Introducing the Internal Medicine Service at Optivet Referrals

Introducing the

Internal Medicine Service

at Optivet Referrals

 

 

Providing a high quality, caring internal medicine referral service

that delivers excellent value to clients and their pets.

Service provision

Cases will be seen by Dr Kit Sturgess MA VetMB PhD CertVR DSAM CertVC MRCVS an RCVS Recognised Specialist in Small Animal Medicine who has more than 20 years experience of referral medicine.

Initially the service will be available 2 days per week at Optivet Referrals in Havant. Telephone back up will be available outside of these times for ongoing cases. The service will be tailored towards non-critical day or overnight cases both chronic / recurrent disease or acute cases that require diagnosis but can be subsequently managed at their primary care facility.

Advanced imaging (fluoroscopy, computed tomography, magnetic resonance imaging) is not currently available on site but can be arranged.

 

Free medical case advice, ECG and x-ray interpretation

 

What cases can be seen?

It is not possible to give an exhaustive list of cases that can be seen; we will always be happy to give discuss specific cases.

 

Congenital and acquired cardiovascular disease

Our Vivid I ultrasound machine has excellent colour flow Doppler capability for cardiac imaging with 2 phased array probes to cover all patient sizes. Together with ECG, radiography, blood pressure and arterial blood gas monitoring we can evaluate both congenital and acquired disease such as in a case of pulmonic stenosis shown opposite.

 

Coughing, dyspnoea and nasal discharge including foreign body removal

Along with conventional radiography we have both rigid and flexible videoendoscopy to
 further investigate respiratory disease and undertake endoscopy-guided procedures including directed bronchoalveolar lavage, biopsy and foreign body removal. All patient sizes are covered for both rhinoscopy, inspection of the nasopharynx and bronchoscopy with our 2.7mm rigid arthroscope with flushing and biopsy sheath, 4mm fibreoptic bronchoscope and 5.9mm videogastroscope allowing high quality images to be captured for patient records and to show to clients

 

Vomiting, diarrhoea, inappetence, abdominal pain and weight loss

Microconvex and linear probes allow full abdominal ultrasound in all patient sizes. Endoscopy can be performed in all sizes of dog from less than one to over a hundred kilograms using full videoendoscopy with our 5.9 and 11.5mm endoscopes. Image quality is excellent and large biopsy channel size ensures good quality biopsies that can be obtained from stomach, duodenum, jejunum, colon and in many cases the ileum as well. The image opposite is from the duodenum of a GSD with moderate inflammatory bowel disease showing nodular flattening of the mucosal surface and inspissated mucus.

 

PU/PD, liver, renal and lower urinary tract disease

Blood tests and imaging can provide much valuable information in these cases but some cases require further investigation and following-on from blood work and ultrasound we can measure glomerular filtration rate and obtain minimally invasive Tru-cut biopsies from the liver and kidneys. Cystoscopic evaluation of the urethra, bladder and ureteric openings along with guided mucosal biopsies is also available for female dogs and cats and larger (over 15kg) male dogs.

 

Blood dyschrasias

Investigation of anaemias and white cell abnormalities can require and in-depth, multimodal investigation including evaluation of bone marrow aspirates and core biopsies. The medicine service can deliver undertake a complete and efficient investigation to achieve a diagnosis and develop an effective treatment plan

 

Endocrine disease

We can offer imaging, clinical experience, ionised calcium measurement and access to less commonly used blood tests to allow full diagnosis and full evaluation of endocrine cases along with long term client support that can be required. 24-hour continuous blood glucose monitoring should become available in the near future.

Unexplained fever (PUO), lethargy, collapse and exercise intolerance,
 non-specific unwellness

Always challenging cases the patient that is grumbling on and just ‘ain’t doing right’, is showing signs that could be attributable to a number of organ systems such as collapse or where the challenge is ‘where to start’ often benefit from medicine’s one hour consultation to gather all available historical, clinical information and previous investigation results together and combine this with in Kit’s wide experience to direct further investigation and treatment.

For example recently seen at Optivet a 12 year old Labrador with collapse, a retching cough, inappetence and dyspnoea turned out to have a large cranial mediastinal cyst that was compressing his trachea and oesophagus from which a litre of fluid has been drained under ultrasound guidance. During his investigation a chronic coliform urinary tract infection was also identified that was contributing to the patient’s general unwellness.

 

Tumour staging and chemotherapy

Full staging of tumours can be undertaken along with delivery of a local, efficient, out-patient chemotherapy surface using the Phaseal system to maximise patient, client and operator safety.

 

For suitable cases we are happy to discuss procedure only visits e.g. for ultrasound or endoscopy

 

Costs

Some examples of charges (VAT included) are below; we are happy to offer a client a fixed price quotation for suitable cases e.g. investigation of a heart murmur or investigation of chronic diarrhoea. Tests already performed will only be repeated in cases where increased diagnostic information is required or the patient status has significantly changed since testing.

 

Initial consultation (1 hour)

£210

Routine recheck

£90

Ultrasound abdomen, thorax or heart

£220

Gastrointestinal disease

Chronic diarrhoea/vomiting (including blood work, ultrasound and endoscopy)

£1250-1450

Disease requiring upper (stomach and small intestine) and lower GI endoscopy

£1600-1850

Jaundice/hepatic investigation (including blood work, ultrasound and US guided biopsy)

£1100-1400

Polyuria/Polydipsia & endocrine disease

 

Preliminary investigation including imaging, hormonal tests, GFR

£950-1300

Investigation of poorly responsive diabetes

£800-1500

Investigation of suspected hyperadrenocorticism

£700-1000

Pyrexia of unknown origin

£1200-2500

Azotaemia/renal disease investigation

Chronic renal failure (may include clearance tests)

£600-1100

Renal biopsy (including light, electron microscopy and immunohistochemistry)

£900-1050

Lower urinary tract disease (may include cystoscopy)

£600-1300

Anaemia/thrombocytopenia

 

Preliminary investigation (including imaging, bone marrow biopsy)

£1000-1500

Respiratory disease

Investigation of cough (including x-rays, bronchoscopy and lavage or FB removal)

£1400-1600

Investigation of nasal discharge (including full rhinoscopy, biopsy and imaging)

£1200-1500

Nasopharyngeal FB removal

£850-1100

Cardiac disease

 

Investigation of congenital murmur with echocardiography and BP

£450-480

Investigation of acquired heart disease (echocardiography, BP, ECG may include x-ray)

£700-1000

Management of heart failure including work up

£900-1050

 

 

 

Visitors welcome – why not come with one of your cases and assist with the work up?

 

How to refer a case:

Cases can be referred using Optivet’s standard fax back form or on line by visiting http://www.optivet.com or by telephoning reception on 01243 888091.

For cases that may be urgent please contact us by telephone so we can deal with the situation immediately

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