of interest and collecting a small sample that can be placed on a slide for microscopic
evaluation by a board-certified pathologist. The procedure is safe and does not usually require sedation or anesthesia.

2. Cystocentesis of the urinary bladder for urine culture – This procedure involves inserting a needle into the urinary bladder to collect a sample of urine. This sample can be evaluated microscopically (urinalysis) or be cultured to evaluate for infection (culture).

3. Abdominocentesis. This procedure is very simple and involves removing fluid that has accumulated in the abdominal cavity. In some instances, only a small volume of fluid is
removed for diagnostic purposes. In other cases, larger volumes are removed to make your pet more comfortable. Samples are usually submitted for pathology review and culture.

Endoscopy

Flexible endoscopy allows visualization, biopsy collection, and/or foreign body retrieval within the pharynx/larynx, esophagus, stomach, small intestine, and colon/rectum. Depending on the patient and the procedure, the majority of cases can be discharged from the hospital the same day. 

There are many forms of endoscopic examination in dogs and cats. The type of endoscopy that is performed depends on the area of the body being evaluated. Types of endoscopic examinations offered by WTVS include: upper gastrointestinal endoscopy, lower gastrointestinal endoscopy (colonoscopy), rhinoscopy, cystoscopy, and bronchoscopy. Endoscopy requires general anesthesia. If you are anticipating an endoscopic examination for your pet, they should be fasted from food after 9-10pm on the day prior to your appointment. Water may be given safely. In some cases, your pet may be discharged from the hospital on the same day of admission. In other cases, your veterinarian may recommend that your pet stay overnight. In still other cases, an endoscopic examination may be delayed for a few days so that additional diagnostic testing may be performed. 

Terms associated with endoscopy and further specialty procedures that WTVS offers: 

  • Endoscopy-evaluation of the upper gastrointestinal tract 
  • Colonoscopy-evaluation of the lower gastrointestinal tract 
  • Cystoscopy-evaluation of the lower urinary tract 
  • Rhinoscopy-evaluation of the mouth and nasal passages 
  • Bronchoscopy-evaluation of the airways

Comprehensive Oncology Teleconsultation

This service is performed by a board-certified veterinary oncologist, who will provide a detailed written summary on the specific patient including staging recommendations (if needed), treatment options (aggressive and conservative), and prognosis as it relates to each treatment option.

Echocardiogram

Cardiac ultrasonography is the gold standard of diagnostics in veterinary cardiology. At WTVS we are able to examine the heart with ultrasound to look for valvular disease (such as mitral valve disease in small dogs), dilated cardiomyopathy (generally large dogs), hypertrophic cardiomyopathy (cats), and cardiac/pericardial masses as well as other acquired cardiac conditions. Sedation is only rarely needed to perform echocardiography; in fact, it is usually preferable not to sedate patients so as not to interfere with cardiac rate, rhythm, and contractility. NOTE: In some cases, particularly those with unusual heart disease, the patient may need to be referred to a veterinary cardiologist for more specialized evaluation.

Ultrasound-guided fine needle aspiration

We can take aspirates of intra-abdominal and intra-thoracic structures for cytologic evaluation. Provided there is no bleeding tendency, the risk of hemorrhage is generally low, and the risks of inadvertent large vessel or organ laceration are minimal when ultrasound guidance is utilized. 

Sedation is usually utilized with thoracic FNA and occasionally utilized for abdominal FNA.

Bone marrow aspiration/biopsy

We can take bone marrow samples in cases where further assessment of bone marrow evaluation is warranted including (but not limited to) pancytopenia, bicytopenia, or severe non-regenerative anemia. The risk of hemorrhage is minimal. Generally will pursue samples at the proximal humerus but, if needed, can use the pelvic approach. 

Local anesthetic and heavy sedation is utilized for this procedure.

Pericardiocentesis

There is a sac around the heart, called the pericardium, which is normally empty (except for the heart, of course). In certain diseases, fluid can build in the pericardium, which prevents the heart from properly pumping blood to the lungs and body. In these cases, our specialists can use ultrasound to carefully draw off fluid with a needle. In some cases, this is a life-saving procedure.

Arthrocentesis

Needle samples can be taken of joints with minimal risk of hemorrhage. 

Heavy sedation is utilized for this procedure.

Esophagostomy tube placement

E-tubes are great for especially cats but also small to medium-sized dogs who would benefit from nutritional supplementation due to prolonged anorexia. 

Requires general anesthesia.

Cerebrospinal fluid (CSF) aspiration

In select cases, we can perform a CSF tap to allow further analysis (microscopic fluid analysis, infectious disease testing, etc.) of neurologic diseases. This procedure carries a risk of brain herniation and is most aptly performed based on the results of a brain MRI or CT scan; however, if transport to a neurologist is not feasible, in certain cases it may be warranted, provided the risks have been thoroughly discussed with the patient’s owner. Requires general anesthesia.

Balloon dilation of benign esophageal stricture

This procedure is performed using endoscopy and involves dilation of the stricture using incrementally larger balloons that are run alongside the endoscope. Some cases respond to a single procedure whereas others require multiple dilation events.